← Compassion in a T-Shirt
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- [00:01]
A
Hi, I'm Dr. Stan Steindl. Welcome back to Compassion in a T Shirt, where we explore the science and practice of compassion and how it can transform lives. Today we're diving into a fascinating topic, Compassion Focused Chair Work. And to help me unpack this, I'm joined by Dr. James Hackley. James is a clinical psychologist at the University of Manchester and Greater Manchester Mental Health NHS Foundation Trust. He completed his PhD under the supervision of Dr. Tobin Bell, who is also a previous guest on Compassion in a T Shirt. They focused on how chair work can help people with depression connect with their ideal compassionate other. His research explores how this unique intervention can help people with depression step outside their usual patterns of self criticism and experience care in a deeply personal and embodied way. We'll be talking about how chairwork brings compassion to life, how it helps navigate fears and blocks to self compassion and what all this means for therapy as well as everyday living. Oh, and you can find a link to his paper, which is open access. Seeing Myself through someone else's. Embodying the perfect nurturer in Compassion Focused Therapy in the journal obm, Integrative and Complementary Medicine, co authored with Alison Dixon, Carol Royal, Christopher Moss, Richard Brown and Tobin Bell in the description below. Just a note, we had some Internet connectivity problems and so while the audio is fine, the video is a little bit jumpy. So if you've ever struggled with self criticism and found it hard to connect with kindness for yourself, then this episode's for you. And so I bring you Dr. James Hackley. Sounds great. All right, well, Dr. James Hackley, welcome to Compassion in a T shirt.
- [02:04]
B
Thank you for having me.
- [02:05]
A
I'm keen to talk about your paper which I've mentioned in the introduction, but I actually wanted to start because I mentioned to you a moment ago that the, the first few paragraphs there in that paper actually really capture a very nice sort of summary, almost like an elevator pitch of CFT and what it is. And I wondered if you could maybe start there. You sort of mentioned the definition, the social mentality theory, some of the practical skills in cultivating the compassionate mind and the fears, blocks and resistances. So yeah, what is cft?
- [02:45]
B
That's a big question. And it's, I think when writing the paper is what I realized it was really tricky to write about because there's so much integration that takes place with cft. But in short, so it's a. It's a psychological therapy, it's a psychological model. It's often conceptualized as a third wave cbt. It is in the UK at least Paul Gilbert, the creator of cft, says that, you know, it's a psychological model. It's not, not, not a CBT model. So it's based on evolutionary theory. And I think this is really a key point of it and that it really normalizes a lot of what goes on in the mind as being part of the mind of what we've inherited from the past, of what we haven't chosen. And it integrates attachment theory and neuroscience and various other strands of theory to create what I think is a really sort of all encapsulated model. One of the key theories involved in CFT is the social mentality theory. So social mentality theory talks about or it's the idea that we have certain processing systems that we've evolved over time that help us to coordinate relationships with others, that help us to form what he calls reciprocal roles. And the idea here is that humans have biosocial goals that we evolve. So for caring, care seeking, care eliciting, and in order to form these social roles, we need social processing systems that help us to form them. And these are based around certain motivations and they organize the mind. So for example, for a child, when a child is distressed and it needs care, needs input from an adult, a child automatically has certain processing systems that signal the needs, signal care needs, so that caregivers can respond. And the idea with these processing systems that help us to communicate is that they impress upon the mind of the other that they influence the mind of the other. But of course, then in order to have a reciprocal role, the other person in this. So the parent or the caregiver needs to be able to be competent at detecting those signals as well and responding to them. So the social processing systems the Gilbert talks about that help us to do this, he calls them social mentalities. And social mentalities is a really important part of CFT because he speaks about sort of certain amounts of caregiving and care receiving, cooperating. But he also talks about a rank based mentality. And this is the one that we really think about in CFT quite a lot, rank based mentality. And the idea of this is when we're sending and receiving social signals is that we're always outside of conscious awareness, sort of weighing up whether or not we can trust someone, whether they're more or less powerful than us, or whether they're a friend, whether they're foe. So all this happens very automatically and it has implications for the way we feel in the moment, for the motivations we feel, and for how safe we feel in A relationship. So social mentality theory is really important actually. And actually it's so difficult, I think, to understand that it's not spoken about as much as it should be in cft because CFT is relational. But if you read the books about cft, sometimes the self help book, sometimes they don't tap into that relational aspect. And there's something that stayed in my mind with that Gilbert spoke about. He says if people are in a rank based mindset and you try to do cognitive challenging, they're going to experience that as a threat rather than as something that's soothing. So we need to tune into what sorts of mentalities are in play during the therapy. So another important component of CFD is the three systems model of emotion. So Gilbert uses a functional analysis, an evolutionary functional analysis of emotion and neuroscience research to cluster emotions based on their evolved function. So he speaks about having sort of three systems, which it is a. It's a heuristic, it's a simplification, but it's a useful heuristic in therapy. I think clients certainly respond to it quite well when I've used it with them. But these three systems correspond to threats, threatened defense. So where we're sort of looking out for signals of threat and how to respond to them, we have the drive system, where we're looking out for resources and we're motivated and enthusiastic, we're seeking goals. And then we have the soothe system, which is where it's called the rest and digest system. But it's where we're in a state of non wanting. We're in a state of being able to. The the term that seems to resonate with clients when we talk about this is being able to let your guard down. Being able to just let your guard down, relax. I think what's important to mention with the soothe system as well is that there is a distinction between safety and safeness. And this is something I talk about with clients as well. And that you can be safe from harm. That doesn't necessarily mean that you're content and safe. So I think so in an imagery practice I did with one client, they had themselves on the top of a hill so they could look out and see where the dangers were. They're not fully relaxed, then their guard wasn't down. They were sort of still vigilant for danger in that particular imagery practice. So we had to sort of rejig the practice a little bit to get them into a place where they felt safe. The reason why soothe system is so important is because it regulates the Other two. So we try to boost the soothe system in CFT to regulate threat and to regulate drive and to bring balance between the three systems. And ultimately one of the