ABSTRACT
This chapter focuses on how compassion focused therapy (CFT) can be applied to support people with experiences of voice-hearing and delusions in psychosis. It suggests that some of the unique challenges of developing compassionate motives in this population start with how psychotic experiences are understood, and how they have been historically medicalised by services and demonised by society. The chapter outlines how a CFT psychoeducation and formulation of voice-hearing and delusions lay the foundations for CFT interventions and the shift from fear-focused to compassion-focused engagement. The chapter describes the psychoeducation of how evolution has set humans up with a tricky brain that has a threat-focused negativity bias that can incline towards dissociating, problematic attention, and overestimating threat, using built-in algorithms of ‘better safe than sorry’. It offers guidance on the formulation of voice-hearing and delusions in terms of their protective function, particularly in the context of interpersonal threat and trauma. It then discusses how to support clients to develop a ‘compassionate self’ identity and how to switch into compassionate mind states that organise multiple physiological processes differently to that of threat states. Together these provide ways to create a secure base from which to do the therapeutic work, and a safe haven for calming and grounding when in states of threat. The chapter outlines guidance on how to encourage clients with psychosis to use these compassionate competencies to achieve therapeutic change, with illustrative examples of interventions such as voice-dialoguing, chair work, imagery, and letter writing.
