I'm Steven Detweiler. I'm a public health analyst for SAMHSA. I'm pleased to moderate today's session, Compassion-Focused Support for Staff in Early Psychosis Services. Now I'd like to introduce you to the faculty for today's session, Dr. Charlie Haryok Maitland. Dr. Maitland is a clinical psychologist, researcher, and trainer at Balanced Minds. For the past five years, he has been researching the application of compassion-focused therapy for people in the UK National Health Services who are experiencing distress in relation to psychosis. He provides CFT therapy, supervision, consultation, and training. He has run over 100 various compassion training workshops, both nationally and internationally. I will now turn the presentation over to Dr. Haryok Maitland. Thank you very much, Steven, for the very kind introduction, and it's a real pleasure to be joining you from my loft here in Edinburgh, in the UK, in Scotland. So today I'll be talking a bit about an introduction to compassion-focused model for supporting staff in our mental health services. I'll be talking a little bit about why compassion is important, some of the sort of theoretical underpinnings for why we might take this approach for our staff support, and I'll also be sharing some techniques as well about how we can put compassion to work in the context of our psychosis services. Okay, so I've got Ben moving the slides along. So could you just move us along to the learning objectives, please, Ben? So these will become a little bit clearer as we go through, but some of the key objectives for today is to really understand how the concept of multiple selves offers a really valuable tool for starting to get the flow of compassion going, especially towards parts of us that are struggling around issues of loss and grief, and if parts of us that are feeling isolated. We will, by the end of today, we'll also be able to understand which qualities of compassion are important for applying to these parts of us that are struggling, and we will be able to summarise techniques. We might even have time to try something out more experientially. We'll see how we're going with time as we go through today. Okay, so we're going to start off, if you could just move the slide forward, we're going to start off with the definition, because this is a real stumbling block when we start talking about compassion. The word itself can have so many different connotations and meanings and associations, so we really want to talk about what we mean by this word compassion. When I run workshops with staff teams and service users as well, consumers, I quite often start with what does this word compassion mean to you, and it's amazing how much of a range of words come up around this and ideas. For some people, there are very positive connotations with kindness and empathy and love, and for other people, this sparks thoughts and feelings of weakness, or maybe it's quite soft, and maybe compassion makes me feel quite vulnerable when you need to be strong in this world and hard. So it's an amazing what an array of definitions people have or feelings people have with this word. So in compassion-focused therapy, which is a model of therapy developed by Professor Paul Gilbert, which is the model that I use clinically, but also in training and research, this is the definition that we use. Compassion is a sensitivity to the suffering and distress of self and others and its causes with a deep commitment to try and relieve it and prevent it. So we can see here in this definition that there are two important aspects of compassion. The first bit is getting alongside, engaging with, and moving towards where the suffering and distress is. Now there's nothing soft and fluffy about that. This is very much a strength and a courage. It's really hard turning towards the pain and the distress. Much, much easier to avoid it and turn the other way. So compassion requires a real courage to engage, to look the suffering straight in the face, and to try and be motivated to do something helpful with it. So that moves us on to the second bit of the definition here, developing the desire and motivation to alleviate this suffering, to uproot it, and to take action and to be committed to that action to try and prevent this suffering in the future. Okay, so if we can move on to the next slide, please. Why do we need compassion? Well, there's a very simple, short answer to this question. We need compassion because our brains are a total mess. The human brain is really tricky. It causes all sorts of problems for us. If you could just move on this slide. The reason is it's not perfectly designed for 21st century life in the United States. It's been through a series of adaptations over many different stages of evolution. There are very different environments that we lived in through these evolutionary stages. So there are some periods in our evolutionary history where it was very important that we had to respond immediately to life or death threats each time we walked out of our cave. So the human brain is a bit more like a compilation brain. We have these really older functions in our brain which are very well adapted to different stages of evolution, and we have these more modern, human-like functions in our brain that we have today that have developed later. It's a bit like an old house that's had a load of extensions built on it. So you've got these kind of rickety old bits of the house where you have to put newspaper in the walls to stop the drafts coming in, and then you have these fancy new bits of the house, the new extensions that we put on later on. So brains are a bit of a compilation. And on the next slide, if we could just move forward, we can very simply think about this in terms of the older functions of our brain and the newer functions of our brain. So in the old brain, this is where are seated some of the basic motives, emotions, and instincts, the kind of things that we can see across different species, that humans share with other species. So we have these kind of basic motives for seeking out food and sex, relationships, status, the kinds of emotions that ripple through our body that propel us towards these survival motives, and the kinds of behaviors and instincts that help us with this as well, instincts that help us feel safe and get safe when we're in danger. And so the old brain is where all these things are seated. And