The Self-compassion Workbook for OCD: A Book Review

by Dr. Lisa McLean

I am someone with lived experience of obsessive-compulsive disorder (OCD), a psychologist working with many clients similarly impacted, and with a strong leaning towards compassion-based interventions, so I really looked forward to reading Kimberley Quinlan’s new book, The Self-Compassion Workbook for OCD.

Quinlan is a licensed Marriage and Family therapist, and Clinical Director of the OCD Center of Los Angeles. She specialises in treatment, advocacy, and education for OCD and eating disorders. This is the author's first book on the topic, and the first one I am aware of that directly centres self-compassion as a core component of OCD treatment. This resource offers a user-friendly guide to understanding the core concepts of both OCD and self-compassion and offers practical strategies for augmenting traditional Exposure and Response Prevention (ERP) treatment, with self-compassion. Quinlan outlines a four-step process for ‘self-compassionate exposure and response prevention’ whereby connecting to your compassionate self is identified as the important first step.

To the frustration of those who genuinely experience OCD, the term has become over-used and diluted in general conversation; “I’m so OCD I have to have all my cushions organised a certain way”; “I’m so OCD, I have to make sure my fingernail polish matches my toes.”  However, it is not OCD unless you believe that by not doing these things, something catastrophic will happen to you or your loved ones and it will be all your fault, or you are unable to leave the house or focus on any other task because the cushions are never ‘just right’. Quinlan does a great job of explaining in simple, clear terms, the core mechanisms and impacts of OCD. She also identifies a number of OCD subtypes that form the focus of obsessions. This includes less commonly discussed subtypes such as paedophilia OCD, sexual orientation OCD, existential OCD, sensorimotor OCD, and hyper-responsibility OCD.

OCD is what psychologists call ego-dystonic, which means acting against your own beliefs or will. This is the most sinister and distressing part of experiencing OCD. Your mind identifies your highest values and worst fears and then uses them against you, causing relentless worry that your fears may come true and/or you will act against your values. Constant vigilance is therefore demanded. The author of this workbook quite rightly identifies OCD as a trauma experience, which causes constant activation of the threat system and creates relentless imagined scenarios of terror.

The Self-Compassion Workbook for OCD cover states “use powerful self-compassion techniques to break through the stigma and shame of OCD”. People who experience OCD will often try to hide their obsessive thoughts and compulsive responses. This results in experiences of shame, secrecy, self-judgement, and self-criticism. Therefore, it makes intuitive sense that a therapeutic approach specifically targeting these internalised experiences will be of benefit.

ERP, which requires deliberate exposure to someone’s worst fear, whilst resisting engagement in the compulsive behaviour that offers short-term relief, can be a very challenging and confronting experience. It requires a lot of courage, commitment, and wisdom, which of course are the core qualities of compassion-focused therapy. In The Self-Compassion Workbook for OCD, the author further identifies six core concepts of self-compassion that will help change the way people impacted by OCD can respond to themselves. These are 1) equality (we are all equal in worth and deserving of compassion); 2) mindfulness, 3) warmheartedness, 4) wisdom, 5) acceptance of imperfection, and 6) compassionate responsibility.

Together with these concepts, the author introduces a number of self-compassion practices, including Compassionate Self, Self-Compassion Break, Compassionate Letter Writing and Compassionate Body Scan. For those who are familiar with Compassion-Focused Therapy you will be aware that the core therapeutic work relates to overcoming fears, blocks, and resistances to compassion. Quinlan similarly identifies and addresses what she refers to as common roadblocks to compassion such as ‘I am not worthy of compassion’, and ‘self-compassion could make me lazy or self-centred’.

The Self-Compassion Workbook for OCD offers brief case studies presented at the start of the book and then used throughout. This provides concrete examples of the application of the concepts. It is also written in a way that provides readers with opportunities throughout the workbook to self-reflect and develop their own ERP challenge list and plan, with helpful prompts and space to write directly in the workbook. It also incorporates a range of exposure practices, including flooding exposure, imaginal exposures, and interoceptive exposures.

Prior to engaging in these practices however, Quinlan helps readers develop skills in self-compassion before proceeding with ERP. Self-compassion is considered a necessary pre-requisite for orienting the mind to respond to the experience of OCD with a sense of warmth, support, and kindness towards the self, and to utilise as a valuable resource in responding to anxiety, uncertainty, and discomfort that inevitably, and necessarily, arise when engaging in ERP treatment.

