Putting Real Muscle into Self-Compassion Practice

November 16, 2015

I teach self-compassion in my own clinical practice and in workshops around the world. I practice self-compassion many times a day. (Life simply gives us those opportunities to practice all the time.) I’ve recommended many excellent practices in these posts and recommended many other teachers of these practices in these posts [see Resources below.]

Now comes along one of the best resources ever for applying self-compassion to “working with stubborn self-criticism and self-sabotage,” Tim Desmond’s new book [released today] Self-Compassion in Psychotherapy: Mindfulness-Based Practices for Healing and Transformation.

Desmond’s book has real muscle to it. First a gentle introduction to what self-compassion is – one of the strongest predictors of mental health and wellness, then to what mindfulness is, then elegant summaries of the current research from affective and cognitive neuroscience and behavioral science, from self-compassion, positive psychology and therapeutic outcome research, that validates the power of self-compassion to shift brain functioning and behavior. Self-compassion is a powerful tool to help people more easily navigate difficult emotions, transform negative core beliefs, manage states of depression, anxiety and shame, and motivate one’s self with kindness rather than criticism. With the caveat that while self-compassion is a skill that can be learned and strengthen through dedicated practice, encoding the learning in the long-term procedural memory of the brain takes practice. Practice, practice over time.

Then some straightforward perspectives to any successful therapy and straightforward steps to incorporate self-compassion practice into the clinician’s own life and into clinical work. With an emphasis that self-compassion is offered and taught moment to moment as the client’s experience in the moment warrants it. It’s not a formulaic one-size-fits-all tool to be used without careful thought and intention. It’s a powerful tool that creates real change and transformation and is to be respected as such.

Self-Compassion in Psychotherapy: Mindfulness-Based Practices for Healing and Transformation is written for clinicians, but it is so well-written and the insights and practices so accessible that I can heartily recommend it to anyone searching for ways to overcome roadblocks to healing from stress and trauma. I can almost recommend Chapter 8 – Working with Stubborn Self-Criticism and Self-Sabotage – as a stand-alone chapter, Desmond is so clear and right on. (see Reflections below)

Desmond is a skilled psychotherapist with years of study and meditation practice with Thich Nhat Hanh. He offers Foundations of Self-Compassion Training through his Institute for Applied Compassion. In the book, he offers many inspiring examples from his own clinical work and trainings. In other words, he’s the real deal.

May your practice of what neuroscientists call the Care Circuit help you meet the disappointments, difficulties, and even disasters of your life with more eae, more success, and more resilience.

REFLECTIONS

Desmond begins with findings that “self-compassion develops a deep source of calming, soothing and positive regard within ourselves, which makes us more resilient and better able to regulate our emotions, and that it’s a potent antidote to the self-criticism many of us experience on a daily basis – the tendency to judge and criticize ourselves for any way that we fail to measure up to our idealized standards. This self-criticism is usually not benign; in fact, it’s one of the biggest predictors of serious mental health problems.”

Early on Desmond distinguishes between self-compassion and self-esteem. “Low self-esteem and believing that you are a bad person certainly is detrimental to mental health and well-being. But the seeking of high self-esteem is tied to comparing ourselves with others, with the need to believe that we are better than other people. We can’t be better than everyone at everything, but being told that we are average can feel like being told we are less than, even worthless. The focus on high self-esteem can lead people to be defensive and competitive. It can lead to a tendency to blame or criticize others and to fragility around receiving negative feedback.”

Self-compassion re-focuses our attention and efforts from evaluating ourselves – and then others – to relating to ourselves – and others – in a kind, non-judgmental, accepting way.

Desmond then describes three perspectives key to both compassion and self-compassion:

“1) We must acknowledge that some sort of pain, upset, misery, suffering is happening. If we don’t pay attention to our own inner experience or to take the time to understand someone else’s, we could blithely overlook some genuine causes of genuine dysfunction.

2) (This may be a stretch for some.) We grant ourselves and others that we are doing the best we can at any given moment. People would rather be happy than miserable; people would rather be skillful than unskillful. If we could do it any better, we would. This perspective moves our consideration of ourselves or others from being ‘bad” or evil to being confused, misguided, inept, but there is room for learning and making better, more skillful choices. Normalizing our behavior or someone else’s as so genuine a part of being human allows compassion to naturally arise; compassion allows better choices to naturally arise, too.

3) We recognize how similar our situation (or another’s) and our response to our situation (or others) is to so many other human beings on the planet. Circumstances may differ greatly, but our vulnerability to being unskillful and suffering does not. And our deep human yearning to be happy, safe, and loved, does not.

These three elements work together to allow us to care deeply about ourselves (and others) and to take wise, caring, skillful action.