we could recognize these things in our pets and in other animals as well. The new brain, as far as we know, is more uniquely human. This is where we have these newer capacities for things like imagination and planning, self-monitoring, mentalizing. Now these are really handy things for humans. These have allowed us to do all sorts of wonderful things, like put people on the moon, develop wonderful vaccines, medications, creative arts and architecture. So this takes wonderful imagination and planning. There is, however, a bit of an evolutionary trade-off between having this fancy bit of kit in our new brain. One of the key trade-offs here and one of the problems here is when the old brain and the new brain interact. So for instance, when we have a strong emotion rippling through our body, an old brain emotion, something like anxiety, what starts happening in our new brain is that it starts becoming organized around that anxiety. So for instance, the imagination parts of our new brain, they start imagining things like the worst case scenario or they start imagining future dangers or all the things that could go wrong. So our new brain starts becoming shaped around the anxiety, same as our planning. So our planning starts becoming focused on how am I going to keep myself safe? And of course, the more that our new brain becomes shaped in this way and organized in this way, the more this feeds back in to creating anxiety. So everything in our new brain is actually fueling and adding anxiety. So this creates a bit of a loop in our brain. The old brain winds up the new brain. The new brain winds up the old brain and we can get caught in a in a bit of a vicious cycle or what we would call a loop. And this can cause real problems for us. If you could just move the slide forward. So if we just had an old brain, this is just another way of looking at it. If you if you look at time along the X axis there and emotion level on the Y axis. If we just had an old brain and that's all we had. This is what it's supposed to do, this green line. So the emotion is supposed to shoot up to a high level. Get the job done. So fight or flight. You know, the emotion prepares our body for fight or flight. And then when the danger's gone, the emotion is supposed to just naturally come down again over time, just to naturally subside. And then if we do the second line, please, Ben. When we introduce a new brain into the equation, what we get is this red line here. So the emotion shoots up to a high level. And just as it's about to come back down again, the new brain kicks in and starts dwelling on what just happened. And then just as the emotions about to come back down again, the new brain kicks in and then starts imagining what's going to happen next. And that sets the emotion off again. We keep re-triggering and re-triggering the emotion with our new brain. And then just as the emotions about to come back down again, our new brain kicks in and then the self-monitoring bit of our new brain kicks in and then says, you idiot. I can't believe you responded in that way, pathetic. And that sets the emotion off again. It's almost like we've now internalized the threat and we've become our own self-critic, our own threat to self through our self-criticism and beating ourselves up. Can't believe how pathetic I was just then. So we can keep the emotion going, suspended at a high level, way, way longer than it was designed to do. Our new brain and old brain can just keep it caught in these loops. And as a therapist, as a mental health professional, a lot of people who come to therapy, they've often been caught in loops for months or years. Whether it's an anxiety loop or anger or depression. So this is a real, real problem for us as humans. Now, zebras don't have this problem. You can, next time you're watching a nature program on TV, you'll see that with the zebras, when they're chased by a lion or some predator out on the savannah, and they're running really fast to get away from this danger, you know, that sort of anxiety and cortisol is pumping through their body, running really fast. But as soon as the lion gives off chase, it's really, and the zebra realizes I'm not being chased anymore. It's really not very long that the zebra just happily returns to munching the grass. It's almost as though, you know, it's, you know, the no danger, oh, that looks delicious. It's like the emotion level comes straight back down again. And it appetite returns, it carries on munching the grass. So next time you're watching a nature program, just look out for it. It's pretty astonishing how quickly the emotion gets regulated or comes back down again. So obviously, with humans, it's a very different story. You know, if we'd been chased by a lion here to this presentation this morning, we'd be going over and over things in our mind. You know, what would have happened, are there more lions around? What would have happened to the mortgage? And we'd have all these kind of images of like blood and limbs being torn apart. What about the kids and school and, you know, we'd be going on and on and on. So it is really tricky being human. We do get caught into these loops and it's not our fault. The other tricky thing about being human is that that doesn't even need to be a threat in the first place. That doesn't even need to be a danger. We can just sit there and imagine that there might be a danger and we can set off the whole evolutionary apparatus just from imagining that could be something. So if you just click forward, then have you ever seen a dog sitting under a tree thinking about how much weight it's put on recently or whether it's going to make a fool of itself later in the park when all the female dogs come out? So humans can just sit there and just, you know, look at our flabby bits or we can remember something or we can imagine something that's happening later this evening and we can set the whole threat, stress, cortisol system up and running, springing into action. So it's no wonder why we as humans get stressed and it's no wonder why we get wear and tear in our stress and our threat system. OK, just press forward, please. So how can we use this knowledge about our tricky brains to support staff who are facing some some really significant struggles and as we know, this year in particular, 2020, there's been a whole different layer of struggles, the whole context in which