Compassionate Intentions in the Psychotherapy Setting

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Compassionate Intentions in the Psychotherapy
Setting

• M. Joann Wright, PhD Jonathan Rhodes, MA

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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)

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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. Ive been
  thinking about the thing for a year and cant 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
  wouldnt 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
  didnt 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 Im the one
  who looks like a loser. I was driving home just
  thinking, Im such an asshole nothing is ever
  going to change. And I couldnt 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? Nothings
  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 its still like nothing
  is ever going to change. Im always going to
  screw up. Whats the point in staying off of the
  marijuana? Its 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

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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

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Empathy

• The process of understanding a person's
  subjective experience - by vicariously sharing it
  - while remaining an observer.
• NOW WHAT?
• Dont stop now...

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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
  lifes story - makes perfect sense. It is our
  choice to find compassion for their suffering, be
  with them in it, and assist in alleviating it.

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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.

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Aren't we?

• Consider the purely mechanistic approach

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Aren't we?

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

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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)

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Compassion and the Clinical Agenda

• Compassion is not the relationship between the
  healer and the wounded. Its 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

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

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Soft Reassurance
Soft reassurance is support for the client
from a willingness to make contact with the
clients 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)
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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.
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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).

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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

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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.

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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)
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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.

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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.

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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
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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.

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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_contextu
alism Hardee, J.T. (2003). CPC Corner An
overview of empathy. Retrieved April 15, 2008,
http//xnet.kp.org/permanentejournal/fall03/cpc.ht
ml. Hayes, S., Strosahl, K., Wilson, K.
(2003). Acceptance and commitment therapy An
experiential approach to behavior change. New
YorkThe Guilford Press.