ACT with Compassion: a conversation with Jason Luoma and Jenna LeJeune

(Nota: la entrevista en castellano está en este link)

Recently we had the privilege of having Jenna Lejeune and Jason Luoma in Buenos Aires, sharing with us a beautiful (and as always, tearful) workshop about clinical work with issues of shame and self-criticism using ACT and self-compassion resources.

In case you don’t know them, Jason and Jenna are peer-reviewed ACT trainers, and the co-founders of the Portland Psychotherapy Clinic, Research, & Training Center, a private mental health center in which the profits go to fund scientific research. Imagine that. They are also the founders of ACT with Compassion, a wonderful website full of all kinds of resources for working with self-compassion. They very kindly agreed to do an interview with me, and more so, they had the patience of sitting with my (very) idiosyncratic English accent, but, good news, our readers won’t have to (but you will have to deal with my grammar, sorry), since this time we had transcribed the interview instead of just posting the audio file. You are welcome.

I hope you enjoy the interview as much as I did!

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Fabián: So during the workshop, you were talking a lot about self-compassion, especially with dealing with issues of shame and self-criticism, and it is quite a popular topic right now, a lot of people are talking about self-compassion so I’d like to start our talk there. The two of you are clinical psychologists but differing in your career emphasis: Jason, you are more focused on research, and you, Jenna, are more focused in clinical work, so I’d like to ask how would you define self-compassion from your respective points of view?

Jenna: When I’m thinking about it from a clinical perspective I try and make it just very simple and also relate it to behaviors or repertoires that they already have. So I just think about it simply as kindness, but it’s kindness that you are applying, that you’re offering to yourself, just like you might be kind to another person or a nonhuman animal. Simply the act of extending kindness to yourself or being friendly to yourself.

It’s not a technical definition but most of our clients have a have an idea of what a kind person is and so you could just say “I’m just being kind but simply in my relationship to myself”. That’s kind of how I would understand self-compassion.

Jason: I think the first thing is to keep in mind that self-compassion is a made-up word and it’s not even that old of a concept. It’s an English word and it was made up, so we can kind of define it how we want.

I mean, on the one hand, you probably want to honor Kristin Neff because she’s the main person who coined that and defined it in her own particular way. And I believe the way she defines it is having to do with mindfulness, self-kindness, and common humanity. And I think it’s a pretty decent definition but there is, from a research perspective, there is some disagreement about the way that she defines self-compassion. The disagreement from my perspective has to do it with her idea of including in self-compassion both the absence of self-criticism, a sense of alienation and isolation, and the presence of these more positive qualities, like mindfulness, kindness, and a sense of common humanity. And to me, since I’m mostly a researcher on social emotions such as shame, I think that by conflating it, by putting those into one concept, basically the absence of self-criticism and shame and the presence of these more positive self-compassionate parts, I think you’re blending two things that shouldn’t be blended, that they’re actually pretty distinguishable.

And in fact maybe it would be really helpful to distinguish them, because what we might have are situations where someone might both have times where they’re highly self-critical but then respond with self-compassion to that, or they might have both self-criticism and self-compassion at the same time, and by treating them like they’re the same I think we lose opportunities to discriminate the difference between shame and criticism on the one hand and self-compassion on the other.

So when I think about self-compassion I think about it more as those positive qualities, and I tend to think of that a bit more simply as just a repertoire behavior,  so it’s a pattern of responding to yourself.  And I think about it as basically equivalent to… in the same way that you would respond to someone else with kindness, and affiliation, and cooperation, and caretaking, do you respond to yourself in the same way? And specifically, if you talk about compassion you are talking about it in situations in which you are suffering. So, can you respond with cooperative and caretaking behavior towards yourself in situations where you’re suffering? Because that’s what the word “compassion” means, it means response to suffering.

Fabián: I think that’s the usual problem with all the complex concepts, there is a lot of stuff in there and that becomes a difficulty when you try to do research with it, like what happens with the concept of “emotion”, for instance.

Jason: Yes.

Fabián: Jenna, what would you say, what are the most common mistakes that people make when talking about or working with compassion?

Jenna: Are you talking about working with highly shame-prone people or in general?

