Compassion-Focused Therapy (CFT) has gained recognition as an effective therapeutic approach, particularly in addressing issues rooted in shame and self-criticism.
Related articles: What is Behavioural Activation Therapy?, What is Metacognitive Therapy?, What is Interpersonal Therapy?
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Introduction
In recent years, Compassion-Focused Therapy (CFT) has gained recognition as an effective therapeutic approach, particularly in addressing issues rooted in shame and self-criticism. Developed by Dr. Paul Gilbert, CFT integrates cognitive behavioural techniques with compassion-based practices, aiming to improve emotional regulation through fostering self-compassion. This article provides an overview of CFT’s history, applications, techniques, effectiveness, and assessment tools, along with case studies to illustrate its clinical utility.
Origins and applications of Compassion-Focused Therapy
The origins
Compassion-Focused Therapy originated from cognitive behavioural therapy (CBT) and was developed as a response to the needs of clients who struggle with severe self-criticism, shame, and self-directed anger. Recognising that CBT alone was sometimes inadequate for such clients, Dr. Gilbert emphasised cultivating compassion as a way to mitigate these feelings. He introduced CFT in the early 2000s, integrating insights from evolutionary psychology, social psychology, and neuroscience to create a framework grounded in the understanding that compassion can regulate emotional pain and reduce self-criticism.
Common clinical applications
Compassion-Focused Therapy is particularly effective for individuals with high levels of shame, self-criticism, and those who have experienced childhood trauma. Research has shown that CFT can be beneficial in treating various mental health conditions, including depression, anxiety disorders, eating disorders, and personality disorders.
Clinical effectiveness: Two example studies
Studies have shown promising results in the effectiveness of CFT across different populations. A meta-analysis by Kirby et al. (2017) found that CFT significantly reduced self-criticism and shame, with moderate improvements in depression and anxiety symptoms. In a randomised controlled trial, Judge et al. (2022) demonstrated CFT’s effectiveness in reducing symptoms of depression and promoting well-being in individuals with chronic mental health issues. These findings suggest that CFT can be particularly useful when addressing mental health issues intertwined with self-criticism and low self-worth.
Compassion-Focused Therapy structure and techniques
CFT generally follows a structured approach, progressing through several phases designed to build the client’s understanding of compassion and develop self-compassionate skills. The initial phase involves psychoeducation, where clients learn about the evolutionary basis of emotions, particularly self-criticism and shame, helping them understand why they may feel negatively toward themselves. Following this, the therapist guides clients through compassion cultivation exercises, including compassion-focused imagery and mindfulness-based practices, to foster a sense of safety and calm.
In later sessions, clients practice specific techniques to respond to self-criticism with compassion, replacing critical inner dialogue with supportive self-talk. The final phase focuses on integrating these skills into daily life, helping clients build resilience and apply compassionate practices independently, leading to long-term improvements in emotional regulation and self-worth. This phased structure provides a comprehensive foundation, allowing clients to progressively develop and internalise a compassionate mindset.
CFT techniques and interventions
Compassion-Focused Therapy employs various techniques, including compassion-focused imagery, compassionate self-talk, and compassionate letter writing, all aimed at fostering a compassionate mindset. We explain and illustrate each of these interventions below.
Compassionate Imagery
Clients are guided to imagine a compassionate figure offering them support and understanding, helping to soothe feelings of self-criticism.
Case example: A 35-year-old client with social anxiety visualises a compassionate figure during therapy sessions, helping to reduce anxiety and self-judgment during social interactions.
Resource tip: This article defines and differentiates four painful, and often hidden, human emotions: Shame, guilt, humiliation, and embarrassment.
Compassionate Self-Talk
Clients are encouraged to replace self-critical thoughts with kinder, more supportive language.
Case example: A client with depression practices compassionate self-talk during moments of distress, gradually building a habit of self-compassion that helps to alleviate depressive symptoms.
Resource tip: This article reviews a variety of ways clients can put compassion for self and others into practice.
Compassionate Letter Writing
Clients write letters to themselves from a compassionate perspective, addressing their struggles with empathy and kindness.
Case example: A client recovering from an eating disorder writes letters to herself, addressing her body image concerns with self-compassion, leading to improved self-esteem and a healthier relationship with her body.
