Compassion-Focused Therapy (CFT)

What is compassion-focused therapy?

Compassion-focused therapy (CFT) is a talking therapy for people who are very hard on themselves.

Professor Paul Gilbert developed it for people with high levels of shame and self-criticism.

Gilbert noticed that some people learned the skills of therapy but still felt no better. They could find a kinder thought, yet it did not feel true. He describes people who say things like this:

"I understand the logic of my alternative thinking but it doesn't really help me feel much better."

CFT works on that gap between knowing and feeling. Researchers describe it as one of the newer "third wave" therapies, a group that also includes ACT.

Sources: CMF: CFT overview, Gilbert 2009, Millard et al. 2023, Hayes et al. 2006

How it works

CFT uses a model of three systems that shape how we feel.

In people with a lot of shame and self-criticism, CFT suggests the threat system takes over. The soothing system is hard to reach. So even a fair and kind thought can fail to bring relief.

The therapist uses compassion practices to strengthen soothing. This work develops a compassionate response, rather than trying to remove threat or drive.

The aim is to replace self-criticism with self-kindness.

Sources: Gilbert 2009, CMF: CFT overview

What sessions look like

CFT often starts by making sense of what you struggle with. Your therapist helps you see that your difficulties are not your fault. They often grew out of ways you learned to keep yourself safe.

Then the work turns to practice, which CFT calls compassionate mind training. Practices can include:

• Compassionate imagery. Exercises that help you feel compassion towards yourself
• The compassionate self. Practising each day how a deeply compassionate version of you would think and act
• Refocusing. Bringing to mind your strengths, or times you were kind or were shown kindness
• Compassionate action. Facing hard things with courage, rather than avoiding them

Many people find kindness towards themselves strange, or even frightening, at first. CFT expects this. Much of the work goes into those fears.

Source: Gilbert 2009

Compassion is not going easy on yourself

In CFT, compassion does not mean avoiding what is difficult or painful. It takes courage, and it can mean facing a hard task.

Gilbert argues that people who stop blaming themselves are freer to take responsibility and learn to cope.

Source: Gilbert 2009

Who is it best suited to?

It can be a good fit if you:

• Have an inner critic that is harsh, constant or cruel
• Carry a lot of shame
• Can see a thought is unfair, but still feel it is true
• Find it easy to be kind to others and hard to be kind to yourself
• Have had other therapy, but the self-criticism stayed

Camden and Islington NHS Talking Therapies runs a compassion-focused group for managing self-criticism. Our low self-esteem page looks at where low self-esteem comes from and how it sounds.

Source: Camden & Islington: CFT

The evidence

An early review in 2015 found 14 studies. Only three were randomised trials. It called CFT promising for mood problems, especially in people high in self-criticism.

It also said larger, better trials were needed before CFT could count as evidence-based practice. A 2020 review found the same promise, and called for a standard manual so studies can be compared.

A 2023 review of 15 studies found improvements in self-compassion, self-criticism and depression. It rated the quality of about half the studies as unclear. Most of the people taking part were women.

Sources: Leaviss & Uttley 2015, Craig et al. 2020, Millard et al. 2023

Where the evidence stops

NICE has not recommended CFT. It is not among the therapies NICE names for depression or for generalised anxiety disorder.

CFT is a reasonable option to ask about when shame or self-criticism is what you most want to change. If you have a diagnosis with a NICE-recommended treatment, ask about that too.

Sources: NICE NG222, NICE CG113