Outline and Session by Session R

Document Sample
Outline and Session by Session R Powered By Docstoc
					   Outline and Session by Session Record of
    Compassion Focussed Group Therapy
Module in the Context of a Local DBT Program

              DBT Therapists:
     Catherine Parker and David Woods

               CFT Therapist:
                Paul Gilbert

     Dates: 8 January– 12th March 2009
                        Session 1 and 2 - 8 and 15th of January 2009
                  Written to be given to our group following each session

At our first session we introduced ourselves. We outlined how we are exploring a compassion module
within a longer dialectical behaviour therapy program. Having been in therapy for about a year, you
very kindly agreed to explore, for research, the value of introducing a compassion module into your

We spent the first two sessions basically exploring the model and I presented some Powerpoint slides
for you which are given on the next pages. We also provided you with a series of handouts (the larger
document (1)) for your interest, so that you could explore some of the ideas behind the therapy and
the kinds of things we would be doing. This document also outlines in detail some of the exercises we
will be doing.

There are a number of key ideas that we discussed:

1.      The first is the fact that we all find ourselves in this life - we sort of wake-up and here we are.
None of us chose to be here at this time, nor did we choose the genes that made our brains, nor did
we choose to have a brain that is capable of feeling the powerful emotions that it does, nor did we
choose to have a family of the type that we had. So, a lot of what happens to us and what goes on in
our minds is not our fault. However, this does not mean that there‟s nothing we can do. Indeed, there
may be many physical conditions that we can get such as diabetes or high blood pressure or even flu
which may not be our fault, but we then can learn how to deal them and reduce risks to our health.
We take responsibility but without blaming. Recognising that we didn't choose to have the kinds of
lives or emotional difficulties we have means that we can move away from self-blaming and inner
shaming. This will help us begin to learn how to genuinely and compassionately come to understand
our mind and feelings, take control over our thoughts, judgements and actions and live with what we
can call an insightful sense of responsibility - We know what we're up against – a tricky brain! Also, of
course, understanding that you did not choose the difficulties you are facing, and much of what goes
on in your brain is not your fault, is not a reason to act out as you wish. Discovering that genes
caused your diabetes is not your fault, but this is not a reason to then eat as many sweet cakes if you
want! Indeed, you have to be more careful! So it may be unfair, but life sets us difficult tasks. All we
are saying here is that we will explore where you can understand your problem, let go of self blame
and shame, and develop a compassionate approach to yourself and others. The recognition of the
harm we can cause ourselves by self blaming, condemning and self-disliking for how we are is

2.      The next key idea is that we have three basic emotion regulation systems. One is our threat
and self-protection system. If we have come from difficult backgrounds this system has been very
„well‟ developed. What this means is that it‟s trigger-happy and we can become very angry or anxious
and run away very easily. This is not our fault because we didn't choose to have brains that do that,
but we need to recognize that only we ourselves can train our minds to be different. We noted that we
have two types of positive emotion. One is associated with achieving and doing and can give us
buzzes of excitement but not necessarily a calm mind. For example this is aroused if something good
happens like we win a lottery. To develop a calm mind that has both it‟s focus on peacefulness and
well-being we need to develop our compassion – a soothing mind.

3.      We discussed how compassion is linked to soothing, and in particular the importance of
kindness and caring. All acknowledged that we can be kind and caring to others because we want to
help calm them and help them with bad feelings, but it's when it comes to ourselves we can struggle
so that is the focus of the work.

4.     Although soothing is vital to compassion we talked a lot about the importance of courage and
learning how to tolerate and face up to difficult situations and emotions. Sometimes compassion is
learning to be with feelings of anger or anxiety. It is learning tolerance and acceptance that, in the
long run, can be soothing. For example, somebody who has agoraphobia will learn to tolerate their
anxiety and go further and further afield. Overcoming their anxiety is important. Learning to do this
and confront anxiety in a kind and supportive way is often the key to success. So, soothing is not
simply a blanket to cover over pain and difficulty, soothing relates to engaging with our pain and
suffering with kindness and support.

This linked with DBT and we revisited some of the things you have been working on, such as the
importance of acceptance and developing emotional tolerance, and behaving against one's
immediate emotions, e.g., not acting on our impulses.

Our sessions are looking at bringing compassionate thoughts, feelings and behaviours to those skills.

First exercise
Our first exercise explored how emotions operate in the body and how to use breathing to become
more aware of emotions and engage in what we call „soothing rhythm breathing‟. This will also aid us
in some of our practice.

This kind of breathing and focusing is not everybody's cup of tea. Some people found that to begin
with they can actually become quite anxious. So with some people we explored how refocusing was
holding something and just directing one's attention to the field of what one was holding. This is a way
of anchoring one's attention.

How and when to practice
In all these things it is the practice that is helpful and practising in a way that you feel will help you.

If something's difficult then practice to the point of trying to develop, but not to the point that it feels
overwhelming to you - our motto is „challenging but not overwhelming.‟ Just like training to become
physically fit, you might exercise to push yourself a bit, but not so greatly that this causes you to
overstretch or strain.

You may also find that sometimes if you are agitated physical activity is better for you than trying to
engage in this exercise. It is important to notice changes in your body when emotions arise, and
having options for things that will help you so that you're not simply acting on the wind of the emotion,
blown along by as it were.

It is also useful to practice soothing rhythm breathing when you are reasonably calm, rather than
waiting until you're upset, in order to get the hang of it.

We use the analogy that you wouldn‟t want to have to learn to swim if you had just fallen overboard in
a storm. It‟s much better to learn in the shallow end of a swimming pool first and then gradually
develop your skills. We would not practice and learn to drive on the motorway on our first driving
lesson, we have to build up to that. Skills are better practiced at times when we don't actually need
              Mindful and Soothing Breathing Rhythm

There are many aspects to resting mind and body so I‟m going to take you through a few key and
simple relaxing exercises. The first one is called mindful relaxing and involves learning how to pay
attention in a gentle and kind way. Once you are familiar with this you can do the exercise sitting
down, lying down or even standing up and walking. It is however, preferable to do it sitting down to
begin with, so you get the idea of it. Find somewhere to sit comfortably and then switch on this talk

Okay, now that you are sitting comfortably, place both feet flat on the floor about a shoulder‟s width
apart and rest you hands on your legs. Now we can just gently focus on our breathing. As you
breathe try and allow the air to come down into your diaphragm – that‟s just at the bottom of your
ribcage in the upside down „V‟. Feel your diaphragm, the area underneath your ribs, move as you
breathe in and out. Just notice your breathing and play and experiment with it. Breathing a little
faster or a little slower until you find a breathing pattern that, for you, seems to be your own
soothing, comforting rhythm. It is like you are checking in, linking up, with the rhythm within your
body that‟s soothing and calming to you. Now we can spend 30 seconds or so just focusing on our
breathing, just noticing the breath coming down into the diaphragm, your diaphragm lifting and then
the air moving out, through your nose. Sometimes is useful to focus on the point just inside the nose
where the air enters. So, in through your mouth and out from your nose. Just focus on that for 30
seconds………………………………………….. What did you notice?

You may have noticed that actually, although it was only 30 seconds, your mind might have
wandered off. You may have had thoughts like, “What‟s this about? Will this help me? Did I do my
job correctly yesterday?” You may have heard various things outside the room. Your attention may
have been drawn to the postman pushing letters through the box, or whatever. The point about this
is that our minds are very unruly and the more we practise this short breathing exercise and the
longer we can extend it, the more we will notice how much our mind simply bobs about all over the
place. When you first do this kind of breathing focusing, it can be quite surprising just how much
your mind does shift from one thing to another. This is all very normal, natural and to be expected.
We train the mind, and the only thing that is important in this training is not to try to create anything.
You are not trying to create a state of relaxation. You are not trying to force your mind to clear itself
of thoughts. All you are doing is allowing yourself to notice when your mind wanders, and then with
kindness and gentleness bring your attention back to focus on your breathing. That‟s it, notice and

Notice the distractions and return your attention to your breathing. In other words, the exercise is
simply an exercise where we learn to focus attention. You are not trying to achieve anything. If you
have a hundred, or a thousand, thoughts, that doesn‟t matter at all. All that matters is that you notice
and then, to the best of your ability, with gentleness and kindness, bring your attention back to the
breathing. Now, if you practise that „attention and return‟, „attention and return‟, with gentleness and
kindness you may find that your mind will bounce around less and less. It may become easier, but
some days it will be easier than others. Remember you are not trying to relax as such. All you are
doing in this exercise is noticing that your mind wanders and then returning to the focus on your
breathing. So, it is „notice and return‟, and each time it wanders that‟s fine, notice if you feel you are
getting angry with it for example, and just kindly bring it back to the focus of your breathing.

The key thing is the mindful attention to the process rather than the result. We can explain that this
is a bit like sleeping, where we try to create the conditions that will help sleep but if we focus too
much on whether we are „asleep or going to sleep‟ this makes sleep more difficult.
Imagery practice
We had a discussion about the value of imagery and how imagery works in our brains. We looked at
the brain diagram link to a meal and so on, and had discussions around the value and importance of
fantasy and imagery. We discussed the way our thoughts, images and fantasies are often directed by
our emotions, For example, we become anxious depressed or angry and those feelings direct what
goes on in our minds. Then, what goes on in our minds can further fuel those feelings. So developing
compassion images is a way of deliberately interrupting those other emotion spirals in our minds. We
learned to have some places to go in our minds when we are distressed, ways we can switch our
attention, and again, practising this when you're not stressed is important.

When we are practicing imagery it can sometimes be useful to spend a little time with your soothing
rhythm breathing. However, if you're a person who really doesn't like that then don‟t worry because
you can just sit comfortably for a moment and then gradually practice your imagery.

We discussed that imagery is the way of stimulating different feelings and things in our brains. For
example, if we lay in bed thinking about something that's worrying us this can make us anxious; if we
lay in bed thinking about things that make us angry this can make us more angry; if we lay in bed
thinking about a lovely meal because we‟re hungry this can start our stomach acids and saliva
flowing; if we are thinking about a holiday this can make us excited. So what we think about and what
we focus on in our minds will have an effect on brain patterns.

Imagery is learning how to utilize this fact and direct our minds. Basically, we want to try to develop
mindful, (as you have been learning in your DBT), compassion brain patterns to offset and counteract
those of threat and self-protection - ones that can surge us with powerful emotions.

Some of you were interested to know more about what compassion actually is. In your packs there is
an outline of what compassion is. It's difficult to define precisely but basically it's about learning to be
sensitive to the suffering of self and others with a deep desire and commitment to try and relieve their
and our own suffering. That is how some people define it. So your first step to compassion is making
a commitment that you will work to understand your selves and do what you can to help yourself with
the painful things you feel - just coming to therapy here today and trying to find a way to better
understand and look after yourself, so that you can feel better, is a major compassion step for you.
This tells you that you're not ignoring your pain, but would like to do something about it.

