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

Section 2
Shame and Depression

CEU Question 2 | CEU Test | Table of Contents
Counselor CEUs, Psychologist CEs, Social Worker CEUs, MFT CEUs

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On the last track we discussed the five common consequences of self-criticism. These five common consequences depressed or dysthymic  clients experienced were Damaged Self-Esteem, Personal Ineligibility, Vulnerability to Other’s Criticisms, Dismissal of Positives, and the Inability to Change.

On this track we will discuss the depressed or dysthymic client’s self-degradation ceremonies. Self-degradation ceremonies are rooted in degradation ceremonies that are general in nature.

As you know, the paradigm, or the epitome of cases of degradation ceremonies are found in formal public rituals in which an individual’s place or status in the community is drastically diminished. In such extreme cases, one person formally degrades another person before witnesses. In private self-degradation ceremonies, the depressed or dysthymic client will fill all three roles. Your depressed or dysthymic client, in a self-degradation ceremony, may serve as the denouncer, the denounced, and the witness. At the end of this track, I will provide you with a "Guilt List" technique for your self-degrading depressive client.

Shiela, a 25-year-old had attended a party at a state park. During the party, a boy that she liked asked her to walk with him through the forest. Sheila excitedly agreed. After they had walked a distance away from the site of the party, the boy stopped walking and suddenly thrust his hand into Sheila’s pants. Sheila stated, "I was so shocked and confused I froze. I didn’t know what to do. But I also didn’t want to make him angry. So I just stood there, and he finally took his hand out after about five seconds." Sheila explained that nothing else happened and the two then walked back to the rest of the party.

However, because of this incident, Sheila criticized herself. Sheila stated, "I’m such a slut. I can’t even socialize with my friends anymore. They’re all good kids, and I’m just a bad person! I’ve lost my morals. I’m easy and dirty. I don’t belong with my friends."

I have found that self-degradation ceremonies, like the one Sheila was clearly participating in, have three common consequences. These three common consequences are Behavioral Restriction, Emotional Distress, and an Inability to be the Final Arbiter of One’s Own Status. Let’s look at each of these consequences more closely.

Three Common Consequences of Self Degradation Ceremonies
1. Behavioral Restriction:
In my experience, depressed or dysthymic clients who self-criticize and experience behavioral restriction tend to refrain from behavior relevant to the sphere of disqualification or experience difficulty engaging in such behavior. Depressed or dysthymic  clients who self-criticize may also restrict their lives because they fear that they might be subjected to painful experiences that reconfirm their degraded status if they took behavioral risks.

In other words, they believe it is better to "pull in one’s horns" and restrict their lives than suffer the reconfirmations. In Sheila’s case, after she labeled herself a slut, she withdrew from all social activities with her friends because she felt she was no longer one of them.

Do you have a depressed or dysthymic client
whose self-criticism causes him or her to restrict his or her behavior?

2. Emotional Distress: This consequence is almost too obvious to discuss, but I have found that there are many aspects to consider regarding emotional distress. In my experience there are four types of labels depressed or dysthymic clients may use in self-degradation ceremonies to cause emotional distress.
a. When labels that a depressed or dysthymic client assigns to him or herself are such that he or she continually feels unable to succeed at vital tasks, such as "stupid," the resulting emotional state is anxiety.
b. Labels that cause the depressed or dysthymic client to feel that they have socially discrediting and stigmatizing characteristics, such as "sexual deviant," result in shame.
c. Labels regarding moral deficiencies, like "selfish," cause the depressed or dysthymic client to feel guilt.
d. Finally, labels capturing conditions that permanently and hopelessly disqualify the depressed or dysthymic client, such as "born loser," cause despair.

Obviously, these labels are not mutually exclusive. As you can see with Sheila, labels from two categories were being used. Sheila was labeling herself as a slut, which resulted in shame, as well as a bad person who lost her morals, which resulted in guilt.

Which labels is your depressed or dysthymic client using? What are the resulting emotional states he or she is experiencing?

