Compassionate Intentions Compassionate Intentions in the in the

Psychotherapy Setting Psychotherapy Setting M. Joann Wright, PhD & Jonathan Rhodes, MAM. Joann Wright, PhD & Jonathan Rhodes, MA

Compassionate Compassionate Intention.Intention.

• ““It is a sensitivity to the client as viewed It is a sensitivity to the client as viewed from an ACT perspective, not the from an ACT perspective, not the mechanical application of metaphors, mechanical application of metaphors, exercises, and concepts, that exercises, and concepts, that differentiates effective and ineffective differentiates effective and ineffective ACT therapists.” ACT therapists.”

• - - Hayes, S., Strosahl, K., & Wilson, K. (2003 Hayes, S., Strosahl, K., & Wilson, K. (2003 p. 268)p. 268)

Case Case ConceptualizationConceptualization

• ““I got stoned last night after staying clean for four days. We had a staff meeting and I wanted to suggest that 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… 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 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 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 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 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 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 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 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; 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 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 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, 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 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 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?”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- The case of “Rick” from Bach and Moran, 2008, pg. 116

EmpathyEmpathy

• The capacity to understand another The capacity to understand another person's experience from that person's person's experience from that person's frame of reference. frame of reference.

• A deeper understanding of another A deeper understanding of another human being.human being.

• The emotional appreciation of another's The emotional appreciation of another's feelings. feelings.

• - - Hardee, 2003Hardee, 2003

EmpathyEmpathy

• The process of understanding a person's The process of understanding a person's subjective experience - by vicariously subjective experience - by vicariously sharing it - while remaining an observer.sharing it - while remaining an observer.

• NOW WHAT?NOW WHAT?• Don’t stop now... Don’t stop now...

Empathy vs. Empathy vs. CompassionCompassion

• Compassion goes beyond Compassion goes beyond empathy. It includes the empathy. It includes the willingness to take action to reduce willingness to take action to reduce suffering.suffering.

• Even though we have not walked a Even though we have not walked a day in their shoes, being open, day in their shoes, being open, listening and understanding their listening and understanding their struggle as if we HAD. struggle as if we HAD.

• The client's behavior - in the The client's behavior - in the context of their life’s story - makes context of their life’s story - makes perfect sense. It is our choice to perfect sense. It is our choice to find compassion for their suffering, find compassion for their suffering, be with them in it, and assist in be with them in it, and assist in alleviating it. alleviating it.

Compassion and Compassion and PsychologyPsychology

The Merriam-Webster Dictionary The Merriam-Webster Dictionary defines defines compassioncompassion as as “sympathetic “sympathetic consciousness of others' distress consciousness of others' distress together with a desire to alleviate it.”together with a desire to alleviate it.”

According to many sources, the According to many sources, the charge of psychologists is to charge of psychologists is to reduce reduce human suffering. human suffering.

Notice the SAMENESS.Notice the SAMENESS.• Therefore, it is our mission to be Therefore, it is our mission to be

compassionate. compassionate.

Aren't we? Aren't we?

• Consider the Consider the purely purely mechanistic mechanistic approach…approach…

Aren't we? Aren't we?

• …“…“I NEED I NEED you to make you to make contact with contact with the present the present moment!!!”moment!!!”

Functional Functional Contextualism and the Contextualism and the Clinical Agenda Clinical Agenda • Interpretation:Interpretation: Explanation of why people suffer.Explanation of why people suffer.

• Prediction:Prediction: Allows us to predict what people with Allows us to predict what people with certain psychological problems will do.certain psychological problems will do.

• Influence:Influence: Tells us how to change the course of Tells us how to change the course of events so that the individual can achieve a better events so that the individual can achieve a better outcome - This is where the relationship becomes outcome - This is where the relationship becomes important.important.

-Hayes, S., Strosahl, K., & Wilson, K. (2003-Hayes, S., Strosahl, K., & Wilson, K. (2003))

Compassion and the Compassion and the Clinical AgendaClinical Agenda

• ““Compassion is not the relationship between the healer Compassion is not the relationship between the healer and the wounded. It’s a relationship between equals. and the wounded. It’s a relationship between equals. Only when we know our own darkness well can we be Only when we know our own darkness well can we be present with the darkness of others. Compassion present with the darkness of others. Compassion becomes real when we recognize our shared humanity.”becomes real when we recognize our shared humanity.”