We then discussed how our approach to compassion is also a little more difficult and complex, but as
you'll see in your pack, I give more detail to this focus on different aspects of compassion. Here you
will see that compassion relates to a motivation to be compassionate and sensitive, our ability to be
tolerant of our feelings and to understand them, (be empathic), in a non-judgmental way. The basic
emotion is one of warmth and kindness. However, we again discussed that compassion is not about
being soft or weak. Sometimes compassion requires courage. For example, an agoraphobic person
needs to develop courage to face up to their anxiety and go a little further each day. Compassion is
the courage to face what we need to in order to nurture ourselves and heal and grow.

Creating compassionate feelings, trying to get that brain system going is related to different types of
compassion focus, such as:

1.      The compassion you feel for others, your desires for them to feel happier, or help them rid the

2.     The ability to feel compassion from others and their desire to help you.

3.     The compassion you feel for yourself and your desire to help yourself nurture and heal.

So this is how we relate to, be open to, and feel about –

      Compassion for others.
      Compassion from others
      Compassion for yourself.

We discussed that we were going to explore ideas and imagery for all of these.

Compassion enactments and embodiments
We discussed a lot about the different difficulties in being compassionate to others, feeling
compassion from others and being compassionate to oneself. You all thought that compassion to
others was the easiest, and the other two were pretty difficult.

We decided that our first exercise was going to be on becoming the Compassion Self - allowing one
self to feel that one has those qualities within oneself. So, we said that if you've ever fancied being an
actor or even a Hollywood star, now‟s your chance – well, at least to practise in your own home. This
exercise is about getting into a role from the inside and involves us practising the body postures and
body states of compassion.

Basically you‟re going to get into the role of a wise, compassionate person, as if you're an actor who,
in order to convince your audience, has to live this part from the inside. To do that, you must really
get in touch with what it is to be that person. Just as a good actor studies the individual who they‟re
going to portray and tries to recreate the role within themselves, you're going to do the same – you're
going to imagine yourself as your ideal compassionate person.

You may have an individual in mind to emulate; you might decide that you want to become like the
Buddha or someone who you consider your compassionate ideal. The idea is not to become them as
such but to use them as a guide or inspiration for you to become the most compassionate that you

We do these exercises mindfully, (in ways that you have learned in your DBT program), so that when
distracting thoughts emerge, notice them and gently and kindly bring your attention to back on task,
being fully present with the different elements of the exercise as best you can. If you have thoughts
like „this can't work me, I'm not a compassionate person, I don't feel compassion‟, then notice these
thoughts but, to the best of your ability, playfully imagine what compassion would feel like in you if
you did access it. Here's what we did more specifically:

Sit or stand loosely and relaxed, looking down or to where your vision is most comfortable. Adopt a
soothing breathing rhythm for 30 seconds or so. Allow your body to relax and go as loose as it is able.
Now, for a moment, imagine that you are a deeply compassionate and wise person. Think of the ideal
qualities that you would like to have as a compassionate person. These might include deep kindness,
warmth, gentleness, being difficult to provoke, a sense of having „been there‟ and gaining wisdom as
a result.

It doesn't matter if you actually have these qualities or not, because you're focusing on imagining and
thinking about what it would be like to have them, what they are and your desire to develop them. So,
think about your age and appearance, your facial expressions and posture, your inner emotions of,
say, gentleness. Now, like an actor about to take on a part, feel yourself become these.

Try to allow your facial expressions to be gentle and compassionate; allow yourself a slight, gentle
smile. Think about the idea that you are a wise person who has seen much in life. When you speak,
think about the tone of your voice, (spend a few moments just imagining the tone of your voice). Think
about what it's like to be a forgiving person who doesn't bear grudges. Think about the qualities that
you really value in compassion and imagine having them. Allow yourself to become this person.
Spend as long as is comfortable practising this role, and try and do it seriously, but also playfully.
With this exercise, it can be interesting to notice how it affects your body, including your posture,
breathing rate and so forth. Do you notice your muscles becoming tense or more relaxed and softer?
Are there any areas of your body that feel warm?
We then had a series of discussions on these exercises and their difficulties.

You can practise this at any time of the day (or night) if you wish. As you move around in your life,
imagine being (and becoming) this compassionate person. To begin with, it may feel a bit artificial but
it can also be great fun. Do be cautious, though. I remember, one morning before work, doing my
compassion practice while slowly walking , focusing on all the qualities that I'd like to have for the day
ahead, keeping my attention to the present moment, and I got quite carried away. Then I
remembered that I‟d left the porridge boiling away, rushed back to check it and fell arse over elbow
over a footstool. So do be careful!

Over subsequent weeks, you can practise your focus on becoming compassionate by recreating
compassionate body postures, facial expressions and tones of voice. All these are designed to help
you think about, and focus on, becoming self-compassionate, and exploring how that affects your
feelings and body. Keep in mind that you‟re in training, learning to cope with the frustrations and
anxieties of life.

During your mindfulness training the issue is to learn to be aware, to pay full attention, and to
remember to focus. So, awareness, attention and memory are key.

As we get through the week keep a record of your practice, where and when you practised engaging
in this exercise, and how it went for you.

We also discuss that you can practice at any time, such as waiting for a bus or lying in the bath. We
also discuss practicing “compassion under the duvet”. Each night before you sleep and each
morning before you get out of bed spend a minute or two engaged in your breathing and imagining
yourself as a wise and compassionate person.

With all these exercises try to be playful, recognise distracting thoughts or feelings as they arise and
then just bring your mind back on task. Remember that there is no perfect way to do this, but try to be
curious and open.

Part of the group began to focus on how we feel about ourselves when we feel bad and how it is then
very difficult to swith to compassion. The bad feelings of the self seem so all-encompassing and
powerful. This is another reason to practice these exercises when you're not at your worst,

This conflict between feelings from the threat system and those from the ceiling in the compassion
system, and how it is difficult to get compassion operating when one feels terrible, are likely to occupy
a lot of our time together during the group.

However, at the end of the session people acknowledged that they had found it interesting and did
feel it would be worth having a go.
       Developing Compassion-

    The Basis for Starting your
              February 8 – March 13 2009

     Paul Gilbert, Kirsten McEwan, Corinne Gale & Chris Irons
                    Mental Health Research Unit,
                   Kingsway Hospital, Derby UK


        Thank you all and welcome

    Thank you all very much for
 agreeing to work with compassion
  and help us learn from you what
              is helpful

 Therapists for this module are Paul Gilbert, Catherine
                 Parker & David Woods

                       Our Sessions
Our sessions will unfold in the followings

1. Introduction to the basic ideas and approach – learning about how
   our minds work and why they are difficult to regulate

2. Looking at what compassion is and how it can help us with our

3. Outline and practice various exercises to help us develop

4. Looking at, and working with, our fears, block and difficulties in
   developing compassion.
   Why our brains and minds are difficult
                  for us
  1. Old Brain
          Emotions:      Anger, anxiety, sadness, joy, lust
          Behaviours:    Fight, flight, withdraw, engage
          Relationships: Sex, status, attachment, tribalism

  2. New Brain
         Imagination, fantasise, look back and forward, plan,
         ruminate, integration of mental abilities
         Self-awareness, self-identity, and self-feeling

  3. Social Brain
           Need for affection and care
           Socially responsive, self-experience and motives

     What happens when new brain is recruited to pursue old brain

              Sources of behaviour
                The Evolved Brain

                 New Brain: Imagination,
             Planning, Rumination, Integration

                 Old Brain: emotions, behaviours,
                       relationship seeking

        So Basic Philosophy is That
We all just find ourselves here with a brain, emotions and sense
of (socially made) self we did not choose but have to figure out

Life involves dealing with tragedies (threats, losses, diseases,
decay, death) and people do the best they can

 Much of what goes on in our minds is not of „our design‟ and
                        not our fault
                    All in the same boat

 First steps to compassion is to be open to suffering, „what we
      are caught up in,‟ with a desire to relieve suffering

       Steps to taking responsibility to learn and change
        Types of Affect Regulator Systems

    Drive, excite, vitality                              Content, safe, connected
      Incentive/resource-                                  Affiliative focused
      Wanting, pursuing,
     achieving, consuming

                                   Protection and

                          Anger, anxiety, disgust


                                   Protection and



     Body/feelings              Attention/Thinking                 Behaviour
•   Tense                   •     Narrow-focused              •    Passive avoidance
•   Heart increase          •     Danger threat               •    Active avoidance
•   Dry mouth               •     Scan – search               •    Submissive display
•   “Butterflies”           •     Internal v. external        •    Dissociate
•   Afraid                      (attribution prediction)


                                   Protection and



     Body/feelings               Attention/Thinking               Behaviour
•    Tense                  •     Narrow-focused             •    Increase outputs
•    Heart increase         •     Transgression/Block        •    Aggressive display
•    Pressure to act        •     Scan – search              •    Approach
•    Anger                  •     Internal v. external       •    Dissociate
                                (attribution prediction)

                            Wanting, pursuing,
                            achieving, consuming



     Body/feelings         Attention/Thinking             Behaviour
 •   Activation        •     Narrow-focused           •   Approach
 •   Heart increase    •     Acquiring                •   Engage
 •   Pressure to act   •     Explorative              •   Socialise
 •   Disrupt sleep     •     Internal v. external     •   Restless
                           (attribution prediction)
                                                      •   Celebrating

                             Affiliative focused




     Body/Feelings           Attention/Thinking           Behaviour
 •   Calm              •     Open-focused             •   Peaceful
 •   Slow              •     Reflective               •   Gentle
 •   Well-being        •     Pro-social               •   Pro-social
 •   Content           •     Internal v. external
                           (attribution prediction)

                            Key Idea
Various therapies have developed exposure and other
techniques for toning down negative emotions but not for
toning up certain types of positive ones. Can‟t assume that by
reducing negative emotion the positives will „come on line.‟

Two types of positive affect related to
•     achievements/doing/excitements
•     affectionate, soothing

Some people have major difficulties in being able to access
the soothing system

 Fear of Positive Affects and A Positive
                  Sexual                      Bully-threat

              Meal          Sex
                                     Bully-          Kind, warm
                                     threat          and caring

                     Limbic system    Compassion

  Stomach acid
                     Arousal                   Fearful

            Compassion Solutions
Ancient wisdom
     Compassion is the road to happiness

     Evolution has made our brains highly
     sensitive to internal and external kindness

     Specific brain areas are focused on detecting
     and responding to kindness and compassion

           Why a Compassion Focus?
 People with chronic problems often come from
 neglectful or abusive backgrounds, have high
 levels of shame, and are often self-critical, self-
 disliking, or self-hating

 Live in a world of constant internal and external

 Have few experiences of feeling safe or soothed
 and are not able to do this for themselves. Often
 do poorly in trials
              Types of Affect Systems
      Incentive/resource                       Affiliative focused
           focused                             Soothing/safeness
                                                  Opiates (?)
  Seeking and behaviour
        Dopamine (?)

                              safety seeking

                               Serotonin (?)

