Compassion Focused Therapy (CFT) and Motivational Interviewing (MI)

A note about this post…

I have not written a blog article in nearly 3 years, interestingly enough this length of time is close to the age of my daughter! I have also changed jobs, recovered from COVID, and moved to a new city. As I begin to gain my stability as a new father in a new city, I hope to start to write with more frequency. The article below is my first writing since my 3 year “sab-dad-ical.” It was very fulfilling to put some of these ideas on paper, and I hope that others will benefit from some of these ideas as well.

​Compassion and MI 

​Motivational Interviewing is how I was first introduced in a deep and meaningful way to the concept of compassion. The helping approach outlined by Miller and Rollnick’s writing on MI seemed like a compassion “how to” manual of sorts. Not only did MI emphasize the importance of a compassionate spirit (what Dr. Miller has often referred to as the “way of being with another”), the practice of MI offered tangible practices that can be ways of “doing compassion.” These practices include using reflections, open ended questions, affirmations, and summaries (OARS), avoiding traps to engagement, seeking consent before giving information and others. MI also pointed me towards a path to follow when practicing compassion with others – Engage, Focus, Evoke, and Plan (the MI processes). Having the MI presence, practices, and path helped me to become more effective and intentional with how I helped others. It seemed to me at this time that compassion was seeking to deeply understand someone without judgment and taking steps towards helping that person (Miller & Rollnick, 2013). MI has a very practical and other-oriented definition of compassion:

“[Compassion is actions taken] benevolently to promote the client’s welfare, giving priority to the client’s needs” (Miller & Rollnick, 2013, p.2).

​Buddhism and Compassion

​Later in my life I was fortunate enough to engage and practice elements of Buddhism. These experiences challenged and widened my view of compassion. I learned about the idea of loving kindness (maitri), a wish that all beings have happiness. I learned about the idea of compassion (karuna), a wish that all beings are free from suffering. Like MI, the Buddhist traditions offered tangible practices related to compassion, but these new practices that I was learning seemed very different. The practices associated with maitri and karuna do not always require talking to another person. Some of these practices take place as part of a meditation or solitary practice, others take place quietly “post meditation” and during daily life. In the Buddhist approach to compassion, there was a strong emphasis on working with oneself and ones ego before taking any steps to help others. Without this difficult preliminary work our efforts can be akin to a bull in a china shop, and we may be of little benefit to others at all (Trungpa, 1993).

​In my experience with Buddhist views of compassion, I noticed that benefiting others in this tradition is often depicted in “larger than life” and aspirational terms. For example, the Buddhist vow to free all being of suffering is extensive and lasts over multiple lifetimes. The MI vow of compassion can sometimes last for only 50 minutes, and it is often directed at one person or one group of people. The MI approach to helping others through compassion involves change goals and increasing self efficacy, the Buddhist tradition often points to impermanence, inevitability of suffering, and renunciation of worldly pursuits. MI seems to emphasize speech (between helper and helpee) as the primary vehicle for acting on compassion, much of what I learned about Buddhism insists on including body, speech, and mind in compassion pursuits (Gampopa, 1998). The Buddhist approach to compassion has pushed me look inwards through meditation and reflection, and it has also inspired me to learn more about other non-religious approaches that use compassion to help others. In this exploration of other helping approaches, I found Compassion Focused Therapy (CFT).

​Compassion Focused Therapy

​I first encountered Compassion Focused Therapy (CFT) a few years ago at a MINT Forum through a training called “Being with versus doing to: The art and science of empathy, compassion & connection” (Orr & Steindl, 2018). I had hoped that this training would help me address some of the questions that had begun to develop in my mind about compassion, helping others, and how to be in the world. Since this training I have continued to learn some of the basics of CFT, and I aspire to continue to develop my understanding and ability to practice this approach to helping others. I am still very much a beginner in terms of my understanding of Compassion Focused Therapy.

