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World Kindness Day: learning about compassion focussed therapy

For World Kindness Day Claire Shaw, consultant nurse at the Trust, shared her insight into Resilience Based Clinical Supervision, its foundation in Gilbert’s compassion focussed therapy, and the importance of self-compassion. She also told us about the impact of the training programme run by the Trust.

What is Resilience Based Clinical Supervision?

Resilience Based Clinical Supervision (RBCS) is a supervision model based on the emotional systems of compassion focussed therapy (Gilbert, 2010). It is a relatively new model (Stacey, 2017) and one that was first developed for nurses but is now used across health care settings. It is a structured and accessible model, one that is particularly useful for those who may not have had much previous experience of facilitation or supervision. In brief it draws on Gilbert’s model to help people recognise the emotional motivation that underpins our responses within our work. RBCS uses mindfulness, reflective discussion and positive reframing to support and develop reflective capacities, normalise experiences and reduce stress. In a simple format, the RBCS model encourages us to notice how we are, the state that we are in, and to be curious about what has affected us and the effect we will have had on others, whilst offering a framework through which these experiences can be explored. Similarly to other models of supervision it requires consistency and practice to develop trust and skills in exploring experiences.

Within the RBCS programme we explore the use of the word ‘resilience’, as more recently it appears to have been used to refer to having ‘broader shoulders’. This was not how it was intended! Given the misuse of the term, RBCS may be more helpfully described as compassion based clinical supervision. It has been a learning curve for myself as a participant and then a programme facilitator. I have had to learn about a different model but also to understand the similarities, despite the different language and framing of ideas.

Tell us a bit more about Gilbert’s compassion-based therapeutic model

Gilbert describes compassion focussed therapy (CFT) as “an integrated therapy that draws from social, developmental, evolutionary and Buddhist psychology, and neuroscience.” (2009). The model is based on an understanding of three emotional regulatory systems: threat and protection, drive and excitement and contentment, soothing and social safeness. The understanding is that these three systems can become unbalanced and rebalancing is one aim of the therapy. Gilbert talks a lot about compassion (to self and to others) and how it is understood and experienced, including the skills of compassion and the importance of self-compassion. The CFT therapist uses compassion, kindness and warmth in their relationship with the client, focussing on the social safeness aspect of the emotional systems and recognising how it mitigates the effect of threat and stress/distress. The client is encouraged to develop and practice a compassionate, kind and warm tone in the way in which they speak to themselves with an idea that once they stop criticising or blaming themselves, they are more able to work on learning to cope with their symptoms.

Why is self-compassion important and how can this support clinicians at risk of burnout?

There is a wealth of evidence to suggest that working within healthcare services, within organisations under pressure, can have a detrimental impact on individuals, including the risk of burnout or compassion fatigue for staff and the subsequent negative impact on patient care. This is also something we each know about from our experience and the theories that we draw on. Self-compassion requires a more realistic view of ourselves and our work, identifying that we are not only care givers (with patients identified as holding all the need) but that we also have basic and more complex needs (conscious and unconscious) in relation to the work that we do. Acknowledging these and understanding them gives us permission to look after ourselves. At worst, and in the absence of self-compassion, compassion to others becomes like an unknown language, unable to be communicated and leaving staff feeling guilty, dissatisfied and worn down, and leaving patients vulnerable to poor care or mistreatment.

A first step is often just taking the time to notice how you are, and to ask others in a meaningful way, how are you? Providing a safe reflective space to explore experiences is both essential and a kindness. If kindness means to be ‘generous, considerate and to show concern for others’ then RBCS offers a kindly space which is non-persecutory, supportive, thoughtful and thorough. Group members identify with the group’s approach and appear to take forward this curious and kindly culture back into their work, both with their own self-care and in their relationships with colleagues and patients.

What have you been doing?

Nursing at the Trust were awarded a grant from the Burdett Trust for Nursing to work in partnership with a national nursing charity, the Foundation of Nursing Studies. Together we have been running the RBCS programme for the last 17 months, working with nurses across the North London Partners ICS. We have had 68 nurses complete the programme and they have come from a wide variety of backgrounds including social care, primary care, the acute trusts and mental health and learning disability services. It has been a fantastic opportunity for nurses to come together and learn from one another, whilst using the model to develop and practice their facilitation skills. Despite working through the pandemic and the current workforce issues, nurses have made a real commitment to be able to attend and to engage in the programme. It has felt a privilege to be part of this. Many of the participants have spoken of the impact that the programme has had, both on them as individuals and in sharing the model with others. This has been very positive particularly with increased awareness of the need for self-care and practising everyday tools in attending to one’s self and to others despite busy working environments.

We are coming to the end of the programme now with our final cohorts ending in December. After this point, we will be evaluating the experience and the feedback we have received and then disseminating this. We have been developing a Community of Practice to ensure the longer-term sustainability of the model in practice and this is an ongoing area of work. It has been a great experience to work with another organisation, to work more closely with nurses from across the board within our ICS, and to feel we have supported them in their development and wellbeing.

Interested to learn more about compassion focussed therapy?

We offer a two-day online workshop providing an introduction to the ideas and approaches of compassion focussed therapy to equip you with the key skills to develop a compassionate mind when working with individuals and families who are in distress.