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Effectively Treating Pathological Self-Criticism in Depressed & Dysthymic Clients
On the last 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 this 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.
We will discuss further techniques for resistant clients on the next track.
4 Types of Resistance to Treatment
Ned, age 39, had convinced himself that he was beyond help. He stated, "You don’t seem to understand; the bedrock truth about me is that deep down I am a complete and utter asshole." I stated to Ned, "It’s not a truth issue; it’s an issue of how you treat yourself."
Resistance # 2. Settling for Mediocrity
Berta, age 51, regularly criticized herself for the perceived poor state of her home. Berta stated, "If I can’t even provide my family with a clean home, what good am I as a wife and mother? If I do as you’re telling me to do, I may not be able to provide my family with the best! Then what am I going to do?"
Resistance # 3. Morally Wrong
Would you have used these questions with any or your morally driven clients?
Resistance # 4. Disbelief in Efficacy
Vince, age 42, believed in tackling what he perceived as his "problem" with a hardline approach. He stated, "I want to come at this thing like I come at everything: full throttle. I just need a little boost, that’s all." I stated to Vince, "Currently, your method is not working. Have you ever been able to shout your own inner critic down or does he always seem to out-shout you?" He stated, "I have tried, numerous times. But I don’t think I ever try hard enough. I was hoping that you would be able to give me a way of pushing even further, but that’s not what this is about, is it?"
On this track, we discussed four different types of resistance to treatment of self-destructive criticism in depressed and dysthymic clients. These four different types of resistance to treatment included: belief in the truth of the criticisms; settling for mediocrity; morally wrong; and disbelief in efficacy.
On the next track, we will examine three steps for minimizing resistance to the therapeutic directive. These three steps for minimizing resistance to the therapeutic directive include: appeal to what matters; the "positive" connotation; and speaking to the client’s positive.
Peer-Reviewed Journal Article References:
Abel, A., Hayes, A. M., Henley, W., & Kuyken, W. (2016). Sudden gains in cognitive–behavior therapy for treatment-resistant depression: Processes of change. Journal of Consulting and Clinical Psychology, 84(8), 726–737.
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.
Rost, F., Luyten, P., Fearon, P., & Fonagy, P. (2019). Personality and outcome in individuals with treatment-resistant depression—Exploring differential treatment effects in the Tavistock Adult Depression Study (TADS). Journal of Consulting and Clinical Psychology, 87(5), 433–445.
Online Continuing Education QUESTION 10
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