In this episode,
This month I am very honoured and excited to talk with Professor Paul Gilbert OBE, the founder of compassion focused therapy (CFT) and compassionate mind training (CMT).
Paul has a new book out which you can find here Compassion Focused Therapy
We talk about how Paul got into psychology, what attracts therapists to CFT and what he has learned from his long career in research and writing.
Hear how to deal with feeling you could have done more for your clients at around 17 minutes, why we need compassion at 20 minutes also Paul’s advice for new therapists at 33 minutes.
Find out more about Paul Gilbert and the Compassionate Mind Foundation on their website – www.compassionatemind.co.uk
Books discussed during the podcast-
- Mindful Compassion by Choden and Paul Gilbert
- Compassion focused therapy, clinical practice and applications, by Paul Gilbert and Gregoris Simos
- Respark: Igniting Hope and Joy After Trauma and Depression by Graham Music
- Existential psychotherapy by Irvin D. Yalom
- Cognitive Therapy of Depression by Aaron T. Beck
- Archetype, attachment, analysis by Jean Knox
LISTEN To the Full Episode HERE
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Episode 43 – Automated Transcript ( mistakes are likely)
people, CFT, compassion, therapy, book, therapists, training, cbt, important, compassionate, clients, mind, question, depression, psychology, guided discovery, realise, system, therapist, thought
Professor Paul Gilbert OBE, Sarah Rees CBT, CFT therapist
Sarah Rees 00:09
Welcome to Ask the Therapist, a monthly podcast for everyone who’s interested in how our minds work building resilience through journaling, and all things therapy. I’m your host, Sarah Rees, a mental health nurse and CBT therapist with over 20 years of experience in the field of mental health.
Hello, and welcome to episode 43 of Ask The Therapists. And it’s the podcast’s third birthday. So happy birthday podcast. I have been celebrating this last month by sharing some clips of my previous guests answering one of my favourite questions, which is what would you say to your 15-year-old self? What would you say to your 15-year-old self? I’d love to know. So if you head over to my Instagram account, sarahdrees.co.uk in the highlight section for the podcast, if you have a look in there, there are some templates where we’ve got the question and there’s a space underneath for you to give your answer. And you can then share it on Instagram or send me a DM using the hashtag #AskTheTherapist and I’ll be sure to find it. And you can find the clips of my previous guests answering the question in the Reels section. And I’ve scattered some in the grid as well. They’ve been really fun to listen back to. And this episode is a real birthday treat. I had the honour and the privilege to interview one of the most amazing people and minds that I know, Professor Paul Gilbert, OBE, I have the honour of training on his course over at Derby University in 2016. And it really had a huge impact on me, professionally and personally and has really changed how I deliver therapy and changed a lot about how I live my life and some of the practices I have every day as well. Professor Paul Gilbert is the founder of Compassion Focussed Therapy, and Compassionate Mind Training. He’s also one of the founders of the Compassionate Mind Foundation, which is a brilliant website, it’s got all the training on there and some resources it’s well worth going to have a look at. He is the author of a number of books, to name a few, including the compassionate mind living like crazy distinctive features for compassion, focus therapy, psychotherapy and counselling for depression, overcoming depression, and a book that I recommend time and time again to people. And it’s what I often go back to, which is called mindful compassion. This was co-authored with Choden. He’s also written a number of journal papers and research papers. And he has the latest book out, which is compassion focus therapy, clinical practice and applications. And that is on its way to me via Amazon as we speak. So I can’t wait to get my hands on that. I thoroughly enjoyed interviewing Paul today, he gives some really useful insights he’s really fun to interview. And his knowledge is just amazing as you can expect, and I know you’re gonna get a lot from it. So sit back, grab a coffee and enjoy the episode. And if you have any feedback for us or any questions, do drop me an email at firstname.lastname@example.org Or you can DM me over Instagram and I will be sharing any feedback with all. I hope you enjoy it.
Firstly, thank you very much for joining me today on Ask the Therapist. It’s lovely to have you here. So one of the first questions I often ask my guests and something I’m really curious about because I think it’s kind of quite a strange job that we do as therapists. That is how you become became a therapist. I’m curious to know how that developed. I’ve been reading some of your work over the last few weeks kind of getting a refresh. And I read I hope I’ve got this right that you did an economics degree initially. And you’ve had some dreams about being a guitarist, I can see the guitar in the background, maybe in a rock band, and then some curious how that went to psychology and becoming a therapist.
Paul Gilbert 04:20
Well, firstly, Sarah, thank you very much for inviting me onto your brilliant podcast, which you do and because I know that you’ve done training and CFT and promoted that brilliantly it’s a wonderful opportunity really to come and talk to you. So it’s lovely to meet again as well. And so how did I get Well, interestingly, when I was younger, I always had the sort of interest in people and was quite a person, kind of person.
then in the 60s when I was doing my A levels, psychology really wasn’t much of a discipline and I studied economics at A level and planning to go into business or whatever and make a bit of money, as you do as a young person, I did think about psychology. But all my tutors said, Oh no, you don’t do that. You’d be much better off doing your basic economics degree. So that’s what I did. But while I was doing that, I always sort of had an eye on the psychology course. And I read this book about the further reaches of human nature, just taken by it really. And that’s what I want to say, Hey, I thought, well, what should I do? So I knew there were a couple of places in the country that did what was called changeover degrees, where they would take somebody from a non-psychology background and train them up in psychology, and also is beginning to think about clinical psychology. But to begin with, I wasn’t I was just thinking, maybe a social thing. So I got my degree and I applied to Aston, which had a sort of combined psychology and economics, or Sussex, which is what I wanted to do was a much more basic science of brain studies and all kinds of stuff. Funny thing was, I got rejected.
