Dr Deborah Lee on ‘Compassion Focused Therapy for Complex PTSD.‘
Dr Deborah Lee has been a thought and practice leader in the development of Compassion Focused Therapy (CFT) for individuals affected by trauma alongside Professor Paul Gilbert for nearly 30 years. In her UKPTS Bites seminar, Dr Lee explained that Compassion Focused Therapy is – at its core – based on a biopsychosocial model of human functioning, with a primary focus on cultivating compassion for oneself and others.
A Consultant Clinical Psychologist, Head of Berkshire Traumatic Stress Service and Op COURAGE Integrated Services for Veteran Mental Health for the South East of England, Deborah has worked in the field of trauma for 32 years and specialises in the treatment of PTSD and Complex PTSD (CPTSD). Her clinical and research interests include working with shame and self-loathing in the context of interpersonal trauma. She has pioneered the development of compassion focused therapy for trauma and CPTSD and authored the best selling self help book, The Compassionate-Mind Guide to Recovering from Trauma and PTSD: Using Compassion-Focused Therapy to Overcome Flashbacks Shame, Guilt, and Fear (2013). Specifically, she is interested in using compassion focused therapy to enhance existing exposure-based trauma memory techniques such as EMDR, prolonged exposure, enhanced reliving, imagery rescripting. More recently she has developed a group-based intervention called ‘compassionate resilience’ to be delivered as part of phased based treatment approaches for CPTSD. The approach is being used as part of a current RCT treatment trial evaluating phased and non-phased cognitive therapy for CPTSD.
Dr Lee’s research and clinical work aims to support individuals who have endured prolonged, often deliberate, interpersonal harm – typically inflicted by someone known to them. This patient group commonly presents with complex PTSD (CPTSD) and experience pronounced difficulties related to shame, self-loathing, feelings of safeness, and a sense of self that is profoundly shaped by their traumatic experiences. Her Bites session explored our understanding of compassion as a motivation, an antidote to shame states, as it fosters a physiological state of safeness as well as orientating the mind to be care giving as opposed to self-loathing.
“Compassion Focused Therapy is rooting the core science of being human.”
– Dr Deborah Lee
Deborah explained that CFT is based on the premise that there is an imbalance in our emotion regulation systems and this imbalance is what gives rise to states of intense shame and self-criticism. “The model sees our psychopathology as symptoms that emerge from being in states of social threat, ” she said. “The antidote to this is to develop one’s compassionate capacities”. By fostering people’s capacity to activate the soothing, affiliative system, CFT aims to bring a balance to an individual’s state of mind and body. affiliative soothing system is wired for soothing and safeness
She argues that shame leaves people feeling profoundly alone, cut off from others and convinced they are unworthy of being cared for. She notes that this painful internal state often drives people toward harmful coping strategies that bring temporary relief but longer-term harm, such as drinking, gambling or compulsive lying. For those living with CPTSD, she argues that feelings of shame can trigger a flashback, the flashback intensifies the shame, and the harmful cycle can become self-perpetuating.
Similar to other trauma-focused therapies, CFT aims to address patient’s psychological difficulties by increase trauma memory integration as well as reducing one’s sense of current threat. Treatment with CFT also aims to address patient’s emotional regulation (e.g. by increasing their capacity for self-soothing), self-compassion (e.g. by developing de-shaming narratives), and social safeness and connectedness (e.g. by developing new social mentalities rooted in care and cooperation).
“We are helping people begin to access and tolerate three key emotions in trauma: fear, anger and sadness.”
– Dr Deborah Lee
This is approach is particularly suitable to those who have been harmed by others. “What we are doing is developing people’s compassionate capacities in their mind first, before we go to where it hurts with their trauma memories. Developing their capacity to soothe their shame, look after their mind and body, before we take it to very profound upsetting, shaming, distressing memories of abuse and interpersonal violence”.
According to Dr Lee, compassion interrupts the cycle of shame by creating a sense of safeness and a mind that can tolerate distress. CFT and increased compassion “opens the door” to healthier coping and to the ability to draw on soothing memories or sensations. She emphasised that this is often extremely difficult for people who grew up without consistent caregiving. Many individuals with CPTSD can offer compassion and warmth to others but feel undeserving of it themselves. In these circumstances, core emotions such as sadness, fear and anger are frequently pushed aside, and what should be anger at the event(s) can be turned inward as self-attack.
Deborah described how CFT can help patients struggling in ‘yes but land’ – where patients with shame states know and understand that the event(s) was not their fault and they are deserving of compassion, but they cannot feel it. She argues that CFT helps individuals build the capacity to feel their difficult trauma-related emotions rather than avoid them. As self-blame begins to loosen, anger and sadness can emerge for patients, along with the feelings of fear that has often been pushed down. She notes that as the mind becomes less traumatised by engaging in states of compassion, individuals gain greater access to feelings of grief and loss – a phenomenon that clinicians should be mindful of when treating individuals struggling after complex trauma.
By taking a CFT approach, it is possible to coach patients to receive compassion from others and from themselves. Dr Lee’s most recent research, which uses a mix of group and individual sessions, shows that a significant proportion of people no longer meet criteria for a CPTSD diagnosis post-treatment. CFT creates a mind that can bear witness to the trauma story with compassion. Further information on CFT for CPTSD can be found here and via the Compassionate Mind Foundation.
UKPTS Bites is a series of short, free, online lunchtime sessions on topics related to PTSD, trauma and beyond. It is hosted in partnership with the ESTSS. More details on upcoming sessions can be found on our events page.
