CFT Made Simple: A Clinician’s Guide to Practicing Compassion-Focused Therapy

by Russell Kolts, Steven C. Hayes (Afterword), Paul B. Gilbert (Foreward)

For the first time ever, CFT Made Simple offers easy-to-apply tools to help clients develop self-compassion, learn mindfulness skills, and balance difficult emotions for greater treatment outcomes.

Created by world-renowned psychologist Paul Gilbert, compassion-focused therapy (CFT) is extremely effective in helping clients work through painful feelings of shame and self-criticism. However, the theoretical aspects of this therapy—such as evolutionary psychology, attachment theory, and affective neuroscience—can make CFT difficult to grasp. This book provides everything you need to start implementing CFT in practice, either as a primary therapy modality or as an adjunctive approach to other therapies, such as acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), and more.

CFT has unique strengths, and is especially effective in helping clients work through troubling thoughts and behaviors, approach themselves and others with greater compassion and kindness, and feel safer and more confident in their ability to handle life’s challenges and difficulties. This book articulates the theoretical basis of the therapy in simple, easy-to-follow language, and offers practical guidance and strategies on how to tailor your CFT approach to specific client populations.

As a clinician interested in the benefits of CFT but wary of the dense theoretical principles that lay behind it, you need a user-friendly guide that will let you hit the ground running. CFT Made Simple is that guide.

Genres: Psychology, Nonfiction, Mental Health, Counselling

248 pages, Paperback

First published July 1, 2016

About the author

Russell L. Kolts, PhD, is a clinical psychologist and professor at Eastern Washington University outside of Spokane, WA, and is founder of the Inland Northwest Compassionate Mind Center. Dr. Kolts regularly conducts trainings and workshops on Compassion-Focused Therapy, as well as on mindfulness and compassion practices. His professional interests lie primarily in the application of CFT and mindfulness approaches to individuals suffering from problematic anger, trauma, mood, and attachment-related difficulties. Kolts has published and presented research in diverse areas such as positive psychology, PTSD, psychopharmacology, mindfulness, and compassion. In his personal life, Dr. Kolts enjoys family time, reading, meditation, outdoor activities, and listening to and playing music.

Reviews

[Adam · Rating 5 out of 5]

Compassion-focused therapy (CFT) is a cutting edge psychotherapy with a simple name, and a comprehensive approach. Do not let the name fool you, this an integrative therapy that takes seriously the criticisms of traditional CBT, as well as the demands of evidence-based practice and it is worth your time to read it.

Dr. Russell Kolts is a world class explicator and his writing makes an honest title of the book. Dr. Kolts takes the complexities of an approach that includes CBT, attachment theory, evolutionary psychology, and compassion, and makes it accessible without ever condescending to the reader. This is hard to accomplish writing on such subjects, but he does so gracefully.

Whether you are new to the field of psychotherapy or an experience clinical veteran, CFT Made Simple is an accessible read with a unique perspective and wealth of clinical interventions for all therapist and case managers.

[Jeremy · Rating 4 out of 5]

Notes:

+ 3 main brain systems
1. Threat-protection system
- Amygdala
- Biased towards “better safe than sorry”
- Aversion and avoidance of anything uncomfortable, even if discomfort leads to something good
- Escape motivation and narrow attentional focus
- Self-attacking keeps the threat system active, while self-compassion brings the Safety system online
2. Safety system (soothing/safeness/contentment)
- Oxytocin/endorphins: connectedness and belonging
- Trauma can make connection feel threatening rather than safe; in this case, time is needed to warm up and force or speed will backfire
- Connection motivation and broad attentional focus
- Therapy can be about bringing the safety system online
3. Drive and resource-acquisition system
- Dopamine: it’s never enough
- Pleasure from attaining goals, even when the goals are harmful to ourselves or others (i.e. addictive video-gaming)
- Feelings of dissatisfaction that propel us to always be chasing after “better”; attachment to outcomes, cravings for more


+ Compassionate understanding (based on evolutionary functional analysis)
- From “something is wrong with me” to “this is part of what helped my ancestors survive”
- Compassion organizes experiences and perspectives differently than the threat system
- This is not avoidance, because after we connect with the compassionate self we turn back to the threatening situation to work with it


+ Factors that normalize the human experience and show it makes sense for for things to be this way
- Human history: genetics and evolution (or at least survival adaptations)
- Early learning environment and attachment styles
- Behavioral reinforcement and doing what worked in a previous context
- Relational frame theory: the mind makes arbitrary connections that stick, even if untrue or unhelpful
- Social learning: what we see others do that seems to work for them


+ Interactions between emotion brain (old) and thinking brain (new)
- Since other mammals don’t have the thinking brain, they are fine after a threat has passed
- Thinking brain isn’t good or bad, it can help us plan for the future and avoid threats, but it can also ruminate or interpret threats where there are none (i.e. interpreting discomfort as threatening, or interpreting thoughts like “there’s something wrong with me” as a threat and provoking anxiety)


+ Environment shapes our emotional experiences and responses
- John Bowlby’s attachment theory types
1. Secure
2. Anxious: unreliable or inconsistent care leads to fear of rejection, having to display intense emotion to get a response; hypersensitive to signs of social threat
3. Avoidant: inhibit, suppress, or avoid emotional experiences due to unavailable caregivers


+ Four roles embodied by the CFT therapist
- Teacher
- Facilitator
- Secure base
- Model of the compassionate self


