Compassion-focused therapy

Compassion-focused therapy was developed for people with a lot of shame and self-criticism, who can find it very hard to be kind to themselves (Gilbert, 2009). It’s one of the approaches worth knowing about if you’re being hard on yourself in a way that hurts. Some people can see the logic of a kinder way of thinking about themselves and still not feel any better. That gap between knowing and feeling is one of the things compassion-focused therapy was developed to work on.

What compassion means here

In compassion-focused therapy, compassion means noticing when you or someone else is struggling, and wanting to do something to ease it or prevent it (Gilbert, 2014). That’s different from being soft on yourself or letting things slide. It’s closer to how a good friend or coach responds when you’re having a hard time.

The aim is to help you build a supportive, caring relationship with yourself in place of the blaming, critical one (Gilbert, 2009). The Approach (modality) The kind of therapy someone uses, such as CBT or psychodynamic therapy. You'll also see it called a modality. More in the jargon decoder was developed in the United Kingdom by Paul Gilbert.

How it works

People who are very hard on themselves often find it hard to feel reassured or safe, even when things are going well (Gilbert, 2009).

Compassion-focused therapy describes three kinds of feeling that work together (Gilbert, 2014):

One alerts you to threats and brings feelings like anxiety, anger or disgust.
One drives you to go after things you want and need.
One lets you feel settled, safe and content, when you’re not striving for anything or guarding against anything.

The therapy suggests that people who are very hard on themselves often find that settled, safe feeling hard to reach. A lot of the work in compassion-focused therapy is focused on nurturing that feeling.

Cognitive behavioural therapy (Cognitive behavioural therapy (CBT) A structured, practical form of talking therapy. It's built on a simple idea: what you think affects how you feel, and both affect what you do. More in the jargon decoder ) tends to check whether a critical thought is accurate, and look for a more balanced one. Compassion-focused therapy puts more of its focus on how you feel towards yourself. That can help if you’ve had CBT and the kinder thought made sense, but didn’t change how you felt about yourself.

What a session is like

Sessions involve learning and practising things, with your therapist and between sessions. The practices include (Gilbert, 2014):

Noticing where your attention goes, and practising moving your attention on purpose.
Mindfulness Paying attention to what's happening right now, including what you feel, without being pulled into the past or the future, and without acting on it straight away. Several therapies teach it, including ACT and DBT. More in the jargon decoder .
Imagining compassion, for example imagining someone caring towards you.
Writing to yourself from a compassionate point of view.
Building a compassionate sense of yourself. The therapy calls this the compassionate self.
Doing kind things, for yourself and for others, on purpose and regularly.

For some people, kindness, from other people or from themselves, feels uncomfortable or even threatening (Kirby and colleagues, 2019). If that’s how it feels for you, tell your therapist. It’s common when you’re hard on yourself, and working with that reaction is part of compassion-focused therapy.

Compassion-focused therapy is often run as group therapy, and most of the research on how well it works has been done with groups. One review of that research suggests it may be particularly well suited to groups (Craig and colleagues, 2020). It’s also offered one to one.

Who it tends to suit

It tends to suit you if you’re very hard on yourself or carry a lot of shame (Gilbert, 2009). That’s especially so if you can see the logic of a kinder view of yourself and still don’t feel any different. It can also suit you if you’d like to learn practical skills rather than only talk things through, or if you’d like to work in a group.

What the evidence says

Most of the research on treating self-criticism itself has looked at therapies built around compassion, and therapies that work with emotions directly. Both reduced self-criticism (Werner and colleagues, 2019).

A review of 15 studies looked at compassion-focused therapy with people who were having mental health difficulties. It found that people became kinder to themselves and better able to reassure themselves, compared with people waiting for treatment (Millard and colleagues, 2023). Several of the studies also found less self-criticism and some easing of low mood. Some were small pilot studies, done to test whether a larger trial would be workable. About half didn’t report enough for the reviewers to judge how well they were run. Less is known about how things go in the longer term. Too few studies compared compassion-focused therapy with other therapies to say whether it works better or worse than they do.

A larger review pulled together 47 studies with nearly 8,000 people, some with mental health difficulties and some without (Petrocchi and colleagues, 2024). Compassion-focused therapy reduced low mood and self-criticism, and helped people feel more compassion for themselves and others. It helped more when a therapist delivered it than when people worked through it as self-help. About a third of the studies were poorly run, and the results suggest studies with disappointing findings were less likely to be published. The differences were much bigger in studies that compared it with a waiting list than in studies that compared it with another treatment or usual care. And the review only looked at the end of treatment, not at how people were doing later. One of the review’s authors is the person who developed compassion-focused therapy.