Desmond then addresses quite eloquently some of the mistaken fears about “indulging” in self-compassion:

“* Self-indulgence: We could believe being kind to ourselves means not trying to push ourselves to do anything. We can do whatever we want, or nothing at all, and kindness means just accepting that and celebrating it. This is actually not compassion because it’s based on ignoring the parts of ourselves that really want to succeed and contribute to the lives of others.

* Self-pity: We could believe that we are in pain and need to stop trying to pretend we’re not. Our suffering is important and we need to let ourselves cry. Saying this could be completely healthy in a certain context, but if we never connect with the kind of wishing ourselves well that actually brings some relief to our suffering, we are missing the most important part of self-compassion.

* Passivity: Compassion naturally leads to action. If we see that our baby is hungry, we don’t just empathize with her hunger. We feed her. Although self-compassion can be a powerful force with no explicit action accompanying it, it’s also important to remember that real compassion sometimes dictates that we make a concrete change to some aspect of our lives.

* Egotism: Viewing oneself as better than another person or being overly involved with one’s own needs at the expense of another’s is not practicing self-compassion. This kind of egotism comes from conflating self-compassion with self-esteem. Self-compassion is not concerned with comparing oneself to others; it values everyone’s happiness.”

Desmond references published studies of Richard Davidson at the Center for Investigating Healthy Minds that show compassion practice creates a “happier brain” in both experienced meditators and first-time meditators, i.e., more neural activity in the left pre-frontal cortex (the “approach” rather than “withdrawal” side of the brain), and more neural connectivity between the left pre-frontal cortex and the amygdala (better regulation of the fear center of the brain.)

And published studies of the affective neuroscientist Jaak Panksepp who demonstrated that the practice of self-compassion activates the Care Circuit (hypothalamus to ventral tegmental area (VTA)) that generates oxytocin and endogenous opioids that have been shown to sooth negative emotions and reduce distress, and create feelings of calm and contentment.

And the published studies of Joseph LeDoux, a neuroscientist who specializes in memory and reconsolidation of negative memories. If a negative memory is recalled and then paired with a positive experience such as self-compassion, the juxtaposition will rewire the negative memory at the molecular level. A powerful application of neuroscience to the field of mental health.

And the published research of Nobel Prize winner psychologist Daniel Kahneman, the importance of practice to move the storage of our learning from the deliberate conscious processing of our higher brain to the more automatic procedural memory of our lower brain where we don’t have to remember the practice, it’s already there.

And the psychotherapy outcome research of Bruce Wampold which shows that unconditional positive regard, empathy, understanding and authenticity of the therapist makes the most difference in successful therapeutic outcome. In other words, the therapist’s ability to create a compassionate alliance with the client.

The self-compassion research of Kristin Neff and Chris Germer, that self-compassion practice decreases symptoms of depression, anxiety and stress while increasing life satisfaction, and the research of Juliana Breines and Serena Chen that shows self-compassion increases motivation to overcome challenges and achieve our goals.

And published studies from positive psychology research that shows that the quality of our relationship (depth of intimacy and breadth of social support) and an ability to frame life’s challenges in positive ways are two of the biggest predictors of happiness. Self-compassion practices do have a positive outcome on our relationships and do create the state of mind that helps us frame life’s challenges in positive ways. Resilience is a direct outcome of self-compassion practice.

For clinicians (and we can all resonate with this), Desmond reviews how important the therapeutic alliance is to effective therapeutic outcome, and that the alliance – warmth, empathy, positive regard, setting shared goals, and introducing the tools of mindfulness and self-compassion – can be effective even in the first session.

Desmond then outlines 8 principles for integrating self-compassion into therapeutic work:

“1. Connect with the client’s goals – what does the client want to change or achieve?

2. Maintain the motivation boundary – helping the client change because they want to change and want help in doing so.

3. Improvise and experiment -interventions are tailored to the needs and styles of each individual client, even as those needs emerge moment to moment in the session. The therapist measures the effectiveness of the interventions by whether the experiences reduce suffering and increase happiness.

4. Be authentic. Not being an “expert” allows therapists to be curious and ask questions.

5. Put yourself in the client’s shoes, all the nuances and details of their experience, and from your own capacity to know your feelings and reactions to any given situation, you can empathize with the client’s experience.

6. Use your own practice as a guide. Deepening one’s own practices of mindfulness and self-compassion develops confidence in creatively adapting these techniques to different situations.

7. Have the client experience a practice before you explain it or even name it. When the client experience the benefits of mindfulness and self-compassion practice directly for themselves, they are much more open and less resistant to the practices than if they hear the words “mindfulness” and “self-compassion” which they may already have preconceptions about.

8. Listen to the client’s reflections while they are practicing a mindfulness or self-compassion intervention. A Dialogue-Based Mindfulness allows you to tailor the experience to address the individual concerns or obstacles the client might be experiencing. If the clients feels successful in doing the mindfulness or self-compassion they are far more likely to continue doing the practice on their own.

