Webinar: Self-Compassion and Mental Health

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00:00 Introduction

02:12 Webinar Learning Objectives

03:22 What Kind of Friend Are You to Yourself?

08:01 What Is Self-Compassion?

10:06 What Is Self-Kindness?

11:27 It’s Okay to Feel Pain and Suffering Sometimes

13:59 Practice Mindfulness to Avoid Over-Identification

17:26 Self-Compassion Is Not Self-Pity

18:27 Self-Compassion Is Not Self-Esteem

20:07 Self-Compassion Is Not Self-Indulgence

21:34 Comic: It’s Important to Have Compassion

21:51 Research Shows That Self-Compassion Is Effective at Reducing Distress

24:25 Comic: Are You Here to Get Me out of the Raincloud Too?

24:36 How Do We Use Self-Compassion in Treatment?

26:11 Psychoeducation Is an Effective Way to Introduce Self-Compassion in Treatment; Comic: Happy Heart & Critical Brain

28:52 How to Introduce Mindfulness in Treatment

31:30 Connecting With the Present Moment

34:31 Talking to Yourself Kindly

36:20 Loving Kindness Meditation

37:11 Inner Child Rescripting

38:33 Common Humanity and Validating Feelings

39:36 Applying Self-Compassion in Therapeutic Interactions

41:47 Addressing Common Objections that Patients Have to Self-Compassion

45:08 Self-Compassion During the Coronavirus Pandemic

00:00 Introduction

Juliana: So it’s 12 o’clock. And I wanted to thank everyone and welcome everyone to today’s webinar,  self-compassion and treatment. My name is Juliana, Juliana Kulic and I’m an account relations manager here at EHN. I’m excited to be here today as your moderator and we recognize this is a stressful time for everyone out there, particularly the most vulnerable, those struggling with mental health and substance use disorders. And I sincerely thank you all for being here. EHN is Canada’s largest and only national provider of mental health and addiction services covering the entire spectrum of care from intensive inpatient programs, treating the most acute mental health and addiction related disorders from outpatient and digital platforms as well with over 270 beds spread across five inpatient facilities EHN treats over 1700 patients every year. On behalf of EHN and our network we thank you for joining us today. I’m pleased to introduce today’s speaker, Sandeep Marwaha.

Sandeep is a registered occupational therapist and a primary counsellor in the mood and anxiety program here at Bellwood Health Services. She provides residential treatment for individuals experiencing mood and anxiety challenges including veterans and first responders with operational stress injuries. She has also worked in the psychological trauma program at the Centre for Addiction and Mental Health, providing cognitive behavioural therapy and return to work coordination for injured workers. She has extensive experience supporting individuals addressing psychological and cognitive contributors to functional impairment. Before I hand it over to Sandeep, I have a few housekeeping items to cover. We are very pleased to share that this webinar is eligible for continuing education credits recognized by the Canadian Addiction Counsellors Certification Federation. And a recorded version of this webinar will be made. We’ll also be hosting a Q and A following Sandy’s presentation. And feel free to send in questions throughout the presentation and then we’ll get to them at the end. So without any further ado, I’d like to kick things off by welcoming our presenter—Sandeep, over to you.

02:12 Webinar Learning Objectives

Sandeep: Thank you so much Juliana, for inviting me to provide this webinar and thanks to everybody for taking time during this very stressful period, to learn a little bit about self-compassion. So this also just full disclosure is the first time I’ve really provided a webinar. So please forgive me if I make any technical technological errors and adjust to kind of talking to myself to a screen without any visual feedback.

Juliana: I’ll try to provide you some feedback here on my end.

Sandeep: So I hope everybody is sitting in front of a computer and doing something very kind for them while listening to us talk about self-compassion. So for today we have three learning objectives. One is to identify the components of self-compassion. Another is to examine the research behind self-compassion, and then understand its use in a therapeutic context. And in terms of the therapeutic context, I’ll be talking pretty much about how I tend to use it and how my colleagues tend to use it here at Bellwood.

03:22 What Kind of Friend Are You to Yourself?

Sandeep: So first what I would like you to do is, if you feel comfortable, is maybe just close your eyes as I walk you through a little bit of a visualization activity, to kind of access what self-compassion might be like. So what I’d like you to do is to imagine, or suppose that you’re going through a really rough patch in your life, it’s very hard. There are all sorts of problems and difficulties and just about everything that can go wrong has gone wrong. In other words, life is pretty crappy right now. And just kind of imagine what that feels like. Where’s the difficulty feeling in your body? How do you feel, what thoughts are kind of running through your head? And while you’re experiencing this and you’re going through this, what kind of friend would you like by your side?

