Q&A

Self-Compassion in Psychotherapy

Self-Compassion in Psychotherapy

Renowned psychologist Chris Germer answers questions on how therapists can help their clients learn the art of self-compassion, accept their imperfections and build inner strength to break free of harsh self-criticism.

Q
Can you share your personal story about discovering and cultivating self-compassion?
A

I stumbled upon self-compassion after struggling with public speaking anxiety for 20 years. I’m a clinical psychologist who specialized in anxiety disorders but couldn’t find any way to help myself. I had been practicing mindfulness meditation for many years, and then, back in 2006, I started to practice loving-kindness (metta) meditation for myself, which uses words of kindness as the focus of meditation – “May I be safe”… “May I be healthy”… “May I live with ease.” After four months of practicing like this, I had to speak at a conference and, to my amazement, the same loving words reverberated in the back of my mind as I stood up to speak. My fear turned to excitement and joy, even love.

In hindsight, I realized I was suffering from a shame disorder, not an anxiety disorder. My anxiety came from my fear of being perceived as a fraudulent or incompetent person when I trembled in front of an audience. Most importantly, I discovered that sometimes we need to hold ourselves in loving awareness (self-compassion) before we can hold our experience (mindfulness), especially when we’re in the grip of intense and disturbing emotions like shame.

Q
Are there actual exercises you can do with patients to help them develop self-compassion or is talking about it enough?
A

Talking about self-compassion can be helpful, but practice is essential to actually respond with self-compassion when we’re in the midst of emotional difficulty. First, we need to understand that self-compassion is good for us and that it will not make us lazy, weak, selfish, or self-indulgent. Burgeoning research shows that self-compassion is strongly associated with emotional wellbeing, coping with life challenges, lower levels of anxiety and depression, healthy habits such as diet and exercise, enhanced motivation, and more satisfying personal relationships. However, to experience the broad range of benefits of self-compassion, we need to have direct experience of self-compassion and make it a habit.

Q
What are the best tools to help clients get started on practicing self-compassion?
A

There are so many ways to become self-compassionate. For example, research has shown that we can increase self-compassion by owning a dog, practicing yoga, savoring nature or practicing mindfulness. However, the best way seems to be explicitly practicing self-compassion. The quintessential self-compassion is “what do I need?”. In answer to that question, we can do inner practices such as loving-kindness meditation, or we can practice self-compassion behaviorally, such as responding to stress with acts of self-kindness (a cup of tea, listening to music, talking with a friend).  

An informal definition of self-compassion is "when we suffer, treating ourselves with the same kindness and understanding as we would treat a good friend." Therefore, when we’re suffering and can’t think of how to be kind toward ourselves, it helps to ask, “how would I treat a friend in the same situation?”.

One of the simplest self-compassion practices is ‘soothing and supportive touch.’ This means to respond to stress with a hand over the heart or another soothing place on the body. Research has shown that this practice reduces the stress hormone, cortisol.  For more information on self-compassion practices, please see The Mindful Self-Compassion Workbook.

Q
Do you have a sequence for how therapists can encourage patients to challenge their harsh inner critic put downs and judgements, and adopt a view of self that validates efforts and their struggles, gently and compassionately?
A

The first step is to understand that most self-criticism is an effort to keep us safe. For example, as children, we internalized the voices of critical caregivers in order to stay out of trouble, even if those internalized voices serve no useful function in adulthood. As adults, we often think that criticizing ourselves still has a useful purpose. In other words, therapists and their patients first need to respect the function of self-criticism and learn from it.

After we have acknowledged the existence and purpose of the critical voice, we need to feel the pain of self-criticism. With that awareness, it is easier to consciously choose to motivate ourselves in a new way – with compassion. How do we cultivate a compassionate voice that validates our struggles? We can start by writing a compassionate letter to ourselves in one of three ways: from a compassionate part of ourselves to ourselves; as if from a compassionate friend to ourselves; or as we would write to a dear friend.

