Compassion Focused Therapy (CFT)

Presenting Problem(s):

• Describe the client’s presentation during the session. Highlight relevant updates to symptoms, behaviours, or situations since the previous session. Comment on the client’s emotional state at the beginning of the session, particularly as it relates to their threat, drive, and soothing systems.
• Document any visible signs of distress, shame, or self-criticism that were apparent.
• Note any life events or current circumstances contributing to the client’s presentation.
• Summarise the client’s main concerns or difficulties discussed in the session.

Session Content:

• Summarise the core issues explored in the session and how they relate to the client’s presentation and treatment goals.
• Detail specific CFT topics, themes, and issues discussed.
• Include information about compassion-related themes such as self-criticism, shame, or difficulties with self-soothing.
• Note any events or situations where the client experienced activation of their threat system or attempted to apply compassionate responding.
• Include any reflections on previous homework completion and learning gained from practice.

CFT Conceptualisation:

• Provide a case conceptualisation from a CFT perspective based on information or insights gained in this session.
• Emotion regulation systems: For the core issues discussed, describe the client’s three emotion regulation systems: threat, drive, and soothing.
• Self-criticism: Describe the client’s self-critical thoughts. Identify key blocks, fears, or resistances to compassion. Note relevant developmental experiences that may have shaped these patterns, particularly early experiences of threat, safety, attachment, and compassion.

Interventions:

• Detail the specific therapeutic interventions applied, with a focus on CFT techniques.
• For each intervention, briefly describe how it was implemented and the client’s response.
• Include relevant CFT-specific interventions such as psychoeducation, compassionate skills, compassionate mind training exercises, chair work, compassion formulation development, work with the compassionate self, mindfulness and attention training, compassionate letter writing or imagery, body-focused exercises, addressing fears and resistances to compassion, threat system de-activation strategies, validation and normalisation, and exploration of functions of self-criticism and shame.

Client Response:

• Describe how the client engaged with and responded to the CFT exercises and interventions.
• Note their willingness to participate in compassion-focused exercises and any difficulties experienced.
• Note any shifts in emotional state during compassion exercises, including positive responses such as feelings of warmth, safety, or connection and activation of fears or resistances to compassion such as unworthiness, anxiety, or grief.
• Document any insights the client gained about their own patterns of self-criticism, shame, or the three emotion regulation systems.

Progress:

• Describe the client’s progress toward their treatment goals or shifts in understanding of their difficulties.
• Include developments in capacity for self-compassion and compassion for others, or reductions in shame, self-criticism, or threat-based responding.
• Document progress in developing their soothing system and compassionate attributes.
• Highlight changes in ability to recognise and step back from the “critic” and access their “compassionate self.”
• Document improvements in ability to tolerate difficult emotions without avoidance or overidentification.

Risk Assessment:

• Summarise any risk factors, such as self-harm or suicidal ideation.
• List protective factors and any action plans if risk is present.

Homework:

• Detail the homework assignments given to the client for practice between sessions.
• Explain the rationale for each assignment and how it connects to the client’s treatment goals and current stage in therapy.

Plan: 

• Next Session: Outline the plan for the next session based on today’s discussion. Indicate how the plan builds upon the current session and addresses the client’s ongoing treatment needs. Note any specific CFT exercises or techniques that will be introduced or further developed.
• Next Appointment: Provide the time, day and date of any future session agreed upon.

Summary:

• Provide a brief recap of key points from the session in no more than four sentences.