So we’ve got two friends that we can choose. We have Friend A who’s sitting beside you and says, “Oh, shut up. Stop your whining. I don’t want to hear about it. What the hell have you got to complain about? There are so many people out there who have it worse than you. You’re just a big wimpy kid. Suck it up and get over it. Just get on with it. There’s better things to do.” And then another friend who maybe is sitting on the other side says to you, “Oh, this is really tough. What you’re going through right now. Anyone would be struggling with. So I want you to know that I’m here for you. I’ve got your back. We’re in this together. I’m with you every step of the way.”

And so if you had a choice, and you do, which friend would you choose? Would you choose Friend A or would you choose Friend B, and why? So I actually did this very exercise, with a group yesterday with a group of clients yesterday in the mood and anxiety program. And they all chose Friend B. And the reasons they gave were that Friend B was supportive and kind and patient. And they had several very unflattering things to say about Friend B, a sorry Friend A. So the question then is, what do we actually say to ourselves when we’re in pain? What do you say to yourself when you’re in pain? Are you more like Friend A, harsh, impatient, critical? Or, are you more like Friend B, patient, supporting, kind.

And what we often find, particularly in our clinical settings, is that although people prefer Friend B as a one to be supportive and kind to them, when it comes to addressing their own pain, they’re often more like Friend A, very harsh, very critical and very unforgiving. And I think this tends to be a little bit of a normal human condition of being much more difficult to ourselves than we would be to others. And so what we are trying to do when we talk to clients about self-compassion and even ourselves and we talk to ourselves about compassion as clinicians, as providers, is really about learning to treat myself or ourselves as we would treat those that we care about. So often another question we’ll ask is, you know, what, what would you say to a friend or a loved one that’s going through something similar right now? And it’s always so striking to see how kind people are to others and how harsh they are to themselves.

08:01 What Is Self-Compassion?

Sandeep: So what is self-compassion? Kristin Neff is one of the leaders in self-compassion research and  she and her colleague simply defined compassion, self-compassion, sorry as, self-compassion, sorry, as compassion that’s directed inwards, it’s very often easy and sometimes automatic for many of us to be compassionate towards others. And so the goal and the challenge is to take that compassion for others and direct it towards ourselves. Dr. Ross Harris, who’s actually, I believe he’s Australian and is quite a leader in acceptance and commitment therapy, which is a mode of therapy that is very heavy on self-compassion, describes it as in acknowledging our own suffering and responding kindly to it. So in other words, treating yourself with the same warmth, caring and kindness that you would extend to someone you love if they were in similar pain.

In terms of what actually self-compassion is, Kristin Neff again, who is the leader in this area describes self-compassion as having three elements or three components. The first one is self-kindness, the second is mindfulness, and the third is common humanity. And I’ll go through each one individually over the next few slides. So when we think about what self-kindness is, it’s often helpful to compare it to self-judgment, which is kind of the, the default or the autopilot that often we find ourselves in, and our clients find themselves in. So whereas self-judgment is kind of like, you know, Friend A questioning the validity of your pain or your painful thoughts or your difficulties. Self-judgment tends to be very rigid and unforgiving. And it’s very harsh and very critical and is often very much involved in punishing ourselves for experiencing the pain and being very impatient.

10:06 What Is Self-Kindness?

Sandeep: Self-kindness on the other hand, is about really about being kind to ourselves in terms of validating that painful experience and being understanding to ourselves that, you know, what, it makes sense that you’re feeling really sad right now. It makes sense that you’re feeling really anxious. You know, like right now I think there is a higher level of anxiety, for example, with,  the pandemic that we’re facing and you know, it’s, it’s understandable that we’re all feeling more anxious right now because there’s a lot of uncertainty happening. And rather than saying, you know, what’s wrong with you, nothing’s going to happen. People are overreacting. You’re overreacting about this COVID, perhaps instead, yeah, it’s, it’s on the news 24 hours a day. It’s kind of a topic of conversation. And when we go out in public, whether that’s, you know, driving on the road or going to a grocery store, we see that the city is kind of bare and quiet. So it’s, there’s constant reminders. And so the self-kind way to address this difficult feeling, the difficult, this painful time is really to be like, yeah, makes sense. You know, there’s, it’s not strange that you feel like this.

