‘Being Kinder To Myself’: Using Compassion Focused Therapy .

Transcription

‘Being kinder to myself’: Using Compassion Focused Therapyand Compassionate Mind Training to help individuals in thehelping professions cultivate compassionElaine BeaumontSchool of Nursing, Midwifery, Social Work & Social SciencesUniversity of SalfordSubmitted in Partial Fulfilment of the Requirements of theDegree of Doctor of Philosophy, 20171

ContentsPage numberList of tables and stractArticles included in the Portfolio of Published WorksSupporting articles/book included in the Portfolio of Published WorksSupporting conference presentationsIntroduction4567810121315Section One: BackgroundBackgroundCompassionate Mind Training/Compassion Focused TherapyPsychotherapy for individuals who experience primary traumaCompassion in healthcareThe cost of caringSummary161723273335Section Two: Rationale, thesis aim and objectives, and published worksRationale, aim and objectives36Contribution of included articles39Summary42Section Three: Critique of the presented publicationsSection overview44Paper One:Beaumont, E., & Hollins Martin, C.J. (2015). How effective isCompassion-Focused Therapy (CFT)45Paper Two:Beaumont, E., Durkin, M., McAndrew, S., & Martin, C. (2016).Using Compassion Focused Therapy as an adjunct to Trauma-Focused CBTfor Fire Service personnel suffering with trauma-related symptoms47Paper Three:Beaumont, E., Hickey, A., McAndrew, S., Goldman, S., & Warne, T. (2016)Minding the gaps: Using narrative accounts to explore people’s experiencesof using North Staffs MIND’s Adult Counselling Service50Paper Four:Beaumont, E., Durkin, M., Hollins Martin, C. J., & Carson, J. (2016a).Compassion for others, self-compassion, quality of life and mental well-beingmeasures and their association with compassion fatigue and burnout instudent midwives53Paper Five:Beaumont, E., Durkin, M., Hollins Martin, C. J., & Carson, J. (2016b).Measuring relationships between self-compassion, compassion fatigue,burnout and well-being in student counsellors and student cognitivebehavioural psychotherapists56Paper Six:2

Durkin, M., Beaumont, E., Hollins Martin, C. J., & Carson, J. (2016). A pilotstudy exploring the relationship between self-compassion, self-judgement,self-kindness, compassion, professional quality of life and well-being amongUK community nurses58Paper Seven:Beaumont, E., Irons, C., Rayner, G., & Dagnall, N. (2016). CompassionFocused Therapy Training for Healthcare Educators and Providers: Does thisincrease self-compassion, and reduce self-persecution and self-criticism? 60Paper Eight:Beaumont, E., & Hollins Martin, C. J. (2016a). A proposal to support studenttherapists to develop compassion for self and others through CompassionateMind Training63Paper Nine:Beaumont, E., & Hollins Martin C. J. (2016b). Heightening levels ofcompassion toward self and others through use of Compassionate MindTraining68Paper Ten:Beaumont, E., Rayner, G., Durkin, M., & Bowling, G. (in press). The effects ofCompassionate Mind Training on student psychotherapists71Summary75Section Four: Ethical considerations, methodological issues, andlimitationsEthical considerationsMethodology and limitationsPragmatic paradigmRationale for data collectionReflectionsSummary788284869298Section Five: Key thesis outcomes and recommendations for practiceand future researchOutcomes99Recommendations for practice and future research101Conclusions103References106Appendix 1: Papers included in the Portfolio of Published Works123Appendix 2: Statement of candidate’s independent work and individualcontribution233Appendix 3: Letters from collaborating authors confirming contribution 237Appendix 4: Ethical approval letters256Appendix 5: Greater Manchester Fire and Rescue Service approval264Appendix 6: Compassionate Mind Workbook contents page266Appendix 7: Example questionnaires2693

List of tables and figuresTablesTable 1: The key attributes of compassion, skills of compassion andinterventions designed to increase levels of compassion. Reprinted with kindpermission from The Arts in PsychotherapyTable 2: Terms associated with the ‘cost of caring’ (Sabo, 2006)Table 3: Details of the papers and the contributions madeTable 4: Compassionate Mind Training Implementation Strategy. Reprintedwith kind permission from the British Journal of MidwiferyTable 5: Compassionate Mind Training additions to the Post GraduateDiploma in Cognitive Behavioural PsychotherapyFiguresFigure 1: Three types of affect regulation system. From Gilbert (2009). TheCompassionate Mind. Reprinted with kind permission from ConstableRobinsonFigure 2: Compassionate Mind Training Model for Healthcare Practitionersand Educators. Reprinted with kind permission from Healthcare Counsellingand Psychotherapy Journal4

