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Compassion is a big buzzword right now in healthcare, but what does it really mean and how can you actually be more compassionate?
This week Paula is joined by clinical psychologist Dr Chris Irons, an expert in Compassionate Mind Training.
The pair examine what compassion is, why it matters and how it can be applied within organisations and teams as well as on a personal level. Chris discusses why self-compassion is such a tricky concept, especially for health professionals and how this is a skill that is something we can learn, for the benefit of ourselves and our patients.
This week there is also a bonus episode of an exercise to help you warm up your compassion muscles for work – so keep an eye out for that in your podcast app.
Chris is Co-Director of Balanced Minds and BalO.
He has written a number of books, including:
- The Compassionate Mind Workbook
- The Compassionate Mind Approach to Difficult Emotions : Using Compassion Focused Therapy
He also runs an online self-compassion course and has developed the Self-Compassion App.
I’d love to connect with you so come and find me on LinkedIn, Twitter or Facebook.
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Transcript
[music]
Paula: Hi, I’m Dr. Paula Redmond, a clinical psychologist and you’re listening to the When Work Hurts podcast. On this show, I want to explore the stories behind the statistics of the mental health crisis facing healthcare professionals today, and to provide hope for a way out through compassion, connection, and creativity. Join me as I talk to inspiring clinicians and thought leaders in health care about their unique insights, and learn how we can support ourselves and each other when work hurts.
Compassion is a big buzzword in healthcare, but how do we actually do it? This week, my guest is Dr. Chris Irons, clinical psychologist, and expert in compassionate mind training. I began by asking him to explain exactly what compassion is.
Chris: It’s a great first question and although it’s simple to ask, it’s not always simple to answer which actually is a really important thing, because compassion is one of those words that we hear all the time, particularly working in healthcare. It’s the sort of word that is known and almost like intrinsically, of course, we’re compassionate and that’s what we do. In some ways if we were to say, what is our business within healthcare, it is about compassion but it turns out that actually, for many of us during our trainings, and even post qualification, we’ve never actually had lots of training specifically on what compassion is, and what it might involve, and how we actually go about doing it.
There’s lots of different ways that people have tried to define and describe compassion, the way that we do from a compassion focus therapy perspective, is a relatively simple definition, which is compassion is a sensitivity to the suffering of self and others with a commitment to relieve and prevent that suffering. From our point of view, this definition holds two important parts, we call them the two psychologies of compassion.
The first part really links to the first part of the definition, which is that to be compassionate to yourself or to other people, you need to be sensitive, you need to be able to notice distress or suffering. If you don’t notice it, if you’re working on a busy ward, and you’re so caught up with your paperwork let’s say, or phone calls, and you don’t notice that a client or patient is in tears, or is in a lot of pain, and of course, there’s nothing that you can do, so we need to be able to notice suffering and distress, we need to move towards it.
We need to be able to engage in it, and to help with the engaging bit, we also need to be able to tolerate it because the reality is when we get in touch with distress and suffering, of course, it can be very painful. We need to be able to be solid in the presence, and be grounded in the presence of it, and if possible, begin to have some understanding about it, the understanding about what’s happening or what’s led to it. That’s the first psychology, we call it the engagement psychology, it’s moving towards noticing engaging with.
The second part of compassion fits with the second part of the definition really, which is about commitment. How do we take a wise dedicated perspective towards this in trying to relieve and prevent suffering? How can we skillfully work with this? If it was somebody else, of course, from our professional training, we have been taught to whole variety of different things about how we might work with or alleviate distress and suffering. If it comes to ourselves, of course, it’s taking a similar perspective.
How do we wisely try to relieve and to be supportive and caring with our distress? I guess, in some ways, a simple way of describing the broader motivation of compassion is this desire to be helpful, not harmful. We’re just to put it into a very small description really what we’re getting at when you’re being compassionate is to be helpful, not harmful.
Paula: Thanks, Chris and I know that, particularly in recent years, there’s been a lot of research and development around this work in terms of intervention and understanding the science of compassion, and why it’s helpful. Could you outline some of those findings for us?
Chris: Yes, I can do. There’s been a huge explosion in the research looking at compassion and this goes across many different areas in many different fields and I think it’s probably quite important at this stage to say that the research on compassion particularly from a compassion focused therapy point of view, it can be linked in many different ways, but one interesting way is to link it to the three flows of compassion. From our perspective, there is the compassion that you can have for other people.
The flow is from you to other people, so you’re sensitive to their distress, you want to try to relieve or alleviate their suffering in some way, so that’s one flow. The second flow is when we’re distressed, can we be open to seeking out and receiving other people’s kindness, care, and compassion, and then there’s a third flow, which is self-compassion. When I’m distressed, am I able to notice my own distress, and to skillfully try to engage with it? What the research, if you spread it across those three flows, has been really interesting that essentially the take-home story is that engaging in compassionate or fear those flows is associated with positive outcomes.
That’s a very simplified, easy starting point, but what we’re recognizing is that actually, each of those flows, although they are similar to a certain extent, do bring with them slightly different benefits or slightly different outcomes. What we know, of course, is that compassion from us to other people, the compassion flowing out. This can actually, of course, have quite amazing benefits for the other person, of course, the person would target, the person who’s in distress.
