← Compassion in a T-Shirt
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- [00:01]
A
Hi, I'm Dr. Stan Steindl and welcome back to Compassion in a T Shirt, where we explore the science and practice of compassion and how it can really transform lives. Today's episode is a little bit special. One of the things I really love about this channel is creating space for early career clinicians and researchers, people who are just stepping into this work to share what they're seeing, what they're learning and what's beginning to take shape for them. There's something really fresh and honest about those early experiences, especially when it comes to discovering compassion focused therapy for the first time in a real world clinical setting. My guest today is Tiffany Luxford, an undergraduate psychology student working at the Anxiety Disorders Residential Unit at the South London and Maudsley NNHS Foundation Trust. Tiff has been working closely with Lisa Williams and is gaining first hand experience of how compassion shows up in an intensive clinical environment, particularly with individuals whose threat systems are really activated through anxiety. What I find especially powerful about TIF's perspective is that it's not just clinical. She also brings lived experience into her understanding of compassion and that combination gives her reflections a real depth and authenticity. On top of all that, Tiff has recently given a TEDx talk which has just been released online. So it's an exciting moment in her journey to be sharing her voice more widely. The link to the TEDx talk is in the description. So this conversation is about beginnings, about what it's like to first encounter compassion in practice, to see its impact and to start imagining the kind of clinician you might become. And so I bring you Tiff Luxford. Tiff Luxford, welcome to Compassion in a T shirt.
- [02:06]
B
Thank you so much, Stan. It's lovely to be here and thank you for having me.
- [02:10]
A
It's wonderful to get to talk with you and to hear your, your experiences. Can you take us back maybe to when compassion really clicked for you? Maybe not just as a theory, but as something you saw working for you or for people around you or maybe even people that you're working with?
- [02:33]
B
Yeah. So I guess I'll give you a little bit of context, but I'm an undergraduate student at King's College London and I'm studying psychology and I'm currently on my professional placement year at the Anxiety Disorders Residential Unit which is located in Kent. You actually spoke with our ward manager, I think it was last year, Lisa Williams, she did a podcast with you. But yeah, I've been here since June 2025 and this is really the first time I've kind of seen compassion or compassion focused therapy In a clinical service, obviously, I kind of had an idea what compassion was before, but I'd never seen it applied in these settings. So coming into adri, or we shorten it to adri, yeah, it wasn't actually what I expected. You kind of hear about compassion in everyday life, but seeing it in a treatment service is very different. And I guess the first impression that I had actually just came from the team itself. So all of our team are trained in compassion or compassion focused therapy. And I just felt extremely welcomed by all of the team on the ward. And you could just see that there was this relationship that just everyone was supportive of each other. And I think when you're in an NHS service, obviously a lot of the time these services are stretched and there is a lot of burnout within services. But this team were just so supportive of each other and looked out for each other. And I really felt that on my first day, and to this day, I've been here for however many months still, just absolutely incredible. And they look out for each other in every single way possible. And I really look up to that. And that is because they give themselves that compassion and that compassion to each other. And obviously that reflects on our residences. So we call the adults we have on our ward receiving treatment, we call them residents or clients. You could really see that they felt supported because the team were also compassionate to themselves. So I think my first session that I observed for the compassion focused therapy was pretty much in my first few weeks, and, like I said, it wasn't what I expected. It was a lot tougher than I thought it would be, actually. And I could see how difficult it was for all of the residents. They really found it valuable. But it was very hard to talk about the things that we were discussing. So this could be talking about feelings of shame or guilt or disgust, and these are maybe things that they had never spoken about before in their therapy sessions. And I think it's really important to recognize that impact, because a lot of the time our residents will have gone through many rounds of CBT previously and before coming to ADRI and seeing them learn all of this new stuff about, like, the evolutionary perspective to compassion, it just kind of highlighted the importance and the role that compassion plays in treatment, because a lot of the time they'll say, I know what I need to do and I'm doing it, but I'm not feeling better. And that comes down to that self criticism and obviously that underlying shame and guilt. So, yeah, I guess that was when I really saw compassion working, was when the Residents were engaging when they were talking about these feelings that they'd never spoken about before, and when they began to make that commitment to kind of practice self compassion.