Overall, The Self-Compassion Workbook for OCD provides a valuable contribution to helping people who are impacted by OCD to offer a self-compassionate response to the distress and suffering they are experiencing, and use this response as the foundation for treatment and recovery. Unlike other books on OCD, Quinlan prioritises self-compassion as a core component of treatment. As someone who understands how relentless and distressing obsessive thoughts can be, and the ultimately futile cycle of compulsions that offer desperate attempts to neutralise them, Quinlan’s book is very welcome. It offers a way for readers to change the way they relate to their OCD symptoms, as well as themselves, and offers a hopeful path to recovery, in an accessible and easy-to-follow format.   

This article originally appeared in the CMA newsletter. You can subscribe to the newsletter here.

Radical Compassion by Tara Brach: A book review

by Dr Helen Correia

It’s interesting to read a book on a topic I have been referring to in practice for some time. So, in picking up Radical Compassion by Tara Brach, it was helpful to bring a beginner’s mind to the reading, to step back from a practice I thought I knew and open up to the wisdom behind the practice. Tara Brach is an internationally renowned meditation teacher, author, and clinical psychologist who for decades has been supporting the integration of meditation-based practices in psychotherapy. She also founded the Insight Meditation Community of Washington, DC in 1998, and together with Jack Kornfield runs courses internationally in mindfulness and compassion, including a Meditation Teacher Certification Program. 

In Radical Compassion, Tara Brach leads us through some steppingstones to compassion through her version of RAIN
Recognise what is happening
Allow life to be just as it is
Investigate with a gentle curious attention
Nurture with loving presence

I have always found this a very accessible practice - for clients and myself in moments of suffering when emotions are high. The easy to remember RAIN practice is a step-by-step guide that lays out a path towards compassion, where we can apply the wisdom of our experience in a way that helps the moment of difficult experiences to flow and ease. 

I have found it most comforting in my darkest moments of grief. I Recognise the heartache, turning towards it with courage to notice how I experience it in mind and body. I breathe into the experience of the present moment, letting go of the struggle and Allow the tears to flow in their own rhythm. I tune in and listen with wisdom and understanding, gently Investigating as my heart tells me how my grief defines what I value and what I need. I respond to my experience with warmth, Nurturing with gratitude what I have gained as much as grieve what I have lost. 

In those moments, RAIN brings together the history of compassion that my mind and body have learned. 

Radical Compassion is divided into three parts. Part 1 of the book walks us through the practice, acknowledging the traps and resistances we can get caught in as we bring awareness to our moments of struggle. Self-reflective questions are weaved throughout the book, to support insight, understanding, wisdom, trust, and providing comforting responses to questions that perhaps many of us have asked ourselves at some point (such as “How do I know if I’m deluding myself about my wise or future self?”).

Part 2 steers us towards our difficult emotions and experiences, recognising that “the beginning of freedom is to bring healing attention to our shame” and awakening us from the grip of fear. Here there are familiar practices of nurturing the seeds of feeling safe through body and breath, compassionate words, and imagery practices. Radical Compassion is not structured as a manual or workbook, the style is more an experiential narrative of Tara Brach’s use of RAIN, with regular invitations to apply and engage in different practices. I appreciated the personal, student, and client accounts that brought these practices to life, as I explored the many ways I could use RAIN. 

Part 3 invites us to extend the RAIN practice to our relationships, and this was where the chapters resonated most.  The book was first released just before the pandemic became global and the themes are salient in a world that seems increasingly defined by division. The RAIN practice is explored through navigating trickier relational issues such as healthy anger versus the trance of blame, and how our mind in threat can dehumanise and turn people into “Unreal Others”. It explores implicit biases and racial divides and how they can limit our compassion. The RAIN practice helps to bring an understanding as to why we hold tightly to blame and makes salient the gift of forgiveness and the steps towards it. It invites us to recognise the humanity in others and through compassion allow another to become “real” to us. One chapter in Part 3 tunes our practice to seeing the basic goodness in others and in ourselves, to transcend bias. I feel we need to remember this now more than ever. 

If you are new to the RAIN practice, or to compassion, the book is a simple yet powerful entry into how to be with ourselves in times of pain, difficulty, struggle and how to learn from what we notice and tend to ourselves in those moments. If you are a seasoned mindfulness and compassion practitioner, some parts will feel familiar. Yet there are still opportunities to extend our RAIN practice, to step out of our busy lives and cravings to discover our deepest longings, to investigate “What matters most in this life?”. 

Tara Brach’s website has a range of resources including a sample of the book (Chapter One) and you can request a study guide to help explore the practice. You can listen to a brief RAIN practice (12 min) or explore further practices at https://www.tarabrach.com/rain/

This article originally appeared in the CMA newsletter. You can subscribe to the newsletter here.