Fabián: More in general

Jenna:  Honestly I think is probably making it a little bit too “mythical”, like “it’s this big thing that you sit down on a safu and learn how to do this kind of unusual practice”, that is often the way in which we talk about it with our clients. And I’ve really over the years have tried to much more simply have it be a more integrated practice into just simply noticing how you’re relating to yourself in all sorts of situations.

So I mean, I have clients who have a regular loving-kindness meditation practice who in the rest of their life, when they’re not sitting and doing their meditation, are incredibly harsh and critical of themselves, and so I do think that trying to kind of help that self-compassion or kindness, I usually talk about it as kindness behavior, be even in the small actions with ourselves, I think it is a pretty important thing. So I try to take some of the weight out of it: it’s just kindness.

Fabián: Instead of giving it too much weight like it is this solemn thing…

Jenna: … yeah, like this big spiritual practice. And of course there is an aspect to that in many traditions, there is, but I also think there’s something that can be helpful about just being a little bit lighter, putting a little less weight on it, because then people can get less critical of themselves when maybe they’re not being as compassionate to themselves.

Fabián: I get it, that could be useful clinically. And you Jason, what do you think are the most frequent mistakes when talking or working with compassion in general?

Jason: I think Jenna’s response is a really good one clinically. I think the thing that I would say is most lacking maybe, both clinically and in research, is that the idea of self-compassion can be so focused on as an individual practice that the interpersonal aspects of developing the kinds of things that you’re trying to develop in self-compassion can be lost.

There are multiple routes to compassion, and one is through self-focused practice, but as I said in the workshop there’s this idea that interpersonal comes first. Sometimes… the origin of shame and self-criticism, or the problems that compassion is often used for, is in our relationships, it’s in the interactions we have with others. And sometimes self-compassion is used as the solution for that, but it’s missing the interpersonal part, the part of the response that is it about the interpersonal matrix and how we relate to others and how they respond back to us, so to me some of the problems is in the focus only on self-compassion. That can be too narrow. We need to broaden it, we need to understand that we are very social beings, that’s an essential part of working with the kinds of things that self-compassion is meant to address.

Jenna: Yeah, sometimes the most self-compassionate thing we can do isn’t to take care of our own needs or try and soothe ourselves, it’s to be with a loved one who can care well for us or ask our loved one to meet those needs for us. Sometimes that’s the self-compassionate move. There’s a lot of times when I’m working with my clients in which the self-compassion is actually about how do you let other people care well for you, and how do you let other people know that you are needing that caretaking, because they’re so focused on “I should just be able to do this for myself, I should always be able to just soothe myself” and I just don’t think that’s how we as humans work, we’re just such social creatures, we need another person, at least one other, help do that for us.

Fabián: Beautiful, I think actually that has become a quite popular criticism of mindfulness too…

Jenna: …absolutely

Fabián: …the lack of focus on the interpersonal things and the lack of focus on the broader social context of mindfulness, and the exclusive focus on how I’m feeling and my stress, my emotions.

Jason: Yeah, and even if you stay within the Buddhist tradition… if you take Buddhism and transfer it to the United States and the importance of the Sangha is downplayed…

Fabián: …oh yes, the collective practice

Jason: …yes, the community. And in the U.S. it becomes typically, or often at least, much more of an individual thing. But, at least from my understanding of the Buddhist tradition, originally was that the sangha was as important as the other practices, was a core part. So we often don’t emphasize that piece of mindfulness.

Fabián: yeah I totally agree with that. I’d like to change the subject and talk a little bit about your clinic the Portland Psychotherapy Clinic Research and Training Center. You published an interesting article in 2015 about doing research outside of the traditional settings, outside academia, and you talked about your own Center as an example. Can you describe what the main idea was behind that?

Jason: Sure. So we started the organization about a decade ago, and the origin of it was largely that we wanted to stay where we lived, which was Portland. We didn’t want to move and there weren’t really very many places where you could work in our area and still do research. The only avenue really in Portland in which we could do that was to join one of these larger organizations that are grant-funded. And I had experiences with submitting grants, being funded on grants for maybe seven or eight years, and I didn’t want to have all of my research be tied to grants, because especially in the last decade or so it’s become much more biological, reductionistic, and the focus has been neuroscience and has been very internally focused and biologically focused. So it’s going to really skew what you do if you’re a psychologist and you’re grant-funded in the United States, you really are going to get pushed around by that.