                Compassion as Flow
               Different Practices for Each
      Other                                 Self

      Self                                  Other

      Self                                  Self

      Non linear empathy for other begins early in life

           Compassion and Evolution
Recognition of the complexity of our evolved

Develop our understanding of the crucial role that
affection, affiliation, safeness and contentment –
the third circle (in contrast to threat) plays in the
way our minds and brains develop and how are

Clarified and cultivate the compassionate mind
that balances the mind.
     Key Targets of Therapy

Fantasy                                       Behaviour

          Motivation             Emotions

     Evolved Dispositions and Designs

   Key Targets of Compassion
    Attention                     Reasoning

Fantasy                Compassion             Behaviour

    Motivation                    Emotions

Threatened mind can block compassion
    Attention                     Reasoning

Fantasy                 Threat                Behaviour

    Motivation                    Emotions
     Multi-Modal Compassionate Mind Training
                              SKILLS -TRAINING
 Warmth                                                                 Warmth

     Attention                                                Reasoning
                    Sensitivity               Sympathy

                 Care for       Compassion        tolerance

      Feeling                                  Empathy         Behaviour


Warmth                                                              Warmth

   Meal                                                       Bullying
                   Meal               Sex
                                                                    Kind, warm
                                                 Shaming            and caring

                              Limbic system


   Stomach acid
   Salvia                         Arousal

  Contrast self-compassion to self-esteem

            Self-Esteem                         Self-Compassion

 Access when things going well              Access when not going well

 Individuality/difference                   Common humanity

 Achievement/doing/drive                    Acceptance/being/content

 Competitive mentality                      Caring mentality
                           Our Group Work session 3 22 January 2009

In our group last week we began to think more about how we often we experience feeling bad. We
explored together the feelings of being personally bad, or as one person said a „piece of shit‟. When
we have these feelings they can sometimes be caused by lots of confusing and conflicting feelings
going off in us at the same time. So we drew a circle and explored these together.

It became clear that when we have the feeling, “I am shit”, it is partly because we feel shitty and that's
because we have many different and difficult feelings that we haven‟t been able to work through. This
is what we drew out together:

                                                     Complex feelings
                     We often have many feelings/memories going on at the same time and these can conflict
                                 with each other and then we judge ourselves too – get locked in

                                                      Meaningless                Alone
                                 Burden                                          (no one understands)

                      Anger                                                                 Anxiety
                      Frustration                      FEEL SHIT

                     Shame and Guilt                                                     Hopeless

                                           Should not feel             Feel different
                                           like this


So, what to do?
Notice the state of mind and „stop‟. This is where mindfulness comes in. Take breath or two and just
notice what is happening, as though you are looking in on yourself, then stay in an observational
position. refocussing on kindness and recognising that there will be resistance from other aspects of
your mind – just note these.

It is very easy to feel personally bad when this happens. Of course, if others have said unpleasant
things about us we can take them to heart and believe them. We are not born with shame and self-
criticism; rather it is something that we learn. So we need to have a way of thinking about ourselves
that can separate out the things that have happened to us and the way our minds go off in all
directions, and the essence of ourselves.

Again, this is where our mindfulness skills are important. We have said that our mind is like a spotlight
and many things can be in the spotlight but those things are not the light itself.
Remember, water is water whether it is muddy or clean. A mirror reflects many things but the mirror is
not those things. So, your mind can be full of many things and be in different mood states, or very
aroused - but you yourself, your being, your consciousness is like the water, like the mirror.

This is why, when we feel overwhelming feelings and have unpleasant memories, feelings or
thoughts about ourselves, we may find it helpful to stand back from these, take a soothing breath or
two and become more mindful and observant of what is going on in our minds, without labelling or
condemning. Our „judging mind‟ can spin us around in circles. We shift between condemning and
blaming when we feel these things to trying to understand and treat ourselves with compassion and

Thinking about compassion together
In the last few weeks we have thought about how our minds work and how compassion can help us,
because if we practice this it can have soothing qualities. Compassion begins with a genuine wish to
care, heal and move forward. That wish can help us with the courage that we sometimes need.
However, we can also train ourselves in the following ways. This is to focus on:

Compassionate attention: It is easy to see a glass as half empty when we feel low, and half full
when we feel OK. So how can we learn to focus in on things that are helpful to us rather than get
caught up in (understandably, but unhelpfully) dwelling on things that stir our anxiety, anger or other
emotions? How can we learn to practice focusing on things that are helpful to us?

Compassionate thinking: There are ways of thinking that will stir our anger and anxiety or shame
feelings but there are also ways of thinking that can be more calming. Last week, a number of group
members came up with some very important ideas about thinking. These included ideas that if people
had been unkind to us then they may not have had our best interests at heart and we should be very
cautious about listening to them or accepting their views about us. Although one would hope that
one‟s parents would always be loving, sometimes this does not happen because of problems within
them. We can learn to treat ourselves and think about ourselves in the same way we would do if a
friend was in the same situation as us. There is no recipe here, and many of you have a wisdom
inside of you that can guide your thinking on what is helpful and kind. It takes practice, though, to ask
oneself repeatedly, day in, day out, “is my thinking helpful and kind?, do I really want to be thinking
what I am thinking or am I getting caught up in an emotional state? If I am feeling bad, can I just be in
a state of emotional acceptance and not fight with my feelings?”.

We can sometimes have thoughts and fears about our emotions; that they are wrong; too confusing;
overwhelming; that others won‟t understand them; and so it can be important to look at these ideas
with understanding and kindness.

If we have done unkind things then we can try to be open and honest about this, recognise that as
human beings sometimes our emotions do get the better of us, (we crash the gears), but also making
a commitment not to get bogged down in self blame or self dislike; think about what we can learn and
how we can improve next time; how we would like to do things differently, and what would help us
learn to be able to do that; how we would like to help others.

Compassionate behaviour: We discussed this in relation to dealing with difficult emotions and many
of you had some great ideas about helpful behaviour. For example, sometimes if one is feeling tired
or upset, we need chill out or take a “duvet day”. All of us acknowledged a difficult “dialectic”. On the
one hand it is important to accept one‟s emotions without blaming oneself, fighting or condemning.
On the other hand, acceptance doesn‟t mean that we don‟t try to help ourselves. So sometimes,
activity and distractions, such as getting up, going for a walk, doing something physical, doing one
thing at a time, which breaks up one‟s thoughts and feelings, can be helpful. Sometimes acting
against a feeling is compassionate. For example, a person who has agoraphobia and is frightened to
go out might decide to face their fear little by little each day. In this case it is not trying to overcome
the anxiety, but working with it that is compassionate and helpful to us.

Last week we looked at a thought form which can be quite useful to get into the habit of using,
because it helps us to refocus and slow down, particularly when our head is a buzz of emotion. So,
here is one that we compiled together last week but didn‟t get a chance to finish.
Compassion-Focused Thought Balancing

  Trigger        Unhelpful / distressing                       Helpful/kind thoughts: Try to create warm tone

                                               Compassion attention: notice and stop, refocus – mindfulness – maybe
Remembering     Lots of different feelings     describe (speak out) in words what one is feeling.
times I felt    linked to anger, anxiety,
bad about       and memories.                  Compassionate thinking: Feeling like this is not my fault and certainly not my
myself.                                        choice. It is my self-protection system that is fired up.
                Feel stuck, and ruminating     It is understandable, however, that I feel like this because of upsetting things or
                on things.                     feeling threatened or let down in some way.
                                               Feeling bad does not make me, my being, bad. (Water is water, whether murky
                                               or clear).
                                               If a friend were experiencing this I would try to be understanding. In fact, in our
                                               group many of us feel the same at times.
                                                I have felt like this before and it passes.
                                                I have more courage that I am reminding myself of .

                Change interfering             Compassionate behaviour: It is helpful to accept my feelings without blaming,
                thoughts. ---I don‟t what to   condemning or fighting with them. The thing that works best for me when I feel
                change. I just want to be      like this is ….
                angry! Why the hell should     Time for a duvet day – let it be – just give myself some space.
                I change?!                     Getting out or away is helpful.
                                               Physical activity is helpful.
                Can‟t be bothered.             Trying as best as I can to operate against my feelings. Not letting my feelings
                                               dictate my actions can be helpful.
                Too overwhelming.              Talking to others – seeing or phoning my therapist.

                                               Compassionate writing: Writing a letter to myself or writing in a diary that is
                                               focused on being kind an supportive.

                                               Compassionate imagery: I can give myself just a few moments to take a couple
                                               of breaths, bring my compassionate colour or image to mind, and see if that
                                               helps. Hand heart practices.

Example2: Finding the going is difficult
  Trigger       Unhelpful / distressing                       Helpful / kind thoughts (try to create warm tone)

Trying to do   What am I supposed to           Compassionate attention: I notice these thoughts and how easy it is for them to
some of the    feel?                           come and then be my focus. They are part of my self protection system that does
imagery.       I don‟t feel anything.          not like change and is fearful of not doing things right.
               I‟m not engaging with it         Well, I can accept these difficulties, notice these thoughts and encourage myself
               properly.                       to return my focus to the exercise, (notice and return).
               I‟ve missed something. I‟m      Compassionate thinking: This is distressing - to be trying so hard and having
               not in touch with my            these blocks and fears. But it my intention and efforts that matters
               feelings, therefore I will be   These difficulties are common so it‟s not just me, in fact they are normal and
               stuck.                          even expected experiences, so it is not that I have „missed something‟.
                                               I have never done this before and am not used to this. It might even feel odd or
                                               frightening to me.
               Does it work for others?        It is the practice that is important and seeing what happens. It is still early days,
               Maybe it is just me then.       so is not about being stuck. I am very in touch with some feelings, but am
                                               learning how to be more in touch with my compassion side and that will take
                                               Compassionate behaviour: I have agreed to try at a certain time each day,
                                               without expectation, to see what happens, (called behaviour experiments). It may
                                               be that there are some things that suite me better than others.
                                               There are other ways to help me bring out and feed this part of myself, such as
                                               trying each day to be kinder to myself.
Compassionate practice and imagery

Over the last few weeks we have been practicing imagery because imagery can also
stimulates our „soothing‟ brains. We have learnt that compassion is like a breath that flows in
and out. We can feel compassion for others, compassion from others, and learn to focus
compassion on ourselves, whilst we also recognise the fear (and „yes but‟) resistances to
doing that.

The first practice we have been focusing on is becoming the compassionate self using our
soothing breathing if possible, compassionate facial expression, and just allowing ourselves
to feel compassion within ourselves, reminding ourselves what we feel like when in a
compassionate state of mind. You are now trying to do this practice every day for at least a
few minutes.

At the end of our sessions we also practised thinking about the struggles of other people in
our group, and thinking about our wish for them to be better, less unhappy, and able to
come to terms with the pain of their lives.

In the weeks to come we are going to be working on different types of compassionate
imagery and something we call compassionate writing.

                        Group Session 4 -- 29th January 2009

The group began by acknowledging that, in open discussions, certain topics will naturally
arise, especially those relating to past painful experiences. However, it was thought that
different people would be at different stages of preparation to explore and discuss these.
The group therefore decided that, although addressing painful feelings together is part of a
therapy and healing process, certain topics would be dealt with in individual sessions. So it
was agreed that anyone feeling unsafe would notify the group and we would explore this to
find the most helpful balance. Identifying and thinking about what is helpful is the key to a
compassionate approach.

