CFT Made Simple: A Q+A with Russell Kolts

Editor’s Note: The following is a Q&A with Russell Kolts, PhD, author of CFT Made Simple: A Clinician’s Guide to Practicing Compassion-Focused Therapy.

Tell us a bit about your journey to learning and ultimately teaching compassion-focused therapy.

As I mentioned in my TEDx talk, I have always struggled with anger and irritability, and when my son came along, it became clear to me that I needed to make some changes if I was to be the sort of father I wanted my son to have. As I was searching for how to do this, I happened to read a book about his Holiness the Dalai Lama called The Wisdom of Forgiveness. This led me to read a number of other Buddhist books, which ultimately led to my pursuing a three-year period of intensive Buddhist practice; meditating one or two hours per day, reading books and texts, going to retreats, learning sadhanas and practices. I set aside my scientific skepticism and threw myself into Buddhism because these methods seemed to produce a certain type of person – the type of person I wanted to become.

After three years or so, my Lama was pushing me to do more practices focused on the time of death, which re-awoke my scientific skepticism as I don’t particularly believe in rebirth. At this point, I reflected on the previous three years, which in many ways had been deeply transformative for me. While I’m still a work in progress, I looked a lot more like that father and person I had hoped I could become. And in reflecting on what had transformed me, although there were inevitably numerous factors involved, it was the compassion practices that stood out.

At this point, I felt that I couldn’t ethically continue to be a psychologist without bringing this compassion stuff into my work. While I’m a mediocre scientist at best, I’m enough of a scientist to be uncomfortable with simply reaching into a spiritual tradition, plucking out some of the practices I like, and applying them in the therapy room. Convinced that I couldn’t have been the only psychologist that had ever had this revelation about the role that the purposeful cultivation of compassion could have in the therapy room, I started looking for others. And that led me to Paul Gilbert.

In compassion-focused therapy (CFT), Paul had drawn upon numerous bodies of science that told the story of why compassion could be so transformative, and had built a coherent therapy model out of it. Seventeen years of teaching introductory statistics to social science majors had shaped my ability to articulate somewhat challenging concepts in clear and understandable ways, so writing a book like CFT Made Simple seemed to be a good fit for me. 

In your TEDx talk you said “we have to discover new ways to be strong.” What does that mean to you, in terms of compassion-based approaches to well-being?

I think I might have been more correct had I said “we have to discover what it really means to be strong.” In looking at our cultural characterizations of “strength,” it seems that many of the ways we understand what it means to be strong are based in the avoidance of uncomfortable feelings and situations.

Think of the phrase, “the strong, silent type,” which equates strength with a lack of communication about emotion. What is strong about that?

Many of us feel that crying means we are weak, when it is really just a physical manifestation of the fact that we are allowing ourselves to feel difficult emotions. What is weak about that?

I think we’ve confused strength with the unwillingness to feel or appear vulnerable; that we’ve confused being strong with feeling strong. Does hurting someone else rather than making the effort to understand their perspective make us strong? Does beating ourselves up for having normal human emotions make us strong? Does being unwilling to feel the normal human emotions that come up in all of us sometimes make us strong? I don’t think so. I think those things make us weak.

Anger is interesting in that it can function either as a primary threat response or as a secondary emotion that quickly follows other experiences like shame or fear. The primary role is why it is associated with feelings of strength — because as an evolved response, it is activating our bodies and minds in ways that orient and prepare us to fight.

But for most of us, anger may show up more frequently in that second way — as a secondary emotion — a substitute for more vulnerable-feeling emotions like shame, fear, or sadness. That doesn’t seem like strength to me. It seems like a way of running away from the things that make us uncomfortable. I can’t tell you how many times I’ve heard people say they use anger to avoid feeling sadness or fear; because it feels strong to them, and fear and sadness feel vulnerable.

To me, strength is reflected in the willingness to courageously face whatever arises in our lives and in our minds; to not let our comfort or discomfort dictate what we do, but rather to have our motives and behaviors dictated by our values. That’s why I see compassion as true strength; because it involves directly turning toward and looking very deeply into sources of suffering in ourselves and in the world, even though doing so means that we will likely feel uncomfortable or vulnerable. It’s not about us, or how we appear. It’s about being willing to help, even when helping is hard. Especially when helping is hard. 

