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by Tim Desmond
W. W. Norton, 2015
Review by Kamuran Elbeyoğlu on Apr 12th 2016

Self-Compassion in Psychotherapy

Self-Compassion in Psychotherapy as the subtitle of the book Mindfulness-Based Practices for Healing and Transformation, integrates traditional Buddhist teachings and mindfulness with psychotherapy. Tim Desmond, as himself a skilled clinician and also a student of Zen Master Thich Nhat Hanh attempts to increase therapeutic effectiveness by combining self-compassion with relationship-based, individual therapy. Tim Desmond brings together findings from different sciences such as cognitive neuroscience, neurobiology, positive psychology and psychotherapy outcome research with traditional mindfulness techniques to explain how clinicians can help clients to develop a more loving, kind and forgiving attitude through self-compassion.

Mindfulness is a technique that is integral to the teachings of the Buddha and it was introduced to the Western culture by its leading advocate, Jon Kabat-Zinn in 2003, and since then it has been influential in the mental health field.  It refers to a compassionate and non-judgmental moment-to-moment awareness of one's experience, and mindfulness-based treatments are helpful for many psychological difficulties in clinical and nonclinical populations. Self-compassion is intimately related to the practice of mindfulness, and the purpose of this book, as stated by Tim Desmond, is to introduce the necessary tools for one to apply self-compassion practices to one's real-life clinical situations. And as Richard J. Davidson said in the Foreword to Self-Compassion in Psychotherapy, "as little as 30 minutes a day for 2 weeks is sufficient, in complete novices, to change the brain and induce more prosocial and altruistic behavior" by teaching to apply the practice of self-compassion to one's life.

According to Tim Desmond, the practice of self-compassion supports effective therapy in two vital ways, first, helping clients become a source of compassion for themselves, and second, helping therapists be happier and generate more compassion for their clients. Accordingly, throughout the book he shows readers how to apply self-compassion practices in treatment by unpacking practical clinical applications, covering not only basic clinical principles, but also specific, evidence-based techniques for building affect tolerance, affect regulation,  and mindful thinking, working with self-criticism, self-sabotage, trauma, addiction, relationship problems, psychosis, and overcoming common roadblocks.

To provide the theoretical background for practical application of self-compassion into therapeutic atmosphere, the first two chapters illuminate what self-compassion is, the science behind it and why it is so beneficial in therapy. Accordingly, first chapter is devoted to explain what self-compassion is and why it is useful in psychotherapy. First thing, he makes in this chapter is to set out the difference between self-compassion and self-esteem. Since self-esteem is about evaluating oneself positively, it is about a value judgment and therefore it comes down to whether you are better or worse or just as good as other people. But, as Tim Desmond aptly warns, what matters more for us is whether we are kind to ourselves and to others, and self-compassion, which is about relating to oneself with a kind and forgiving attitude, provides the foundation for us to send compassion ourselves and others when needed. The whole intention of Desmond for this book is in his own words "to serve as a guide to applying this powerful practice in almost any clinical situation" (p. 17).

After this opening chapter, Desmond explores five distinct areas of research—neuroscience, cognitive science, psychotherapy outcome research, self-compassion research and positive psychology—in order to show self-compassion is a vital part of effective therapy and supported by cutting-edge science. The following chapter is about basic clinical principles. The core message of this chapter is that all self-compassion practices can arise naturally out of the therapeutic relationship, rather than from rigidly following a script. Desmond aims to show that integrating self-compassion as a core focus of therapy, gives a therapist an effective tool for building a strong therapeutic alliance and using dialogue in order to better guide clients through meditation exercises.

Following two chapters are about mindfulness of the body and thoughts, respectively. By providing excerpts from his practices with his clients, the fourth chapter explores techniques for building affect tolerance and regulation. In the fifth chapter titled Mindfulness of Thoughts, he, again through excerpts from his mindfulness practices with his clients, provides techniques for building cognitive flexibility.

The brain's compassion center, which neuroscientists call the Care Circuit, can be targeted and fortified using specific techniques. The next chapter is about exploring and unlocking a client's natural compassion by learning how to engage the Care Circuit in the brain and strengthen it through deliberate practice. The following chapter is about how to use the compassion a client found deep in oneself to heal and transform suffering in the past and present through case stories.

The eight chapter opens up with the question "why are people so mean to themselves?" and continues to explain why self-criticism and self-sabotage can be so stubborn and how self-compassion practices can break through the stagnation to create real change. Chapter 9 gives more specific guidance about how to use mindfulness and self-compassion practices with people who have experienced trauma, addiction or psychosis.

Next chapter outlines several specific clinical roadblocks to self-compassion and offer suggestions for how they might be overcome. After offering these practical tools, Desmond says: "and more importantly, I recommend applying practices in this book to your own life and your own suffering". And the last chapter focuses entirely on self-compassion practices for the therapist him/herself.

In Self-Compassion in Psychotherapy Tim Desmond shows us why self-compassion is at the heart of therapeutic healing, and how to integrate compassion training into clinical practice. He offers a step-by-step guide to teach his own "dialogue-based mindfulness training," a technique for teaching mindfulness and self-compassion in which the client is guided through a meditation while giving the clinician feedback about their experience in real-time. The clinician uses this feedback to adjust and custom tailor the meditation instructions in order to ensure the client learns the technique effectively. The wonderful insights, vignettes, and wise teachings sprinkled throughout this book will be of great benefit to any clinician who wishes to incorporate compassion practices in his or her work. Readers do not need any background in mindfulness in order to benefit from this book. However, those with mindfulness experience will find that self-compassion practices settled out in this book will provide them the capacity to add new layers of depth to mindfulness based therapies.

This book is intended especially for clinicians, but can also be useful for researchers, teachers and students at all levels of expertise. I heartily recommend it both for clinicians who wish to build the capacity for self-compassion in their clients as well as themselves, and therefore more deeply integrate mindfulness and psychotherapy, and also as a valuable tool for classroom use to facilitate discussions for any classes in clinical psychology.  


© 2016 Kamuran Elbeyoğlu


Prof. Dr. Kamuran Elbeyoğlu, Toros University, The School of Management and Social Sciences, Department of Psychology, Mersin, TURKEY

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