Also as the giver, as the person who is being pro-social and caring, and having this motivation actually, actually lots of studies now showing that this can lead to increases in well being, increases in meaning and a sense of feeling that you’re contributing to something bigger than you and interesting that there seems to have a buffering effect on stress and on anxiety. Actually, if you’re able to do even if it is small things for other people, it doesn’t have to be grand gestures, but small acts of kindness and compassion, that this actually seems to help you to feel less stressed and less anxious.
Some really lovely findings, looking at compassion flowing from us outwards. Now, interestingly, we also know though that if you are able to receive compassion from others, this can actually have quite a powerful effect as well in terms of your psychological well-being. People who are more able to be receiving of compassion, tend to have significantly lower levels of things like anxiety, stress, they are generally less shame prone, and tend to have higher levels of well-being and happiness.
Again, there seems to be something about feeling connected, I guess, because we can look out to other people, and rather than feeling that I have to be isolated, and I have to deal with everything on my own, I can actually see that other people might be there for me, that might be supportive, might be helpful. For those of your listeners who are interested in attachment theory, a lot of people can begin to see the overlap here, and of course, we can begin to see that the outside world is benign and caring and supportive, and crucially will be there for us when we need it.
Then the area that I guess has had the most interest probably over the last say 15 years or so, has been self-compassion, and that there’s been a huge explosion in the number of research studies looking at the potential power of self-compassion, and actually will take us longer than this podcast episodes to go through all those different areas, but some of the fascinating studies really, I can give a little bit of a sense really. Maybe it’s helpful, I can link it to some of the myths, the downsides of compassion, because often when you talk to people about compassion and self-compassion, a lot of myths, a lot of concerns pop up, or make me selfish or maybe indulgent, it will make me make more mistakes, it’s like I’m letting myself off the hook.
Well, interestingly, there have been studies that found that rather than letting yourself off the hook, people who have higher levels of self-compassion are more likely to take responsibility for the difficulties and mistakes that they make in life. You are more likely to make amends if you have made a mistake, you’re more likely to study hard again, after an initial failure. Rather than actually just letting go of and making mistakes, and it doesn’t matter, this self-compassionate mindset is motivation towards self actually buffers against that, it makes it more likely that you are bothered about these things, more likely that you want to take responsibility.
We also know that self-compassionate mind states is actually negatively associated with narcissism. Actually, the higher you are in self-compassion, it doesn’t make you some narcissistic and self-focused, actually, if anything, it’s the other way around, which is intriguing, because higher levels of self-esteem can be associated with higher levels of narcissism, and self-focus whereas actually the self-compassion this isn’t found. Then when it comes to it as well, when we look at self-compassion, and the idea of weakness, it actually turns out that when people are more self-compassionate, they tend to be more resilient.
They tend to have lower levels of things like anxiety, and stress, and depression symptoms, they have low levels of things like self-criticism and shame. Actually, higher levels of things like feeling securely attached, being able to reassure themselves if they are distressed, and also higher levels of wellbeing. It’s important to let people know that when you look at the research on this, whilst there are wonderful benefits, of course there’s no panacea in the world.
There is nothing that is going to perfectly work for all people, but the research coming back on this is actually relatively clear that having a self-compassionate perspective and a way of engaging yourself in a caring, supportive way seems to be associated with a whole range of benefits.
Paula: It’s really fascinating. I guess I’m thinking, as you’re talking about, again, maybe some of the ways that we might perceive compassion often thinking about compassion as a feeling or as an emotion, and then sometimes the things that we come up against don’t feel nice, don’t feel good. I think that can be confusing for people if compassion, which sounds like something warm and fuzzy, doesn’t feel good. I’m wondering if there’s a misunderstanding about compassion, sometimes being thought of as an emotion, when in fact it is something more complex than that, or something very different to feelings.
Chris: It’s a really nice point that you’re making. Actually, in the literature, there are some really quite well known compassion folk who describe compassion as an emotion, as a feeling that’s often linked to warmth and being tender hearted, and sometimes love. Actually, from our perspective, it’s really important that we don’t hold the compassion is an emotion. Now, that doesn’t mean that compassion is emotionless, but rather that for us, compassion emerges from a caring motive.
Compassion is tied into motive, rather than feeling or emotion, and that’s really crucial. Maybe if I give an example here that might resonate with people. If you think about your career, working with your patients, can you say that you have always without fail liked and had positive emotions towards and about your patients?
Paula: Not without fail?
Chris: I think it’s fair to say that most of us recognize that whilst often we can like our patients, and we can have positive towards them, sometimes that’s not the case. In fact, actually, depending on the person, maybe certain things they’ve done, or how they’ve been treating you or your colleagues or other people, actually we can hold some negative emotions and pleasant emotions about them. Actually, we might at times, not like our patients in various ways. Here’s the question then, does that stop you from being compassionate towards them?
Well, if compassion is an emotion, if it’s about liking, is it about warmth, if it’s about love, it’s about tenderheartedness, then actually that is going to be very difficult. If you’re working with people who have caused, let’s say other human beings a lot of pain and suffering, they’ve been an abuser, or they have committed some pretty awful crimes, and caused a lot of people pain. It’s going to be pretty hard to be compassionate towards that person, if actually compassion is dependent or contingent to upon warmth, love and tenderheartedness.
