CFT Note

Session Summary

The client reported a difficult week after receiving corrective feedback at work. The session focused on shame, harsh self-criticism, and the client’s fear that self-compassion would reduce accountability. The therapist used the three-systems model and soothing rhythm breathing, and the client agreed to practise a brief compassionate response after work-related self-critical thoughts.

Current Presentation and Context

The client reported replaying the feedback conversation several times and staying late twice to redo work that had already been accepted. They described the main trigger as their manager saying a report needed more clarity. The client wanted help responding without becoming consumed by the thought that they were incompetent.

CFT Process Formulation

The therapist used a CFT formulation to map the feedback as a threat trigger. The client identified threat responses including stomach tension, scanning for further criticism and the urge to avoid the manager. They also identified drive-based overworking as an attempt to regain control. The soothing system was discussed as difficult to access when the client believes they have made a mistake.

Self-Criticism, Shame and Compassion Difficulties

The client reported a self-critical message that they always make mistakes when it matters. They described shame about needing reassurance and said compassion felt like avoiding responsibility. The therapist clarified that compassion was being considered as a way to respond with courage and responsibility rather than as avoidance of repair.

Compassionate Self, Safeness and Inner Resources

The client identified that a compassionate version of themselves would be firm, steady and fair. The client chose a compassionate reframe that treated the feedback as information rather than a verdict. The client reported that the reframe reduced the intensity of the self-critical thought slightly, though it still felt unfamiliar.

Progress, Obstacles and Treatment Review

Progress included the client distinguishing responsibility for improving the report from the wider conclusion that they were incompetent. The main obstacle was the belief that self-criticism is necessary to maintain standards. The client said they prefer practices that are brief and linked to real work situations rather than long imagery exercises.

CFT Interventions and Psychoeducation

The therapist explained the threat, drive and soothing systems using the feedback example. The therapist also explored the function and cost of self-criticism, and distinguished compassionate accountability from reassurance. The client questioned whether compassion would make them complacent, then identified that overworking had made the report harder to complete rather than better.

Experiential Practices and Client Response

The therapist guided soothing rhythm breathing for approximately two minutes, asking the client to slow the breath and notice contact with the chair. The client reported some initial awkwardness and then a small decrease in stomach tension. The therapist then invited the client to pair the breath with the feedback-not-verdict reframe. The client said this felt more usable than trying to generate warmth.

Between-Session Practice and Next Steps

• Client compassionate practice: Practise two minutes of soothing rhythm breathing after work on three days.

• Compassionate action or reflection: Write one compassionate accountability statement after any self-critical feedback-related thought.

• Next-session focus: Review whether the practice affects overworking, reassurance-seeking or avoidance of the manager.