• - Pema Chodrow - Pema Chodrow

Compassion and the Compassion and the Clinical AgendaClinical Agenda

““Compassion is the radicalism of our Compassion is the radicalism of our time." time."

- Dalai Lama- Dalai Lama

Compassionate Compassionate IntentionsIntentions

• Finding a way to connect Finding a way to connect with the client. Even the with the client. Even the most resistant client desires most resistant client desires connection. connection. • ““Eyes On” Exercise.Eyes On” Exercise.

• Listening intently to their Listening intently to their stories because there we stories because there we find clues to what matters find clues to what matters most in life to them. most in life to them.

• We listen to their stories to We listen to their stories to find out HOW to make this find out HOW to make this connection.connection.

Soft Reassurance Soft Reassurance

““Soft reassurance” Soft reassurance” is is support for the client from support for the client from a willingness to make a willingness to make contact with the client’s contact with the client’s sense of emotional pain, sense of emotional pain, validate it and normalize it validate it and normalize it without avoiding it or without avoiding it or rescuing the client from it. rescuing the client from it. ((Hayes, S., Strosahl, K., & Hayes, S., Strosahl, K., & Wilson, K., 2003; Wilson, K., 2003; p. 272) p. 272)

Compassion and Compassion and Creative HopelessnessCreative HopelessnessThe effective therapist needs to be willing to step back from the verbal The effective therapist needs to be willing to step back from the verbal

sparring that occurs during psychotherapy, to see words as words, sparring that occurs during psychotherapy, to see words as words, feelings as feelings, and to witness the behavior that is going on in the feelings as feelings, and to witness the behavior that is going on in the room from the point of view of an observer. (room from the point of view of an observer. (Hayes, S., Strosahl, K., & Hayes, S., Strosahl, K., & Wilson, K., 2003; Wilson, K., 2003; p. 270). p. 270).

Even the most ineffective behaviors can be moments of truth. They can be 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 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, about it in a way that stunts well being rather than promotes it (Sanders, 2008). 2008).

Being willing, as the therapist, to see behaviors as JUST behaviors without Being willing, as the therapist, to see behaviors as JUST behaviors without labeling them as bad or good.labeling them as bad or good.

Non- "Expert" StanceNon- "Expert" Stance• A shared struggle: therapists and clients A shared struggle: therapists and clients

are snared by the same language traps - are snared by the same language traps - both personally and professionally - as both personally and professionally - as clients, suffer many of the same clients, suffer many of the same struggles, and can learn much from struggles, and can learn much from each other.each other.

• ACT makes room for the client and the ACT makes room for the client and the therapist to be on the same therapist to be on the same humanistichumanistic playing field.playing field.

• Understanding that the formula for Understanding that the formula for successful living is unique to each successful living is unique to each individual-no right or wrong way to live.individual-no right or wrong way to live.

• ““ACT purposely capitalizes on the ACT purposely capitalizes on the commonality between the client and commonality between the client and therapist to help move the client, and by therapist to help move the client, and by implication, the therapist, forward in their implication, the therapist, forward in their lives”.lives”. ( (Hayes, S., Strosahl, K., & Wilson, K., Hayes, S., Strosahl, K., & Wilson, K., 2003; p. 267).2003; p. 267).

Non- "Expert" StanceNon- "Expert" Stance

• Willingness to refrain from Willingness to refrain from being the “expert”; clients often being the “expert”; clients often resent an expert (recall “Rick”).resent an expert (recall “Rick”).

• Not seeing ourselves as Not seeing ourselves as heroes or superstars. We are heroes or superstars. We are just ordinary people, who go just ordinary people, who go through struggles just like our through struggles just like our clients. clients.

• Learn from your client as your Learn from your client as your client learns from you.client learns from you.

• Two Mountain MetaphorTwo Mountain Metaphor

Present Moment, Present Moment, CompassionCompassion

• If, you are lost in your head If, you are lost in your head figuring out your therapeutic figuring out your therapeutic strategy, you have lost contact strategy, you have lost contact with the NOW of the session. with the NOW of the session.

• If, instead, you attend fully to your If, instead, you attend fully to your client while they share with you client while they share with you their story, their suffering, their life, their story, their suffering, their life, you are in the present moment. you are in the present moment.