Then directing self-compassion to where it is needed most:

– To the experience my self is having in the present or recent moment and to myself for having that experience

– To earlier layers of self that experience suffering in the past

– To various parts of myself that may be un-integrated or even in conflict vis-à-vis a particular situation or other person

– To a negative core belief (often invisible and sometimes stuck) that is shaping my thoughts an feelings now

– To the inner critic or any part that would self-sabotage my happiness and well-being now.

In Chapter 8, Desmond directly addresses working with stubborn self-criticism and self-sabotage. He presents his theory of modular constructivism in a way that is easy to comprehend. That the mind constructs stories to make sense of our experience and that when the mind doesn’t have all the information it needs it fills in the information to make sense of experience as best as it can.

And that different parts of the brain may make sense of the same experience in different ways. I.e., as an adult a person can understand the impact of a parent’s abusive treatment when younger and the negative beliefs that abuse would have generated, and can even understand why the parent may have acted the way they did, and can hold themselves with an awareness of the beliefs that developed way back then but don’t have to be true now, never were true even back then.

But a different part, a younger part, would have constructed a story back then to make sense of the experience back then. “My parents yell at me and are mean to me because I’m a bad kid.” That earlier part may have never updated the story it constructed back then and when the younger and adult parts don’t communicate with each other, the adult can “know better” and the younger part still feels rejected and bad. The therapist directs the client’s self-compassion to the younger part that still feels bad and uses memory reconsolidation to do the healing.

“Reconsolidation: If you want to transform a memory, you activate it and then expose it to new information. If you want to heal a distressing memory, you activate it and then send yourself compassion. If you want to heal the younger part, you activate it – evoke the thoughts and feelings and body sensations associated with this younger part and guide it through a self-compassion practice. An example of confirming that the younger part has in fact been activated would be to learn if that part is feeling intense sadness and fear in the form of tension and heaviness in his whole body, and if the client reports it would feel true to say the sentence “I know that I’m bad.” Visualization is the most commonly used technique to accomplish the conversation between the adult part and the younger part. The client could visualize himself as a young child and have a conversation with that child. He could also image being that young child and talk with the adult from that state.”

“If a therapist wants to help a client find compassion for his younger self, the therapist begins by reflecting on what would help him to feel compassion for a child like that. He might take a moment and imagine a 6-year-old child who comes from an emotionally volatile home. In imagination, the child says, “I’m a bad kid and that’s why my mom and dad always yell at me. It’s my fault.” When the image is really clear, the therapist notices how he feels in his body – sad, angry, is there a strong urge to comfort and support that child. He deepens into the feeling, letting it get really strong, and then reflects on how he could express his compassion to that child. Does he feel like giving him a hug, offering to protect him, or tell him that he’s not a bad kid? The therapist then imagines interacting with this sad little boy. When the therapist imagines expressing compassion in different ways, he notices how the child responds.

The therapist uses the three key perspectives for compassion: to make sure he recognizes how this child is suffering, which may be pretty obvious. In understanding that the child wants to be happy and is trying to create that, however unskillfully, the therapist can understand that when the child blames himself, it’s not his intention to make things worse. He blames himself because he has no other way to make sense out of why his parents would be so mean. And then putting himself in the shoes of that child, the therapist sees how he might think the same way if he were in a situation like that.

When the therapist gets in touch with compassion for the inner child of the clients, he can more clearly guide the client in expressing self-compassion for himself.

The client might imagine picking up the child, holding him, telling him how much he is loved. Sometimes that child part won’t be able to accept love until he stops blaming himself for the abuse. In situations like this, he will need to create a different story to make sense out of what happened. It’s almost impossible to let go of an old story until we have a new one to replace it. And old story always has a purpose, which is to explain why something happened. The new story will need to answer that questions in a way that’s at least as compelling as the old one.

The new alternative story needs to makes sense to the age of the inner child. “Your parents are not mean to you because you are bad. They are like that because other people have been mean to them, and they never learned how to be kind.” Parts that were formed in childhood will continue to operate at the level of cognitive development from when they were formed.”

Desmond ends this description of working with stubborn self-criticism and self-sabotage with:

“Most of us view self-criticism and self-sabotage as enemies that should be challenged and defeated, or at least ignored. In this case, we can see how deeper understanding can transform the inner critic from an enemy into a child in need of love and compassion.”

Throughout the book, Desmond offers transcripts of clinical sessions and trainings along with very readable explanations of why he’s doing what he’s doing so you can see how the process unfolds moment by moment. (See Stories to Learn From below) For instance, in illustrating using mindfulness of the body to strengthen affect tolerance and affect regulation, Desmond presents three different transcripts to show how he helps clients experiment with mindfulness to deal with difficult emotions, to calm performance anxiety, and to address social anxiety and addiction. Because Desmond trains clinicians in his Foundations of Self-Compassion Training, his offerings in this book are very, very clear and very, very useful.