Whereas, if compassion is actually linked to a motive back to that definition really being sensitive to somebody’s distress, and skillfully trying to relieve it, it turns out that you don’t have to like the thing that you are being compassionate towards. Now, for us, this is really crucial because it also turns out to be the case when it comes to self-compassion. It’s fair to say that many people that I work with really do not like themselves. It’s not just the absence of positive feelings towards themselves.
At times, actually people actively hate themselves. They feel angry about themselves. They feel disgusted. They feel a huge amount of shame. If we were working in a self compassionate way, and trying to cultivate self-compassion here, this would almost be impossible then, because the starting point here is that people hate themselves. If self-compassion is dependent upon liking them self, then we’re struggling. Whereas actually for us, because self-compassion is a motive, it’s emerges from a caring motive.
I don’t have to like myself to begin to pay more attention and notice that I’m distressed. I don’t have to like myself to begin to take wise steps to try to relieve my distress and suffering. Now, of course, it’s probably fair to say whether it’s compassion outwards to others or compassion to yourself, it is easier if you like the person that you are engaged with in terms of compassion, it does make it easier. The key thing for us is you don’t have to like this person, you don’t have to feel compassionate feelings towards them.
What we often say is that the compassionate feelings often is that warmth, tenderness, kindness, and so on, they will follow in time maybe, but we don’t have to start there. We can actually start just with this motivation and from there, of course, do a whole bunch of things from a compassionate state of mind that could be helpful and supportive to somebody.
Paula: Chris, I know that that you’ve worked directly with health professionals in different ways, can you tell us about that work and what things have come up?
Chris: I think it’s important to say a few things just to start off with here. Working with healthcare professionals, I think is fascinating being a healthcare professional. Of course, I’ve been always very curious to this is that during my training and during my time where I was on my clinical psychology training, and other psychotherapy trainings, we were talked to about the importance of things like self-care, but often that was linked to relatively simple things. I don’t mean to demean these things, they’re important, but things like getting good sleep, exercising, eating healthily, not drinking too much, having supervision.
Don’t get me wrong, these things are important, but never will we actually talk through one about what compassion actually is, what it’s constructed of, but the second thing really about how it might be important for us to have the same compassion towards our self that we might have towards our clients and our patients. It’s really fascinating me really, that our job really is being out there being compassionate to others, trying to alleviate their suffering, but very rarely have we been taught explicitly how to do that same thing to ourselves.
More broadly, it fascinates me just as a culture really that if you were to think about it, you will spend far more time in relationship with yourself through your life, than you will do any other person you ever meet. In fact if you add up every single hour that you will be in relationship with other people throughout your life, it comes nowhere close to how many hours you spend in relationship with yourself. Here’s the problem. What relationship do most people have with themselves?
Do they tend to treat themselves with the same warmth, the same kindness, the same care, the same empathy as they would do their best friends, their loved ones? Sadly, often the answer is then no, we don’t. Just in a general population way, we tend not to do this. We tend not to learn how to do this for ourselves. We teach children at school and college, amazing things about science and maths and history and geography, and all these stupendously wonderful things.
Actually, we tend not to teach our children our young adults about how they actually can learn to be with themselves. The most important relationship that I’ll ever have. We don’t actually spend much time on helping people to learn about their emotions, how to manage their distress, how to do any of those types of things. I think it’s important to say then as a broad starting point before we even go in and work with healthcare professionals in and about compassion, to recognize that there is the broader things at play.
Then of course, we can start leaning in and thinking more specifically about healthcare professionals. I guess in addition to the fact that many of us as professionals have never actually had lots of explicit training on how to be compassionate to others or to ourselves. It also is important that we recognize that there are many levels that we need to hold in mind. Of course, I’ll come on in a moment just to talk about how I can work with individual healthcare practitioners.
It’s always really important that we don’t hold that somehow all of this is only in the individual, that it’s only in the individual nurse, the individual psychiatrist, the individual psychologist or social worker who has deficits or problems in being compassionate to their patients, or being compassionate to themselves. One of the things of course, we always try to hold is the context in which this all plays out. We’ve got some nice studies on that.
Some colleagues of mine, this was Lauren Henshaw and some other colleagues up in the Northeast of the UK did a wonderful study a number of years back where they asked healthcare practitioners across three different trusts to rate the degree of their organizations, their NHS trusts level of compassion, or the degree of threats in the organization that they perceived. Low and behold, what they found was that the more that healthcare practitioners felt that their NHS trust was high in threat as an organization, they reported significantly lower levels of compassion to others and compassion to themselves.
Whereas you can probably guess the more that healthcare practitioners reported that they felt that NHS trust was compassionate to them, that was associated with significantly higher levels of compassion, outwards and significantly higher levels of self-compassion. In these types of workshops that I’ve been doing with healthcare practitioners go back from 5, 6, 7 years probably longer than that, we’ve always had a section where we’re trying to think about the context of this and how whilst many healthcare trusts have in their values, empathy, kindness, compassion, all these words.