we're operating and delivering services. So how can we use this knowledge about tricky brains to get an understanding of how our brains are working and causing problems for us to improve our well-being and support each other? OK, I could just move on. The first thing we can do is we can develop an awareness about what's happening in our minds so we can develop a view from the balcony, a mindful awareness. We can become an observer of the loops that are going around in our brain. That's a really crucial first step so that we're not self-perpetuating, we're not just sort of caught in the loops, you know, perpetuating them. We can take a step back and look back. But the thing is, we don't want to step back to the balcony and then see what our brain is doing and then say, you idiot, because that's not particularly helpful. That potentially just sets up a whole nother loop of self-attacking, self-criticism, shame. Then we're into something else. So this is where we think about what type of view we bring to ourselves and our brains. And if you could just click forward. And here you can see on the animation, we're trying to develop a view that brings a more compassionate awareness. It warms up that awareness. This is a brain that's been designed by us, not for us. This is an evolved brain. This is not something we chose. If I could design a brain, I probably wouldn't design it like this. I'd probably have a nice little off switch probably near the ear somewhere where you can just sort of switch off these emotions. But the thing is, we've got this brain, the one that we've inherited, and it's not our fault, but we're all in the same boat with this. So you can see how this evolutionary understanding, this evolutionary psychoeducation might help us to develop more of a de-shaming awareness, more of a compassionate awareness about how we relate to our own brain. And it's particularly when we're struggling, when we're faced with experiences like isolation and loss and COVID and all the struggles that, well, especially you guys in the United States have been having recently. This is when the loops in our brain get really activated, and it's almost like being stuck on a cycle in the washing machine. We can really get caught when we're under a lot of pressure. So can we develop more of a compassionate awareness from the balcony? OK, just if you could go forward to the next slide. I'm going to show you a video now, and this is just going to, it's just a quick one, it's only about four or five minutes long. It's going to give you a quick recap of what we've covered so far, talking about the tricky brain, the old brain, the new brain, and how that can create loops. This is actually a video that you can access on YouTube. So if you type into YouTube, developing a compassionate mind, a balanced mind, you'll be able to get it there if this is helpful and you want to watch back later with yourself or your clients or colleagues. It just recaps what we've been talking about, old brain and new brain, and then it introduces the concept of multiple selves and the role of compassion within the, how can we help ourselves with this tricky brain of ours? How can compassion be a place from which we can learn to do something useful, more helpful with this tricky brain of ours? OK, so I'm just going to leave you to watch that, if you could press play. Our amazing brains are a combination of old and new parts. We have an old brain which developed millions, you need to click it forward, you need to click it forward one more, Ben, to get onto the animation. Amazing brains are a combination of old and new parts. We have an old brain which developed millions of years ago and the earliest humans evolved from apes. Our brain is where we hold our basic instincts and emotions. This kept us alive in very different times when we needed to respond immediately to threats. Most animals only have this type of brain. Our new brain has developed in the last few thousand years. The new brain is what makes humans special. We use this part of our brain to do lots of incredible things. It gives us imagination, creativity, and self-awareness. However, the old and the new parts of our brain don't always work well together. On its own, the old brain makes us alert and ready. But when the threat passes, it quickly calms down. Think about a zebra, which immediately stops to enjoy grass as soon as it escapes. In humans, when the old and new brains interact, they create loops. These loops can keep an emotion going for a long time as we keep going over and rethinking a challenging experience. This can make it difficult to get calm and settle as we ask ourselves questions like, Why did that happen? What could have happened? Whose fault was that? What if it happens again? Questions like this can be very difficult to switch off. They keep us in our stressed state, even after a threat or challenge has gone. It's really hard to make thoughtful decisions when your brain is in this loop. Our old brain emotions create loops which shape our minds in different ways. Because they shape our minds in different ways, we can think of them as our different emotional selves. Angry self, anxious self, and sad self. In a challenging situation, these emotional selves are difficult to control, and they can also conflict with each other. Angry self thinks anxious self is a wimp. Angry and anxious cells stay away from sadness. These conflicts make threat situations very hard to manage and tricky to resolve. However, in challenging situations, we can choose to show up as our compassionate self. Our compassionate self helps us to recognize the feelings and behaviors of our angry, anxious, and sad selves. Our compassionate self can give us permission to take a step back and choose words and actions that will help to calm and improve the situation. This can give us the space to ask, how would my compassionate self respond in this situation? Our project, Developing a Compassionate Mind for Parents, helps us understand the feelings created when the behavior of your child is challenging. We can see that these are very normal emotions caused by our tricky old and new brains. If our compassionate self can recognize angry, anxious, and sad selves in difficult situations, it can also help us to make thoughtful decisions which reduce confrontation and improve our relationships. Okay. I'm not sure how you, it was on your screens, but