+ Techniques (basically in order as they build on/layer over each other)
- Soothing Rhythm Breathing (SRB): activate parasympathetic nervous system by focusing on slowing down the breath to a pace that is comfortable and soothing
- Shifting awareness: move attention to many categories of things to demonstrate how quickly attention can shift (elbow, foot, tongue, the feeling of the breath, buzzing of the lights, tater tots, justice, South America, world peace, what you’d like to have for dinner)
- Mindful checking-in: practice noticing body sensations, feelings, and thoughts just as they are, not thinking about them but experiencing them. Should not be extended practice, but brief practice so noticing can happen quickly during real life
- Mindful breathing: frustration comes from the drive system focusing on the goal of sticking to the breath, rather than on the ability to notice the pull of distraction from thoughts
- Mindfulness of body, eating, walking, showering, task completion, physical exercise
- Two teachers exercise: for clients resistant to letting go of critical self, imagine (for a child learning a new and difficult skill) a harsh/critical teacher vs. compassionate/understanding teacher - which would you prefer? Which one is probably more effective at teaching?
- Guided visualization of what the compassionate self would do and say, especially toward the vulnerable self
- Compassionate letter-writing to vulnerable self (example in book and saved in files)
- Cultivating compassionate thinking: not avoiding thoughts or pushing them away or replacing them, but bringing a compassionate frame, broader perspective or more effective response to a situation of threat; soothing the anxious self, or encouraging the depressed/unmotivated self, not making these selves the enemy; new paths take a while to wear in and old paths take a while to grow over
- Using compassionate imagery: not about creating vivid mental pictures, but creating mental experiences; can build competence and confidence by starting with imaging/remembering favorite vacation; can imagine safe place/soothing space; can imagine an ideal compassionate figure to hear from; can imagine compassion from internal or external source being extended to self then others
- Chair work: empty chair, two chair (vulnerable self, compassionate self), three chair (adding the self-critic)
- Multiple selves practice for exploring affect: typically the angry self, anxious self, sad self; typically a chair exercise but can be done as written homework w/4 quadrants divided on a page; start w/body sensations, feelings, thoughts, and action urges for each emotional self, then introduce Captain of the Ship metaphor for compassionate self, comforting passengers through a storm and having the confidence to proceed forward; end with body sensations, feelings, thoughts and effective actions compassionate self could take


+ Techniques for case conceptualization
- Downward arrow technique to get to core fears in the threat system (letting the client in on the process so it’s not so annoying): What is upsetting about that? What does it mean?
- Uncovering safety strategies: defensive behaviors designed to minimize threat-related distress (often rooted in avoidance)
- Understanding unintended consequences of safety strategies


+ My thoughts on the limitations of CFT
- The goal of showing the client their emotional experiences make sense can be helpful but also implies that we need to understand the experiences before we can respond to them effectively. Even if we can’t pinpoint how an experience came about and how it makes sense in context, we can still respond effectively to it




Quotes:

Although warmth and gentleness can be part of compassion, compassion requires a certain toughness, assertiveness, and a great deal of courage as well… Compassion in CFT is an orientation to suffering—one that empowers us to approach suffering with the helpful motivation to work with it and alleviate it… With all the potential suffering and struggle that we and all humans will face, compassion is the only response that makes sense.

The ways we think, pay attention, and act are guided by motivations. Of course, beliefs and things like organizing schemas come into it—in fact, these are linked to motives—but the crucial issue is motivation… Research has revealed that many people with mental health problems are motivated primarily through competitive social rank systems.

We’re working to layer an interactive set of processes—nurturing relationships, powerful understandings, deepening awareness, and the purposeful cultivation of compassionate strengths—to help clients shift away from threat-focused ways of existing in the world and toward a perspective that is kind, wise, and confident, and which draws upon a body of effective skills for working directly and courageously with life challenges… A fundamental goal of CFT is helping clients shift the perspective they take toward their challenging thoughts and emotions from condemnation and judgment to compassionate understanding and commitment to helpful action.

Instead of I’m a terrible father, compassionate correction would look more like this: It makes sense that I would yell because of my own experience, but that’s not the sort of father I want to be. It’s time I committed to interacting with my kids in ways that model the things I’d like them to learn. What might help me do that?

We can build our lives around endless efforts to stay comfortable, or we can make them about pursuing goals and relationships that are deeply important to us and imbue us with meaning, safeness, fulfillment, and joy. But we can’t do both. Compassion gives us a way to turn toward the things that scare us—with kindness, wisdom, and courage—and to work with them. When we stop trying to avoid discomfort, we can turn toward suffering and look deeply into it, so we can come to understand the causes and conditions that create it—perhaps even learning enough to help make things better. Perhaps most of all, compassion involves courage: the courage to let our hearts break. But here’s the thing: our hearts are going to break anyway. Bad things sometimes happen in life, and we all have to find ways to work with them. Remember, it’s the price of admission to have a human life. The question is this: What are we going to do when that happens? Will we close ourselves off, or open ourselves up?

[Fern · Rating 4 out of 5]

Some brief mentions of self harm.

[Adam · Rating 5 out of 5]

Contextual CBT is the future

Third wave CBT, such as ACT, DBT, MCBT and, what this book is about, CFT, are full of the evidence based interventions of the future. As a fan of traditional CBT in clinical practice, I don’t think any serious CBT therapist can avoid acquainting themselves with these different interventions if they take evidence-based practices seriously.