ideas is that states of distress can be brought about by imbalances in these systems. Often clients will have a very large, sort of symbolically very large threat system, maybe a slightly smaller drive system, but quite large and very small soothe system. So the idea is to bolster the soothe system. I think the other key part of CFT that's worth mentioning is the tricky brain. So I quite like the concept of the tricky brain. We have the new brain and the old brain. And again this is part of the normalizing of the de shaming, sort of the philosophy of deshaiming that's involved in cft. And it's that we have this old brain with motives and emotions that we share with much of the animal kingdom. But we also assume we have this new brain that is capable of imagining the future and replaying the past. And the sort of. The example Gilbert uses, as if a deer escapes a lion, he'll look around, realize the line is no longer there. He'll return to grazing and relax and be calm again. Whereas human beings have all these thoughts such as what if there was two lines? What would have happened if the lion caught me? And we can get in these loops, we call them loops where new brain processes stimulate old brain emotions and motives which again stimulate new brain thinking. And we get in these patterns that perpetuate the stress. So they're the sort of key parts. And then we have compassionate mind training which involves breathing exercises and mindfulness and then experiential exercises which we're going to talk a little bit about today. But ultimately it was designed for people with and for people who are experiencing high levels of shame and self criticism. And the idea is to cultivate compassion, you have to step into these care based mindsets.
- [09:59]
A
Beautiful mate. I mean that, that is a really great sort of snapshot of, of some, some pretty complex and comprehensive aspects to cft, isn't it? Like you said, it's not an easy one to, to really sum up and you did, did a wonderful job. But, but yeah, the social mentality theory that that notion of, of humans as social beings and, and so exist in relationship with others and then the way that the external can also become internal and then we sometimes start to have those same relationships with ourselves, sometimes through the social rank starts to come in as self criticism and then that can lead to the sort of the psychological distress that you're Talking about how can we cultivate the compassionate mind. And your study really starts to look at that through combining, I suppose, compassionate imagery and chair work. People can sometimes struggle with imagery, I've noticed in my own clinical work, and you allude to this in the paper too, that might chair work be your way in to help people to really sort of work with and play with and sort of explore the idea of imagery around a compassionate other. So what is chair work then? How would you kind of sum that up and how does it fit, I suppose with within cft.
- [11:35]
B
So chair work's got a long history in therapy, in the therapeutic arena. So it started with Jacob Moreno and he spoke about a concept called surplus reality. And he wanted people to play out their fantasies using chairs. I mean, I suppose I should say to begin with is so, so it's, it's using chairs and movements between chairs for therapeutic ends and dialogue between different, different parts of ourselves. So, so, so in terms of a basic theory, chair would say that the mind is a society of mind. It's made of multiple parts, sub personalities and so on. And that these different parts, if you, if you separate them out, they can communicate with one another. So, so Jake Moreno started with chair work and he wanted to he the nice quote, he says to bridge the gap between inner and outer worlds, which I think is quite nice quote. And then Fritz Pills sort of took it on and he. Another nice quote from Fritz Pills was, you know, it's not enough to talk about our experiences, we have to psychologically return to them. And there's something about Chairword that allows people to do that. So in Chairwood generally there's certain set pieces you'll play out and you might put. So a really common one is putting the critic on the chair and going and embodying the critic. But we can also, there's certain set pieces that involve speaking to people from our life or from our past. So Chowak is really versatile, can use it in a lot of formats and actually I use it quite in my, in my own work, just in small moments. If you see someone enact a rank based mentality in the moment, if they get really self critical, you can just swap seats with them, do what they just did. So you sort of role play what they did and then you can see how they react. And usually they have, goodness me, I'm, I'm being really mean to myself. And they can see it from that perspective, but not when they're in the original chair. So chair work involves a lot of movement between chairs. It involves embodying different parts of ourselves or different people from our past and creating dialogue between these different parts in cft, I suppose that the sort of the Tobin called it. Tobin Bell, who you had on. You've had on before on your podcast to. Well, calls CFT and Cheru a match of theory and practice. Because, again, CFT also views the mind as multimodal. It's made up of different brain states, different parts that. And I think this is the key really, that at time conflict, and when there is conflict between these parts, it can be very disorganizing. And I think it's sort of a common conflict, might be one between getting along or getting ahead, you know, so if we work and a colleague asks for help, something that we know about, and there's a little bit of an internal conflict there of whether we want to be competitive, whether we want to be caring. So CFT and chair, it seems to fit together quite nicely. I think another part of CFT that Gilbert talks about is that we can be encapsulated in certain mentalities or certain self parts can dominate experience, internal experience, and in share, we can again use it to separate out these different parts and to embody different parts and build up sort of different representations of self that might be sort of down regulated or shut off from experience because of threat processing. So in cft, the distinctive part of CFT chair work is building up the compassionate chair, which will involve the client embodying the compassionate attributes, and then sitting in a chair and trying to direct compassion to different strands of experience of different parts of the self. There's a few set pieces again, which sort of Tobin's led on researching. So you've got this sort of compassion chair, compassion sharer for self criticism, where we have this critic there. And this is a really nice exercise because we're not trying to sort of get rid of the critic or to. To sort of cognitively challenge it away. We're trying to understand it. We're trying to understand the emotions that are behind it, the function that it's serving, often a protective function. And we're trying to understand its origins. And by. By using chairwork and sort of activating these. These sort of implicational cognitive structures, this deeper processing. It seems to bring all that stuff to the surface. It can be really useful. But then you have a multiple self chair with where you separate all the different emotions into different chairs and you have them converse with one another. And then we have the one, the one that Tobin and I did, which is where we embody the compassionate other. So it's really useful. It's sort of, it's quite powerful. I think this is the thing with Chad that always strikes me. It's very powerful. It's emotionally evocative and often at the end of therapy if I say to clients, you know, what was the, where was the turning point for you? And that they, a lot of the time they say it was when we did chair work.
