Effectively Treating Pathological Self-Criticism in Depressed & Dysthymic Clients

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

Principle # 1. Position of Control
When all proceeds according to plan in the present strategy, the client ideally will make a radical positional shift. 

His or her initial position is the very low power one comprising:
a. Not realizing how one is functioning as a critic
b. Genuinely conceiving self as victimized and therefore helpless, and
c. Holding a problem formulation that renders solution impossible. 

The client’s final position is the high-power one comprising:
a. Knowing what one is doing as a self-critic to create the problem
b. Doing this in a conscious, deliberate, and planful way and
c. Fully appreciating one’s reasons to continue or discontinue these actions. 

In this final position, the behavior is into awareness and off of automatic pilot.  The client is actively choosing and in charge of the very behavior that is causing the difficulties.  This is a position from which the choice may also be made to cease the behavior.

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. 

At first, he was reluctant.  He stated, "I want to stop this behavior, not encourage it!  If I don’t resist it, it will take hold of me and possibly my life!"  Eventually, Percy did agree to try the technique.  After four days, he stated, "I almost don’t need it anymore.  The last time that I caught myself being overly critical, I stopped and started berating myself consciously and it made all the difference!  Instead of feeling helpless afterwards, I still felt in control of my actions and my thoughts."  At this stage, Percy’s position of control was evident. 

Think of your Percy.  How has he or she gained a position of control?

Principle # 2. Neutralization of Unhelpful Self-Coercion
Frequently, when clients realize what they are doing to themselves as critics, their initial reaction is "I must stop doing these destructive things to myself."  They place an immediate coercive pressure on themselves to cease.  This self-coercive "reflex" disregards their reasons for doing as they are doing, their right to consider these reasons, and their right to make a true personal choice. 

Thus, it typically elicits resistance from the self, which here takes the form of refusing to relinquish the maladaptive critic behaviors.  In the present strategy, however, I attempt to take the position that the client should not stop the behavior but should consider carefully their reasons for doing it.  This directive succeeds in getting the client to refrain from self-coercion and thus prevents its detrimental resistive consequences.  It also permits the free consideration of the behavior that the client’s self-coercion would have preempted. 

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. 

Instead, you need to become master of your own thoughts again and stop criticizing yourself for not being able to achieve perfect inner harmony.  This is a process that you may or may not find difficult."  At this point, Jared had not fully neutralized his own self-coercion because he had not understood the concept and goal of the directive.  Instead, he had resorted to his old coping methods and begun to resist the inner critic. 

Think of your Jared.  Is he or she unable to neutralize his or her self-coercion?

Principle # 3. Dynamics of Ambivalence
In addition to a position of control and neutralization of unhelpful self-coercion, the third principle behind the method of non-resistant change is the dynamics of ambivalence.  To be ambivalent about a behavior, I believe, is to have reasons for and against engaging in that behavior.  When a client acts on, or is forced to one side of an ambivalence, he or she satisfies his or her reasons for acting in the opposite way, thus rendering them more salient relative to the satisfied reasons. 

In the present strategy...individuals are urged to act temporarily only on one side of their ambivalence when they are urged to continue enacting problematic self-critical behaviors.  In doing so, the possibility is created that the reasons to discontinue the behavior, left unsatisfied, gain thereby a greater prominence for the individual.

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. 

Coupled with this, Darcy’s divorce confirmed what her family members had raised her to believe in childhood:  that she was not beautiful.  Even though she believed herself to be the woman that would please her family and ex-husband, Darcy still criticized herself for being too fat or not lady-like enough.  She stated, "I know they’re all wrong about me.  That I’m a nice and wonderful person.  But still there is this voice inside of me telling me that everything they say is right.  So I buy into that and start berating myself for my large hips and thick ankles!" 

When she began to encourage her criticizing under the directive, Darcy found that she could now give in to at least one side of her mental battle.  Her ambivalence did not completely evaporate, however, and the next week, Darcy stated, "I feel a little relieved I don’t have to fight that battle anymore.  But I can still see how much this behavior is hurting my life.  I feel more confirmed in my goal now more than ever." 

Think of your Darcy.  Is he or she suffering from ambivalence?

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.

Online Continuing Education QUESTION 13
What are three principles behind this method of non-resistant change in regards to self-critical depressive clients? To select and enter your answer go to CEU Test.