Sarah Rees 06:07
Oh my gosh, I bet they’re kicking themselves now.
Paul Gilbert 06:11
But my parents in those days because this is 73, by now, my parents in those days were in Dubai. So I flew out to Dubai for a holiday after my degree and finish my degree, but that was great. And then think about mid-August, I got this phone call to say, Look, somebody dropped out for the course and you’re on the waiting list, do you want to come for an interview? So my father arranged for me to fly back quite quickly. So I flew back to Sussex and had an interview and they accepted me on the course. So I did the Sussex MSc and subsequently, I discovered that Stuart Sutherland who was there had a depression problem that he’s written about. No secret was told that one of the people that dropped out from the MSc and here was the list of individuals to choose from and he just said, oh I don’t know I’ll have him.
Sarah Rees 07:05
Paul Gilbert 07:08
Isn’t that the story? Whether it’s true. I know that no, but it’s a nice story, isn’t it? So anyway, there we were. And but actually, I failed my neurophysiology paper, and did pretty well in other papers but not in neurophysiology. So it’s down at Sussex for a year. This is the change areas degree of Sussex MSc and so I had to pay for myself. So I went and worked as a psychiatric nurse and did night duty in Brighton. And that was quite interesting because Brighton was an interesting place in those days, all the people who come down from London, take drugs and go crazy on the weekend. But it was very, very interesting. And so I learnt quite a lot. And because it was night duty you would sit around and talk to clients all the time. And so that was great, really, for me. So then I did manage after a lot of your facilities. And then originally went to Birmingham, but that didn’t work out and transferred to Edinburgh, with Ivy Blackburn and Ivy Blackburn, of course, was doing the first cognitive therapy trial. And the rest as they say is history, which I can talk about if you’re interested. But that was the story. So yeah, then I went to Edinburgh and studied- did a PhD on depression.
Sarah Rees 08:20
what’s driven you in your career? We’re just talking a little bit beforehand. And your retirement doesn’t sound very much like retirement, You’ve done a lot, so much. What’s been the driving force?
Paul Gilbert 08:32
Yeah, I think a lot of things are to do with personality, but also it’s to do with fascination. Partly it’s to do with narcissistic self-promotion. But I think one of the interesting things is in economics, you’re taught right from day one, you have to learn how things interact, right? You have to build models of economies, and so on. So when I came to psychology, we can’t do that now, it’s too complicated. You’re gonna do a course on learning and a course on psycholinguistics and a course on social psychology. But yeah, but how does it actually work? And how does the brain Oh, I don’t know is too complicated. Can’t do that. So I was always interested in model building, was very interested in model building, and trying to get a picture of actually how things work and fit together. And Sussex was very much into classical conditioning. So that’s always stayed with me the importance of the body, you know, the Body Keeps the Score. So what drives me is just absolute fascination, with how the mind works.
Sarah Rees 09:39
that’s fantastic. Thinking about this might take you back to the other point that lots of CBT therapists find a way to compassion-focused therapy. I know when I did my training in CBT I then went I was working in a very divided, deprived area of Manchester and the clients that I worked with had been handpicked during my cbt training. So they just have panic disorder ect. I don’t know how they found them. And then just, you know, very fit all the models. And then when I was let out into the real world, it didn’t look like the models and the books and how I’ve been taught. And that’s probably how I found my way into compassion-focused therapy, What’s your take on why so many CBT therapists kind of find the way to CFT?
Paul Gilbert 10:35
Well, CBT is a bit of a sad story in a way because we learnt with Tim Beck and stuff like that. And he tells an interesting story that he was doing a demonstration behind a one-way screen. And they had people from all over America come to watch him do demonstrations and they had this group watching him do a demonstration. And he did this really nice piece of work, he helped clients identify some of their automatic thoughts and how that was linked to various underlying beliefs and how these beliefs have been rooted in their history and everything. And so he thought, that’s great. So he came out from around the room, and he looked at these people, they all looked at him blankly. And they said, what was that we’ve just watched? And he said, well, that’s, that’s cognitive therapy. And they said, Not it’s not, it’s counselling. So he taught us right at the beginning, which has been lost. I think, personally, that actually getting to know your client was really crucial. And let’s see, CBT assumes you have good counselling skills, it assumes that you’re good at that kind of stuff. And then beginning to use Socratic questions, Guided Discovery within that context, but it’s sort of moved on a little bit like that. And it’s become a bit more like a factory
Sarah Rees 11:52
Yeah, it definitely wasn’t part of my training. I’d done my background in Mental Health Nursing, and I’d done counselling training, but that was just a fluke that I’d done the counselling training.
Paul Gilbert 12:05
Yeah, but it’s really the foundation, I think. So when people first come across CFT what they discover is actually, some basic counselling stuff, again, of actually slowing down taking an interest. What Guided Discovery actually is, its about understanding people and helping them begin to understand themselves and so on. And that takes time. You know, this trying to push people through successions. And Tim was actually never really, he was always ambivalent about manuals, and that kind of stuff. There’s a wonderful, can’t remember the title of it now, but it’s in my new book interview with him about five years ago, and some of his reflections. I think CBT is this rapid turnover, I mean, you can understand it, because people are wanting to get access to some kind of psychological help. If you think, say 10% of the population, and it’s more than that really have psychological problems, in a million people, you’ve got 100,000 people, right? So it’s huge. So, you can understand the push for it, but I think the problem is that as you say the real people have gotten complex, multiple problems and it just takes time – therapy takes time.
