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In the last section, we discussed three goals that depressed and dysthymic clients are trying to achieve through their pathological self-criticism. These three goals of self-critical depressed clients included: self-improvement; avoiding egotism; and reducing expectations.

In this section, we will examine four different types of resistance to treatment of self-destructive criticism in depressed and dysthymic clients. These four different types of resistance to treatment include: belief in the truth of the criticisms; settling for mediocrity; morally wrong; and disbelief in efficacy.

4 Types of Resistance to Treatment

♦ Resistance # 1. Belief in the Truth of the Criticisms
Clients frequently lock themselves into destructive, self-critical scenarios by mistakenly regarding the whole matter as a truth issue. They see themselves, not as active critics, but as victims, compelled by the evidence to recognize factually grounded truths about themselves. They do not choose how they see or treat themselves; they are forced by the facts to draw certain conclusions.

Ned, age 39, had convinced himself that he was beyond help. He stated, "You don’t seem to understand; the bedrock truth about me is that deep down I am a complete and utter asshole." I stated to Ned, "It’s not a truth issue; it’s an issue of how you treat yourself."

This statement, which I make to many of my resistant clients, draws their attention to the simple but crucial distinction between the facts and one’s response to those facts. Even in those cases where there are undeniably negative truths about themselves for persons to contend with, these do not necessitate any particular treatment of themselves.

Think of your Ned. Is he or she clinging to the belief of truth in his or her criticisms?

♦ Resistance # 2. Settling for Mediocrity
Many clients are unwilling to give up perfectionistic standards because, in their minds, doing so is tantamount to settling for mediocrity and abandoning the struggle for personal excellence.

To these types of clients, it is better to strive for perfection and suffer some painful consequences than to lower their personal standards. I believe that going against these values is a losing game. Rather, I prefer to allow my clients to keep these standards, but to use them in a new way that will better achieve their existing purposes. The problem lies not in the standard itself, but in their treating it as a criterion of personal adequacy.

Berta, age 51, regularly criticized herself for the perceived poor state of her home. Berta stated, "If I can’t even provide my family with a clean home, what good am I as a wife and mother? If I do as you’re telling me to do, I may not be able to provide my family with the best! Then what am I going to do?"

I stated, "It’s not a matter of settling for imperfection. Instead, I want you to think of your desire for perfection as more of a guiding star that will rarely if ever be attained, but that may nonetheless point a direction for your striving. Remember, nobody’s tombstone ever said that ‘She never had any dust behind her couch.’"

Think of your Berta. How would you convince him or her that he or she was not settling for mediocrity?

♦ Resistance # 3. Morally Wrong
Many clients persist in their self-destructive ways because they believe it is virtuous to do so and immorally egotistical to appraise themselves in more positive ways.

In the cases of morally driven clients, I have found the following questions beneficial to discuss with clients:

Is it any more virtuous to abuse and damage oneself psychologically than it is to do so physically with alcohol, tobacco, or other substances?
Since destructive self-criticism is so damaging to our ability to function, do we have a moral obligation to others such as our children and families not to destroy our ability to care for and relate to them?
Do not destructive self-critical practices fail a very critical moral test insofar as they diminish our ability to change our unacceptable behavior?
Is it morally acceptable to treat any human being the way you are treating yourself?

♦ Resistance # 4. Disbelief in Efficacy
Some clients fear that many of these approaches will prove too weak for correcting their own mistakes. If they are to change such weaknesses, they believe they must bring serious negative consequences to bear on themselves. Many times, the client’s current approach is the same one they wish to continue, no matter how ineffective the current approach is.

Vince, age 42, believed in tackling what he perceived as his "problem" with a hardline approach. He stated, "I want to come at this thing like I come at everything: full throttle. I just need a little boost, that’s all." I stated to Vince, "Currently, your method is not working. Have you ever been able to shout your own inner critic down or does he always seem to out-shout you?" He stated, "I have tried, numerous times. But I don’t think I ever try hard enough. I was hoping that you would be able to give me a way of pushing even further, but that’s not what this is about, is it?"

Think of your Vince. Is he or she stuck in his or her old methods?

In this section, we discussed four different types of resistance to treatment of self-destructive criticism in depressed and dysthymic clients. These four different types of resistance to treatment included: belief in the truth of the criticisms; settling for mediocrity; morally wrong; and disbelief in efficacy.

In the next section, we will examine three steps for minimizing resistance to the therapeutic directive. These three steps for minimizing resistance to the therapeutic directive include: appeal to what matters; the "positive" connotation; and speaking to the client’s positive.
Reviewed 2023

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.

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.

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.

QUESTION 10
What are four different types of resistance to treatment of self-destructive criticism in depressed and dysthymic clients? To select and enter your answer go to Test.

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