Compassion-focused therapy

Domain II · Behavioural & cognitive · Paul Gilbert · 1990

What it is

CFT is an integrative, process-based therapy that adds evolutionary psychology, attachment theory, Buddhist-derived compassion practice and affective neuroscience to CBT. Gilbert developed it in the 1990s–2000s with clients high in shame and self-criticism, often from neglectful, abusive or cold…

Format

• Move on when the client can describe their difficulties in three-systems terms with less self-blame, has a shared written formulation, and practises a body-based soothing skill (even briefly) between sessions.
• Goals: tell apart the threat emotions (angry, anxious, sad selves) and the self-critic; let the compassionate self relate to each of them; use chairwork. In Bell et al.'s study, multiple-selves chairwork came after psychoeducation, formulation and compassionate-self practice, at sessions 7–17 (mean…

Who practises it, and how they are trained or regulated

• Gilbert (2009) does not set a fixed sequence of stages. He describes three interlocking components: (a) formulation, (b) psychoeducation, and (c) compassionate mind training delivered through a warm, de-shaming relationship. The phases below follow the module order Kolts et al. (2018) use to teach CFT to therapists. Using the same order with clients is a common clinical practice, but in this guide it counts as.
• a 6-session trial adaptation combined with breathing retraining (Trials 2023 protocol table);
• Version followed: Paul Gilbert's compassion-focused therapy (CFT) and its core skill-building component, compassionate mind training (CMT), as set out in Gilbert (2009, Advances in Psychiatric Treatment) and sequenced in the module order of Kolts, Bell, Bennett-Levy & Irons (2018, Experiencing CFT from the Inside Out). Chairwork follows Bell, Montague, Elander & Gilbert (2021). The current definitive clinical text,…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Forced or busy imagery. Keep it simple.
• All-or-nothing "I've failed" after a lapse.
• Numbness. Accept "nothing yet" without pushing.
• Nodding agreement while fears remain. Revisit 4.18.
• Grief and idealisation of caregivers. Pace the work.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.