Sadly, many people who work for those organizations don’t feel that the healthcare organization has the same care, kindness and empathy for them as employees. That actually, we need to be really careful that we are not just asking healthcare workers to have to do more stuff on their own, and that it’s somehow on their shoulders only. What we do need to do is think about what are the structures which actually cause suffering in healthcare organizations. Also how do we work with leaders to cultivate their own compassionate leadership skills?
As they can be more supportive, more caring and more aware of the distress and the difficulties of their employees. That’s a broad brush stroke that we always need to hold in mind, and such an important area that we’re trying to work on here of cultivating more compassionate leadership, and thinking with organizations about things that inhibit or facilitate their employees feeling supported and cared for and essentially safe within the organization.
Paula: Yes. It’s something I’ve been thinking about recently, because I know you based in Portugal, but in the UK at the moment, there’s Adam Kay’s This Is Going To Hurt on the BBC. I don’t know if you’ve seen it.
Chris: I’ve heard about it, but not seen it yet.
Paula: Yes. I’ve only watched the first episode so far, because I need to pace myself with it, but I’ve been really struck. I read the book, and I think the book is less hardcore, and more funny than the show, but it’s been really interesting to see responses on social media, and there’ve been two different groups of people responding to it. One have been people who’ve been really distressed by the way women who have been treated in the show.
It’s about in an Obs and Gynae ward, and a sense of women suffering quite horrible birth trauma and being treated in quite uncompassionate ways and that being very distressing to watch and see. Then the other side is I’ve heard lots of doctors who’ve watched it, having a real post traumatic response to seeing how badly that the doctors and the staff are treated, the horrendous working conditions just ruthless environments.
That there’s some battle, I guess in social media between these two groups, but I think that the issues are so connected, aren’t they? It just given, what you were just saying, how if an organization isn’t able to offer safe working environments for people to, the staff to be able to be cared for and able to meet their basic needs. As you mentioned before their capacity for compassion will be really limited. How not even maybe able to notice the distress and suffering that’s around.
I think as you said, the context is so important and the joining up of that in terms of, if we can provide compassionate spaces for people to work in, that will flow to patients. It’s not only good for staff, but it’s necessary and good for patients.
Chris: I think you’re spot on. I think one of the things that we’ve learnt through some pretty awful things in the NHS over the years, whether its the [unintelligible 00:24:29] debacle from many years back, now to individual cases where tragically maybe a patient has died, or they have suffered greatly because of seemingly very poor care from professionals. That sadly what often happens is that an individual nurse, doctor, psychologist will be highlighted or a set of people in the team will be highlighted. That’s rightly so at times.
We have to take responsibility that if we haven’t done certain things in the way that we professionally should have done, then of course there needs to be responsibility there. In some of these instances, what we’ve also seen is that there’s very little understanding of context. Whilst there maybe has been a big mistake that’s happened, very rarely then has the organization or even the professional body been able to bring the camera lens back, and be able to say, “Well, look clearly here there were problems, distress was missed. This thing should have happened and it didn’t happen.
Actually here was this doctor who was relatively junior doctor who was covering three wards, and 60 patients because their consultants were ill, and because this thing and this thing hadn’t happened. Rather than actually recognizing that of course this was a mistake, but given the context, no wonder there was a mistake. Then of course the problem is we end up blaming individuals rather than recognizing that this was a systemic failure. Some of this harks back actually to some wonderful research from many years ago, a very famous social psychology experiment.
We always need to keep some of these experiments with a little pinch of salt, but some of you will know, it’s called the good Samaritan study. In this study Darley and Basson got a group of people who were training for seminary college. They were training for the priesthood, and they split them into two. One half of the group had to read the parable of the good Samaritan, and the other half of the group, if I remember correctly, had to read something which was completely unrelated, something quite technical to do with their training.
Something quite boring, and anyway they then asked all of these people in the study to go to another building and to give a talk about what they had just been reading. Now, because it was a social psychology experiment, there’s often a little intruding twist to the study as you know, and here it was that there was somebody who was in on the study. Basically one of the researchers was slumped, was collapsed outside in between the two buildings. Actually the whole research study was how many of these people, part of the study would actually stop and notice the person who is in obvious pain and basically try to help them.
Essentially the are two parts of compassion that I was talking about earlier. Now the figures on this are fascinating. Of the total people, I think there was maybe 40 people in the study. I think it was 40% stopped. Actually a relatively low number of people stopped, but within that figure, well they actually found was two quite significant different subgroups in a way. One group who stopped 63% of the time, and one group that only stopped 10% of the time. Now, of course, when you first hear this study, you think, “What’s the difference?
What was what made the group who stopped 63% of the time? Surely that must have been the people who had been primed. They must have been the people who read the parable of the good Samaritan,” but the researchers found that that wasn’t the case. Then of course you start thinking about other things, maybe it was something to do with something intrinsic to those people. Maybe they were more conscientious. Maybe they just happened to be more caring, personality-wise.
