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

Section 5
Perfectionism in Depressed Clients

CEU Question 5 | CEU Test | Table of Contents
Counselor CEUs, Social Worker CEUs, Psychologist CEs, MFT CEUs

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On the last track we discussed the four perfectionist standards which depressed or dysthymic clients who self-criticize may use. These four standards were "Being Number One," "Being God," "Better Way," and "Ceaseless Productivity."

On this track we will discuss six consequences of perfectionism in depressed or dysthymic clients.  These five consequences of perfectionism in depressed or dysthymic clients include:  Constant Failure; Demotivation; Disillusionment; Never Beyond Reproach; and Negative Focus.

Remember Caroline from the last track? Caroline was a successful graphic artist with a diagnosis of depression who used the perfectionist standard of "Being Number One." After attending a party and seeing a man in attendance who was a better conversationalist than herself, Caroline began feeling depressed, worthless, and angry.

Caroline stated, "There was no way I could compare. I felt so socially awkward I wanted to sink into the floor." Caroline then went on to say that she felt others were criticizing her social ineptitude as well. Caroline stated, "I just felt like everyone else could see my deficiencies because of Seth. I felt paranoid every time I heard other guests laughing and hadn’t heard a joke myself. I just assumed they were laughing at me.  Everyone was ignoring me, so I started to ignore them.  I know I don't deserve your time, but you could at least be somewhat courteous."

5 Consequences of Perfectionism

Consequence # 1. Constant Failure

The first common consequence is Constant Failure. Recall from the previous track that Caroline mentioned her anxiety about attending parties. Caroline stated, "Usually every time I go to a party, something happens and by the end of the night I go home depressed." Caroline faced this Constant Failure every time she attended a party or social gathering.

Obviously, depressed or dysthymic clients with this consequence feel that success is a rare occurrence.  They lose faith in themselves to break the cycle of failure and begin to see their life as a series of self-fulfilling prophecies

In addition to criticizing themselves, they also look to others to either confirm or deny these internalized beliefs.  If the family member or loved one agrees with the client, it further deepens the scar left by the self-criticism.  If the family member or loved one denies the client's internalized belief, she or she will be thought of as dumb or unsympathetic.  

Consequence # 2. Demotivation
Obviously, perfectionist depressed or dysthymic clients receive very little self-reinforcement or self-acknowledgement in their perfectionism. Once in perfectionist patterns, depressed or dysthymic clients often find themselves facing the question, "Why do anything when nothing is ever good enough?" 

As you already know, depressed or dysthymic clients constantly shift from one extreme to the other.  At one point, they may be motivated by a passion for a hobby and the next they become disillusioned with that same hobby. Sound like a client of yours?

Consequence # 3. Disillusionment
As you already know, depressed or dysthymic clients can never maintain stability in their relationships with other people and swing between idealization and devaluation.  This devaluation period is precluded by a perceived insult or betrayal and subsequently a disillusionment in the infallibility of the other person becomes imminent.  This disillusionment will not only manifest itself in interpersonal relationships, but also in the clients themselves.

Obviously, to expect oneself to meet a standard of perfection is in a way making an exalted claim. By holding themselves to a standard of perfection, depressed or dysthymic clients are implicitly saying that they can attain this standard.

As you may predict, the result is that when depressed or dysthymic clients cannot attain their standard of perfection, they often experience the failure as a painful blow to their pride.

Consequence # 4. Never Beyond Reproach
As you know, one possible definition of the word "perfect" is "beyond criticism or reproach." Often depressed or dysthymic clients impose perfectionist standards because it is important to them to place themselves beyond others’ criticisms. When perfectionist depressed or dysthymic clients are imperfect, they often feel extremely vulnerable and endangered.

Again, recall Caroline’s case. Her primary fear was that other people at the party were criticizing her in comparison to Seth.  When they cannot achieve that goal in any aspect of their lives, depressed or dysthymic clients feel they have failed and this obviously contributes to their sense of worthlessness.  They can never accept being less than someone else, and become frustrated when faced with their own limitations.  This could result in angry outbursts at others or sulky, brooding episodes when the client refuses to speak with anyone.

