Sponsored by the HealthcareTrainingInstitute.org providing Quality Education since 1979
Add to Shopping Cart

Effectively Treating Pathological Self-Criticism in Depressed & Dysthymic Clients
Effectively Treating Pathological Self-Criticism in Depressed and Dysthymic Clients

Section 18
Self-Criticism Coping Technique:
Compassionate Mind Training (CMT)

CEU Question 18 | CEU Answer Booklet | Table of Contents
Social Worker CEUs, Counselor CEUs, Psychologist CEs, MFT CEUs, Nurse CEUs

Safety Strategies/Behaviours and the Functional Analysis of Self-Criticism
A number of therapists have pointed out that self-criticism can serve a number of functions (Driscoll, 1988). Gilbert et al. (2004) found that self-criticism was a complex process with different forms and functions. One aids empathy Pathological Self-Criticism psychology continuing educationfunction focuses on self-correction, such as stopping oneself from making mistakes or keeping oneself on one’s toes, alert to errors and striving to achieve. Another function was to harm the self and take revenge on the self because of anger and contempt with the self, and trying to rid the self of bad aspects. Both forms of self-criticism were highly associated with shame and low mood. As noted above, for high shame-prone people, self monitoring, self-blaming and self-criticism/attacking could be forms of safety and self-regulation strategies, which require careful assessment of their origins and functions before trying to alter them (Gilbert & Irons, 2005).

Rather than trying to identify these processes as distorted cognitions/behaviours or maladaptive, we frame them in the language of safety behaviours (Kim, 2005; Salkovskis, 1996; Thwaites & Freeston, 2005); that is, people are doing the best they can to regulate painful situations, memories and emotions. We stress the fact that powerful feelings and thoughts (automatic reactions) can emerge in us as a result of our evolved emotion systems and past conditioning and in this sense ‘are not our fault’. Shame-prone patients can be so riddled with ideas that there is something fundamentally bad or incompetent about them that we see this ability to ‘stand back’ and see safety behaviours as automatic defences (rather than as distortions or maladaptations) as essential and helpful to a de-centering process, which aids empathy and understanding of one’s distress and self-criticisms.

Compassion can then be extended to one’s self-critical thoughts and behaviours as often automatic safety strategies/behaviours. This avoids people becoming critical of their self-criticism or trying to aggressively rid themselves of, or subdue, their self-criticism. Without this formulation CMT can be difficult, because people can fail to see their efforts as safety behaviours—that they developed to deal with fears of others (e.g., their rejection or contemptuous anger). If the underlying fear is not addressed, people can be very reluctant to give up self-criticism. For example, one person from a rejecting background thought that her self-criticism made her work hard and kept her negative emotions in check and in this way she could ‘earn her place in the world’. If she gave up self-criticism she might not work so hard, not spot her mistakes and never find a place where others loved or valued her. Directly working on self-criticism was less helpful than working on her fear of rejection and of ‘never finding a place of acceptance or belonging’. She learnt to recognize her self-criticism as fear based and to be compassionate to that fear.

We thus discuss self-criticism by formulating it as arising from the following.

