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Working with the inner critic: Therapeutic approach
Nele Stinckens (corresponding author), Germain Lietaer & Mia Leijssen
Nele Stinckens, Ph.D., is a guest professor at the Department of Clinical
Psychology at KU Leuven. She is coordinating the postgraduate training in client-
centered psychotherapy and she teaches psychological treatments at the
master’s level. She is doing practice-based research on helping and hindering
processes in psychotherapy at the UZ Leuven, Campus Kortenberg. She has a
private psychotherapy practice.
Postal address:
Nele Stinckens
Afdeling Klinische Psychologie
Tiensestraat 102
B-3000 Leuven
Tel. 0032/495654085
E-mail: nele.stinckens@psy.kuleuven.be
Germain Lietaer, Ph.D. is Emeritus Professor of Clinical Psychology at KU
Leuven, where he taught client-centered/experiential therapy and process
research in psychotherapy on the master and postmaster level. He was Chair of
the board of WAPCEPC 2000-2003 and has co-edited many books, the most
recent one being the Dutch Handboek gesprekstherapie. De persoonsgerichte
experiëntiële benadering (co-edited with G. Vanaerschot, H. Snijders &
R.J.Takens, 2008).
Mia Leijssen,
Working with the inner critic: Therapeutic approach
Nele Stinckens, Germain Lietaer & Mia Leijssen
Abstract
The inner critic symbolizes the strict, inner normative voice which people use as
a self-constraint. It exhibits during therapy through a variety of manifestations
and different degrees of intensity. Several pathways to change need to take
place in order for this process disruption to evolve in a more adaptive self-aspect.
In this article we offer a differentiated look of what therapists can do in concrete
terms in order to facilitate these pathways of change. A research was set up that
analysed in depth a comprehensive and varied sample of therapy episodes in
which the inner critic was manifested. The research demonstrated that a variety
of strategies was used to encourage the inner critic into motion. A flexible
approach, tailored to the nature and intensity of the inner critic, appeared to offer
the best chance of success. Maintaining a uniform approach to the problem
without any regard to the way in which the critic was gradually being expressed,
appeared to delay the therapy process or even, in certain cases, to be counter-
therapeutic, particularly where the critic was quite intense.
Keywords: inner critic, self-constraint, therapist approach, relational aspects,
task aspects
Introduction
In a previous article (Working with the inner critic, part 1), we discussed the
variety of manifestations the inner critic may exhibit during therapy. We also shed
light on the different pathways to change that need to take place in order for this
process disruption to evolve in a constructive way. This article explores what a
therapist can do in concrete terms in order to facilitate these change processes.
The client-centered/experiential approach forms our most important source of
inspiration here; however elements from other therapeutic approaches are also
integrated with this. There are two important aspects that are distinguished in the
therapeutic approach, although in practice these are difficult to separate: the
relational and the task aspects. The relational environment forms the foundation
onto which interpersonal experiences are grafted and it functions as a medium
for corrective interpersonal experiences. The task aspects represent the
strategies the therapist uses to help the client to navigate through the various
pathways to change. These strategies also help to reinforce the working alliance.
1. Task aspects
Rogers’ approach to working with the inner critic remained limited to implicit
clinical knowledge which was not explicated within a specific microtheory. In his
writings (Rogers, 1942; 1959) we find no more than a few ‘directional guides’
specifying the attitude variables in respect of the inner critic. Rogers argues
strongly for a full acknowledgement and acceptance of the client’s critical and
negative self-attitude. However, a first, superficial analysis of some transcript
excerpts (Stinckens, Lietaer & Leijssen, 2002a, 2002b) leads to the conclusion
that Rogers did not always do what he claimed to have done; his ‘in vivo strategy’
also appeared sometimes to be aimed at negating or setting aside the inner
critic. His approach was therefore more differentiated than his theory of therapy
would lead us to believe. Rogers appeared to intuitively tailor his strategy to the
type of client: when the client’s critic was "in process” and could be easily let go,
Rogers ‘chose’ to simply move aside this process disruption and focus attention
on the awakening positive self-experience. However, when a client indicated that
he/she was not ready to give up the critic, he changes strategy and focuses on
the inner critic’s track. The question of which process markers are determining
factors here remains unfortunately unanswered; Rogers’ differential process
diagnostics always remained limited to implicit clinical knowledge.
