May 11, 2018
By Dennis Tirch, PhD
This post is the second in a series for practicing mental health professionals.
In a best-case-scenario, evidence-based psychotherapy practices will evolve at a rapid rate, advancing what is possible for our clients. Right now, the science of mindfulness, as well as acceptance and compassion-focused therapies, are growing at warp speed. We clinicians are steadily presented with new treatment options for anxiety and depression that are grounded in centuries of meditation tradition and tested and honed by advanced research.
It’s understandable that this rapid emergence of new methods and techniques can seem a little daunting. After years of education and many more years of practical experience, do we really want to roll up our sleeves and learn a whole new mode of therapy? Would we even have the time and energy for that?
Thankfully, we don’t need to begin again from scratch when we wish to work with innovations in mindfulness and self-compassion. We can build upon our existing knowledge base and our expertise by integrating new ways of working into our own frameworks and methods. As an example of this modular, user-friendly approach, let’s take a look at the basic concept of self-compassion.
The most common definition of self-compassion in Western psychotherapy circles comes from Dr. Kristin Neff (2003). Based upon her interpretation of Buddhist philosophy, Dr. Neff’s model of self-compassion is comprised of three elements:
The quality of mindfulness involves focused and flexible awareness of the present moment, with acceptance. While often pursued as an end in itself in current psychotherapies, mindfulness has traditionally been taught as a foundation for the development of other, vital qualities of well-being and personal liberation. This is precisely how we use mindfulness in the training of self-compassion today.
The second element of self-compassion, self-kindness, entails regarding oneself with warmth and care, rather than criticism and harsh judgments. The third element, common humanity, calls for the recognition that all human beings face suffering and pain as they move through life. A sense of common humanity also allows for insight into the connection between one’s own experience and the experience of others.
Taken together, these components can bring forth a sensitivity to our own suffering. Coupled with a willingness and commitment to take action to alleviate and prevent this suffering, they contribute to our well-being and flourishing (Neff, 2003; Neff, Hsieh, & Dejitterat, 2005; Neff, Rude, & Kirkpatrick, 2007).
The research of Neff and her colleagues has also demonstrated that self-compassion is correlated with important positive dimensions of our wellness, such as life satisfaction, feelings of social connectedness (Neff, Kirkpatrick, & Rude, 2007), personal initiative, and experiencing positive emotions (Neff, Rude, & Kirkpatrick, 2007). People who report high levels of self-compassion also report high levels of many useful psychological traits, including autonomy, competence, and emotional intelligence (Neff, 2003; Neff, Rude, et al., 2007).
Several studies have found that self-compassion can serve as an important, active process variable in psychotherapy. For example, one study of compassion-focused therapy (CFT; Gilbert 2010; Schanche, Stiles, McCullough, Svartberg, & Nielsen, 2011) found that self-compassion was an important mediator in reduction of negative emotions associated with personality disorders. The study recommended self-compassion as a target for therapeutic intervention. In fact, in a meta-analysis of research concerning both clinical and nonclinical settings, compassion-focused interventions were found to be significantly effective (Hofmann et al., 2011). Research has shown that self-compassion can be distinguished from self-esteem and predicts some aspects of well-being better than self-esteem (Neff & Vonk, 2009).
Given this growing and encouraging research, it seems like a good idea to begin exploring how self-compassion might empower your work, even in small ways. I invite you to consider a classic compassion-focused technique – writing a compassionate letter to yourself. This is an exercise you can use with your clients – and also with yourself. In fact, it’s probably best to learn this exercise by first working with your own inner critic and practicing self-compassionate responses.
This exercise is particularly useful when working with shame-prone clients but can be applied to anyone who might benefit from developing greater self-compassion. When you think about it, this applies to most of us! You might choose to use self-compassionate letter-writing as an alternative to cognitive restructuring; the technique can be used at just about any point in the course of treatment.
In the moment, we will direct our attention to a difficult topic. Rather than treating ourselves with harsh judgments or “tough love,” we’ll use kind and accepting language, and validate and hold space for ourselves, just as we would with a beloved friend who is hurting. This exercise is taken from my book, The Compassionate Mind Guide to Overcoming Anxiety (2012). After you engage in it, you might wish to reflect on what you’ve learned, either in discussion with a trusted colleague or in a brief written reflection.
If you choose to use this technique with clients, it’s a good idea to practice the exercise during a session and then discuss the client’s experience. After this real-time learning, the technique might be suggested as a homework exercise to cultivate self-compassion in the flow of everyday life.
