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Learning from Experience: Compassion-Focused Therapy Chair-Work for Self-Criticism

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Abstract

This presentation summarises recent research on CFT chair-work for self-criticism. The research involved an interpretive-phenomenological analysis of clients’ experiences of a chair-work intervention. Key themes included: the importance of embodiment and movement; differentiating and integrating parts of the self; the role of emotional connection; the presence of spontaneous imagery; and the transformation of the critic with compassion. The presentation will conclude with learning points for clinical practice and training, as well as insights into the nature of self-criticism.
Tobyn Bell
Learning from Experience:
Compassion-Focused Therapy Chair-Work
for Self-Criticism
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
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