Hello and a very warm welcome to Compassion in Therapy training series. I'm Dr. Deborah Lee. I'm a consultant clinical psychologist and I'm based in Oxford in the United Kingdom and I've been treating people who've been traumatized for 33 years and I've been involved in the development of compassion-focused therapy for trauma with my colleague Paul Gilbert, Professor Paul Gilbert, for the last 23 years. So I'm absolutely delighted to be here. to present to you my work and the way that we work with trauma and complex PTSD through the lens of compassion-focused therapy.
So as we know, there are very different types of trauma, and trauma is often described as type 1 or type 2. And what we mean by that is really the way the trauma impacts on the brain and the human and psychological experience. So type 1 is often a one-off incident. unexpected, the rugs pulled on from beneath you out of the blue, whereas type 2 is really more repeated exposure to trauma that hurts you in a psychological, emotional and physical way of which you can't escape.
Now for many years the majority of the research for treating trauma has been based on exposure. So what that means is that in all the major trauma therapies with their evidence bases, the heart, of the therapy is working directly with trauma memories, whether that be EMDR or trauma-focused CBT, narrative exposure therapy, cognitive processing therapy, prolonged exposure. There is a history to that which I won't go into too much detail, but in brief, in the 1980s when PTSD became an emergent new diagnosis, the academic research population drew heavily on the the research and the treatment of phobias, big fear responses to things in order to inform our trauma treatment. Now, as we have evolved, developed and got much more sophisticated in terms of our understanding of trauma and especially interpersonal trauma with its impact on the human psyche, we've really been able to appreciate the role of shame. Now, shame is very different from fear.
Shame is a state of threat. It's a state of social threat, but it is very different in terms of how we treat it. And of course, when we think about people who've been hurt and harmed at the hands of others, other people's minds have had motivations to hurt and harm, to base demean them, then of course, shame is very key in the experience of the distress that emerges from this sort of interpersonal social threat. So we need to really address this in our therapy. And this is why Compassion and compassion-focused therapies are really pivotal and helpful in working with people who have these very distressed symptoms related to profound shame states and self-loathing.
Now, my career as a clinical psychologist working with trauma transformed when I first began to work with Compassion and Paul Gilbert, because prior to that, I'd been very kind of wedded to cognitive therapy exposure-based models and schema models, which... rely on very different brain systems to affect clinical change. And there was this particular case who I worked with of a woman who was burned from head to toe. Her nightie caught fire when she was about 11 and she was very traumatized and very ashamed and very disgusted with her body. And we worked so hard to help her find new ways of living, find new meanings, find ways to accept herself and begin to love and value herself.
And we always ended up in this yes, but, yes, but. I know what you're saying. I know what you mean, but I can't feel it. And this is really interesting.
So we call this the heart-head lag when what we know doesn't resonate with our emotional world. So we get this sort of like incongruence between our knowing states and our feeling states. And that in itself can become even more shaming because I ought to know, I ought to be able to be helped by my thoughts, but I'm not. I know what you mean, I can see what you're saying, but I don't feel any different. And it was really when I went to a workshop on compassion and shame delivered by Paul Gilbert many years ago that I suddenly realized that I hadn't actually understood.
what the state of shame was. Even though I've been very well qualified as a clinical psychologist, I didn't appreciate the state of social threat and shame. My therapeutic techniques were relying far too heavily on cognitive processes rather than embodiment and emotion focus.
This was the start of my journey in developing compassion-focused approaches for trauma. In the UK, we've benefited from ICD-11 introducing complex PTSD as a new diagnostic system. So although this talk will play to how we might work with complex PTSD, it is also very relevant to trauma presentations. But the reason that I'm particularly interested in defining PTSD and complex PTSD is this particularly difficult symptom that we work with, which are these fragmented... trauma memories, these flashbacks, reliving nightmares, fragmented trauma experiences that make our clients feel as if things are happening again.
So, complex PTSD has been a really helpful and actually de-shaming diagnosis because prior to that, we were often calling people or using words like personality disorder to describe people's very best efforts to get through their life once they've been traumatized. So there's something interestingly quite helpful about complex PTSD as a diagnosis because it is de-shaming. But what it has at its heart are the three core symptoms of PTSD.
That re-experiencing that I've just talked about, avoidance symptoms, because re-experiencing original traumatic material that makes you feel like it's happening again, that sense of current threat, is very, very distressing. Very distressing and very alarming and understanding. understandably people are very keen to want to avoid and do all sorts of things to avoid feeling as if the event were happening again and of course we know that PTSD is linked to hyper arousal hyper arousal that's still very prevalent symptom presentation and people that have experienced this type 2 trauma related to interpersonal and hurt and harm but what we also see in people that have been repeatedly harmed at the hands of others and other people's minds, especially in their early years and their attachment system, is that they really struggle to regulate their emotional world. They often have this sense of profound self-loathing.
So it's not just negative automatic thoughts or negative beliefs. It's this profound sense of hatred and disgust for themselves. of course, they really struggle interpersonally.
If their template of relating is traumatized, then the template that they have to navigate their way through their social world is equally traumatized. We really struggle to find meaningful relationships with each other if trust, safeness, and intimacy are violated. So, what's very helpful is compassion and compassion-focused approaches and compassion-focused therapy. plays to three really important domains. It's physiological, which really helps with emotion regulation.
It's psychological, which really helps with the development of self-compassion. And it is related to social relating. It is rooted in social relating, which really helps with the development of social safeness and connectedness. So compassion-focused therapy offers us three clear domains of working, which are attend to the areas of distress that we see affected by interpersonal trauma and attachment trauma in our clients. So it's no surprise that being hurt at the hands of other people is related to much higher rates of complex PTSD.
And some epidemiological studies suggest that the rates of PTSD are over 60% in those that have experienced interpersonal trauma. And The research also tells us that this state of shame, this state of social threat and its characteristic self-loathing is also very high. The higher the shame states, the more severe the symptoms of PTSD. So we are working with people that are living in very fragmented minds with these traumatised attachment templates with interpersonal issues and this lack of safeness. Now when we have underdeveloped social emotional relating, then we see these areas of difficulties that our clients struggle with.
One of them is real difficulties connecting with an internalized sense of another. So the idea that there are other people in their lives who have become reciprocally internalized roles of helpful others, and they often instead experience themselves as different, odd. don't know how to join in, disconnected, can't form relationships, don't know what the rules are.
