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CBT Techniques for Building Client Self-Esteem
On the last track we discussed methods for cognitive restructuring for self esteem. Three methods we discussed were self reproach evaluations, personifying the critic, and introducing the healthy voice.
On this track we will discuss the pathological critic and how it relates to raising the self esteem of your client who has been abused. The pathological critic is a term coined by psychologist Eugene Sagan to describe the negative inner voice that attacks and judges clients, especially those with a history of abuse.
5 Determining Factors of the Strength of the Self Critic
An Arsenal of Shoulds
Sam stated, "My father hit me. He was a lawyer, so the critic says that I should be a professional and that anything else is a waste. I feel like I should have forced myself to go to school. I feel like I should read real books instead of the sports page. I feel like I should be doing something in the world instead of mixing drinks and heading over to my girlfriend’s house."
Clearly, Sam’s self esteem was severely damaged by a critic who insisted that he be something other than himself. The fact was that Sam liked the comradery of the bar and wasn’t the least bit intellectual. But he continually rejected himself for not living up to his family’s expectations.
For client’s like Sam, the critic is born during early childhood experience. When Sam’s father abused him physically, verbal abuse often accompanied it. Sam stated, "Dad would always yell that I was a good for nothing. I think that really got into my head." By design, forbidding gestures are frightening at a young age. Sam not only felt the withdrawal of parental approval very acutely, but came to believe that only by reaching what his father saw as his real potential could he avoid further punishment. Thus, we begin to see the origin of Sam’s pathological critic.
Factor # 2: A second determining factor of the pathological critic’s strength is the degree to which parents failed to differentiate between behavior and identity. Would you agree that a child who hears a stern warning about the dangers of running in the street will have better self esteem than a child who only hears that he’s a bad boy when he runs into the street?
Factor # 3: Third, Dr. McKay describes the frequency of the forbidding gestures as a determining factor in the strength of the pathological critic. Clearly, the frequency of negative messages from Sam’s parents had an impact on his early and present feelings of self worth.
Factor # 4: In addition to mislabeled ethics, differentiation between behavior and identity, and the frequency of forbidding gestures, a fourth determining factor is the consistency of forbidding gestures. Take for example a parent who did not let the child use the word ‘shit.’ Even though the child may have found that prohibition rather stuffy, if the parents were consistent, the child would manage to get along without the use of that word.
Suppose, however, that the parents would let the child say ‘shit’ sometimes and blew up at the child for saying it at other times. Let’s also suppose that the parents of this child were equally consistent about other rules. At first the child might be confused, but the randomness of the attacks may lead some children to a painful conclusion.
That is it isn’t what the child does that is wrong. Instead, it is the child himself which bad. Children who experience similar circumstances may come to believe that there is something fundamentally wrong with them. Have you treated a client who feels as if they have done something wrong, but because they can never get the rules straight is unable to determine what?
Factor # 5: The fifth determining factor in the strength of the pathological self critic is the frequency with which forbidding gestures were tied to parental anger or withdrawal. As you probably know, children can tolerate a fair amount of criticism without experiencing much damage to their self worth. However, if that criticism is accompanied by parental anger or withdrawal, it has potential to send the child messages of rejection. Think of your client. Is his or her pathological self critic and low self esteem indicative of any of these five determining factors?
On this track we discussed the pathological critic. I find that these critics begin with an arsenal of shoulds which can be linked to five determining factors of the strength of the self critic. These five factors are the degree to which issues of taste, personal needs, safety, or good judgment were mislabeled as moral imperatives, the degree to which parents failed to differentiate between behavior and identity, the frequency of the forbidding gestures, the consistency of forbidding gestures, and the frequency with which forbidding gestures were tied to parental anger or withdrawal.
On the next track we will discuss responding to the critic. Once your client, like Sam, begins to hear internal criticism as dysotonic, he or she can begin responding. I find that ineffective response styles manifest in three different ways. These are passive response, aggressive response, and passive aggressive response.
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