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Effectively Treating Pathological Self-Criticism in Depressed & Dysthymic Clients
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On the last 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. Clients who are depressive and self-criticizing have tried numerous times to stop themselves from being too critical. Often, I have found that many clients are already aware of the damaging effects of their behavior. Because of this, I believe that a method of non-resistance is often the most effective. In this method, I ask my clients to accept the self-critical episode and even to enhance the criticisms. Although many are resistant to this type of exercise, it helps them to gain control of their own self-criticism. Once they have been able to overcome the obsessive and automatic thoughts that appear in their minds, they can better be prepared to understand and control their own impulses. On this 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. 3 Principles Behind Non-Resistant Change Percy, age 29, had described feeling out of control and helpless during his episodes of self-criticism. Percy had been diagnosed with depression at the age of 25 and since then had had intermittent periods which would be characterized by frequent obsessive thoughts of inadequacy. I suggested this course of action during his second week in therapy. Principle # 2. Neutralization of Unhelpful Self-Coercion Jared, age 47, had been trying for a week to gain control of his inner critic. He stated, "It’s too hard! I will never be able to stop these voices inside my head! It’s just too strong of an urge to resist!" I stated, "But the point of this exercise is not to stop it. Up until this point, your first impulse has always been to stop these voices from gaining control, yet they still seem able to return with renewed force. Principle # 3. Dynamics of Ambivalence Darcy, age 39, had become depressed after her husband had left her three years before. During that time, Darcy had internalized the belief that she was an undesirable human being, both sexually and emotionally. In addition, Darcy had been raised in a family of harsh critics who demanded perfection from family members. Darcy’s slightly overweight physique became the receptor for many of these attacks. On this track, we discussed 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 included: position of control; neutralization of unhelpful self-coercion; and the dynamics of ambivalence. On the next track, we will examine three image techniques to help self-critical clients become more receptive to constructive criticism. These three image techniques to help self-critical clients become more receptive to constructive criticism include: parent; boss; and nasty thermostat.
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. Bruckman, J. C. (2008). Overcoming resistance to change: Causal factors, interventions, and critical values. The Psychologist-Manager Journal, 11(2), 211–219. 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. Hewitt, P. L., Smith, M. M., Deng, X., Chen, C., Ko, A., Flett, G. L., & Paterson, R. J. (2020). The perniciousness of perfectionism in group therapy for depression: A test of the perfectionism social disconnection model. Psychotherapy, 57(2), 206–218. Monroe, S. M., Anderson, S. F., & Harkness, K. L. (2019). Life stress and major depression: The mysteries of recurrences. Psychological Review, 126(6), 791–816. Online Continuing Education QUESTION 13 |
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