There's a real sense of social disconnection which is really related to shame, that state of isolation. And we also see of course underdeveloped self-worth, profound lack of self-care, often seen in things like substance misuse or self-denigrating statements or self-harm of other kinds and this sense of social isolation. And of course, they also have this underdevelopment of their affect.
They really struggle to stay in their emotional world and experience a capacity to resolve intense emotions, which are normal, natural, and helpful to us. But the real skill is learning how to down-regulate those intense emotions to a place of equanimity and connectedness. So if we can't regulate our emotional worlds, of course, we know that we see dissociation, self-harm, aggressive behaviours, substance misuse, affectability and numbing. So this idea of traumatised attachments, sometimes in compassion-focused therapy, we refer to as an algorithm, if A then B. So our attachments become traumatised, so the way that we seek care in others is traumatised, if A then B.
If distressed, seek help. If distressed, was hit. If crying, was hit.
If crying, was comforted. You get this idea of an algorithm and a conditioned emotional response to some of the core human experiences. Of course, our clients are living in traumatised states of mind.
I really want you to begin to hold this idea of a state of mind because compassion focused therapy is a brain state. therapy that is rooted in algorithms, conditioned responses to social relating. So we have traumatized algorithms, traumatized states of minds, and traumatized behavioral patterns. So our clients behave in ways that are always rooted in functionality of get me safe, get me safe, get me safe from your mind and your potential harm, and get me safe from my mind.
and its potential to harm me. So, we see these patterns emerging. We see they'd follow the defence cascade of fight, flight, freeze, appease, faint, fatigue.
We'll talk about that a bit later. We see people's repeated efforts to get through their life with this traumatised lens, trying to form relationships with people, trying to live in their own mind, having a relationship with themselves, but with really underdeveloped capacities. through no fault of their own, that would support their flourishing. So in compassion-focused therapy, we are very rooted in science and our very important message is that we need to see therapies that work with science and not symptoms. So one of the reasons we called it compassion-focused therapy is regardless of perhaps some of your therapeutic domains and what you might routinely use, See if you can bring a compassion lens, a caregiving lens to the work that you do and see if you can really begin to bring an understanding of the role of compassion and how compassion becomes blocked or inhibited in our clients and what we can do to facilitate compassionate states of mind because it's not a cognition, it's not a feeling.
Compassion is a state of mind. So we really need to root any of our therapeutic practices. in the science. And so, in that sense, compassion-focused therapy is a little bit like a match made in therapy heaven for complex PTSD. Complex PTSD symptoms emerge because of the mistreatment our clients have at the hands of others, the dark side of the human mind.
Their lives are totally affected and shaped by these dark motivations of others in terms of being cruel and mistreating. It's highly linked to rank competitive mentality, which we understand from an evolutionary context. And experiences of debasement and downranking and shame can be understood from this framework.
So compassion-focused therapy provides opportunities to foster different motivations of caregiving and compassion, to develop safe minds, affiliative motivations and social safeness, social relating through the lens of safeness. and of course, the ability to regulate our emotions to de-shame our inner worlds. So, compassion-focused therapy creates a mind that can bear witness to its mind that can bear witness to the trauma story, the story of pain and suffering with the lens of compassion, because we need to be able to stay in our mind to help our mind. So the good news is there's emerging evidence from both sides of all sides of the world around the effectiveness of compassion-focused therapy for trauma. And this is emerging evidence-based, and I'm sure we will see more and more.
evidence to support this approach. So what I've been working on for the last 23 years is an application of a phasing of compassion-focused therapy for people who have been traumatised. Now it is sort of influenced by this notion of phasing, creating a mind, developing capacities in a mind that can then turn to the state of mind of trauma to find ways to heal. and then be able to live a life without trauma.
So from that original Judith Herman work of stabilizing trauma work and reintegration, our compassion-focused approach has been informed. So there are some core therapeutic processes that compassion-focused therapy talk to. Awareness, differentiation, tolerance and safeness, integration, cultivation. transformation and adaptation and the way that we harness our client's ability to work through these phases or to work through these phases therapeutically are to develop their compassionate capacities, what we call developing compassionate resilience.
So we start our therapeutic process with engagement with the core qualities of the compassionate mind and teaching and educating our clients how to. shift their state of mind. We then at some point in agreement, in collaboration and with choice, invite our clients to bring that compassionate lens to their stories of trauma and to narrate, to account their life story, particularly focusing on the parts of the traumatic events that they found particularly difficult, particularly shaming, so that we can bring a new lens, a new meaning.
of compassion, promote grief and resolution, and moving away from these states of shame and self-blame to ones of compassion and states of grieving and ultimately, hopefully flourishing, being able to live a life without being defined by the trauma. So it's not stabilization, it's developing capacities. for brain states that are linked to psychological safeness and compassion. So obviously I just need to retouch on the definition of compassion as we see it from compassion-focused therapy. We see it as a basic motivation.
Compassion is a motivation and it has an SR algorithm, stimulus response. So this is why we talk about brain states, states of mind, motivational states. Compassion is rooted in old brain.
the evolution of the old brain and it's rooted in caregiving which is a mammalian functioning linked to the attachment. But what it is, is a sensitivity to suffering and distress and the needs of others and ourselves but with a commitment to alleviate and prevent future suffering. So there are two parts to it, a sensitivity to suffering, an ability to engage with suffering.
but then a motivation, a plan to take action to alleviate and prevent future suffering. So one of the core strengths of compassion-focused therapy for working with people with interpersonal trauma and shame is its de-shaming psychotherapy. I don't want to go into too much detail in this because this is much more clinically orientated, but I will refer you to the lecture by Professor Paul Gilbert who has highlighted, I think in depth, the context, the theory and the evolutionary legacy of the human tricky brain. But just in brief, to remind ourselves that the human brain is evolved and has been evolving for millions and millions of years.
It has capacities that are hugely inspiring but it's also got capacities that are really difficult and tricky for us to work through. We've got the basic motivations of the reptilian brain. We've got the mammalian brain and then we've got the evolved human brain. And our brain will present us with all sorts of challenges because of this evolved historical nature, which is just simply not our fault. It's not our fault.
And when we're working with people who have been traumatized, we're very keen to put at the beginning, none of this is your fault. You didn't ask to be born into the family that you were born into. You didn't sit in the cloud and say, please, can I be born here? You didn't ask to be treated and mistreated so badly in your childhood or at times in your life when you had so little agency and ability to influence your life experiences. You didn't.
ask to have this tricky evolved human brain that gets highly conditioned and sensitized to threat stimulation. You didn't ask for any of this. It's not your fault.
