Self Compassion for Therapists

Are you a better therapist when you meditate regularly? Some research says you are. Therapist’s mindfulness can impact clients’ outcomes [e.g., Grepmair, et al 2007;  and see Davis & Hayes 2011 for a review]

Therapists, no less than clients, have “tricky brains,” wired thru millennia to rapidly process threat and with executive functions like a tiny rider on a big elephant. Evolution designed us to be easily hijacked by emotions that rapidly ‘take over’ to fight, flee, or freeze. Regulation, in a simplified way, can be thought of as a dance between our:

  • drive system, energizing us to pursue goals and resources, and generating emotions like excitement, desire, and motivation to achieve.
  • threat system, focused on keeping us safe, and generating emotions like anger, fear, disgust, and shame.
  • safeness/affiliative system, focused on soothing and connecting us to others, and helping us feel safe, content, nurtured, friendly.

For example as therapists, triggers of our threat systems can be as routine as declining a new referral or as obviously stressful as the powerlessness of slow change with a highly suicidal client. Choosing between taking care of ourselves versus our clients (ending the session on time instead of going over). Feeling incompetent (sitting across from a client and having the thought, “man, that’s a real problem! You should see someone for that! If only you had a better therapist!”). And then, just as our clients, moving immediately from threat-focused emotions with urgency into habitual patterns of over-commitment, feeling like an imposter, blaming ourselves for being upset or struggling.

As we draw practices from the world’s wisdom traditions into psychotherapy, it’s a bit like grafting two species of trees. We end up with “mindfulness-based” interventions and “compassion-focused” therapy, where elements of a tradition, bits of its wisdom and practice, are brought into psychotherapy.  On the one hand I think, “Well, but the point of psychotherapy is not enlightenment.  Why shouldn’t we pick and choose from this ancient technology and graft it onto a Western psychotherapy agenda?”

For example, while the efficacy data are only preliminary, Paul Gilbert and colleagues compassion focused therapy (CFT) offers an integration of scientific understanding and the cultivation of compassion. In particular, CFT intends to target situations where our soothing/affiliative system simply does not register more adaptive new learning in part because it is insufficiently stimulated. We know rationally we are probably as competent as the next guy, yet knowing this we do not feel reassured. The emotional systems that give rise to feelings of reassurance are not active enough — or the threats are so great that the threat system overrides them. In order for our thoughts to be meaningful to us, we need to feel congruent affect. Emotions ‘tag’ meaning onto experiences. When the affiliative system for such linkages is not activated there is little feeling to the thought. We can’t assume that by reducing negative emotions the soothing, affiliative ones will ‘come on line.’ Instead, CFT argues, toning up certain types of positive emotions is needed.

Therefore, compassion focused therapy provides practices to build our capability for compassion. That is, the CFT therapist guides the client in practices to strengthen courage, extend care, and build our ability to skillfully help alleviate our own and others’ pain and suffering. Here is one exercise for you I’ve been experimenting with myself (a big thanks to Russell Kolts for his influence on me).

Yet on the other hand, in picking and choosing what we graft, we can inadvertently leave out powerful elements.  For example, the concept of Sangha, a community who devotedly support each other’s practice seems to me to have been lost as we pick up individual practices. The dark sides of meditation, and its potentially harmful effects are hard to detect and help without a tight community and competent teacher.  As Annie Lamott says, “My mind is a bad neighborhood I try not to go into alone.”

So even as mindfulness-based interventions become so prevalent that they are hailed as revolution in healthcare by mainstream media, our stance at PracticeGround is to engage in an exploratory dialogue between personal experience and scientific study. To learn practices from the inside-out, read and participate in the scientific study as we can, so that our use of these wisdom traditions is smart and done in community.

—Kelly Koerner, Ph.D.

References

Davis, D M.; Hayes, J A. (2011) What are the benefits of mindfulness? A practice review of psychotherapy-related research. Psychotherapy, Vol 48(2), 198-208. doi: 10.1037/a0022062

Grepmair, L., Mitterlehner, F., Loew, T., Bachler, E., Rother, W., & Nickel, M. (2007). Promoting mindfulness in psychotherapists in training influences the treatment results of their patients: a randomized, double-blind, controlled study. Psychotherapy and Psychosomatics, 76(6), 332–338.