AbbreviationsBABCP: British Association for Behavioural and Cognitive PsychotherapiesCBT: Cognitive Behavioural TherapyCFT: Compassion Focused TherapyCMT: Compassionate Mind TrainingDSM: Diagnostic and Statistical Manual of Mental DisordersEMDR: Eye Movement Desensitisation and ReprocessingFSP: Fire Service personnelSRB: Soothing rhythm breathingTF-CBT: Trauma-Focused Cognitive Behavioural TherapyTPS: Threat Protection SystemUKCP: The UK Council for Psychotherapy5

AcknowledgementsI am very fortunate to have been supervised throughout this process byProfessor Caroline J Hollins Martin, Professor Alison Brettle, Dr GillianRayner, and Dr Mark Widdowson. Your support, encouragement, inspiration,and guidance have helped me throughout my research journey.Thank you to the Counselling and Psychotherapy team, Lisa Bacon, DrSue McAndrew, and Dr Neil Murphy for your continued support andencouragement. I feel lucky to be part of a team and organisation thatdemonstrates compassionate care.Thank you also to Professor Paul Gilbert and the inspirational team atThe Compassionate Mind Foundation who continue to be supportive andencouraging of my work.I have worked on a variety of projects with a variety of collaboratorswho have encouraged scholarly discussion and debate. Thank you to all myco-authors.Thank you to Greater Manchester Fire and Rescue Service and to thestudents and clients who agreed to take part in the various projects.Finally, thank you to Sue, this would not have been possible withoutyour care, good humour, and support.6

DeclarationThis thesis includes a portfolio of publications that have been published inpeer-reviewed journals. This thesis also includes a range of published works,a research report, and a book, which act as supplementary evidence. Thepublished works can be found in Appendix 1. The extent of the author’soriginal contribution is listed in Appendix 2, which is verified by thecollaborating authors in Appendix 3.Date 3rd March 20177

AbstractSelf-critical judgement, low levels of self-compassion, symptoms of stress,compassion fatigue, trauma and burnout can all have a negative impact onindividuals who work in the helping professions. Continued absence ofstrategies that promote self-care, puts individuals in the helping professions atrisk of experiencing such symptoms, which can impact on performance andcompassion levels. This highlights the importance of developing, creating andtesting interventions that promote self-care.This portfolio of ten published works and eight supporting publicationsoffers a unique contribution to knowledge by adapting and using CompassionFocused Therapy and Compassionate Mind Training, with populations whowork in the helping professions (e.g. Fire Service personnel, studentmidwives, student nurses, student counsellors, student cognitive behaviouralpsychotherapists and healthcare educators). This population may experiencetrauma-related symptoms as a result of bearing witness to suffering. Teachingprogrammes were devised and tested and results from empirical studies inthis portfolio of works suggest that CFT/CMT increased levels of selfcompassion and reduced self-critical judgement. Interventions aimed atcultivating compassion for one’s own suffering were incorporated intopsychotherapy to help individuals who experience primary trauma and intoHigher Education programmes, to help students who may experience lowlevels of self-compassion, high levels of self-critical judgement and/or traumarelated symptoms.Collectively the publications provide a body of knowledge, whichsuggest that incorporating CFT/CMT into psychotherapy and healthcare8

practitioner training may help individuals ‘be kinder to self’ in times ofsuffering. Helping individuals in the helping professions respond to their ownsuffering with compassion may build resilience and equip them with the toolsneeded to face the demands of practice and training. Whilst suffering cannotbe prevented, interventions that focus on the cultivation of compassion can beemployed to encourage healing.This Portfolio of Published Works offers a unique contribution toknowledge, bridging a gap between practice and theory by offering tested,practical ways of enhancing compassion in populations that may suffer, as aresult of bearing witness to trauma.9

