ACT With Compassion

“I don’t understand why I’m like this. I wasn’t abused or bullied. My parents weren’t ever critical of me. What’s wrong with me that I hate myself so much?” Statements like this are fairly common when someone who is highly self-critical and shame-prone clients is asked to reflect on the origin of their problems.

Sometimes it can be hard for us to tell when shame is present. It often operates in the background, driving particular action tendencies, thoughts, bodily sensations, social signaling, and memories. When someone is experiencing shame from the inside, it can be sort of like being trapped inside of a dark room without a flashlight. This is especially true in the case of overwhelming shame that may be accompanied by dissociation and disorientation. The client may believe there is something wrong with them or that they have done something terribly wrong while they are stuck in shame. In these times it can often be helpful to foster a sense of curiosity about what the experience of shame is like while it is happening.

If you read our recent post about the top 20 science-based recommendations for working with highly self-critical and shame-prone clients, you already know that the pursuit of high self-esteem should be dead. The scientific community has definitively shown that attempts to raise self-esteem don’t generally work, and may even have some negative side-effects (Baumeister, Campbell, Krueger, & Vohs, 2003). In contrast, self-compassion has all of the positive benefits of having higher self-esteem, without the downsides.

This month’s tool: Guided meditations for highly self-critical and shame-prone clients

We have updated our resource page with some of our favorite meditations that we find useful in working with shame-prone and self-critical clients. Often, people who are highly self-critical and shame-prone tend to spend a lot of time with emotion systems related to threat activated, or alternatively spend time feeling overwhelmed in response to their internal judgment. Their threat system may be chronically over activated, while their social safety system under activated. The social safety system signals to the person that it is safe to relax and explore, because the person is supported by their tribe or otherwise safe and experiencing a relative lack of aversive stimulation. Lovingkindness and compassion meditations can be very valuable for stimulating the social-safety systems of people who are highly shame-prone and self-critical.

This month’s tool: Books on shame, self-criticism, and self-compassion for the public

We have updated our resource page with some of our favorite books on shame, self-criticism, and self-compassion for the public that we find useful in working with shame-prone and self-critical clients. We find that it can be helpful to recommend these types of readings for clients who are unsure about attending to their shame or about cultivating self-compassion, or for clients who are all-in and want more information. These books are great for therapists to read and apply too! If you have your own favorite books, we would love to hear about them!

This month’s tool: Video recordings for highly self-critical clients

We have updated our resource page with some of our favorite videos that we find useful in working with shame-prone and self-critical clients. Some of the videos are educational for clients, some are emotionally evocative, and some are both educational and evocative. Videos can be a powerful tool for engaging working with clients to approach difficult topics from a place that is non-judgmental and connected to a sense of common humanity. If you have your own favorite videos, we would love to hear about them!

This month’s tool: Recognizing trustworthy others with BRAVING (adapted from Brene Brown):

People don’t operate in a vacuum

Have you ever worked with a client to change the way she treats herself, only to have her come back the following week beating herself up  because of a difficult interaction she had with a loved one that week? The fact that people don’t operate in a vacuum has been the frustration of many a clinician! At ACT with compassion, we believe it’s important that we help client’s change their relational/social context that serves to maintain their struggles with self-criticism or shame. We need to take into account not only our clients’ relationships with themselves, but also the factors in their environment, which may be shaping or reinforcing their self-criticism and/or self-compassion. One primary contextual factor affecting clients’ shame and self-criticism is their relationships with others.

Each month we highlight some practical resources for therapists interested in compassion. Our aim here is to provide a brief overview and offer you a few resources where you can find out more information if these ideas are of interest to you.

Case conceptualization with highly shame-prone and self-critical clients may often be thought of as case re-conceptualization. That is, clients with high degrees of shame and self-criticism often arrive in therapy with their own conceptualization of their problems, one that is often driven by fusion with the story that they are broken, damaged, incompetent, stupid, or in some way inadequate. For example, the client may state, “I’m not doing anything with my life. I’m basically a failure.” Or they may present self-critical ways of relating to internal experiences, for example, “I just want to stop being sad. It’s pathetic,” or even, “I hate my anxiety.” The goal of case conceptualization is to develop a new viewpoint that that is not based on a critical view of a self that needs to be “fixed.” This conceptualization forms for the core of the subsequent therapy contract. Furthermore, a collaborative re-conceptualization process may serve to loosen fusion with self-related content and begin the development of a new perspective on oneself that is more flexible, warmer, and more conducive to living a valued life.

In our previous Tool of the Month posts, we have written about two assessment measures we often give clients who are struggling with shame and self criticism, the Forms of Self-Criticising/Attacking and Self-Reassuring Scale (FSCRS) and the Fears of Compassion Scale. This month we highlight another self report measure, the Self Compassion Scale, Short Form (SCS-SF, Raes, Pommier, Neff, & Van Gutcht, 2011) that is part of our standard package of measures we give often clients at the outset of therapy. This 12-item measure provides a useful overview of how a client might typically respond to themselves during times of struggle. With questions such as “When I feel inadequate in some way, I try to remind myself that feelings of inadequacy are shared by most people.” and “When I’m going through a very hard time, I give myself the caring and tenderness I need.” the SCS-SF assesses various aspects of self compassion including one’s sense of a common humanity, mindfulness, and self-kindness.