- [06:19]
A
I love how you started with the. The team part of it. The. The, you know, it's sort of like you walked in there and compassion was in the air or something. It. It.
- [06:30]
B
It was.
- [06:31]
A
It was sort of. It was palpable for you. You could see it and hear it, and there was something. The flows of compassion were evident and. And, you know, sort of walking the talk in a way. And what did you notice about. To stay at that team level for a moment, if that's okay. What did you notice about the willingness for different clinicians or practitioners or therapists to both give and receive the compassion? Because often there is. That block isn't there to receiving. And so, yeah, what did you notice about the giving and receiving and the flow that was. That was there amongst the team?
- [07:16]
B
Yeah, I think it really comes from. Lisa's an amazing ward manager. She really looks out for everybody. And I think that sense of kind of we're all there for each other is really dominant and it's really felt. And I think it comes to the fact that people feel able to say if they're finding things difficult and they're able to express that. I think that's really important because a lot of the time you just like, go, go, go. And you kind of try and continue despite that overwhelm that you're feeling inside. And I think because everyone's able to communicate that with each other, that's what makes it such a compassionate environment as well. As a student coming into adri, I think a lot of the time you feel like you want to impress, you want to do everything that you can. You want to be, go, go, go. I need to make a really good impression, and I am definitely guilty of this. I'm someone who always wants to be better. And that changed when I came into Adjur. And my friends have said this as well. They've said that I'm definitely a lot more flexible with things. I'm not so hard on myself about things. And that really comes down to the fact that I felt valued for who I was, and I felt able to say if I was feeling overwhelmed, to ask for time off if I needed it. I think that's really important to highlight just being able to communicate how you feel with each other.
- [08:53]
A
Yes, that team compassion. I spoke to someone, Helena Nguyen, recently, who's an academic down in Melbourne University, and, yeah, this idea among especially health related teams of team compassion that we're actually, you know, collaborating and working together in, in this more compassionate way. And I suppose it creates safeness too, doesn't it? Because a lot of that idea of, you know, I must, I must be better, I must do well, I'm, you know, I want people to, to be impressed or at least approve of me and so on. A lot of that's coming from something in and around threat and drive systems, I suppose. Would that be exactly y. Yeah.
- [09:39]
B
I think throughout my life, my drive system's very much been about 100 times bigger than the soothing system. And the same with the frat all through academia, really. So I think this experience has really shaped who I am now and something I'll take forward in the future. And that is down to the fact the team are so compassionate and it's something that I really, really value.
- [10:10]
A
So with the, with the residents, how. How do you, I guess, formulate anxiety, really? And maybe it's the three circles or maybe it's some of the evolutionary kind of tricky brain sort of stuff, but yeah, what's been your sense there about anxiety, threat system, how to formulate?
- [10:33]
B
Yeah, so most of our residents will have OCD or body dysmorphic disorder. So we will kind of have weekly compassion focused therapy sessions. And these are group sessions. Obviously we do apply compassion in individual CBT too, but we find that the group CFT sessions are extremely beneficial. So obviously this is kind of covering broader topics. So we will focus a little bit on, I'll say, like psychoeducation. So talking about evolution, talking about the free systems, and talking about soothing rhythm breathing and exercises they can do to help engage with the soothing system. I guess what we're really trying to get at is what is the function of these behaviors. We're trying to look at the guilt, the shame, the disgust that's underlying. And I think we really, really try and focus on the fret system being, like I said, 100 times bigger than the soothing system. A lot of the time our residents will have never engaged with their soothing system. They don't even know what compass self compassion looks like because they've never been shown it. That could have been in their, in their early life. Maybe their caregivers were also engaging in their fret and drive system a lot and they didn't have an example of what self soothing looked like. So we're really trying to work with our residents to find what helps them, what helps them to engage with their soothing system. So that might be like, I Said soothing rhythm, breathing and we'll kind of look at things that work individually for them. But what I like about these group sessions is that residents can share their individual stories which helps others to feel able to also share that stories. And I think that sense of community again is so important and that space feels safe for them to do that. So that's really what we mostly cover in the sessions. Yeah, those kind of like feelings of guilt and shame.
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A
I'll come back to that in a sec actually. But so what would compassion look like or sound like for someone perhaps whose threat system is running the show?