Resource tip: This article explores how therapists may utilise DBT-informed approaches to support clients with binge eating disorder.
Mindfulness and Soothing Rhythm Breathing
Clients focus on calming the nervous system through breathing exercises to encourage a state of relaxation and reduce anxiety.
Case example: A client with PTSD practices soothing rhythm breathing daily, which decreases hyperarousal and promotes a greater sense of safety.
Resource tip: This case study illustrates how a soldier suffering from PTSD healed from traumatic events during his deployments, using techniques such as rapport-building, psychoeducation, and prolonged exposure (PE) therapy.
Comparison to other therapeutic approaches
CFT shares similarities with other compassion-based approaches, like Mindful Self-Compassion (MSC) and Acceptance and Commitment Therapy (ACT). However, CFT’s unique focus lies in addressing the evolutionary origins of shame and self-criticism, targeting these issues more explicitly than other therapies. While MSC and ACT emphasise mindfulness and acceptance, CFT places a stronger emphasis on nurturing an internal compassionate self, offering tools to specifically counteract self-criticism and promote self-soothing.
Effectiveness relative to other approaches
Comparative studies suggest that Compassion-Focused Therapy may be particularly effective for individuals with high levels of shame and self-criticism, which are sometimes less directly addressed in CBT and other modalities. Gilbert (2019) found that while CFT and CBT were both effective for reducing depressive symptoms, CFT had a more significant impact on reducing shame and self-criticism, highlighting its utility in this specific context.
Assessment in Compassion-Focused Therapy
Assessment in CFT typically involves evaluating a client’s levels of shame, self-criticism, and self-compassion. Some common assessment tools include:
- The Self-Compassion Scale (SCS): Measures levels of self-compassion and self-criticism.
- Forms of Self-Criticizing/Attacking and Self-Reassuring Scale (FSCRS): Assesses self-critical and self-reassuring thoughts.
- Depression, Anxiety, and Stress Scale (DASS): Used to measure psychological distress levels.
Regular assessment through these tools allows therapists to monitor progress and adjust interventions as needed, providing a structured way to observe shifts in self-compassion and emotional regulation.
Conclusion
Compassion-Focused Therapy offers a robust framework for addressing issues of shame and self-criticism, integrating compassion as a central therapeutic focus. Studies indicate that CFT is effective for a range of mental health conditions, particularly those involving self-criticism and trauma. The unique techniques in CFT, such as compassionate imagery and letter writing, provide clients with tools to cultivate self-compassion actively. As research on CFT continues to expand, it holds promise as an effective approach to enhancing emotional resilience and well-being, especially for clients struggling with self-directed negativity.
Key takeaways
- CFT was developed by Dr. Paul Gilbert to address issues of shame and self-criticism, integrating compassion-based techniques.
- CFT follows a phased structure, beginning with psychoeducation on self-criticism, moving into compassion-building exercises, and culminating in techniques to integrate compassionate practices into daily life, empowering clients to enhance self-worth and emotional resilience.
- Techniques like compassionate imagery, self-talk, and letter writing are central to CFT and help clients foster self-compassion.
- Studies have shown CFT to be effective for depression, anxiety, and other disorders involving self-criticism.
- CFT may be particularly beneficial for clients who struggle with shame and self-directed anger, offering distinct advantages over other therapies.
References
- Gilbert, P. (2019). The Compassionate Mind: Compassion focused therapy. Little, Brown.
- Kirby, J. N., Tellegen, C. L., & Steindl, S. R. (2017). A meta-analysis of compassion-based interventions: Current state of knowledge and future directions. Behavior Therapy, 48(6), 778-792. doi:10.1016/j.beth.2017.06.003
- Judge, L., Cleghorn, A., McEwan, K., & Gilbert, P. (2012). An Exploration of Group-Based Compassion Focused Therapy for a Heterogeneous Range of Clients Presenting to a Community Mental Health Team, International Journal of Cognitive Therapy, Vol. 5. DOI:10.1521/IJCT.2012.5.4.420 Corpus ID: 145173911
- Gilbert, P., McEwan, K., Matos, M., & Rivis, A. (2011). Fears of compassion: Development of three self-report measures. Psychology and psychotherapy, 84(3), 239–255. https://doi.org/10.1348/147608310X526511