Effectively Treating Pathological Self-Criticism in Depressed & Dysthymic Clients

On the last track we discussed self-degradation ceremonies and the three common consequences of those ceremonies. The three common consequences of self-degradation ceremonies were Behavioral Restriction, Emotional Distress, and an Inability to be the Final Arbiter of One’s Own Status.

On this track we will discuss the differences between destructive self-degradation and constructive recognition of personal limits.

Obviously, not every instance of self-criticism that results in the appraisal of diminished status and eligibility is problematic. For example, if an alcoholic has been negatively affecting his family for years through his heavy drinking, sobering up may cause him to come to the conclusion that his alcoholism caused him to be selfish for many years. He may then realize that his selfishness hurt his family.

So how do you tell if your depressed or dysthymic client’s self-criticism is a part of a self-degradation ceremony or simply the recognition of personal limits?

Rachelle, age 22, a sophomore in college, had for years called herself "intellectually dull." Growing up, she was the youngest in her family by two years and as a result was always a little behind everyone else. Her family treated her as a cute, amusing, and slightly dim-witted baby of the family, and Rachelle herself adopted this view, which contributed to her depression and the belief that she was not as "good" as everyone else. Although she graduated from a competitive high school with a 3.5 GPA and was carrying the same GPA at her college as she began therapy, she maintained that she was not very smart.

As a result, Rachelle also felt strong feelings of worthlessness. When I asked her about an A she received in a class, she stated, "Yeah, it’s amazing what a dull person like me can do if I work hard enough! It’s too bad I’m not actually smart. Think of what I could do then!" When confronted with other A’s in different classes, she responded that she had been lucky and that the professors had not been very demanding. When I finished asking about her grades, Rachelle immediately jumped in to point out her C grade in physics and stated, "You completely ignored this one. See, I really am pretty dull. I just get lucky sometimes."

I have found that there are generally three criteria for distinguishing between constructive recognition of personal limits and destructive self-degradation. As I list the criteria and explain how they applied to Rachelle, think of your depressed or dysthymic client. How much of his or her self-criticism is constructive recognition of personal limits? How much is destructive self-degradation?

Three Criteria for Recognizing Self-Degradation
1. Realism vs. Lack of Realism: As you know, where the imposition of disqualifying labels seems to disagree with the available evidence, it is safe to say the self-criticism is needlessly destructive and not a simple recognition of limits.

As you can see with Rachelle, her self-criticism and disqualifying labels were clearly creating dissonance with the actual evidence. Despite her strong GPA and numerous good grades in school, she continued to claim that she was intellectually dull. Obviously, this is a case of destructive self-criticism, and not constructive recognition of personal limits.

2. Wider Implications of Worth: For some people, it is possible to recognize personal limitations but also recognize that they still have strengths. However, have you found, as I have, that most depressed or dysthymic clients seem to wrap their total basic value into single deficiencies?

In other words, their entire worth as a human being is thrown into question by their self-attribution. It goes without saying that situations in which the implications drawn are ones of global worthlessness are situations in which the self-criticism is simply destructive self-degradation. As you can see with Rachelle, she placed her worth into just one thing: intelligence. Because she believed she was not intelligent, she also believed she was worthless.

3. Degree of Self-Punitiveness: Finally, following the criteria of realism versus lack of realism and wider implications of worth, the third criteria is the degree of self-punitiveness present. Have you noticed that some depressed or dysthymic clients not only brand themselves with degrading labels, but also ravage themselves with scathing self-attacks?

In clients whose self-criticism is constructive recognition of personal limits, the client usually realizes that beating him or herself into the ground will not accomplish anything. Depressed or dysthymic clients who are simply in destructive self-degrading patterns, though, will often continue the scathing attacks despite the fact that it accomplishes nothing.

Does this sound like a depressed or dysthymic client you may be dealing with?

Technique:  Destructive Judgment Journal
I asked Rachelle if she would like an exercise to help her overcome her destructive self-degradation. She stated, "Yeah, I guess so." I then explained to her the "Destructive Judgment Journal" exercise. As I explain how Rachelle used this exercise, think of your depressed or dysthymic client. Would the "Destructive Judgment Journal" be an appropriate exercise for him or her?

I explained to Rachelle that to do the "Destructive Judgment Journal," she would need to keep a journal for a week. I stated, "For a week, use this journal to record the exact time, date, and occasion when you said something self-destructive about your intelligence, or when you made a destructive judgment about yourself."

I then explained that over the course of the week, she should make a goal to have fewer entries at the end of the week than she did at the beginning. I stated, "Make a conscious effort to cut that number down." Rachelle looked doubtful but agreed to give the "Destructive Judgment Journal" a try.

At the end of the week, she reported in the next session that while she still had many entries on the final day representing her self-critical comments, she did manage to drop ten from the day that she started.

I have found some clients react well to being provided with the facts of their disorder.  Would it be beneficial to play this track or other tracks in this CD set for a client of yours? 

Do you have a depressed or dysthymic client that makes self-criticizing comments? Based on the three criteria, is this self-criticism constructive recognition of personal limits, or is it destructive self-degradation? If it is the latter, would the "Destructive Judgment Journal" be an appropriate exercise for your client to try? Would you consider replaying this track in your next session?

On this track we have discussed recognizing the difference between destructive self-degradation and constructive recognition of personal limits. We have discussed three criteria for determining if self-criticism is destructive self-degradation or not. These three criteria were realism versus lack of realism, wider implications of worth, and degree of self-punitiveness present.

Online Continuing Education QUESTION 3
What are the three criteria for determining if self-criticism is destructive self-degradation or constructive recognition of personal limits? To select and enter your answer go to CEU Test.