So I wanted to see, is there a way to fund the research and not be tied down to what the granting agencies want to fund? And I had enough background in basic business and Jenna had been in business and we thought, is there a way that we could create a business to do something like this, to fund the research? We knew a little bit about things like social enterprise or social businesses, like the Grameen Bank of Muhammad Yunus, where the company competes in the commercial marketplace and then they use at least some of the funding to do things that aren’t commercially successful, that the goal of it isn’t to make more money but the goal is to maximize the social good.

So we tried basically to create an organization that would both bring in revenue through providing training, through providing healthcare services, and a portion of that revenue went to basically salaries to do research, because in psychology pretty much most of the money is salaries, unless you are doing MRIs or something like that.

So that was the idea and then basically we bootstrapped it from there: we hired our first postdoc who had some time dedicated for research and then stayed on as a psychologist with some time taken for research; we hired another postdoc for some time who had time for research and they stayed on as a psychologist, and over time basically we had grown, a bit at a time each year, and now we got to the point where I think we have 16 employees considering me and Jenna…

Jenna: …I think so, I think so

Fabián: That’s impressive. And how are you doing in terms of research? Because the last time I checked you had 24 peer-reviewed articles.

Jason: so we usually publish as a group, about three to four publications a year in peer-reviewed journals –I’m thinking that should start going up at this point, it’s been 3 or 4 per year for the last 10 years. And we have some new researchers coming on because we’re growing, so it should go up the next year too. This year we should have five or six, I think, hopefully, it’ll sustain that. So it’s pretty good, you know, compared to an academic.

Fabián: What are the main issues you have to tackle in your context in order to do research?

Jenna: I can address at least some of them. The ones that people ask us about all the time are things like ERB, how did you develop an ERB, or get access to an ERB…

Fabián: …ERB?

Jason: oh, Ethical Review Board, in the US.

Jenna: yeah, sorry. That was something that Jason collaborated with several other kinds of small private clinics or individuals around our country to create an independent ERB. That’s a very unique thing, it’s the only one, I think, in the US, or one of the few in the US, because they’re always at academic institutions.

So that was one thing that we had to do I think, and you can talk more about this too, I think from our perspective as the owners –because Jason and I are the owners of the clinic and then the other folks are the employees– I think the main thing was for us to make a decision, that the clinic we wanted to develop, the clinic not as a way for us to make money but rather as a way for us to contribute to the social good.

So we get paid a salary the same… I’d probably get paid about what I would get paid if I were in private practice, but then the rest of being a business owner is just about us getting to contribute to these important things, or the things we think are important, so I’d say that’s ok.

Jason: and I think that adding to that, a big part of the challenge is how do people get paid. This is one of the big things that is a barrier. Lots of people in clinical settings, they’ve been trained as scientists-practitioners in the United States, many of them have a Ph.D., and they have the capacity to research and they aspire to do research, but the reality of it is that very very very very few people in clinical settings actually do research despite their best intentions, and a good part of that is because like they didn’t get paid to do it…

Jenna: …yeah

Jason: …and usually if they do research they’re actually gonna lose money by doing the research because they’re gonna get paid less because it takes away from other things. So it’s very hard to do research.

I think there’s a lot of well-intentioned people that say like «well you can run a study on the side», or “collect some data while you’re running your practice», but it just almost never happens. Money, whether we like it or not, as human beings, at least in a capitalist society, it’s such a huge reinforcer, it has massive consequences. It’s even hard to admit, and becoming an employee or employer it’s really sensitized me to that, to how important to have a good way that you handle how money works at a variety of levels.

Jenna: Having a time that is actually paid, that you are paid to do your research, is what helps that happen rather than just saying «well I’m just gonna not work on Fridays and I’ll just do research on the side», that doesn’t really work. You have to say «I’m getting paid to do research on Fridays» and then you’ll keep that time separate.

Fabián: Are you happy doing your own research?

Jason:  what I’ve liked about it traditionally is that I don’t have any organizations impinging on what I do so I can do what it is that I think it’s most important and or what I’d like to do research on.