The group then discussed the difficulties of becoming compassionate even though we all
understood the value of it. The group noted that a block to becoming compassionate to one
self can be caused by us constantly refering to unresolved past experiences and shaming
ourselves. There was a recognition of the need to find one's own way to heal these

Developing Warmth
This led to a discussion about the nature of our work together, in particular how to develop
compassion, especially for oneself.

The group then raised the idea that it's not just compassion they struggle with, but thinking
about anything positive about themselves or future. We wrote down some of the typical
fears and thoughts about fear of the positive. I have included a few of the typical ones:

      People only do or say nice things because they want something from you.
      I don‟t know what it would feel like, it seems very odd.
      Taking your guard down, like taking bricks out of the wall.
      Fear of becoming too excited.
      Fear of becoming arrogant.
      Fear that it is not deserved, or is false and will be taken away.
      If you let yourself rise up you have further to fall.
      It‟s all or nothing. I‟m not sure how to start small.
      To think nice things about myself would seem „not me‟.
      I feel I'm letting myself off the hook, and therefore will feel worse about myself.

We also noted in passing that sometimes the beginning of kindness can spark feelings of
sadness and grief which can seem overwhelming. However, as some of you noted grief can
also be healing.

We discussed why we keep positives „out‟ and this is related to our „threat and self
protection system‟ being in too much control - the system works on a better safe than sorry
basis. It is one of the most common reasons for all kinds of difficulties including
agoraphobia, panic etc.

Two of the most common basic modes of self protection are:

      Anxiety, shut-down avoidance.
      Anger-attack.

Learning how to help our „better safe than sorry‟ system tone down a little to let some
positives in is part of the therapy. We can think of our positive systems like a muscle that
needs exercising. Therefore, it is thinking about how we take on our fears in a step-by-step,
bit-by-bit, way, actively thinking, “how could I work on this fear?”

We discussed that these fears and worries are understandable. However, they will block us,
so it's a case of making a commitment to try to work with them in a kind and understanding

way, going a step at a time. This way we can work towards healing these fears and working
with them, rather than letting them dominate our lives.

The group then raised an issue about how we can be more aware of feelings because often
feelings and mood states flush through us without us realizing that our emotions have been
aroused until the volume‟s full up. We suggested that this happens in steps using many of
the skills you have learnt in your therapy up to now. For example, we discussed the
following options:

1.      When you do notice that your emotions are highly aroused, try and notice what is
happening in your body and switch into a mindful observational mode.
2.      Learning to give yourself some space so that your emotion doesn‟t just blow you
along. If we speak out our emotions, “in this moment I am feeling …. and I am having the
thoughts ….”.
3.      Bring to mind the fact that emotions pass like a storm.
4.      Mindfulness helps us to take a step back, to be like the fly on the wall, paying
attention to the rising and falling of our feelings.
5.      Retracing our steps, (chain-analysis). This involves paying attention to what
happened immediately in the moments before this one, and retracing our thoughts and
feelings back through time, noticing triggers and events and thoughts that might have added
to our emotions.
6.      Reflecting on whether we might have noticed that process earlier and headed it off.
7.      Sometimes we have not learned to be attentive to the rising and falling of our
feelings. Sometimes we might have tried to block them out and not become familiar with
them. Mindfulness helps us to take a step back and pay attention to the rising and the falling
of our feelings.
8.      Distinguish between your feelings and yourself. Feeling bad does not make you bad.

We discussed this in terms of the self as a mirror or water. What the mirror reflects is not the
mirror; water can contain a poison or a medicine but water is neither the medicine nor the
poison. So, it is learning not to identify with what one feels, (“you are not your emotion”), but
to see it as states of mind that ebbs and flows.

We then discussed how one could track one‟s feelings, especially looking back in time if one
loses one's memory of feelings; if we dissociate. This is difficult and is easier to discuss with
your individual therapists. It can help to go back to the point at which one can remember and
reflect on what might have been happening in one‟s mind at that point. It can help if we try to
be mindfully curious and inquiring of our minds - a genuine desire to work with one's mind
rather than just let the protection system shut other systems down. Difficult, though, but
maybe worth a try, going gently, kindly, and step by step; nothing should be forced.

You noted that when we feel unhappy or depressed or suicidal or very angry we can often
have the idea that “we shouldn‟t feel like this” and there is something wrong with us if we do.
This can make us very judgmental and we then start fighting with our feelings or trying to get
rid of them. It can help if we learn to accept our feelings. There may well be all kinds of
reasons why we are feeling like we are feeling. For example, we may be at a low ebb, things
may have reminded us of the past, a lot of things may have all come together or there may
have been a lot of stresses and setbacks. Sometimes we can even feel anxious if things are
going well. So maybe there are all kinds of reasons for why we feel what we feel.

The key, then, is learning how to be compassionate with one‟s feelings and learning to be
with them in an understanding and kind way. It is always the approach of “given that I do
feel what I am feeling (and I am not choosing to feel like this), what would be the most
compassionate way for me to work with my feelings or help myself?” So our feelings may
not be desirable or wanted, but we can accept them as part of our being rather than fight

with them, be self-critical for having them or try to avoid them - which usually makes them

Understanding how our own minds contribute to our suffering
Through no fault of our own we can find our minds walking on well-worn tracks of feelings
and negative thoughts. Many people noted that when they feel bad they dwell and ruminate
on how bad they feel, how bad they think they are, and painful things. This is very
understandable but it means that we are caught in a loop and will be constantly pumping out
stressful chemicals in our bodies. This is why it's so important to recognize when one's been
caught up in that stream, and to have ways of trying to step to the side of it and switch to a
new stream.

Compassion is a way of recognizing that you're in a stream of unhelpful thinking; that your
threat system will try and hold you in that stream, and that you can practise making
deliberate efforts to shift your attention to a mindful and compassionate focus.

This will be easier to do if you have been practising when you have been feeling relatively
calm. For example, we have said it is not easy to learn how to swim if you have fallen
overboard in a storm. It is much better to learn in calm, shallow water and build up your
skills. This is the point of the practice.

Compassion Practice
We are now at the point in our therapy where we need to develop our practice. Doing these
exercises can seem artificial and can be difficult, but with practice they can become easier.

So far we have worked on two key aspects of practice. One is using imagery.

The simplest one is to imagine a colour that is associated with compassion for you and
imagine this colour bringing feeling of compassion to mind.

Another one we focused on was safe place imagery – going through all the senses and
bringing to mind feelings that the place welcomes you – it is your unique place, you created

The third practice is called becoming the compassionate self (embodiment). This practice is
imagining oneself to be a compassionate person. Here you imagine yourself being kind, with
wisdom that you have gained from life experiences and having developed certain strengths.
You imagine how you think and how you speak when you are in your compassionate mode.
You create a compassionate facial expression. You then imagine that you have all of your
ideal qualities of compassion. It does not matter if you feel that you really have them or not,
just as we can imagine our ideal meal, it is the process of trying to create them in your mind
that is important. So spend as long as you can practicing imagining being that person.

The fourth practice is to imagine having compassionate thoughts and desires for others that
you care about with a genuine wish for “them to be well, be happy, and free of suffering”.
This is to try to fill one‟s mind with kindness for others.

You can imagine how your brain will be operating when you direct it to do these exercises,
in comparison to dwelling on your unhappy feelings.

We and now going to develop a new exercise which focuses on you developing your ideal of
compassion, to build a compassionate image for you; an image that you feel can direct
compassionate feeling and desires for you.

Building a Compassionate Image
This exercise is to help you build up a compassionate image for you to work with and
develop, (you can have more than one if you wish, and they can change over time).
Whatever image comes to mind or you choose to work with, note that it is your creation and
therefore your own personal ideal, what you would really like from feeling cared for and
about. However, in this practice it is important that you try to give your image certain
qualities. These will include:

Wisdom, Strength, Warmth and Non- judgement
In each box below think of these qualities (wisdom, strength, warmth and non-judgement)
and imagine what they would look, sound or feel like.

If possible we begin by focusing on our breathing, finding our calming rhythm and making a
half smile. Then we can let images emerge in the mind – as best you can – do not try too
hard. If nothing comes to mind, or the mind wanders, just gently bring it back to the
breathing and practice compassionately accepting.

Here are some questions that might help you build an image: Would you want your
caring/nurturing image to feel/look/seem old or young? male or female (or non-human
looking e.g., an animal, sea or light)? What colours and sounds are associated with the
qualities of wisdom, strength, warmth and non-judgement? Remember your image brings
compassion to you and for you.

 How would you like your ideal caring, compassionate image to look/appear –
 visual qualities?

 How would you like your ideal caring, compassionate image to sound (e.g. Tone of

 What other sensory qualities can you give to it?

 How would you like your ideal caring, compassionate image to relate to you?

 How would like to relate to your ideal caring, compassionate image?

               Review of our Therapy Session 5 Therapy (12-2-2009)

This week our discussion was focused on how feelings can lead us to behave in certain
ways, leaving us feeling bad and causing us to self-criticise or self-dislike. That increases
the chances that these feelings will come back. For example, something might make us
angry, we act out that anger and then we feel bad and angry with ourselves! Unfortunately
this increases our feelings of vulnerability and threat, and so increases our sensitivity to the
things that trigger our anger or anxiety, making it easier to become angry next time. We can
get caught in a very unpleasant loop. Rather than trying to tone down the emotion systems
we inflame them and maintain them or try to suppress them.The self blame, while
understandable, can actually make things worse for us as the diagram shows.

Diagram 1

                               Understanding unhelpful cycles

                                  Self -Protection   Act Out     Self blame and
                   Trigger                                          put down
                                  Anger Anxiety                     Feel bad

These are very common and easy to understand cycles because we can feel critical about
the feelings of anger and anxiety themselves, as well as what we do when they take hold of
our minds. Actually, it is quite common for us humans to be taken over by our emotions.
Learning how to recognize and better regulate our emotions can be tough.

Learning how to recognize and better regulate our emotions
If we can learn how to recognize and regulate our emotions, and indeed learn to focus on
emotions and feelings about the self which are helpful, it is likely to be much better for us.
Diagram 2 outlines some of the things you've been working on to help you. This is not
comprehensive and there are many other things that we have been working on together
over the year.

Diagram 2

                   Self-Criticism Working with unhelpful cycles
                                           Awareness and Mindfulness
                                         Examine Beliefs that maintain it
                                           Advantages -Disadvantages
                                     Plan and practice new Coping behaviour

                                     Self -Protection        Act Out            Self blame and
                  Trigger                                                          put down
                                     Anger Anxiety                                 Feel bad

                                                 Compassion focusing
                               Desires to change and improve rather that just self-blame
                               Commitment and Practice becoming the self you want to be

Awareness and Mindfulness
Practicing awareness and mindfulness is about learning how our bodies and minds can
react quite quickly to things. It can help us though, if we practice putting words to our
feelings as they are happening. Speak out loud, “right now I am feeling………… and my
body is experiencing……”, so that we notice what's happening in our bodies; we look at how
our emotions are pushing and pulling our thoughts; we notice how certain bodily feelings
make us want to do certain things.

