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Compassion-Focused Therapy

Reviewed by Psychology Today Staff

Compassion-focused therapy (CFT) is a therapeutic approach that aims to help those who struggle with shame and self-criticism, often resulting from early experiences of abuse or neglect. CFT teaches clients to cultivate the skills of self-compassion and other-oriented compassion, which are thought to help regulate mood and lead to feelings of safety, self-acceptance, and comfort. The technique is similar to mindfulness-based cognitive therapy in that it also instructs clients about the science behind the mind-body connection and how to practice mind and body awareness.

CFT is a relatively new modality, developed by British psychologist Paul Gilbert in the first decade of the 21st century. Some small studies and research reviews suggest that it can be effective for the treatment of mood disorders and anxiety; it can also help people who are especially prone to self-criticism manage those behaviors. Some researchers have also begun to test whether it can be beneficial to people with eating disorders or symptoms of psychosis, with some positive results so far. However, most studies on CFT have been small, and some lack proper controls. Further research, conducted on larger samples, is likely needed to determine the efficacy of CFT on a broader scale, as well as identify which conditions it is best suited to treat.

When It's Used

CFT can be used to help manage many long-term emotional problems related to persistent shame, self-criticism, and an inability to view one’s self and one’s behaviors kindly and compassionately. Potential clinical issues that can be helped by CFT include anxiety disorders, mood disorders, personality disorders, eating disorders, hoarding disorder, and psychosis, as well as anger issues, poor body image, and relationship challenges. It has been used to treat children, teens, and adults, and can be practiced in individual or group sessions.

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What to Expect

CFT treatment works toward the overarching goal of cultivating compassion for the self and others. To that end, the therapist will often start by teaching the client about the evolution of the brain, the construction of the self, and the systems that regulate emotions, as Gilbert theorizes that disruptions in the brain’s emotion regulation systems lead someone to hyperfocus on threat while disregarding the need to self-soothe.

The therapist will then help the client develop the key skills of compassion, self-compassion, and mindfulness via a technique known as compassionate mind training, or CMT. CMT is comprised of guided exercises—including role-playing, visualization, meditation, and activities intended to foster appreciation for daily life—that aim to help the client recognize what compassion feels like and become better at practicing it, both toward themselves and toward others. Clients will also learn how to recognize self-criticism and develop techniques for defusing it when it arises. This may include visualizing their internal critic or identifying compassionate images to call to mind during moments of self-criticism.

Clients typically receive homework to practice these skills on days without sessions. CFT requires a high degree of self-focus—which can be challenging for those who are hypercritical of themselves or who dislike attention—and it may take several sessions before the client starts to notice positive effects.

How It Works

CFT is postulates that humans have at least three different emotion regulation systems: a threat and self-protection system, which generates anger, disgust, or fear to protect us; a drive and excitement system, which motivates us to seek outside resources like mates, food, and status; and a soothing and social safety system, which is activated when we feel peaceful and content enough that we are no longer compelled to seek outside resources.

Imbalances between these three systems can result in mental illness and/or maladaptive thought processes and behaviors, CFT theorizes. People high in shame and self-criticism may not have had enough stimulation of their soothing system early in life, and too much stimulation of their threat system. As a result, they can struggle to be kind to themselves or feel kindness from others. They may be highly sensitive to criticism or rejection, whether real or perceived, and internalize that disapproval. The goal of CFT, then, is to correct this imbalance in the emotion regulation systems.

Gilbert drew on evolutionary, social, and developmental psychology, as well as neuroscience and Buddhist ideas, to specifically address clients’ feelings of shame and habits of self-criticism, both of which often arise from abuse, neglect, and bullying. People who experience early trauma can come to feel that their internal and external worlds are almost always on the brink of hostility, Gilbert posits. For some people who have experienced early trauma, Internal self-berating and fear of outside rejection can lead to depression and anxiety, he notes.

CFT overlaps with therapies developed to treat trauma, most of which address early memories, recognize negative thoughts, and correct misperceptions. But for some clients who struggle with shame and self-criticism, being able to counter unreasonable thoughts isn’t enough; without self-compassion, logic does not translate into feeling better.

The goal of CFT is to replace feelings of hostility and insecurity toward oneself with compassion and understanding, so that clients can begin to soothe themselves, accept soothing from others, and generate feelings of contentment and safety.

What to Look for in a Compassion-Focused Therapist

Someone interested in CFT should look for a licensed mental health professional with specialized training and experience in cognitive behavioral therapy and mindfulness, as well as further training and supervised experience in compassion-focused therapy. Several organizations, like the Center for Compassion-Focused Therapy, offer workshops on the foundations of CFT, but there is no formal certification in the United States. In addition to these credentials, it is important to find a therapist with whom you feel comfortable.

References
Chou C.Y., Tsoh J.Y., Shumway M., et. al. (2019) Treating hoarding disorder with compassion-focused therapy: A pilot study examining treatment feasibility, acceptability, and exploring treatment effects. British Journal of Clinical Psychology. 2019 Jul 4. doi: 10.1111/bjc.12228
Frostadottir A.D., Dorjee D. (2019) Effects of Mindfulness Based Cognitive Therapy (MBCT) and Compassion Focused Therapy (CFT) on Symptom Change, Mindfulness, Self-Compassion, and Rumination in Clients With Depression, Anxiety, and Stress. Frontiers in Psychology. 2019 May 17;10:1099. doi: 10.3389/fpsyg.2019.01099
Cuppage J, Baird K, Gibson J, et. al. (2017) Compassion focused therapy: Exploring the effectiveness with a transdiagnostic group and potential processes of change. British Journal of Clinical Psychology. Jun;57(2):240-254. doi: 10.1111/bjc.12162
Leaviss, J., & Uttley, L. (2015). Psychotherapeutic benefits of compassion-focused therapy: an early systematic review. Psychological medicine45(5), 927–945. https://doi.org/10.1017/S0033291714002141
Gilbert, Paul (2009) Introducing compassion-focused therapy. Advances in Psychiatric Treatment;15(3):199-208. doi: 10.1192/apt.bp.107.005264
The Center for Compassion Focused Therapy, New York, NY
The Compassionate Mind Foundation-USA, New York, NY
Last updated: 09/01/2022