Compassion as a Process (Part 2)

Image by Dr Gráinne Schäfer

by Professor Paul Gilbert

In Part 1 I discussed the central importance of courage and wisdom in compassionate action. Now I would like to address the six competencies that help us to engage, turn towards and process suffering and six that underpin how to take wisdom. The therapist develops these for themselves but also helps the client develop their own competencies. To help us engage with suffering we need to be motivated do it, able to be sensitive when suffering arises, be emotionally moved by suffering, able to tolerate those experiences, make sense of them using empathy and be accepting rather than condemning. When it comes to action we need to switch our attention to what is likely to be helpful, run scenarios in our mind about what's likely to be helpful, use our reasoning skills, then take appropriate actions, work with our bodies so that we can then tolerate whatever feelings arise from appropriate actions according to what is needed. This is captured in the diagram.

The key to the whole therapeutic process, is that it's orientated through a compassionate perspective, a genuine desire to be in touch with suffering and to have an empathic insight into its basis. This leads to finding the wisdom for healing, for prevention, and for coming to terms with that which cannot be changed.

Slightly adapted from Gilbert & Choden (2013, figure 4.3)

These basic processes can be used in many different contexts. For example, think of how we deal with conflicts with people we love or even those we don't. In CFT there are three domains for relational processes that are helpful in achieving personal autonomy and confidence. These focus on assertiveness, apology and forgiveness. Consider each of these in the context of the above diagram.

In a relationship it's important to be clear and, as much as possible, be honest about what is going on with one’s own needs and feelings but to also have the courage and wisdom to realise that relationships are two-some’s not one-some’s. In other words, we need a focus on the other and not only on ourselves. 

Assertiveness training has helped many depressed people who may be avoidant of conflict, submissive and frightened of presenting their own values and needs. However, assertiveness trainers have always been sensitive to the fact that we're not training people simply to be selfish egotists and making demands regardless of the other. So, our assertiveness needs to be compassionate and sensitive to the mind of the other but not submissive. 

Clearly, a lot of close relational conflict is based on disappointment and as flawed human beings’, things can be said or done that are hurtful. So, forgiveness becomes extremely important for both small and large things. Such forgiveness requires the courage and wisdom to work with the forces within oneself that might not want to forgive and repair or might even want to be vengeful or ruminative. There is now flourishing research on forgiveness therapy.

We also need the courage and wisdom to realise that we too can be harmful particularly when we feel upset or hurt. Or, when we are overstressed, we can strike out and become aggressive and then justify our hurtful actions. We need courage and wisdom to enable us to simply notice that we are fallible human beings, not to turn it into an opportunity for a major self-beating up but to learn how to apologise and acknowledge without feeling diminished.

In conclusion, we take a motivational orientation to compassion rather than trying to list a limited set of qualities because there are a range of processes that are involved in compassion that vary according to context. As we come to understand these processes and how they vary from situation to situation and from client to client we can be clearer on how to root therapy in compassion motivation. At its core, is the motivation to address suffering and prevent it and to do it courageously and wisely. This is the same orientation for both the therapist and the client.

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Here is a link to Paul Gilbert speaking on courage and compassion on The Mindful Living Show. 

This article originally appeared in the CMA newsletter. You can subscribe to the newsletter here.

Courage and Wisdom are at the Centre of Compassion - Part 1

by Professor Paul Gilbert
 

In the last 30 years, there has been an explosion of interest in the science of compassion on what it does to our minds, bodies, brains and social relationships. The motive for compassion is to address suffering, being sensitive to suffering and turning towards it, not away from it. Second, we need to respond wisely otherwise we can make things worse. When we move towards suffering and take steps to address it, we need the key qualities of courage and wisdom. These qualities are at the centre of compassion and Compassion Focused Therapy (CFT) and are necessary for understanding how to develop the competencies for courage and wisdom. 

Compassion is not one thing; it is very much linked to contexts. People can be good at one aspect but not another. For example, if you are a firefighter or COVID worker, wise courage is essential if you are to pursue your intention to save people from dying. But the counsellor working with the bereaved relatives of those who have died will need different competencies and skills and these may not be not interchangeable. The same is true in psychotherapy. Clients with different problems may need different types of courage and wisdom, too. 

We might think that compassionate action requires a calm mind, this is certainly a mind we want to develop, and that helps us in many contexts. But those desperately working on a COVID ward in the conditions that they were in were not in a calm mind, but they possessed a mind that was sufficiently in control to follow through with their intention to save their patients. Courage is not fearlessness. Courage is the pursuit of intention in the face of fear. Indeed, COVID clinicians were able to continue working while feeling frightened, angry and sad with the unfolding tragedy around them and maintaining their dedication is the mark of courage.