11:27 It’s Okay to Feel Pain and Suffering Sometimes

Sandeep: Another part of self-compassion is, to understand and to bring ourselves into a sense of  acknowledging that there is some common humanity in pain and suffering versus separating from people and convincing ourselves that, you know, I’m the only that’s dealing with this or I’m the only one that’s suffering. You know, it’s in a lot of religious philosophies. Although, this isn’t a religious, you know, technique necessarily, but a lot of philosophies particularly, you know,  Eastern philosophies, do identify that suffering is part of being human. You know, being happy all the time is, is really a fallacy. And that humankind and life has had moments of joy and happiness and, and pleasure and also has moments that are really, really difficult and dark and hard. And so another part of self-compassion is to help clients and ourselves realize that when we’re feeling pain, when we’re going through difficulty, there’s nothing wrong with us because we’re experiencing that, we’re not defective. We’re not crazy to put quotes around that. In fact, the fact that we’re even feeling something that we’re feeling difficulty, that we’re feeling pain is a reminder that we are human, is a reminder that we care, that something matters. And that it is something that can connect us with other people around us. So just like, you know, COVID,  really the whole world is kind of dealing with like this. You know, I’ll be perfectly honest, I, you know, I’ve got two small kids that are at home right now with my partner and leaving on Monday morning, I felt really guilty. And I felt really scared. I was like, you know, I’m going to work, my family’s at home, what’s going to happen? And I started to get into a really negative headspace, feeling guilty, feeling anxious, and then coming into work and actually just talking with my colleagues and us acknowledging how anxious we felt really helped to alleviate some of that distress I was experiencing because I realized, okay, this is not just me, that’s, you know, feeling like this. It’s, we’re all kind of in this together. And it really helped also to kind of be really more solution-focused and okay, we’re in this together and what can we do to support each other.

13:59 Practice Mindfulness to Avoid Over-Identification

Sandeep: Another element of self-compassion is mindfulness versus over-identification. So over-identification really, it kind of refers to getting really fused and connected and stuck with those difficult feelings and difficult thoughts that we experience. Believing that the thoughts that come up, particularly the self-critical thoughts that come up are 100% true. And realizing that,  you know, and so often, sorry, over-identification can then lead to getting really stuck, ruminating on, you know, what I’ve done in the past that’s been wrong. And perseverating on all the things that are wrong with me. And, what’s, what I’m limited by. And over-identification can also lead to trying to avoid the pain. So if I believe that I’m defective, if I’m broken, if I believe that all these negative thoughts I have are true and I’m not using really effective healthy strategies, I’ll try to find some way to avoid feeling that pain. So often it results in numbing. Sometimes it can result in unhealthy behaviors. You know, substance use, behavioral addictions, you know, watching too much TV, gaming, engaging in healthy, unhealthy and risky behaviors. So over-identification can really make those negative thoughts and feelings get stuck. And we’ll try to do whatever we can to avoid feeling those. And while it may result in some short-term relief in the long term, the over-identification remains. And so one way to manage this in a self-compassionate way is to be mindful. And so when we talk about mindfulness in self-compassion, it doesn’t only mean meditation. So absolutely there are meditative practices that we can do that are quite self-compassionate.  but mindfulness in this context also means being present in the, in the moment. So being here, being in the here and now, and really noticing and acknowledging those painful thoughts. So rather than going and getting swept away, it’s noticing, okay. Yeah. You know, I’m noticing I’m, I’m feeling really anxious and it’s turning up with a lot of anxiety and like knots in my stomach. I’m getting easily distracted, I’m having trouble focusing, because these are all signs that I’m feeling really anxious or I’m feeling really sad. And then also really exploring that pain with curiosities. So, okay. You know, I’m noticing, you know, I’m hearing all this COVID stuff and it’s bringing up all these really angry thoughts for me. Like, what’s that about? You know, why do I feel so angry? So the only way we can feel compassion for ourselves, for a pain, is to attend to the pain. If we just keep ignoring it or avoiding it, then there’s no way to be compassionate. So mindfulness in the self-compassionate way really is about just noticing and acknowledging pain, which is not easy to do because our default is to avoid it. And so part of it is just to kind of be like, yep, I’m feeling anxious and I think it’s due to X, Y, Z. Or maybe I just don’t even know why I feel anxious. I just know where I feel it in my body.