That’s the real upside of it, there’s a lot of freedom and a lot of control over what I do. And the downside of it probably is that I’m not embedded in an academic department, and there is something important about being in those social flows of information: all of the things you learn and all the collaborations you build just from bumping into people at hallways, all of those loose ties, not close people but all the people you know less that’s well, that results in a lot of learning. So when you’re in a setting like this you have to focus more on building collaborations and maintaining collaborations, I think, so sometimes it’s harder to maintain collaborations not being in academia.

Another thing is harder, you know, we don’t have so much access to, say, students, postdocs, but outside of the postdocs, we don’t have many students in the lab or things like that. It’s harder to maintain relationships with students as well,  it’s not hard to have trainees to train clinically, but students who are gonna be involved, research-wise, that’s harder.

Fabián: and that bring us to the next topic, the Portland Consultation Model, did it sprang from research…? wait, actually, probably not a single one of our readers know what it is… for me the consultation model is a really interesting thing because it is a little thing that  I haven’t seen that in any other psychological model, so  can you tell us about it?

Jenna: so the model is an experiential model of learning and practicing ACT and it’s intentionally non-hierarchical and so it does not have, the way we have participated in it, is that it doesn’t have a leader and there are several roles we meet. The group meets once a month and there are several roles. At the heart of it is this: you have one person who is wanting to practice a specific skill, an ACT skill, it could be an actual intervention that they want to practice or a process that they want to work on, and then everybody else in the group has a role in helping support that person, which we call the skill builder, practicing their skill.

This is where I think it is very different than most consultation groups, that focus is not on the client or solving a client issue, the focus is on the therapist and helping the therapists practice a skill, so the skill builder is really the focus, and then there’s another person in the group who helps the skill builder practice their skill by being in the role of the «client» -but you know in ACT we think we’re all in the same soup, so you’re just talking about your own stuff, but you’re talking about it in the service of letting the skill builder practice this one skill or process. And then there are other roles: there’s somebody who is monitoring how ACT consistent or inconsistent it is, there are people who are sort of tracking where on the act six processes or in the hexaflex the interventions are, so there are several different roles.

And I’ve heard that as this, what’s called the Portland model, has been utilized around the world people are making really cool changes and modifications to it, and adding new role;s like I heard here in Argentina they have added a role about the relationship piece of things in one of the groups, which is so beautiful and wonderful, so I hope that it’s the kind of thing that continues to progress and grow and can be flexible and adapt to whatever needs you have.

But I would say the main part of it is that the focus is on building a skill rather than solving a clinical problem. Jason, do you want to talk about the history of it?

Jason:  Sure. The origin of this peer consultation model was twofold. One was after I left Steve Hayes lab. Steve, when he ran its training groups, they were hierarchical; Steve would expound on ACT topics brilliantly, for extended periods of time, and provide beautiful case consultation, supervision on things, and so when we moved out of there and moved into a more of a peer context, that was the model we had.

And there were some downsides. One was that if, say, I or Jenna were in the peer consult group, everyone would look to us for the answers as the experts, and that sometimes interfered with their own learning because they’re always looking to the same people, and there’s actually a lot to be learned from all the other people in the group. And second, it resulted in a lot of burden on us as the leaders of the group, and we didn’t really want that, we want it to be a peer consult group, not a supervision group, and so one thing we thought was how can we shift this so that the burden of organizing the group, leading the group, providing the feedback, all that, didn’t fall in one or two people’s lap but be distributed amongst the whole group. Just to share the workload in some sense but also to share the learning.

So one of the origins was that kind of shift from a supervision to a consult, the peer-based thing, and then actually the second major influence was Toastmasters. I don’t know have you heard of Toastmasters

Fabián: um, no?