POETRY AND QUOTES TO INSPIRE

[all quotes from Self-Compassion in Psychotherapy: Mindfulness-Based Practices for Healing and Transformation unless otherwise noted.]

Compassion is the essence of mindfulness and the foundation of fearlessness.

* * * * *

Compassion and self-compassion lie at the very heart of well-being.
– Richard J. Davidson, Center for Investigating Healthy Minds, University of Wisconsin-Madison

* * * * *

Mindfulness leads to insight and that insight leads to compassion. When we apply mindfulness to our suffering, our mind calms and we eventually come to understand its causes. This understanding gives rise to compassion.

* * * * *

Compassion is the radicalism of our time.
– Tenzin Gyatso, 14th Dalai Lama

* * * * *

This kind of compulsive concern with “I, me, and mine” isn’t the same as loving ourselves….Loving ourselves points us to capacities of resilience, compassion, and understanding within that are simply part of being alive.
– Sharon Salzberg, The Force of Kindness

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The individual is capable of both great compassion and great indifference. He has it within his means to nourish the former and outgrow the latter.
– Norman Cousins

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Although humans inherit a biological bias that permits them to feel anger, jealousy, selfishness and envy, and to be rude, aggressive or violent, they inherit an even stronger biological bias for kindness, compassion, cooperation, love and nurture -especially toward those in need. This inbuilt ethical sense is a biological feature of our species.
– Jerome Kagan

* * * * *

When you begin to touch your heart or let your heart be touched, you being to discover that it’s bottomless, that it doesn’t have any resolution, that this heart is huge, vast, and limitless. You begin to discover how much warmth and gentleness is there, as well as how much space.
– Pema Chodron, Start Where You Are

* * * * *

We have learned that training as little as 30 minutes a day for two weeks is sufficient, in complete novices, to change the brain and induce more prosocial and altruistic behavior. While compassion and empathy each activate some of the same circuits in the brain, there are important differences. Compassion activates circuits that have been associated with positive emotion and reward, while empathy does not necessarily include the activation of those circuits. Moreover, compassion leads to prosocial behavior more systematically than empathy.
– Richard J. Davidson, Center for Investigating Healthy Minds, University of Wisconsin-Madison

* * * * *

It doesn’t matter if the source of compassion is oneself or another person. What matters is that somehow compassion makes direct contact with our pain.

* * * * *

When our communication supports compassionate giving and receiving, happiness replaces violence and grieving.
– Marshall Rosenberg

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Being willing to improvise and experiment is absolutely essential for cultivating mindfulness. Rather than rigidly trying to follow one specific set of instructions, we can familiarize ourselves with many different ways of meditating and creatively experimenting to find something that works for us in a particular moment. If you can embrace the understanding that mindfulness practice is a creative and constantly changing process, the benefits are limitless.

* * * * *

If a therapist is too focused on change, he or she will have a harder time modeling acceptance. We have to be willing to accept whatever comes up for our clients without any resistance in order to help them develop that ability. This is why I suggest that therapists think about mindfulness of the body in terms of developing affect tolerance. If we focus on training ourselves to be present with painful feelings in a way that isn’t reactive, we can eventually develop the ability to observe our strong emotions with warmth and compassion.

* * * * *

What matters most is that the part of myself that is suffering is embraced with open acceptance and love. If we can hold our suffering like a mother lovingly holds her crying baby, that kind of openness and warmth can be enough to create real transformation and healing.

However, sometimes being held is not enough. If a baby is hungry, wet, or in pain, true compassion requires that the mother address the source of the problem. She holds the baby with compassion and this helps him feel somewhat calmer, but if the baby is still crying, the mother begins to inquire into the causes of his suffering. Once she understands the causes, it is only natural for her to act to remedy them. You wouldn’t expect a mother to notice her baby has a wet diaper and then just empathize without changing it. That would be weird. When she understands what is causing the baby’s suffering the mother takes action. The practice of self-compassion is the same.]

* * * * *

Is it truly possible to heal the past? We have all suffered, and we all carry pain from our past into our present relationships and decisions. Many of our clients are so impacted by past events that living in the present and appreciating what is good or beautiful in this moment can seem impossible. So we might ask, to what extent can this situation be changed? We certainly can’t erase the past or change things that objectively happened, so are we doomed to have our lives dictated by them?

Buddhism and neuroscience are both very clear in saying that it’s possible to free ourselves from past suffering so it no longer limits or obstructs our ability to be happy in the present. This is possible because, as Thich Nhat Hanh often says, the past is contained in the present. If we imagine a 100-year-old tree, we can see that the 50-year-old tree is contained within it. You could count the rings and point to the exact place where the 50-year-old tree is present in the 100p=-year-old tree. We can see that the 20-year-old tree and the 10-year-old tree are all concretely present in the 100pyear-old tree.

