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

Section 1
Self-Criticism and Depression

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New Content Added: To update the content we have added Dream & Depression and Solution-Focused Brief Therapy information found at the end of the Table of Contents.

On this track, we will discuss some of the common consequences of depressed or dysthymic clients’ pathological self-criticism.

As you know, self-criticism is a common symptom of depression and dysthymia. A client diagnosed with depression or dysthymia may experience low self-esteem, guilt, and a feeling of no self-worth. His or her ability to evaluate him or herself objectively plummets. Feelings of worthlessness or inappropriate guilt may persist most of the day, nearly every day. Your depressed client may have unrealistic negative evaluations of his or her worth, and may have guilty preoccupations or ruminations over minor past failings. 

Also, as you are aware, depressed or dysthymic clients will often misinterpret neutral and trivial day-to-day events as evidence of personal defects and begin to express a great deal of aggressiveness towards others and most importantly themselves.

In addition, a depressed or dysthymic client’s sense of worthlessness may be of delusional proportions, such as blaming him or herself for world poverty or believing that he or she is essentially a bad person. Thus, as you can see, treatment of the depressed or dysthymic client’s self-critical behaviors is key to helping him or her cope with depression or dysthymia.

We will talk about clients who have a depressive disorder related to a pathological form of criticism. By pathological, I mean your depressed or dysthymic client is manifesting self-critical behavior that is habitual, maladaptive, and compulsive.

Mary, age 22 recently graduated from college and was diagnosed with depression. Mary came to a session upset because she had said something in a job interview that she immediately regretted. Mary stated, "The interview was going along fine, until they asked about how familiar I was with the company." Mary explained that she told them she had never heard about the company before hearing that they were hiring.

Mary stated, "Then I said I had really only looked up a few details about the company. As soon as I said it, I wished I could take it back. It looks so unprofessional to know so little about a job you are applying for! I spent the rest of the interview kicking myself about how stupid I am. I always say something stupid in my interviews!  And those jackasses knew it all along!" 

In the days following the job interview, Mary’s self esteem plummeted and her depression worsened. Mary stated, "I knew I wouldn’t get the job. Even if I hadn’t said that I didn’t know much about the company, they probably would have figured out I was unqualified anyway."

I have found that there are five common consequences that self-criticizing depressed or dysthymic clients, like Mary, will face. As I explain these five common consequences and Mary’s experience, think of your depressed or dysthymic client. Which consequence is he or she facing?

Five Common Consequences of Self-Criticism
1. Damaged Self-Esteem:
As you are well aware, a person’s summary appraisal of his or her own worth is his or her self-esteem. Your client’s self-esteem is clearly a product of the depressed or dysthymic client’s functioning as a critic of him or herself. Thus, if the depressed or dysthymic client repeatedly brands him or herself as unlovable, selfish, screwed-up, and other such negative labels in hateful and abusive attacks, his or her self-esteem will be abysmal. As you can see with Mary’s case, because she kept beating herself up over one slip-up in a job interview, her self-esteem dropped drastically.

2. Personal Ineligibility: Obviously, when depressed or dysthymic clients criticize themselves so destructively, they are doing more than just beating themselves up. They are also making evaluations that affect their sense of eligibility to behave in the world. I have found that depressed or dysthymic clients who self-criticize frequently experience tremendous doubt, behavioral paralysis, and despair. This is especially true as they pursue desired relationships, jobs, and other opportunities in life.

Does this sound like something that your depressed or dysthymic client may be dealing with? As you can see with Mary, her self-criticism made her feel that she was unqualified and ineligible for the job to which she had applied.

3. Vulnerability to Others' Criticisms: I have found that this vulnerability can occur in three ways.
a. First,
the self-critical depressed or dysthymic client is often immediately ready to concur with the negative judgments others pass. As you know, this is because depressed or dysthymic  clients generally believe the worst about themselves.
b. The second way that the vulnerability to others’ criticisms manifests itself is that the depressed or dysthymic  client will generally become dependent on the reception of esteem from others. I have found that this usually comes in the form of approval, love, and recognition.  This also relates to the depressed or dysthymic  client's need to attach him or herself to authority figures or loved ones.
c. Finally
, the third way that the vulnerability manifests itself is that the self-critical depressed or dysthymic  client tends to adapt his or her behaviors inappropriately to what he or she perceives to be others’ desires. In Mary’s case, she became much more vulnerable to the criticism doled out by her parents. After Mary told her parents about what she had said at the job interview, they concurred with her opinion that she had been stupid and told her not to "screw up" again.

