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.

As you may know, clients who perceive the criticisms as inflicted upon them by someone else remain in low-power positions from which they will likely not be able to change their behavior. Clearly for this reason, the depressed or dysthymic client could also benefit from understanding the common reasons that they self-criticize. In my experience, there are eight common reasons that depressed or dysthymic clients may engage in self-criticism.

8 Common Reasons for Self-Criticism

Reason # 1. First, your dysthymic client may be trying to achieve self-improvement. In Janelle’s case, one thing that she constantly criticized herself for was grades. She had received her first D in a class her first semester in college. As a junior, Janelle was still criticizing herself over it. Janelle stated, "It was just so stupid of me. I should have gotten a B in that class, but I just screwed it up!" The common form of self-improvement criticism is criticism made to ensure that the individual does not forget past mistakes so that he or she will not repeat them. Janelle’s constant criticism of her grades and that D was a reminder to herself to keep from getting such a low grade in a class again.

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
One exercise I have used with depressed or dysthymic clients who have difficulty taking ownership of their critical behaviors, including Janelle, is called the "Negative Notecards" exercise (Bergner p 43).

To do this exercise, I asked Janelle to carry a notecard or set of notecards with her for a week. I stated, "Anytime you find yourself self-criticizing, write down on the notecard what exactly you said in your self-criticism, what the events were that happened before you criticized yourself, and what you thought immediately following the self-criticism."

I then explained that we would discuss these notes at our next session. As you can tell, this is a self-monitoring technique. I have found that self-monitoring techniques tend to be helpful for self-criticizing depressed or dysthymic clients because it helps them become more aware of their self-criticizing behavior in addition to helping them take ownership for those behaviors. Do you agree?

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.

Online Continuing Education QUESTION 8
What are the nine common reasons addicts engage in self-critical behaviors? To select and enter your answer go to CEU Test.