me to stay in that role physically, which kept me emotionally and psychologically there'. Clinical tip: Use the body to access, 'hear' and remember each self ...
Learning from Experience: Compassion-Focused Therapy Chair-Work for Self-Criticism
Tobyn Bell The Compassionate Mind Foundation 7th International Conference 2018 London
The exercise: ‘the critic’
The exercise: ‘the criticised’
The exercise: ‘the compassionate self’
The research Participants:12 clients with depression, already receiving CFT in primary care were interviewed immediately following the self-critic chair-work intervention The therapy session was recorded and rated for therapist adherence Interviews were transcribed and analysed using Interpretative Phenomenological Analysis (IPA)
Theme 1: Physicality Physical embodiment and enactment P3. ‘When you are writing it down you can’t really express it as much. Tone of voice you can kind of use like harsher words or negative words but it is still hearing your own voice out loud it is a lot different to reading something you’ve written on paper’ P4. ‘I got into that position and I stayed there, that allowed me to stay in that role physically, which kept me emotionally and psychologically there’ Clinical tip: Use the body to access, ‘hear’ and remember each self
Movement P4. ‘it was helpful sitting in the chair but it was more helpful getting out of the chair, and realizing that the emotions which weren’t from that voice, if you see what I mean, and gaining greater clarity.’
Clinical tip: Movement ‘breaks’ connection between self states and offers new ‘perspective’
Externalizing and physically situating parts of the self P9. ‘so it is nice with a separate chair if you like, separate people, and you can almost imagine what it would be like said to another person and yeah, suddenly it becomes a lot easier’ P6. ‘So rather than speaking to friends, countryman, romans, it was speaking to the chair, speaking to the person in the chair, the voice in the chair, the sense of that character in the chair’ Clinical tip: Speak to rather than about. Externalization highlights the relational nature of self-criticism and compassion
Theme 2: Emotional intensity and connection Accessing and experiencing heightened emotions P8. ‘I only ever hear my self-critic so hearing my vulnerable side, it is not something I’m used to. So being in the position where I do hear it and I recognize that I’m sad or upset or whatever it was scary to see that that side of me is so shut off that I don’t even realise it is there most of the time…it was like a brick wall that had hit me in the face, it was so effective: I was really moved by it.’ Clinical tip: Emotional intensity= initially aversive, but important: e.g. to aid identification of various emotions and increase emotional tolerance/mastery
Theme 3: The self as multiple Expanded sense of self: differentiation P4. ‘it develops your understanding, you have got a lot of different emotions and inclinations and, you know, there’s lots pulling you in different directions…the self is very messy…I feel like I’m doing well to organize such complex thoughts now, there is a sense of pride in that I guess.’ P11. ‘because then if you didn’t differentiate between those parts then you might not even think that you could try and step out of this and into this’ Clinical tip: Positing the self as ‘multiple’ opens potential for new mentalities and ways of being; allows for inner organisation
The compassionate self as integrating and unifying P4. ‘then as the compassionate self, you know, because you feel so strong and confident, you can talk to the person over there in the critical chair and you talk to the person over there in the criticised chair… it’s almost like suddenly you are King Solomon’ P12. ‘So I need to, we need to, keep her and we need to keep her, she needs to be quieted down, she needs to be brought up a bit, we need to work together.’ Clinical tip: Use the compassionate self for internal integration
Theme 4: Mental representation of selves P6. ‘I was picturing the person speaking when I was being the critic voice as well, because that seemed to be the most successful way of connecting with the voice, connecting with the sense of it, because I picture that person now mentally’
Clinical tip: Encourage the client to imagine the selves in the other chairs. Assess for spontaneous image change, memories and metaphors
Theme 5: Blocks, fears and facilitators Difficult reactions P11. ‘ I dismissed it straight away, this is going to be rubbish, and I thought what? I can’t believe the extremes of emotions that I had in the three chairs, it was bizarre, and I know I’ve said that before. I’ve never looked into myself that far before. So I’m quite impressed with it actually. I think I’ll remember these blue chairs for the rest of my life.’ Clinical tip: As a therapist, expect and tolerate initial fears/blocks regarding chair-work
The role and impact of the therapist P5. ‘there is this professional sitting in front of you who recognizes and is working with you and doing these things where you are pretending to be different people… recognizes that it kind of makes it okay, so you don’t feel crazy…for that to be recognized from a professional, that you do have these different selves and it is normal, I think that is helpful’ P12. ‘he is a lovely person and I do feel very bad sometimes when I do swear in front of him so I mean that was difficult and I know a lot of therapist don’t like it’ Clinical tip: Importance of therapist presence, support and capacity to tolerate client’s anger/distress
Theme 6: Experiencing and transforming the critic Experiencing the violence and dominance of the critic P8. ‘I was sat in the chair, but it felt like I was on the floor…someone was stood on me, just pushing me down, it was a physical feeling of just, your gut, it was nothing there, absolute deflation, I felt so distressed I was being emotionally and physically attacked…I felt, like this was going to be it, this was how I was going to feel forever in that moment…I knew if that I showed any emotion that anger would get worse so just put your head down and don’t look up’
P8. ‘It felt really cruel because I was envisioning it as individual people so I kind of didn’t really see the vulnerable self as me at this point so when I was telling it the feelings that the self-critic feels I felt like a bully, I felt like I was telling this child, you are worthless, get up, shut up, don’t do this, don’t do that…knowing that is what I do every day to myself it was really upsetting, because I would never dream of saying that to someone else, so why would I say that to myself?’
Clinical tip: The importance of experiencing and witnessing the full force of criticism: demonstrating the relationship it creates and the impact it has. Compare self-self to self-other relating
Transforming and understanding the critic with compassion P4. ‘it is kind of a switch-flicking moment where I do actually, I understand that rationale, I understand what it is there for, its purpose, which is helpful in understanding how to calm it down…actually they overlap and become the same voice.’
Clinical tip: Utilise the compassionate self to understand the fears and function of the critic
Conclusion CFT chair-work facilitates and expresses CFT’s core principles: -Identifying various social mentalities and the internal relationships they create -Shifting motivation, mentality and emotion -‘Self’ as multiple (new potential) -Differentiation, integration, transformation of threat experiences -Embodiment and enactment -Experiential learning -Importance of therapist compassionate courage and tolerance -Working with fears behind protective reactions