Q
What causes people to be self-critical and should they re-evaluate their relationships with critical partners, family members and friends?
A

Self-criticism is probably hardwired into our DNA. For example, when we feel emotionally attacked and there is no external threat to counterattack, we tend to attack ourselves.  However, when self-criticism is a habit, it is probably due to internalized messages from people whom we know, or from our culture.  

When those messages are ongoing in our lives, we need to take a stand and protect ourselves from them. That’s fierce self-compassion, beautifully described in a book by the same name written by my colleague, Kristin Neff. Non-harm is the basis of self-compassion. When someone is harming us in word or deed, we need to say “no!”.

Q
How do we know that self-compassion is an antidote to shame? How could I describe this to my clients?
A

Theoretically, self-compassion is an antidote to shame. The three components of self-compassion are: mindfulness versus overidentification/rumination; common humanity versus isolation; and self-kindness versus self-criticism. The opposite qualities to self-compassion – rumination, isolation, and self-criticism – are key aspects of shame. The research also reliably shows that as self-compassion increases, shame decreases. This can be seen in correlational studies and also in successful psychotherapy.  

Therapists don’t usually need to convince clients suffering from shame that self-compassion is a good idea. All they need to do is become aware of the impact of shame and consider the opposite. However, from my own experience, self-compassion reduced my shame about public speaking anxiety before I even knew that I was suffering from shame.

Q
How do you handle it when narcissistic patients talk about self-compassion as something they want to prioritize, but in fact you intuit that what they actually need is compassion for others? Any recommendations on how to approach this?
A

It is certainly possible that self-compassion can be misappropriated by narcissistic patients and used as an excuse for behavior that disrespects the needs of others. However, that isn’t self-compassion. When we are truly self-compassionate, we sense that our struggles are part of the human condition. Research shows that as people grow in self-compassion, they tend to grow in compassion for others. The first self-compassion challenge for narcissistic patients is to be open to emotional pain in a mindful way – to be able to say, “this hurts.”  That awareness is especially elusive when inner pain is due to shame, since narcissism appears to be a powerful defense against shame. In other words, self-compassion is probably a good treatment for narcissism if self-compassion is correctly understood and wisely applied.

Q
Do we ultimately need self-compassion in order to be compassionate with others?
A

Correlational research shows that the majority of us are more compassionate toward others than ourselves. That suggests that self-compassion is not entirely necessary to be compassionate with others. However, research also shows that if we want to grow in compassion for others, learning self-compassion can help. 

From my own experience, self-compassion sets the stage for compassion for others. Many people feel overwhelmed by the suffering of others and can’t imagine being more compassionate. However, when we drop into our own experience of empathic pain and bring kindness to ourselves, we usually feel relief. We feel calmer and safer, which is reflected in evidence of reduced sympathetic arousal and increased vagally-mediated heart rate variability. These physiological changes, from threat to care, form the basis of compassion for others.

Q
Why do we seem to need 'permission' from someone outside of ourselves to be self-compassionate?
A

I had the privilege of teaching self-compassion all over the world and discovered that each culture has its own way of discouraging self-compassion and encouraging compassion toward others. The assumption is that we are already self-compassionate enough and we should use that awareness as a model for how to treat others. Ironically, since research shows that we are actually more compassionate toward others than ourselves, nowadays we need to use how we treat others as a model for how to treat ourselves. 

In my opinion, first we need ‘permission’ because of cultural proscriptions against self-compassion. The research tends to give us permission. After that, we need to ‘remember’ to be self-compassionate when we’re suffering, rather than getting entangled in self-criticism, self-isolation and self-absorption which are the opposite of self-compassion. Finally, we need ‘skills’ to apply in our daily lives to cultivate self-compassion. A moment of self-compassion is always a relief, so when we practice in an easy and enjoyable manner, it becomes self-reinforcing, and, over time, a way of life.

For more on research and teaching self-compassion in professional settings such as psychotherapy, please see Teaching the Mindful Self-Compassion Program.

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