- [12:57]
B
Yeah, I think it's really about trying to not respond with the drive system as well. Because a lot of the time our residents will go into an erp, so exposure and response prevention and we'll ask them to do an ERP task. Say if it's contamination ocd, it could be touching the floor and then eating food with their hands. And a lot of the time they'll go into it and they'll do the task, but it'll kind of be like going in with it with a very. I'm not thinking about this, I'm just doing it, doing it, doing it. Then distract after I'm not feeling the discomfort and that's when the system is really kicking in and then they're responding with drive. So after that they might like try and go to the gym or do something where they're not thinking about that feeling. So a lot of the time I guess we're just trying to get the residents to build up their soothing system so they can one go into the ERP a little bit more self compassionate. They're doing the ERP and then they're not trying to engage with the drive system, they're engaging with the soothing system. And these uncomfortable feelings will come up. But we're going to be kind to ourselves and we're going to think, yes, this is hard, but I didn't choose this. I didn't choose to have ocd. So those feelings of self criticism will gradually over time decrease if they're engaging with that self compassionate, that soothing system, the soothing rhythm, breathing for example,
- [14:33]
A
compassion and self compassion just take so much courage, doesn't it? I mean exposure and response prevention is, is a really great example of something that is motivated by compassion. It's about trying to alleviate or you know, alleviate suffering now or prevent further suffering. And at the very same time it's extremely uncomfortable and very, very difficult and scary. I suppose as much as anything. It's very scary and so it takes so much courage to follow that self compassionate path towards exposure and response prevention.
- [15:19]
B
No, sorry, go ahead, go on you go. I was going to say that it's so much courage and we always say this to our residents like we know it's so difficult. Even being at ADRU is a massive exposure. Some of our residents might not have left their home for years and coming into a community setting is extremely difficult. And I think it's really important to consistently remind them and remind them of their bravery and acknowledge the courage that it takes. And it's really important for them to hear that because inside they are probably beating themselves up about it.
- [15:58]
A
We have the team compassion, which really creates an atmosphere and modeling, I suppose then we have the residents in a group and they're able to, you know, kind of give and receive compassion, I guess in a sense in, in the group as well. Takes a lot of courage to get there and, and well, to get to the, to the service, but also to get the group and then to do some of, some of the treatments. But yeah, you've mentioned a couple of times shame and self criticism, I suppose. What, what have you observed there in, in terms of where shame might come into an anxiety presentation?
- [16:40]
B
Yeah, I think it's a lot of the time our residents will have intrusive thoughts and they feel very shameful about them and they think that they can control them or maybe they chose to have them. And I think that's where a lot of the time the feelings of shame might creep in. And again, where compassion is really helpful because we're looking at the evolutionary perspective, we're looking at how we have tricky brains. And I think that's where we also see residents begin to realize that actually our brains are built that way. They didn't choose for that. Like they didn't choose to have these thoughts. And I guess that's where compassion really kind of kicks in with tackling those feelings of shame. Obviously it takes time and a lot of courage, but I think, yeah, I think compassion is extremely helpful for our residents with those feelings of shame.
- [17:32]
A
It can be shocking sometimes, can't it? The way that people just speak to themselves or relate to themselves or the, the sorts of things they say sometimes so attacking and, and just contemptuous or, or you know, this, this shaming self criticism, shame based self criticism. And, and yet often people find it really hard to let that go as well. At the same time, you know, they, they would never say that to a friend or someone they loved or someone they were wanting to really be helpful for and yet they have so much. It's so hard to let go our own shame based self criticism?
- [18:17]
B
No, definitely. We find a lot of our residents are very self critical, yet they are some of the most compassionate, kind and caring people to others. It's just obviously really difficult to apply it to themselves. And that's another thing we kind of look at is to try and treat yourself like a compassionate coach or treat yourself like you would treat your best friend, for example. So we're looking at what would we say to someone else and then try and apply that to ourselves or what qualities of your best friend makes them a compassionate person and then again like a trying to apply that to themselves. But definitely self criticism is really, really difficult for a lot of our residents.
- [19:02]
A
Have you witnessed a moment maybe where compassion has led to a genuine shift for someone, a client or a resident or that sort of thing, even in a small way, especially with the self criticism or the shame. What have you notice people doing there or achieving?
