ACT With Compassion

Newer forms of Cognitive Behavioral Therapies are on the rise. These therapies share certain elements (e.g. an active and collaborative therapeutic alliance, the use of traditional behavioral strategies and an understanding that cognition can maintain behaviors). Yet, each type of therapy is distinct in important ways, with unique underlying theories, assumptions, mechanisms of change and treatment approaches. An understanding of these distinctions can help therapists discern when and how these approaches may serve a client.

It’s often painful to get feedback from other people, and even harder to know what to do with it when we do get it. It can feel like an attack on our person, and it can be hard to identify whether there is something in the feedback that we can actually change.

Four Emotion Systems: Flexibility is key!

In our work with clients who tend to be highly self-critical and shame-prone, one of the first things we seek to do is to create a deblaming platform for understanding how the person has come to operate the way they do in the world. It’s important that client (and therapist alike!) understand that even though certain behaviors or tendencies might be contributing to someone’s suffering now, these things likely evolved for very understandable and important reasons.

We humans are an incredibly social species. One of the reasons why shame is such a powerful and painful emotion for us is that it is intimately tied to our sense of belonging, and in particular, a feeling that our place in the “tribe” may be threatened. In order to understand shame, we also need to understand the role that belonging and a sense of tribe has for us as a species.

It’s apparent from the data that practicing lovingkindness meditation (LKM) has a host of benefits (see our prior blog post if you would like more evidence). However, just knowing that something is good for us doesn’t always mean that we will change our behavior to move toward it -- yep, I’m looking at you, spinach! One way to help support and sustain behavior change is to track our behavior and its consequences. For this reason, when we introduce the idea of LKM in groups or with individual clients, we encourage people to use a daily tracking form. Every day, people can record whether they practiced LKM, what happened during the practice, and if they noticed any changes as a result of the practice. We encourage clients to approach this tracking as a scientist would an experiment—be curious and collect data. We ask them to track any patterns that may have emerged, indicating what worked and what didn’t work. We encourage them to track whether the data support our hypothesis that LKM might be beneficial to their therapy goals, or whether we should try something else.

Lovingkindness meditation (LKM) is an effective way for highly self-critical people to engage their social safety system. LKM helps highly self-critical clients put a brake on the threat-based loop of self-criticism and negative emotions, and helps clients have a sense of safety and belonging. 

Self-compassion is great. It feels all nice and warm and fuzzy, right? Actually, maybe not, at least not for everyone. In fact, for a lot of folks, particularly those who struggle with chronic shame and self-criticism, compassion can actually be pretty scary! In fact, we know from research that highly self-critical clients tend to find compassion-related cues to be anxiety provoking.  

Do you ever have times, maybe at the end of a long day of seeing clients, that you feel disconnected or apathetic? Of course you do; we all do. It’s tough to remain present to suffering hour after hour. During times like this it’s common for therapists to try to just “push through”, to ignore our feelings and power on. But we would like to suggest a different, more compassionate, and also probably more effective strategy—getting in contact with your values through a brief perspective taking exercise.

In a recent post, we wrote about how the absence of criticism in a person’s history is not the same as the presence of warmth.  It is not necessary for clients to have a history of extreme levels of abuse or verbal criticism from others in order to develop a shame prone and self-critical tendency. A mere absence of responsive and warm communications and physical contact from their caregivers can contribute to high levels of shame and self-criticism, even in the relative absence of abuse or criticism.

In working with highly self-critical and shame-prone clients, we (at ACTWithCompassion) often utilize chair work as a way to increase flexible perspective taking and facilitate self-compassion. Much of what we rely on for guiding our chair work comes from Leslie Greenberg, Ph.D. and his colleagues in Emotion-Focused Therapy (EFT). EFT provides an empirically-grounded and well-researched methodology for working with internal conflict and self-criticism. We have two books that we recommend for learning about chair work on our resources page.