- [16:32]
A
Yeah, yeah, right. Yeah. It's so interesting.
- [16:34]
B
I.
- [16:37]
A
I've sort of talked before about how my grandmother got me into psychology actually, and, and she was a GP back in the day and, and she introduced me to Carl Rogers On Being a Person was, was one book. But she also was really into Fritz Pearls at the time and for a reason. I'm not sure I, I really gravitated towards Carl and. But she was certainly very kind of interested in Fritz Pearls and did a lot of work with couples and you know, sort of did the chair work as well and some of the gestalt sort of approach she, she used and so on. And you've reminded me I must, I must dive back into some of Fritz's work as well. But it's powerful stuff. I agree with you that, that kind of, that, that agility in a way, that therapist agility to, to sort of, you know, sort of notice something and then bring movement in and shifting about and moving chairs or swapping chairs and that, that ability to create a different perspective and to actually feel something different, to even have a different perspective on the critic, not so much to then become critical of the critic because that would be, you know, the, the dragon eating its own tail or something, but to have that kind of compassionate understanding of the critic and where it arises from in the social mentalities, in the social rank stuff in amongst the threat and drive or whatever it might be and, and, and being able to work with it. Your study did try to use chair or did effectively use chair work, but more around sort of developing a sense of a compassionate other and often an imagery practice that we might use. Developing the compassionate other using imagery with the eyes closed and so on. But how did you actually. Yeah, just explain the exercise and how you brought those two together.
- [18:45]
B
So with the compassionate other imagery exercise. So it's some of the theoretical things we spoke about before is sort of tapping into them. So we're trying to develop a caring image so we can shift people into care based mentalities, but we're also using these new brain competencies to generate signals of caring. And so the idea sort of initially with the imagery practice is that you generate an image or you build an image in the mind of someone who's sort of perfectly caring or it's a perfect nurturer, another researcher has called it perfect nurturer. And sort of this image embodies all the compassionate attributes and the compassionate qualities. And sort of a question that I tend to ask clients is, you know, when you have a problem, what is it you need in that moment from someone to give you support, feel good, what are the needs that are going on met? And people begin to construct this image. And the process of that's quite interesting because first of all you sort of tune into who people are picking and often people find it tricky to identify someone. Sometimes people identify self critical, compassionate elders, which of course is counting productive which sort of gives you an insight into how, how married they are to certain beliefs. Self criticism is positive sort of meta beliefs that it's doing something good for them. You construct this image and this image can be sort of anything people want it to be. It can be a character from a book, it can be an animal. The idea really is that it's as long as it's sentient and it can communicate. And then you identify a problem that the, that the client's having and then you try to get them to imagine this image offering them care. And again, the idea here is that it's sort of, we're imagining signals of caregiving through the image with the aim of sort of stimulating a care receiving mindset. So we're helping them to step out of rank based mentalities. That's sort of the key aim. So we did it through chair work. So again that the construction of the image followed the same processes as it would for the imagery exercise, well then, rather than have people sit still and close their eyes and imagine the image, which people can find pretty tricky by the way, and there's another study that supervised and they found that when people struggled to generate the image, they actually became self critical. So it's important to establish with clients whether or not or how easily they're finding it to create this image. Of course the image doesn't need to be perfect, it's more of a sort of a sense. But, but yeah, important to know. And then so once we had the image build up, we introduced the third chair and we asked clients to go and become their image. So I don't know, an example of one might be. Well, example one was Mrs. Doubtfire. So okay, quite, quite, quite nice. And this sort of motherly, maternal joker, loving and Quite humorous character. So they went and they sat there and they, they said to them, so how do you feel now? What you notice is different. Where do you feel the motivation and the care and the, and what sort of thoughts are going through your mind now you're this, now you're Mrs. Doubt by, you know. And then we would ask them to look at themselves in the original chair, experiencing the distress. And again the idea is who were trying to imagine them picturing signals of someone who is in need of care. So generate those care basement, that care based mentality to cultivate it. And then so they would give care back to themselves in the original chair. Of course the chair's empty, but it's. This is where the imagery comes in. Then we would have them move back to themselves and we'd explore with them how it felt to receive that care and the compassion. And then you move between the chairs a few times to see how to see how they experience it, to see, to see what's going on for them. And again, something I forgot to mention at the start is this is of course tapping into different, what we call flows of compassion. So in one chair here, we're enacting the giving of care. So a sort of other or self to other flow of compassion. And then we're asking them to flip over into the chair and be. Receive that compassion. And that's important because we know that people have different problems with different flows. People can have the three flows from self to self, from other to self and self to other. They're correlated, but not perfectly, which means there's different processes involved. So we're trying to get them to enact these different flows. And then we explore it. We explore the experience of giving and receiving care and what shows up for them. And of course what often shows up for people is problems. There's difficulties of giving in which. Which I think you did a paper on. Fears, blocks and resistances to compassion. Yes. Yeah, yeah.
