Compassionate Intentions
in the
Psychotherapy Setting
M. Joann Wright, PhD & Jonathan Rhodes, MA
Compassionate Intention.
•
“It is a sensitivity to the client as viewed
from an ACT perspective, not the
mechanical application of metaphors,
exercises,
and
concepts,
that
differentiates effective and ineffective
ACT therapists.”
•
- Hayes, S., Strosahl, K., & Wilson, K. (2003
p. 268)
Case Conceptualization
•
“I got stoned last night after staying clean for four days. We had a staff meeting and I wanted
to suggest that new product again. I’ve been thinking about the thing for a year and can’t get
up the balls to talk about it… But then, when I was even just thinking about speaking up, my
hands started to shake and my face got all hot and my mind started to go blank. I knew I
wouldn’t be able to say anything without looking like an asshole, so I just kept my mouth
shut. And then while I was thinking about this stuff, I didn’t hear the boss ask me a question
and all of the sudden everyone was staring at me waiting for me to say something. I know I
turned all red and I heard someone snickering when I had to ask the boss to repeat the
question. And then I just mumbled something stupid. I wanted to just disappear. And then
the real kicker – Adam suggested the product I was going to suggest and everyone said what
a great idea it is. Now he, as usual, gets all the kudos while I’m the one who looks like a
loser. I was driving home just thinking, “I’m such an asshole; nothing is ever going to
change.” And I couldn’t stop thinking about that damn meeting. And then when some
neighborhood kid asked if I wanted to score some good weed, I was like, “What the hell?
Nothing’s ever going to change.” So I bought a half ounce and got real stoned. I felt great
until I woke up the next day, and now it’s still like nothing is ever going to change. I’m always
going to screw up. What’s the point in staying off of the marijuana? It’s like, the only thing
worthwhile in my life. Why should I quit it just because some shrink thinks I should? No one
else really cares if I smoke the shit or not. Why should I care?”
•
- The case of “Rick” from Bach and Moran, 2008, pg. 116
Empathy
•
•
•
•
The capacity to understand another
person's experience from that person's
frame of reference.
A deeper understanding of another
human being.
The emotional appreciation of
another's feelings.
- Hardee, 2003
Empathy
•
The process of understanding a person's
subjective experience - by vicariously
sharing it - while remaining an observer.
•
NOW WHAT?
Don’t stop now...
•
Empathy vs. Compassion
•
Compassion
goes
beyond
empathy.
It
includes
the
willingness to take action to reduce
suffering.
•
Even though we have not walked a
day in their shoes, being open,
listening and understanding their
struggle as if we HAD.
•
The client's behavior - in the
context of their life’s story - makes
perfect sense. It is our choice to
find compassion for their suffering,
be with them in it, and assist in
alleviating it.
Compassion and
Psychology
The
Merriam-Webster
Dictionary
defines compassion as “sympathetic
consciousness of others' distress
together with a desire to alleviate it.”
According to many sources, the
charge of psychologists is to reduce
human suffering.
Notice the SAMENESS.
•
Therefore, it is our mission to be
compassionate.
Aren't we?
• Consider
the
purely
mechanistic
approach…
Aren't we?
• …“I
NEED
you to make
contact with
the present
moment!!!”
Functional Contextualism
and the Clinical Agenda
• Interpretation: Explanation of why people suffer.
• Prediction: Allows us to predict what people with
certain psychological problems will do.
• Influence: Tells us how to change the course of
events so that the individual can achieve a better
outcome - This is where the relationship becomes
important.
-Hayes, S., Strosahl, K., & Wilson, K. (2003)
Compassion and the
Clinical Agenda
•
•
“Compassion is not the relationship between the healer
and the wounded. It’s a relationship between equals.
Only when we know our own darkness well can we be
present with the darkness of others.
Compassion
becomes real when we recognize our shared humanity.”
- Pema Chodrow
Compassion and the
Clinical Agenda
“Compassion is the radicalism of our
time."
- Dalai Lama
Compassionate Intentions
•
Finding a way to connect
with the client. Even the
most resistant client
desires connection.
•
“Eyes On” Exercise.
•
Listening intently to their
stories because there we
find clues to what matters
most in life to them.
•
We listen to their stories to
find out HOW to make this
connection.
Soft Reassurance
“Soft reassurance”
is
support for the client from
a willingness to make
contact with the client’s
sense of emotional pain,
validate it and normalize it
without avoiding it or
rescuing the client from it.