It is the same with us. Every experience we have is recorded in the shapes of connections in the neural networks in our brains. If a past experience is still impacting us in any way, that is because the connections that were made during that experience are still concretely present in our brains. Someday our brain imaging technology could be accurate enough that we could point to the exact place that our brain stores the experience of our 5-year-old self being humiliated by an older sibling, or our 10-year-old self being bitten by a neighborhood dog.

We cannot change what happened in the past, but we can change how it impacts us. The metaphor of the rings in a tree shows us how the past can be accessed in the present because its mark remains within us. Through the process of reconsolidation, we know that it’s possible to active the neural network where a past experience or core belief is stored and transform it using self-compassion.

* * * * *

Self-compassion is a practice of deep nonviolence. We do not turn our own thoughts and feelings into enemies that must be destroyed. Instead, we use compassion and love to transform those enemies into friends. We listen, empathize, dialogue, and reconcile.

This deep motivation to cultivate our own well-being is essential for the development of self-compassion. We begin by truly giving ourselves permission to be happy. We have to see that it is possible to prioritize our own well-being as a service to others, rather than as a way of neglecting the. Our happiness is not separate from the happiness of other people. In fact, our happiness is the happiness of other people. The more you nourish yourself with serenity and self-love, the more those energies are available to support everyone and everything to with you are connected. Try to see that the greatest gift you can give the world is your own peacefulness and happiness.

* * * * *

In every moment of life, there are infinite reasons to be happy and infinite reasons to suffer. What matters is where we focus our attention. If you were to take a few minutes and make a list of everything you could be upset about right now, it would be easy to create a long list. On the other hand, if you were to spend the same amount of time making a list of everything you could be happy about – the blue sky, the laughter of children, your loved ones – that would be a pretty long list, too. Paying attention to the conditions for happiness that are already present can lead to the experience of profound gratitude.

* * * * *

Imagine approaching every moment of life in this way. You wake up filled with gratitude and wonder at the miracle of being alive. As you sit up in bed, you are deeply aware of all the sensations in your body. You enjoy the feeling of the soft sheets and blankets, and you notice the pleasant temperature on your skin. You pause and take 10 or 12 conscious breaths, completely unhurried and smile broadly that you have clear air and functioning lungs. As you shower, you fully enjoy the experience of showering. As you eat breakfast, you bring your complete concentrated presence to every bit of food and savor the taste and texture. You feel overwhelmed with gratitude for having enough food to eat. Every action and every moment of life becomes a miracle.

STORIES TO LEARN FROM

[all stories excerpted from Self-Compassion in Psychotherapy: Mindfulness-Based Practices for Healing and Transformation.]

Janet, a professor of economics, came to see me about some anxiety she was experiencing during teaching. She was the kind of person who was great at math and research, but not as good at interacting with people. She was an intense perfectionist and very driven. Her success in academia had been the result of her excellent research, but she had always had difficulty teaching and working collaboratively.

The problem she described as her reason for coming into therapy was that she had begun to dread giving lectures. Just thinking about an upcoming lecture would make her feel queasy. I asked if she knew what about teaching made her feel so uncomfortable, and she said, I’m just not good enough at it. I know the concepts, but sometimes I can’t articulate them well enough and I see the students look confused and I know it’s my fault. I hate it.”

We talked more about Janet’s experience of teaching and got a really clear sense of the role that self-criticism was playing in her problem. Any time Janet didn’t articulate a concept as well as she would have liked, she would get extremely frustrated with herself and start thinking. “I’m such an idiot! Why am I even allowed to reach? They should fire me because I don’t belong here.” It was easy to see why giving herself no margin of error as a teacher, which wasn’t a natural area of strength for her, was creating a lot of problems.

Over the next few weeks, I learned that this powerful self-criticism had been an important motivating tool for Janet since at least junior high school. She believed that her relentless work ethic and the success that had come from it were the direct result of holding herself to very high standards. At the same time, she could see how this tool had actually begun to interfere with her ability to achieve. She referred to her inner critic as her “slave driver” and said, “I used to beat myself up and it would get me to work harder. Now, you’ve helped me see how, in this case, I’m so scared of the slave driver that I’m freezing up.” Although this new insight was valuable, Janet expressed being scared that if she lost her slave driver, she wouldn’t be able to motivate herself enough to succeed at such a demanding job.

I suggested that we try an exercise in which she would imagine giving a lecture and see what it would be like for her to practice self-compassion in a moment like that. I asked Janet o recall a recent lecture in which she felt that she wasn’t living up to her expectations and to picture herself back there. When she really felt like she was there, I asked what thoughts we coming up, and she reported a lot of the same self-criticism: “I’m not saying this right. What’s wrong with me?”

