An exploration of compassion focused therapy chairwork for clients with depression, self-criticism, and shame

Depression is a leading global cause of disability, impacting on physical, social, and psychological wellbeing. Despite developments in psychological and pharmacological treatments, depression continues to be associated with high levels of chronicity and relapse. One way to understand depression is as a heterogenous syndrome that can take the form of various subtypes and constellations of symptoms. There is the potential to improve client outcomes by developing treatments that target specific processes or symptom clusters in depression. Shame and self-criticism are examples of such processes. They both predict and maintain depression and reduce the effectiveness of evidence-based treatments for depression.

Compassion-Focused Therapy (CFT) was designed specifically for clients with self-criticism and shame and is an integrative psychotherapy based on the scientific application of compassion. A core-component of CFT is ‘chairwork’, which refers to a collection of experiential psychotherapy methods that utilise chairs, their positioning, and movement between them. One CFT chairwork exercise encourages clients to enact their self-critical dialogue, between different chairs, before bringing compassion to both sides of the internal conflict. Another exercise, known as ‘multiple selves’, seeks to differentiate multiple threat emotions by using various chairs, allowing clients to explore emotional conflicts and regulate their emotions with compassion. Despite the central role of chairwork in CFT, there has been no previous research on the subject. There is also limited research on client’s experience of chairwork as a psychotherapeutic intervention.

This thesis explores the two CFT chairwork interventions mentioned above, and their application for clients with depression, problematic shame, and self-criticism. The research is qualitative in nature and seeks to give voice to clients’ experiences and meaning-making regarding the interventions. A total of 21 clients with depression were interviewed after undertaking the chairwork exercises. Their interviews were transcribed and analysed using Interpretative Phenomenological Analysis (IPA).

From the first analysis of data relating to the self-critic chairwork exercise, the following themes were identified: ‘embodiment and enactment’, ‘externalising the self in physical form’, ‘emotional intensity’ (chapter six). The second analysis generated themes of ‘differentiating selves’, ‘mental imagery of selves’, and ‘integrating and transforming selves with compassion’ (chapter seven). The analysis of the multiple selves exercise developed themes relating to ‘appreciating emotional complexity’, ‘the role of chairwork process’, and ‘compassionate integration’ (chapter eight). A final analysis took account of the data-set across both interventions to explore the role of relationship factors in CFT chairwork (chapter nine). The analysis generated themes of ‘being directed and coached’, ‘being seen (bringing the inside out and outside in)’, and ‘being in a caring relationship’.

The results provide insights into the core mechanisms and processes of CFT chairwork and, more broadly, of chairwork as a psychotherapeutic method. The implications for CFT practice and training are discussed and a ‘guidelines for best practice’ has been produced. The results are also discussed in the context of depression, shame, and self-criticism