The New “Old Wisdom”: Treating Shame and Self-Criticism with Compassion Focused Therapy (CFT)

Chances are if you’ve been in therapy before, your therapist may have worked with you on a technique called “thought reframing.” It’s a common practice in modern psychotherapy, rooted in the Cognitive Behavioral Therapy tradition (CBT). A therapist trained in CBT will guide clients to identify, challenge, and reframe unhelpful thinking patterns and beliefs that lead to BIG, unwanted emotions (e.g. if you go to a party and think ‘no one here likes me,’ chances are you will not be brimming with confidence and, hence, won’t party at the party). A therapist trained in CBT would prompt a client who thinks “nobody likes me” to consider alternative ways of thinking about the situation—e.g. ”I was invited to the party by ____, and I had a good time talking with ____ the last time I saw her, so I’ll probably enjoy myself this time as well.” Likewise, even if you’ve never set foot in a therapist’s office before, there’s a good chance that family and friends have intuitively utilized aspects of CBT to support you…perhaps by encouraging you to consider alternate ways of looking (i.e. thinking) about a difficult situation, with the intention being to “cheer you up.”

CBT is a widely accepted treatment for one simple reason—it works. But…in the spirit of CBT, which cautions against seeing the world in absolutes (i.e. always, never, all the time, etc), I would clarify that CBT works…some of the time…

When I was in school studying to be a therapist and during the early years of my practice, I learned and often incorporated elements of CBT into my work with clients. The treatment was often effective, but I noticed that amongst a certain segment of clients, it proved strikingly less so. Clients that possessed high levels of shame and self-criticism tended to intellectually get the concept of thought reframing, but their insights didn’t produce significant changes in how they were feeling. For example, a client might acknowledge being equally, if not more, qualified than other applicants when considering whether to apply for a job, but would remain mired in doubt and anxiety and still revert back to the old familiar pattern of self-criticism—so much so that maybe they wouldn’t even apply for the job they expressed an interest in in the first place.

To my mind, shame is that deeply felt sense of not measuring up—of not being ____ enough (for perhaps the most vivid description of shame I’ve ever heard, take the time to watch this Ted Talk by noted author and social theorist Brené Brown). Shame is an intense, multi-layered emotional experience (think embarrassment times a thousand) that we all feel from time to time, but some of us, particularly those with early childhood experiences that contain abuse and neglect, experience high, problematic levels of it. The rumination that often accompanies shame tends to be filled with self-criticism and, in turn, contributes to frequent reoccurrences of depression and other mental health issues. Shame…or the anticipation of feeling it…is like a vampire, draining us as we consciously (and unconsciously) avoid experiences that might otherwise bring vitality and purpose to our lives.

I was elated to come across a wealth of scientific research that backed up my initial observation regarding CBT “thought reframing” techniques not being particularly effective for individuals with high levels of shame and self-criticism. As it turns out, British psychologist Paul Gilbert has devoted much of his life’s work to this very topic, and he has developed Compassion Focused Therapy (CFT), in part, in response to that gap in care for individuals who struggle with shame and self-criticism (for a review of just what compassion is, see my previous post). Although CFT incorporates elements of CBT, it differs in that CBT targets emotional suffering through reframing thinking, while CFT seeks to cultivate emotion-focused experiences that elicit the innate, self-soothing capacities we all possess. In other words, as Dr. Gilbert points out, “In order for us to be reassured by a thought (say) ‘I am lovable’ this thought needs to link with the emotional experience of ‘being lovable’” (citation here)

If you tend to be someone who struggles with shame and/or self-criticism, the felt sense of “being lovable” may be unfamiliar, even scary territory. In my practice, I utilize Gilbert’s CFT techniques in conjunction with other treatment modalities that also emphasize compassion (the work of Christopher Germer and Kristin Neff in particular…more on their good work here and here). All of these treatments blend centuries-old meditative practices (the “old wisdom” I mentioned in the title) with evolutionary psychology and modern neuroscience. My hope for all my clients who struggle with shame-related issues (frankly, I don’t know anyone, myself included, who doesn’t) is to reach a point where one recognizes they are lovable and can offer compassion for themselves and others. Unlike self-esteem, which is contingent on us doing “stuff” (i.e. determining our worth through our accomplishments), self-compassion emphasizes that we have inherent worth…just because we exist. It’s our birthright.

In the weeks to come, I’ll be sharing more about the cultivating a “compassionate mind” on this blog. If you are interested in learning more about the healing potential of compassion, and cultivating a deeper sense of it for yourself and others, please call me at (706) 425-8900 or email me at [email protected].