Articles included in the Portfolio of Published WorksThroughout the portfolio the papers included in the submission will be cited inbold (e.g. Beaumont & Hollins Martin, 2013) to help distinguish these papersfrom other citations. The research papers listed below can be found in Appendix1.(1)Beaumont, E., & Hollins-Martin, C. J. (2015). A narrative review. Howeffective is Compassion Focused Therapy? Counselling PsychologyReview, 30(1), 21-32.(2)Beaumont, E., Durkin, M., McAndrew, S., & Martin, C. (2016). UsingCompassion Focused Therapy as an adjunct to Trauma-Focused CBTfor Fire Service personnel suffering with trauma-related symptoms. TheCognitive Behaviour Therapist, vol. 9, e34, 1-13.doi:10.1017/S1754470X16000209(3)Beaumont, E., Hickey, A., McAndrew, S., Goldman, S., & Warne, T.(2016). Minding the gaps: Exploring the effectiveness of a voluntarysector mental health counselling service. Journal of Counselling andPsychotherapy Research, 16(4), 298–306.(4)Beaumont, E., Durkin, M., Hollins-Martin, C. J., & Carson, J. (2016a).Compassion for others, self-compassion, quality of life and mental wellbeing measures and their association with compassion fatigue andburnout in student midwives: A quantitative survey. Midwifery, 34, 239–244.(5)Beaumont, E., Durkin, M., Hollins-Martin, C. J., & Carson, J. (2016b).Measuring relationships between self-compassion, compassion fatigue,burnout and well-being in student counsellors and student cognitivebehavioural psychotherapists. Journal of Counselling andPsychotherapy Research, 16(1), 15-23.(6)Durkin, M., Beaumont, E., Hollins-Martin, C. J., & Carson, J. (2016). Apilot study exploring the relationship between self-compassion, selfjudgement, self-kindness, compassion, professional quality of life andwellbeing among UK community nurses. Nurse Education Today, 46109–114.(7)Beaumont, E., Irons, C., Rayner, G., & Dagnall, N. (2016). DoesCompassion Focused Therapy Training for Healthcare Educators andProviders increase self-compassion, and reduce self-persecution andself-criticism? Journal of Continuing Education in the HealthProfessions, 36(1), 4-10.10

(8)Beaumont, E., & Hollins Martin, C. (2016). A proposal to supportstudent therapists to develop compassion for self and others throughCompassionate Mind Training. The Arts in Psychotherapy, 50, 111118.(9)Beaumont, E., & Hollins Martin, C. (2016). Heightening levels ofcompassion towards self and others through use of CompassionateMind Training. British Journal of Midwifery, 24(11), 3-12.(10)Beaumont, E., Rayner, G., Durkin, M., & Bowling, G. (in press). Theeffects of Compassionate Mind Training on student psychotherapists.Journal of Mental Health Training, Education and Practice.11

Supporting articles/book included in the Portfolio of Published WorksIn addition to the 10 papers fundamental to this portfolio, there are also anumber of supporting papers, conference presentations, and a book thathelped develop knowledge and understanding of the concepts covered in thisthesis. In order to help identify the supporting works they are cited throughoutthe thesis in bold italics (e.g. Beaumont, 2016). The supporting works arelisted below.(11)Irons, C., & Beaumont, E. (2017). The Compassionate Mind Workbook.A step-by-step guide to developing your Compassionate Self. London:Little, Brown Publishers.(12)Beaumont, E. (2016). Building Resilience by Cultivating Compassion.Healthcare Counselling and Psychotherapy Journal, 16(3), 22-27.(13)McAndrew, S., Hickey, A., & Beaumont, E. (2015). The Impact of N.Staffs MIND’s Adult Counselling Service on the Mental Health of theirClients: A Research Report. University of Salford: ISBN: 978-1987842-76-4.(14)Beaumont, E. (2014). Healing the wounds of trauma, shame and grief:A case study. Healthcare Counselling and Psychotherapy Journal,14(2), 15-19.(15)Beaumont, E., & Hollins Martin, C.J. (2013). Using CompassionateMind Training as a Resource in EMDR: A Case Study. Journal ofEMDR Practice and Research, 7(4), 186 -199. Ten citations.(16)Beaumont, E. (2012). Compassionate Mind Training: ‘Self-soothingafter trauma’. Healthcare Counselling and Psychotherapy Journal,12(3), 18-22.(17)Beaumont, E., Galpin, A., & Jenkins, P. (2012). ‘Being kinder tomyself’: A prospective comparative study, exploring post-traumatherapy outcome measures, for two groups of clients, receiving eitherCognitive Behaviour Therapy or Cognitive Behaviour Therapy andCompassionate Mind Training Counselling Psychology Review, Vol.(27), 31-43. Forty citations.(18)Beaumont, E. (2010). A comparative study exploring therapy outcomemeasures of two groups: One group received Cognitive Behaviour12

Therapy following a traumatic incident and the second group receivedCognitive Behaviour Therapy and Compassionate Mind Trainingfollowing a traumatic incident. Salford: University of Salford (Master’sThesis).Supporting conference presentationsBeaumont, E., Hollins

Figure 1: Three types of affect regulation system. From Gilbert (2009). The Compassionate Mind. Reprinted with kind permission from Constable Robinson . Figure 2: Compassionate Mind Training Model for Healthcare Practitioners and Educators. Reprinted with kind permission from Healthcare Counselling and Psychotherapy Journal. 4