The researchers researchers tried to look at that, and nothing was found actually what was found to explain this was that those who stopped 63% of the time, were told that they had to go and give this speech, but that they had time, that they didn’t have to rush. The people who only stopped 10% of the time. They were told they had to go and give this speech in the other building, but that they were late, that they had to rush. Now, I think this study is significant, because if we think about and if those listening now could hold in mind, which of those two scenarios they feel is more familiar with their day to day job.
Having bosses and leaders in their organization saying, “Don’t rush, you’ve got time. We’ve got enough resources for you. It’s okay, go slower,” or is it the version where you feel that actually you don’t have enough resources and essentially you feel that you are having to rush from one thing to the next, and you’re having to see more patients, and do more paperwork, and so on and so forth. I think many people recognize it sounds a bit more like the second one.
The problem across then is that we can tend to blame the individual for not being compassionate enough, rather than recognizing that certain context make it less likely that you are able to be sensitive to suffering and distress. It’s these types of studies and this type of understanding about compassion in a contextualized organizational way, that we really need to be learning about, and really need to be guiding our services on. Of course we have to be realistic.
We all know that there’s a finite amount of money. We all know that there are going to be problems with resources, but that doesn’t excuse the fact that people tend to ignore these types of understandings and are very quick to jump in and blame the individual. It’s this type of thing that I think, Paula, it is so important for us to try to recognize before we then start moving in to think about, as an individual or as a team, what can I also do to try to help you to cultivate a more compassionate way of being in the world? Which is something, obviously, we can move on and talk about in a moment.
Paula: Could you tell us a bit about the work that you have been doing with healthcare professionals in the NHS?
Chris: Yes. One of the things that we’ve been doing is, again, if I think about these levels I had mentioned earlier, so one level, of course, would be on the small organizational, speaking and working with leaders, the next one might come to thinking about more at your local level, within your team, and how could we begin to get the flows of compassion going within your team and within your colleagues? Some of the work they’re doing has been great because essentially what we’re trying to do is that this is your family.
People we work with day in, day out, they’re your family, and just like a real family, it doesn’t mean that you have to like or love every single person that you work with, but they’re going to be the people that you spend a huge amount of your life with. Therefore, how do we try to see each other then as sources of support, connectedness, and care? Working with colleagues and to be able to start this process of how could I be oriented to think about the wellbeing of the people who work in my team?
My fellow nurses, my fellow doctors, my fellow psychologists, and what could I begin to do, even if it’s just small little things, to show that I notice, to show that I’m bothered, to show that actually, I am here as somebody who you matter to me, that I care about you? During this bit in which we can try to get more of those types of behaviors flowing outwards to each other, but also then encouraging and working with healthcare professionals to be able to receive kindness and care from their colleagues.
Now, I remember very clearly, gosh, a decade or so ago, working in a busy community mental health team in Tower Hamlets in East London, and I’d had the morning from hell. I’d had three clients back to back, and basically, each one of my clients had, in one way or another, told me that I was a shit psychologist, and one in particular had said to me that they were going to harm themselves, they might even kill themselves, but before doing so, they were going to write a letter to the local newspaper, and blame me for it. I’d had this Monday morning that was just awful.
I came out of my third appointment to go back into our shared open-plan office, to go and get my notepads. We had a team meeting. It must have been obvious that I was really quite distressed actually, it had been quite a difficult morning. One of my colleagues, Bauler, who was one of our CPMs, she came up to me, and put an arm around me, and she said, “Chris, it looks like it’s been a pretty cracking morning. Why don’t we just go and grab a coffee and sit outside for a little while? These meetings always start late anyway. No one’s going to miss us for 10 minutes.”
If you think about it, there was the flow of compassion. That’s the definition of compassion. She was sensitive to my distress, and she was doing something that could be helpful. “Let’s go for a cuppa. Let’s get some fresh air. Let’s just go for a bit of a chat. Let me know what’s going on.” Now, do you think I was able to take that in? Well, no. I wonder whether many of you listening also had the same thing really as well, where we have been distressed, a colleague has been sensitive, and they actually extended something that could be helpful, so they embody compassion, but rather than taking it in, it’s almost like we tried to push it away.
I said to my colleague, I was like, “Oh, no, no, no, I’m fine. I’m fine. I just didn’t sleep well last night.” I made an excuse. Actually, I’ve done that a number of times. I’ve certainly witnessed that happening between colleagues of mine. It turns out then that it could be very difficult for us at times to be vulnerable at work. It can be very difficult for us to actually show our distress to our colleagues. There can be this idea in a way that somehow we have to be superiors.
That somehow we are going to be working with some of the most distressed, any human being can ever, ever go through, and somehow we are stoic through that, that we aren’t affected by that, that we have to just keep a similar level of emotional stability, where actually if you think about it, it’s a load of rubbish. Of course, as a human being, this can hurt me a huge amount, hearing the stories that my clients are telling me, seeing their suffering.
One of the bits then is how do we help ourselves really in the sense of being open to knowing that this isn’t me being soft or vulnerable or in a sense of weakness, that actually, vulnerability can be a type of strength, that there can be a courage that sits with compassion, and that this is a really, really important thing that we talk about in our approach that’s one of the key qualities of compassion is often strength and courage. Sometimes we use the example here to help people understand this and recognize this, is to use the analogy of firefighters.