4. Dismissal of Positives: Obviously, when depressed or dysthymic  clients are always prepared to criticize their mistakes and faults but never recognize their strengths and accomplishments, they rob themselves of satisfaction in life. In cases when the self-criticizing depressed or dysthymic  client does notice accomplishments, he or she will at best experience meager feelings of satisfaction.

Do you have a depressed or dysthymic client who feels little satisfaction in his or her life due to his or her self-critical behaviors? My client Mary, a depressed or dysthymic client, also experienced this consequence of dismissing the positives. Although she had recently graduated college and was the first in her family to do so, Mary gave herself little credit for this accomplishment. She instead focused on her lack of a job, and stated, "If I were really all that smart, I’d have a job, not just this piece of paper that says I was in school for four years."

5. Inability to Change: Have you noticed in your depressed or dysthymic  clients who self-criticize that the criticism contains little that your client may use to modify his or her behavior in the future? In my experience, most depressed or dysthymic clients can give harsh, self-prosecuting attacks but can rarely give themselves advice as to how to correct their behavior.

As you can see with Mary, she spent the rest of the interview and days following the interview criticizing herself because she said something that she labeled as "stupid." However, this behavior did not offer her any methods of preventing her from saying something "stupid" again in the future.

Technique:  Just Good News
To help Mary get beyond the destructive self-critical behavior she was exhibiting following the job interview, I invited her to do an exercise. The exercise I invited Mary to do was the "Just Good News" exercise. As I explain how the "Just Good News" exercise worked for Mary, think of your depressed or dysthymic  client. Would this exercise be appropriate for him or her?

To do the "Just Good News" exercise, I first asked Mary to review the day’s happenings so far. Next I stated, "Single out those activities that were enjoyable, constructive, productive, or positive in any way." Mary struggled to come up with positive happenings, and finally listed, "Well, I made it to work a little early, and my boss noticed. And this afternoon I got gas at a station where the price was ten cents cheaper than any other station in the city."

As you can see, the key to this exercise is counterbalancing the exclusively negative self-critical focus exhibited by most depressed or dysthymic  clients. I explained this to Mary, stating, "The essential nature of the task is a self-reinforcing, self-affirming one." I then suggested that  Mary might practice the "Just Good News" exercise every day before she went to sleep.

Do you have a depressed or dysthymic client like Mary who practices pathological self-criticism? Is your Mary experiencing any of the five common consequences of self-criticism, which were Damaged Self-Esteem, Personal Ineligibility, Vulnerability to Other’s Criticisms, Dismissal of Positives, or the Inability to Change? Would the "Just Good News" exercise be appropriate for your client?

On this track we have discussed the five common consequences of pathological self-criticism, or criticism that is pathological due to its being habitual, maladaptive, and compulsive.  These five common consequences were Damaged Self-Esteem, Personal Ineligibility, Vulnerability to Other’s Criticisms, Dismissal of Positives, and the Inability to Change.

On the next track we will discuss self-degradation ceremonies and the three common consequences of those ceremonies. The three common consequences of self-degradation ceremonies are Behavioral Restriction, Emotional Distress, and an Inability to be the Final Arbiter of one’s Own Status.

Peer-Reviewed Journal Article References:
Chui, H., Zilcha-Mano, S., Dinger, U., Barrett, M. S., & Barber, J. P. (2016). Dependency and self-criticism in treatments for depression. Journal of Counseling Psychology, 63(4), 452–459. 

Joeng, J. R., & Turner, S. L. (2015). Mediators between self-criticism and depression: Fear of compassion, self-compassion, and importance to others. Journal of Counseling Psychology, 62(3), 453–463.

Kannan, D., & Levitt, H. M. (2013). A review of client self-criticism in psychotherapy. Journal of Psychotherapy Integration, 23(2), 166–178. 

Online Continuing Education QUESTION 1
What are the five common consequences of self-criticism? To select and enter your answer go to CEU Test.

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