17:26 Self-Compassion Is Not Self-Pity

Sandeep: And so one of the other things to talk about is, what self-compassion is not, because it can get confused. So self-compassion is not self-pity. So like what is self-pay? Pity is when we’re overly focused on ourselves and we forget that others have similar challenges. That’s when we over identify with our negative, negative or painful thoughts and we forget that there is a common humanity with pain. And so this can lead to us not stepping back and looking at our situation objectively. And it really works to isolate us and keep us stuck in that pain. Self-compassion on the other hand really is about recognizing that our suffering is common and it connects us to others. Although people may, other people may not have the exact same experiences that we do, those feelings are often quite similar across groups, across people.

18:27 Self-Compassion Is Not Self-Esteem

Sandeep: Self-compassion is also not self-esteem. So self-esteem is defined as, you know, how we see ourselves in terms of worthiness, how valuable we perceive ourselves, and also about how much we like ourselves. Self-esteem is very much, self-evaluative. And often it’s particularly in Western context where, you know, we kind of value the individual. It’s about individual strengths and individuals overcoming their weaknesses. There often is this stress on it’s really important to be above average. In our society it’s not okay to be average. That’s not acceptable. We need to be better than everybody else. And so self-esteem also is something that fluctuates across our lifespan, across contexts. We can have high self esteem, for example, in one group of people that we think maybe, you know, maybe I’m a little bit better, I’m, I’m on average with these, on par with these people. And then we may have very low self esteem in another context where we feel that, you know, everybody here is a bit smarter than me. Self-compassion on the other hand is not evaluative. It is the knowledge, it’s the awareness that because I’m human, because I’m alive, because I’m a person, my, my burden is unconditional and my worthiness as a human being is similar to others. We’re all equally worthy. And so self-esteem on the other hand, is not like that. Self-esteem is very much conditional often.

20:07 Self-Compassion Is Not Self-Indulgence

Sandeep: Self-compassion is also not self-indulgence. You know, I’ve had clients express this concern to me that, “oh, you know, if I am kind to myself, well then that means I’m not going to hold myself responsible. I’m just going to let myself off the hook. I’m going to do things that aren’t healthy for me.” Self-compassion really is about, yes, it’s about acknowledging our pain and suffering. Yes, it’s about being kind to ourselves, but then it also requires that we do something about it. It may be that we don’t do something about it in the moment, but it also really helps, when it’s done effectively helps us to be a little bit more solution-focused. For example, when I was talking about, you know, COVID, my anxieties around COVID-19 before and I was feeling really sorry for myself because I had to go to work and my kids were at home. And then when I came to work and I realized, okay, no, everybody else is in this with me. I’m not alone. It made me more solution-focused in terms of, okay, so what can we do to make sure that we’re safe at work? What can we do to make sure that our clients are safe because they’re here with us too and they’re experiencing this anxiety and it’s my responsibility, as a provider to ensure that my clients are feeling less anxious and feel safe with the care that they’re receiving here.

21:34 Comic: It’s Important to Have Compassion

Sandeep: Just have a little comic here. Would you guys read through it?

 

 

21:51 Research Shows That Self-Compassion Is Effective at Reducing Distress

Sandeep: So it does, you know, other than just, you know, the fact that self-compassion sounds nice and it sounds pretty and it sounds soothing. There is a bit of research that’s been done that does show that self-compassion as a coping skill, as a, as a therapeutic strategy is quite effective at reducing distress. So I’m not going to go into a lot of detail, but, you know, basically with different populations, it’s been shown to reduce compassion fatigue and burnout among helpers. It’s been shown to be effective, among student populations. So, students who are kind of a bit more self-compassionate are much more adaptive, after experiencing academic failure, using mindful self-compassion has been linked to reduced rumination and reduced rumination can then lead to improved mood. The risk of developing substance use disorders is inversely related to self-compassion. So the more self-compassionate we are,  the less risk of developing substance use disorders. And using self-compassion as a strategy has resulted in improved success rates for behavioral interventions. For example in smoking cessation and managing binge eating disorder.

There have been a couple of RCTs [randomized clinical trials] as well. So there was one RCT that was focused on clients who, or sorry, participants, who have diabetes and mood disorders and using a self-compassionate approach was found to improve mood and metabolic outcomes actually for those participants that were involved. And there is a recent meta analysis of RCTs that showed a significant improvement across psychosocial outcomes, in studies that use self-compassion as a therapeutic strategy. And also psychologists who use mindful self-compassion reported decreased stress and burnout. So not only is using self-compassion successful or showing promising results for clients who are experiencing various challenges with mood, it’s also quite effective for care providers, in terms of reducing our compassion fatigue and burnout.