What would you say to someone who feels intimidated by having to learn a whole new model on top of the model(s) they’re already using? Is CFT compatible with other therapeutic models?

I’d suggest they dip a toe in and see how they like it. And if they like it and find something that is helpful, maybe go a little deeper, bit by bit. The whole focus of CFT Made Simple was to organize CFT into a set of processes and practices that could be easily understood and dipped-into a bit at a time, individually, with the potential for the clinician to take things as deep as they’d like to go.

In terms of compatibility with other models, I don’t see anything in CFT that is incompatible with other evidence-based therapy approaches. That said, when people dive deeply into CFT, they might find themselves understanding and potentially approaching the things they already do in different ways, even as they learn new things that can potentially enhance and expand their existing clinical repertoires. Ultimately, though, I don’t know that my opinion on this matters so much. I’d encourage people to try it out and see what they find. My guess is that they’ll be pleased by what they discover.

CFT is based on evolutionary science which ultimately implies that many of the things we struggle with are basically not our fault but simply a result of human evolution. How do we balance this truth with also taking accountability for our actions and living according to our values?

The whole idea behind the ‘not your fault’ pieces of CFT is to help free people up from shaming and attacking themselves on the basis of things they didn’t choose or design, so that they can take responsibility for the aspects of their lives that they do have some influence on. We allow ourselves to be informed by our observations of our histories, but the focus has to be forward-moving. For instance, “given _________, what would be helpful?”

We can’t do that if we’re constantly lost in a cycle of beating ourselves up for things we didn’t choose to begin with. Even the poor choices we’ve made that have led to suffering in our lives of those of others occurred within contexts — systems of causes and conditions — in which they made sense. So rather than making our life narrative about punishing ourselves for those poor choices, can we instead focus on the changes that need to happen to facilitate the making of better choices in the future?

Why is CFT particularly good for clients who struggle with shame-based difficulties?

Because it addresses the causes and conditions that maintain their shame both explicitly and implicitly. The therapeutic relationship creates a context of relational safeness, and models compassionate ways of relating to the self and to one’s experience, so that the individual can get a sense of a different way in which they can approach their challenges. CFT facilitates a set of realizations and understandings about the human condition that directly undermine the sort of blaming processes that contribute to shaming attributions, and can help the client see their motives, feelings, and behaviors within a context in which they make perfect sense. 

We work to help the client have a nonjudgmental, mindful awareness of their experiences, so that they can work skillfully with them instead of mindlessly reacting to whatever thought or emotion shows up (like shame).

Finally, CFT features an extensive repertoire of compassion-based practices that can be used independently or in conjunction with other therapeutic strategies to directly undermine the toxic effects of shame and self-criticism — including bringing compassion to the shame itself (the version of the self that is convinced that s/he is bad).

One challenge that we’ve heard clinicians say they struggle with is knowing how to communicate with their supervisors and managers about the use of compassion-based therapies; they express fear that they will not sound scientific enough or that they will be unable to articulate clearly why compassion is an empirically-sound option for healing. What advice would you give to someone in this situation?

I’d recommend that they do a bit of homework first (like reading CFT Made Simple!), so that they can consider how the understandings and practices of CFT can apply to their cases, and can articulate these things to their supervisors or managers. It’s very easy to get really excited about something and want to dive right in, but babbling to our supervisors about how great compassion is without having a specific understanding of how and why it is likely to be helpful to our clients probably isn’t going to be very convincing. On the other hand, being able to bring in a specific example of how it might be applied helpfully to this client in this situation is much more likely to gain the confidence of a skeptic.

While I can’t prescribe any one method that’s likely to win over all supervisors, I’d approach it the way I do when doing compassion-work with people who are likely to be resistant to it (which I do a lot). Try to find a way to link it with their experience, or what they value. So if I had a supervisor who was deeply committed to our interventions having empirical support (which I hope most supervisors are), I might bring in a paper or two that documents the growing body of evidence surrounding compassion interventions to share if it seemed like it might be helpful. In any case, I’d want to know enough that I could not just articulate that I want to bring a compassion-focus into my work, but a little bit about specifically how to begin doing that, and why I think it would be helpful. I think most supervisors would respond to that.