In preparation, set aside some time when you can engage in this exercise without interruption and without hurry. Find a space that feels private and safe. Sit in a chair in which your back is straight and supported, and you can feel your feet touching the ground.
As you begin, take a minute or two to engage in mindful awareness of the flow of your breath. Maintain a slow, relaxing rhythm as you breathe, paying attention to the movement of your breath in and out of the body. After a few minutes of mindful breathing, shift your attention to the flow of your thoughts, and reflect on your current life situation. What conflicts, problems, or self-criticisms come to mind? What emotions arise within you?
With your next natural exhale let go of these thoughts, and on your next natural inhale shift your attention to an image of yourself as a compassionate, loving, and wise person who possesses wisdom and emotional strength. You are unconditionally accepting of all that you are, in this moment, and are completely non-judgmental. Your compassionate self radiates emotional warmth. For a moment, recognize the calmness and wisdom that you possess and the physical sensations that accompany this. Recognize the strength and healing quality of a vast and deep kindness. Recognize that this loving kindness, this powerful compassion, exists within you as an abundant reservoir of strength.
Remember to acknowledge and validate your feelings and remind yourself that there are many good reasons for the distress you are currently experiencing. Your automatic pilot has evolved to make you feel and react as you do. You were not designed to deal with the particular pressures and complexities of your current social environment. Your learning history has presented you with strong challenges, and situations that have caused you pain. Can you open yourself to a compassionate understanding that your struggle is a natural part of life, and that it’s not your fault?
Reflect on this, and then when you’re ready, write a letter to yourself from the perspective of that deeply compassionate, wise, and unconditionally accepting person. If you feel comfortable, you can imagine yourself as this loving, kind presence, an expression of your innate loving kindness and intuitive wisdom. Try to fill at least one side of a piece of lined paper.
If you’re working with a therapist, you may choose to take this letter with you to your next session, where you can read it together and reflect upon the words and feelings that you have allowed yourself to express. If you’re working independently, set aside some time to mindfully read the letter back to yourself with great care. Let yourself hear the words and feel the emotional tone of compassion.
Please remember that each time you practice a self-compassion exercise, you’re learning to come into closer contact with your compassionate emotional regulation system, and are gradually developing your compassionate mind. So feel free to practice as often as you wish, and as often as you can.
Gilbert, P. (2009). The compassionate mind: A new approach to life’s challenges. London: Constable and Robinson.
Hofmann, S. G., Grossman, P., & Hinton, D. E. (2011). Loving-kindness and compas- sion meditation: Potential for psychological interventions. Clinical Psychology Review 31, 1126–1132.
Neff, K. D. (2003). The development and validation of a scale to measure self- compassion. Self and Identity 2, 223–250.
Neff, K. D., Hsieh, Y., & Dejitterat, K. (2005). Self-compassion, achievement goals, and coping with academic failure. Self and Identity 4, 263–287.
Neff, K. D., Kirkpatrick, K., & Rude, S. S. (2007). Self-compassion and its link to adaptive psychological functioning. Journal of Research in Personality 41, 139–154.
Neff, K. D., Rude, S. S., & Kirkpatrick, K. (2007). An examination of self-compassion in relation to positive psychological functioning and personality traits. Journal of Research in Personality 41, 908–916.
Neff, K. D., & Vonk, R. (2009). Self-compassion versus global self-esteem: Two differ- ent ways of relating to oneself. Journal of Personality 77, 23–50.
Schanche, E., Stiles, T. C., McCullough, L., Svartberg, M., & Nielsen, G. H. (2011). The relationship between activating affects, inhibitory affects, and self-compassion in patients with Cluster C personality disorders. Psychotherapy 48, 293.
Tirch, D. (2012). The Compassionate Mind Guide to Overcoming Anxiety. Oakland, CA: New Harbinger.
If you want help learning to respond to your emotions with mindfulness, acceptance, and compassion, Lyra can connect you to a therapist. You can get started today if Lyra is offered by your employer. Sign up now.
DISCLAIMER: The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.
ABOUT THE AUTHOR
Dennis Tirch, Ph.D. is the founder of The Center for Compassion Focused Therapy in New York City, Associate Clinical Professor at the Icahn School of Medicine at Mt. Sinai, and author of several books on mindfulness and compassion in psychotherapy. He trains therapists and researchers in the science of compassion globally and is an acknowledged expert in Acceptance and Commitment Therapy (ACT), Cognitive Behavioral Therapy (CBT), and Compassion Focused Therapy (CFT).