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Effectively Treating Pathological Self-Criticism in Depressed & Dysthymic Clients
On the last track, we discussed Eternal Penance in depressed or dysthymic clients. We have also discussed the "Compassion Meditation" technique.
On this track, we will discuss assessing ownership of critic behaviors and assessing what clients are trying to accomplish with self-criticism.
One thing I notice frequently in depressed or dysthymic clients is a tendency to attribute self-critical comments to someone else. They refer to him or her as "my critic" or "my critical parent part." In a sense, the person giving the criticism is a dissociated entity within the client. As you may know, these kinds of statements imply that not only is the critic not the client, but also that the client has no control over the self-criticism.
Janelle, age 20, a junior in college struggling with depression, had a problem with self-criticism. On good days, she would say things like, "My critic has been quiet lately and given me a break, but I am always afraid she’ll come back to berate me over my mistakes." When she was having a hard day and being overly self-critical, Janelle would often let me know at the beginning of the session by commenting in an ominous tone, "She’s back again." Before a depressed or dysthymic client can overcome his or her self-criticism, he or she needs to own his or her own critic acts.
8 Common Reasons for Self-Criticism
Reason # 2. The second reason depressed or dysthymic clients may engage in self-criticism is to avoid egotism. For many, the idea that a person can think well of him or herself is morally wrong. They believe it is a sin of pride. As a result, behaviors like putting oneself down and downgrading one’s strengths and accomplishments are behaviors that they view as virtuous behaviors. For depressed or dysthymic clients using this reasoning, they cannot find the line that separates humility from self-mistreatment.
Reason # 3. Following trying to achieve self-improvement and avoiding egotism, the third reason that depressed or dysthymic clients may self-criticize is to protect themselves from dangers. In these cases, they believe bad things would happen if they thought more positively of themselves. Not criticizing themselves puts them in the danger of getting "shot down," of having their hopes dashed, or of receiving criticism from others.
Reason # 4. Fourth, a depressed or dysthymic client may criticize him or herself to atone for past sins. Similar to the self-improvement reasoning, they criticize past mistakes repeatedly. However, unlike the first reason of self-improvement, for depressed or dysthymic clients repeatedly criticizing themselves to atone for past sins, the primary goal is to atone for those sins and ultimately receive forgiveness. Remember Laura from the final track on the previous CD? In her Eternal Penance, she was constantly criticizing herself to atone for a past sin.
Reason # 5. The fifth reason depressed or dysthymic clients may self-criticize is to maintain a needed sense of superiority. For these clients, criticizing themselves for lapses from perfection implies that they believe that they are people for whom perfection is possible. They believe that superior standards are the mark of a superior person and often have double standards, with the lower standard being set for others.
Reason # 6. I have found that some depressed or dysthymic clients will criticize themselves for the sixth reason, to secure reassurance and sympathy. These depressed or dysthymic clients will criticize themselves because it will cause their spouses, family, or friends to pay attention to them, console them, and say positive things about them. Sound like a client of yours?
Reason # 7. The seventh reason a depressed or dysthymic client may self-criticize is to express hostility. Self-criticism can contain an implicit hostile message. One client, Teri, a 29-year-old suffering from depression, told me of a situation when she tried to make a nice dinner for her husband. He came home late from work that night, and commented that the chicken was a little dry. Teri became extremely upset, and said "I’m a terrible cook, and I can’t do anything right!" Teri then ran from the room sobbing. Although her statement was criticizing herself, Teri was also attacking her husband with the implicit statement, "Look how upset you’ve made me with your insensitivity."
Reason # 8. Finally, the eighth reason that depressed or dysthymic clients may criticize themselves harshly is to reduce the demands and expectations of others. These depressed or dysthymic clients believe that they are not capable of undertaking much and are frightened that others may hold them responsible or expect much from them.
Technique: Negative Notecards
Do you have a client like Janelle who has problems with self-criticism? Would your Janelle benefit from the "Negative Notecards" exercise?
On this track we have discussed assessing ownership of critic behaviors, the eight common reasons addicts self-criticize, and the "Negative Notecards" exercise.
On the next track, we will examine three goals that depressed and dysthymic clients are trying to achieve through their pathological self-criticism. These three goals of self-critical depressive clients include: self-improvement; avoiding egotism; and reducing expectations.
Peer-Reviewed Journal Article Reference:
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.
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.
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.
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 8
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