I think people like this slowing down aspect of it, they like the more counselling side to it, they like the focus on motivation, rather than just the strength of your belief, actually, the motivation, the ability to genuinely feel a compassionate motivation, the desire to be helpful, the recognition that also depends upon a certain kind of physiological ability, you know, vagus nerve and all that. So they begin to get into that feeling about the motivational change. Motivational switching has to underpin cognitive switching and people kind of like that.
Sarah Rees 13:57
Yeah, I think the neuroscience as well and helping people understand the brain has been, you know, something it was really transformative, helping people say they have really tricky brains.
Paul Gilbert 14:08
Yeah, I mean, I think that’s very well, I don’t think was ever meant. But the think good feel good, sort of Americanisation well, by most Americans. But that sort of hype stuff hasn’t done CBT any good or any favours at all, because Tim was much more nuanced than that. I mean, he had an evolutionary view and so on, so yeah, so the idea is just to get people to think differently than they will change. That was never really his view, his view was that you help people understand how their thinking contributes to the distress, and that makes them change so it was much softer than you sometimes hear now, but this CBT is extremely useful. I mean, it’s very, very useful sort of, if you really use Guided Discovery Socratic question behaviour experiments, as they were designed to be used, they can be incredibly helpful to people.
Sarah Rees 15:03
What was Aaron Beck like? Had you met him a number of times?
Paul Gilbert 15:07
Yeah, he was, he was always very kind to me. He did a review of the 84 depression book and on the back, he wrote a very lovely endorsement. He was always extremely good and supportive to me we had lots of discussions about evolutionary approaches and he uses evolutionary pressures quite a lot although people don’t always realise that.
Sarah Rees 15:26
Well, I’ll be interested to go back to that and have a re-read. As we develop as therapists, you kind of, well, you’re just forever learning, aren’t you at their courses and the training and the development doesn’t end. And one of the things that comes up a lot has come up a lot for me and the people I supervise is that as we grow and get new knowledge and maybe learn more about compassion focussed therapy, we kind of look back over the clients that we worked with and think, Oh, God, you know, I wish I’d known that then and feel like we’ve really done people a disservice. What would you advise therapists around that?
Paul Gilbert 16:04
I saw that question and thought there was a wonderful question. So the first thing is actually, that view. That’s fantastic, isn’t it, you know, I wish I’d known that then because then I could have been more helpful. But that is the way it always has to be it can never be any different to that, right? And when I was trained, because I was lucky after I’d done my PhD and obviously, I went on and did group psychodynamic training for a few years, and I worked for five years in the Jungian day hospital and did a lot of Jungian training. But I’d only been qualified for about six months, working in the acute unit. And the patient, the people there were really quite tricky, you know, abuse and all kinds of things. So my supervisor this lovely woman, she was an analyst really, and I said look, you know, these clients that are on this inpatient unit, they’re really struggling, and I’m only just qualified, I don’t know what I’m doing half the time, I think there must be somebody else they can see, somebody that’s got more experience than me, because these are really quite severe, you know, suicide and goodness knows what. And she looked at me and said, well there’s only two of us. I said, Yeah, but there must be somebody else, surely. She said, well look, I suppose you could look at it. Think about it they’d probably all do a lot better if we had Sigmund Freud. But the problem is, he’s dead. There is only you, there is no one else right? Then the thing is, all you can do is to be the best six-month qualified therapist you can be and for sure, in 20 years, you probably know more and be better, but you can’t have it today. That is one of the lessons of being a therapist is actually don’t get caught up in narcissistic, overidentification, or feeling you should know, be more, have more, do more. That is a trap you do not want to catch. Okay. And in 20 years, you’ll look back and you this way. She said, You look back and you think it’s funny, I’ve done that. And hopefully, you do, because if you don’t do that, then you haven’t moved you haven’t improved.
Sarah Rees 17:59
That is very true!
Paul Gilbert 18:02
The next part of the question, however, so the idea is that that’s a good thing to be doing that realise how much more you know now and how you a better now, and in another 10 years, you do the same thing again. But then you’re doing clients a disservice. While that’s then can become a source of guilt or disappointment or upset, and that you do need to be careful about because then you get into self-criticism and all kinds of stuff, which is not helpful at all. So not to think you’ve done them a disservice. But always think that at the time, you try to help them the best way you could. And yes, now you might have other techniques, therapists have moved on the science has moved on, we’ve all learned more, I’ve learned a lot more from all kinds of people and all the others. But it takes time.
Sarah Rees 18:52
I think that’s really useful. And one of the reasons I asked that is because I remember you teaching it on the course. And it really so useful for me. And actually, sometimes when I find myself catching, going into that kind of self doubt and stuff really just working a lot more on me so I can be the best I can be in that moment.
