Podcast Summary: Compassion in a T-Shirt

Episode: Understanding Depression and Compassion Focused Therapy
Guest: Professor Gregoris Simos
Host: Dr. Stan Steindl
Date: February 12, 2025

Overview

In this engaging episode, Dr. Stan Steindl interviews Professor Gregoris Simos, an internationally renowned psychiatrist and expert in psychotherapy from the University of Macedonia, Greece. Their discussion centers on Professor Simos’s work in Compassion Focused Therapy (CFT), his co-edited landmark book "Compassion Focused Therapy: Clinical Practice and Applications," and, most importantly, his integration of CFT in understanding and treating depression. The conversation also delves into the relationship between self-compassion and empathy, conceptual models of depression, the interplay of shame, and the fascinating synthesis of CFT with schema therapy.

Key Discussion Points and Insights

1. The Making of “Compassion Focused Therapy: Clinical Practice and Applications”

[01:49–08:06]

• Genesis of the Book: The idea emerged after a successful symposium on self-compassion in 2018. A publisher’s invitation led Professor Simos to partner with Paul Gilbert, the originator of CFT.
• Collaborative Effort: The project blossomed into a major compendium, featuring foundational theory by Gilbert (ten chapters) and practical/clinical chapters from numerous international experts.
• Notable Quote:

  "I could have never done this book without Paul Gilbert. He is the master. He's the one." — Prof. Simos [02:49]

• Purpose: The book fills a gap by serving as a “reference book” for at least the next decade, synthesizing theory and practice.

2. Self-Compassion, Empathy, and Emotion Regulation

[08:53–14:10]

• Research Findings: Professor Simos’s symposium work revealed significant correlations between self-compassion and empathy, as well as self-compassion and emotion regulation.
• Understanding the Link: Self-compassion is seen as "self-empathy," and emotional regulation is harder for those lacking self-compassion.
• Quote:

  "Self compassion actually equals self empathic for oneself... To be empathic with others but also to want to help and prevent their suffering." — Prof. Simos [10:54]

3. CFT’s Three Circles Model and Depression

[14:10–22:20]

• Model Explanation: Depression, in CFT terms, is characterized by:
  • Overactive Threat System: “A civil war inside.” Heightened self-criticism leads to internal strife and pain ([14:10], [20:55]).
  • Inhibited Drive System: Marked by low motivation and energy.
  • Exhausted Soothing System: The capacity for self-comfort is nearly depleted.
• Metaphors: Simos likens depression to a “civil war” within, where self-attacking parts do deep harm.
• Host Reflection: Dr. Steindl references Kristen Neff’s “enemy or ally” metaphor and the tragedy of needing, yet being cut off from, soothing and connection ([18:53–20:55]).
• Notable Quotes:

  "This internalized threat produced by self-criticism—it's actually a civil war. Half of my person fights with the other half. But this is a disaster." — Prof. Simos [14:10]
  "The soothing system... is exhausted. It cannot do anything more." — Prof. Simos [16:35]

4. Sadness, Shame, and Depression’s Dynamics

[22:28–28:15 | 40:53–46:57]

• Sadness in Depression: Sadness becomes pervasive, disabling the soothing system and feeding learned helplessness. It’s both expected and adaptive in some contexts, but in depression, it can be overwhelming and paralyzing.
• Shame’s Role: Shame feeds and feeds off depression, especially via social rank and defeat dynamics. The sense of being fundamentally flawed, withdrawal from others, and the fear of being "found out" sustain depression.
• Notable Quotes:

  "Shame actually empowers a negative self view... and there's a reciprocal relationship. The more shame I feel, the more depressed I become." — Prof. Simos [44:37]
  "If I have so many flaws, I feel very much the same and same actually... triggers the threat circle. And when this is triggered, it causes pain, disaster." — Prof. Simos [44:37]

5. Evolutionary and Psychological Models of Depression

[28:15–38:18]

• Three Key Models:
  1. Control and Learned Helplessness: Depression arises when one loses the belief in their ability to affect their environment or outcomes.
  2. Attachment and Relational Loss: Insecure/failed relationships breed loneliness, which increases depression.
  3. Social Rank, Defeat, and Entrapment: Drawing on primate hierarchies, Simos notes how defeat and withdrawal mirror depressive states to avoid greater threat.
• Evolutionary Utility: Depression may once have been adaptive—a period of withdrawal and recuperation—but is maladaptive in the modern context ([34:47–36:23]).
• Notable Example: Reference to Seligman’s learned helplessness experiments ([37:55–38:18]).

