Introducing compassion-focused therapy

Why CFT arose1

Shame and self-criticism are transdiagnostic problems; people with them may struggle to feel relieved, reassured or safe.

Logic is not enough1

Some clients get skilled at alternative thoughts in CBT yet still do not feel better; CFT targets that gap.

An unbalanced system1

In high shame and self-criticism the threat system dominates and the soothing system is poorly accessible, often because it was understimulated in childhood.

The therapist's role1

Help the client feel safe with the therapist and replace self-criticism with self-kindness.

Threat and protection1

Notices threats fast and produces anxiety, anger or disgust, with fight, flight or submission; it runs on "better safe than sorry".

Drive and excitement1

Energises us toward rewards and goals; it can serve threat, as in driven "shoulds" and status-seeking to avoid rejection.

Contentment and soothing1

A calm, not-seeking well-being, linked to being cared for; it regulates the other two systems.

Attributes of compassion1

Care for well-being, sensitivity, sympathy, distress tolerance, empathy and non-judgement.

Skills of compassion1

Compassionate attention, thinking, behaviour, imagery, feeling and sensation.

Fear of compassion1

Many clients fear self-kindness as soft or undeserved, or fear becoming lazy without self-criticism.

"I know I'm not to blame for the abuse but I still feel that I am"1

A typical client who understands the logic of therapy without feeling helped.

Imagining a meal1

Just imagining a lovely meal starts saliva flowing; likewise self-critical thoughts trigger the threat system, and kind ones can soothe.

The compassionate self1

Like method acting, the client practises being a deeply compassionate person, with its face, posture and voice.

Savouring1

Clients may be asked to appreciate the taste of food, the colours of the sky or music to free attention from threat.

Effort, not results1

Clients learn to appreciate their effort, however small, rather than how far they fall short.

Grief in warmth1

For people from harsh backgrounds, the therapist's first warmth can bring up deep sadness and grief.

Little evidence then1

Gilbert wrote that there were limited data on the value of the approach and much research still to do.

Small samples2

A 2015 review found early CFT studies were very small; one pilot had six participants.

Since then2

A 2024 meta-analysis of 7,875 participants found CFT effective, but called for larger, higher-quality trials.

The Compassionate Mind

Gilbert's book-length account for general readers, with exercises.

Compassion-focused therapy

The topic page: how a session works and the research since.

Teaching the Mindful Self-Compassion Program

Neff and Germer's parallel, group-based compassion training.