I asked Janet to try saying to herself, ‘I really want to do a good job and I’m having a hard time. This isn’t easy for me.” I explained that she isn’t making an excuse, but just stating a fact. She was quiet for about a minute and then said,’ Yeah. That’s really what’s going on. I’m trying and it’s not easy for me. It felt a little scary at first, when you first had me say it. But then I felt a big relief. I’m not making an excuse. It’s just true. Just naming it like that makes me feel a little better.” At this point, I had helped her to name what was going on without judging it. This very initial experience of mindfulness is an important step toward self-compassion.

I told Janet that I was glad she was feeling better, and asked if she wanted to continue with the exercise. She did, and I asked her to picture herself back in that same scene, giving a lecture and not feeling as eloquent as she would like. When she felt like she was there, I asked her to try saying, “I’m trying to do something, and I really want to do it well. It’s hard for me, and whatever feelings come up for me are OK. It’s OK for me to really want something and not be able to do it.” Her eyes were closed and she was quiet for a while before she said, “That felt really powerful. Just giving myself the permission to want something and not to be able to do it. It’s a huge relief. I think this is going to help me.” This was another important step toward self-compassion. Janet had a deeper experience of mindfulness in which she was able to accept her feelings in a difficult moment.

Janet and I spent a few more weeks practicing this kind of attitude until she was ready to take it a step further. At that point, I asked her to picture herself at a time when she felt insecure giving a lecture. When she felt like she was really there, I asked that thoughts were coming up now, and was glad to learn that she wasn’t having the same kind of harsh self-criticism that she had reported a few weeks earlier. She said, “I know I’m struggling here, but it’s OK. People struggle and it’s hard.” She looked at me and commented, “I still feel insecure but it’s much better than it used to be.” Now, I asked her to try saying to herself, “I know you are struggling and I am here for you. I want to support you any way I can.” She look a little confused. “Do you want me to say that to myself? Like I’m talking to myself? I told her to try those words and see how they felt. Janet closed her eyes and said out loud, “Janet, I know you are struggling and I am here for you. I want to support you any way I can.” She was quiet for moment and then said it again, this time adding “You are doing your best, and I see that.” She started crying softly, and after another minute or two of silence said, “That feels really good. I don’t think I’ve ever been so nice to myself. It makes me cry. And it makes me really feel like am OK being who I am. Thank you so much for this.”

Although it took Janet a while to internalize this attitude and develop it into a habit, her relationship to teaching began to improve right away. Janet had been afraid that if she stopped criticizing herself, she would lose her motivation to achieve. However, as she developed more compassion toward herself, especially toward her insecurities, she found that she was able to be more productive than ever. She said, “It’s like instead of being my own slave driver, I’ve become my own cheerleader, and it feels a lot healthier.”

* * * * *

Patrick wanted to let go of shame and self-criticism, which I knew had originated in his traumatic childhood. If the source of someone’s suffering is in the past, then we want to send love and compassion to the past. Therefore, my goal was to help Patrick learn how to direct compassion to himself as a child.

PATRICK: I’m doing so much better, but if I’m honest, I still don’t really like myself. It’s like I feel embarrassed all the time or like people are going to realize I’m a phony.

THERAPIST: OK. (pause) Let me see if I’m understanding. Even though your mood and energy have been a lot better, there is still this sense of not liking yourself or feeling embarrassed. Is that right?

PATRICK: Yeah. Is that something we can work on? Can that change?

THERAPIST: Absolutely. I’ve worked with a lot of people who have been able to change those kinds of feelings. I can’t say how long it will take, but we can definitely start today. We can look at some different practices and see ifany of them seem like they could help you.

PATRICK: Great. Let’s do that.

THERAPIST: Sure. Before we start, what is the level of distress you are feeling right now, where 0 is feeling fine and 10 is the worst you’ve ever felt?

PATRICK: I guess I’m at like a 4 or 5.

THERAPIST: OK, thanks. (Pause) Let’s start with the practice of picturing your niece [a previously created resource of warmth, safety, and love] With your eyes opened or closed, get a clear image of her, and let me know when she’s there.

PATRICK: (Closes eyes.) She’s there.

THERAPIST: And what are the feelings in the body now?

PATRICK: A lot of warmth in my heart, and I feel open and relaxed.

THERAPIST: Great. Let’s just stay here, and really let yourself deepen into this experience. (long pause) Now, how old is your niece as you’re picturing her?

PATRICK: She’s 5 or 6.

THERAPIST: Great. (pause) Can you picture yourself as a 5- or 6-year-old boy standing next to her? Let me know if you can picture that.

PATRICK: Sure.

THERAPIST: What do you notice in your body now?

PATRICK: (eyes still closed) I just get angry. I hate that little jerk.

