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

250 Pages·2016·6.26 MB·English

by  Russell L Kolts

“This book is not just simple. It is elegant and powerful. Through engaging didactics and detailed
clinical examples, Russell Kolts demonstrates how we can bring compassion to clients’ lives by
applying innovative and precise techniques of compassion- focused therapy (CFT). You will learn
to use perspective- taking shifts and imagery techniques formally and through natural conversa-
tions. You will learn to help clients understand and overcome their struggles using evolution and
contextual sciences. Be kind to yourself and to your clients: read CFT Made Simple.”

— Matthieu Villatte, PhD, coauthor of Mastering the Clinical Conversation

“An excellent book. Well written, easy to read, insightful, and inspiring. And bursting with practi-
cal ideas that will be useful for any health professional with an interest in compassion and mindful-
ness. A valuable contribution to the field of health and well- being.”

— Russ Harris, author of The Happiness Trap and ACT Made Simple

“A clinician’s ability to be compassionate, to help clients face their pain with kindness and courage,
is at the core of all effective therapies. Bringing together evolutionary psychology, affective neuro-
science, attachment theory, behaviorism, and mindfulness approaches, Russell Kolts provides a
compendium filled with heartfelt wisdom, step- by- step guidelines, and exercises that therapists of
any orientation can use immediately to help their clients reclaim warmth, affiliation, safeness, and
hope in their lives. This indispensable volume is a must- have in any clinician’s library.”

— Robert Kohlenberg, PhD, ABPP, and Mavis Tsai, PhD, codevelopers of functional

analytic psychotherapy (FAP)

“CFT is a revolutionary new approach to therapy firmly rooted in ancient wisdom and modern
science. The author has an uncanny ability to present this multidimensional model in a practical,
straightforward manner without losing any of its subtlety. This book is a wonderful resource for
clinicians who wish to dive deeply into CFT, or who simply want to integrate key aspects of the
approach into their existing practices. Drawing directly on our innate capacity for compassion,
CFT offers compelling insights for therapy and how we may live our daily lives more fully. Highly
recommended!”

— Christopher Germer, PhD, author of The Mindful Path to Self- Compassion, and

coeditor of Mindfulness and Psychotherapy

“This is a phenomenal book that manages to convey the complex theory underlying CFT into
extremely simple ideas and practices that translate directly into clinical practice. This book will be
an essential tool for any therapist wanting to effectively incorporate compassion into their work
with clients.”

— Kristin Neff, PhD, associate professor in the department of educational

psychology at the University of Texas at Austin, and author of Self- Compassion

The Made Simple Series

Written by leaders and researchers in their fields, the Made Simple
series offers accessible, step-by-step guides for understanding
and implementing a number of evidence-based modalities in
clinical practice, such as acceptance and commitment therapy
(ACT), dialectical behavior therapy (DBT), compassion-focused
therapy (CFT), functional analytic psychotherapy (FAP), and
other proven-effective therapies.

For use by mental health professionals of any theoretical
background, these easy-to-use books break down complex
therapeutic methods and put them into simple steps—giving
clinicians everything they need to put theory into practice to
best benefit clients and create successful treatment outcomes.

Visit www.newharbinger.com for
more books in this series.

CFT
made simple

A Clinician’s Guide to Practicing
Compassion-Focused Therapy

RUSSELL L. KOLTS, PhD

New Harbinger Publications, Inc.

Publisher’s Note

This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold
with the understanding that the publisher is not engaged in rendering psychological, financial, legal, or other professional
services. If expert assistance or counseling is needed, the services of a competent professional should be sought.

“On Pain” from THE PROPHET by Kahlil Gibran, copyright © 1923 by Kahlil Gibran and renewed
1951 by Administrators C.T.A. of Kahlil Gibran Estate and Mary G. Gibran. Used by permission of
Alfred A. Knopf, an imprint of the Knopf Doubleday Publishing Group, a division of Penguin
Random House LLC. All rights reserved.

The table in the section “Compassionate Thinking and Reasoning” in chapter 10 is adapted from
Kolts, THE COMPASSIONATE MIND GUIDE TO MANAGING YOUR ANGER (2012), with
permission from Little, Brown Book Group.