- [19:20]
B
Yeah, I think in terms of compassion making a difference in the moment. I worked with a resident a little while back and again they struggled with self criticism and put other people first, which was a massive thing for this resident and we see it quite a lot as well. Again, obviously given that compassion and kindness to others, not themselves. And they were kind of going out their way to help the other residents in the community. And this was something they struggled with throughout their time here. And towards the end of their treatment we kind of have this thing, we call it like an out and about. So we might go out to London, for example, as a community with some of the staff and they wanted to go, but kind of felt like it was more because they wanted to support everybody else. And they actually said on the day, no, I want to stay here and I want to go to the gym. I think it was. Or do something for themselves. And I think that was such a massive shift because at the beginning of their time or even a few months in, they wouldn't have been able to do that. But yet they were prioritizing themselves and what they wanted and they were being kind to themselves because they knew that the reason they wanted to go out wasn't because they wanted to go and have a fun day, it was because of other people. So I think that was something that was really significant. And again, I think when our residents turn towards soothing river breathing, but they're doing it themselves, they're not kind of getting permission from others to do it, say they're distressed and they'll Take themselves away and they'll say, I'm just going to do some soothing rhythm breathing. And I think that's a massive change as well, A massive turning point. When they're making that commitment to engage with the compassion work that we've kind of talked about in sessions. Actually sometimes they do their own, like self guided meditation as well and mindfulness, which is again a massive shift because a lot of the time our residents find it hard to slow down because that's where those feelings of shame and guilt and disgust, self criticism will creep back in.
- [21:39]
A
I love those moments where people express the mind awareness. You know, they're able to notice their own minds and notice the old habits or something like that. You know, that particular person could see that if they were to go on that out and about, they would probably be motivated by compassion for others, but in a way at their own expense. And they saw it, you know, they noticed it and they were able to express it. And they were able to make just another little different alternative choice, which is, which was also, you know, really a really positive compassion choice, but directed at the self and stay back at the unit and get to go to the gym or just to focus on the self. Do you notice kind of fears, blocks and resistances there? I mean, do people find that self compassion option really, really difficult?
- [22:42]
B
Yeah, definitely. There is a lot of fears and blocks that obviously again, it's something they haven't engaged with. And I think a lot of the time there's that fear, like I was saying, about slowing down and not engaging with that drive system. And I think obviously a lot of the time self compassion or self soothing rhythm breathing, it involves slowing down, which means those feelings can creep in. So again, there are a lot of fears and blocks here. So a lot of the time if residents do find compassion particularly difficult, we might set ERP tasks around like self care and doing things that they want to do for enjoyment. And this is again something very difficult for them. So a lot of the time we'll set these tasks, we might support them with it, or they do it individually. And it's about trying not to engage with OCD behaviors. For example, afterwards, try not to engage with compulsions or rituals and sit in with that discomfort. And I think over time it becomes easier and eventually they get to that point where they can do things for themselves and not have to kind of feel like they have to respond in disordered behaviors.
- [23:52]
A
I guess actually that's really clever that sometimes fears of self compassion can be approached with exposure based approaches, but exposure to self compassion or exposure to self care types of action. And so we're trying to help people just little bit by little bit, do things towards that kindness and compassion towards themselves. You've mentioned, I think before, or you mentioned before to me that in some ways your appreciation of compassion comes not just from the clinical work and the experience recently, but also from lived experience. How's that shaped the way your own lived experience? Has that shaped the way that you understand or even practice compassion?
- [24:50]
B
Yeah. So I guess just for a little bit of background, When I was 16, I was diagnosed with an eating disorder and I did receive inpatient and outpatient treatment. I did also struggle with ocd and I've now fully recovered from both, which is amazing. But I think my recovery journey was very up and down. And a lot of my journey, especially with the eating disorder, came down to the fact that I didn't want to recover. I didn't feel like I was worthy of recovery when I was receiving treatment. I didn't actually have any sort of compassion or compassion focused therapy input within my treatment. And we're talking about years here. So obviously that to me was very surprising once I kind of learned a little bit more about compassion. I remember sitting in the first session, I was thinking, wow, like this is kind of relatable, to be honest. And I was thinking this would have been so helpful when I was going through treatment if I had these sessions because it was really kind of looking at things that were at the core of my eating disorder. So now I'm kind of trying to look into the compassion world and eating disorders as well and trying to advocate for that. So obviously looking at the work of like Ken Gossip as well and the work he does with compassion and eating disorders. So yeah, I guess that's kind of where my lived experience comes into it and why I'm so passionate about it as well, because it really kind of tackles those underlying issues at the core of the disorder.