To engage in compassionate action, we need to build a mind and a body that can pursue our compassionate intentions without being forced off the road by our threat responses: fight, flight, and freeze. Equally, we require insight into what is needed and the courage to act on it. COVID-19 clinicians, for example, need to know a good deal about respiratory medicine. Part of the role of psychotherapy is to help clients discover 'a good deal about how their minds work' so that they don't engage in actions that make their difficulties worse. Their courage is guided by wisdom. Hence, as therapists, we support our clients to engage with their pain and difficulty and to face their pain and difficulty with courage and dedication. 

There are different types of courage and there are different types of wisdom, which can be very contextual. You may be a brave firefighter but not an empathic parent, or a very empathic therapist but not a brave firefighter. We can identify particular personality styles that are more oriented to certain types of compassion than others and how that links to the organisation of the autonomic nervous system. 

The autonomic nervous system has two branches, the activating (sympathetic) and the settling, soothing and deactivating system (parasympathetic). Research shows that people who are generally orientated to compassion and kindness have a good balance between these systems. Those who struggle are more likely to be sympathetic dominant while the settling and soothing aspects of the autonomic nervous system are less available to them. This is why in CFT we spend a lot of time helping clients develop part of the parasympathetic system called the vagus nerve. 

Any intention will require a body to follow through. You may want to climb a mountain or run a marathon, but you are unlikely to succeed if you are unfit. So, getting a fit body is necessary to use the skills of climbing or running. Today researchers have identified a range of brain systems, neurotransmitters, and patterns in the autonomic nervous system that supports compassion motives. There is increasing interest in developing interventions to target these physiological systems and this knowledge will help us build a better picture of how to cultivate courage and wisdom.

In part 2 of this blog, I will discuss the twelve different competencies associated with engagement that each play a role in courage and wisdom.

This article originally appeared in the CMA newsletter. You can subscribe to the newsletter here.

How I Learnt Self-Compassion and How I Help Other Doctors to do the Same

Image by Gráinne Schäfer

by Dr Ira van der Steenstraten

Going through medical school in the late 1980’s in The Netherlands meant that I was taught the medical model and the focus of my training was illness- based. We were continually trained in new evidence-based treatments, which gave me a toolkit with a wide variety of treatments for my patients. I trained as a psychiatrist and psychotherapist, but nowhere in my training was I taught self-compassion, something I only discovered relatively recently. Fortunately, I am now a more self-compassionate person, and I am passing my knowledge onto other doctors.

I have always been very interested in strength-based approaches; how could I help my patients to improve the quality of their lives whilst becoming independent from me. I think this approach was influenced by my own experience as a chronic patient, being born with a severe bleeding disorder. I was missing a blood clotting factor that caused spontaneous internal bleeds, mostly in the joints, leading to pain and immobility. From the moment I could speak, I had to learn to read my physical symptoms and react to it appropriately; a skill I now recognise as mindfulness. Treatment meant intravenous administration of the missing clotting factor, which was done at the hospital until I was 11 years old. After that, I leaned to administer it myself which allowed me to become more independent.

I dealt with my condition in a mixed way, on the one hand I did not talk about it much, trying to ensure it would not prevent me from doing things. Of course, this would not always work out and often I had to admit my ‘defeat’ when a joint bleed prevented me from doing what I wanted to do. On the other hand, I learned to appreciate the moments when I was not in pain so much more; I experienced gratitude. Now I realise how important this gratitude has been for my mental wellbeing, and in making me a person with a very positive mindset.

My bleeding disorder has led to severe osteoarthrosis and arthritis. In my twenties I had the painful knees of a ninety-year-old and I was considered a chronic pain patient. But during my medical training, like so many other junior doctors, I found it hard to speak up when physical complaints were bothering me, I would rather just battle on. Like many other doctors I exhibited a personality style that is prone to having little self-compassion: hardworking, conscientious, reliable, self-critical, and perfectionistic. These characteristics can make you a good doctor when focusing on patients, but not on yourself. Working in a hierarchy for years under, sometimes, very critical and uncompassionate supervisors, ensured that taking care of myself was not high on my list of priorities.

However, after finishing my training and becoming a consultant psychiatrist, overcoming medical obstacles getting a double knee replacement and becoming a mother helped me to accept my vulnerabilities better, as Brené Brown would say. David Roland interviewed me a couple of years ago for his book “The Power of Suffering” and this made me reflect on the coping skills I had developed over the years. I think accepting our vulnerabilities also means becoming more self-compassionate, it might be a big part of the same process.