However, with practice we can learn to be more aware and conscious of what's happening
in our bodies as emotions spring up. We note that our mind can be filled with different
emotions. Today it might be anger, tomorrow anxiety, the next day we might be much more
relaxed or happy. Emotions can even change hour by hour. Emotions come and go but what
does remain constant is your conscious awareness. So „you‟ are like water that can carry a
medicine or poison but the water itself is not the medicine or poison. Learning to be mindful
helps us remind ourselves we are like the water and different emotions can flow through us.
We are training our minds to attend more and stand back and observe the patterns of our

Examine Beliefs that maintain unhelpful emotions
We had a very good discussion about how we can learn to rely on our defensive emotions
because of things that happened to us in the past. Our brains have automatically developed
quick acting defensive systems for us - that is not our fault - but they can become more of
a problem than a help when we are adults. So we need to take responsibility for our actions.

We also discussed the matter of emotions like anger can cause us to have beliefs that
actually increase the chances of us becoming angry. For example, ideas such as, “if
someone crosses me I mustn't let them get away with it - I must get my own back”, “I am
weak if I don't show them”, “I can feel better and stronger if I get into a fight”, “anger distracts
me from my feelings of vulnerability and sadness”, “they deserve my anger”, I need to be

angry to show people how much I'm hurting or what they‟ve (or the world has) done to me”,
“I must never show vulnerability. I must be strong”.

We all have our own personal beliefs about having anger. We can also have beliefs about
anxiety. For example, “my anxiety is overwhelming and I must run away”, “if I stay and learn
to tolerate my anxiety and feelings then something bad will happen”.

One of the things we've been exploring in this course is the basis of these beliefs. We have
been recognizing that ultimately they were designed to protect us, one way or another.
However, although they are powerful these emotions evolved many millions of years ago
and now sit in our brains and can make life difficult for us. They may have been highly
trained up in childhood too, which makes it even tougher. We have to think about whether
or not they really are protecting us now or whether our emotions are running on automatic! If
so, do we want this? We come to therapy because we don't want our minds to be on
automatic. We do want to find ways in which we can exert more control over our minds and
take back our minds from the programming they received in childhood. So we try to retrain
these strong emotions.

Sometimes we can become very anxious and frightened because inside of ourselves we are
actually frightened of our and anger and rage at things. Sometimes it's the other way round,
we become very angry as a cover for our fear or upset about things. Remember, both anger
and anxiety are powerful defensive emotions and can play off against each other.

We also discussed the importance of black-and-white thinking. When your emotions are in
control they tend to be very black-and-white because they don‟t have complex thinking
abilities. Our complex thinking abilities come from another part of our brain so we need to
actively practice recognizing when we are thinking in black-and-white terms and try to think
in terms of alternatives or shades of grey.

We also touched on the idea that in being self-critical “I must be a bit good”. If I forgave
myself or did not punish myself, well that would be very bad, like I didn‟t care, and I do care,
so I must punish myself.

We discussed that self-punishing does not help. However, trying to understand the issues
and improve will.

Advantages – Disadvantages
We had a long discussion about the advantages and disadvantages of our beliefs and of
allowing our emotions to run the show. We discussed that anger, for example, can be very
harmful to ourselves, to others, to our relationships, and dangerous. In extreme cases we
could actually end up in prison because we have allowed the emotions to run the show.

Sometimes it really helps it we stand back and think carefully through the advantages and
disadvantages for ourselves. It helps if we then make a clear commitment to practice and
develop things that are genuinely in our best interests. So, we want to learn to better
understand, become more mindful of, and control what we do when we experience very
strong emotions, because it's good for us. Before we worry about anybody else this is the
key advantage.

Plan and practice new Coping behaviour
One of the key behaviours when we experience strong emotions is learning not to act them
out, learning to act against the emotion or in spite of it. This is making a commitment to
yourself to specifically try not to act out an emotion that is not going to be unhelpful to you in
the long term. Indeed, we discussed how important that was. Some of you had already
come to this conclusion, recognizing the real dangers to you in acting out your emotions.

We discussed that this commitment is the beginning of the process of change, because until
individuals really decide that they don't want their emotions to be in the driving seat change
can be more difficult.

The most important coping behaviour is breaking away, moving away from a situation that's
making you angry, or learning to tolerate and stay with the situation that's making you
anxious. Keep in mind the advantages of your being able to do this, think how you would
feel if you could do this.

You can also think through for yourself what type of behaviour would be helpful to you when
you have strong emotions - have plans in advance.

Practice your plans when your emotions are not too strong. Remember we said, “It's not
helpful to learn how to swim when you fall overboard in a storm, it's better to learn when
things are relatively quiet”. It's the same with all practice, begin gently and build up.

Compassion focusing
What the last few weeks have been about, of course, is bringing compassion to your way of
dealing with your minds, your lives and your backgrounds. We have outlined why this is
important. It is important because you are trying to develop a new part of your mind in order
to help yourself. You have a lot of intuitive wisdom and you know perfectly well that when
people are struggling, upset, angry or anxious, that kindness is one of the most helpful
things we can offer. We also discussed that you're not used to kindness and that we have to
train ourselves in it. We've also covered that you have a certain fear and resistance to
developing self kindness, or forgiveness, but at the same time because you recognize the
wisdom of kindness, have made a commitment to have a go.

The most important first step is to realize that much of what goes on in our minds and the
power of our emotions is not of our choosing. We would much prefer to be relaxed, happy
and chilled out! It is because we find our minds so difficult to regulate, that's the problem -
but that's not our fault, It ‟s the way our brains are designed and because of all the things
that happened in our backgrounds.

Now the tough thing of course is that only we ourselves can take responsibility to try and
bring some order to our minds. We are responsible for our own minds, even though it's not
our fault that we can feel such powerful emotions.

Desires to change and improve rather that just self-blame
Once we really understand that then we develop a genuine desire to self improve, rather
than sit in self-blame. This is very important because although self-blaming and upset are
very understandable, they are not helpful for how your mind is working. Remember the brain
diagram from our first session and also have a look at diagram 1 above.

We want to develop a genuine desire to improve, to have more control and to be able to
stand back in a wiser way, but we will have to work at that.

Commitment and Practice becoming the self you want to be
One of the things we have focused on is the importance of a commitment and practice to
becoming the self you want to be. We recognize that, in terms of self-compassion, this can
be tricky for some of us, because of the feelings that come with it. We may feel we don't
deserve it, or that it is unreliable, or it can make us feel angry or very upset. When we stand
back from those feelings we can recognize that this means that we have extra work to do
because if we think about it purely in terms of how our brains are working we need that
system to help us.

We have been looking at how to do the following
We have been practicing imagining being a compassionate self. This is called
embodiment. We become curious and interested in what that feels like. What would the tone
of our voice be like?, how would we be thinking?, how would we be standing?, how would
we behave? Remember the compassionate facial expression. In a conflict, how does the
compassionate self behave? We know how our angry or anxious selves behave of course,
but if we could bring compassionate self to the conflict how would that be? We recognize
that compassion itself is not weak. Actually, compassion sometimes requires quite a bit of

You are trying to practice this as often as you can, possibly when lying in bed, taking a bath,
or when standing by a bus stop. Any time you can use to focus your mind, just take your
soothing breath and imagine yourself as a person who‟s strong inside, calm and kind, as a
person you would like to be.

We have also been thinking and working on:

      Compassionate helpful acceptance and mindfulness.
      Compassionate helpful attention.
      Compassionate helpful thinking.
      Compassionate helpful behaving.
      Compassionate helpful feeling.

So in the last few weeks you have been trying to see if you can notice events and times in
your life which you can bring this more compassionate approach into, by standing back,
remembering our discussions and even writing things down on the thought forms we
provided you. Often we start with small steps and gradually become more and more

Compassionate imagery
We have done a number of compassionate imagery practices. For example, we have
explored safe place imagery - practicing creating a safe place and imagining that the place
takes delight in you being there and welcomes you. It is your own creation. Those feelings of
being welcomed may seem strange, but again it's about practice. Just as if you want to
learn to play the violin your fingers may be very difficult to work to begin with, but practice
can help improve things. Don‟t give up because it feels awkward, that's to be expected!

We also explored the concept of a compassionate colour, of just imagining a colour that
conveys to you compassion, understanding, kindness. We have been practicing imagining a
compassion colour surrounding you. It understands our pain and difficulties and we allow it
to flow through us. This is the way we train our attention to focus on something

Last week we moved to imagining an ideal compassionate other. This image of a
compassionate other has to have a mind that understands what it is to be a human being –
all the difficult feelings we have to contend with. The image represents the ideal carrying out
what we would want for ourselves. It is wise, strong, kind, warm and never judgemental.

Sometimes people create a human-like image, but not always. Sometimes people like to
have an animal as their ideal compassionate image, or the sea, or light, or a mountain or a
tree. Images change and you can have more than one. The key is focusing on the feelings
that the image has: a deep and genuine wish for you to be free of suffering.

We discussed that sometimes these exercises can be difficult because it can make us sad
or we have trouble concentrating and focusing on the image. In these situations we simply
practice mindfully. That is, when our minds wander we bring them back on task.

We recognize that we don't create clear pictures in our heads – things are much more
fleeting and sometimes people only have a sense of their image, they never really see it.
They may have a feeling that flows from it, or they can imagine a type of tone of coice.
There are many different varieties of experience here. Just go with what you feel is helpful to

All of these are really about helping you to have a go at developing compassion as a way of
helping yourself – get that brain system going.

Understanding how compassion can be a scientist for much of what we
think and feel
In an effort to show to how compassion is a way of organizing our minds I wrote out different
aspects of our minds as a circle. We can pay attention to things, think and reason about
things, behave in certain ways have certain feelings and motives, and have various images
and fantasies coming into my mind. Now, we can allow this to be a threat to us, or we can
make an effort to bring compassion to order those. When we do we are enabling
compassion to organize our minds and this is what we mean by a compassionate mind -the
organization of different aspects of ourselves and of different pots of ourselves.

                             Key Targets of Therapy

                      Fantasy                                    Behaviour

                                Motivation           Emotions

                             Evolved Dispositions and Designs

                         Key Targets of Compassion
                          Attention                  Thinking

                      Fantasy                Compassion           Behaviour

                          Motivation                  Emotions

Threatened mind can block Compassion
   Attention             Reasoning

Fantasy         Threat               Behaviour

   Motivation            Emotions

                                   Session 6 19th 2-2009

This was the sixth session of seven - we lost one session due to snow. We discussed how
to continue to focus on compassion with Catherine and David.

Today we began more detailed work on developing compassionate imagery. We discussed
that imagery is not about having clear pictures in our mind, mostly they will be in bits,
fleeting and hazy. If I say imagine a nice meal, now imagine a tree, now imagine a blue sky,
you will sense that each image is different even though you can't necessarily see them
clearly. The exercise really is the act of focusing on a compassionate image rather than
trying to create something clear in one's mind.