Paul Gilbert 19:10
I mean, you know, we, as you know, we’ve talked about this on the course you know, I’ve lost people to suicide, you look back the mistake they’re going to shoot on the case I often talk about is young lad who I was working with, and he had to move back with his parents because he lost his job and things and he was quite shy sort of chap. And anyhow, so we work to develop his confidence and so on. He had gone off and apply for this job and came back and said he thought he done very well and they protect he was very pleased with himself in the interview and they’d started to talk to him about you know, when you start here and when you start here. So I think they are only talking to me because I think they have their thing going to get this job and then I can move out you know, so and I always say Oh, that’s great and you haven’t you don’t work so I was trying to reward the hard work because his confidence was wasn’t good. And he really struggled to make himself give the interview. Today lad was dead, saying he obviously hadn’t got the job and then gassed himself, I was caught up. So caught case comes up, obviously, it’s gonna be kind of. So I went again. So the psychologist is the guy who consults accounts was going to call me. And I said, I’m terribly sorry, I made this awful mistake because I should have asked him, I should have asked him what happened? What happens if you don’t get the job? And what are you going to do and how you’re going to be and how you’re going to cope with not getting a job. And they should have done this. He said, Stop. Are you telling me seriously, that having a 10 minute or a 15-minute conversation with you about how he’s going to win will save his life? Are you serious? Yeah, yeah. Please don’t be so narcissistic. We’re not gods. With GABA, a guy had very serious problems and all kinds of stuff and integrate trancey. But don’t believe 15 minutes of you chatting about how you go. That was a really wake-up call. And anyone else say, Look, if you’re going to work with real mental health problems, you will lose people because, you know, we often think that these series of depressions which is my area, they’re killers, they will kill you, they will kill people. It was again, a wake-up call about the same kind of thing you’re talking about, which is, let’s just be doing the best we can to make sure that obviously, you do your risk assessments and all the right things. Of course, that’s correct. But if you’re going to work with people who’ve got major mental health there, because they are risky, and they do everything you can, but occasionally, over 40 years of life, you will suddenly lose people. And your ability to cope with that is very important. And not to start, you know, bashing yourself on the head, because it’s not a disservice to them as well. You’re gonna need then I could have said, Yeah, I mean, me. It’s not like that, you know, it’s the ability to grieve for the pain that person was in. That’s the most important thing.
Sarah Rees 22:03
I think that leads us on to my next question, which is, hopefully not too tricky for you, which is why compassion? Can you tell us why it’s so important that we develop compassion with our clients? And for ourselves?
Paul Gilbert 22:19
I think, well yeah, it’s a really interesting story. Because if you want in the more personal side of it, I think you do a couple of things, really. So this was a lady who’d had had a very difficult background of being adopted and into a difficult family and thought she shouldn’t have been born and all that stuff. But she’d made quite a good relationship with a good ratio of the husband and kids. So you could do the cognitive stuff. And she’d been in and out of hospital law, suicide attempts. Psychiatry said I don’t know what we can do with see what you can do. So she’s to blame me. Yeah, I know, you’re trying to help me, but I can’t, I’ve got to kill me. So you have to spend on GP and so it’s quite tricky. But so one day, then we were doing this cognitive step of actually looking at some of the thoughts that preoccupied me, I shouldn’t have been born. I’m not really wanted. I, I’m just a fake. You know, people say they love me. But I think that’s only because they, it was tough. We got to be able to say well, but you know, if you stand back from that, do you could you see that your, your husband has behaved in a way that shows that he loves you? And so you could do it? We could do all of that sort of checking out? What’s the evidence for it? She said, Yes, I can see it really, I suppose. But it doesn’t make any difference. And so I said to her well, okay. I don’t know why I said this, too. It was one of those things where what am I going to do now? I don’t know what to do. So I said to her, how do you hear them in your mind? How do you hear those coping skills? When do you really think she’s so well? Actually, no, my husband’s stood by me and he does care about me. And he’s worried about me and so on, so on. How do you hear them in your mind? Is that what you mean? How I actually hear them? I said, Yes. Speak them up. Tell me how you speak them as you actually hear me. She was a little bit embarrassed, but she said, Okay. Come on. You’re doing cognitive therapy. I’m sure. You got a husband and loved you. You got a lovely job. Is that how you should Yes, I’m doing cognitive therapy. I know I’ve got a I’ve got to make myself believe this. Oh, my goodness. I thought No wonder you know what, okay, what would happen if you can’t keep the same information and you cope with those but you change the tone, you name this? Imagine that part of you that’s really compassionate and wants to support you understands how depressed you’ve been? What a struggle that’s been for you and is genuinely interested in helping you what would happen if you created that kind of tone in your mind that she said, I’m not doing that. Why would I want to do that? That’s pathetic. I’ve never been kind to myself. I can’t see how I don’t deserve it anyway. But how on earth would that help me, I’m just gonna make myself believe this stuff. So that was the second show refresher was really the real hostility was being carried in the emotion not in the content. The second shot was this real resistance, they didn’t want to do it. And the third shot was when we did start to do Oh, boy, it really opened up big, big issue of trauma in the county system. Because in any emotional system being a sexual system or caring system, or an assertive system, if you’ve got a lot of trauma in that system, the moment you start to trigger it. Up, it comes. So the problem with compassion is that when you start compassion as a therapy, you don’t get into oh, let’s be kind to myself, isn’t this wonderful? Isn’t this nice, you don’t get that you get grief, you get rage, you get a doubt, you get fear, all the stuff that’s coded in that if you’ve been abused or neglected, that’s all coded in your attachment system. Right? That’s where it is. And so that was the third shock, really. And so that CFT really became partly a way of detoxifying the attachment system. So that people could begin to generate a more compassionate, tone to themselves more helpful motivation to themselves and just try to force themselves. Give you one more example. When people are very depressed, you want to get them out of bed, because they lay there ruminating. So you’re getting out of bed, do some stretches, but a yoga have a cup of tea. Stretching is quite important. The movement is quite important. So we know we know that longer. So there we are. So we had a little note that she put on the side of a bed when she woke up to get out of bed, did these stretches and have a cup of tea. So I think I think good. So she comes back next week. How did you get on? She said, Yes, I I remember when I was in bed, and I saw the notes I made myself get up. So So what So what went through your mind? He said Yes, I saw the note and I said come on, get out of bed y you fucking lazy bastard! And I said, hang on a minute, where did that come from? We know that’s the truth, isn’t it? That’s the truth get out. stretches. So what became very interesting I became very soon is this hostility as it was in the emotion-motivational system wasn’t really so much in the cognitive system.