In 2008, I came to Brisbane, thinking it would be for a sabbatical of one year after which I would go back to my psychiatry practice in The Netherlands. But now, 13 years later, my family and I are still here, and I have focussed on the prevention and early intervention of mental health problems. I started a Life Coaching company, Breeze Life Coaching. The Australian Medical Association Queensland (AMAQ) asked me to develop a wellbeing program for junior doctors in response to the 2013 report by Beyondblue that showed the absolute shocking numbers of mental health problems in medical students and doctors. I knew immediately that this suited me. We did a systematic review to see what components should be in such a program, but I knew it would also be valuable to incorporate my personal and professional experiences into the program.

Queensland Health decided to make it available and mandatory for all Queensland interns from 2017 to complete the program. To date, I have presented the program ‘Wellbeing at Work’ (previously called ‘Resilience on the Run’) to over 4000 interns across Queensland. The feedback has shown how important it is to the interns that I understand from my experience what can be perceived as obstacles to selfcare. There is evidence that mindfulness is very helpful but over the years I have also included other practical, evidence-based strategies and I think cultivating self-compassion is one of the most important of these. I find that Professor Paul Gilbert’s Compassion Focussed Therapy model works well to explain the importance of self-compassion to analytical and self-critical minds.

My first real encounter with the self-compassion movement was when I attended a University of Queensland Compassion Symposium. I was excited to present the details of my program at the symposium a year later. I also jumped at the opportunity to attend a masterclass by Professor Paul Gilbert. All I could think was, how much I wished he had written his books 30 years earlier. Thinking back, I realise that most of my patients, especially those in psychotherapy, had suffered from low self-compassion. I wish I could have had the tools then, to help them more effectively.

I am excited for the future and I hope the ongoing research into self-compassion will equip us with greater understanding and tools. In my current role as President of the Queensland Medical Women’s Society (QMWS) I recently arranged a Self-Compassion Masterclass for medical women by Dr Marga Gooren. I plan for my next project to help young people to become more self-compassionate. Finally, being part of the management committee of Doctors’ Health in Queensland (DHQ) enables me to ensure that fostering more self-compassion in all doctors will be high on our list of priorities.

Thank you all for your interest in this important field and I hope to maybe work with you some day!

This article originally appeared in the CMA newsletter. You can subscribe to the newsletter here.

“Culture eats strategy for breakfast!” Using visual arts to facilitate self-compassion in Aboriginal and Torres Strait Islander peoples

In the organisational psychology literature, there’s a phrase that’s sometimes used: “Culture eats strategy for breakfast!” Culture eating strategy for breakfast is what we found when we first tried to run compassion focused therapy (CFT) groups for Aboriginal and Torres Strait Islander peoples (hereafter respectfully referred to as Indigenous Australians).

At the start of the project, we were well aware of the need for cultural relevance and adaptation. So we held several preliminary meetings with Indigenous health workers. Our aim was to make the CFT materials and strategies culturally appropriate. After the health workers’ feedback we made a number of adaptations to standard CFT materials – made them more visually appealing, made the concepts more culturally relevant, using some Indigenous examples etc. But ultimately the groups were predominantly wordy and verbal - like most groups in a therapy context (including CFT groups) tend to be. The usual “sitting around in a circle talking” way of doing CFT groups didn’t translate well to the Indigenous Australian context.

We were pretty concerned after these first groups. What did we need to do? One thing we did was carefully listen to the feedback from group members. A couple of them said: “Why don’t you try art?” So after a big rethink, we teamed up with some local community artists, and channelled compassion skills training through the medium of art.

Second time around, the difference in response was extraordinary! Instead of the groups’ “threat systems” being activated by all the “wordiness”, art facilitated the group members “soothing systems”. There was lots of humour, laughter, fun and joy – as well as participants’ favourite music on Spotify.

The groups had a three-part structure:

• 20 minutes of introduction to the topic of the day by the psychologists;

• 2-3 hours of art focused on the topic of the day – and a tasty lunch together;

• 30 minutes showing, discussing and reflecting together on our art and its meanings.

Examples of artwork created by the group members

Each week introduced a different aspect of compassion (e.g. safeness, the three circles, the three flows of compassion) which became the focus of the art for that week. Typically while doing their art, group members started informal conversations. This enabled them to engage with compassion in an easy, non-threatening way, giving and receiving compassion in the process. The images above, used with permission, are examples of the artwork.

At the end of 2020, we published a paper in the journal Frontiers of Psychology describing the arts-based group and its impact on group members. It can be accessed here. Not only was bringing art into compassion focused therapy something new in the CFT world. We had recognised the wisdom of the members of that first CFT group - and had taken on the understanding that when it comes to working outside of majority cultures, culture does indeed eat strategy for breakfast!