We discussed how difficult that can be and that imagery itself can be. However, there was
general agreement that when it comes to negative things some of us find that much easier,
so it is a matter of practicing more balance.

Compassionate colour
We discussed that it can be helpful to learn to practice trying to direct whar one's mind
focuses on. It is so easy when we are anxious or angry for the mind to focus on what the
emotion wants us to focus on, because those emotions are powerful and operate through
our bodies. If somebody bumps into us in the street, the pain of the bump might go within
minutes, but if our minds ruminate on how rude that person was, and how we need to get
our own back, we can make the pain and upset last much longer!

So, it's useful to refocus on something compassionate. We began by thinking of a
compassionate colour - each of us had a colour. We then just imagined this colour,
surrounding us, wrapping us up and gently moving through us. We imagined that the colour
had a mind of its own and that it's only focus and concern was to help us to care for our
selves, to nurture us and help us find peace of mind.

Some people found it easier than others. We discussed the idea that, “I need to know what's
happening before I can do the process”. We discussed that this is linked to a feeling of
needing to be in control. Imagery is simply trying to stimulate different parts of our minds.
The whole point of the exercise is to show that we do not have control over our minds, they
hop about all over the place, so if we really are into control then we will be practicing hard.
However, when we do practice it can produce resistances in other parts of our mind.

We discussed how easy it is for us to be distracted with many different types of intrusions.
We can't really focus on an image because something else pops up in our mind, or we might
trigger a difficult emotional memory. We discussed how to recognize this as a normal (if
unpleasant) process, and then practice simply noticing how much one‟s mind does this
slipping an sliding here and there if we are not practiced.

We then discussed how difficult it can be when one's life is full of difficulties that take up so
much time in our minds. We will acknowledge how hard this is, but if we could learn to
practice this would be in helpful.

We reminded ourselves that it's useful to practice when we are reasonably calm, (we don't
learn to drive on the motorway, we start in the quiet back streets), and build up one‟s
compassionate feelings so that they are more easy to use when we are upset.

Compassionate Image
We then explored the compassion exercise which is given again at the end of this
document. The key here is to practice thinking about a compassionate image that has all of
the ideal qualities of compassion that you would want, such his wisdom and strength,
understanding never ever being critical - if it's your ideal. Just as you might think of your
ideal house or car or job, it will have everything you could possibly want.

We explored the qualities of our compassionate image and how we would like to relate to it.
We discussed how these images can be human or not, and how they are unique to us.
We might start by thinking of somebody we know who is very compassionate but it is
important to make it unique and personal to us. Sometimes the images can be quite

Sometimes people say, “yes but it's not real”, but in a way that is the point. We are trying to
stimulate a brain area and feeling rather than seeking out the real person as such. We are
using our imagination to create a feeling, so it is real to the extent that it is a part of you that
you can imagine and you can focus your attention on when you need listening to.. Indeed,
one of the key elements of change and therapy is that we start to pay attention to different
parts of ourselves, but we must make a space to hear them. We think about these pots of
ourselves and practice bringing them into our lives.

We discussed that are compassionate images can change and that you can have more than

We discussed that sometimes we can combine our compassionate images with our safe
place imagery, a place where we think about and converse with our compassionate image.
Sometimes our safe place images convey compassion in unusual ways. For example, I said
that sometimes I imagine looking out over at sea as a storm passes, with the vibrant, dark,
blue grey and purple clouds and a fresh wind blowing. This gives me a feeling of strength
and vibrancy and is an image I find helpful. It may be related to a memory, but it's not
everybody's cup of tea.

Vision or Sound?
Sometimes, imagining sounds or tones of voices are much easier than creating visual
images. Indeed, when we are compassionate to others it's often not so much what we say
but how we say it; it‟s our tone of voice and feeling that‟s important. So, here it's about
learning to spend a moment and create the sound of a compassionate voice in your mind,
even if you can't visualize anything.

Sometimes chunks can be helpful. One that was offered to us by one of our group was
Nam Myoho Renge Kyo. I said I would look this up on the Internet and try to find a short
definition of it. This is what I came across.


                      What is NAM-MYOHO-RENGE-KYO?

The phrase NAM-MYOHO-RENGE-KYO is taken from the title of the greatest
teaching of the first historically recorded Buddha, known as Siddhartha Gautama
or Shakyamuni Buddha, who lived in India around 500 years before Christ was
born. This teaching, called the Lotus Sutra, declares that all living beings,
regardless of gender or intelligence (that means everyone - including you and
me!), have the potential to attain Buddhahood. In the Lotus Sutra, Shakyamuni
Buddha teaches that inside each one of us a universal truth known as the Buddha
nature. Basing our lives on this Buddha nature enables us to enjoy absolute
happiness and to act with boundless compassion. Such a state of happiness is
called enlightenment. It's simply waking up to the true nature of life, realising that
all things are connected, and that there is such a close relationship between each
of us and our surroundings that when we change ourselves, we change the world.

In the 13th Century, a Japanese priest called Nichiren (1222-1282) realised that
the message of the Lotus Sutra was summed up by its title, NAM-MYOHO-
RENGE-KYO, which can be translated as the teaching of the lotus flower of the
wonderful law. Nichiren declared that all of the benefits of the wisdom contained in
the Lotus Sutra can be realized by chanting this title NAM-MYOHO-RENGE-KYO.
Since the time of Nichiren many, many millions of people have followed his advice,
chanting NAM-MYOHO-RENGE-KYO regularly as a means of improving their
health, happiness, wisdom and compassion. The goal of chanting NAM-MYOHO-
RENGE-KYO is to manifest the enlightenment of the Buddha in our own lives. We
can then realise our own creative potential as individuals and, in so doing, create
thriving and peaceful families, work places and communities. Eventually this
gradual transformation of individuals will create peace and prosperity in societies
throughout the world.


Nam(u) is used in Buddhism as a prefix expressing the taking of refuge in a
Buddha or similar object of veneration. Broken down, Myōhō Renge Kyō consists
of Myōhō (妙法), "sublime," unfathomable" or "mystic" law, the Dharma underlying
all phenomena; Renge (蓮華), the Lotus Flower, which blooms and bears seeds at
the same time and therefore signifies cause and effect; and Kyō (經, "thread
passing all the way through a bolt of cloth", but also "scripture"), meaning a
teaching of the Buddha.The seven characters na-mu-myō-hō-ren-ge-kyō are
written down the centre of the Gohonzon, the mandala venerated by most Nichiren
Buddhists. Precise interpretations of Nam(u)-Myōhō-Renge-Kyō, how it is
pronounced, and its position in Buddhist practice differ slightly among the
numerous schools and sub-sects of Nichiren Buddhism, but "I take refuge in
(devote or submit myself to) Myōhō Renge Kyō" might serve as an universal

We discussed the importance of not getting too worried about specific techniques, but that
it's how we ourselves have to gain a foothold, or „foot in the door‟ approach.

There are other chants that you can use such as:

     May I be well.
     May I be happy.
     May I be free of suffering.
These are not just chanted mindlessly, but each time one says them one tries to create
compassionate thoughts in the mind and a general feeling of this.

Compassionate Letter Writing
The last part of the session was taken up with another way of trying to understand what the
compassion crisis is gathering for us. This is done with writing rather than imagery.

There is now evidence that it can be a great help to learn 'expressive writing'– that is, writing
about difficulties, problems and dilemmas. Compassionate letter writing is a way of doing
this. The idea is to help you refocus your thoughts and feelings on being supportive, helpful
and caring of yourself, rather than being self-critical. Practising this can help you access an
aspect of yourself that will tone down your more negative feelings and thoughts. Through it,
you can activate your compassionate mind making it think things through with you, and it's a
way for you to exercise a certain quality of mind.

Before you begin your letter, try to ensure that you'll have some time when you won't be
disturbed. Find a sheet of paper and a pen or pencil; engage in a soothing breathing rhythm.
Then, either bring your compassionate image to mind and imagine it writing the letter with
you, or put yourself into your compassionate state and imagine yourself as a highly
compassionate person writing a letter. Spend a few moments really thinking about this and
trying to feel in touch with that „kind‟ part of you.

As you write your letter, try to allow yourself to have understanding and acceptance for your
situation, difficulty, feelings or distress. For example, your letter might start with, „I'm sad that
you feel distressed' or 'Your distress is understandable because…‟. If you're writing from the
compassion self, you might start with, „It's sad that I'm feeling distressed today, but this is
understandable because…‟. It's not known whether it's more helpful to write such a letter
from the „I‟, (first person singular), point of view or, by imagining a compassionate image or
friend writing to you, from the „you‟, (second person singular), viewpoint. Just work out
what's best for you.

In the next stage, note the reasons for your distress, realizing that it makes sense. This is
called 'validation of feelings'. Then perhaps you could continue your letter with, „I'd like you
to know that…‟ – that is, your letter might point out that distress comes with a powerful set of
thoughts and feelings, so that how you see things right now may just be the distressed view
on things. Given this, we can try to step to one side of the distress and focus (through
writing) on how best to cope and on what is helpful to us.

Any number of ideas might appeal to you to be included in your letter. Do not feel that you
have to cover them all. In fact, you might want to tackle different things in different letters to
yourself. With all of these ideas, try to avoid telling yourself what you should or should not
think, feel or do. There's no right or wrong way; it's the process of trying to think in a different
way that's important.

Standing back
Once you've acknowledged your distress, it is useful if, while writing your letter, you can
stand back from the distress of your situation for a moment. If you could do that, what would
be helpful for you to focus on and attend to? For example, you might think about how you'll
feel about the situation in a couple of days, weeks or months, or you might recall that
distressing feelings can lift and then remember how you'll feel when this happens. It can
also be helpful to recall in your letter, thus bringing to your attention the times when you've
coped with difficulties before. If you show a tendency to dismiss them, note this but try to
keep your focus on your letter. It will concentrate on your efforts and on what you are able to

Some things to watch out for
There are various things to look out for when writing compassionate letters, in particular, the
validation of your feelings. For example, consider a person dealing with being shunned at
work. An invalidating and unhelpful letter might read something like this:

„Dear Me/self/your name,

       I'm so sorry to hear that you were feeling distressed and upset because your friend
       shunned you at work. This is upsetting, especially given some of the things that have
       happened in the past. However, you know that it's the past operating through the
       present and you do have a tendency to make mountains out of molehills. You should
       try to get hold of your thinking and achieve a better, more balanced perspective. You
       clearly won‟t feel okay if you continue to dwell on your anger. So, you must stop this
       because you know it's bad for you. Be positive and focus on positive things. You
       need to refocus your attention and do some of those exercises that are in this

The first bit is okay but the rest of it is awful. To be told that you tend to 'make mountains out
of molehills' and „you should try to get hold‟ and „you must stop dwelling on the past' and
„you need to think positive and refocus‟ – well, you can see that these statements are all
very uncompassionate. This letter was written as if by a stern, harsh, cold parent who, full of
advice, delivers it in such an unhelpful way that you just feel that you've been „naughty' for
being upset.