- [23:40]
A
There's a really great table in your paper, Table two actually that I would draw people's attention to it really. It steps through what you just described. Really, you know, the, the. There's eight steps in the table, I guess, but yeah, I have it up on my screen. But it did stand out to me as a really useful table because it just sort of steps out. Exactly what we're trying to do when using chair work with the compassionate other. We're trying to identify a problem and sort of develop a sense or an image of the compassionate other. We imagine them in that other chair we then change seats to embody that compassionate other. We. We then sort of offer compassion to ourselves in the other chair, or the image, I suppose, of ourselves in the other chair. At some point, we swap back again and think about what it feels like to receive that compassion. It is really a great example of where those flows of compassion really are flowing, aren't they? They flow back and forward. And in some ways, self compassion is partly receiving and partly giving. I suppose, you know, those two elements are there in, in self compassion.
- [25:00]
B
Yeah, yeah, yeah. Well, in self compassion, you're Same as self criticism in where you're playing out both roles. You know, you're part of those roles and self criticism, you both, the critic experience the anger of the critic and the disappointment, but you're also the criticized and feel beaten down. So it's the same with this compassion. So in this exercise, what I like about it is really we're trying to tap into all three flows of compassion, and that means we can. We can explore the experience of all three flows in one exercise. So I think one of the big findings from this really was that people or therapists who think of this as not just an intervention. Sorry, there's some angry drivers peeping, not just as an intervention, but as a. As an assessment tool as well. You know, it's. It's yielded a lot of information for formulation.
- [25:47]
A
Yeah, absolutely. It's sort of. We're sort of, as the therapist, we're listening, we're observing. We're kind of listening with our ears and our eyes trying to notice. Yeah. What. What information is coming back in terms of the three flows, the fears, blocks and resistances. But also, you know, sometimes the. The wisdom is profound, isn't it? When people really engaging with the exercise and moving into the chair of the compassionate other and then start to talk about, you know, what, you know, offering sort of ideas to the. To the suffering self or whatever. The, the wisdom that that kind of arises is. Is really very impressive.
- [26:28]
B
Well, that's one. That's one thing I really love about doing this sort of with. With clients is that they know. They know what they need. You know, once you get them sort of moving around and into a different mindset or into a different perspective, then they can see what they need. They have the answers within them, but it's difficult to see it. You know, we all know if we're sort of swamped in sadness or very anxious, it's hard to look beyond that perspective. And what Chairwix seems to allow people to do is to move beyond Their perspective. And so really we're not. We're not then telling clients what to do or what they need. They're moving into these different positions, seeing their distress, and then they're generating the responses themselves. And that's what I think is really powerful about this, is that then they're modeling exactly what they need to do outside of therapy and beyond therapy.
- [27:16]
A
Yeah, that's the power, in a way, of the chair work itself, isn't it? Is that it creates the structure around which sort of allows and invites and helps to bring to the surface that. That intuitive wisdom that Paul also talks about. It's sort of just a mechanism of guided discovery. We're not necessarily. Not necessarily the ones to give the wise words, but rather create this experience whereby the client might discover those things for themselves. One of the key themes from your research was care that feels real. Can you just sort of share a bit about that or what that might mean? How the chair work and. And the compassionate other chair work was really experienced by some of those participants.
- [28:12]
B
Yeah, so this was an interesting theme, and I think the reason why it interested me a lot because this is. Was the one that surprised the participants. Aha. So they sort of. When you ask people to do chair, they sort of look at you as a few, you know, asking them to do something really bizarre, which in a way you are. And. But then it's really powerful. And this is what clients spoke about. So they sort of said that when they went and became that compassionate other, they noticed this shift, this internal shift, as well as sort of. So they physically moved, but they noticed different motivations arising, which again, really taps into CFT theory, into the social mentality theories. So all of a sudden they noticed the motivation to care for someone else arising within them. They noticed that they had feelings towards this person in the chair who of course, was them experiencing this, experiencing some distress. But they also spoke about sort of mentalizing in a way, as we would when we're giving care. So they were sort of thinking or focusing on this other person. So they had all these experiences that really made them feel as though they were this other person caring for someone else. So that was. So they'd access to a social. Sorry, a caregiving social mentality. But then when we asked people to. To go back to the original chair, they spoke about it in the sort of. In the converse. They said, well, I really felt like someone's caring for me.