James Bennett-Levy & Natalie Roxburgh
University Centre for Rural Health, The University of Sydney

Reference: Bennett-Levy, J., Roxburgh, N., Hibner, L., … Gilbert, P. (2020). Arts-Based Compassion Skills Training (ABCST): Channeling Compassion Focused Therapy Through Visual Arts for Australia’s Indigenous Peoples. (2020) Frontiers of Psychology, 11, 568561.

This article originally appeared in the CMA newsletter. You can subscribe to the newsletter here.

Forgiveness

Image Credit: BenteBoe from Pixabay

Edited extract from ‘The Power of Suffering’ by David Roland (Simon & Shuster, March, 2020)

Trauma inflicted by another adds an extra dimension to our recovery. If we react in an eye for an eye manner we become what we abhor. When the action of the perpetrator is criminal, the law of the land replaces the immediate vengeful response and passes judgment and rectification in a more considered way. But, the actions of the law do not necessarily liberate those who feel wronged from feelings of personal vengeance. It is up to the person to find release. I am reminded of the story of Mary Johnson, an African American, from Minneapolis, Minnesota.

Mary lives in the apartment adjoining the home of 34-year-old Oshea Israel and they share a porch. She assisted him to become her neighbour. In February 1993, the then 16-year-old Oshea shot Mrs Johnson's son, Laramiun Byrd, 20, in the head after an argument at a party. Laramiun died as a result.

Mary wanted justice. "He was an animal. He deserved to be caged," she said at the time. Oshea served 17 years in jail for second-degree murder before being released.

However, before his release and ten years after the murder Mary, at her Pastor’s suggestion, began to pray for Oshea like she prayed for herself. Her Pastor said, ‘Every time his name comes up, every time you hear it within yourself, say, ‘I choose to forgive.’

Mary did this and she began to change. Oshea, maturing, also changed. In 2005, Mary contacted the Department of Corrections requesting a face-to-face meeting with Oshea. The meeting lasted two hours and they learnt a lot about each other. At the end of the meeting they hugged.

‘I instantly knew that all that hatred, the bitterness, the animosity, all that junk I had inside me for 12 years, I knew it was over with. It was done. Instantly, it was gone,’ Mary has said.

Thich Nhat Hahn, the Buddhist monk and Noble Prize nominee, has said, ‘When you look deeply into your anger, you will see that the person you call your enemy is also suffering. As soon as you see that, the capacity for accepting and having compassion is there.’

 ‘Unforgiveness is like cancer,’ Mary has said. ‘It will eat you from the inside out. It's not about that other person, me forgiving him does not diminish what he's done. Yes, he murdered my son - but the forgiveness is for me.’ This is a deeper level of connection with oneself, posttraumatic growth; I think. Mary and Oshea now travel the country speaking about the power of forgiveness.

Research has pointed to forgiveness of a personal transgression requiring a spiritual element, a going beyond of how we ordinarily think. Dr Fred Luskin, a psychologist and director of the Stanford University’s Forgiveness Project has said that this level of forgiveness, like Mary’s, is more common than most people would imagine and that those who have long practised a forgiving attitude are more likely to be able to forgive.

The Forgiveness Project has developed a nine-step secular training using proven psychological techniques. One of the steps is described as, ‘Remember that a life well lived is your best revenge. Instead of focusing on your wounded feelings, and thereby giving the person who caused your pain power over you, learn to look for the love, beauty and kindness around you. Forgiveness is about personal power.’

But we don’t need to experience the degree of trauma that Mary Johnson lived through to benefit from forgiveness. We can engage it in more generally. During my recovery from stroke and PTSD, I had hard feelings towards those whose actions I found harmful. But, after a time, I realised that focussing on these feelings fed more resentment and hindered my progress, sucked on my personal power.

I turned to a loving-kindness meditation drawn from Buddhist practices. First I cultivated loving-kindness for someone I easily felt love for, usually my daughters, then I focussed the loving-kindness on myself, then on a neutral person and then a difficult person. I did this practice daily for months. I didn’t understand it then, but I would now explain it as cultivating the affiliative/soothing system.

Remarkably, my resentment towards difficult people softened, without altering the details and import, in my mind, of their transgressions. It didn’t change them directly, but it changed me. This is forgiveness for oneself, I think.

Forgiveness for the other, as Thich Nhat Hahn describes it, requires seeing the other’s suffering. Early in my career my work as a prison psychologist had caused me to wonder many times, if I had grown up in the circumstances the prisoners had, would I have ended up in prison? A child or young person doesn’t get to choose their parents or their life circumstances and we don’t get to choose the upheavals that life unexpectedly throws at us but we do get to choose what we do with them.

