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

Section 9
Goal Attainment in Depressed Clients

CEU Question 9 | CEU Test | Table of Contents
Social Worker CEUs, Psychologist CEs, Counselor CEUs, MFT CEUs

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On the last track, we discussed assessing ownership of critic behaviors, the eight common reasons addicts self-criticize, and the "Negative Notecards" exercise.

On this 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 depressed clients include:  self-improvement; avoiding egotism; and reducing expectations.

3 Self-Critical Goals

Goal # 1. Self-Improvement
Self-critical clients believe that their favored modes of self-criticism will result in self-improvement, and that failure to implement them will result in complacency, stagnation, and repeated failure.  If they do not denounce themselves for failure to meet the highest standards, vilify themselves for their mistakes, or bring home to themselves the "truth" about what degraded creatures they are, they believe that they will never achieve the improvements that in their minds they so desperately need. 

A common form of this general self-improvement agenda is one where individuals believe that in order to avoid repeating past mistakes, they should make sure they never forget them.  To accomplish this, clients continually remind themselves of these mistakes.

Anna, age 32, regularly diets in order to avoid weight gain, often skipping meals.  A few years earlier, she had been told by her mother that she had eaten too much during a Thanksgiving dinner.  Anna stated, "I asked for a second helping of pie, and my mother told me that I had had enough.  She said that I had already gained enough weight as it is.  Whenever I think of getting another piece of pie, I always remember how fat I was during Thanksgiving, and sometimes that will stop me."  Anna’s mother’s comment had so imbedded in Anna’s mind that she had internalized the belief that she is too fat

Think of your depressed client.
  What belief is he or she internalizing in order to bring about self-improvement?

Goal # 2. Avoiding Egotism
The second goal of the self-critical depressed client is avoiding egotism.  It is a widely held belief that it is morally wrong to think well of oneself.  In clients’ view, to recognize a personal strength or accomplishment or to "pat themselves on the back" for anything is to be unacceptably egotistical, self-aggrandizing, conceited, or boastful.  Many will say that they refrain from such public, and even private, behavior so as "not to get a big head." 

Behaviors such as putting oneself down, refusing to be satisfied, and downgrading one’s strengths and accomplishments are seen by self-critical clients as positively virtuous.  To behave in such ways is to be humble.  They cannot distinguish between these widely acknowledged virtues and destructive practices such as self-degradation.  They cannot find the borderline between humility and self-mistreatment.

Jake, age 41, displayed this type of inability to distinguish between humility and self-abuse.  Although he was a successful business executive with a loving, supportive wife and family, Jake constantly refused compliments and self-praise.  He stated, "In my line of work, you can’t let yourself think you’re unbeatable.  As soon as that happens, some young blood’s going to take you down!  I never congratulate myself for anything!  What have I done?  Squat, really." 

I stated, "Even though all your loved ones and friends constantly compliment you, you still believe that you are not deserving?  If you do not allow yourself any compliments, your self-esteem could be irreparably damaged." By not allowing himself any credit, Jake had effectively cut himself off from an essential system of support. 

Think of your Jake. 
Is he or she self-critical in order to avoid egotism?

Technique:  Making Compliments
To help clients like Jake become more receptive to positive remarks, I suggested he try the "Making Compliments" exercise.  I asked Jake to write up a list of compliments every night in order to facilitate his recovery from his own self-criticism.  Jake stated, "I don’t really think it will be that easy.  I don’t deserve compliments, least of all from myself."  I stated, "Giving credit where credit is due does not harm or inflate your ego.  Rather, it can boost you through more difficult times." 

For the first week of this exercise, Jake’s list was nominal, listing:  had a good hair day; got up on time; and finished work on time as the first list of compliments.  Because I told him that he could not use the same compliment twice, he soon began to run out of minimalist compliments and began to look at his actions and better character. 

Think of your Jake.  Could he or she benefit from "Making Compliments"?

Goal # 3. Reducing Expectations
Some clients criticize themselves because they fear that others will hold them responsible or expect too much of them.  These clients believe they are not capable of undertaking very much, and the prospect of others holding them responsible or expecting a great deal from them is quite frightening.  If they communicate their inferiorities and incapabilities by publicly criticizing themselves, they might avert the danger by causing others to lower their expectations.

Gina, age 35, was a journalist at a high-pressure local newspaper.  Each time someone offered her a story, she would bring up her inexperience and her lack of qualifications.  She stated, "I’m so afraid that if someone believes in me, I may disappoint them, and I can’t stand to disappoint anyone."  I stated to Gina, "If you really wanted to be a journalist, at some point in your life you must have known the risk-taking involved.  In any form of job, there is some level of responsibility." 

Think of your Gina.  Is he or she trying to reduce expectations out of a fear of responsibility?

On this track, we discussed three goals that depressed and dysthymic clients are trying to achieve through their pathological self-criticism.  These three goals of self-critical depressed clients included:  self-improvement; avoiding egotism; and reducing expectations.

On the next track, we will examine four different types of resistance to treatment of self-destructive criticism in depressed and dysthymic clients.  These four different types of resistance to treatment include:  belief in the truth of the criticisms; settling for mediocrity; morally wrong; and disbelief in efficacy.

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.

Dickson, J. M., Moberly, N. J., & Kinderman, P. (2011). Depressed people are not less motivated by personal goals but are more pessimistic about attaining them. Journal of Abnormal Psychology, 120(4), 975–980. 

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.

Moore, E., Holding, A. C., Moore, A., Levine, S. L., Powers, T. A., Zuroff, D. C., & Koestner, R. (2020). The role of goal-related autonomy: A self-determination theory analysis of perfectionism, poor goal progress, and depressive symptoms. Journal of Counseling Psychology. Advance online publication. 

Online Continuing Education QUESTION 9
What are three goals that depressed and dysthymic clients are trying to achieve through their pathological self-criticism? To select and enter your answer go to CEU Test.

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