it was a little bit jumpy from my screen. So, do, please do find the original version on YouTube. It's on the Balanced Minds YouTube channel. And if you're interested in learning more about that, you can find the original version on YouTube. It's on the Balanced Minds YouTube channel. And you'll be able to have another look at that uninterrupted. I'm sorry about the quality there. It was only about two minutes before I came live that we realized that I couldn't share audio from a PowerPoint on my computer, which is why I'm having to get Ben to share the slides from his computer. But anyway, so, please do, yeah, go and find that. It's quite a helpful tool that I've been using quite a lot with some of my clients to introduce some of these key psychoeducation points about tricky brains. You know, in Compassion Focus Therapy, it's, the psychoeducation is designed to create a real de-shaming foundation for the work we're doing. We're not trying to say it's not your fault, so don't bother, you know, so what the hell can you do about it? We're saying it's not your fault. So, but it is your responsibility. You know, now that you can see that a lot of what happens in our brain is really, you know, due to evolutionary processes, you know, we shouldn't really be beating ourselves up about it, and we, but now that we can start seeing that, can we start taking some compassionate action towards ourselves? Like, how can we start shaping our brains and shaping the loops in our brains in a more helpful way that are going to improve our well-being and give us a better chance of dealing with some of these struggles? So it's not your fault, but it's, it is your responsibility. That's one of the key messages here. Okay, can you just move forward to the next slide, please, Ben? So this idea of multiple selves, this was introduced in the video, and this is a very powerful and effective tool for starting to bring compassion towards our struggles. Just even the concept itself, that there are different emotional parts of us, so there are different emotions that I can be in a relationship with. So just thinking about that for a minute, the difference between I am feeling anxiety or I'm, you know, I'm enveloped by anxiety compared to the experience of I am in a relationship with my anxiety. So, or the anxious part of me is thinking X or feeling Y or has an urge to act as Z. So it really starts shifting and helps us be able to think about how do I want to be in relationship with this emotion of mine? So it could be an anxious self or an angry self or a sad self. It could be a part of me that is struggling with grief and loss. It could be a part of me that feels isolated and is struggling with the isolation and disconnection that has been brought by COVID-19 and the quarantines and lockdown restrictions. So it's a very powerful tool to start getting to know the parts of me that struggle, being able to notice and name them and then being in a relationship with them. So if you could just do the next, yeah, great. So on this slide I've basically just shown how we can map this out for ourselves, you know, so and here I've used space on the slide to represent, you know, the type of relationship I have with these different emotions. So for instance, anxiety is something that I'm experiencing quite readily, that's quite close to me, whereas sadness is something a bit further away. It's off up there in the top left corner, you know, so that's representing that maybe my relationship with sadness is not quite so, you know, easy and readily activated as my relationship with anxiety. So sadness is something I might have to spend a bit longer trying to get to know, it's something that I'm not really spending much time with. And again I've put there, you know, maybe there's the parts that are struggling with grief and loss, maybe there's parts that have been traumatized or feel quite helpless by something that's been happening at work or something I've heard or seen with some of my clients. And also we can, importantly for a lot of us, we can identify this another character, our self-critic. This is often a part that in therapy I do a lot of work with people, a lot of work with my clients, helping them get to know their self-critic, the part of them that beats them up and puts them down, particularly when they're struggling. So this is just a kind of an example really of a kind of map of how we might start mapping out multiple selves. And if you could just click forward and then we can introduce, as we saw on the video, we can then introduce a self-identity that we in compassion-focused therapy we would refer to as the compassionate self. Now this is something that can be trained up. So if you click forward, got some animation. So you see it's getting bigger there. So we can train this up and we can bring it more central into our map so that this can, we can practice and train this to become the place from which we relate to the other parts. So just click one more time. Essentially the compassionate self, we can train up to become the secure base from which we engage with sadness or from which we try and listen to our anger or from which we try and negotiate with our self-critic or from which we try and help the parts of us that feel quite powerless or excluded or helpless or disempowered. So in compassion-focused therapy, we try and help people cultivate a self-identity. At the beginning, you know, it might feel like a bit like acting but that doesn't matter. You know, we try and say things like, what would your compassionate self think? Or how would your compassionate self help out the part of you that's struggling with grief? So even if we can't necessarily feel that compassion towards ourself, and a lot of us struggle with self-compassion and bringing compassion to ourselves, we can still try and use acting techniques, embodiment techniques to think what would that look like? What would the voice tone be? If I was really being at my most compassionate best towards a part of me that's anxious, what would the voice tone be? What about the body language, the facial expression? What would that look like? And what qualities would my compassionate self have in order to help this part of me? So some of the key qualities that we really try and focus on as qualities of compassion are qualities like strength, which I've already mentioned before, you know, because compassion