What you find is you're living in a mind that's been traumatized by other people's motivations and minds, not yours, other people's. But when the mind becomes traumatized, then it will act out the trauma patterns. So it repeats patterns of social engagement.
that can lead to more distress and upset. It's not your fault. It's not your fault.
Your brain is like a pattern-recognition machine, recognizing a pattern that's familiar rather than what's good for you. So the brain doesn't like novel things, so an interpersonal pattern that's familiar is safe to you rather than an interpersonal pattern that's not. Sometimes we talk to our clients and we say, you know, If you say things like, well, have I got a sign on my face that says, you know, why don't you take advantage of me? Why don't you abuse me? Then, you know, because this keeps on happening, it must be something about me because every relationship I've been in, the same pattern is, and I'm the one that gets hurt and I'm the only one that they've all got in common.
No, what's happening is your brain is traumatized and it is recognizing with the stimulus response, which is very primitive conditioned emotional response. It's a primitive part of your brain that is responding to the social relating algorithm. It's the competitive hierarchical mentality that's responding.
So when you are experiencing someone who's dominant, automatically you submit, submit to the powerful other. You're not choosing to submit. You're biologically, the algorithm is kicking in and you're submitting. And when you submit, then you're being vulnerable to be taken advantage of again, because your strategy. to engage in social relating is competitive and striving and driving and self-blaming.
It's not your fault. The pattern has emerged. So what we need to do is start to de-shame this traumatised version of our mind and think about other ways to shape a mind that is more linked to supporting our well-being and flourishing. So Paul Gilbert has developed social mentality theory which is the heart of compassion-focused therapy and again without going into too much detail, it roots us humans in our evolutionary social relating context. We're social beings, we live in social groups, and we've got highly evolved mechanisms to help us navigate our way through our social world and navigate our way through other people's minds and actually form safe, relating, so helpful, safe, supportive relationships.
But social mentality theory is really clear that there are other reciprocal roles and ways in which human beings can interact with each other, and not all of them are in the pursuit of creating safeness. So the human mind is a multi-mind, and the two major motivations in social relating that we're interested in are competitiveness and caregiving. So if you look at these two motivational states, competitive states of mind, and caregiving states of mind, we see very different outcomes.
What's important to appreciate from the theory is that these motivations, compete, create, connect, are linked to different brain systems. They are linked to different physiologies. They're linked to different genes and epigenetic expression.
They are highly socially dependent. The ones we cultivate and how we cultivate are related to social. Context.
Create safeness, compete. Now, if we just touch on the competitive mentality linked to mammalian brain hierarchy, what we see is rank, rank mentality. So, in brief, animals and mammals can order their groups through a hierarchy. And when we're looking at the most dominant hierarchy, we see it from a hostile dominant submissive response.
So there is some biological architecture within us that gives us the capacity to be powerful or produce a submissive response in another. Get safe. So when we're working in... animal land or mammal land, my antlers are bigger than yours, so pipe down. It's quite an easy kind of thing to get your head around.
I'm the superior. I'm the silverback. Pipe down.
I'll use my aggression to put you in your place. There's a rank, there's an order, and for the moment, the order is safe until there's another contender to the hierarchy. Now, that in human worlds becomes much trickier because they've still got that capacity. to use that as a safety strategy of relating, using a competitive mentality to engage in social relating.
But the problem is when we're humans with our evolved socially conscious minds and our social goals, is that it doesn't bear very well because we're either in states of feeling better, superior than others, comparing ourselves, social comparison to others, in a way that makes us favorable, looking down on others, being. highly sensitive to humiliation, being highly sensitive to using aggressive strategies to maintain status, striving to maintain status through aggressive attacks and being very blaming of the other uprank, as we call it. And of course, the other side of that is the downrank state where we are comparing ourselves unfavorably to others, where we're feeling inferior, we're very prone to sensitivity about other people's states of mind.
how we're living in other people's minds and we're very prone to shame, that's where shame comes from and the submissive response, the appeasing response, keeping safe by being submissive and appeasing and striving, striving to be better. If only I were better, if only I was more clever, if only I was more attractive, striving to become more upranked and this is associated with internalised rage. The anger is turned inwards, self-blame as a safety strategy. So this is a really important point to remember that human brains can function with this competitive mentality. And of course, clients who have been hurt and harmed by others have been on the receiving end of being seriously and cruelly downranked by others through acts of debasement and demeaning and humiliation and abuse.
So they're often living in this state of downrank. Now, most people do. sort of like flipped up and down like the kind of states of shame to states of humiliated fury.
How dare you to states of shame to humiliated fury? But it's really important to remember this is a mind state and it's linked to get safe, get rid of the threat, get rid of the threat, get safe. Okay, get safe by submitting, get safe by attacking, get safe. Now as I said, this is a rank mentality that really plays to our understanding. of human cruelty because within that great motivation of human competitiveness, we need to remember that human beings are the cruelest predators on the planet and the way they treat other humans is shocking and appalling and heartbreaking.
The human mind for its capacity for cruelness is well documented in many different social and academic domains. So when we've had a life shaped by the dark side of the human mind, we really are prone to be living in this rank mentality, threat-based rank mentality of get safe. It's a state of mind.
And that's particularly the case because shame, which is the rank mentality, if we're now beginning to understand shame as social threat linked to social comparison, then shame emerges when we fear that we're living in the state of living in the mind of another as less than. as ugly, as demeaned, as being debased and that we are feeling internally that state of not good enough, disgusting, worthless, being treated so badly by another human being. So shame emerges from the rank where we are taking into account other states of minds, our own state of mind. Because the motivation of rank mentality and the competitive mentality is to get safe, Then we engage in all sorts of safety strategies to get safe from our own minds, taking drugs, self-harming, addictions of all sorts, eating disorders, sex addictions, gambling addictions, substance addictions.
And then we have a whole set of safety strategies to get safe from other people's minds, appeasing, being a chameleon, never revealing, not telling anybody the truth about who you are, avoiding people completely. And of course, When we're living in these states of social threat, shame states, then over time, the unintended consequences. develop and we are lonely, very, very lonely, very disconnected, in very tortured states of mind, not being able to access other people's minds for our help and guidance because other people's minds are to us dangerous. But there is another really important mentality that helps explain the human condition and that is the one that's linked to states of compassion, the caregiving mentality.