- [29:34]
A
Yes.
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B
They felt like there was someone there. And they sort of. People spoke of a warm presence. They said they felt like they were in dialogue and that they were receiving new communication. I think this is the key part really. It was stuff that they sort of beforehand hadn't been able to generate patterns of thought and feeling they hadn't been able to generate before. So they felt like they were receiving it. And ultimately a lot of the participants said, you know, I felt soothed. After I did feel soothed, I felt calmed. So, so it would sort of what we can take from that is that this sense that we, we seem to have activated sort of a caregiving and care receiving mentality that formed of a successful reciprocal role between just themselves playing out. I think what's important to note in this is that clients as well, and this is something again to note for therapists is if they noticed that they shift when they got into these care based mentalities, it probably tells us they were in a rank based mentality beforehand. So without sort of knowing that this shift took place and without moving, without the moving and sort of exploring this, then again that risk of sort of clients remaining in a sort of threat type of processing and that blocking of the work is there. So I think that was another sort of implicit finding of that theme. But yeah, clients thought, clients really experienced a sense of caring for someone else and they really experienced a sense of being cared for even though it was just them in the room sort of doing the exercise.
- [31:00]
A
Yeah, I really loved that in the findings. The way that, you know, the reciprocal piece that you were saying, the two directions they were literally able to shift with their body and with this kind of motivation and feel, the caregiving and then the care receiving just sort of kind of arise. I mean they, they, they were participants who were fairly well versed in cft, I think. And this was a single session, chair work session that was then, you know, you interviewed the participants to explore their, their experiences. But it, but you know, when, when sort of timed right I guess in the treatment plan, it can have these really. They used words like genuine or authentic and, and you know, the, the feeling there was, was very real.
- [31:52]
B
Yeah, yeah, it was, it was interesting. It's interesting. And I think again the participants were surprised by it. That was really what I quite liked when.
- [32:05]
A
One of the comments that stood out for me. And it was when you, in the theme one care that feels real, one of the clients or the participants said, I got a bit emotional at one point, which I felt a bit stupid for because I'm not actually this person I've chosen and so on. And it was just, yeah, I think that was what you were alluding to before, when we really listened to, to the client and their experience of things that, that they'll, they'll give you information. I mean, is that fears, blocks and resistances arising there, do you think, or, or is it something else?
- [32:42]
B
No, I mean, I think, I think so. It's in this exercise a lot of. I think it is a fear, block and resistance. So they, they were sort of self conscious. It's not resistance. I think in the, in the usual sense of how we talk about them in cft, this was more clients felt very silly about doing the exercise at first. So in the third theme we talk about this, they sort of, they felt an uncomfortable self consciousness at the prospect of having to play out these things. And I think again, this is what one of the, one of the outcomes from this really was for therapists was to sort of normalize and anticipate this. So the clients, you might say this might sound a little strange. Do you mind giving something a go? So you're sort of anticipating it. But I think also there may be something in there about three blocks and resistances in a typical sense of how we discuss them in cft. And I think this is something, the exercise really brought these out. So people found it really tricky to give care to themselves and to allow themselves to receive it. And again, often people might see this as, as well, it is a challenge, but they might see it as a problem. But it's not a problem per se because in CFT we want to identify FBRs, these fear stocks and resistances. So when this stuff showed up, it was important stuff and it's, it's something to be explored and to be formulated in therapy rather than a problem per se.
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A
Yeah, yeah, I appreciate that.
- [34:14]
B
And that was a fear of block and resistance coming up.
- [34:16]
A
Yeah, well, but I like how you have differentiated it because I think not everything is sort of literally fears, blocks and resistances to compassion. In some ways that was a block to the chair work, feeling self conscious and so on, which I guess starts to remind us again of the social rank kind of side of things and the self conscious emotions and embarrassment or, or sort of even shame potentially arising, which isn't directly a fear or block or resistance to compassion, but it's obviously very related because of the self consciousness that's arising there and the self criticism that I guess comes out of that self consciousness, which we do often find actually that self criticism can be a block to self compassion. So it's a little bit, maybe a Venn diagram there where there's two kind of bits, but they're overlapping for sure.
- [35:19]
B
I think the thing to remember with fears box resistances is that we have them for. For all types of experiences, not just for compassion. So this is. I mean, I see Cherokee as a form of play. So if it. But if a child grows up and whenever they play they're criticized, then we'll have FBRs for play. We'll have sort of inhibitions that stop going through with them. So I think that that was really what's showing up for this with people. You're asking them to engage in what is a very playful exercise in many ways. It's based in imagery, it's based in the imagination moving around. We're speaking to people who aren't there. So if people have had difficult experiences with play growing up, or indeed no experiences with playground, then. Then those FBRs for play will be activated when you ask them to do this as well, which often happens, you know, but again, and then you talk about sort of. You can explore that and formulate that, you know, it's not a. It's not, okay, well, we won't do it then. It's. Tell me more about what's going on for you. When we asked to do this. When I ask you to do this.
- [36:16]
A
Exercise, you briefly touched on how to introduce chair work a moment ago to kind of just preempt some of this. But could you elaborate a little bit? Like what. What might be the way to. To introduce the idea of chair work as a. As a technique and, you know, but. But in a way that helps to. Not sure, just help them to feel comfortable and safe with. With, you know, proceeding with that.