24:25 Comic: Are You Here to Get Me out of the Raincloud Too?

Sandeep: Another little comic.

24:36 How Do We Use Self-Compassion in Treatment?

Sandeep: So that image, that little, you know, comic was just a segue to talk about, you know, how do we use self-compassion in treatment? And really part of our role as providers is to, you know, meet clients where they’re at. Also to model compassion. And so I’ll actually, I’ll go back to that. Sorry. Technical difficulties. So if I go back to this image and you know, often clients are asking us, you know, just fix me, just make me better. And, you know, if only we could snap our fingers and give a pill and make everybody better. But you know, what I really feel, our roles as providers is, is really to meet clients, where they’re at and sit with them and to show them that, you know what?—these emotions, these thoughts, these memories, these experiences, yeah, they’re really, really difficult. And, nobody likes to feel these. Nobody likes to feel sad. Nobody likes to feel anxious. Nobody likes to be in withdrawal and have urges and cravings. Nobody likes that. It is hard. And so what I’m going to do is sit here with you and let’s learn together how we can tolerate these unpleasant experiences a little bit better. How can I show you what it’s like to be compassionate? How can I show you what it’s like to be self-compassionate? So that’s really what I feel anyway. My role as a therapist is particularly with our clients. You struggle with so many, so many stressors, and so many challenges.

26:16 Psychoeducation Is an Effective Way to Introduce Self-Compassion in Treatment

Sandeep: So there’s different ways to introduce self-compassion in treatment. There’s not, I think, a right way or wrong way. One of the things that I find really helpful is to provide some psychoeducation and not in a really heavy way, but just really about, the brain’s evolution. And I, I really like this comic here because you know, here you have the heart saying, “hey brain, look at all these good things that’s happening in the world. And the brain is like, “I don’t got time for this. I got to focus on all this bad stuff.”

And again, like kind of using that in the context of, you know, evolution that, you know, we as humans developed in very precarious times where survival was pretty challenging. And so the brain has really developed in a way to protect us and to keep us alive and to have us look out for all the bad things that are happening. Because that might, you know, kill us or might hurt us. And so in our modern times, you know, what we’ve kind of done is our brain is looking out for all those, you know negative things like what’s bad, what’s wrong. And some people will say, see research will say, sometimes the brain needs to take in four good things to kind of balance out the one bad thing that it sees. And this is also a part of that common humanity. And part of that validation that yeah, it makes sense that you know, your brain is, is beating you up like this. It makes sense that your mind automatically jumps to all these really painful and hurtful thoughts and is pointing out all the difficult things. That’s kind of what in a way our brains are designed to do. And so one thing that we can do is, is, is instead of, you know, beating ourselves up and fighting with our brain, like, why do you keep doing this? Maybe what we can do is use some other strategies that, rather than fighting with our brain just kind of is compassionate with our brain and with our bodies. So that we can then, kind of go forward and be a bit more solution-focused or be a bit more, you know, nice to ourselves. And, I  was going to leave this comment for later, but, I also have a lot of, really helpful resources and videos actually on YouTube that kind of explain the, the cave person mind and, I’ll make sure to include those afterwards I’m in an email with a follow up and Juliana will do that for me cause I have no idea.

