Compassion-Focused Therapy (CFT): How it Works & What to Expect

What Is Compassion-Focused Therapy (CFT)?

CFT involves using compassion-focused approaches in modern therapy. It is based on calming our emotional regulation system, which is activated during times of stress. Treatment focuses on bringing awareness to these emotional regulation systems and their effect on our thoughts and behaviors. The idea is that by bringing more awareness into how these systems affect our thoughts and feelings, and vice versa, clients can bring about balance.

Compassion-Focused Therapy was developed by Dr. Paul Gilbert, who wanted to develop a way to incorporate compassion into healing. The idea was that by decreasing self blame and self criticism, clients are better equipped to develop insight and self awareness to do what they need to cope and heal.¹ CFT has even been found to be helpful with therapists who are struggling with compassion fatigue.²

How Does CFT Work?

Compassion-focused therapy involves a compassion mind training that takes place within the treatment approach. It teaches about the mind-body connection, and how increasing compassion and sensitivity for the body’s sensations and emotional feelings can bring about peace and cohesion.

Because this modality focuses on addressing shame and lack of self-compassion, it is a good tool for people who have a critical and shaming inner voice, which often stem from experiences of childhood neglect or abuse in their family of origin.

Some compassion-focused therapy techniques include:

• Appreciation exercises: This exercise involves creating moments to increase appreciation of oneself and ones achievements and resilience.
• Compassion-focused imagery exercises: This technique involves imaging scenarios or places that evoke compassion in the client.
• Compassionate letter writing: Because many people high in self-criticism are often very sensitive to any slight perception of criticism or rejection, compassionate letter writing is often used as a way for them to practice regulating these negative thoughts and feelings. This helps to correct the imbalance they are experiencing in their emotional regulation system.
• Mindfulness: Mindfulness is the act of bringing one’s attention to the present, which can help with decreasing symptoms of worry and anxiety.
• Meditation: For centuries, meditation has been used by many cultures to provoke a sense of calm and balance. This can help with emotional regulation.

Emotional Regulation Systems & How They Affect Our Emotions

Emotional regulation systems are the parts of our body that evolved to protect us from stressful or dangerous events but giving us the worry or anxiety we need to motivate us to escape from this situation. However, sometimes our emotional regulation system reacts to save us from a perceived danger that may not exist. An example of this is when we react in an overly sensitive way during a personal conflict with a friend.

Imbalances between these emotional regulation systems can result in maladaptive thoughts or behaviors, or even symptoms of mental illness. People with a high shame response have likely not learned a way to self soothe. CFT works to help them achieve this by creating balance with these emotional regulation systems to decrease uncomfortable sensations or symptoms.

The three emotional regulation systems are:

Threat & Self-Protection System

The threat and self-protection system is the part of our emotional response system that reacts to perceived threats. This system evolved to help us escape danger, such as when we come across a bear in the woods and need to escape.

However, when this system is dysregulated, we can react with the same anxiety and adrenaline even when faced with something much less dangerous than a deadly animal. This is often seen in people who jump to conclusions that they are about to be fired when they see an email from their boss.

Drive & Excitement System

The Drive and Excitement System is what gives us the motivation to accomplish goals and seek out stimulation. An example of this drive being dysregulated is when people take high-risk chances such as driving recklessly or engaging in substance misuse.

Soothing & Social Safety System

This system is what drives us towards happiness and safety, and is usually linked to a sense of social connection and belonging. When this system is not regulated, it can affect the previous two systems and exacerbate any resulting symptoms or feelings.

Who Can Benefit From CFT?

While compassion focused therapy can be beneficial for anyone, there are specific populations that benefit from this form of therapy.  CFT is especially relevant for people struggling with self-compassion and low self-worth.

Having a compassionate approach when experiencing painful emotions helps you see yourself in a more positive way, which will help you stay focused on how to effectively cope with these situations.³ Allowing yourself compassion and grace can help prevent some of the shame and self-criticism that is common for many who struggle to cope with low self worth.