Sarah Rees 27:25
What I find really interesting is that lots of people until you ask those questions do not don’t have awareness of mind. They don’t know how they’re talking to themselves, do they? But I do remember learning about self-criticism and then thinking I don’t do that I’m okay. And then it caught up with me. And I was like, Oh, my God, I need to work on this awareness of mind,
Paul Gilbert 27:47
Absolutely brilliant, brilliant point, you make , is mind awareness. And you tune in, that’s what Guided Discovery is in a way of you coax people into that. And they are often not aware of the hostility of their criticism and criticisms. Okay, and it’s going to help them but actually, the hostility and the criticism is pretty awful.
Sarah Rees 28:06
really detrimental to our mental and physical well being isn’t a huge level. Yeah. Yeah. Do you think there are questions that we are not asking in therapy? So if you could, you know, think about therapists, other questions that you think we should all be asking a little bit more of? Are there questions that we avoid?
Paul Gilbert 28:27
I think, if you want to do the CFT view, you’d always find where is the caring motivational system. Where are the threat systems, those two, you’re always interested in those to see what is your greatest fear of could be of change of being compassionate of giving up self-criticism of our so the first thing is always to find out what the threat system is up to. And the second thing is, where is the support system, the caring system, the system that kind of picks you up, because, you know, self-criticism will kick you whereas compassion will pick you up and support you and guide you and carry you a bit. So find out how easy is it for them to be caring how easy it is for them to generate genuine compassion motivation, if you’ve had somebody who’s abused, right, and it’s failing them very bad with themselves with guilty, whatever it is, how is it for them to take a genuine compassion orientation to their experience and reviews? And what you find of course, is a lot of people can’t do it. So they’re trying to do exposure, whatever it is, but actually, there’s no system of caring or support to hold it. So those and for non-CFT therapists what you find is a very rarely do any work on creating a secure base, safe haven that sort of context that holds and cares and supports and guides and so on.
Sarah Rees 29:51
No, sometimes when I do the model about explaining CFT and I get to the soothing system, and I just kind of say what it’s about, and people just burst into tears?
Paul Gilbert 30:03
Yes, I think yeah, that’s a really important point. Grieving is incredibly important to the CFT, the ability to grieve for inner loneliness and that sense of you may be carried or that you’re not really lovable, or there’s something wrong with you, or whatever, the ability to grieve. And that, again, was a bit of a shock. Because when, particularly if you’re working with people who have been traumatised, when they start to grieve, I mean, this whole body in the body, just so few tears, they’re just like, the body breaks, you know, breaks open all that pain come to break, so. So that also was something that I hadn’t actually experienced just doing CBT of this real deep-felt sadness, grieving.
Sarah Rees 30:50
and how did you manage to hold that level of emotion?
Paul Gilbert 30:53
Well, again, I think I had it because of my counselling background, I was kind of able just to sit there. And I mean, as you know, the client, are we sharing the training, and this went on for some weeks, and you just need to be present, it’s called being present to them so that they are having an experience, which in attachment theory are provided in a sense of secure base and safe haven, as a container for their journey. So grief is a journey. It’s not like a panic attack, where you go in and you’re grieving as a journey, it’s a process of changing a whole range of processes within the carrying itself well, within the social relating systems, really a whole series of processes of changing, so So grief, any kind of grief. It’s the process as the beginning stages, and you have to go through it. So it’s important to help therapists realise that it’s not like trying to change your panic attack its a very different process. And it’s just learning to be there and to be able to tolerate it without, I think the other thing that you sort of indicated in a way is, don’t put pressure on yourself to your client experience or do something right, you guide them, of course, if you do this, we’ll get to discoveries. But don’t put pressure on yourself that you’ve got to move this along, you got to make this happen. You got to make that happen. You’ve got to stop and cry and good. things unfold in the way that they unfold.
Sarah Rees 32:18
This holding, it’s part of the journey that you go on together. Yeah, and lots of people listening to this will be interested in therapy, I think we’ve been really selling it to people. Somebody was listening to this, and maybe having their own therapy, what would you want them to know? What would you kind of advise them to do to get started or to be able to engage in the process?
Paul Gilbert 32:44
Oh, yes. Well, of course, the great difficulty with it is because it’s not that many trained therapists like you, I mean, you’re a well-trained therapists, and so on. But there are not that many of your gems, like you, it is great. And I mean, the usual things I’m afraid is to, you know, check out with your GP, but also on the compassionate mind website, we now have a register. Now, we’re not endorsing therapists, because we can’t do that. But therapists who have done some training and want to make it known that they will try and provide compassion type therapists, there is a register on the compassionate mind website. And as you said, it’s growing. But we don’t, at the moment regulate it in terms of accrediting because we’re just too small,
Sarah Rees 33:31
and for new therapists, starting out. Do you have any advice for new therapists?