Most of the research has been on compassion-focused therapy in groups, and much less is known about it one to one (Craig and colleagues, 2020). Most of the studies didn’t compare it with another therapy, so some of the improvement may come from having therapy at all rather than from this approach in particular.

So there’s a lot of research behind compassion-focused therapy, and it’s a promising option. The research is clearest that it helps people become kinder to themselves and better able to reassure themselves.

Other approaches for self-criticism

Compassion-focused therapy isn’t the only approach that works on self-criticism.

Schema therapy A longer-term talking therapy that works on deep, long-standing patterns. A schema is a deep belief about yourself and other people, formed early, that shapes how you read situations. More in the jargon decoder . Schema therapy is a longer-term therapy for long-standing patterns. One of the states it describes is a harsh inner critic, and part of the work is practising how to respond to that critic.
Internal family systems (IFS) A therapy that starts from the idea that your mind isn't one voice. It treats having different parts as normal, and works with those parts directly. More in the jargon decoder (IFS). Internal family systems works with the different parts of you, including the critical one. Self-criticism is a particular focus of IFS, but there isn’t much research yet on how well it works.

There are also versions of CBT designed for low self-esteem and for perfectionism.

Getting it in Australia

Many therapists bring compassion-based work into another approach rather than offering compassion-focused therapy on its own. It’s worth asking how they use it, and what training they’ve done.

Psychologist Someone trained to assess mental health problems and treat them with therapy. It takes at least six years of study and supervised practice, and they're registered with Ahpra, the national regulator. Psychologists can't prescribe medication. More in the jargon decoder , Counsellor Someone trained to help people talk through and work on difficulties. The title isn't protected in Australia, so it's worth checking a counsellor's training and registration. Medicare doesn't give a rebate for counsellors. More in the jargon decoder , Psychotherapist Someone trained in therapy, often for longer-standing patterns. Like counsellor, the title isn't protected in Australia, and Medicare doesn't give a rebate for psychotherapists. More in the jargon decoder , Mental health social worker A social worker with an extra mental health accreditation. They're trained in therapy, and in the practical things around it, such as housing, money, family services and the systems people get stuck in. More in the jargon decoder and mental health occupational therapists may all use compassion-focused therapy in their practice.

Compassion-focused therapy isn’t named on Medicare Australia's public health insurance scheme. For mental health, it gives rebates on sessions with psychologists and some other professionals, usually through a Mental Health Treatment Plan. More in the jargon decoder ’s list of approaches that can be used under a Mental Health Treatment Plan A document your GP writes with you. It makes you eligible for a Medicare rebate on up to ten individual sessions a calendar year: six, then a review with your GP, then the remaining four. The plan itself isn't therapy. More in the jargon decoder . A psychologist using it will usually be working under a broader heading. Ask the practice whether the Rebate The amount Medicare pays back towards a session. It comes back to you after you've paid, so what you pay yourself is the fee minus the rebate. More in the jargon decoder applies.

There are several ways to pay for therapy:

Full fee. Seeing a private psychologist, counsellor or psychotherapist directly, with no limit on the number of sessions. Medicare doesn’t cover counsellors or psychotherapists.
Workplace programs. Many employers pay for a few sessions for their staff.
Community services. Non-profit organisations and local community health centres provide low-cost care.
headspace A national youth mental health service for anyone aged 12 to 25, with centres around Australia and support online and by phone. It's free or close to it, you don't need a referral or a parent, and you can book it yourself. More in the jargon decoder . headspace offers free or low-cost support for people aged 12 to 25.
Groups. Therapy groups usually cost less per session. Under a Mental Health Treatment Plan, Medicare also rebates up to ten group sessions a calendar year, separately from the individual ones.
A Mental Health Treatment Plan. Your GP (general practitioner) For most people, where getting help starts. A GP can write a Mental Health Treatment Plan, prescribe medication and refer you on, and some are trained to deliver a small number of structured therapy sessions themselves. More in the jargon decoder assesses whether a plan suits you. A plan gives you a Medicare rebate on up to ten individual sessions a calendar year. Ten sessions a calendar year is a funding limit, not a judgement about how much therapy anyone needs.

Free and low-cost options has more on each of these. If you’re under 18, a GP or headspace can help you find someone to see.

Whichever approach you choose, how well you and your therapist work together matters a great deal. Why who you see matters more than what they do explains why.

If things are difficult right now, Lifeline is on 13 11 14, the Suicide Call Back Service is on 1300 659 467, and Kids Helpline is on 1800 55 1800 for anyone aged 5 to 25. In an emergency, call 000. Crisis and emergency support has the full list.

Where next

If you’re still working out whether you want therapy at all, what therapy actually is covers the basics. Would I benefit from therapy? starts from what you’d want to be different, rather than from whether things are bad enough.