is all about getting alongside the things that are most painful. Now that requires a lot of strength and distress tolerance and groundedness. So these are the qualities that we try and train up. So we spend time focusing on these qualities, feeling that strength in the body, locating the strength in our posture. We also want the compassionate self to be wise. We don't want a stupid compassion, you know, who just sort of rushes into everything without thinking of the consequences. So sometimes we really need to focus on the wisdom of compassion, the wisdom about what would be helpful here and what would be the most helpful in the long term as well. What skills are we drawing on to try and help out this part of me that's struggling? And also we want commitment. We really want the compassionate self to be committed, strong, wise and committed to caring. You know, it's not something that necessarily is just, you know, something that can be helped overnight. You know, if it is something like we're grieving or we're struggling with loss that's happened, you know, we're going to have to be in this for the long haul. This can take time. So we need that patience and commitment in that self-to-self relationship. So, okay, you can see also here, wait, before we move on, we can see also here that the compassionate self is providing quite an integrating function in terms of integrating parts of our mind. So you remember on the other earlier slide, we had sadness way off up in the corner, you know, and that might be for those of us who struggle with that emotion. You know, a lot of people do struggle. They feel quite defeated and vulnerable when they access sadness. So the compassionate self is also playing quite an integrating function. It's trying to help us make contact with the feelings that we struggle with, that we're afraid of. Try and bring them into that inner circle so that these difficult emotions aren't left out. Okay, let's just move forward another slide. In compassion-focused therapy, essentially what we're doing is we're trying to create the optimum conditions in our mind, in our body, in our social environment that are going to give us the best chance of engaging with our threat-based emotions. So the whole model is about learning from evolutionary psychology and neuroscience, and actually there's big influences from attachment theory as well about how we can create the conditions within our relationships and our social experiences that are going to give us the best chance of courageously engaging with the things we struggle with the most. Essentially, it's a training in how we prepare our mind for emotional engagement, for emotional processing, and this might be about courageously engaging with trauma that we experience as mental health workers, and particularly in 2020 where we haven't necessarily had the same resource and connectedness that we would usually have as a team. So CFT and the compassion-focused approach to staff support is all about what are the optimum conditions, biopsychosocial, so creating the conditions in the body, postures, voice tones, facial expressions, creating the conditions in the mind, how we are motivated, wisdom, strength, courage, and creating the conditions socially within our team connections, with that sense of belonging with colleagues, and obviously support at home with the family as well. How can we create work on all of these biopsychosocial conditions to give us the best chance of compassionate engagement with what's difficult. That loop that I've got at the bottom right-hand corner of the slide, that's really the nuts and bolts of what we're trying to do in compassion-focused therapy. The more that we can feel physiologically safe, so safeness in our body, the more that that safeness experience enables our minds to start doing things that are conducive for compassion. So feeling more safe in the body enables our minds to do things like empathy, it enables our mind to do things like mentalizing, taking perspectives, so we can't do this stuff if we're not feeling safe in the body. So we're really trying to create physiological safeness, and the more safe we feel in our body, the more our minds can be organized with compassion, and then the more our minds are organized by compassion, the more that feeds back into feeling more socially safe, connected, more close to people, and that creates more safeness experience. So essentially in this approach, we're really just trying to get people into that pattern of safeness and compassion. Okay, if we could just go forward. We're trying to do this across each of these three levels, the level of the system, the work we do with the clients and service users and families, and how we do this in our own minds as staff. So just click one forward. Thanks Ben, thanks Ben for keeping up. So at the system level, what we're talking about here is how we can create contexts in which compassion can flourish. How can we organize our systems and our leadership within our teams to create contexts in which compassion can flourish? And this might involve, for example, how we can foster inclusive, affiliative, supportive relationships, how we can foster a sense of shared purpose and direction within the team, within the service, and how can we counterbalance some of the natural threat biases in the brain that, you know, as a team, and I don't know about the teams you guys have been in, but certainly teams that I've been in, there's a real tendency for our team meetings and team discussions to get quickly hijacked by conversations about risk and threat and when things are going wrong. And that's just our natural threat bias in our brain. So can we organize our systems to give ourselves opportunities to notice good practice and, you know, to be inspired by each other's compassion and for us conversations to to make sure that they're more balanced so that we can talk about risk in a helpful and wise way without getting hijacked by risk and threat in all our conversations. Okay, and then at the level of clients and families, if you could just click. So this would be about facilitating our clients' development of safeness and compassion. This might involve sharing some of the psychoeducation that I've been talking about, you know, education about tricky brains, loops in our brains, threat system, and how we can use things like getting grounded, breathing, posture to support