Jason: Toastmasters is a public speaking organization and it’s probably the largest, almost certainly, the largest organization that helps people learn how to be good public speakers, and they’re in the whole world.  I’m guessing there are probably a bunch of meetings in Buenos Aires [note: there are, indeed]. I was just talking to someone from London the other day about Toastmasters and he went on his phone and he saw there were like 100 meetings in London every week, 100 meetings at least. So it’s a very widespread organization that basically teaches people how to do public speaking, and it’s similar in the sense of there are no leaders, it’s distributed, there may be a lead at a particular meeting but there’s not a leader over time. And they have this method that’s an experiential learning method where people take all these different roles, they have opportunities to be speakers, they have opportunities to be evaluators, they have opportunities to learn how to run a meeting, and all these different roles and in each of them they get a chance to speak and get evaluated, and it’s all a distributed experiential learning process. So that was a lot of inspiration for how to organize the group, to have these different defined roles that had different functions and altogether made an effective learning experience.

Jenna: can I add to that?  Also I think Jason and I get asked about the Portland model most frequently because we’re a little bit more in the public eye and so people often think Jason and I made up the Portland model and I really do want to be clear, we didn’t make this up on our own, the whole consult group together that we were meeting with came together and said, okay we had been meeting for, I don’t know a couple of years, and we all came together and said this isn’t working, we want to figure out a different way to do this, and everybody came together and Jason had this experience with Toastmasters, and everybody sort of came together…

Jason: …and Brian Thompson was also at Toastmasters and he is the first author of the paper

Jenna: Oh, yes, yes, absolutely. So it is important to me that everybody realizes that was very much a group effort which I think represents what we want in the consult group: that this isn’t how one or two experts dictating how it’s going to go, this was something that was created out of a group of peers.

Fabián: Yeah, yeah, I remember Brian Thompson was the first author, and there were six or seven other people on the paper. And what do you do with the clinical issues? a separate meeting?

Jenna: We have in the very beginning of the consultation group a small dedicated time, if there are short questions for a more clinical kind of consultation that can come up, or you seek that someplace else, this is this isn’t the group to solve a particular clinical problem, but a very nice thing is… because at our clinic, in particular, we have a consult group where we can consult with each other, but the larger peer-consult group that runs this Portland model, most of them are in private practice, so they don’t have access to that, but the cool thing is by participating in this peer-consultation skill-building group they have so many more connections with other providers that they can call up and say «hey I’m having a difficulty with this client, can I consult with you about that?» so it also helps with those relationships and the sense of isolation for people who are in private practice.

Jason: Every meeting has a part of the meeting that is open to anything, any kind of consultation, then it transitions into the skill building part.

Fabián: yes, I can see the use of it. I give supervision myself and I find that many times a lot of the clinical issues are a lack of skills: «I don’t know what to do with this» or “how can I, say, get a client more defused» or something like that.

Jenna: sure

Jason: And what we found was that when we didn’t have the structure of peer-group consultation, oftentimes the consultation would  devolve into this similar pattern, where a person is coming in which describes the situation, and it may take anywhere from 5 to 30 minutes, and then you’d have this one person saying «I think you should do this» and another person saying «I think you should do this» and then this third person would say»I think this about the case» or a person say this…

Jenna: haha, right

Jason: and then everyone is interrupted and nobody really gets to work their idea out, and it was just frustrating. And it happened again and again and again, and so this was a solution in part to that

Fabián: it is a really interesting thing also because I know a bit about DBT and I always liked this idea of DBT that therapists need support.

Jenna: absolutely

Fabián: it is a core idea that many times gets neglected in the psychological models, so when I read about the Portland model I saw it as the ACT response to the DBT consultation group because DBT includes that as a standard feature of the model.

Jenna: Yeah, yeah, and it’s kind of cool that the person who’s getting support, it’s like a twofer, because it is also helping the other therapists practice skills, so it’s like both needs are potentially getting that, because the therapist who’s in the client role is working with their own stuff, which is usually stuff about being a therapist and how hard it is to be a therapist

Fabián: yes, it is difficult to be a therapist, we need support.

Jenna: it’s difficult being a human being, and it’s difficult being a human being who sits with other humans who are suffering all day.

Fabián: So, move on. Let’s talk about the CBS and the future of CBS. I’d like to ask both of you: what would you hate and what would you love to see happening in the CBS in the future?

Jenna: I have a strong response to that, haha.

Fabián: I was aiming for that!

