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

Section 12
Triggers for Self-Criticism

CEU Question 12 | CEU Test | Table of Contents
Social Worker CEUs, Counselor CEUs, Psychologist CEs, MFT CEUs

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On the last track, we discussed three steps for minimizing resistance to the therapeutic directive.  These three steps for minimizing resistance to the therapeutic directive included:  appeal to what matters; the "positive" connotation; and speaking to the client’s positive.

On this track, we will examine three situational triggers for self-critical depressed and dysthymic clients.  These three situational triggers for self-critical depressed and dysthymic clients include: criticism from others; certain individuals; and loss of control.

3 Situational Triggers

Trigger # 1. Criticism from Others

Oftentimes, debilitating self-critical attacks are triggered by the subtle and not-so-subtle negative judgments of others.  Clients have little defense against such judgments because they tend to agree automatically with them.  Some of these clients simply conclude that they are "guilty as charged." 

Further, even when the matter might not be a topic of great importance for the external critic, clients will often view it as a "federal offense."  The net effect will be that these persons will report such things as being "crushed" or "devastated" by external criticism and brooding about the criticism for long periods of time. 

Other self-destructive critical clients have a different reaction to external criticism.  They too at heart concur with their detractors, but their immediate reaction is to lash back at their critics.  Sensing their own vulnerability and sensing the degradation inherent in going along with their external critic, they counterattack quickly and strongly in the face of others’ negative judgments. 

Chris, age 23, became aggressive whenever his employer gave him a more critical review.  He stated, "I know, deep down, that everything my boss is telling me is true, I just feel so down on myself that I have to take some form of action.  I’ll yell or say sarcastic comments, which I know I shouldn’t do.  Sometimes I just sulk, which can be even worse because then I appear juvenile." 

Chris’s lashing out instead of merely turning on himself, hurt his own self-esteem and his relationships with his superiors.  To help Chris, I suggested several anger control methods including counting to ten, controlled breathing, and self-talk. 

Think of your Chris.  How could he or she control his or her lash outs?

Trigger # 2. Certain Individuals
Many clients report that their self-critical behavior will be greatly exacerbated after contacts with certain other persons in their lives.  The most infamous of such others tend to be the client’s parents or other family members, and for this reason family visits will tend to leave the client depressed and feeling self-critical about themselves. 

Others who provoke such reactions may include friends, ex-spouses, bosses, enemies, or even mere acquaintances.  These critical family members or friends may trigger self-criticism in two ways. 

Two Ways Individuals Trigger Self-Criticism
I. The first is the individuals may be highly critical of the client in direct or indirect ways. 
II. The second way has to do with the other person having certain characteristics that tend to engender strong negative comparisons in the self-critical individual.  For example, the other person might appear extremely self-assured, brilliant, highly achieving, or gifted in attracting romantic partners. 

The self-critical client, perceiving such characteristics, turns on him or herself with severe indictments.

Caroline, age 48, was sent into a self-critical episode every time she spoke with her sister Jill, a successful stock broker.  Caroline is divorced, childless, and believes herself to be in a thankless job as a secretary to a construction firm. 

On the other hand, Jill has been happily married for twelve years, and has three children.  At the last family barbecue, Jill made an announcement that she would be becoming a junior executive at the stock broking company.  Caroline stated, "I felt like I had had my heart ripped out.  Once again, my sister proves she’s better than me.  I’ll never reach her status, even if I live longer than her." 

Think of your Caroline.  Does he or she have a trigger individual?

Technique:  Positive Reassurance
Because Caroline’s thoughts immediately turned to her obsessive, automatic thought of, "Jill is better than me", I suggested she try the "Positive Reassurance" exercise.  In order to counteract her automatic thoughts, I asked Caroline to say instead, "I am a valuable person" and "I don’t measure myself with others."  At first, Caroline was reluctant, stating, "Just thinking those things won’t make them come true!" 

However, a few weeks later.. she stated, "The last time I talked with my sister, I found out she was moving to a bigger house.  My first thought was, ‘My house is much smaller than hers’ so I stated out loud, ‘I don’t judge myself through Jill’ and the thought stopped.  I didn’t quite believe what I had said, but I did something different and it took me in another direction." 

Think of your Jill.  Would he or she benefit from "Positive Reassurance?"

Trigger # 3. Loss of Control
Many clients have very sensitive areas in their lives where they strive mightily to maintain control, and where they regard failure to do so as especially abhorrent and mortifying.  For some clients, and especially male clients, this might be strength and decisiveness.  Any nonassertive behavior on their part that could be construed as weak would be grounds for severe self-criticism as well as humiliation

For others, this sensitive area might be maintaining self-control in general.  For example, avoiding becoming drunkenly unrestrained or blowing up angrily.  For these clients, any lapses from the maintenance of tight control in these sensitive areas tend to bring very strong self-critical reactions.  In part, this serves to punish the crime severely and a way to reinstate self-control.

Herman, age 49, had been raised by a violent and physically abusive father.  Since an early age, Herman had strove to maintain control of his temper in order to avoid becoming like his father.  Each time Herman may have lost his temper, however justified, he would severely criticize himself.  When he found out that his wife had been sleeping with another man, Herman became upset and yelled at her. 

Afterwards, he berated himself severely for losing his temper.  He stated, "I should know!  A man does not have to be a man by lashing out at people!  I should be kind and understanding.  Maybe it was my temper that drove her to cheat on me.  I’m so stupid!  I could have really ruined things for myself!" 

I stated, "In this case, you experienced indignation, not anger.  You have been deeply hurt by someone you trusted and loved.  Expressing that indignation and pain is not only justified, it’s healthy.  From now on, I want you to ask yourself if the anger you feel is actually irrational anger or indignation."  By making this distinction, Herman could better express his justified anger. 

Think of your Herman.  What aspect of his or her life does he or she strive to maintain control over?

On this track, we discussed three situational triggers for self-critical depressed and dysthymic clients.  These three situational triggers for self-critical depressed and dysthymic clients included: criticism from others; certain individuals; and loss of control.

On the next track, we will examine three principles behind this method of non-resistant change in regards to self-critical depressive clients.  These three principles behind the method of non-resistant change include:  position of control; neutralization of unhelpful self-coercion; and the dynamics of ambivalence.

Peer-Reviewed Journal Article References:
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.

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. 

Klein, D. N., Harding, K., Taylor, E. B., & Dickstein, S. (1988). Dependency and self-criticism in depression: Evaluation in a clinical population. Journal of Abnormal Psychology, 97(4), 399–404. 

Polizzi, C. P., Baltman, J., & Lynn, S. J. (2019). Brief meditation interventions: Mindfulness, implementation instructions, and lovingkindness. Psychology of Consciousness: Theory, Research, and Practice. Advance online publication.

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.

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 12
What are three situational triggers for self-critical depressed and dysthymic clients? To select and enter your answer go to CEU Test.

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