Contrast that letter with this one, focused on compassion and kindness:

„Dear Me/self/your name,

       I felt very upset when my friend shunned me, but humans feel upset by such things,
       and given some of the things I've had to contend with in my life, it's understandable
       why feeling shunned is particularly upsetting to me. If I stand back a bit, I guess I can
       see that this person does tend to be like this and can be quite moody, and not just to
       me. I guess they've difficulties of their own; it can't be much fun being moody like
       that. I have other friends who don't treat me this way and I'm just going to remember
       them and the feelings I have when I'm with them.

       I guess I was also upset because life has been a bit of a struggle recently. There
       have been conflicts with my son and I guess I'm worried about him really. Sometimes
       we're just at loggerheads…‟

In your letter, you can let your mind and writing flow with your worries and concerns.
Remember to see if the the emotional tone can be compassionate and as gentle and
understanding as you can.
      Is my motivation genuinely one of caring, and nurturing; is it helping me?
      Am I being sensitive to and observant of my feelings?
      Am I allowing myself to be moved by my distress rather than trying to block it out?
      Am I being mindful and tolerant, recognizing the human condition?
      Am I being empathic, standing back and trying to understand my feelings and the
       way in which I think?
      Am I being non-judgemental?
      Am I keeping my emotional tone as focused on warmth and kindness as I possibly

These are the qualities that you're trying to bring to your letter writing. The compassion skills
comprise the ways you use your attention and imagination, your thinking and reasoning,
your behaviour and feelings.

When we are being compassionate with others it is often the tone of our voice, far more than
what we actually say, that conveys our compassion. So, once you have written your letter
take time to pause before reading it to yourself, and perhaps practice offering compassion to
somebody else before you read it aloud to yourself.

Building a Compassionate Image
This exercise is to help you build up a compassionate image for you to work with and
develop, (you can have more than one if you wish, and they can change over time).
Whatever image comes to mind or you choose to work with, note that it is your creation and
therefore your own personal ideal, what you would really like from feeling cared for and
about. However, in this practice it is important that you try to give your image certain
qualities. These will include:

Wisdom, Strength, Warmth and Non- judgement
In each box below think of these qualities, (wisdom, strength, warmth and non-judgement),
and imagine what they would look, sound or feel like.

We begin by focusing on our breathing, finding our calming rhythm and making a half smile.
Then we can let images emerge in the mind, as best we can – do not too try too hard.If
nothing comes to mind, or the mind wanders, just gently bring it back to the breathing and
practice compassionately accepting.

Here are some questions that might help you build an image: Would you want your
caring/nurturing image to feel/look/seem old or young?, to be male or female (or non-human
looking e.g., an animal, sea or light)? What colours and sounds are associated with the
qualities of wisdom, strength, warmth and non-judgement? Remember, your image brings
compassion to you and for you.

   How would you like your ideal caring, compassionate image to look/appear –
   visual qualities?

   How would you like your ideal caring, compassionate image to sound (e.g. tone
   of voice)?

   What other sensory qualities can you give to it?

   How would you like your ideal caring, compassionate image to relate to you?

How would like to relate to your ideal caring, compassionate image?

                             Group Session 7/8 - 26/02/2009

This was the last session that I was able to be with you, and we had a review of the basic
premises of our therapy. You understand that we focus on trying to develop a
compassionate approach to ourselves. The reason for this is that it‟s very good for our
brains, (recall the three circles), and also because we may not have had a chance to do
that. In fact, we might focus on anxiety and anger more of the time.

Compassionate letter writing
Last week you were asked to write a letter from a compassionate point of view. The way to
do this is to spend a few moments imagining yourself as a compassionate person, or bring
to mind your compassion image and then to write to yourself. You approach this in the spirit
of writing to someone you care about and really want to be helpful, understanding and
supportive to. You‟re writing showing misunderstanding and desire to be helpful. The usual
focus of the letter is something that you are upset or unhappy about, but start off with
something that's not too difficult. Previously we outlined some guidelines for you.

Some of you had tried to do this but found it difficult to read out; some of you found it difficult
to do at all, some only did it in their head, and some focused on a memory. So this will
probably require some practice and you may need to re-familiarize yourself with it again. To
be clear about the point and purpose of the exercise, what you are training yourself to do,
and are committing your self to is recognizing the importance of practice.

Anger and compassion
You all, however, acknowledged that compassion was a lot more complicated than you
thought it would be, and that you found being compassionate to yourself very hard. We had
a long discussion on this and one of the key themes that came out was anger. Indeed, at
times you thought writing about your anger would be more helpful. This may be true and is
worth experimenting with if you can explore your anger compassionately. The idea is to
understand it, accept it, and work with it rather than just act out or ruminate.

Some of you thought that when you become compassionate what actually comes into your
mind is not compassion at all, but anger. This is because compassion reminds you of
relationships that you would like to have had (in the way of kindness and support for others,
especially parents or partners), but did not receive. So, compassion activates memories of
a lot of hurt in the past and of a lot of anger. We also discussed that with this anger comes
a desire to try to make other people see what they did to us. It can therefore be very difficult
to let go of that anger.

We discussed the fact that other people can find it difficult to understand how compassion
can trigger anger, but actually when one thinks about it, it makes perfect sense. So we
came to the conclusion that for some of us, at least, it is the degree of our anger and rage
(and feelings of distrust with others) that is blocking our ability to become compassionate to

We looked at some of the functions for anger:

      Keeps me strong and on my guard.
      Stops me letting others get one over on me.
      Forces others to notice and respect me.
      Keeps me safe.
      Teaches people a lesson.

We then looked at some of the fears of letting go of anger, which are related to the above,
such as becoming weak, or letting others off the hook – „they deserve my anger‟, „I must
keep people out‟.

We also discussed how anger can be automatic, and that takes us back to the diagrams we
explored in our fifth meeting, (the one before last, due to the snow!).

We moved on to talk about ways in which we could move beyond the anger, to transcend it,
to see it as part of one‟s life, but we also acknowledged that it can be like a ball and chain
around us.

We explored the degree to which some of our feelings of anger can cause us to be in
conflict with ourselves. We discussed how we can be compassionate to that anger,
because that anger represents a lot of hurt and upset and feelings of vulnerability. Being
compassionate with our anger rather than fighting with it may help us to work through it.

Over and over again the message is learning to become more aware and observant of our
feelings in a compassionate and understanding way.

Upset can arise when anger gets the better of us and we act it out by shouting, being unkind
or even hitting people. We discussed this further, recalling that it reminded us of some work
we did in the fifth week. We had worked on how to be kind if we lost control of our feelings,
but at the same time increase our determination to exert more control by noticing but not
acting on anger – learning „opposite action‟.

It might be helpful to look back at some of the discussions and diagrams from session 5.

Don’t deserve compassion
In addition to anger, some of us felt a sense of not deserving compassion, that somehow it
was letting oneself off the hook or was a kind of softness, weakness and indulgence.
Sometimes this is related to a desire to get rid of things that have happened, not to have
them as part of oneself, rather to become compassionate about them. We touched on, but
didn‟t go into, the notion of transcendence – simply noting that it is when we learn to leave
things behind we move beyond them, we transcend them.

We also touched on, again, the idea that somehow it is wrong to be compassionate just not
“how one is”. I am reminded here of a comedian called Groucho Marx who said, “I would not
want to be a member of a club that would want me as a member”. There can be a feeling
that there's something not right, or even bad, about being compassionate towards oneself.
The way to work on this is to recognize it as a feeling linking to your fears and gradually chip
away at it, recognizing that it is something to work on.

Fear of compassion
This took us on to the next theme of blocks on compassion, where we also talked about the
fear of compassion. This began with fear about letting oneself be open to other people.
When others have become close to us and then have hurt us in various ways we can
actually „shut up shop‟, we can build a wall around us to protect us. The only problem with
that is that it is also a very lonely place. We are then confronted by the fact that our own
safety behaviours, that are trying to keep us safe and protected, are destining us to a lonely
life. As our own prisoners we can also feel ratherr unhappy, so it's as if we have a choice to
reach out to others but get hurt, or stay safe but be alone.

The first point here is to be compassionate to this diorama to recognize how and why we
have it. learning to first accept it in a compassionate way before trying to change anything.
Sometimes we just need time to heal; sometimes we need to recognize that we can be quite
black-and-white about things; sometimes it's coming to terms with the fact that some people
really are hurtful and that we can learn to spot these and defend ourselves more quickly.

Being compassionate allows us to start to notice the small chinks in the wall, such as
coming to this group and, in certain ways, talking about one's feelings. That is a big step for
some people and shows a lot of courage. Recognizing that inside you have this courage can
be helpful. Even though we have built walls it may not be quite so black and white.
Sometimes allowing ourselves to take small steps and see what happens can be helpful, but
stay compassionate to one's feelings of vulnerability.

Compassionate imagery
Having discussed some of the fears and worries about compassion we then began to
explore compassionate imagery again.

We also discussed that some people prefer compassionate sounds or compassionate
voices, and prefer to focus on those. We discussed that it is the act of focusing and trying to
generate feelings and voices of compassion in our heads that are very helpful.

A couple of people were concerned about the idea of having compassionate voices and
thought that I, Paul, should perhaps need to see a psychiatrist, (very affectionately of
course!). However, it is important that we learn to identify different types of thinking which
we can give a voice to. So, when we are very anxious we can give a voice to our anxious
thoughts, (e.g, even speak them out “right now my body is getting anxious and I'm thinking
about what I have to do. This is worrying because…‟), or when we are very angry we can
give a voice to our angry thoughts, („right now my body is moving into a state of tension and
anger. I'm angry because… My angry thoughts are…‟). Doing this helps us to get that little
bit of space to think and reflect on our feelings. It also helps us to recognize that there are
different paths for us to choose, so it is like having an angry part or an anxious part in us.
For compassion we have to learn to identify, think about, and give a voice to our
compassionate thoughts. Sometimes just saying the words can help, for example:

„I do deserve compassion‟, or „Compassion is healing for me like everybody else‟.

These can be helpful. Even if you didn't feel anything and it seems a bit detached just saying
the words can be helpful. Remember you did not choose this life or the feelings you feel
That is the very beginning of compassion, when you truly recognize that.

We then revisited the idea that we have different aspects of compassion:

Practicing the compassion itself; creating inside of your self means imagining yourself to be
at a very wise, compassionate and gentle person; trying to be curious and feel yourself in
that role just like an actor might. Also, recall yourself when at your best, calmest and most

From that position, imagine being compassionate to others, maybe bringing to mind people
you care about, and really focusing on the desire for them to be happy, for them to be well
and to be free of suffering. Even see their face smiling back at you.

Learn to be open to the kindness of others and allow yourself to feel that. Learn to notice
small acts of kindness.

Linked to this exercise is compassionate imagery, which we use when we deliberately
practice imagining a compassionate image that we can see or hear in our mind. Some
people like to imagine meeting the compassionate image in a safe place, others just imagine
it close to them. These exercises are all ways of helping you focus your attention and
access certain patterns in your brain.

Take every opportunity to bring your compassionate self to help you. You are practiced at
listening to your anxious or angry thoughts and so it's important to learn to to listen to your
compassion thoughts, especially in preparation for when the fears and blocks pop up.
Imagine your compassionate voice acknowledging those fears and blocks with you.