- [26:30]
A
Just a little thought has occurred to me. I wondered whether you maybe intuitively stumbled onto something kind of like self compassion, you know, through your own journey. It wasn't formally presented to you and through the therapy and so on, but I wondered, does it, does it feel like you became a little bit more compassionate in the way that you related to yourself around these sorts of things and, and so on?
- [27:00]
B
Yeah, definitely. I was very self critical and very perfectionistic about things and I've really kind of learned what my values are. And I think that was something that obviously wasn't presented as compassion, but it Kind of was, in a way, it was integrated into the cbt, kind of looking at who I am as a person and the fact that my eating disorder wasn't a choice, it's not a representation of my values. And actually it's what's preventing me from kind of acting in a way that is in line with my values. I think throughout my treatment, I could kind of start to recognize that self criticism wasn't healthy. And that was actually just maintaining the eating disorder and looking at kind of the things that were important to me instead of what I think are important to other people. So I could really kind of find out who I was as a person, as kind of like cliche as it sounds, but I could really start to express my interests, my values. So, for example, I'm half Japanese, and it's something I talk about a lot now. I always try and engage with that side of my, my kind of background as much as possible, but before I really suppressed it, I was very critical about it because I was bullied about being half Japanese when I was in school. So I think it's kind of a little bit like rescripting that, but also, again, coming down to that self criticism, realizing where it. What is the function of that.
- [28:36]
A
Yeah, so you, you, the, the TED talk that you're. Or the TEDx talk that you've, you've presented, it's not, it's not live yet, but that's, that's you presenting on some of this experience in your life, I think.
- [28:50]
B
Yeah. So the TEDx talk I did is talking about my lived experience of an eating disorder, my recovery journey, and kind of just trying to, I guess, address what was at the core of it to help raise awareness, but also to empower others going through a similar thing. And I talk a lot about uncertainty in my talk, and I always kind of say like, what if? Because I think that was a massive thing throughout my recovery. And something obviously that's very relatable to OCD and BDD is like the what if? And then it's kind of like that fear is a massive block to do and say that ERP or not doing the compulsion. Because it's like, what if this happens? I should just do this compuls emotion because then at least I'll be safe. And again, that was the same with my eating disorder. It was kind of like, what if I ate this? What if? It feels awful, I lose control. It's better to just not. And I think again, that's why I wanted to do that talk, to really get that point across because I understand what that internal battle feels like and that, that like burning frustration inside when you know what you need to do, but you just can't bring yourself to do it because of that block.
- [29:59]
A
Yeah, thank you for sharing that. I know that that's your sort of personal journey, but it really sort of teaches us a lot, doesn't it, in terms of just how we can make our way through some of the self criticism, the perfectionism, the threat based drive. It's very. Well, it's built into us, I suppose, and we can get caught into that and it starts to. Starts running the show. Working in the current setting, you sound like you, you can, you sort of in a way can relate really to the people who are, who were there, really empathize even with, with some of the residents or what, what their challenges are. I mean what, how's that sort of influenced you in, in terms of the kind of psychologist that, that you want to become?
- [30:52]
B
Yeah, I think working in a clinical setting it's about trying to communicate your experience without explicitly saying it as well. And I think a lot of obviously what I have been through in the past really kind of makes me realize how difficult that internal battle is. And I really try to just continue to acknowledge the bravery if a resident does make a positive, a positive move, like say they do an erp, they do really well. It's about recognizing that, saying well done, I can, but also acknowledging how difficult that was. So saying well done, I can see that was very, very difficult for you because we don't want them to think that that kind of fear is not seen. I think a lot of the time that's what I struggled with was I would make a positive move in my recovery. I'd be told, oh, well done. Like that was amazing. But then inside I'm thinking, but I feel awful. So I think it's about acknowledging that that kind of fear is a normal response to what you're going through. So I'd say that's how it kind of will influence me as a clinician in the future. And I definitely want to train in cft. As a clinician, I think it's just as important as the CBT work. I think you need both of them really because like I said a lot of the time our residents will have gone through many rounds of CBT previously. And the CFT is what really gets at the core.