the patterns in our mind that are conducive of compassion. And how can we develop and support our clients to develop some of their own compassionate practices. At the level of staff, well, yeah, we're really getting good at this, Ben. Mind reading. So at the level of staff, can we develop an awareness of our own emotion systems, our threat system, our drive system, our soothing system? How can we notice that our own emotional parts, our own angry self, anxious self, sad self, our own self-critic, and how can we develop our own practices with getting grounded before we jump into being compassionate? You know, for instance, when we're helping, we're providing therapy or consultation for our clients and support for each other. How can we make sure that we're getting grounded, that we're creating the conditions in our body and mind and attention that are going to give us the best chance of engaging with distress, which is a really, really hard thing to do? It's much easier to disengage. And how can we practice showing up for ourselves with compassion or show up for ourselves as our compassionate self-identity? Okay, if you could just move it on. So I showed you this earlier, which is more about how at the personal level, the compassionate self has a role of integrating. The compassionate self provides an integrating function for different parts of our own internal emotional world. Actually, just to mention something, as Dan Siegel, who I'm sure many of you have heard of when he he talks about integration and he he says when we talk about integration we're talking about fruit salad not smoothie okay fruit salad not smoothie so fruit salad integration is where we're holding multiple parts multiple individual parts together we're not blending it all together into one we're not going for that kind of smoothie integration so this is what the the compassionate self is doing here the compassionate self is almost like the fruit bowl holding the sort of kiwi fruit the strawberry the grapes it's all these different parts of us sad sad self angry self anxious self self-critic and compassionate self is the holder and and if you could just put the slide forward we can also think about this at the team level so in the same way that the compassionate self provides a holding and integrating function for our own lines we can think of the compassionate team as providing that holding and integrating function for diversity and differences within the team and you know particularly during this is COVID year you know some of the some of the splits and and and cracks that might naturally have started coming into the team just because of the lack of connection and be able to sort of you know make coffee together in the mornings and that kind of thing so we can really think about the compassionate team as that holder and integrator for at the team level as well and I won't have time to talk about it today but there is some wonderful work that that that me and some colleagues have been doing in the UK social services about trying to bring compassionate leadership and compassionate at the team level in providing social services care we've been really trying to do a lot of work yeah trying to get get teams organized things like the processes of the teams how the team meetings are run how we can hold spaces compassionately within our teams to listen to issues of diversity but also issues of distress and struggles within the team okay you could just go on another slide now this slides a bit more for a rainy day we've got plenty of rainy days in Scotland so these are these are my kind of slides this is just a slide summarizing some of the data so at the kind of more individual level there's quite there's some quite good data now about the benefits of training our minds by compassion and some of this has been done with brain scan neuroimaging fMRI research looking at the the structural changes that take place as a result of you know just eight weeks compassion training or compassionate meditation training there's also some evidence about the role of CFT training for health care staff and how that affects people in the more professional role there's also some some great data on the role of compassion in organizations and how this helps lead to increased commitment to organizations connection with colleagues etc so anyway these are some things to follow up on a on a rainy day if you could just go on to the next slide and I want to finish up just by sharing some of the actual techniques that you can start putting into practice how we can actually put the compassionate self to work and these are these are techniques that I've used with with teams I've used with clients I've used for myself and the first one there is chair work and you know really this is and this is a kind of extension of the multiple selves work that I mentioned before so we you know you might have in one chair the compassionate self and you might have in another chair the part of me that's experiencing is part of me that's grieving and a loss and and so you could just almost like set up a role play and trying to embody and and act these different parts you know try and really get into the character of that sad part the grieving part really try and occupy that space and in your body and then spend a bit of time shifting over to the compassionate self chair and responding compassionately to that part and and also I'll talk a little bit about some imagery techniques and some other embodiment techniques and some letter writing as well so if you could just move the slide forward a bit and so a lot of the the support I do with teams and I do try and really get the get people to connect with these feelings in the body so if you could just click forward so a lot of teams tend to do this a lot of sort of talking head-to-head talking and so I think in a CFT approach something that we would really encourage if you click forwards Ben is how we can how we can bring the work and the conversations more into the body more into the room and there are certainly challenges doing this over zoom which is you know where I've been doing most of the sort of team support work recently but but just to kind of hold the space and connect with the feelings and where do you notice that in your body so if you can just click forward the slide a bit and again so asking questions like this you know that must be really difficult for