So rank mentality linked to mammalian brain functioning, the human mind has great capacity for compassion and to care. So human beings don't just care in a protective way for their human babies. They need to care for the human baby's emotional world and teach skills to enhance safe social relating.
So there's a whole other system underpinned by different brain physiology and brain states related to the... care giving mentality. And this, our ability to notice distress, to engage with distress, and be motivated to want to help is what creates safeness.
And safeness is a state of mind. And safeness creates affiliation between another state of mind. So if you just think about someone in your own life who you know has got your back, who you were held safely in their mind, that you could tell very upsetting, distressing, and potentially shaming things to, and know that you'll be met with care and comfort and non-judgment and wisdom about how to navigate your way through this, the caregiving mentality rooted in compassion.
So some of you who are familiar with compassion-focused therapy will be aware of the three circles model, which is a sort of a heuristic model to talk about our emotional worlds, but it's linked to what I've just said. So, motivational systems get safe, create safeness. Remember, compassion is a motivational state about creating safeness and care are underpinned. Emotions are recruited by motivational systems in order to get the work done.
So emotions help motivational systems meet their goals. So we've got a whole set of emotions to deal with threats, which I'm sure we're all very familiar with. Fear, anger, disgust, shame, sadness.
We've got a whole set of emotions that stimulate us to go out and acquire and achieve the drive system. Get safe, go out, acquire, meet the need, meet the threat, get rid of the threat, get safe. And we've got a whole set of emotions that give rise to senses of contentment, safeness, peacefulness, slowing down, the soothing system.
So emotions are recruited by the motivational systems to get the work done. So this basically means that the human mind has two strategies to deal with threat. Get safe, create safeness.
Now, if we are in physical threat, we want to get safe. When we are in physical danger, we want to get rid of the threat. We need that mammalian strategy in our life. But humans have a different challenge as well, which is that of social threat. Because we're social beings, our world is full of social threat.
Because we've got evolved socially self-conscious minds, we know that other minds exist and we No, we live in other people's minds. And so it matters to us how we live in other people's minds. It matters to us that we matter to other people.
Now, if we can't live safely in other people's minds because that system of caregiving and compassion has been underdeveloped, then we've got a problem on our hands because then we are left with the physical threat system to work with, the mentality, the social mentality. of social comparison. So it matters how we live in other people's minds, but we fear we live in other people's minds in shame states, demeaned and debased. And we live in our own mind in the downright position of less than and unworthy. So if we use a physical get-safe strategy, get safe, get through, don't engage, don't involve yourself with other people, keep yourself private, submit, submit to deal with a social threat.
like being shamed or demeaned, then problems arrive. Mental distress arises. And compassion focused therapy suggests that all mental symptoms of mental distress and those threat focused symptoms we see emerge from the fact that we are using physical competitive strategies to deal with social threat. Social threat needs compassion and connectedness.
So we need the therapies that are based in the science and we need to root our therapy for complex PTSD. We need to root our interpersonal trauma therapy, of course, in relational states and in the caregiving algorithm. So compassion-focused therapy is very attachment orientated. And if you just look at the functions of attachment, it's to provide both a secure base and a safe place to live.
and a safe haven. So that seeking of proximity to your key attachment figure ought to provide you with a secure base so you can go out and explore and take risks, return to secure base, go out, explore, take risks, learn, develop wisdom, have a mind that's validated and empathized and mentalized and emotionally guided by the mind of another, a mind that brings playfulness and joyfulness into the human experience. But equally, you need to seek haven from that mind. So you need to be able to access part of the attachment system that is soothing and grounding and containing and settling.
And we need both. We need both present at the human party so that we can live in this mind that can regulate threat. So When we go through very, very difficult experiences, trauma experiences, and we have these distressing states of fragmented memories and flashbacks, and we're flashing back to horrible events that make us feel ashamed, when we've been hurt and harmed by others, then we really need a mind that is orientated to affiliation and soothing, a mind that can reach out to other people's minds to say, help me, I'm struggling, so we get a sense of connection. connectedness and de-shaming.
A mind that can experience itself as worthy of that loving, caring experience. A mind that can use internal representations, memories of how others used to comfort us and soothe us, even if they're not in our lives any longer. And a mind that is primed by neurophysiological networks that trigger states, physiological and emotional states of soothing. So it's not a cognitive... experience.
Emotions are in the driving seat of the human condition and it's the limbic system powerhousing our cognitive capacities that gives rise to this state of mind. So it's important that we take account of the physiology because we'll be needing to foster this and trigger this and stimulate this in our therapy. We need an algorithm that is rooted to caregiving, an algorithm that uses oxytocin and vasopressin and autonomic nervous system functionality and the role of vagus nerve to create neurocircuits and shape epigenetics so that we have this if A then B pattern of physiological response. If in distress, mother comforts, but in comforting, mother triggers a physiological response in the baby, in the human baby's mind and body, and that physiological response gets conditioned.
to this is what it feels like to be cared for. If A, then B. Child is hungry, the algorithm meets the need.
But if the algorithm is traumatized and the need isn't met, then the algorithm gets conditioned to a very different response. If the child is upset and crying, ideally the algorithm ought to trigger connective connectedness, warmth, caregiving, validation. But if that doesn't happen and the needs aren't met and the child is traumatized, then a very different conditioned response emerges.
And when we say the child learns, remember the child learns an embodied response to their needs not being met. So if the adult mistreats the child in any way or fails to meet the needs, the child learns other people are unsafe. And this happens repeatedly. The child learns other people aren't safe. Other minds are dangerous and needs and well-being are important.
They don't seek comfort from others. Other people aren't a source of comfort. Relationships are difficult and dangerous.
And the sense of self is underdeveloped and undeserving of love, care and protection. It's an algorithm. and it's rooted in a physiological response.
So our clients are living in states of mind that are a little bit more like this. So when they have very distressing experiences of flashbacks, states of shame, remembering horrible memories related to their trauma experiences, their mind cannot escape itself. In fact, it shames itself. The states of self-blame, you've only got yourself to blame, you deserve this.
The states of threat, the... hierarchy, the rank, up rank, down rank, perpetuate the states of threat. Other people aren't comforting.
They're dangerous. You can't reach out. You can't ask for help. You can't talk for fear of being shamed by other people's minds.
Neurophysiological networks are just primed for that threat. Really distressing. And of course, in that threatened state of mind, our biological defense cascade pops up. You know, there are very limited ways that our primitive, traumatized mind can behave in states of threats. Fight, flight, fright, flag, fate, the dissociative shutdown response associated with chronic repeated exposure to threat and harm.