Distributed in Canada by Raincoast Books

Copyright © 2016 by Russell L. Kolts

New Harbinger Publications, Inc.
5674 Shattuck Avenue
Oakland, CA 94609
www.newharbinger.com

Cover design by Sara Christian; Acquired by Melissa Kirk;
Edited by Gretel Hakanson; Indexed by James Minkin

All Rights Reserved

Library of Congress Cataloging-in-Publication Data on file

Printed in the United States of America

18 17 16

10 9 8 7 6 5 4 3 2 1 First printing

For my dear friend, colleague, and mentor Paul Gilbert. Paul, your brilliant work,

inspiration, nurturance, and tutelage have made this book possible, and have given me a
professional life that is more meaningful and rewarding than I had ever dared to dream.

Contents

Foreword
vii

Introduction
1

1
Origins and Basic Themes
13

2
Introducing Compassion
25

3
Compassionate Relating: Roles of the Therapist in CFT
33

4
Compassionate Understanding: How Evolution Has Shaped Our Brains
49

5
Compassionate Understanding: Three Types of Emotion
61

6
Compassionate Understanding: The Social Shaping of the Self
75

7
Compassionate Awareness: Cultivating Mindfulness
91

8
Committing to Compassion: Working with Self- Criticism
107

9
Cultivating the Compassionate Self
115

10
Compassionate Thinking and Reasoning
129

11
Using Compassionate Imagery
141

12
Embodying Compassion: Chair Work in CFT
155

CFT Made Simple

vi

13
Compassionate Integration: Case Formulation in CFT
171

14
Exploring Affect: The Multiple Selves Practice
181

15
Riding the Third Wave: Integrating CFT into Your Therapy
195

Conclusion
203

Afterword: Unpacking the Compassionate Mind
205

Acknowledgments
207

Appendix: Reproducible Forms
209

References
217

About the author
223

Index
225

Foreword

In this beautifully and skillfully written book, Russell Kolts uses his experience to outline the key
themes in compassion- focused therapy (CFT). It’s very easy to think that compassion approaches
to psychological therapies are just about helping people be kind to themselves and others. In
reality, the center of compassion— particularly in the therapeutic arena— is courage. Russell himself
has worked with anger problems in prison inmates and has developed a CFT approach that he calls
the True Strength program, highlighting compassion as the strength and courage to turn toward our
suffering, and that of others.

I must confess that I was dubious about “making therapies simple” because this can easily be

seen as dumbing them down. It’s important to note that compassion- focused therapy is in some
ways very complex: based in consideration of basic scientifically established psychological pro-
cesses; the ways in which emotions, motives, and cognitions operate; and the manner in which
humans are deeply socially embedded and organized through their social relationships. So when
you read this in terms of “made simple,” don’t think that Russell is saying the therapy is “simple.”
Rather, he is outlining some of the crucial concepts of CFT in the hope that they will be useful to
you, and perhaps excite you to learn more.

I’m delighted to say that Russell achieves his goal brilliantly and in a way I never could. I am one

of those people who tend to see complexity rather than simplicity. So here is a wonderful guide to
introduce you to the realities of the toughness, difficulties, and complexities of CFT— but, as
Russell says, creating the layers and building blocks in relatively straightforward and simple ways.

As explained in this book, CFT began in a relatively simple and straightforward way in the

1980s. It started with just noticing the importance of understanding the emotional tone people created
in their heads when they tried to be helpful to themselves. For example, imagine you are trying to
generate helpful thoughts when you’re feeling depressed. But imagine “hearing” and experiencing

CFT Made Simple

viii

these thoughts in a very hostile way, as if you are irritated and contemptuous even as you say them
in your mind. How will that be? Even an encouraging phrase like You can do it becomes venomous
when communicated in a hostile mental “tone of voice.” You might try saying that to yourself in a
contemptuous, sort of hostile way and notice how that feels. Notice whether you feel encouraged.
Then imagine that you can really focus on warmth and empathic understanding in the words,
focusing on the feeling— maybe as if you were hearing somebody who really cared about you say
it with a heart that wishes for you to be free of your depression, or maybe as if hearing your own
voice as supportive, kind, and validating with the same intention. Actually doing exercises like this
is helpful, because in CFT getting personal experience by doing the practices yourself is key to the
development of your therapeutic skills.