28:52 How to Introduce Mindfulness in Treatment

Sandeep: So what I thought I would do is talk about, how can we introduce the different elements of self-compassion in treatment. And so the strategies that I’m introducing here are not, totally, you know, all inclusive. There are many different ways to do this. And so what I’ve done is kind of included the ways that I like to include mindfulness, self-compassion strategies. So in terms of how can we be more mindful, so sometimes, you know, when you’re with a client, on one-on-one or sometimes even in a group, it’s helping them notice when they’re verbalizing, painful thoughts and feelings or when they’re, you know, self-critic is really activated like it, it’s always so interesting how quickly clients will start to talk like the self-critic in their mind. Or if we’re noticing clients are in distress, sometimes it’s just like, hey, like what’s going on for you right now? What, what painful thoughts, are you noticing in your mind? But what really painful or distressing feelings are coming up for you right now? So having them notice and name what’s happening. And sometimes even that noticing and naming can create a little bit of distance and they don’t become so fused and or identify with those, with those painful experiences. And some, something else that I’ll often challenge clients is, you know, sometimes they’ll be like, “Oh, you know, I’m, I’m so dumb, my brain doesn’t work. Or, you know, I’m, I, you know, I don’t know how to use a computer.” Sometimes I’ll just challenge themselves and say, okay, so how can you say that same thing without self-judgment? How can you say that in a kinder way or in a more even balanced way? And again, that’s just kind of like catching clients in their autopilot and, and, and just making them break that break from running away with those negative or really challenging thoughts. And another way to do that also is to kind of disarm the self critic. So again, like noticing, hey, what’s, what’s your self critic saying to you right now? Okay, how do we make the self critic not as strong? And sometimes what’s helpful, is even I, I’ve done this with my clients is, okay, you know, there is this one part of you that’s really harsh on yourself. Like, you know, can we give this person a name or can we give that part of yourself, your, your, your mind, a title. So sometimes people are like, “oh, that’s mean me, or you know, or that’s the really harsh me.” And it’s like, okay, how can we bring the kinder you out? How can, what would kinder, you know, Juliana say, or what would more balanced Juliana say in this scenario?

31:30 Connecting With the Present Moment

Sandeep: Connecting with the present moment is also one way to kind of prevent clients or catch them in the ruminations or the worries. It’s like, okay, I’m hearing all of these really challenging thoughts that are about what happened yesterday. Like, what, how do I bring you back to the right now? What, what’s actually happening in the present moment? Let’s connect with your body. Let’s connect with your mind. Let’s connect with what’s happening in the environment. And something else that can be a little bit more challenging and a little bit more abstract for, for clients. And this is a little bit more of that meditative, type of strategy is, is making room for pain. So often what will happen when we’re experiencing really painful emotions, it will try to fight it and we’ll try to resist it. And so sometimes, you know, for clients this will come up as, you know, that lump in their throat, or like feeling a lot of pressure in their chest. And so that, you know, in a way is like their mind and body trying to fight or push down the pain rather than letting the pain be there and, and let it move through their body the way that it needs to do. And so what I’ll sometimes do with them is have them ground themselves really quickly and say, okay, let’s, let’s explore. Like, where in your body are you feeling these painful thoughts or feelings? Or if they can’t identify what those painful thoughts or feelings are, I might just say, okay, can you tell me what, what are you feeling in your body right now? You know, where are you feeling? Are you feeling any tightness anywhere or are you feeling any constriction or are you feeling any tingling? And then if they identify that, then encourage them. Okay, let’s do some, some deep breathing. How can you, can you picture what that, you know, what that pain or what that sensation looks like? Can you create an image for me? You know, and I’ve had clients say, “oh, you know, it’s my brain, my, my head feels really, really, heavy and really jumbled.” And like, okay, can you give me an image? What might that look like? And I remember when I had one of my clients say, “you know what it’s like, I have a tree in my head and it has all these branches that are just shooting off in every direction. And every branch has like a different thought, a different feeling that I’m finding really overwhelming.” And so then we’ll just kind of take some moments and be like, okay, let’s, how do we, you know, create some more space for that tree to really branch out? And, and what can, can we even look at some individual branches? Which one is the one that’s the biggest, which one is the one that is kind of heaviest? And then, you know, kind of like, okay, how do we create space? Let’s do some deep breathing and open up space for that, that pain or that distress to, to kind of expand. And what often I find is by doing that, clients will say, “you know what, yeah, the pain is, it’s, you know, it’s, it’s still there. And it’s not as intense. I’m, I’m kind of holding it and being really kind to myself.”

34:31 Talking to Yourself Kindly

Sandeep: And some other ways to introduce self-kindness strategies are, I’m encouraging clients to use kind self-talk. So sometimes I might, you know, elicit that by saying, okay, so I’m noticing that there’s a lot of really harsh thoughts happening right now. But what you’re experiencing, if you had a friend who was having the same experience, what would you say to that friend? So how can you start to say that to yourself? You know, or, you know, what would, if your best friend was here, if your, your favorite relative was here right now, someone that you feel really safe with right now, what would they say to you? Or what have they said to you in the past that’s really helped you kind of manage or cope with what you’re experiencing right now? And then I’ll have them say, okay, well how can you modify that statement so that you’re saying it to yourself? And sometimes too, you know, imagining kind images or using some kind of kindness type of visualization can also be very self-compassionate. You know, like for me sometimes when I’m going through a really rough time or if I’m feeling really distressed, you know, I’ll imagine myself in a place where I feel really safe. And that I really enjoy, so for me, that’s a particular beach in Barbados that I’ve gone to several times and I will really kind of visualize myself there, and really taking in and focusing on what are the parts of that experience that soothe me, that made me feel comfortable, you know? And so for some other people it might be imagining pets or imagining loved ones, and really kind of taking in what that’s like to be with them and feeling that, feeling, that warmth.