you and then pausing holding the space dropping into the body and where do you feel that you know rather than the alternative which is what we what we quite often do which is that sounds really difficult for you but another way of looking at it is this was this you know trying to sort of problem-solve trying to positively reframe you know these are all really helpful things but but sometimes actually we just need the space to connect with this and where that is that is in the body before we rush ahead with trying to fix it so going back to that definition right at the beginning compassion is all about engaging with the struggling engaging with the struggle and the pain and the distress and then secondly moving towards trying to help so we don't want to rush in too quickly with trying to help we need to create space to notice and and feel and make contact with the distress before we try and help okay so if you could just move forward again and we we use a lot of imagery as well and before any imagery practice we would always get the prepare the body so prepare get grounded engage with the soothing breathing rhythm engage the parasympathetic nervous system the vagal nerve get the get the body in the right place where we can do some something useful with our compassionate minds and there are various practices we use with directing other to self compassion so directing compassion from others towards the self so for instance we can imagine safe places colors memories ideal compassionate figures and use these as use these those practices where we can experience receiving compassion to us from from another or from a place or from a color and we've got we've got a load of practices as well where we direct it's in another flow from self towards others so doing visualizations of someone someone you love or a colleague who's struggling and someone who's who's really going through a tough time and just focusing imagery of directing your compassion towards that person and of course we have a load of practices of developing self compassion where we might imagine for instance walking along the street as our compassionate self and then meeting ourself in the street you know and what would that feel like what's that feel like directing compassion towards yourself what would you say what would you do do you put your arm around him or her sit down on the bench how would you engage what would be the body language the voice tone and what would that feel like in your body so and also the multiple selves as well so you know you could obviously be walking on the street and meet your anxious self walk along the street and meet your angry self and walk along the street and meet your self critic so there's some endless possibilities here but imagery is a really quick route in to getting into the feelings of this interaction you know it's compassion is not a cognitive exercise it's not an intellectual exercise it's about engaging motivations and evolved deep-rooted evolved motivational systems okay just move on to the next slide so this is compassionate letter-writing again this is just another technique it's a bit of a kind of whistle-stop tour really today of some of the examples in case you did want to go away and put this into practice this is definitely something that you could run with straight after this sessions finished if you've got nothing else to do writing a letter from your compassionate self to yourself and the guidance that we usually give with this is to start off the letter just trying to name and pay attention to a part of you that's struggling so it might be you know a day-to-day struggle like so I might write dear Charlie I can see you're really struggling to keep on top of those emails those flagged emails again and I know you've struggled with this a lot over the last over your whole life and I can see you've been making efforts to cope with this and I can understand why it's so tricky for you that you can't quite get on top of it they just keep coming so so we're really trying to name a problem name a struggle at the beginning the next bit is moving into empathy and understanding it's understandable why you're finding this hard and it's understandable why this has led to all sorts of efforts and ways to cope with this so so the first bit of the letter is really about that first bit psychology of compassion the engagement bit before we move on to the problem-solving it's only later in the letter that we want to start moving into yeah have you tried this this might be helpful there's anything helped in the past with this that might help now and finally just finishing with a with an action plan so what might you be able to do over the next coming days to take this forward and to develop support with this okay so just flick on to the final slide if you would Ben it's just a list of references here again this is another slide for a rainy day you should all have a copy of these I hope there's been a some helpful bits in there and I really look forward to hearing your questions any comments thank you and dr. Harriet Maitland wonderful presentation I do have a few questions from our audience today and I'm going to read them and you can respond the the first there the first two are actually similar questions I'll read the whole thing how would you recommend bringing CFT into practice with clients that may see compassion or vulnerability as weakness I'm thinking especially in male populations that may already be adverse to therapy from the beginning and then the related I think related question when I'm in it when I've introduced this to youth young adults sometimes they report it's making excuses for themselves going too easy on themselves how do you develop compassionate mindset while not excusing yeah that is that is spot-on that question and and this is this is something that the we are we anticipate in the compassion focused therapy model in fact when we started when CFT we started using CFT with clients or Paul Gilbert started using CFT with clients he thought well this sounds like a good idea developing compassion and he noticed that there was a huge backlash of all the fears and all the resistances and all the blocks so actually you know this is just one of the the nuts and bolts of this approach is that fears of compassion are exactly what we're working with here we're exactly working with people's beliefs around the word and people's