Paul Gilbert 33:37
Yeah, look, I would say for new therapists look, think about it like this, you know, there’s something like 300 different schools of therapy, right? Put it for under somebody were less but there are wisdom in all of them. Because you know, and really tried to start with the fact that we need to understand a little bit about how minds work. That’s why CFT is very strong. With science, we think about how emotions, work, our emotions work, how things are empathy, reasoning, work, all that stuff. So try and think to yourself, well, the first thing is for me to try to understand the mind of the person that’s sitting in front of me. So rather than thinking about What score do I need, what set techniques to only start with trying to understand that person and helping them to reflect and think about themselves, if you can do nothing else, and that would be terrific. And then the next set of skills is really helping people to think about what they might need in order to progress on the journey of change, that maybe they will need to learn how to challenge their thoughts. Maybe they will need how to learn to be more compassionate to themselves, maybe they’ll in need to learn how to be more sad or whatever. But you’re working with them to thinking about how can we understand you, and how can we think about what would help you on your journey to deal with whatever it is you’re wanting to deal with? And only at that point, do you then start to refer to whatever school of appeals to you.
Sarah Rees 35:04
So it’s good to get that foundation and build on top of that. And it is a lifetime of training, isn’t it in developing? So, as you look back over your clinical career, what would you say you’ve learned most from the people that you’ve worked with either clients or colleagues?
Paul Gilbert 35:22
It’s a wonderful question. Just about everything. I mean, yes, of course, you pick up stuff from the, you pick up stuff from the training, of course, you do. But at the end of the day, if you’re open to allowing your client to educate you because every single client will give you something slightly different, just a little texture here, a little texture there. It little bit like that, if any of you are musicians, it’s like playing the guitar, you know, you can talk to other guitarists. Oh, yeah. I didn’t know that. Oh, can you do that? Oh, that’s interesting. Oh, that, Oh, God. So you know, and over the years, you just get better with your technique, you play more things forever. So all training is a little bit all life is a little bit the same, is that everybody has something to offer you if you are open to it. So that’s the first thing really. And then the next thing is how they affect you. I think one of the things we don’t talk enough about as therapists is that there’s something very odd about us really, I mean, why do we want to spend ourselves listening to other people’s pain? year in and year out? I mean, what can we forget from our job?
Sarah Rees 36:33
it is interesting, isn’t it?
Paul Gilbert 36:36
And when I started my psychodynamic training, That is a very strong friendship. He said, So how many of you would say you are voyeurs? Anybody in the room are you a voyeur? And because we were young we said No, no, no, we’re not voyeurs. Does anybody like to go into their friend’s houses and wonder what goes on in the other rooms? No. He said, Then please don’t become a therapist. Because if we have no fascination in the mind of people, you’re no good.
Sarah Rees 37:10
Yeah, it is fascination isn’t it and curiosity.
Paul Gilbert 37:14
Yeah, need this basic curiosity. And your client begins to see they are a source of your interest, their source of fascination, they’re not just another case coming through check all of them is, they actually are a unique human being that has a unique story. And it’s like you’re reading another novel, you know, their new personal, story, new, all kinds of things going on. So that I think is very, very important. But, you know, we do hear a lot of awful things. And it’s about how you sustain yourself with that. And, and we find, I’m sure you find this as well, that the therapists tend to struggle more than ones that are always trying to achieve something and do something and do something and do so. But those that just stay with the client and just like other clients, and they’re on their journey, they’re less likely to get burnt out. It’s the ones who are struggling to change make this happen, make that happen. But when travel?
Sarah Rees 38:16
Yes, And I think that sometimes happens if you work in an eye up service, and you can be thrown into that modality, don’t and can’t you, but it’s the stepping back and just being with sometimes hugely important. Yeah.
Paul Gilbert 38:30
I think the key issue is always remembering the role of us really, whether it’s, we think about capitalism, poverty, or whatever it is. social systems really causes a lot of the pains that we feel actually, you know, you can be caught up in a system that puts pressure on you. And it’s important to realise that the pressure is coming from the system, and it’s not about you.
Sarah Rees 38:55
Yes, yes. That’s an interesting point. Yeah. Yeah. Do you think it’s important that therapists, EFT therapists, or all therapists kind of apply it to themselves? Because, you know, like, CBT you don’t have to have your own therapy, do you? But I think that’s unique. Most therapies, you do have to have your own therapy.
Paul Gilbert 39:15
Yeah, that’s correct. I mean, it’s, it’s recommended though, and CBT James Bennett levy is written the inside out books and and so on and so on. It is certainly recommended. You should have some experience of your own therapy, and certainly should use that as your own guide for life. There is not very I’m known as the CBT therapist, one to the right therapy. So they went so secondary therapists sick as I said, I don’t think so, the key thing then is, if you can’t make your techniques work for you, then what are you doing, right? Helping if you’re doing CBT then if you’re able to Paying attention to what you think being able to stand back, doing Guided Discovery on yourself, maybe writing some letters to yourself or whatever techniques, and they’re helpful to you. That will really help you in your therapy. But if you’re somebody who doesn’t use them yourself, I think therapy then becomes more mechanical. The other thing is that, you know, mindfulness now is really quite an important part of CBT. Okay, and you really should have your own personal practice. And in CFT, is, you know, Sarah, we suggest, quite strongly you have your own compassion practice, because it does change you.
Sarah Rees 40:40
Yes, yeah, my background was in nursing and then CBT. And so I was kind of always very full on working long shifts, then then doo doo doo. And when I hit 40, and then I did the CFT training. And then a couple years later, I hit 40, and developed a thyroid condition. And then celiac and like, the wheels fell off at 40. And I really had to change how I kind of care for myself and think about my own well being. And it’s, it’s an I wish I had done it years ago, you know, in terms of applying what I know, to myself, it’s been, you know, made me a much better therapist. Well, I think my clients say the same. But also I think the my clients can tell when you practice what you’re talking about, as well, in the last few your experiences. And you know, when they first start off with mindfulness, which is kind of the foundation of compassion, try mind training, you know, this blocks and struggles that regularly come up in that training, and you need to know about them, and people can tell if you’ve never done it can’t know.
