A thematic analysis of compassion‐focused imagery for people with personality disorder: Inhibitors, facilitators and clinical recommendations

Abstract

BackgroundCompassion‐focused therapy (CFT) is increasingly being offered for a range of conditions, including personality disorders (PDs). A key process in CFT is to identify inhibitors to developing compassion and helping clients to overcome these. This study explores inhibitors and facilitators for clients with PD trialling compassion‐focused imagery (CFI) over 1-week.MethodsFifty‐three participants with a diagnosis of at least one PD engaged in CFI for the first time, before and after a negative mood‐manipulation. Semi‐structured group interviews and written open‐response questions were used to collect data on experiences of CFI, immediately following CFI and after 1-week of daily practice. Participants were invited to practice CFI daily for 1-week then complete further open‐response questions online. Data were analysed using thematic analysis.ResultsCFI generated both positive and negative experiences for clients. Six superordinate themes were identified regarding inhibitors of CFI: weak imagery ability, fear of compassion (with multiple subthemes), lack of compassionate experiences, and psychological symptoms. Most inhibitors remained following 1-week of practice. Several facilitators of CFI were identified.ConclusionsClients with PD diagnoses face numerous inhibitors to CFI that occur transdiagnostically. Others may be more specific to this population, such as fear of compassion focused on a dangerous “other.” Some inhibitors are not overcome with practice alone, including weak imagery. Failure to assess for and address inhibitors prior to introducing CFI in this population risks causing harm to clients.