- [36:43]
B
So I think it largely depends on the client that you're working with as well and the relationship that you've already got with them at what point in therapy you're doing it. So if I'm working with someone who maybe have had a few sessions with them and was sort of getting on quite well, then I will. I'll try to be quite spontaneous in the. Introduce it. So. So as I mentioned earlier, I see sort of self criticism in play. I won't give you much pretext. And I might just say, do you mind if we just swap chairs for a minute? And actually, part of the power of that, I think, is not saying anything, not giving any instruction. So I'll just play out what they've just done and I'll say, I look at them and say, tell me what you're thinking. And they know straight away. They say, God, I'm being awful to myself. If clients sort of with more complex attachment histories and maybe have more difficulties with trust, then I'll just give a little introduction. Say, say sometimes we might move around a little bit, we might use chairs and play different parts of ourselves. But I'll always say, and it, it's going to feel weird, it's going to feel tricky and you might look at me as, you know, sort of lost it a little bit. But would you, would you, would you humor me a little bit and give it a go? Of course the sort of, the, the bottom line is that if people don't want to do it then, then you don't make them do it. But I think there's only, I think sort of several years now of using chair. There's only ever been one client who's just flatlined, said no. Most clients are pretty, pretty open to the idea and once you tell them about what Cherry might be able to do or what we're looking for with it, then they get on board with it. A lot of it comes down as well to your confidence as a therapist. And I think this is something that we. Another takeaway from the study really was that the three therapists we trained up, they had one three hour workshop on chair work and then they went and did it really well. And I know again this might have been your paper as well, but sort of looking at therapists fears for chair work and one of them was just that therapists are anxious about doing it because they've not done it much. So what we've sort of showed here is that if you learn some of the basic principles of this and you maybe have a, have a step by step guide to begin with is that as a therapist you can do it confidently. And then of course confidence and sort of assurance is infectious and the clients will trust that and give it a go.
- [38:58]
A
Yeah, some really great, great tips there. I think for the, for the client's sake it might be something that you, you know, kind of in amongst other things, let them know might be part of therapy going forward. You might do the occasional more spontaneous one that doesn't require a lot of description or preempting but just sort of in the moment, then you might just gradually build, I suppose and, and it's, it, it's a little bit gradual exposure and, and you know, sort of getting, getting used to it across, across the treatment plan maybe.
- [39:34]
B
I think also as well as to begin with usually I will be, I'll involve myself in it so they'll See me not being particularly self conscious, I might maybe role play their self critical role playing my own self critic or so on. And so that sort of tones down the embarrassment because we're seeing that I'm just doing it as well. So if you form that strong, if you, if you form that good relationship and you're sort of acting as a bit of a safe base, the therapeutic environment comes a bit of a safe place. And from that point you can explore sort of attachment theories are safe, safe haven, safe and safe place. So, so we create the safe haven and from there we can, we can head off into different techniques.
- [40:14]
A
Which sort of speaks to the, the therapist skills and experience and, and confidence that you were mentioning. You know, if the therapist is sort of confident and moves into these things and sort of demonstrates it or uses it in a way that kind of actually is experienced experienced in, in a powerful way, then then the, the person's. Yeah. Feels in safe hands I suppose and, and is able to, to, to go ahead and, and give these things a try. Because the last little piece there was yeah. Drawing meaning from the experience. I mean despite some of the challenges and, and some of the self conscious feelings that are. Might have arisen and so on, it it also was, was a very meaningful experience for people.
- [41:01]
B
Yes. So, so this was of course if it didn't have the meaning then and the sort of the benefit, then we probably wouldn't do it. But I suppose so. Yeah. So I think this is one of. And again the key takeaway really I said before and I think I'll say again is that this is an assessment tool as well as an intervention tool. So a lot of the participants spoke about the blocks that came up or the difficulties they had being really important for them. And so they weren't aware of it. Some had difficulties with giving compassion to themselves, some difficulties receiving it. But then they'll say, you know, and I wasn't aware of that beforehand. So it gave insights that sort of opened up new avenues for therapy really. But there's also something about the, the experiential nature of it. I think I remember there's one quote this and it showed me that I could do it. So there was me. So there was an inhibition sort of play in the mind for this client where she just felt like she couldn't do compassion, she couldn't do caring for herself. And then actually she did this exercise and embodied it used the body to sort of build up from the, from the bottom up as it were, rather than the top down and, and Challenge some of these beliefs there about being unable to get confession. But yeah, and then sort of if we can draw out these, these fears and blocks, then they're there for work as well. So if someone, it's pretty common for people to say, well, you know, I don't feel that I deserve the compassion. I don't feel as though I deserve the care. And then once that's out, it's not like that's not the end point. You then you follow that and you say, well, where does this come from? Or memories are associated with this particular feeling. How old were you when she always felt this feeling? And then actually I will use chair work, not necessarily CFT chair, but to work with that as well. So often once we get that and we have an age and an image of the client at that particular point where they first felt this thing, then we might put the child at that age on the chair as well, or we might have the client go and become that 10 year old. And this is really powerful. I remember one session where I asked the client to imagine their 10 year old self when they first felt this particular feeling they were feeling now, this one they'd had a really difficult time with. And as soon as they sat in the other chair and imagined themselves as a child, they just burst out in tears. And it was the first time really that child, that sort of, that version of that child in mind had ever been given sympathy, you know, because when they were growing up they were just criticized and bullied. So, so it's sort of identifying these blocks really is the work that allow the clear way for the compassion to be cultivated. And of course it's modeling and it's, it's building up these different representations of self that can then challenge sort of more entrenched negative self representations. So yeah, I think what's important as well is they enjoyed it and clients enjoy doing it. Right. Yeah. Therapy doesn't need to be. Therapy's tough. So I always set up therapy and saves and it's, it's not, not easy. Good therapy is tough. When you bring in these playful exercises and the client sometimes enjoys them, that's really useful. I think something with chair work as well is that it's really distinctive so it stays in mind. It's easily, it's an easily triggered memory after the event. Yes. So, and I think I said to you earlier at the end of therapy, often clients say that chair work was, it stays in mind for them.