vulnerability the that is triggered by the word so so I think I think one of the first things that that I would do with clients would be to spend a lot of time on the definition like I did with you and using lots of examples from their personal life to get an intuitive sense so they have an intuitive sense of what compassion means and what qualities are involved so for instance saying a lot of things like and you know if you if you got a phone call from a really good friend who has had just been told they had to go to hospital for an emergency admission how would you want to be with that person how would you respond what would be your voice tone what would you want for that person so so it's almost like almost like going the word itself is really problematic but once we get into examples and vignettes and scenarios we start getting a sense of really what what this looks like and then also another really useful tool is something called the fears of compassion scale so there's there's actually a scale out there you can google it it's downloadable for free from the Compassionate Mind Foundation website CompassionateMind.co.uk and the fears of compassion scale this the very existence of this scale is a very normalizing validating experience for people who struggle with compassion because what we're saying is these are so common these are so common so usually I would go through the items of the scale and just see which are which are some of the fears that resonate with you I'm trying to bring validation understanding and how do we start taking step by step by step gradual approach to start overcoming some of these fears so the journey towards compassion is definitely quite a long one it's quite a bumpy road but you know this is this is exactly the kind of thing that that I in my opinion is the kind of road that is helpful for people to start treading along because it's actually because they because they struggle with compassion or self-compassion that's one of the things that keeps them stuck it with their struggles and so so yeah a lot of validation and not a lot of normalization that compassion is hard but it might still be worth it other question then our medical director attends staffing via zoom right now with us the therapist she's very aggressive and my supervisor is trying to figure out a way to reduce her aggression but has to be mindful of her position any ideas on how to approach this from a subordinate position oh my goodness we can be careful about advice I give here you guys are quite good at suing people for giving the wrong advice okay well I think I think that this is is a really important thing to recognize is what you pointed out is this this social rank positions that we get caught in there's subordinate dominant mentalities this is this is a lot of where the CFT theorist theory came from in the in the early days is that it's a lot of struggles within our services but a lot of mental health struggles as well are due to these power dynamics and these these dominant the dominant subordinate roles that we find ourselves in and actually how these can if we are in dominant subordinate roles with a with a dominant medical director for instance how that can often start playing out in terms of how we are with ourself so a dominant part of us starts beating up a subordinate part of us so it's almost like these these roles start getting internalized and in terms of self-criticism self-doubt putting ourselves down so I think the the best advice would be really to start with noticing noticing whether we are exacerbating this subordinate experience and defeated experience within our own minds and our own loops and if we can organize our minds by compassion and we can start practicing the kinds of qualities the the the compassionate qualities I mentioned like getting grounded feeling that strength in our body feeling the feet on the floor developing our our compassionate wisdom then then I think that would prepare us for a more collaborative embarking on a more collaborative conversation with our medical directors we can't we can't change them unfortunately but we can but we can create our own empowerment and our own stance in relation to how we approach this but importantly how this plays out in our own minds in terms of our own self-criticism so I can't fix that one for you whoever asked that question and I do know we do need to get better at choosing our leaders what what what do you do when safety is threatening and yeah that's a that's a really good question and so so some people as they start moving towards they start moving towards compassion and safeness that can really activate their threat system because it might involve a letting down of your guard you might have always learnt through your life I've got to keep I've got to keep my guard up I've got to be tuned in to all the potential dangers out there so the the journey into safeness might require graded exposure it's a bit like overcoming any fear like same as if it's like a phobia of spiders or a phobia of getting on airplanes you know usually the way we would approach that is in it is it is through graded exposure it's exactly the same with a fear of safeness or a fear of compassion we we start we start going slowly with that and let the the person guide their their journey into safeness and but this is a this is a big big issue and I'm glad you raised it because the people I work with quite have got quite complex trauma histories and a lot of childhood sexual abuse these are people who later develop psychosis probably as a result heavily of a lot of that trauma and and this is and this does take time you know I'm definitely one for trying to get make therapy something that gets extended you know six months eight months the research I've been doing here in the UK we've been trying to see people for for at least six months to really start creating the spending time getting into the safeness experience it's not something you can rush so it's a really good point and thanks for raising that those are really some great questions and I appreciate your responses to them thanks again to our dr. Harriet Maitland for such an interesting presentation you

Compassion-Focused Support

Staff support

Early psychosis services

Compassion-focused therapy

Mental health services

Vulnerability

Negative behaviors

Multiple selves

Chair work

Imagery

Compassionate letter writing