Vessels for ChangeVessels for Change

"If we cannot embrace our own "If we cannot embrace our own frightened and vulnerable hearts, we frightened and vulnerable hearts, we cannot love the world. Sadly, we are cannot love the world. Sadly, we are often at war with ourselves." often at war with ourselves."

- Tara Brach (p. vii) - Tara Brach (p. vii) "Opening your heart to compassion "Opening your heart to compassion

and loving-kindness for yourself and and loving-kindness for yourself and then others will help you dissolve then others will help you dissolve feelings of inadequacy, inferiority, feelings of inadequacy, inferiority, and disconnection." and disconnection."

(Flowers & Stahl, 2011; p. 110) (Flowers & Stahl, 2011; p. 110)

Vessels for ChangeVessels for Change

• Reframing the context of myself as Reframing the context of myself as “therapist”“therapist”• What does “therapist” mean?What does “therapist” mean?• Redefining my role as a compassionate non-Redefining my role as a compassionate non-

expert.expert.

• In a psychotherapy session, compassionate In a psychotherapy session, compassionate behavior by the therapist would increase if behavior by the therapist would increase if reinforced by the client and clinically relevant reinforced by the client and clinically relevant gains or extinguished when not reinforced. gains or extinguished when not reinforced. You are more likely to be an agent for You are more likely to be an agent for change when you “join” your clients. change when you “join” your clients.

Vessels for ChangeVessels for Change

• If we are successful, helping our If we are successful, helping our clients to make sense of their clients to make sense of their lives helps us to be more lives helps us to be more compassionate.compassionate.

• It reinforces the idea that this is It reinforces the idea that this is what we are called to do.what we are called to do.

Compassionate Compassionate IntentionsIntentions““For [these] interventions to function the way that For [these] interventions to function the way that they are meant to function, the therapist must be they are meant to function, the therapist must be willing to enter into a relationship with the client that willing to enter into a relationship with the client that is open, accepting, coherent, and consistent with is open, accepting, coherent, and consistent with ACT principles.”ACT principles.”((Hayes, S., Strosahl, K., & Wilson, K. (2003, pHayes, S., Strosahl, K., & Wilson, K. (2003, p. 268) . 268)

Revisiting "Rick" Revisiting "Rick" - The case of “Rick” from Bach and Moran, 2008, pg. 116- The case of “Rick” from Bach and Moran, 2008, pg. 116

ConclusionConclusion

• To be compassionate is to be blessed with a To be compassionate is to be blessed with a burden: To contact our pain and suffering burden: To contact our pain and suffering allows us to show up more completely for our allows us to show up more completely for our client.client.

• To be compassionate raises basic issues of To be compassionate raises basic issues of values, meaning, and self-identity.values, meaning, and self-identity.

• When entered into compassionately, the When entered into compassionately, the relationship with the therapist and client relationship with the therapist and client model the purpose and nature of ACT.model the purpose and nature of ACT.

References.References.Bach, P, and Moran, D.J., (2008). Bach, P, and Moran, D.J., (2008). ACT in Practice. Case ACT in Practice. Case

Conceptualization in Acceptance & Commitment TherapyConceptualization in Acceptance & Commitment Therapy. . California: New Harbinger Publications. California: New Harbinger Publications.

Flowers, S. & Stahl, B. (2011). Flowers, S. & Stahl, B. (2011). Living with Your Heart Wide Living with Your Heart Wide Open: How mindfulness and compassion can free you from Open: How mindfulness and compassion can free you from unworthiness, inadequacy and shame.unworthiness, inadequacy and shame. California: New California: New Harbinger PublicationsHarbinger Publications

Fox, E (2005). Fox, E (2005). About contextualismAbout contextualism. Retrieved April 8, 2008, . Retrieved April 8, 2008, http://www.contextualpsychology.org/about_contextualism

Hardee, J.T. (2003). Hardee, J.T. (2003). CPC Corner: An overview of empathyCPC Corner: An overview of empathy. . Retrieved April 15, 2008, Retrieved April 15, 2008, http://xnet.kp.org/permanentejournal/fall03/cpc.htmlhttp://xnet.kp.org/permanentejournal/fall03/cpc.html..

Hayes, S., Strosahl, K., & Wilson, K. (2003). Acceptance and tance and commitment therapy: An experiential approach to behavior commitment therapy: An experiential approach to behavior changechange. New York:The Guilford Press.. New York:The Guilford Press.