- [32:18]
A
I think this interweave between the lived experience and the training and clinical experience. That's going to be a very powerful combination. For you. In fact, let's go big. I mean, if you could design a mental health service from scratch or something, what role would compassion or compassion focused approaches play, do you think? In its culture or even at the team level, but in the day to day running of the place.
- [32:50]
B
It's funny you asked this question actually, because my best friend Molly, I met her at uni, but it's like we've known each other forever. She won't mind me sharing this, but she's also had similar experiences to me. So we're both very passionate about going into the clinical psychology field and we always kind of half heartedly joke about opening our own clinic when we're fully trained in the future. And although this is half hearted, we are kind of serious about it too. But we said that compassion is definitely like the number one thing that's got to be there because unfortunately I still feel like it isn't integrated as much as it should be in a lot of services. And obviously seeing the value that it has and having that lived experience and know how valuable it would be or is, we just, it's a must. Like everyone will be trained in compassion focused therapy. And I think it's really about recognizing we're all human beings with tricky brains and we didn't choose to have these uncomfortable feelings and thoughts, recognizing that we're all individuals with different backgrounds. And I think that really kind of takes out the hierarchy as well. I think a lot of the time that's a massive barrier in like the therapeutic relationship. There can be this sense of hierarchy. So again, just recognizing we're all human beings here. We were just kind of born on this planet. We didn't, we didn't choose to be here really. And yeah, just about remembering that we are the only person we're going to be with for the whole of our lives. And really getting that point across. Remembering that is so important, I think, because that really helps you to work on your relationship with yourself.
- [34:31]
A
Yeah, that's a really nice way to think about it. Paul Gilbert talks about it. CFT is really an integrated model of the mind, doesn't he? And so it does feel like it. Cft, you know, CFT can be, yeah, really the sort of the broad based approach approach that a service might take. So. Yeah, that's really good. What, what about other psychology students who are maybe discovering cft? What would you want them to know about compassion, you know, at the start of their journey too?
- [35:09]
B
Yeah, I think it kind of comes back to what I was saying earlier about students coming in to do work experience, for example. And there can be that big need to impress and to really push themselves to do more and more to kind of, you know, that you want to make a good impression. And I think a lot of the time when you're going into a field like clinical psychology, you probably have personality traits where you are very caring, but maybe struggle to give that back to yourself. So I think it's really good to experience compassion in a service like this because one, you learn a lot about yourself. I remember sitting in the sessions and I still do and I'm thinking like, wow, like I really want to look more into this and kind of relating to your own experiences as well because obviously we're all human beings here. But I guess for students coming in, I think it's just brilliant to learn about it because you can apply it to yourself. And I think obviously we do need to be more self compassionate to ourselves. We are going into a very difficult field and with the additional pressure you're putting on yourself to constantly being in that drive and to impress, we need to take a moment to step back and look at ourselves and how we're doing, check in with ourselves. We can't be given to everybody else all the time because then when we're just not going to be able to anymore, we're going to burn out. And obviously that's the same for anyone, but especially as students who are new to this field. It's definitely what I found anyway. And I know the other students at ADREW have really felt that compassion and have been able to kind of incorporate it to themselves a lot.
- [36:57]
A
Wise words. I, I agree. In fact, these are things that as a sort of aging clinical psychologist myself, it continues to be a kind of an ongoing practice really. It's something that if we can, if we can bed that down early, it actually helps with making things sustainable and in the long term.
- [37:22]
B
Yeah, definitely. Compassion is a lifelong journey for most people for sure. Yeah.
- [37:27]
A
Nice one. Well, Tiff Luxford, you are an inspiration and I'm so glad that you've had a great exposure to compassion focused approaches and in the unit there. It really does sound like it. You can sort of just sort of simmer in the whole warmth of compassion amongst everyone, which is very lovely. And yeah, thank you very much for sharing all of that with us and for speaking with me on compassion in a T shirt.
- [37:55]
B
Thank you so much, dad. It's been lovely to chat and thank you for everything you do as well. It's really making a big difference.
- [38:01]
A
Oh, thank you thank you very much.