What I found all those years ago was that while people could “cognitively” learn to generate

new perspectives and coping thoughts, they often did so with a contemptuous or hostile, irritable
tone. Indeed, they often found it very difficult to experience coping thoughts that involved two
important aspects that are now recognized as being core to our understanding of compassion.
First, they struggled to direct these thoughts toward themselves with a heartfelt motivation that is
based on empathic concern to address the deeper causes of the difficulties (compassionate motiva-
tion). Many patients actually blamed themselves, or thought they did not deserve compassion, or
that compassion was weakness in some way— just too soft! Sometimes they were very avoidant of
the causes of their suffering— for example, not wanting to address the traumatic experiences
underpinning their depression, or the fact that they needed to make life changes. It takes courage
to begin working on these difficult issues. Second, they tended to struggle with generating sup-
portive, kind, understanding, and validating emotions when they actually created those thoughts in
their mind (compassionate action).

So CFT began with trying to think about how to help clients generate compassionate motivation and

care- orientated emotions, and also within that motivation, to create certain kinds of emotional
balancing within the mind. As Russell says, we use a standard definition of compassion— one that
captures the heartfelt wish for suffering to cease, a preparedness to develop “sensitivity to suffering
of the self and others with a commitment to try to alleviate and prevent it.” The prevention part is
important, because the training that we do is aimed at reducing suffering both in the present and
in the future. So the first psychology of compassion is about how we begin to address our suffering
and really start to understand it. As Russell outlines here, there are many competencies that we are
going to need, such as how we pay attention, how we experience being in contact with distress,
how we tolerate our distress, and how we empathically understand it without being judgmental or
critical.

The second psychology of compassion is really about developing the wisdom of knowing how

to be genuinely helpful. True helpfulness requires the development of wisdom— we must under-
stand the nature of suffering before we are well equipped to work with it. Minds are very tricky and
are full of conflicted motives and emotions. Also, although warmth and gentleness can be part of
compassion, compassion requires a certain toughness, assertiveness, and a great deal of courage as
well. Parents are prepared to argue with their children over their diets or going out late at night

Foreword

ix

because they want to protect them, even though this may cause conflicts. In some therapy encoun-
ters, clients are frightened of their anger or anxiety or grief. Therapists may then need to encour-
age these clients to experience such emotions, even when a client is reluctant to do so, and even
when doing so may not be pleasant at the time, because that is what’s required to help this client
learn to experience and work with these difficult feelings. It’s a therapeutic skill and wisdom that
allows the therapist to know how and when to do this. Indeed, some years ago, studies showed that
some of the warmest therapists were behaviorists! That makes sense, because behavior therapy
often has to encourage clients to engage with things they’d rather not connect with.

CFT also uses evolutionary functional analysis to help us understand how our emotions work.

As Russ clearly outlines, we consider emotions in terms of three functionally distinct types of
emotion- regulation system: there are emotions for dealing with threats and trying to protect us,
emotions that are stimulating us to go out and achieve and acquire resources, and emotions that
give rise to feelings of contentment, safeness, and slowing down— which are sometimes linked to
the parasympathetic functions of rest and digestion. Many of our clients are very out of balance
with these emotions, and the capacity for contentedness and peaceful feelings can be almost impos-
sible for them to access. Studies of the parasympathetic nervous system have shown that this
system is out of balance in many people with mental health problems, with the major emotion-
balancing and regulating systems not operating appropriately. In such cases, we have to help them
get these feelings of safeness online. In this way, building and cultivating the capacity for slowing
down, grounding, and experiencing safeness, connectedness, and affiliation are central treatment
targets for CFT. This creates the competencies and strengths for people to then engage with
feared material— be these things they need to do in the outside world, or in the internal one.

Given that CFT is an evolutionary- based therapy, it will not be surprising to hear that it draws

from attachment theory and its extensive research base. Attachment theory tells us that relation-
ships with caring others can provide a secure base (which can be the platform to enable us to go
out and try things, take risks) and a safe haven (a safe and secure base where we can be soothed,
helped, and supported when we’ve gotten into difficulties). CFT helps clients begin to experience
and develop this internalized secure base and safe haven.

Once a person understands the nature of those three different types of emotion we visited

earlier, then a lot of things fall into place. For example, when soldiers are trained, their secure base
and safe haven can shift away from their families and toward their combat buddies— because that
is indeed the source of their safeness in combat. When they go out on sorties they will be in high-
stakes arousal, and when they come back they will calm down and find that safe haven within the
company of their buddies. So the soothing systems have been rewired to respond in connection
with these combat buddies. When they come home, they can then lose the secure base and safe
haven that their brains have gotten wired up for, and there will be fewer intense “dopamine rushes.”
Even though they are now at home with their families in a physically safe environment, it can be
very difficult and even stressful, because those families are not now the source of the secure base
and safe haven.