Paul Gilbert 41:45
Certainly can, yeah, they certainly, and I think it’s such a good point that you make and also using self care, to be genuinely self care. And not just to apply a set of techniques to SAP because you’re supposed to do that. That’s what they say, I’ve got to do practice on myself. Because if you don’t, and it all comes back to motivation, doesn’t it, you know, if you don’t really have that motivation to genuinely take care of yourself. I mean, it’s a very ancient process. You know, you go back in evolution, I mean, even birds, you know, preen themselves and keep themselves clean that then make get rid of all the bugs and all stuff like that. So self care, physical self care, saying all animals have to do. And we just have to self care for our minds, we just have to just be aware of some of the toxins might have been or where we’re not really feeding the good part, and we’re letting the threat system get a bit too heavy. So yeah, it’s very important.
Sarah Rees 42:44
I definitely when I started really applying it to myself, I did it out of fear, because I wasn’t well, and everything else didn’t work. And I thought, Oh, God, now I really have to apply this mindful stuff. So did it out of fear initially, and then how to kind of work on letting go of the fear.
Paul Gilbert 43:01
That’s right. And I think the key I mean, I didn’t know what, but the ability to sit down and just imagine a part of you or a compassion imaging saying, what a terrible thing you’re going through. This is so different. So that empathic connection, is your first really feeling that you can allow yourself to imagine or be with the fact that this is bad. I’m going through a lot of pain right now. Rather than fighting with them mustn’t have it, but no, no, it is, it is bad. But that that sense of a compassion to that pay that empathic connection to the pain, compassion, the empathic connection to I’m actually really, in a, that’s a first step, really. Because you’re not trying to sue things away, which is often what people get confused about soothing grounds you but it’s not to sue that away. It’s really to it to give you the courage to hold on to tolerate that’s there to do.
Sarah Rees 44:02
Well, it’s the first psychology of compassion, isn’t it? That turning towards the struggle
Paul Gilbert 44:09
Turning towards your pain, grounding, containing it, not trying to hide it away. It’s very important. Yeah, very, very important. Yeah.
Sarah Rees 44:20
And if you think I’m sure you can, well, I know. You’ve read lots and lots of books. You could recommend a few books that you think have been really kind of fundamental to him very important that we should all read, what what would they be
Paul Gilbert 44:33
for therapy books, I suppose a book really impressed me. We’re very young therapists was Yalom’s book Existential Psychotherapy. It was 1980 so it’s quite old now. But that was really, as a therapy book. I thought that was good. But obviously then there’s, you know, you’ve got Tim Beck’s book of 79, that depression book, one of the first really major CBT books and so forth. So that that’s important. Also, there is a book by Jean Knox called attachment in archetype. And more recently Graham Music’s book. So I read a lot of every kind of stuff on the attachment stuff. Because I think it’s really helps you in terms of clinical process, I mean, it’s not not terribly technique oriented, but it will help you intensely, because you can learn new techniques, go to workshops, and all the rest of it. But these books, I think you might find quite helpful. So the alarm I liked your alarm because it talks about the basic human existential issues, death, loneliness, meaning and so forth. And as I said, like the union stuff, use with difficult to read in a row, so you have to read other people. But I think you’d enjoy Jean Knox’s book, archetypal attachment, and also Anthony Stevens book on the the nature of self, which was quite an important book for me when I was younger, the archetype of the sale. So there’s a couple of books, which I think are correct.
Sarah Rees 45:58
Fantastic. Thank you. And thinking about the direction of therapy and psychology, what do you think we should be looking out for or keeping an eye on? How do you think it’s going to develop going forward?
Paul Gilbert 46:10
Well, it’s very interesting that we are fast approaching a much more biopsychosocial approach. So if you think about things like Steve August, his his work or Daniel Siegel’s work, or consulenza, his book, he’s just bought this book out on the the neuroscience of psychotherapy, we are beginning to need to understand what interventions how people to change their brains and their bodies. The whole issue of embodiment now is becoming really, really quite important. And that is a little bit of evidence coming that if people do not change physiologically, then they either don’t change at all, or they don’t have sustained change. Patrick Stephen in America has done some very interesting work on CRT and shown that if people change, they also have change in our variability. But if they don’t change how they do, the whole issue of neuroplasticity, I think is very, very interesting. So that that’s coming. And I don’t think we can avoid the body for too much longer to be honest, Howard, two very interesting conference, I think it was solved by the Royal Society of medicine, but I might be wrong about that. But whenever, and they were talking about long COVID And the depression COVID. And a lot of these individuals have got problems with their immune system. And, you know, these viruses really mess up your immune system. And there’s a big link between the immune system and depression. So one of the key things is asked to begin to understand that depression is a multifactorial, you know, there’s many, many paths into depression, you know, women can get depressed in the menopause, or all kinds of things can trigger the cycle. psychological therapies work can be helpful, but they need to be at recognising that. It’s not just, it’s not just about cognitive beliefs, or motivational systems, they, the mind and the body are very complicated. So I think that is the future coming. And we’re also looking at epigenetic changes, actually, these studies and epigenetic change and CFT.