THERAPIST: OK. (speaking slowly) Can you tell me what you don’t like about him?

PATRICK: He’s just this worthless little whiny baby who cries all the time.

THERAPIST: OK. Now let’s see what happens if you go back to just picturing your niece. She’s there by herself again. Let me know what comes up when she’s there by herself.

PATRICK: Yeah. I relax a lot. (big sigh and long pause) The love comes back when I picture her.

THERAPIST: OK, great. Let’s stay here for a minute or so. (long pause) Now I’d like you to picture another little 5-year-old boy next to your niece. This boy is not you, but he looks a little like you. He’s also lived through a lot of the same things you’d lived through at his age. His mom is really unstable and his dad is never home. (pause) Can you picture that boy next to your niece?

PATRICK: Yeah, I can.

THERAPIST: Can you describe him a little? Does he look sad or happy or some other way?

PATRICK: He looks really sad. (pause) My niece is trying to cheer him up. She just gave him a toy. (Looks very emotional, like he might cry.)

THERAPIST: Perfect. Let’s stay there for a moment. (pause) Now let me know how you feel about this little boy or what you might want to say to him.

PATRICK: I just feel sad for him.

THERAPIST: Is there anything you’d want to say to him?

PATRICK: “I’m sorry you’re so sad.” (pause) “I wish you had a better life.”

THERAPIST: When you picture him, could you feel the same kind of love you feel for your niece? Picturing them together, can you feel love and warmth for both of them? You might try saying, “May you both be happy and safe.”

PATRICK: (a lot of emotion in his voice) Yes, I can feel that.

THERAPIST: Wonderful. (pause) Now see what comes up if you try saying to him, “No matter how your parents treated you, you are still lovable. It is not your fault.”

PATRICK: (Crying a little) Yes. I think that’s true.

THERAPIST: (long pause) Now, I’d like you to imagine yourself as a 5-year-old boy standing next to these two other kids. Your niece is there, the other boy is there, and you are there as a 5-year-old. Let me know when you can picture that.

PATRICK: Sure.

THERAPIST: Good. Notice how those two boys both look pretty sad. They have lived through a lot of the same things, and they are both sad. See if you can recognize that they are also both lovable.

PATRICK: (pause) Yeah, I can see that. They didn’t ask for nay of that stuff to happen to them. They didn’t want it, and they can’t make it better. (still crying)

THERAPIST: Yeah. (pause) Now I’d like you to try to say to all three of them, “You are all lovable. You deserve good things. May you all be happy and safe.”

PATRICK: (sobs for almost a minute.) I just want to protect them.

THERAPIST: Yeah. That makes sense to me. (pause) Let’s just stay here, especially focused on yourself as a 5-year-old boy. Let him know how much you love him and how you wish you could protect him.

PATRICK: I do.

THERAPIST: If you want, you can pick him up or say something to him.

PATRICK: “It’s not your fault.” (eyes still closed and crying.)

We stayed with this scene for another 15 minutes or so, and Patrick’s connection with his 5-year-old self deepened over that time. He became calmer and described feeling powerful warmth and love for that image of himself. At the end of the session, I told him to continue this new practice with the same diligence that he’d shown over the past week. I said that it might work to begin by picturing himself as a 5-year-old, but if it doesn’t, he can use the same progression we used that day: First picture his niece, then the other boy, then himself as a boy.

Over the next 6 weeks, Patrick experienced an incredible amount of healing and transformation. It seemed like he had a new insight to report at the start of almost every session. He would tell me about an experience of abuse or neglect and how he no longer felt responsible for it or ashamed about it. He was grieving his childhood in a healthy way and moving forward in his life. In our last session, he said, “My anxiety and depression are basically gone, and I’m starting to feel like I could like myself for who I am. I’ll call you if I need some help in the future.”

* * * * *

In our work we are exposed to a huge amount of other people’s pain. Over time, being present with all this pain can deplete our energy, and we may even develop secondary trauma symptoms. The summer before I began graduate school in psychology, I was on a long meditation retreat and asked one of the elder monks about this issue. I said, “How can I keep from getting overwhelmed by other people’s suffering without shutting down emotionally?”

He was quiet for a while and then responded: “It begins by recognizing the importance of caring for yourself. You have to recognize suffering when it is present in you, and know that caring for that suffering is the most important thing you can do. Don’t let anything else come first. Breather with your suffering and embrace it with compassion. Don’t stop until you feel light and calm in your body, even if it takes hours.”

Not many of us demonstrate this kind of dedication to self-care. In fact, many mental health professionals will prioritize almost every other responsibility over nourishing their own well-being. I know it’s not easy, but we have to recognize that caring for ourselves is the greatest gift we can give to the world.

EXERCISES TO PRACTICE

[adapted from Self-Compassion in Psychotherapy: Mindfulness-Based Practices for Healing and Transformation.]

