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Effectively Treating Pathological Self-Criticism in Depressed & Dysthymic Clients
Safety Strategies/Behaviours and the Functional Analysis of Self-Criticism
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.
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.
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