Finally, we completed our session with a short meditation putting ourselves into a
compassion self mode, and then imagining each person in the group and truly trying to
generate feelings of compassion for them, deeply wishing for them to be well be happy and
to be free of suffering.
                        My Thanks
I would like to take this opportunity to thank you all for agreeing to work with us on
compassion focused approaches. Eight weeks is not very long but I am very impressed by
your work and insights and many thoughts you had about how to improve our therapies .
You have taken to the ideas and tried to work with them as best you can, and, as you can
see from the notes of the discussions we've had you have had some full and in-depth
discussions. You have helped us to better understand the blocks to compassion and for all
of us to work harder to find ways to help people with these blocks. You have given us much
feedback and food for thought.

You have been open and forgiving when we‟ve stumbled, and have returned to try again
when you felt overwhelmed. Remember, we did not choose this life or this brain, which can
cause us so much unhappiness, and it‟s not our fault. All we can do is try as best as we can
to gently and compassionately work with ourselves. Remember too that water can carry a
medicine or poison but the water itself is not the medicine or poison. Think of your minds like
the water, they could be full of different things and feelings. Our emotions can blow up and
then calm down. This is why it's helpful to learn to stand back and reflect without judgment
but with desires to improve and become more as we truly wish to be.

So, thank you once again for taking part in this work. I truly wish you every success in your
efforts in the months and years to come.

                         Group Session 8 on 5th March 2009
                         (Written up by Catherine Parker)

This was the first group session held without Paul.

We discussed how there had been a focus in the sessions so far on the blocks to
compassion and that it may be useful to focus on practicing skills in these last 2 sessions.

We discussed how Paul‟s notes summarising the session had been useful and we decided
to continue with this.

Paul has asked whether he could put these session notes on the Compassionate Mind
Foundation website. Following discussion the general feeling was that the group were
happy for this to happen, and identified how these summaries could be useful to others
having Compassionate Mind Therapy. No-one other that the therapists will be identified.
Catherine asked everyone to read through the summaries and let us know whether there
was anything that anyone would like removed before they were put on the website.

We discussed how people had found the compassion work. Some had found this easier to
work with than others, though all were very interested in the approach and wanted to learn
and practice more. Particularly useful aspects have been:

       “It‟s not your fault”.
       Learning to understand how problems have developed, and how our brains are
affected by experiences.
       Helping to explain and extend some aspects of DBT.
       The idea that deep down we „already know‟ some underlying truth about what is
useful to us, or how to understand our problems. This is similar to the DBT idea of „wise
       Illustrating ideas in pictures.

We set an agenda for practice in this session and the next session, which was as follows:

      Compassionate thought balancing.
      Compassionate mind diary.
      Imagery practice: safe place.
      Colour imagery.
      Developing the Ideal compassionate self.
      Compassionate breathing using CD.
      Compassion flowing to others.
      Discussing blocks to compassion, using concrete examples.

Compassionate Mind Diary
We agreed to look at the Compassionate Mind Training Diary and each of us thought about
an example from the previous week, when we had experienced self-critical thoughts
following a particular situation or event. We then discussed helpful and compassionate
alternative thoughts and compassionate behaviour. As a group we focussed on validating
the distress we were in.

Situation: Thinking that my daughter may be pregnant

     Self-critical          Compassionate thoughts               Compassionate
      thoughts                                                     behaviour

 I am a bad mother.        At least she came to me and       Talking to friend.
 I should have done        trusted me.                       Taking a break: having
 more to prevent           I did well: I stayed calm.        a drink but not making
 this.                     It helped to imagine what a       things worse. I was
                           friend would say to me:           aware of what I was
                           remembering the empty             doing.
                           chair exercise.                   Distress        tolerance

Situation: Council workers being in my home and finding this distressing

     Self-critical          Compassionate thoughts               Compassionate
      thoughts                                                     behaviour

 I shouldn‟t be            It‟s not my fault.                Focussing on the here
 feeling like this,        It is understandable to feel      and now, (using
 I‟m a bad person.         like this.                        distress tolerance and
                           Most people would feel this       mindfulness skills).
                           way.                              Spending time tidying
                           I am struggling with this         up as distraction, (but
                           situation.                        compassionately
                           I am working hard at              limiting this time).
                           managing this situation in a      Seeking support from
                           new way.                          others.
                                                             Telephoning therapist.

Situation: Having urgent appointment with psychiatrist

     Self-critical          Compassionate thoughts               Compassionate
      thoughts                                                     behaviour

 I am weak to ask          It is only a temporary thing to   Seeking help.
 for help.                 get me over a hard period.        Accepting help.
 I am insignificant.       It is OK to ask for help when
 I should not have         I am suffering.
 had to have an            Other people have hard
 urgent                    times too and do ask for
 appointment.              help.
                           I still deserve help.
                           It is not my fault.

Situation: Partner first saying we had no future and was leaving me, and then I offered
for her to stay with me. This made me feel anxious

    Self-critical           Compassionate thoughts               Compassionate
     thoughts                                                      behaviour

 I should not have         It is OK and perfectly            Give myself some time.
 done this.                understandable for me to
 She‟s only there          feel anxious.
 because she has           It will only be for 6 months.
 no choice.                I‟m in a real dilemma here.
                           Relationships are tricky.

                         Group Session 9 on 12th March 2009

Compassionate Mind Diary
We agreed that it had been useful to look at the Compassionate Mind Training Diary last
week, so continued with this by discussing the diary sheets people had completed for
homework, as a way of building on our capacity to be compassionate to ourselves.

As a group we identified that although filling in the diaries was difficult, and generating
compassionate thoughts for ourselves was difficult, we were finding it much easier to identify
compassionate thinking for other members of the group. We therefore asked other group
members to help in identifying compassionate thinking we could take on board. On the
other hand, we found that many of us had actually behaved towards ourselves in a
compassionate way.

The examples that we discussed were:

Situation: Measuring myself and finding that my new belt does not fit

     Self-critical            Compassionate thoughts                  Compassionate
      thoughts                                                          behaviour

 I am fat.                   Life has been a struggle             Seeing GP about
 I am unattractive.          recently.                            weight loss.
 I am obese.                 What I would like for myself         Asking for referral to
 I am unlovable.             is to be less miserable.             the weight nurse –
                             Over-eating can be a way of          seeking support.
                             caring for my self at this
                             I want to deal with this and
                             ask for help.

Situation: Requesting to stay with GP practice, but GPs saying „No‟.

     Self-critical            Compassionate thoughts                  Compassionate
      thoughts                                                          behaviour

 They don‟t give a           I had a go & asked for what I        Asking for support from
 fuck about me.              wanted.                              others.
 I shouldn‟t have            It‟s not my fault.                   Taking some time out
 believed they               Just because they made this          for a „self-regroup‟.
 cared.                      decision now, it does not
 I‟m a crap & bad            mean that they haven‟t cared
 person: it‟s no             about me in the past.
 wonder they did not         Maybe this is a new start.
 want me there.

     Situation: Being scared to talk to David, if I need to, next week at the research

          Self-critical            Compassionate thoughts                Compassionate
           thoughts                                                        behaviour

      I am ashamed of             There are good reasons I            Acknowledging how I
      myself.                     feel like this.                     feel.
      I should be able to         Other people have the same          Raising this issue so
      talk to men about           experiences as me.                  that „male X‟
      difficult things.           There‟s no shame in being           understands it, which
                                  scared.                             should make it easier
                                  This is a universal response        on the day.
                                  to stress.

     Situation: Getting a text from ex-partner asking to use my computer: I said “OK”

Self-critical thoughts           Compassionate thoughts                   Compassionate
I‟m too soft.                 It‟s a difficult situation & I didn‟t   Get rid of stress with a
I should put my foot             want to make things worse.             punch bag!
  down.                       It‟s understandable that we all         Take time out: have a
I am paranoid & over-            want others to like us.                smoke?
  sensitive.                  This is a sign that I am a kind &       Try to relax with a bath,
I‟m an arsehole.                 and decent human being.                (self-soothing).
                              Saying “No” is really hard.

     To finish today we practiced a safe-place imagery exercise using the CD that was provided.
      We discussed difficulties practicing this imagery, e.g. feeling a bit self-conscious in the
     room with others and that it was hard to concentrate on developing an image. CD‟s have
     been distributed to all group members for practice at home.

     We discussed now being half-way through the DBT programme. This brought up a lot of
     painful feelings. It was understandable that this made members of the group think ahead to
     the ending of it. Some of the group were feeling abandoned, and we identified that this was
     understandable, in terms of how much attending the group means to us, and also in term of
     the impact of other experiences of being abandoned. Group members were anxious about
     what happens after the group so we talked about the Advanced Group, and the opportunity
     to set up a self-help group through NEDCASH.

     Finally, we congratulated ourselves at making it to the half-way point, and remembered how
     past group members had told us how the first round of modules was the hardest.

  Follow-up Research Interviews
   – Qualitative Interview Post
            CFT Course
At the end of the interviews participants were asked:

1.     How they found the CFT module?
2.     How they felt CFT and DBT worked together?
3.     Whether they thought CFT added anything to DBT or whether there were any

Participant 1 Spoke of CFT being understandable but often quite difficult to put into
practice. They found the idea that it is ok to feel bad about feeling bad very appealing – this
enabled more acceptance and was definitely helpful. The participant believes that the DBT
module was well placed beforehand. She believes you needed the mindfulness to allow
understanding and willingness in order to try compassion: “…it gives you the basics, the
background”. She found Prof. Gilbert easy to engage with, as he conveyed information and
techniques very well, and especially found the handout/notes very useful.

Participant 4 Found CFT difficult but very interesting and is definitely willing to keep trying
the techniques learnt. He felt that CFT & DBT worked well together; often CFT made sense
of things covered in DBT. The participant found some aspects of DBT quite hard but CFT
helped things “…fall into place”. articularly enjoyed the „It‟s not your fault‟ aspect and has
taken on board the fact that it‟s ok to have a bad day. The participant is finding new ways to
vent aggression and believes they are using alternative coping strategies well. also found
that self-soothing can be very difficult. Was very appreciative of Prof. Gilbert and believed
his delivery enhanced understanding.

Participant 5 Believed that CFT was the best part of the course “…brilliant”, and found Prof.
Gilbert‟s groups very interesting, “... The participant particularly enjoyed and took on board
the “It‟s not your fault”. Believes that CFT and DBT work very well together, in fact
sometimes CFT explained aspects better than DBT. Believes they will take more away from
the CFT module and that they don‟t believe DBT alone would be as successful. However,
the participant did find some aspects of CFT difficult, e.g. imagery, safe place.
Participant 7 Found CFT difficult to cope with in the beginning as it brought back lots of
memories. Towards the end of the module though, the participant believed it had been
beneficial, “…makes you think in a different way”, but admitted to struggling with
compassion to self. Felt that CFT and DBT complemented each other well; “It teaches you
how to be nice to yourself”. The participant felt that they did struggle with certain aspects
but was very willing to keep practicing.