It turns out firefighters are actually often governed very strongly with a compassionate motive. Back to the definition we shared at the start of the talk today, sensitivity to the suffering of others, well firefighters are very sensitive to, I don’t know, a child trapped in a burning building, they’re noticing it, they’re concerned about it, they want to move towards this. Then, of course, firefighters are trained to take wise action to how to safely extract somebody from a burning building.
They do the second bit. It’s really fascinating, of course, because if you think about it, would we ever describe firefighters as weak, as wishy-washy, as soft, or any of these myths that are sometimes associated with compassion? Well, absolutely not. Actually, firefighters, we often would describe as courageous, massively strong. Actually, it turns out that compassion sometimes does require strength and courage. That can be the strength and courage I need to engage in your pain, in your distress, your suffering.
Often it can be about a type of strength and courage for me to be with my pain, and to remain open to signaling to you that actually, I could do with some help. That I need you to be supportive of me in one way or another. That’s one level then that we start looking at within the team, in a way, how do we cultivate a more compassionate sense of teamwork and supportiveness and connectedness with each other, and then, of course, we can go to think about you specifically and maybe your own levels of self-compassion.
Paula: There’s something I think, Chris, that happens that is a funny thing, when if you’ve had a bad day, or you’re really struggling, and you can really hold it together until someone is kind to you. That always strikes me. I think sometimes you can, especially if you’re having to go to work, avoid those people who are compassionate and kind because somehow that’s going to be the final straw, to see someone’s kind face or receive a kind gesture from someone is just– Which is so interesting. What do you make of that?
Chris: It’s fascinating, isn’t it? There can be a wisdom sometimes to this. For example, if us two are driving in a car together, Paula, and you start saying something to me which makes me start crying, maybe that’s not the most helpful time for me to be tearful, because of course, tears aren’t the best thing to see through to avoid oncoming traffic. Similarly, of course, we need to have a sense of wisdom about, if I’m about to go in and see a patient, when is it most helpful for me to be able to open up and manage my emotions and share with you?
Of course, wisdom comes in here, but there is something really interesting which is, again, this philosophy which is often quite implicit, really, but sometimes can be explicit too, that somehow we have to cope, that we need to hold things in, that we need to be, or we should be stoic, and this idea that somehow showing our emotions, the flipside of this, of being tearful, showing frustration, showing our fear, showing our sense of feeling that we’re not good enough, or whatever else it might be, somehow is something that we shouldn’t be.
Whereas, of course, on one level, it is how we feel. Many of us will recognize that being at work, working in the health service, that we will feel angry, frustrated, irritated, annoyed, that we’ll feel disappointed and sad at times, that we’ll feel that we’ve failed, that we’d let people down. We’ll feel sometimes like we’re an imposter. We’ll feel guilty that we didn’t do more to help somebody, and many, many, many more feelings on top of that. That is being human. That is the essence of what it is to be human, that we understandably have emotional reactions to the things that go on around us.
Therefore, creating safeness, where we can wisely know that it’s okay to be able to show our distress, it’s okay to be able to show our feelings, and that we know on one level, and this very much gets to this idea of psychological safety, or psychological safeness, that if I do show that, that my colleagues are okay with seeing it, that my colleagues won’t judge me, that my colleagues won’t somehow start to see me as lesser, that actually compassionate, caring teams actually facilitate and allow emotion to be there. Then, of course, once we’re able to be like that.
Once we’re able to recognize that, just your kindness to me say, Paula, that’s starting to set off my tearfulness or my sadness or my emotions. Then of course, it allows me to slow down and say, “Gosh, why is it that actually a simple smile, and a bit of empathy from Paula somehow kicked off this big shift in my emotional landscape? What have I been holding onto that maybe I hadn’t recognized?” How could I use that as to be curious to take a step back and saying, “Wow, if it just took a little phrase from Paula, just to set off my sadness, my tearfulness.”
Had there been things that I’ve been holding in them over the last few days or weeks that maybe it might have been helpful at an earlier stage to be able to go and speak to somebody about, or for me to do my own self-compassionate work around? I think it’s a fascinating point that you are raising here. Again, what we’re trying to do here, of course, it’s always guided by wisdom, but it’s really thinking about how ultimately would I like to be able to be at work? Do I really want to be at work where I can never share my feelings? I can never share my distress?
I can never share my sense of apprehension or being unsure about how a piece of work is going, or would I like it if I could actually be at work, surrounded by people where I feel safe, where I know like a common humanity, really all of us struggle, none of us will ever be able to get all of our patients well, it’s impossible. There’s not one clinician that’s ever lived. That’s been able to do that. The reality is all of us struggle with this work. How about we actually just have that front and center? How about we find a way of making that the reality, rather than actually somehow pushing it down. I was going back to that stoic way of being.
Paula: Maybe coming now onto that third layer, in terms of thinking about the individual and how we can cultivate, would you say the skill of compassion?
Chris: Skill, mind, motivation, intention. All these words are a bit like Venn diagrams, they share space, don’t they?
Paula: A sense that it’s something that we can learn and practice and get better at.