3. Inability to be the Final Arbiter of One's Own Status: This consequence often results from labels that depressed or dysthymic clients assign to themselves that leave them in especially vulnerable positions. As you know, depressed or dysthymic clients who label themselves as "irrational" and "intellectually inferior," for example, put themselves in a position to be controlled by others’ beliefs about them. These labels involve a lack of belief in one’s own competence at seeing the world realistically.

As a result the depressed or dysthymic client feels he or she cannot derive sound, logical judgments and decisions, including judgments and decisions about their own worth. Thus the depressed or dysthymic client experiencing an inability to be the final arbiter of his or her own status is entirely dependent on others’ judgments of his or her worth.

Technique:  Guilt List
For Sheila, it was clear to me that one key to getting over her depression was overcoming her guilt. To help her do this, I invited her to participate in the "Guilt List" technique. As I explain the "Guilt List" technique, think of your depressed or dysthymic client. Would this technique work for him or her?

To do the "Guilt List" technique, I handed Sheila a notebook and asked her to list some of the bad things she had done in the previous year. Sheila began by listing the incident at the graduation party. She then listed "argued with mom about curfew," "refused to drive brother to school," and "called in sick to work when I wasn’t sick." I stated to Sheila, "Now, look at each item objectively and give yourself points on a scale of one to ten for how much guilt is appropriate for them." Sheila thought and, after several minutes, wrote "graduation party, 5. curfew argument, 3. drive brother, 4. called in sick, 5."

Although Sheila was still assigning inappropriate guilt for the graduation party incident, she had downgraded her amount of guilt she felt she deserved. I explained to her that now she needed to add up her guilt points. Sheila stated, "OK, 17. What does that mean?" I replied, "Does it make any difference if that score is 17 or 100 in the present?" Sheila hesitantly responded, "I guess not." I stated, "The present moment is still the same regardless of your guilt score. The guilt you feel is merely a wasteful activity." I stated that when she started feeling overwhelming guilt, she could do the "Guilt List" technique again to reevaluate her levels of guilt.

Do you have a depressed or dysthymic client like Sheila who practices self-degradation ceremonies? Is he or she experiencing behavioral restriction of the inability to be the final arbiter of his or her own status? Or is your client, like Sheila, experiencing emotional distress? If so, would the "Guilt List" technique be appropriate for him or her?

On this track we have discussed self-degradation ceremonies and the three common consequences of those ceremonies. The three common consequences of self-degradation ceremonies were Behavioral Restriction, Emotional Distress, and an Inability to be the Final Arbiter of One’s Own Status.

On the next track we will discuss recognizing the difference between destructive self-degradation and constructive recognition of personal limits. We will discuss three criteria for determining if self-criticism is destructive self-degradation or not. These three criteria are realism versus lack of realism, wider implications of worth, and degree of self-punitiveness present.

Peer-Reviewed Journal Article References:
Andrews, L. A., Hayes, A. M., Abel, A., & Kuyken, W. (2020). Sudden gains and patterns of symptom change in cognitive–behavioral therapy for treatment-resistant depression. Journal of Consulting and Clinical Psychology, 88(2), 106–118.

Birk, J. L., Kronish, I. M., Moise, N., Falzon, L., Yoon, S., & Davidson, K. W. (2019). Depression and multimorbidity: Considering temporal characteristics of the associations between depression and multiple chronic diseases. Health Psychology, 38(9), 802–811.

Kim, S., Thibodeau, R., & Jorgensen, R. S. (2011). Shame, guilt, and depressive symptoms: A meta-analytic review. Psychological Bulletin, 137(1), 68–96.

Perry, J. C., Constantinides, P., & Simmonds, J. (2017). Dynamic conflicts in recurrent major depression: Does combined short-term psychotherapy and antidepressive medication lead to healthy dynamic functioning? Psychoanalytic Psychology, 34(1), 3–12.

Sullivan, R., Green-Demers, I., & Lauzon, A. (2020). When do self-conscious emotions distress teenagers? Interrelations between dispositional shame and guilt, depressive and anxious symptoms, and life satisfaction. Canadian Journal of Behavioural Science / Revue canadienne des sciences du comportement, 52(3), 210–219.

Online Continuing Education QUESTION 2
What are the three common consequences of self-degradation ceremonies? To select and enter your answer go to CEU Test.

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