ABSTRACT
Introduction .................................................................................................... 234 What is shame? ............................................................................................... 235 Social mentality theory .................................................................................. 235 Self-soothing ................................................................................................... 236 Is cognitive therapy effective for individuals
with shame-based difculties? .................................................................. 237 What is compassion-focused therapy? ....................................................... 240 Integrating theory with practice .................................................................. 240
Developing a compassionate mind ........................................................ 240 Phase 1. Therapeutic relationship ........................................................... 241
Formulating cases with a compassionate mind ............................... 241 Jennifer’s compassion-focused formulation ..................................... 243
Phase 2. Ending maintenance cycles by working with critical dialogues ........................................................... 244 Developing self-soothing relationships ............................................. 245 Helping Jennifer develop a compassionate reframe to the rape ... 245
Phase 3. Using compassionate imagery to develop self-soothing ..... 246 Developing perfect nurturer images ................................................. 247 Using perfect nurturer images to work with shame ashbacks .... 248
Conclusions ..................................................................................................... 249 Acknowledgments ......................................................................................... 249 References ........................................................................................................ 250
Introduction Jennifer lives in a tortured mind: “I can’t report my rape to the police because it was my fault. I must have done something wrong to deserve to suffer in this way. What he did was so disgusting, I must be disgusting, too. If others nd out what happened to me they will think badly of me and not want to know me. I don’t deserve to be helped because I am a worthless piece of nothing. I brought this on myself. I am bad because I was born that way. I don’t deserve a place in this world. My presence is toxic to others. I loathe myself and I just want to die. I don’t deserve your help, and you make me angry when you try to be nice because you don’t understand how loathsome I am.” Jennifer is a 32-year-old who was raped and has a history of childhood sexual abuse. She presented for treatment with posttraumatic stress disorder (American Psychiatric Association, 2000) characterized by ashbacks to the adult rape and childhood sexual abuse. She suffered from very low self-esteem. She misused alcohol and engaged in deliberate self-harm. This was her third attempt at treatment.