Compassion-focused therapy may be used to treat:

• People with distressing thoughts, behaviors, or feelings
• Anxiety
• Shame
• Self-criticism
• Depression
• Disordered eating
• Self-medicating with food or substances
• Anger
• Self-harm/self-injury
• Mood disorders⁶
• Psychosis
• Hoarding disorders⁷
• Coping with unpleasant or difficult situations⁴

What to Expect in CFT

You might have many questions about what you can expect during a CFT session. Luckily, with advances in technology, therapy in person or through online therapy platforms will be quite similar, so feel free to choose whichever modality you prefer.

What to Expect at the First Appointment

During your first CFT appointment, it is likely that the therapist will do a full psychosocial assessment, discuss treatment options and give an overview of what to expect for treatment. This is the time to ask any questions or share any concerns about CFT.

What to Expect During Ongoing Appointments

After your first session, future appointments will likely be held weekly, at least in the beginning of treatment. Is it usually provided in individual sessions, but can also be provided in group therapy.

How Long Does CFT Treatment Last?

Like most therapy modalities, the typical duration of treatment largely depends on the context and the event that you are treating. It will likely last anywhere from 5-15 sessions, but can last longer, especially when used with another modality.

How Much Does CFT Cost?

The average cost of therapy can vary greatly depending on what region you are in, available resources, and whether your insurance covers therapy. While costs can vary widely, expect to pay anywhere from $50-$200 per session.

How to Get the Most Out of CFT

Like any therapy modality, it is important for the client to be willing to work at their treatment. Therefore, you will need to work hard to see results. Keeping up with homework, remaining focused, and being honest are some ways to get the most out of your treatment.

Below are some tips for getting the most out of your CFT sessions:

• Do your homework between therapy sessions: This therapy technique often involves homework that is given for the client to practice in between sessions.
• Remain focused: This modality requires a high amount of self-focus in order to get the most out of the techniques
• Expect some discomfort: People who are high in self-criticism and shame often had experiences of abuse or neglect in their past, likely with few- if any- opportunities for compassion. Thus, it can feel weird at first to show compassion towards yourself.
• Be patient: Sometimes it can take a few sessions before you will notice changes in yourself. Trust that this is a normal part of the process.
• Be willing to be vulnerable: Having compassion for yourself often involves allowing emotions and feelings to come, which can feel vulnerable.
• Be honest: If any discomfort is present, or an increase in certain feelings or symptoms, mention this to your therapist.

How CFT Integrates With Other Therapies

One of the best parts of CFT is its complementary nature with other therapeutic approaches. Many therapists incorporate this therapeutic model with other interventions such as cognitive behavioral therapy (CBT) or dialectical behavior therapy (DBT). In one 2016 study among firefighters suffering from trauma symptoms, CFT was used as an adjunct to trauma focused-CBT. Results suggest that therapeutic interventions used to cultivate self-compassion are beneficial.⁵

Because of its ability to be used with other therapies, therapists can incorporate a compassion focused healing model into many forms of treatment. As it is common for mental health symptoms to come up, or even get worse, during treatment, incorporating a compassion focused therapy approach as part of the treatment can help people support themselves.

How to Find a Compassion-Focused Therapist

If you feel that CFT might be a good fit for your treatment goals, consider finding a therapist offering CFT. Ask for a consult, and during this time, inquire as to whether this therapeutic modality might be a good fit for your particular challenge or situation.

If you are wondering how to find a therapist, the best place to start is an online resource such as an internet search or online therapist directory. The internet can be a helpful resource because it can show you many of the therapists that are licensed in your area. Another option is to call your insurance company and ask for a list of therapists who take your insurance. Although, be mindful that insurance companies are sometimes not accurate, and they may not have an idea which therapists use CFT or which ones are accepting new clients.