​CFT has roots in both Tibetan Buddhism and Psychotherapy approaches. The founder Paul Gilbert uses the CFT approach not only as a way of helping others, but he also addresses the need to practice compassion with oneself as well. The method of helping others is different in CFT - whereas MI uses compassion to evoke change talk, CFT sets its focus on helping oneself and others build compassion for themselves, for others, and to develop the ability to accept compassion (the three flows of compassion). The CFT definition of compassion also includes self compassion, a key component. Compassion is conceptualized as having 6 attributes in CFT: Sensitivity, Sympathy, Empathy, Motivation/Caring, Distress Tolerance, and Non-Judgement. The definition of compassion in CFT is different from MI in that is includes self reflection, has a focus on suffering, and uses the strong language of “commitment” (Gilbert, 2009; Steindl, 2020).

​“[Compassion is] a sensitivity to suffering in self and others with a commitment to try to alleviate and prevent it (Gilbert, 2009, p.13).”

​CFT also uses non-verbal techniques to help others, whereas MI is primary verbally based. During a recent CFT course that I attended, the facilitators taught the importance of the helper’s physical posture, facial expression, and tone of voice. Later in this course, skills such as visualization and centering exercises were taught. The facilitators emphasized that these activities are just as important to practice ourselves as they are to teach others (Tirch & Silberstein-Tirch, 2020). In fact, it seems that a prerequisite to helping others in CFT is having a practice oneself. In this way the line of “helper” and “helpee” is a little bit blurred in CFT when compared to MI, both parties are ideally “practitioners.”

​Compassion Focused Therapy and Motivational Interviewing 

​Stan Steindl and his colleagues have done excellent work in regard to combining the motivational approach of MI with the deep compassion focused approach of CFT. CFT has a robust and multidirectional concept of compassion which can complement a practitioner’s development of the MI Spirit. CFT’s focus on body, speech and mind of the practitioner can expand the MI practitioner’s practice of expressing compassion beyond the verbal and language. Given the amount of skills, meditation, and other activities involved with CFT, it makes sense that one would need considerable motivation to keep up regular practices. MI can support the practice of CFT in building motivation and in practicing CFT skills and activities. MI can also help to develop autonomy and self-efficacy with someone who is gaining confidence in practicing the three flows of compassion. Stiendl et. al.’s recent work on the Compassion Motivation and Action Scales, highlights the importance of motivational approaches such as MI to support the practice of CFT (2021).

​I am still very much a learner when it comes to compassion in general and the “three flows” of compassion specifically. I am just starting to learn about Compassion Focused Therapy and how to use this approach in my work with others. In comparison to MI, CFT has a more explosive view of compassion – this makes sense, the CFT practice is named after compassion! Many of the CFT ideas have helped to me to dive deeper into compassion, and explore new ways of using the practice of compassion to help others in a tangible manner. Learning about CFT has helped me to ground some of the aspirational Buddhist compassion approaches in way that that I can apply practically when helping others professionally.

Works Cited 

​Gampopa (1998). The Jewel Ornament of Liberation. Ithaca, NY: Snow Lion Publications.

Gilbert, P. (2009). The Compassionate Mind: A New Approach to Life Challenges. London: Constable and Robinson Ltd.

Miller, W.R., and Rollnick, S. (2013). Motivational Interviewing: Helping people change. NY: Guilford Press.

Miller, R. M. & Rollnick, S. (2013). Glossary of Motivational Interviewing Terms. NY: Gilford Press.

Orr, M. & Steindl, S (Nov 2018) Being With Versus Doing to: The art and science of empathy, compassion & connection (Training). New Orleans, LA: 2018 MINT Forum.

Steindl, S. (January 2021). Motivational Interviewing: Bringing compassion to the World (training). MINT Forum.

Steindl, S. (2020). The Gifts of Compassion: How to understand and overcome suffering. Samford Valley QLD, Australia: Australian Academic Press.
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Steindl, S., Tellegen, C., Filus, A., Seppälä, E., Doty, J. & Kirby, J. (2021). The Compassion Motivation and Action Scales: a self-report measure of compassionate and self-compassionate behaviours. Australian Psychologist, DOI: 10.1080/00050067.2021.1893110

Tirch, D. & Silberstein-Tirch, L. (July 2020). Foundations of Compassion Focused Therapy Course (Training). Oakland, CA: Praxis.

Trungpa, C. (1993). Training the Mind and Cultivating Loving Kindness. Boston, MA: Shambhala Classics.