Jenna: well partly it’s something that I think I’m seeing a little bit more of in the CBS community, and I think I feel sadness, or I feel anxiety that it could increase and I think I’m seeing a little bit of this division between the basic science researcher type and the clinician type, and I just think that would lose so much of what is meaningful about the CBS community, because I guess one of the things about our clinic, I’m not primarily a researcher, in fact right now I’m spending none of my professional time doing research, and yet I really want my clinical work to inform what the researchers are doing and I really want my clinical work to be informed by what they’re doing. And what I see in the CBS world is we’re starting to get into two different camps, we have the track for people who want RFT and basic science, and then we have the clinical track and the people who don’t want to have anything to do with RFT.

And part of what I love about the work that people like Jen and Matt Villatte, and people like Niklas Torneke are doing is that they’re bringing that RFT language and helping clinicians see how applicable it is, and I really hope that there are clinicians who are helping the researchers see how important the clinical end of things is.

So that for me would be one of the most import things, in addition to the conversation that’s been going on for the last couple of years about having a more inclusive and diverse voice in CBS, including the voice of women and gender and sexual minorities, and people outside of the United States, those are my two big things.

Fabián: I like that.  I was thinking, I’d say the book of Louise McHugh goes on those directions…

Jenna: …yes, yes, absolutely, absolutely, I would say Louise McHugh is absolutely in that camp as well.

Fabián: and Jason, what would you say?

Jason: well there are many things… I agree with the things Jenna said. If I could geek out a little bit more…

Fabián: …oh, yes, by all means

Jason: As a researcher, I think the broadest thing that I would like contextual behavioral science to take more seriously is the issue of motivation. I feel motivation in terms of a process of reinforcement and consequences as motivating, I think really that’s been well articulated, but the topic of establishing operations and motivating operations, I feel like behavior analysis has never really taken that very seriously, it doesn’t have a good analysis of motivating operations. If you look in the literature on how many papers there are about motivating operations, there aren’t very many, and there aren’t very many that studied that experimentally.

So I think that CBS needs a better theory about motivation, and in ACT that’s largely tied to the process of reinforcement, and things like augmentals and values, and outside that you don’t have a lot about motivation. To me, this is part of why I’ve gone into affective science, because in many ways affective science is the study of motivation, as much of what it’s about. It’s also about the study of social signaling, of how the expression of emotions signals various things, the suppression of expression which signals various things to other people and shapes their behavior, but I feel CBS and behavior analysis in general, it doesn’t have an adequate analysis on the topic of motivation.

Fabián: do you think we need more besides augmentals and the verbal stuff?

Jason: yeah, and I feel like there’s a lot of aspects of motivation, there are both verbal ones but there are also ones that aren’t verbal, that are just biologically ingrained, and we don’t have an experimental analysis of those. We have ideas about it, but we don’t have an experimental analysis of that. Like, how do you move around motivating operations? How do you change those experimentally? I don’t think we really have a good experimental analysis of that, outside of this idea of augmentals. I think there’s a lot to be done there.

Let me just give you an example. Humans are born into the world with a certain repertoire of innate emotional expressions, and they function in a somewhat innate way, in the same way that for example, it’s hard to teach a pigeon to press a lever with their wing, it’s much easier to teach them to press a lever with their beak, their biology has prepared them to peck; we are biologically prepared to respond to certain stimuli in certain ways, and to certain other stimuli in other ways. That isn’t it always acknowledged inside of behavior analysis, it’s almost like people are blank slates that can be shaped in any way, and I think we don’t have a good analysis of what is that, what is that that stuff that we come into the world with, prepared to respond in certain ways.

And I think some of the research on affective science, for example, studying some of those things, of how do we tend to respond to different things, and how we could have that inform how we work with people and try to help them. I just feel like there’s a very rich literature there that addresses that.

Fabián: I was remembering while you said that, this researcher working in behavior analysis, I cannot remember his name [note: it was Timberlake] , that he found that when you changed the position of the feeder in the conditioning boxes for pigeons you had different kinds of responses, in superstitious behavior for instance, so if you put the feeder on the ground, that’s where the food usually is for a pigeon, you had a completely different repertoire, so yeah it makes sense, since a human is a little bit more complicated than a pigeon.

So, Jenna, Jason, I don’t want to take any more of your time, you have earned your rest, I hope you have a great stay in Argentina and really, thank you, it has been an honor for me.

Jenna: thanks

Jason: thank you.