6. Fear, Blocks, and Resistance to Self-Compassion in Depression

[48:23–52:47]

• Misunderstandings: Self-compassion is often misconstrued as weakness or passivity.
• Resistance: People may resist changing their identity, fearing the unfamiliarity of self-compassion or happiness itself (“the calm before the storm”).
• Quotes:

  "People sometimes fear compassion... because they think they might become weak" — Prof. Simos [48:33]
  "There are people who actually are fearful of being calm, of feeling happy because they say, ‘okay... the disaster is coming now.’" — Prof. Simos [51:08]

7. Integrating CFT and Schema Therapy

[53:58–67:48]

• Rationale for Integration: Both approaches address deep-rooted, long-standing patterns, especially where compassion has been missing (e.g., emotional deprivation, abuse).
• Key CFT Elements: Simos highlights the powerful refrain "it’s not your fault," using personal examples to illustrate how circumstances beyond our control shape us.
• Therapist’s Role: Compassionate presence and “limited reparenting” in schema therapy mirror the compassionate stance of CFT.
• Endpoint vs. Means: Healthy Adult (schema therapy) is an endpoint; the Compassionate Self (CFT) is both a means and an end.
• Experiential Techniques: Both therapies use “chair work” and other experiential interventions to evoke and nurture healthier self-states.
• Notable Quotes:

  "There are things that are inevitable... It’s not my fault that I was born in that family... But I didn’t choose to have this father and this mother anyway." — Prof. Simos [56:31]
  "The most hearting schemas are the ones where compassion was missing... I think compassion, self-compassion training, is probably quite good for those humans." — Prof. Simos [60:43]
  "Helping someone, the compassionate self, is not the endpoint — it's the means." — Prof. Simos [60:43]
  "The way schema therapists provide limited reparenting is like what the CFT therapist provides…with compassion." — Prof. Simos [64:56]

Memorable Moments and Quotes

• On Self-Criticism as Civil War: "It's very painful... you might be fighting your brother, might be fighting someone that used to be your friend. So this is very painful to have a civil war instead of having a war with an enemy outside." — Prof. Simos [20:55]
• On the Tragedy of Disconnection: "The person who's very, very depressed really needs and yearns for social connection... and yet is feeling so disconnected, so detached from others..." — Dr. Steindl [18:53]
• CFT Accessibility: "Compassion Focus Therapy, our book, has been translated into Italian, Portuguese, Turkish, and Korean... I think it's a great success..." — Prof. Simos [70:26]
• On the Therapist’s Compassion: "In any treatment... we need compassion, self-compassion. This is something that can fit everywhere." — Prof. Simos [62:45]

Important Segment Timestamps

• Book Development and Purpose: [01:49–08:06]
• Empathy and Self-Compassion Research: [09:02–14:10]
• CFT Depression Formulation (Three Circles): [14:10–22:20]
• Sadness, Shame and Social Rank in Depression: [22:28–28:15]; [40:53–46:57]
• Psychological Models and Evolutionary Perspective: [28:15–38:18]
• Fear and Resistance to Compassion (in Depression): [48:23–52:47]
• CFT x Schema Therapy Integration: [53:58–67:48]
• Translations and CFT’s International Reach: [70:26–71:21]

Tone and Style Notes

• Warm, Compassionate, and Thoughtful: Both Dr. Steindl and Prof. Simos maintain an empathic, humble, and personally relatable tone throughout.
• Anecdotal and Practical: Simos frequently grounds abstract concepts in personal or clinical anecdotes.
• Accessible Language: Complex psychological models are clearly explained with concrete metaphors and simple analogies.

This episode is essential listening for clinicians, researchers, and anyone interested in the deep psychological roots and treatment of depression through compassion-focused approaches. Prof. Simos offers practical insights and moving metaphors that illuminate both the challenges and the hope within compassionate clinical care.