- [44:34]
A
Yes.
- [44:35]
B
So, you know, it brings up these blocks, it brings out these challenges. But Then that highlights avenues for further work. They get this experiential experience. They get this experience of actually being compassionate which shakes the system a little bit.
- [44:51]
A
Yeah. And kind of sticks. Yeah. That the. It's, it's sort of important what you're saying because we often worry about, you know, did the exercise work or something, you know, and actually it's not about these exercise working or not working. It's, you know, whatever happens is actually food for thought or grist for the mill or something like that. And not least the fears, blocks and resistances when they arise. But even the self consciousness and the stuff you mentioned around play, but certain certainly, you know, the, the shift in, in motivational sort of state and, and being able to sort of feel that and experience it and, and that's sort of the. Some of the key takeaways. You mentioned something there that I noticed in the, some of the comments or the, the quotes from participants. Feelings of, of sadness or feelings, I think think of sympathy. And I often find that people can still worry about sympathy. They feel that sympathy is too much like pity or something like that or you know, empathy good, sympathy bad. It's something I think about, you know, when. Well, also when training cft, but with clients as well. Do you have any comments on that? Like, what are your thoughts about that, the role of chair work in just helping create a kind of a sort of feeling sympathetically moved by one's own pain and distress and suffering?
- [46:31]
B
Well, I think, I mean, I don't see sympathy as a bad thing. So just. And I think the key really is. So the definition of compassion is to a sensitivity to suffering in self and others with a motivation to alleviate, prevent it. So the first part of that, the first psychology involved in compassion is turning towards and being moved by suffering, moved by pain, suffering. So if clients can feel this sense of sympathy, then actually what it's telling me is that they're turning towards the suffering rather than turning away, which has been generally, which is the usual way they've approached it in life or they've learned to approach it through experiences is by pushing it away, trying to distance from it. So what it tells me if clients are sympathetic towards themselves is that they're now tapping into that first psychology. They're turning towards the distress. So actually for me it's always a good point in therapy. I think grief, I think you mentioned sort of sadness there. Grief's a little different to thinking that once we turn towards this sadness and we really see it there, it sort of opens the floodgates Gilbert calls it frozen grief. Know this sort of. When we've had these attachment experiences that have been painful and we learn to distance from them when we, when we get this emotional warmth going again and start turning towards it, first thing we see there is all the pain. There's all the, the, the pain in the person's attachment history. So again, if people become sad doing this, then actually again it's a good sign for me from a therapeutic point of view because they're now leaning into all the, all the stuff in their past that maybe they perhaps distance from as a safety strategy, you know, and we can do that together in therapy. So sympathy and sadness, grief, to me, they're always signals or signatures that the therapy is moving in the right direction.
- [48:20]
A
Yeah, good. No sadness. Sometimes I associate sadness or sorrow with sympathy, I suppose. But I think you make a really important point about a sort of a sadness that is also the grief that just comes sometimes rushing in when we kind of open our heart to our own suffering and see that in ourselves or like you mentioned, imagining ourselves as that young vulnerable child who was harmed in that way and the grief that's there. And Gilbert often talks about the rage as well. The, the rage that is. Is perhaps present and suppressed or held back or something because it's, well, sadness and, and rage, they're, they're frightening sorts of emotions, aren't they? And, and so.
- [49:15]
B
Part of the threat system. And I think with this, with the rage and anger as well, it's another really important emotion in cft. And I'll use that for some CFT Cherokee because, well, I mean, you'll do it in the multiple cells1. But when we, when we get there. So they might imagine the child in the chair. And then this is where I see a chair work session can sort of start rolling out, become really long. But so if we access that sinus, we like where they might do someone finished business and bring the parent in and this is where it can get, this is where it's play, you know, so we might. So there's a few times where I've had a person being their compassionate self, they've had their younger self next to them on a chair, you know, and they're speaking to the, to the person, the parent or whoever who didn't meet their needs or who was mean to them or who abused them, which is a sort of similar to sort of schema therapy where you step in to the image to try to, to meet the needs, basic needs of the client. But yeah, and then that One anger is really important. I think what's really fascinating, when I have done that one so often, clients will say, whenever I'm with that parent, I feel like the child I was years ago. Even though they're an adult now. And when they do that exercise and we imagine that whoever it was in that chair who was not good for them, you see them sort of become that child again. You know, they go a little bit meek and a little bit scared. So you can see now they're tapping in, they're being pushed back into a different state, as it were. So then modeling this sort of healthy aggression, you know, standing up for this for yourself, can be really transformative as well, because it's, it's their sort of restructuring a memory, a core emotional memory that's been for a long time and it still is really easily triggered.