During your workshop at ACBS this year you talked about the role compassion can play in work with members of society who are particularly difficult to feel compassion for. Can you give an example about an unlikely situation in which calling upon compassion could be useful and why?

Sure. Let’s take the gun debate. On either side of that debate, you’ve got people who are deeply entrenched in their views, and deeply threatened by their perception of the perspectives, motives, and agendas of people on the other side. So people who like guns see folk who are for gun-control measures as wanting to take something away from them, robbing them of their means of protecting themselves from those who might seek to harm them. On the other side, gun-control people can see pro-gun folk as insensitive to gun violence and championing policies that continually perpetuate a cycle of tragedy.

But I bet if we were to get a group of these folks together, help all of them feel safe, and give everyone in the room the chance to express their thoughts and feelings about the situation, we’d discover a lot of amazing things. If we were willing to really listen, we’d likely see that both sides’ perspectives make complete sense within the contexts in which they’ve been socialized and currently exist. We’d likely see that their motives aren’t so different from our own. The desire to protect themselves and those they care about, for example. And if we felt safe enough to really consider their perspectives, rather than getting caught up in defending our own, we might even find our own views shifting a bit, or at least might be more invested in finding common ground that worked for everyone.

This can only occur when we’re willing to face discomfort, recognize and be moved by the hurts and fears and suffering that show up on both sides, look deeply into the struggles so as to understand the causes and conditions that produce and perpetuate them, and then be willing to act from a motivation that seeks to help; not just me and mine, but all involved. That’s what compassion is about.

In your opinion, how and where does compassion fit into the psychological flexibility model of acceptance and commitment therapy?

I don’t know that much about ACT, but I love what I know of the psychological flexibility model, and although we use a bit different language, I think it’s safe to say that CFT talks about many of the same dynamics. Where an ACT therapist may understand that certain relational frames (frames that CFT would likely anchor in experiences of threat, for example) are associated with insensitivity to context with a corresponding narrowing of behavioral repertoires, the CFT therapist might be more likely to discuss things in terms of the way threat emotions are associated with a narrowing of attention, reasoning, and mental imagery, leading to threat-based motives and related (and narrowed, threat-focused) behaviors. But so much of what we seek to do is the same; creating shifts (by assisting the individual to see their experience from a compassionate perspective, for example) that open our clients to new ways of relating to their experience, and a broader awareness of both this experience and the ways in which they could respond.

You may understand compassion as a relational frame that allows an individual to broaden their perspective around their suffering, soften to it, hold it lightly, and be more flexible in pursuing their values, or as a motivation-driven process that allows them to approach their suffering, help themselves feel safe, and ask, “what would be helpful in working with this?” Either way, we can see that approaching our suffering with warmth, kind curiosity, and a helpful motivation can be a powerful thing.

Unfortunately, I’m not familiar enough with the psychological flexibility model in ACT to say much more than that – hopefully I didn’t get it wrong!

In CFT Made Simple, you write about the six attributes that are purposefully cultivated through CFT. How do clinicians measure their clients’ progress in cultivating these qualities?

Historically, I think much of that assessment has occurred informally, through discussions with clients and observations of their behavior in and out of sessions. Are they doing a better job of noticing when they struggle (sensitivity)? Do they find themselves responding to their struggles with sympathy and understanding (empathy), rather than harsh criticism (non-judgment)? Is their behavior increasingly motivated by a desire to help themselves or others (care for wellbeing), rather than a desire to limit their exposure to uncomfortable feelings and situations (distress tolerance)?

However, Paul Gilbert and a number of researchers including myself have recently developed a measure of the three flows of compassion (self to self, self to other, other to self) that aims at directly assessing these attributes. We’re in the process of publishing the measure, so I hope that in the near future, clinicians will be able to use it as well.

For more about learning and practicing CFT, check out CFT Made Simple.