Table 6.

Suggested clinical recommendations and implications.

Acceptability-related outcome/goal	Recommendation
Engagement	• Clinicians to be mindful of potential negative attitudes and beliefs about self-compassion in initial discussions with service users. Questionnaire measures, such as the Gilbert, McEwan, Matos and Rivers (69), may be useful for eliciting these beliefs which can then be explored and normalised. • Clinicians to also be aware of the potential for anxiety around participating in group therapy in this client group. Presenting information on the potential benefits of the group may help to alleviate these anxieties, as well as providing reassurance that the focus of the group will not be on revealing a lot of personal detail.
Retention	• Clinicians to be mindful that service users may initially find compassionate exercises difficult and that they may need additional support to help problem-solve and individually tailor compassionate exercises to fit their cognitive profile and lifestyle. • CFT interventions offered should include all the recognised components as outlined by Gilbert (2, 18, 20), i.e. psychoeducation, compassionate exercises, and group discussion as all appear valuable to participants. • It is likely to be necessary to make adaptations to the delivery of the intervention content, particularly the psychoeducational material, when working with individuals with intellectual disability and other forms of neurodivergence. • Facilitator approach is important to the participant experience of CFT. A good standard of training and supervision will support facilitators to maintain the level of openness and responsiveness that participants value. Personal practice of CFT may also be also help support group facilitators in this (70).
Other	• If feasible, it may be helpful to offer additional ‘top up’ sessions for participants to help sustain and build on therapeutic gains. • Group facilitators should ensure that they offer support to group members to process the feelings of loss they may experience at the end of the intervention, and to think about how and where they can access support from others following the intervention. • If appropriate, it may be useful to help group participants to consider how they may stay in contact following the group so that group members can continue to offer each other peer-support. • When evaluating group CFT interventions services should ideally include a longer-term follow-up, so that benefits that might have accrued following the intervention are not missed.