(Hayes, S., Strosahl, K., &
Wilson, K., 2003; p. 272)
Compassion and Creative
Hopelessness
The effective therapist needs to be willing to step back from the verbal
sparring that occurs during psychotherapy, to see words as words,
feelings as feelings, and to witness the behavior that is going on in the
room from the point of view of an observer. (Hayes, S., Strosahl, K., &
Wilson, K., 2003; p. 270).
Even the most ineffective behaviors can be moments of truth. They can be
examples of how the client has tried to make life work for them but going
about it in a way that stunts well being rather than promotes it (Sanders,
2008).
Being willing, as the therapist, to see behaviors as JUST behaviors without
labeling them as bad or good.
Non- "Expert" Stance
•
A shared struggle: therapists and clients
are snared by the same language traps both personally and professionally - as
clients, suffer many of the same
struggles, and can learn much from
each other.
•
ACT makes room for the client and the
therapist to be on the same humanistic
playing field.
•
Understanding that the formula for
successful living is unique to each
individual-no right or wrong way to live.
•
“ACT purposely capitalizes on the
commonality between the client and
therapist to help move the client, and by
implication, the therapist, forward in their
lives”. (Hayes, S., Strosahl, K., & Wilson, K.,
2003; p. 267).
Non- "Expert" Stance
•
Willingness to refrain from
being the “expert”; clients often
resent an expert (recall “Rick”).
•
Not seeing ourselves as
heroes or superstars. We are
just ordinary people, who go
through struggles just like our
clients.
•
Learn from your client as your
client learns from you.
•
Two Mountain Metaphor
Present Moment,
Compassion
• If, you are lost in your head
figuring out your therapeutic
strategy, you have lost contact
with the NOW of the session.
• If, instead, you attend fully to your
client while they share with you
their story, their suffering, their life,
you are in the present moment.
Vessels for Change
"If we cannot embrace our own
frightened and vulnerable hearts, we
cannot love the world. Sadly, we are
often at war with ourselves."
- Tara Brach (p. vii)
"Opening your heart to compassion
and loving-kindness for yourself and
then others will help you dissolve
feelings of inadequacy, inferiority, and
disconnection."
(Flowers & Stahl, 2011; p. 110)
Vessels for Change
•
Reframing
“therapist”
•
•
•
the
context
of
myself
as
What does “therapist” mean?
Redefining my role as a compassionate nonexpert.
In a psychotherapy session, compassionate
behavior by the therapist would increase if
reinforced by the client and clinically
relevant gains or extinguished when not
reinforced. You are more likely to be an
agent for change when you “join” your
clients.
Vessels for Change
• If we are successful, helping our
clients to make sense of their
lives helps us to be more
compassionate.
• It reinforces the idea that this is
what we are called to do.
Compassionate Intentions
“For
[these] interventions to function the way that
they are meant to function, the therapist must be
willing to enter into a relationship with the client that
is open, accepting, coherent, and consistent with
ACT principles.”
(Hayes, S., Strosahl, K., & Wilson, K. (2003, p. 268)
Revisiting "Rick"
- The case of “Rick” from Bach and Moran, 2008, pg. 116
Conclusion
• To be compassionate is to be blessed with a
burden: To contact our pain and suffering
allows us to show up more completely for our
client.
• To be compassionate raises basic issues of
values, meaning, and self-identity.
• When entered into compassionately, the
relationship with the therapist and client
model the purpose and nature of ACT.
References.
Bach, P, and Moran, D.J., (2008). ACT in Practice. Case
Conceptualization in Acceptance & Commitment Therapy.
California: New Harbinger Publications.
Flowers, S. & Stahl, B. (2011). Living with Your Heart Wide
Open: How mindfulness and compassion can free you from
unworthiness, inadequacy and shame. California: New
Harbinger Publications
Fox, E (2005). About contextualism. Retrieved April 8, 2008,
http://www.contextualpsychology.org/about_contextualism
Hardee, J.T. (2003). CPC Corner: An overview of empathy.
Retrieved
April
15,
2008,
http://xnet.kp.org/permanentejournal/fall03/cpc.html.
Hayes, S., Strosahl, K., & Wilson, K. (2003). Acceptance and
commitment therapy: An experiential approach to behavior
change. New York:The Guilford Press.