David Roland is a committee member of Compassionate Mind Australia, and worked for over twenty years as a clinical and forensic psychologist. He is the author of ‘How I Rescued My Brain, and the upcoming title ‘The Power of Suffering’.

Is Shame an Inevitable Legacy of Childhood Sexual Abuse?

Image credit: pixabay

By Lisa McLean

I work with adult survivors of childhood sexual abuse.

As I sat with a client reflecting on her therapeutic journey, affirming all the wonderful progress she had made as a result of her courage and commitment to change there was one comment I could not shake from my mind. “I no longer believe that I am to blame for what happened to me. I mean, I still have the feeling of shame, but I know it’s not my fault.  I guess that feeling will never go away, but I feel like I can live with it better now.”

It was not the first time I had heard this sentiment from clients.  Shame felt like the last, immovable barrier to healing. But I was discomforted by the off-handed way my client said it was something she would have to live with, as though the transferred ownership of shame was an inevitable legacy. The fact that she knew she was no longer to blame despite the persistence of shame, did not seem like a satisfactory consolation prize to me.

There had to be a way to shift even this most deep-seated shame, internalised since childhood, and reinforced by patriarchal social and cultural messages of victim blaming. I could not accept this as the fate of survivors of childhood sexual abuse. Thankfully, I discovered the healing power of self-compassion.

Initially, I was drawn to the work of Dr Deborah Lee.  I will never forget the feeling of hope, excitement, and discovery whilst reading her book Recovering from Trauma using Compassion Focused Therapy (CFT)[1] and thinking ‘this is it; this is the missing piece of the therapeutic puzzle!’. Lee even validated the words of my client referring to the ‘head-heart lag’, where there is a discrepancy between what clients know in their head and what they feel in their heart. I was passionate to learn more.

CFT was developed by Professor Paul Gilbert. He defines compassion as “the sensitivity to suffering in self and others with a commitment to alleviate and prevent it “ [2]. Gilbert recognised the potential of compassion to counteract the debilitating impacts of shame and self-criticism and developed CFT specifically for this purpose.  

The evolved function of shame is to alert us to the potential social threat of being rejected by our ‘tribe’ due to violations of social and cultural norms.  As Dr Lee explains, “This social threat is highly linked to the experience of shame, disgust and humiliation. This means that we may believe that ‘who we are’ has been contaminated or damaged by our traumatic experience, or we may fear that other people will think less of us if they were to know what happened to us or what we went through”[3].

Shame can significantly impact our sense of self-worth.  It can convince us that we are ‘less than’ in some way and that we are at constant risk of rejection. It can very hard to offer self- compassion if we do not believe we are worthy of it.  It can be harder still if we have no (or limited) experience of receiving it, which is often the case for survivors of childhood sexual abuse.

The process of cultivating self-compassion is therefore not as simple as telling someone to ‘just be kinder to themselves’.  It is not enough to rely solely on rational, cognitive processes.  For many survivors of childhood sexual abuse, their sense of shame and trauma symptoms are not just something they ‘know’ in their mind but feel it in every part of their being. Therapeutic responses therefore need to be similarly embodied and offer survivors an alternative way for them to experience being with themselves.

Through the use of breath, body, and imagery practices as well as information to help provide a context and explanation for their trauma symptoms, compassion cultivation is able to target both the head and the heart.  Through the lens of self-compassion survivors not only understand cognitively that what happened to them was not their fault, they are able to genuinely respond to themselves and all they have experienced with a sense of warmth, empathy, care, courage and wisdom, rather than shame, judgement, and criticism.

I now run CFT-based group programs for adult female survivors of childhood sexual abuse. This format provides an additional benefit of reducing isolation and allowing the flow of compassion to expand to the giving and receiving from others. Kristin Neff[4] identifies one of the core elements of self-compassion as shared humanity, an awareness that we are not alone in our suffering. When shame has evolved to make us fear rejection from the tribe, the experience of acceptance, non-judgement, and belonging offers a powerful alternative story. As Brene Brown[5] explains, shame survives on secrecy, silence, and judgment, but if you douse it with empathy (and compassion) it cannot survive. In a group context, survivors can lift the veil of secrecy and silence, feel heard and understood without judgement, and receive and offer empathy and compassion to each other. 

A recent message from a participant (reproduced with permission) highlights the journey from head to heart, and the feeling of being released from shame and self-blame.

Loving my Self is no longer a string of words that I recite at a therapist’s suggestion. But a reality. I am worthy. I am good. I am not the problem nor the reason for all the trauma. AND I NEVER WAS. 

