Question 1

What's a common misconception you encounter around the idea of compassion?

Paul Gilbert · Accepted Answer

That compassion is the same as kindness, which it isn't for many reasons. Kindness is a way of being compassionate and it has a lot of wonderful impacts on oneself and others for sure --certainly in contrast to coldness or unkindness! Kindness is also essential in building quality affiliative relationships closeness, joyfulness and happiness

Gilbert, P., Basran, J., MacArthur, M., & Kirby, J. N. (2019). Differences in the semantics of prosocial words: an exploration of compassion and kindness. Mindfulness, 10(11), 2259-2271.

That your compassion is about love, which it isn't. The strongest compassion is for the people you don't love and the people you dislike. Also, if you make love central then people really struggle with compassion if they feel they can't love others. . For example, depressed mothers will really struggle if you focus on love. So, what you need to focus on is behaviours in the early days – the values of caring behaviours.

In the Buddhist tradition, the focus has always been on the freedom from suffering and the causes of suffering. The problem is the translation of words because loving in the Buddhist traditions does not mean the same as love in the western traditions, and people get these confused. So universal love in the Buddhist tradition is the universal wish that all sentient beings be free of suffering and the causes of suffering. That is the essential aspect of compassion.

So, it's very important to help people understand the definition, how and why its motivation, and how and why courage and wisdom are its central supports.

Question 2

What is compassion?

Paul Gilbert · Accepted Answer

Compassion is a motive that emerges out of the evolution of caring behaviour which is primarily a mammalian rooted motivational system. What turns caring into compassion is our new brain competence is for thinking, empathy and mindfulness. When we engage in caring behaviour with knowing intentionality that becomes compassion. I've written quite a bit on this.

Question 3

How can compassion focused therapy be integrated with CBT?

Paul Gilbert · Accepted Answer

Again, like the other question on DBT, it's important to distinguish between a model of the mind and model of therapy from techniques of intervention. Tim Beck, who I was fortunate enough to do some training with in the late 1970s and early 80s  was always very clear that he was not that interested in developing complex models of the mind, but was very interested in developing heuristics and easy ways for clients to be helped. So CFT utilises a lot of the interventions that have come out from the last 40-50 years of these traditions, including things like guided discovery, inference chains, behavioral exposure, behavioral experiments and more recently mindfulness and so on.

However, we have never considered ourselves a third wave CBT therapy. In fact, I've always argued we don't need more waves of a particular therapy.  We need an integrated, science based - and here science means the science of physiology, psychology, sociology and so on to help us understand mental health problems.

For example, there's a lot of data now coming out that early life experiences have an impact on our epigenetic profiles, and we're now doing studies to see if intense compassion training can change epigenetic profiles. This is the future of psychotherapy -- how do we change the physiology. You are probably familiar with the fact that there's a lot of research now on how compassion changes the vagus nerve, and pathways in the frontal cortex and so on.

Question 4

What is the difference between compassion and empathy?

Paul Gilbert · Accepted Answer

Compassion is a motive that organises the caregiving system whereas empathy is a competency. Competencies are used by motives but they're not primary motives themselves. So, for example we know that highly manipulative people and narcissists can be very good at empathy but the motivation behind their mind reading abilities it's not compassionate. So, do make a clear distinction between what a motivation is and what a competency is. Paul Bloom is also written quite a bit on this area.

Question 5

Is Compassion Focused Therapy considered an evidence based intervention?

Paul Gilbert · Accepted Answer

Very much so, and in fact there are somewhere in the region of 50 studies now. We are lacking a good meta-analysis but that is underway, and there are several excellent studies that are also underway. Keep in mind that this is a relatively new therapy, getting money for a new therapy is very tricky and we certainly have tried. But the data is appearing all the time and it's really good not only in terms of effectiveness but dropout rates and so on. I would give it another three or four years and then the database I think will be very strong but it's wise to keep your eye on the database.

Question 6

Any advice for defining compassion with clients? Especially if they are particularly self-critical and struggle with any sense of kindness or warmth towards themselves?

Paul Gilbert · Accepted Answer

It's usually best to elicit their understanding of compassion first and then see how they think about it. Ask them what worries them about it. Sometimes they'll say ‘it's weak’ ‘an indulgence’ or ‘I don't deserve it.’ So you elicit their resistances quite early.

You are then going to guide them towards the standard definition, which is sensitivity to suffering and self and others with a commitment to try to relieve and prevent it. It is very important you understand the root and the reason for this definition because there are many definitions floating about on the Internet which for clinical work are not always very helpful

From there, highlight the two key qualities of compassion which are courage and wisdom. Sometimes, we say dedication to wisdom. You want to avoid the client confusing compassion with the ways of being compassionate, such as being kind honest empathic and so forth. Those are ways of being compassionate, but the root of compassion is courage and wisdom

There are various ways you can do this. For example you could ask: what are the key emotions and skills of a firefighter rescuing somebody from a burning house, and guide them with Socratic dialogues to this recognition that such actions are obvious ones of compassion, to risk your life for another and then highlight  the importance of courage and wisdom. You need the courage to enter the burning house but also a lot of skill to know how to do it wisely -- so keep coming back to these to core qualities.

Another exercise we do is to invite somebody to think about how they would help a friend who needed to go to hospital for an urgent operation but was hospital phobic. Through discussions, you guide them to see that they would try to give their friend courage by say, talking with them supportively, maybe going with them to the hospital. They come to the recognition of the central role of courage and wisdom. So, do you make a big distinction between the core elements of compassion, it's based on a motivation to be sensitive to suffering, and this commitment to try to help and to do that, you will be building courage and wisdom. For example, empathy becomes part of wisdom, kindness becomes part of wisdom, because doing things unkindly wouldn't be compassionate. If clients confuse kindness with compassion, that's when you can run into trouble.

Question 7

Can CFT be used alongside DBT? I'm particularly interested in the idea of integrating chain analysis alongside CFT.

Paul Gilbert · Accepted Answer

Compassion focused therapy is about how you focus your therapy. As you will know there are many things in DBT which you will find in the old mindfulness texts and so on. So, we're all moving towards a better science of therapy and breaking out of our tribes. Also, sharing interventions that are helpful to people.

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