Now, Gilbert's written a lot about the state of entrapment and of course, if we think about that state of entrapment being linked also to the shutting down of cognitive capacities. So we give up planning our escape, and Gaelis describes this as mental defeat in the cognitive model. Our mental planning of escape, which is very protective, gets shut down and our bodies, through no fault of their own, go into physiological shutdown. So now we can't stay in our mind to help our mind because our bodies won't support that state. So what does CFT bring to that understanding?
And one of the reasons I have spent the first part of this lecture reminding ourselves of some of the key theory is because it's really, really important to use this psychoeducation from the moment that you start to work with your clients, you are de-shaming them with the basic science of human nature and suffering. So it's really important that that is something that is familiar. and that resonates and speaks to your way of working because it's so important to start saying it's not your fault. Your brain was shaped by these experiences.
It's not to do with you. The motivations came from other people's minds. You didn't choose this life or these experiences and all your brain and body has done is respond to it from a very threat-focused perspective.
So compassion-focused therapy is a brain state approach. I touched earlier on the eight core processes of working with CFT for trauma. Paul Gilbert talks about seven CFT processes and I've added an additional one in to pay kind of respect to the work that we do specifically on trauma memories when they are decontextualized and fragmented as we see in complex PTSD. So the core processes are creating awareness, awareness of a mind that's been traumatized. I want you to be able to see your mind rather than be caught up in your mind, to understand through the psychoeducation what your mind's about, how your emergent properties of your mind are experienced from a threat-focused perspective.
So creating awareness, a wise observer of the human condition rooted in the psychoeducation. differentiation, always differentiating out people's emotional states, versions of themselves, traumatized version versus the compassionate version of themselves and differentiating out their emotional worlds. We'll talk on this later, but just to touch on it now, we use that lovely analogy of Dan Siegel that our emotions, when they're traumatized, they're like a smoothie. And what our job is to help the smoothie become a fruit salad.
differentiating out those emotional states, but we're also creating physiological states of safeness. creating physiological states and safeness in people that have never felt safe. So things like safe place imagery doesn't work if you've never felt safe.
So we really do need to attend to embodiment of these core physiological processes. And of course, creating safeness increases window of tolerance and is linked to hippocampal functioning and our ability to stay in our mind, to help our mind. So it's playing to...
factors of a dissociation and states of hypo or hyper arousal so we're really trying to increase people's capacity to engage their hippocampus so that they can bring their trauma to a working mind that can access a compassionate lens so it can bring a new focus a new meaning to those experiences meanings from moving away from states of self-blame to ones of promotion of grief and sadness and adaptation. So we're also, one of the key processes is actually creating the compassionate mind, the integrating capacities. We're now having to teach people the language of compassion because it's not there.
If we just reduce the threat, the language of compassion just doesn't pop up online. It's not being clouded by threat. It's a state of mind.
And if that state of mind has not been developed, fostered, supported, and supported, then we're going to have to create a state of supported through attachment experiences. It's not going to just suddenly be there, like a language that I can speak. So we've got to really get into this idea of teaching our clients the language of compassion that's supported by the embodied physiology.
And then we need the process of honoring the trauma story and revisiting and contextualizing some of these fragmented memories to move them from states of shame to states of compassion. ultimately we are helping people cultivate this state of mind, this version of them, that is hopefully leading to transformation and adaptation in future life tasks. Contextualising trauma memories is the additional core CFT process that I've added into Gilbert's seven core processes. Now, as we embark on this work, it's always important to remember that trauma and grief go hand in hand. And when you work with traumatized people, they have not been able to grieve for all the losses and all the hurts and pains in their life because trauma arrests those processes.
And especially if trauma has been maintained by states of shame and self-blame, then self-blame stops grief processes because how can you grieve for stuff you've brought on yourself. That's when sympathy, a really important gateway emotion to compassion, kind of tips into wallowing in your own self-pity. So as we de-shame the traumatized brain, as we help people truly understand it's not their fault and they connect with that emotionally, the heart-head, like they connect emotionally with the enormity of how they've been treated by others, then we see the emergence of loss. and grief and sadness. And this is really, really frightening for some people because, of course, the sadness is linked to loneliness.
And as you know, loneliness is a core human terror. And some of my clients for sure are terrified of those states of being lonely because when they were younger and they were really frightened and really sad, then no one came and no one rescued them. connected with them and protected them.
So they were in states of being alone in this very threatening, frightened world. And that's what they're frightened they will walk into when they start to grieve. Because when we're really sad, we're biologically primed to want to be comforted by another human being.
You know, tears elicit sympathy and care in the minds of others. So they're really, really helpful. So in those kind of important systems have been contaminated with trauma, then the very, very important processes get arrested. And it's huge, by the way, and it's enormous. And I'm sure you'll be well aware of this.
The losses that clients have endured are unbearable, and sometimes they are unbearable. And so when people truly understand it's not their fault, it's not necessarily a liberating kind of moment of, oh, I'm free. Because then the mind goes to, well, whose fault is it?
And actually, it could have been very different. and my life could have been very different. And that's really, really painful when there's a lot of loss.
And sometimes it's really hard for clients to really allow themselves to develop compassion, to help themselves work on and move on through these experiences. Because if they, and I put this in inverted commas, parenthesis, get better, and that isn't a word that... phrase that I like, but just for the sake of this description, if they get better, then that means what they went through didn't matter. If they can recover from the enormity of the brutality of how they've been treated, then was it all for nothing. Hey, ho-hum, it didn't matter.
So to them, being traumatized and being really affected is like a kind of a living testimony to how they've been treated. And sometimes that is motivated by wanting the perpetrators to see how they've been affected. And of course, the tragedy is, as you know, that the perpetrators don't care.
So they are drinking the poison, hoping that the other person might die. So when we move on now to thinking about how do we develop this new compassionate algorithm? How do we develop a compassionate state of mind to help us with the trauma work?