Chris: Absolutely. In that sense very obvious analogy, it’s a little bit like fitness, it doesn’t matter who you are. We all know that we can get at fitter if we choose to, and that there are various different ways of getting fit. Some of us like to get fit by running, but other people hate that, they much prefer to get fit by cycling or swimming, or some people really enjoy going down to the gym and working out certain sets of muscles.
In a way, compassion is a little bit similar in the sense that we can tone up different aspects of compassion. We can tone up compassionate actions or behaviors. We can tone up or work on a compassionate way of thinking or mentalizing, so working on, say empathy. We can tone up our ability to notice so that in a way compassionate attention to what we notice and how we pay attention, but underneath all of this, a bit like general levels of fitness is this motivation for us.
This is what we’re trying to build this from, this intention then to be a certain way. One of the things that we can try to do then with individuals links to something called compassionate mind training. These are the body and mind trainings that we can take anybody through. It could be that I could take my patients through these in terms of compassion focused therapy. I could take healthcare professionals through these. I could take anyone anywhere in the world and sit them down, and get them to begin to engage in things like attention training, mindfulness, body posture work, breathing rhythm work, compassionate imagery work, compassionate memory work.
I could keep on going and keep on going. All of these are activities and skills that we can spend time cultivating. We know that these have of significant benefits, whether they are physiologically in the brain and body, whether they in terms of our psychology and what they can lead to in the cultivation of more compassion for self and others. Then of course we can think with people about how they can pick their own combination of this, just like it might be if you’re getting physically fit, you might want to pick the different ways in which you do that. We can do this with people.
This idea of compassionate mind training, or CMT for short is then a way that we’ve been trying to work with, whether it is me going in and doing a workshop with a group of healthcare professionals from a particular team or service, or whether it might be through, for example, one of the books that we published that people can take their time reading through, and trying out exercises, whether they sit on their own and do some guided practice through an audio file, or some other ways that we’ve been doing it.
That we’re building research off at the moment. We have an online short online self-compassion course, which is only 30-minute video sessions. You get four of them. Essentially, it’s just me talking people through some ideas about compassion, a little bit about the model that we use, guide people through some practices. We just published some research on this just a couple of months ago, essentially just in very small amounts of people just doing some practice at home over the four weeks led to significant reductions in depression, anxiety, and stress.
Reductions in shame and self-criticism and increases in things like wellbeing and self-compassion. Actually the effect sizes here were quite, decent size actually for a relatively small amount of training. Actually similarly we’ve just recently released the self-compassion app, which again is another way of just helping people to have at their fingertips really on their smartphones, a whole bunch of ideas and practices that they can take themselves through, which have been shown to again, bring significant changes in some of these psychological factors that I was just telling you about.
What we’ve been trying to do is increase people’s ability to access resources that have been shown scientifically to lead to higher levels of compassion for others and self compassion. Then secondly, we are also looking at how we might be able to embed these types of practices during healthcare professionals training. At the moment, we’ve got some studies looking at, training clinical psychologists and also therapists who are training to end up working in IOPs the increasing access to psychological therapy services.
We can get them practicing some of these things and have small workshops on this in their training. Can this help to buffer some of the psychological distress that they might experience as they go through their training and as they’re then qualified? Then similarly we’re doing some studies as well, looking at if we can help nurses to access some of these practices that I was just touching on. Again, will this moderate some of the psychological distress that they might have been experiencing both through COVID times, but also just in their day-to-day work?
These are research studies that up and running or about to start that we’re very excited, really just to see if this can be another part of the process that could be linked to either your professional training or your just day-to-day working lives, which might be helpful for you.
Paula: I’ve found your, the compassionate mind training work really helpful personally and professionally, your workbook is one of the things I have permanently on my desk to refer to. I found also doing the practices, I guess it’s one of those things that you have to do to get, don’t you? That you have to experience it, particularly the body posture work, which always sounds a bit weird to people, but until you do it, you don’t really get it. I suppose that’s mindfulness and all those things generally. I want to if you could, if we could maybe do something together now to illustrate or demonstrate some of these techniques and strategies?
Chris: One of the ways that sometimes I talk to people about this to healthcare professionals is to start off by talking about Serena Williams. Just stick with me for a moment, folks. Let’s my imagine that Serena Williams is playing in Wimbledon final. The match is supposed to start at midday, and she’s been staying in a hotel, and she wakes up and rolls over on the morning of the Wimbledon final and looks at her alarm clock, thinks, “Oh shit, it’s actually eleven o’clock. I must have slept through my alarm.”
She starts panicking and running around her hotel room, grabbing her kit, grabbing her tennis rackets and her bag. She runs down to the front of the lobby and hails a taxi. Then there she is in the taxi trying to get changed into her kit as she’s on the way to Wimbledon. You’ve got all these fans taking pictures of her as she’s in the taxi. She finally gets to the outside of Wimbledon with five minutes to spare, and she sprints through Wimbledon pushing the fans aside, and she just makes it onto the center court with five seconds to spare.
She runs onto the court and almost breathlessly serves for the starting of the match. Well, of course as a concept, this is utterly ridiculous on many levels. I will admit, but on one level, of course it’s ridiculous, because we know that before Serena Williams and any other sports women or sportsman actually starts doing their event, they spend time to warm up. They will prepare their body and mind for what they’re about to do, for the vigorous activity, for the both psychologically, but also clearly in terms of their body stretch, they prepare and so on.