We do not have to accept shame as an inevitable legacy of childhood sexual abuse.

Compassion is the antidote.  

Lisa McLean is a registered psychologist, current PhD candidate, and Compassionate Mind Australia committee member.

[1] Lee, D. (2012). The compassionate mind approach to recovering from trauma using compassion focused therapy. London, UK: Constable & Robinson Ltd.

[2] Gilbert (2014) Gilbert, P. (2014). The origins and nature of compassion focused therapy. British Journal of Clinical Psychology, 53(1), 6-41. doi:10.1111/bjc.12043, p.19.

[3] Lee, D. A. (2012, p. 65). 

[4] Germer, C. K., & Neff, K. D. (2013). Self-compassion in clinical practice. Journal of Clinical Psychology, 69(8), 856-867. doi:10.1002/jclp.22021

[5] TED Talk, Listening to Shame: https://www.ted.com/talks/brene_brown_listening_to_shame/transcript?language=en

Self-Compassion and Parenting an Emerging Adult

By Dr Hayley Quinn

Photo credit: Hayley Quinn

When I brought my baby home it felt daunting, overwhelming and such a huge responsibility. Would I be a good parent? Would I do what was right for this beautiful little human? Was I ready to be a caretaker of another life? People were ready with advice, often helpful and at times not asked for or welcomed. There were 1000s of books espousing how I should raise my child, and parenting classes I could attend.  If he were born today there would be online forums abounding. Somehow I managed to find my way through the parenting maze picking out parts that aligned with who I am and how I wanted to raise my little human. 

Fast forward two decades …. and that beautiful little human who was so dependent on me and absorbed much of the focus of my life is all of a sudden (it passes so fleetingly, far too quickly, it’s almost cruel) an emerging adult. He may have been taller than me for many years now but he was still reliant on me. Now he is making his own decisions, about what’s important and what he likes. Over the last few years, I have had to start a process, again, of redefining my role, stepping back enough so he can emerge but not too much so that he no longer knows I’m there for him. More recently the time has come for him to move out of home. How do I now fit into his life? How do I redefine my own life after such a significant role in someone else’s? What does this mean for my own identity? Where are the people, now, ready with advice? Where is the information to reassure me that what I am feeling is normal?

There’s a voice inside of me, you know, the one that whispers to you throughout this parenting journey. Did I do it ok? Have I damaged this beautiful human? Did I teach him what he needs to brave this world? Have I taught him enough to love himself no matter what? At times that voice becomes loud with self criticism, highlighting all the things I wish I could go back and change. The times I was dismissive, got irritated and angry, did something one way and then found out it wasn’t helpful.

How do we manage when the self critical voice is the loudest in the room? I have learned, in my personal and professional experience, that when we slow down, use our breath to engage our parasympathetic nervous system, we can be in contact with a mind that is grounded and calm, a mind reflective of a system that is soothed. We can turn down the volume on the self critical voice and hear the compassionate voice that resides within us. This may be a voice that you have never listened to before or only rarely. We can train our minds to be more compassionate, and develop the skills of self compassion. I have worked with many clients who knew all too well the voice of self criticism and have now come to know the voice of self compassion.

I noticed a deep sense of sadness, as I was going about my business other day, I stopped and gently placed a hand over my heart. I asked myself in a soft and gentle tone “Why are you so sad my darling?” As my breath settled into a soothing rhythm I heard the words “You are grieving, this is a time of letting go. Just know it is all going to be ok. You’re both going to be ok”. If you notice the heavy feeling of sadness, and you hear the self critic berating you, try engaging in a soothing rhythm of breath. I invite you to take a seat for a moment, adopt an upright posture with your feet on the floor and your shoulders gently back to ensure an open diaphragm.  I now invite you to bring your attention to your breath, just gently noticing the rise and fall of your breath. As you slow down your breath with an equal in and out breath, allow your breath to find it’s own soothing rhythm. Notice how your body feels. Now I invite you to gently place your hand on your heart and notice how that feels, perhaps a sensation of warmth. As you think about your role as a parent, a carer, a mother, or father, of a beautiful little human, who is now emerging into adulthood, stepping further away from your close embrace, listen to the words of your inner wisdom. Listen to the soft tone of your compassionate self.  Perhaps it will remind you that you are in a process of grieving, maybe it will offer you words of comfort like you have done the best you could within the circumstances you were in. If you are struggling to hear this inner voice, remember it will develop with practice. In the meantime go gently with yourself, and remember that you are finding your way.

 Go well and go gently.

Dr Hayley Quinn is a Clinical Psychologist in private practice, and President of the Compassionate Mind Australia Committee.