Well, compassion-focused therapy has defined engagement and action. Remember the algorithm, if A then B, engage with the suffering, take action to alleviate it. So we need a whole set of competencies to help us engage with suffering. And then we need a whole set of cognitive competencies and behavioral competencies to help us alleviate and prevent suffering.
competencies of engagement which we are fostering and developing in our clients are the motivation to care. Now this is of course everything. We are creating a different motivational state, a state of mind that wants to care. Now of course the traumatized mind will feel that it doesn't deserve care, that it deserves to be punished and that's why we'll spend a lot of our time working on the fears and the blocks of allowing compassion.
into our hearts and our minds, which is why the psychoeducation and the formulation are really helpful at this phase. Gently, gently, gently helping people to realize it's not their fault because it's that's the point when they can begin to develop the compassionate capacities, when they stop this kind of self-blame. So we need sensitivity to distress, distress tolerance, sympathy.
epathy, non-judgment. And then we need competencies that can help us move away from the suffering. We need a mindset, a state of mind that will support a different outcome, a body-brain that facilitates attention to things that are helpful, emotions that can co-regulate and be present together, a reasoning mind that's wise and knowledgeable.
a mind that has memories of caregiving that support the compassionate motivation, and of course, behaviors that are courageous and different. So just to put this a different way, just for a kind of a summary really, this idea of a brain state with the physiology supporting that state of mind, then the threat mind colours. a very different state of mind. And the traumatized mind, of course, colors the brain in a way that means the motivation is entirely primed to get safe, keep safe. The attention is hypervigilant and focused on threat.
Emotions are all the horrible emotions of fear, anger, disgust, shame. Reasoning is dichotomous, paranoid, catastrophic, self-blaming. Memories are fragmented.
nightmares, flashbacks, all sensory modalities can be fragmented in body visceral memory states. Behaviors are defensive, on the defense cascade, fight, flight, freeze, appease, faint, fatigue, faint. And of course, the body states are in states of total disconnect with poor regulation, poor heart rate variability, dissociative states, hyper-hyperarousal. traumatized states of mind.
So this slide is hopefully a helpful summary to what our tasks are our therapeutic goals. Here we have the state of mind with the threat motivation helping us move towards a compassionate motivation, a mind that can be helpful, attention that can be broader, contextual, emotions that include warmth, playfulness, sadness, can regulate. reasoning that is knowledgeable, wise, helpful, memories that are integrated, updated, narrated, behaviors that are engaged, action-focused, courageous, and a body-brain physiology that is regulated, window of tolerance, improved heart rate variability, and vagal tone. So as we move into This part of the lecture, I just want to draw your attention to some of these key processes and how we do it.
So as I said before, we start with developing compassionate capacities. So six competencies of engagement, motivation to care, it's not your fault, it's not your fault. Psycho-education, rooting, in the science, rooting in the evolved human brain, remembering that you didn't choose your life script, that you didn't ask to be treated this way, that the motivations to hurt and harm you came from the minds of others.
Let's look at what happened to you, not what's wrong with you, what's happened to you. Let's use the formulation, your our understanding of what you went through to develop this observer perspective so you can see that you've been traumatized. always working on the fears and the blocks. What would happen if we discovered that you did deserve compassion? What would happen if we changed deserve to need?
Compassion is a basic human need. What happens if we discovered you need compassion? What would happen?
What would be your fear? What would happen when you got in contact with the sadness of your life? So what about our body-mind? Part of the approach is what I call kind of befriending the body.
Your poor body didn't mean to behave or respond in the way it did. It didn't mean to hurt you. It's trying to protect you.
Even when you have a disgust response, it's trying to protect you. You may think you're disgusting because you feel it, but the disgust response continues to say, this is bad for you, let me get rid of it. So we know when we're in chronic states of stress, it undermines our vagal nerve capacity.
to downregulate and it impacts on this hippocampal functioning. So we've got to start bringing embodied states, using breath practice to help regulate heart rate variability, using grounding, coming to our senses, our posture, our core strength, yoga, diet and sensory motor exercises to begin to embody and befriend our body so that it can support the work that we need to do. And then as we are increasing awareness, using grounding, coming to your senses, understanding these really tricky feedback loops of the tricky brain, using our minds to orientate themselves towards compassionate states that are more helpful.
Now, my clients, traumatized clients, don't like mindfulness. They find it terrifying because they don't want to be mindful of their traumatized mind. And whenever we do anything more kind of mindfulness-based activities, they do tend to come at the end of treatment to support well-being going forward. But mindful attention and de-shaming and mindful attention can be really helpful as we're creating awareness.
But then we need to develop these. compassionate capacities, a mind that can help itself. So when we talk about helping a mind support its emotions, the emotional state, remember I used the Dan Siegel analogy of a smoothie to a fruit salad.
This is about differentiating, okay? And this is about promoting sadness and grief, but also developing playfulness and joyfulness and ways to regulate. emotions, with grounding and increasing that wind of tolerance.
There's a lovely phrase that I found on the internet. Unfortunately, I don't know who came up with it, so I can't. credit them, but it basically said, I'm not here to help you feel better. I'm here to help you become better at feeling.
And that really sums up some of the work we're doing in compassion focused therapy. I'm here to help you become better at feeling because your feelings weren't taken care of. They weren't validated. They weren't co-regulated when you were younger, and they've turned into this horrible ball of pain and suffering.
So we need to find a way to help you develop capacities to regulate those emotional states. There are three key emotions that we see repeatedly in trauma, fear, anger, and sadness. And as I said before, sadness is a very frightening emotion to our clients because it makes them feel lonely.
And loneliness is a core human terror. It's linked to our survival psychologically from an evolutionary context. We need other people.
We need to feel connected with other people. So what we see in trauma is this kind of melching, this kind of like undifferentiated state of these emotions. And so we're always working towards enabling these states to play out. Fear, anger, sadness.
So when you think about this, some of you will be already linking this to the core grief process too. So if you look at the literature around grief processes. states of panic, ending of attachment, rage, sadness, rage, fear, going around until we move to states of acceptance. So we're creating a mind that can engage with its suffering, that can stay in its mind, a body that can support physiologically the process of increasing window of tolerance. So we can stay, so that when we bring states of upset, when we experience our emotions that are frightening to us, we can bring other states of mind.
So in compassion-focused therapy, we really focus on the three flows of compassion in helping people to care for others, helping letting other people in to care for them, and of course, caring for themselves, self-compassion. Now, these states are all really important. So practicing caring for others is something that our clients usually don't need a lot of practice.
of because they are very good at caring for others. In fact, they would usually say, I would never treat another human being the way that I've been treated myself. So that's usually a flow of compassion that isn't inhibited. But do be careful that caring for others isn't a wolf in sheep's clothing. It's actually what I call subjugated compassion, compassionate appeasement.
So it looks like it's compassion, but it's motivated by appeasement, a threat strategy, a get-safe strategy. So you are doing things to help so that you don't trigger a threat response in the mind of the other as opposed to the motivation of doing things to help because you care. But we focus on all flows. We want to kind of unblock all flows. So it's a real skill to let other people in, to begin to experience other people's minds as safe so that you can use them to help you.