Here’s a question, how come as health professionals, we haven’t been taught to do that? That we haven’t been taught, that given we are going to be working with huge amounts of suffering and distress on a day to day level. How come we haven’t thought maybe, just maybe we could do with warming up physically and psychologically, to be a able to engage in that? I think we’ve had almost a sense that somehow each day we go to work, we are going to be the same compassionate versions of ourselves.
It’s literally a stable level. My height is the same every day. My height is the same. It doesn’t change, that somehow my level of compassion, my empathy is gonna be the same. If you think about it, it’s utter rubbish. Of course, that’s not going to be the case. Of course, if I haven’t slept very well from the night before, do you think that might have an effect on how clearly I’m able to think, empathize and like, “Well, of course it will.”
If I’ve had a big argument with my partner or a family member, if I am suffer and from my own physical health scares, of course these things are going to have a big input. Never mind the people that I’m working with, how many clients I’ve got in the day, how complex the kind of client work that I’ve got, all of these things are going to have an impact on us. From our point of view, then we really need to get away from this idea that this is some sort of stable level and actually recognize that we might be able to strengthen this generally by doing compassionate mind training as we talked about earlier.
Also at the start of the day, maybe even sometimes before each client that I see, maybe it would be helpful for me to take a little bit of time to slow down and to warm up the qualities in the components of me as a therapist or as a clinician that I need to have at the front of my mind that are going to be most helpful. Then I guess to extend this analogy, of course, whether Serena Williams wins that final at Wimbledon, or whether she loses after the final, she’ll take time to warm down. She will actively do things.
Maybe she chats with her coach, looks over what happened, talks about how they could change things in the future. Physically of course, she’ll stretch. She might go into an ice bath, she’ll do a whole bunch of things that will help her body to recover. Again, it’s always fascinated me that very few of us explicitly, some people do, but very explicitly, we don’t tend to warm down at the end of a really long day, having worked with huge amounts of human suffering. The fascinating thing for me then is that we can leave work, and maybe some of us are quite naturally able to warm down.
We don’t need to do so much explicitly, but I think it’s probably fair to say that many of us take stuff from our working day into our home lives. The problem there is, of course, let’s say you’re taking distress, pain, suffering, anger, frustration, whatever it might well be from the hard day you’ve had. If that’s maybe for one evening that your family had, or your partner has to be with you when you are still holding some of this, I’m sure that’s fine if it’s all week even a month. If you were to imagine that that was over an extended period of time, let’s say 6 months a year, even longer.
Of course, the point there is that’s going to have a significant impact on your family members, on your partner, on the types of relationships you have, on your wellbeing, on your happiness, outside of work. There’s another important factor here about how do we warm down? How do we explicitly try to slow down, recognize what’s happened in the day, be sensitive towards our emotions, and how we’re feeling based upon what’s happened in the day? Also then be able to set our intention about how am I going to be this evening with my family?
How am I going to bring to the front of my mind, a different set of competencies or qualities that might be different from those that I’ve been needing whilst I’ve been doing my day job? Then of course, almost like as an internal transition, I can switch between Chris as psychologist and therapist, to Chris as dad and husband, and set my intention for how am I going to be different in that way? It’s almost like I warm down, prepare myself for a different type of activity.
Paula: I need this in my life, Chris. You’ve mentioned a lot of the resources that you’ve developed, and we’ll put all the links in the show notes, but I’m just wondering if people are have found this helpful today, and want to take one step towards developing these skills. What would you suggest would be a good place to start?
Chris: I guess the place to start really is to know which method or mode might you find most helpful. If I just repeat a few of them, you might find that doing a self-help book, like our compassionate mind workbook, that would be great. That would be a great start. If you like reading stuff, if you want to just listen to audio files like audio practices, then you can go onto our balance minds website. There’s a sub tab called audios, and there you’ve got free access to a bunch of these practices.
It might be that you like something a bit more engaging in terms of like a guided course. That might well be then the self-compassion course, the online one, which again, is on our balance minds website. It’s quite brief, it’s quite straightforward, and quite accessible, but engaging. Then if you’re somebody who feels very comfortable and really likes, being on your phone and using apps, then I’d probably say that the, self-compassion app would be a great one.
You’ve got a huge amount of sort of information and practices there. Of course, in terms of accessibility it’s literally there it is, it’s in your hands and you’re able to read stuff, listen to stuff, and practice a whole variety of exercises that could be very helpful for you.
Paula: As part of the interview, Chris took me through an exercise in warming up and winding down. We’ve put that in a separate bonus episode. Do check it out.
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Paula: If you enjoyed this episode and you’d like support the podcast, please do share it with others, post about it on social media, or leave a rating and review. I’d love to connect with you. Do come and find me on LinkedIn or Twitter. You can also sign up to my mailing list to keep up to date with future episodes and get useful psychology advice and tips, straight your inbox. All the links are in the show notes. This is the last episode in series two of the When Work Hurts podcast. Thank you so much for listening. We’ll be back in a few weeks with season three.
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