Self-compassion is a skill that can be learned. And the learning requires lots of practice to encode in the brain’s long-term procedural (implicit, outside of awareness) memory. Lots of practice, repeated over time.

In Tim Desmond’s words:

Activating the Care Circuit

1. Explore different objects until you find one that brings up natural, uncomplicated feelings of warmth and love.

For some people this might be a baby, it might be an animal, or it might be a baby animal. We want to use whatever image helps turn on the Care Circuit and get the oxytocin and opiates flowing.

It’s important to choose your own objects; there is no way to know what is going to be the most powerful image for someone else. Desmond has had clients choose a cut flower, their childhood teddy bear, even a rainstorm.

Once you choose your object, track the sensations in the body. If there are feelings of warmth and openness, fine. If not, consider finding a new object.

2. Imagine a being – whether it’s someone you’ve known, a religious figure, an image from nature, or even a fictional character – that could completely love and accept you.

Perhaps a grandmother, Jesus Christ, a white light., whatever imagery stimulates the Care Circuit

Activating the Care Circuit through these visualizations and experiencing the felt sense of warmth and love builds resources before moving to mindfulness of experience and offering self-compassion for suffering.

Spirit of Experimentation

Although it is possible to enjoy every moment of life, it’s not easy for most of us. We have to experiment with many different ways of practicing to learn what works best for us in different moments. For example, if I’m late for an appointment, I will ask myself if there is anything else I could to do arrive sooner. If there is a practical and realistic solution to the problem, I want to do that.

However, there might be nothing more I can do. If I’m stuck in traffic, surrounded by cars that aren’t moving, I don’t have the power to change the situation that moment. Recognizing, this, I remind myself to practice letting go of my attachment to being on time and try to consciously cultivate helpful thoughts like “There is nothing more you can do right now. You can just let yourself enjoy your breath.”

If these thoughts don’t seem to be helping me feel better, I might switch to mindfulness of the body. Noticing any tension or agitation, I allow myself to feel all the sensations in my body without trying to make them change. Often, this leads to a calming down and feeling more spacious.

However, if I feel overwhelmed by the strength of my distress in that moment, I might switch to a self-compassion meditation – for example, putting a hand on my heart and saying to myself,” “You would really like to be on time because you want to respect other people, and that is a wonderful value. You don’t have the power to make that happen right now, even though you would like to. You are suffering because you can’t have what you want, which happens to everyone. May you know that all of your thoughts and feelings reveal your beautiful human nature.”

Working with Difficult Clients (for clinicians)

Take a moment and picture your toughest client. You can choose someone whose personality gets under your skin, whose intensity can feel overwhelming, or whose symptoms don’t’ seem to be improving from therapy. Let the image be really clear in your mind. Let yourself see that person’s facial expressions and hear how she or she talks with you. Is he or she angry, dissociated, pleading, or something else?

Now keep that image there and notice all of the sensations in your body. Bring your awareness to any tension, heaviness, or other sensation that might arise. Name whatever you are feeling in our body. It might be tension in your jaw, agitation in your legs, or a strong impulse to move in some way.

Do your best to stay focused on the sensations in the body. Even if it’s really uncomfortable, try to let yourself feel all of it and not lose yourself in discursive thinking. If a strong thought arises, notice that it is just a thought. Don’t argue with it or agree with it. Just accept it and allow it to be there. You can say, ‘This thought came up in my mind. It can stay or go, however it wants.”

Stay with the image of your client and keep coming back to the physical sensations in our body. Let those sensations be as powerful as they want to be. Let them get stronger, stay the same, or change in any other way. Experiment with saying to yourself,” It’s OK to feel this,’ or “I’m strong enough to tolerate this,” or “These feelings are welcome.” You might even imagine holding these feelings with the tenderness of a mother holding her crying baby.

You might naturally discover some part of yourself that is in need of compassion. Experiment with different ways of directing compassion to yourself until you find one that feels powerfully helpful. You might try the following:

* Put your hand on your heart and imagine sending healing energy to yourself.

* Picture some other being (someone you’ve known, a religious figure, etc.) sending compassion right to the place where your suffering is located in your body.

* Say the phrases to yourself such as: “May you be happy. May you be healthy. May you be safe. May you be loved.”

* Picture yourself when you were a child and express love and compassion toward your younger self.

If you haven’t done so already, take at least ten minutes to try this practice. If it takes an hour or more before you begin to feel peaceful and solid, continue to persist. If you notice that you feel stuck or blocked in any way, experiment with different forms of practicing until you find something that helps. With enough determination, you will find something that works for you.

Once you have finished with this exercise, picture your client again. Notice how your feelings have changed. Can you relate to this client differently from a more peaceful state of mind? Many therapists find that practicing self-compassion opens up new possibilities for working with tough clients.