And of course, the therapeutic relationship is hugely important to this because your mind, as the therapist, creates a state of safeness, oftentimes the first state of safeness that your client has been able to access and use in their life. And of course, we are directing compassion towards ourself as well, learning the art of self-compassion. Now, compassion-focused therapy uses a lot of imagery.
because imagery is very powerful in changing physiological states. So we harness, and in fact, we know that from trauma. In fact, one of the horrible symptoms of PTSD are flashbacks. So trauma memories create terrible states of trauma and terrible fear-based states and shame-based states. So compassionate imagery and compassionate memories create states of caregiving.
So we use lots of different types of imagery. caregiving imagery. We use imagery that creates senses of protection, creating safe place, safe haven.
We use compassionate imagery flow exercises that create connection and affiliation. And we use perfect nurturing imagery. Now, this is an imagery that I developed to work with my clients who've had really difficult experiences of usually mothering, unfortunately.
And they don't really they really struggle to think of other people as caring um or have memories of being cared for or having friends that are really caring so we've created a perfect nurturing imagery which you can read in um my self-help book that really helps people develop these sort of archetypal and fantastical states of minds but have this kind of reciprocal role function of another part of your mind with a sentient mind helping you so using imagery drawing on the compassionate qualities to create different states of mind you at your best is another very kind of important quality that we use perfect nurturing images i've just touched on Creating a mind that has wisdom, imagery that has wisdom to know, intuitive wisdom, how to help you. A mind that can bear your pain, that's moved by the suffering, that understands what you've been through, that can mentalise and that wants to help. So now we've got sort of brain states using breath practice, using imagery, using embodied states of mind to create the culture of which we develop our compassionate mind, a mind that can begin to talk to itself in a reasonable, knowledgeable, empathic, wise way. And again, remember we are teaching people how to draw on all the knowledge, the psychoeducation, the de-shaming psychoeducation to understand why they're suffering like this and why they're feeling this. and then to access their wisdom, their intuitive wisdom about how to do something that would be more helpful to them.
Knowledge, understanding, wisdom and strength. Cues to compassion, creating an inner voice to help us. Knowledge, everything we know about human nature and the science, tricky brains, social threats, hierarchy, get safe, social comparison. why human beings treat each other so cruelly and maliciously. Our understanding of our own experiences, what we've been through, how we can bring empathy and understanding to a life we didn't choose.
And using imagery, maybe perfect nurturing imagery, or other imagery to access these states of mind which are compassion and wise. And then harnessing the courage and strength to act differently. How can I act differently? to alleviate suffering? How can I change my relationship with myself?
Act courageously."So we have little problem-solving sheets. Again, you'll find these in the self-help book. They just help people train situations that upset me. What did my threat brain say? Okay, how can I bring my cues to compassion to think about this differently? Remembering always that when we're bringing our cues to compassion, remember we're still using the cognitive system. for us to begin to feel the cues to compassion, we need to remember to activate the embodiment. We need to activate the physiological system, use the breath practice and the imagery, the motivational state of mind, and then to hear the cues through that lens. So then we move on to working with trauma memory. So we're trying to create compassionate capacities, compassionate motivations, and then wanting to bring that compassion lens to trauma stories. Now, for me, I come from a tradition of really wanting to pay testimony to honour the trauma story. Some clients don't want to talk about their trauma and some of the research that we've conducted have shown developing a compassionate mind. in itself is enough to seriously reduce symptoms of complex PTSD to the extent that people are no longer diagnosable. So it's not necessary that people need to talk about their trauma stories, but sometimes it's really powerful to share and bear witness to another mind that sees you and hears you and validates your story and encourages you to bring a compassionate lens to your story. So when we've got these tricky trauma memories that are decontextualized. That is because of what's going on in the brain. So the amygdala effectively, in the sensory modality, is firing off these sensory-based trauma memories and it's sort of kicking out hippocampal functioning and making it really tricky for these trauma memories to be processed. updated and integrated into an autobiographical narrative. And that's why they're very problematic because when they're triggered, they create this sense of current threat. So people feel as if they're being traumatized again. And that's really, really frightening. They can smell things you can't smell. They can hear things you can't hear. Their body feels pain that isn't physically there as such. It's just a memory. It's important that we pay attention to all the sensory modalities and that we update the sensory modality with its antidote and that we remember states of trauma to update to, so not necessarily memories but sometimes states of abandonment, loneliness and dread. So we use a lot of imagery to update a net need in our trauma clients like caregiving imagery to update states of abandonment, protective imagery to update states of feeling very vulnerable and unsafe, and empowering imagery to update memories of feeling very disempowered, and of course safe place, safe haven imagery to update states of feeling unsafe. Now I am a, you know, at heart a trauma therapist and a PTSD and complex PTSD expert and I'm trained and all my clinic are trained in these core trauma therapies. At the heart of these trauma therapies, they have trauma memory techniques, imagery re-scripting, flashback updates, EMDR interweaves, or narrating a stone narrative. So you may or may not be familiar with these types of trauma memory techniques, but what they all have at the heart is updating. the emotional state contained in that fragmented memory. So, if we're having a visceral flashback to shame, we've got to update that with compassion. It's not going to resolve on its own. So, we might use EMDR if you're trained in that procedure to update that state. We might use flashbacks or re-scripting if you are trained in those states. But we still use the cues. So, we work it all out. We think about the flashback. and we think about what did the threat mind say when you were flashing back to that memory when the abuse started. Then we think, okay, let's engage our compassionate mind. So let's do our breathing. Let's bring our imagery into mind. Let's use our compassionate posture and stance. Let's use our voice tone. Let's bring our compassionate motivation. Then let's use our wise mind, our knowledge about everything we know, the psychoeducation, our understanding of what we've been through, to de-shame ourselves, to bring wisdom, something to our mind that's more helpful and supportive, that's de-shaming, that honours the pain that you went through and how hard it was, that fosters sadness, that gets in contact with justifiable anger. and promotes grief, cues to compassion. So we're using that really as a framework to really shape the compassionate lens, the compassionate language of these shame states of mind. Just briefly on process, remember when we're updating emotion and meaning, remember to embody it. It's physiologically driven, so prepare the mind. by using compassionate motivation, grounding, attention, imagery, breath. Bring the flashback up to the compassionate state of mind. So some trauma therapies trigger flashbacks and then try and update the meaning from them in that state. In compassion-focused therapy, we bring online