- [51:01]
A
Yeah, it's.
- [51:01]
B
It's.
- [51:02]
A
It's amazing process for someone to go through it. It really speaks to the. The strength and courage and the wisdom. The strength, the courage and that commitment to care and be helpful. You know, it just weaves through all of this, doesn't it? And it takes enormous amounts of those kind of qualities to face the pain that perhaps we've been through. And you make a. You're sort of inspiring in a way, I think, for other therapists who, lots of people do feel a little bit tentative around chair work. But what you say is very inspiring. You know, there's multiple moments across the treatment plan where chair work might just create that experiential bang for the buck sort of thing that people take away, you know, whether it's in that. That sort of, I guess, maybe slightly earlier stage of developing the compassionate other or the compassionate self or whether it's working with self criticism. And I really find that not notion of the, the critic and the criticized in their different chairs and working with that or whether it's with the. The multiple selves work and these different, you know, very powerful emotions. Using chair work historically, in terms of, you know, imagining a younger self, it's really, it's powerful stuff. So what, what would be, you know, your concluding remarks really, like, especially from the paper, I mean, what, what, what would you say are some of the, the, the key takeaways for us given, given all those various findings?
- [52:40]
B
I mean, so some of the things that have stuck out for me in this really. Is that. So it didn't take long to, to. To train therapists to do this very competently, you know.
- [52:52]
A
Yeah.
- [52:53]
B
So, I mean, when I did my Tobin, basically, he did Some teaching for us, which got me onto it. And then he just gave me some one to one supervision for an hour. We just did the exercise and then sort of you go with it and you play with it from there. So that's sort of one thing. I think another thing is to remember that therapy does not need to be a static endeavor. You know, it's we, the mind and the body. And sort of this Cartesian dualism sort of seeps into therapy still sometimes. But the mind and body are one, it is one system. And we know from research on embodied cognition that changes in bodily, in the body can bring about changes in emotions. So when we move around and use the body, we can stimulate different types of thinking and feeling. I think another key takeaway is that is looking at the type of social mentality that clients are in session as well. Because it might, for all intents and purposes appear that you're having a good conversation with them. There'll be little signs that, that maybe they're viewing you in a sort of power dynamic way. Whether or not I think one, one sort of common hint for me that people in an outbase mentality is if they sort of. And they. People should be able to do this and it's fine, but they're sort of questioning your capabilities or credential how intelligent you are and stuff. They're looking for a powerful person there to lead them. You know, there needs to be a certain amount of that because they need to trust you and know that you know what you're on the brain. But they're sort of wondering if you're powerful enough to therapist. Another one might be sort of clients worry about looking silly or stupid in front of you. And that would indicate again to me that they're sort of still in a rank based mindset. They're still weighing you up as someone who potentially is a threat. So when we do this exercise and we move people between the different mentalities, if they are. If they say I noticed a big shift and big difference, then I might indicate that previously it might not, but it might indicate that they were sort of still in that rank based mentality with you in the room, which is really important because therapy is going to move pretty slowly if they're still in a base mindset. But yeah, the chair and I think sort of something you mentioned earlier as well is that people have a real difficulty sometimes with imagery. There's a condition called aphantasia, fantasia being the ancient Greek word, sort of image or eye, mind's eye and a being the negative prefix to that. So some people have a condition where they don't see mental images in them. Some people just struggle with mental imagery, including myself, if I try and picture an image is pretty blurry. So a way we can explore and ask clients about that is really important because if they, if we just do imagery exercises with them, we don't ask them how they're finding it or whether, whether or not they feel capable of doing it. And we know that that can lead to self criticism. So using the chair work or exploring that imagery and then using the chairwork as an alternative, if, if clients do have difficulty with imagery, it's another, another key take.
- [55:57]
A
Yeah, and, and the, and the big one is that, yeah, it, it really helps people feel, you know, kind of surprised, but also, you know, pleased with the effect of it. And it really gives them a different experience and something that they can take away. And bringing that kind of exercise, I think, into our therapeutic work is really, it's a massive opportunity, I think, in terms of being, trying to be helpful. So, so what's just before I let you go, what's next for Dr. James Hackley? What are you, are you doing further research on this or what's happening next?
- [56:44]
B
So Tobin and I are just finishing up a review on Shame Memories.
- [56:49]
A
Okay.
- [56:51]
B
So we're having a look at that and then for the time being, so I've recently started a new role, so I'm just going to settle into that and then I think. So there's chair work is CFT sort of research. I'm hoping there's going to be more to come. For now, I'm going to enjoy using it and polishing the skills in practice, I think.
- [57:14]
A
Beautiful. That sounds like a really great idea. Doing the thing. Sounds good. Well, mate, no, it's a great paper. As I say, the, the intro stands alone in some ways, but also these are really interesting and useful findings. The good thing is it's actually an open access paper so everyone can go and have a look at that. I'll include it in the description, of course, and so on. But thank you for coming and speaking with me on compassion in a T shirt.
- [57:47]
B
It's been my pleasure. Thank you for having me. I've enjoyed it. It's been nice to be here.
- [57:52]
A
Good, good.