  • Early trauma, such as abuse and neglect, bullying or parental/peer criticism. Such traumas are commonly associated with powerful sensory based autobiographical memories and the therapist may explore these in some detail because they have qualities that are like trauma memories (Lee, 2005). Unaddressed, these can make it difficult for the patient to feel safe. For example, one patient could vividly recall the ‘look of hatred’ on her mother’s face and her own terror when Mother had one of her rages. These experiences lay down the emotional memories that form the basis for carrying key fears through life.
  • Basic fears are of two types, externally focused and internally focused. Externally focused fears relate to what the outside world can do to the self, e.g., ‘others have the power to reject and hurt me; they can turn nasty at any moment’. Internally focused fears relate to (a return of) anxiety, panic, shame, depression or rage that one feels one cannot control.
  • Basic safety strategies/behaviours/beliefs are the ways that people have learnt to try to avoid or defend themselves against external attacks and the internal emergence of unwanted emotions that can feel overwhelming or shaming. People may try to avoid harm from others by being overly submissive and non-assertive, blaming self, silencing the self, always putting the needs of others first, not trusting others and keeping them at a distance, or working excessively hard to make themselves desirable to others. Alternatively, they may use avoidant strategies, bully others or keep others at a distance and avoid intimacies. Control of internally aversive experiences can be via dissociation, substance misuse, cutting oneself, reminding oneself of one’s faults and weaknesses or trying to rid oneself of ‘bad things inside me’.
  • Unintended consequences. What start off as understandable efforts to defend the self from external and internal threats often have unintended consequences. Being overly submissive means others may not take you seriously; always putting the needs of others first means one does not learn what one’s own needs and values are, or how to satisfy them. Criticizing oneself to try to reduce errors (and thus reduce threats from others) leads to self-harassment and exhaustion, and rarely being able to be at peace and content with oneself. Keeping one’s distance from others, being highly self-reliant or being a self-concealer can lead to feelings of emotional isolation and never really feeling part of relationships—always the outsider.
  • Self-attacking for unintended consequences. While self-criticism can be part of a safety strategy it can also arise because of the unintended consequences. For example, one submissive woman said that she hated herself for always being so submissive and letting fear overwhelm her. A man who abused alcohol said that at times when he stood back and saw what his addiction had done to him he hated himself for his weakness, got depressed and drank more. In such cases, one starts with compassion for the submissiveness and fear that underpins it, and for the need to use alcohol to soothe the self. Rather than hating the ‘alcoholic self’, we develop compassion for it. Key then is to always seek out the fear or sense of threat that underpins safety strategies.

It is very useful to help people see these links and stand back from them by diagramming them out. This aids a number of processes, including functional analysis. Over time the therapist helps the patient to do the following: (1) Be in tune with the feelings associated with memories, which can have trauma-like and sensory qualities (e.g., being able to recall facial expressions of angry others (Lee, 2005)). (2) Understand the development of the safety strategies as both conditioned emotional responses and planned strategies (and meta-cognitive beliefs) to cope with and avoid external threats (from others) and also the internal threats of the (re)activation of feelings that can seem overwhelming and automatic—we stress the ‘not one’s fault’ concept. (3) Learn compassionate acceptance and empathy for the origins and use of safety strategies. (4) Recognize that we have multiple subsystems (called multi-self, e.g., to attack or flee or seek reassurance, or win approval) that can have different priorities and action tendencies and can pull us in different directions—and these ‘inner conflicts’ can be confusing. We might focus on the fact that ‘different parts of you have been trying as best they can to defend you or help you cope. However, these parts of you never have the overall picture, nor can they see far ahead. So they can pull in opposite directions and be very confusing and feel overwhelming’. (5) Develop compassionate imagery and compassionate and mindful ways of attending to fears and safety strategies that can provide the emotional basis for new forms of attention, thinking, behaving and feeling. We try to teach how to bring compassionate images to mind and reframe self-criticisms, e.g., ‘it is sad I feel frightened/ worthless/confused but this is understandable given the fears I have been confronted with. However, if I am gentle and kind to myself I can focus on . . . ; and it would help to me to do . . .’. CMT focuses on how each aspect of the difficulty has some functional aspect behind it, is linked to the defense system and is usually self-defensive, and how we can be compassionate for this, and change.

Thus we look at the defensive strategies, seek to explore the fears that fuel it (e.g., of rejection or harm from others) and work with those fears compassionately.

- Gilbert, Paul, Procter, Sue; Compassionate Mind Training for people with High Shame and Self-Criticism: Overview and Pilot Study of a Group Therapy Approach; Clinical Psychology & Psychotherapy; Nov/Dec 2006; Vol. 13; Issue 6.

=================================
Personal Reflection Exercise #4
The preceding section contained information regarding Compassionate Mind Training.  Write three case study examples regarding how you might use the content of this section in your practice.

Online Continuing Education QUESTION 18
How does CMT approach coping with self-critical thoughts? Record the letter of the correct answer the CEU Answer Booklet.

 
Others who bought this Depression Course
also bought…

Scroll DownScroll UpCourse Listing Bottom Cap

CEU Answer Booklet for this course
Forward to Section 19
Back to Section 17
Table of Contents
Top

CEU Continuing Education for
Social Worker CEUs, Counselor CEUs, Psychologist CEUs, MFT CEUs, Nurse CEUs
Effectively Treating Pathological Self-Criticism in Depressed and Dysthymic Clients

OnlineCEUcredit.com Login


Forget your Password Reset it!