Compassionate Intentions in the Psychotherapy Setting

1. Compassionate Intentions in the Psychotherapy Setting • M. Joann Wright, PhD & Jonathan Rhodes, MA

2. 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)

3. 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

4. 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

5. Empathy • The process of understanding a person's subjective experience - by vicariously sharing it - while remaining an observer. • NOW WHAT? • Don’t stop now...

6. 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.

7. 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.

8. Aren't we? • Consider the purely mechanistic approach…

9. Aren't we? • …“I NEED you to make contact with the present moment!!!”

10. 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)

11. 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

12. Compassion and the Clinical Agenda “Compassion is the radicalism of our time." - Dalai Lama

13. 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.

14. 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)

15. 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.

16. 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).

17. 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

18. 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.

19. 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)

20. Vessels for Change • Reframing the context of myself as “therapist” • What does “therapist” mean? • Redefining my role as a compassionate non-expert. • 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.

21. 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.

22. 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

23. 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.

24. 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.