36:20 Loving Kindness Meditation

Sandeep: And then there is some, like really specific meditations or strategies which I will provide resources for. So there’s a loving kindness meditation, that involves a client visualizing, like a, a loved one or even like a pet or an animal that they really love and them wishing goodness and kindness on that loved one or that pet. And then the exercise involves the loved one or the pet saying those same kinds of things to the client and then the client then using the language for themselves. I mean it’s really interesting to see clients go through this. And early on in treatment, sometimes clients will say, “being self-compassionate or saying the nice things to me was really, really hard.” And then when we do the same exercise later on in treatment, there’ll be like, “wow, I was actually able to sit with the nice words for myself.”

37:11 Inner Child Rescripting

Sandeep: Inner child rescripting is also another way to start to use some self-kindness. Often what happens is, you know, self-compassion and compassion is something that’s learned. And for people that have not really had, you know, for whatever reason, compassionate upbringings or compassionate environments, we may have them imagine themselves when they were younger, when a time they really needed some care and nourishment and talk about, well, what would you have needed? What can you imagine yourself giving that to yourself as a child? And how can you continue that? Now? Other things that we can introduce to self-kindness strategies are different ways to self-soothe, or provide self care. So often what I’ll ask clients is, you know, what can you do today to take care of yourself? What can you do to be kind to yourself? What kind of activities can you engage in? So also looking at activities as you know, giving to others. So being kind to others. What’s something kind you can do for somebody else? How can you contribute to society or to somebody else’s wellness? And something else is, you know, if they aren’t able to or if it’s really challenging for them to be kind to themselves. Can you find some people that are kind to you that are, that treat you really well? Can you spend some time with them? Can you get nourished by people that are loving and caring?

38:33 Common Humanity and Validating Feelings

Sandeep: And some ways to introduce common humanity is validating the pain that, hey, you’re experiencing something hard right now. And that’s, you know, it’s, it’s human to feel that way in the situation. Feeling the pain means that you care about something, that things matter to you, that you have a heart. You know, the human experience is imperfect. We are all fallible. And then exploring, okay, well what do you have in common with others? How does, how does what you’re experiencing right now, how does that connect you with other people? How can you work with other people to kind of process and find some kindness and sharing with others? You know, and that’s kind of what I did. If you remember I mentioned coming into work and realizing, okay, everybody else is struggling with this, you know, a weekend away when so much of the world was changing, I came into work and like, okay, it’s not just me. And, and reaching out to my friends. You know, they’re also struggling with this.

39:36 Applying Self-Compassion in Therapeutic Interactions

Sandeep: And so just kind of, you know, how do we do this actually in real life? So in individual interactions like I’ve mentioned, sometimes you can use it on the fly, right? So if a client is being really self critical or expressing a lot of hopelessness, that’s sometimes a good time to introduce some self-compassion. And it can also be much more formal where you teach it as a skill.  Introduce some, you know, homework and ask them to keep a self-compassion diary or a log. It can also be done in group sessions. So as I mentioned, I just did a session on self-compassion yesterday and it’s actually one of my favorite sessions to do. And that would also include, you know, it’s a session that’s a combo of psychoeducation, skills teaching, and then having time to practice. And we can also use it on the fly in group. And often one of my favorite things to say is, you know, clients will be talking and say something really harsh and I’ll be like, okay, how can we say that without judgment? How can you say that in a kinder way? Or, you know what I’m noticing that there’s a lot of, that was what somebody to share, that was really, that was a really hard thing to share. And can we all just take a minute to, to just feel, what that’s like. And again, just kind of, you know, talking about self-compassion, connecting with others, in the moment it really reinforces that common humanity. And sometimes, if a client is sharing something particularly different, or difficult, sorry, I’ll be like, you know what? Like is that it? Does anybody else in the room, has anybody else had similar thoughts? Does anybody else have similar feelings or experiences? And overwhelmingly the group will be like, “yeah, I’ve been there.” And that also helps to reduce that sense of isolation and helps clients really connect. If there’s one thing that I’ve really taken away from, from working in a residential center and doing a lot of group based work is that clients are always like, “you know, I felt so alone before I came here. I felt like I was the only one. And then I came here and I realized, okay, there’s actually other people going through something similar. I’m not defective, I’m not quote unquote crazy.”