Consequence # 5. Negative Focus
As you know, perfectionist patterns lend themselves to negative attentional focus. The depressed or dysthymic client will generally pay attention only to his or her deficits. she or she does not notice positive actions, accomplishments, or even personal qualities that might be appreciated or celebrated.

During sessions, when I turned the conversation to the client’s positive attributes, he or she would be quick to counteract with a negative attribute.  Often, this is a challenge of the therapist-client relationship resulting from the client’s fear of abandonment.  The client wishes to test the waters, so to speak, and discern whether or not the therapist is going to leave the client as they perceive everyone else in their life has.

Technique:  Mantras
To help Caroline overcome her perfectionist self-critic, I offered her a simple technique called "Mantras." See if this technique sounds like it would work for your self-critical depressed or dysthymic client.

To do the "Mantras" technique, I asked Caroline to pick a short phrase, or mantra, to use to respond to her critic. I offered the mantra examples of "Shut up!" and "Stop this garbage!" I explained to Caroline that any time she felt a critic attacking her, she should speak firmly and clearly at his critic. I stated, "Mentally scream at the critic and try to drown her out with your anger.  The important thing is to catch the critic just as she starts, before she can do damage."  

I try to avoid associating anger with this exercise because of the potential sporadic outbursts that can often occur with depressed or dysthymic clients.  Obviously, we are trying to reduce these outbursts, not encourage them. 

Do you have a perfectionist depressed or dysthymic client like Caroline dealing with any of the common consequences of Constant Failure, Demotivation, Disillusionment, Never Beyond Reproach, or Negative Focus? Would your Caroline benefit from the "Mantras" technique?

I have found some clients react well to being provided with the facts of their disorder.  Would it be beneficial to play this track or other tracks in this CD set for a client of yours? 

On this track we have discussed the six common consequences of perfectionism. These common consequences were Constant Failure, Demotivation, Disillusionment, Never Beyond Reproach, and Negative Focus.

On the next track, we will discuss the "Hanging Judge" syndrome in self-critical depressed or dysthymic   clients and its three components: self-hatred, injustice, and a lack of compassion for oneself.

Peer-Reviewed Journal Article References:
Cunha, C., Gonçalves, M. M., Hill, C. E., Mendes, I., Ribeiro, A. P., Sousa, I., Angus, L., & Greenberg, L. S. (2012). Therapist interventions and client innovative moments in emotion-focused therapy for depression. Psychotherapy, 49(4), 536–548.

Dunkley, D. M., Starrs, C. J., Gouveia, L., & Moroz, M. (2020). Self-critical perfectionism and lower daily perceived control predict depressive and anxious symptoms over four years. Journal of Counseling Psychology. Advance online publication.

Hewitt, P. L., Smith, M. M., Deng, X., Chen, C., Ko, A., Flett, G. L., & Paterson, R. J. (2020). The perniciousness of perfectionism in group therapy for depression: A test of the perfectionism social disconnection model. Psychotherapy, 57(2), 206–218. 

Nepon, T., Flett, G. L., Hewitt, P. L., & Molnar, D. S. (2011). Perfectionism, negative social feedback, and interpersonal rumination in depression and social anxiety. Canadian Journal of Behavioural Science / Revue canadienne des sciences du comportement, 43(4), 297–308. 

Richards, C. S., Cohen, L. M., Morrell, H. E. R., Watson, N. L., & Low, B. E. (2013). Treating depressed and anxious smokers in smoking cessation programs. Journal of Consulting and Clinical Psychology, 81(2), 263–273.

“Self-critical perfectionism and depressive and anxious symptoms over 4 years: The mediating role of daily stress reactivity”: Correction to Mandel et al. (2015) (2017). Journal of Counseling Psychology, 64(2), 232. 

Shanok, N. A., Reive, C., Mize, K. D., & Jones, N. A. (2020). Mindfulness meditation intervention alters neurophysiological symptoms of anxiety and depression in preadolescents. Journal of Psychophysiology, 34(3), 159–170.

Online Continuing Education QUESTION 5
What are the six common consequences of perfectionism? To select and enter your answer go to CEU Test.

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