Sarah Rees 48:09
Wow. So you say it’s kind of like, feeling and embodying compassion. And yoga, I suppose will be big, but what do you think about nutrition? And, you know, a lot of serotonin is made in the gut, and we just, you know, to neglect that, don’t worry.
Paul Gilbert 48:28
Yeah, very, very important. That’s coming as well. And as you say, the gut there’s a big link between the gut and the vagus nerve and various other things. So the kind of bacteria you’ve gotten your gut hooks, I mean, the thing is, we’re beginning to realise just how complex these systems are. I mean, Ed Watkins, and new worlds done a really interesting paper on reviewing psychotherapies, and they’re not as good as we think they are. You know, I mean, you know, quite a lot of depressed people don’t do that well with these psychological therapies. And when you think about it, it makes a lot of sense, because, you know, you’re putting people into trials, but there’s some of them have got really tricky backgrounds. Some of them are problems of poverty, some, you know, all kinds of some people are on inflammatory diets. And some people are very sensitive to inflammatory drugs. Some people can eat or pastors they like, and we’ll never get large, but other people just need to look at a pizza and they sort of put on three kilos. So they’re always fascinating individual variations, we have to think about a biopsychosocial approach, really, that the mind and the body on how we create these interconnections? So that’s why CFT spends a lot of time talking about what are the physiological systems you’re trying to hit in a Chinese scene has done some fascinating work looking at empathy training, compassion training and mindfulness training. And they all stimulate slightly different systems in your brain and body. So some individuals you’re going to really want to be stimulating quite a lot on training and quite a lot in mindfulness. Maybe because off but others you might want to do a lot more on empathy. training, because they do compassion, but they do, they can’t mentalize it’s a problem, right? So you’re gonna have to maybe teach them how to mentalize when they can mentalize that has a range of physiological effects as well. So exciting times, extremely exciting time. So we got to get up all these tribes and this therapy gets that therapy, we need a science, which allows us to have an integrated understanding of this person. And there was a wonderful paper written by Eisenberg in 1986. Version was a catchy was called mindless and brainless science. And that was very influential man. It’s a very clever paper, because it says that the problem that we’ve, we’ve got this fragmentation everywhere you look in mental health is fragmented, with all the hundreds of therapies that are out there, whether it’s some individuals who are interested in the body, but other people are not. Some people run the other end of the spectrum, everything is biological and nothing’s. So it’s, but what we don’t need is either these two sciences, either a mindless science just it’s all to do with the body and just couldn’t go to university, or a body of science.
Sarah Rees 51:11
Yeah, it’s bringing it all together, and how unique and tricky every single person is.
Paul Gilbert 51:17
Yeah, that’s why what you were saying sample and dance and yoga, and all of these things, the ability to aground in your body. Because one of the most important things is, you know, is learning not to fight with your own mind. That’s what you’re experiencing, or to fight with your own, what you’re, what you’re feeling, and so on, but actually to be able to work with whatever is arising for you.
Sarah Rees 51:41
It’s really useful. Thank you, I have more training her ahead of me. But no, it’s exciting. It’s all exciting. And the last question I always ask guests is, if you could go back to the 15 year old version of Paul Gilbert, what would you say to him?
Paul Gilbert 51:58
Keep going with your guitar, you would have made a lot more money!
Sarah Rees 52:03
go to the stage.
Paul Gilbert 52:06
I think the point is, when you look through life, and you’d see all the things you worried about, and what happened, I mean, some bad things happen, but you realise that most of it was if you if I could have gone if you can go back and say look, you know you’ll have ups and downs but it’ll be like the weather is fine. Just Just learn from them and path through it. Because sometimes you get very desperate about things that you but the thing is, you know, I think my 15 year old would say it’s alright for you, you’re an old bastard!
Sarah Rees 52:40
Oh, what are you like? So there’s telling that to your 15 year old self and your 15 year old self hearing it and embodying it not chance or wedge. So and if people listening to this want to follow your work, what book do you think people should read first of your work? You’ve written quite a few books,
Paul Gilbert 52:58
I think probably the easiest one to get into and it’s correct summarising everything is mindful compassion, which I wrote with a Buddhist monk. That’s probably the easiest way.
Sarah Rees 53:07
I’ve been listening to it on audiobook, I listen to the compassionate mind too. Paul Gilbert 53:16
It’s very, we’ll have to send you a copy of the new book, which comes out next week, which is on the comparison practice therapy, which is actually I’ve got it here. It’s really, really big. But it is a reasonable dip in book. So I wrote the first part of the book, the science and then we have about 16 other chapters with different authors talking about depression and anxiety and chair work and group work and it’s called compassion focused therapy, clinical practice and applications, it’s me and Gregoris Simos. Yeah, we’re very pleased with three years. I mean, it’s just, it’s a labour of love. I love I’ve loved writing.
Sarah Rees 53:49
Thank you so much for this hour we spent together I’ve really really enjoyed it. I could ask you about another keep you going for another couple of hours. But thank you so much for really enjoyed it.
Paul Gilbert 54:01
My pleasure, Sarah.
Sarah Rees 54:06
Thank you for listening to ask a therapist. For more information about the CBT journal, visit my website at sarahdrees.co.uk. You can also sign up to download your free guide to building emotional resilience delivered straight to your inbox. You will then also receive regular newsletters where I share my blog posts, podcasts, and tips and strategies for better mental health and psychological resilience. Don’t forget to review and subscribe to the podcast and you can also share episodes on social media using the hashtag #askthetherapist. This episode was written and presented by me Sarah Rees and edited by Big Tent Media and produced by Emily Crosby Media
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