41:47 Addressing Common Objections that Patients Have to Self-Compassion

Sandeep: And so, you know, just like with any other modality, any other treatment, you know, we’re going to get clients who are like, “what the…?” you know, “what are you talking about? This stuff doesn’t make any sense.” So, I did talk a little bit about it, a little bit earlier, in comparing kind of like, you know what it’s not, so it’s not self pity, it’s not self indulgence. So some, you know, more specific comments that might come up. And this again is not exhaustive. You know, sometimes people will be like, “that self-compassion stuff, that’s too hippie. That sounds way too new agey.” For particularly like, you know, our military members or first responders who are very much into the macho culture, you know, like “that’s women’s stuff,” you know, “that’s too feminine. You know, I don’t want to sit here and talk about my feelings.” You know, and hey, it’s fair. And again, it’s always like validating. Yep. You know, I get where you’re coming from, given your experiences, you’re, you know, talking about your feelings, you know, that wasn’t really, you know, the cool thing to do. If you were considered strong, it could push those away and just keep forcing through. And then one of the other things I always say is like you, okay, so like how has that actually working for you now? Pushing things away, you know, I mean, using a little bit of levity, it’s like, okay, yeah, and now we’re all at Bellwood. So, you know, how has pushing things away and working for us using a little bit of humor, right? And you know, acknowledge that being harsh is common and habitual. So sometimes like what I’ll do is use the two friends metaphor and be like, okay, if you had a choice, what kind of, you know, friend would you choose? So how can you start to be that friend to yourself? And sometimes also, maybe we just don’t use the term self-compassion. We can just use a different term. Like, hey, how do we be nicer to ourselves? Some other people will be like, but being harsh and cruel to myself motivates me. And yes, that probably has helped, particularly for our overachievers and our perfectionist. And also kind of point out, and so maybe it’s helped in short term, but how has it really helped in the long term? And there are some really helpful metaphors that, we can use as well to kind of illustrate, the cons or the long-term, you know, drawbacks of being harsh. And I’ll share those in resources with you as well. And some people also really aversive to touch for whatever the reason. So like I don’t feel comfortable touching myself or getting myself a client touch. So maybe we can just talk about, like how can we send yourself some kind of energy, some kind of light. And others will say self-compassion is selfish. And again, I’m talking about how caring for ourself makes us a more effective carer and helper. We can also introduce the two friends metaphor. And for people who’ve had little to no experience of proceeding compassion,  we can ask them, you know, start noticing other people being compassionate to each other. Maybe notice when somebody is really kind and compassionate to you. Spend more time with people that are kind. And then inner child rescripting is also really helpful in this scenario. So what I’ll do is maybe spend like a couple minutes just practicing.

45:08 Self-Compassion During the Coronavirus Pandemic

Sandeep: So what’s a common concern around the world right now? I think I’ve only mentioned it like 85 times?

Juliana: COVID-19.

Sandeep: Yeah. So, Kristin Neff on her website, so at the center for mindfulness and self-compassion actually has, like on, I think like one of the first most recent entries is on self-compassion and COVID-19. So I actually borrowed that from what they had written. So I’m just kind of mindful of time and I’m not going to go into too much detail, but, I did include the website [https://centerformsc.org/self-compassion-and-covid-19/] there and really it’s like how do you start to use those different elements of mindfulness and common humanity and self-kindness to manage the distress that we’re all experiencing during this time. And there’s this really interesting quotation, in that article and I’m just gonna read it out. “Human history goes through cycles of expansion and contraction, but the periods of expansion are longer than the periods of contraction. ‘And why are the expansion periods longer?’ Chris asked. And the driver, the person he was in the car with said, ‘because the human heart prefers expansion.’” And I just thought that was really, kind of like a nice thing to close on. And remembering that, yeah, we’ve gone through lots, human history has gone through famines and plagues and wars and you know, we’ve turned out okay for the most part. So let’s stay hopeful and optimistic.

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