the compassionate state of mind and then we bring the trauma memory to that state of mind. because that increases the window of tolerance and our capacity to access more helpful states of mind. And of course, when people start to feel sad and angry, that's exactly what we want them to begin to start to feel. Because remember, we're helping them begin to become better at feeling rather than feeling better. So feeling sadness and rage with an ability to ultimately co-regulate it down is part of that process. So just as we're nearing the end, I just wanted to take you through a little rescript. Now, this rescript takes about 90 minutes of therapy. And again, the process of doing that is outlined in various book chapters and the self-help book, which will be with the reference list available to this lecture. So the nine bullet points are just a brief summary to make really important points. But here's Gemma wanting to rescript a shame memory, and it's a memory of... when her stepdad came into her room at night and used to interfere with her. She feels very disempowered and very ashamed and very frightened. So the therapist would say something like, well, how do you want to feel in this state? How do we want you to be able to feel? And Gemma said something like powerful, disdainful, in control. And again, of course, it's for Gemma to come up with for the moment what she wants to feel. That's her prerogative. The therapist will then say something like, okay, so we're going to re-script this memory so it didn't happen the way it actually happened because we can do what we like in our minds. Remember that memories aren't true representations of what happens. If any of you are Harry Potter fans, you'll know the power of re-scripting horrible images. So we can do what we like. So what would you like to happen? And Gemma comes up with this kind of script in her head. Well, actually, what I want to do is I want to come in. I want to get one of those big guns, you know, honey, you shrunk the kid's guns. I want to zap him. I want to see him shrinking. So he's really not frightening. And then I want to see him begging and just being really frightened. Like he used to make me feel, and I want to see that look on his face of terror and looking really pathetic. That's what I want. So the therapists might work out the script. They might write it down and then they rehearse it. So it comes quite freely to the person. And then they say, okay. So let's sit down and let's see if we can relive the new re-script. So let's get you into a state where I'm going to invite you to speak out loud as if it were happening again, this re-script. So we're going back to that moment in time when your stepfather walked into your bedroom at this age, you contextualize it as if you were doing normal reliving to trauma memory. And then I want you to bring in, so now you've got the gun. Can you see the gun, the zappy gun? You're zapping him down, he's shrinking. and you coach Gemma to imagine the new script and then to notice what she's feeling like. And so at the end of this 90-minute session or so, Gemma reports feeling good. You know, how are you feeling? Because remember, we're updating emotional states. It's really important that we really focus on the feeling in the body. And she says, I feel good, I feel powerful, I feel strong. And you know, arguably, that's a good session. You might be pleased with that session, but from a compassion-focused lens, if we're thinking about what's being triggered in the mind and the body, then the therapist and Gemma inadvertently are actually using a get-safe strategy. They're removing the threat. Get safe. Now, remember that from the hierarchy. So they are pushing Gemma up rank to be more powerful, to hurt the perpetrator. Now, I mean, this isn't a matter of kind of moral ethical judgment here, because that's a really possibly important state for Gemma, you know, to move from a state of debasement to one of feeling powerful. But what it isn't is a resolved shame flashback with compassion, because that comes from a completely different state. So we need Gemma to care for her state of shame in her rescript. We need Gemma to balance those emotional states with compassion. So compassionate re-script looks the same. Again, prepare for 90 minutes. What do you want to feel? I want to feel safe and cared for, that it's not my fault, that my body isn't dirty. What needs to happen for you to feel like that? Again, whatever Gemma might say, this is the core piece of the... of the therapy session, I need to focus on feelings of warmth, care, kindness. I need to focus on the sadness of the memory, understand how hard it was. My anger is trying to protect me. How dare you do this? This is your mind. You're 30 and I'm four. We might recruit perfect nurturer to come into the image to help, to protect, to provide haven, safe haven. But what we're doing is using a very different system. We're engaging the compassionate motivation and the compassionate state of mind in Gemma's body. So this time when we say, okay Gemma, Let's go back to that memory. Okay. And when we think about the shame, I want you to really bring on board the compassionate state of mind. Let's orientate our mind to compassion. And then let's imagine your perfect nurturer coming in to protect you. Protect. Get rid of the threat. You need the get safe strategy. Get rid of the threat. Get rid of the perpetrator. Now, come back to Gemma. and heal her emotional pain, heal the shame, foster the conversation around compassionate engagement and warmth and looking after and wisdom and de-shaming and helping her realize it's not her fault, helping her feel appropriately angry and sad and offer comfort in the mind. And that is a very different state of empowerment at the end of the session as opposed to powerful. So when we're doing these types of re-scripting, just remember the three P's, as I call it, and make sure that there's proximity so that your client is seeking another, going to perfect nurture for comfort in their mind, and that re-scripts offer protection. Get safe is important. Back off. Get off her, him. Let me protect you. But then remember, provide the safe haven. Update the shame state. with feelings of comfort and care and emotion regulation, promoting sadness and anger, working directly with the trauma memories. So we continue to do this, to contextualize, update. We work with embodiment, visceral flashbacks, whatever it is necessary to create the antidote to the state of fragmentation so that our trauma narrative is coherent and integrated. So that's just a kind of a handy, hopefully handy, kind of outline really of the process. If you like things to be a little bit organised in your mind, I mean, of course, it isn't a manual, unfortunately, compassion focused therapy, and you're always bobbing and weaving around the core processes and the core tasks. But that in some way gives you some sense of phases that you might go through. And then finally, just in the closing comments, then of course, we are really trying to enable our clients to behave in ways that support their wellbeing and connectedness for the rest of their life. Whether that be some of the interpersonal stuff where they need to develop empowerment and boundary assertiveness, compassionate assertiveness. where they need to change relationships to things, take courageous actions to leave relationships that are not supporting them. All sorts of behaviours, behavioural experiments promoting safeness in their world going forward. And this is the phase we call living with compassion in your life, the final phase of compassion-focused therapy for trauma. This is my final slide and for anything that I've spoken about that's caught your attention, then please do refer to the two self-help books that I've written which contain all the techniques that I've spoken about. It is a self-help book so it's for clients but it can be quite a good reminder to therapists when there's a lot of new information to take on board. I've also written some key chapters which will be made available to you. The references will be made available to you so you can see some of the way that some of the client work has played out in some of these chapters. And I do hope that you found this lecture useful and thank you for taking the time. And I hope that you and your clients benefit from this very valuable and needed work. So thank you very much indeed.