Since the nineteen-eighties there has been a movement in client-
centered/experiential therapy which argues for more differentiation in the
psychotherapeutic approach. Therapy should not only be focused on
encouraging self-acceptance and self-trust, it should also assist in helping to
solve more specific problems of self-organisation. This idea has been used to
describe a whole series of “therapeutic tasks” that have been translated into
specific microprocesses (Elliott e.a., 2004). Various process directives have been
formulated regarding the problem of the inner critic, particularly those with an
experiential focus. All of these directives draw on the same conviction: the inner
critic needs to be approached in an active way, as it will not change or disappear
of its own accord. In this respect Leijssen (1998) has proposed that not dealing
with the inner critic directly leads to the client continuing to run aground in the
same way; the therapist needs to actively intervene in the modification of the
process disruption.
The strategies that are used to approach the inner critic in a more active way
appear to be highly diverse. We have distilled five categories on the basis of the
literature and an analysis of therapy excerpts: 1. identifying the inner critic; 2.
distancing the inner critic; 3. attuning to the inner critic; 4. shifting attention
towards the organismic experience; 5. integrating the various aspects of the Self.
The various strategies are discussed in more detail below.
1.1. Identifying the inner critic
According to Leijssen (1998) the therapist him/herself needs firstly to be able to
recognise the inner critic attack; it is only once this has occurred that he/she can
help the clients to identify their inner critic. The therapist therefore needs to have
knowledge of the diversity of process markers through which the inner critic
manifests itself. This process diagnostic knowledge can subsequently be used by
the therapist in order to bring clients in touch with their inner critic. Often clients
are not fully aware of the presence of their inner critic and normative voice; they
just feel tense, despondent, despairing, depressed, etc. In these circumstances
the therapist’s task consists of diagnosing the inner critic; he/she needs to
explain to the clients how they induce the feelings in themselves by rapping
themselves on the knuckles, belittling, judging or rejecting themselves (Müller,
1995).
It is not only important here to pay attention to the contents of what the inner
critic introduces, but also the way in which this happens (Elliott, Watson,
Goldman & Greenberg, 2004, Chapter 11; Hinterkopf, 1998; Leijssen, 1998). By
pointing out to the clients the specific way in which the critic belittles them, the
therapist can teach them to differentiate between the demanding, depressing,
unsubtle and generalising speech style of the inner critic and the soft, friendly,
consoling and personal speech style of the experiential self. This helps the
clients to become aware of the process blocking nature of their inner critic.
Elliott et al. (2004) attempt to intensify this consciousness even further by
allowing the client to speak from out of the inner critic. Elliott et al. make use of
the two-chair dialogue developed in Gestalt therapy. The client is asked to sit
successively on two different types of chair: The critical chair and the experiential
chair. When the client is on the experiential chair he/she is instructed to give “I
messages”, in order to evoke the experience. When the client takes seat on the
critical chair he/she is asked to provide “you messages” in order to further
emphasise the accusatory and attacking nature of the critic. Therefore instead of
telling the client that he/she is attacking and accusing oneself, he/she is
effectively being invited to do this to oneself: "you're a good-for-nothing", "you
never do anything right". By repeating and even over-emphasising these
statements the client becomes more sharply aware of the way in which the inner
critic sets to work and with which affective intensity this is associated.
Lisa feels blocked. She doesn’t dare to be herself out of fear of rejection by
others. T proposes to allow the issue that is blocking her to speak.
T: Would you like to try something? Would you like to come and sit over
here and let the issue that’s blocking you speak? There is something
that is blocking you, isn’t there?”
C: Yes
T: Can you show me how you block yourself? You stop her (points to
other chair) in some way? You say things that block her?
C: Mmm.
T: Block her. Stop her from being herself.
C: Ehm...Don't say things that will make other people laugh at you. If you
say that, people will think you’re ridiculous.
T: Tell her what will happen if she’s herself.
C: Ehm. They’ll make jokes about you. They’ll think you’re an idiot.
Other modern client-centred therapists will also emphasise the emotional
valence of the client's self-criticism, rather than just the self-criticism alone; this is
brought about by formulating the critical voice more sharply, intensively or vividly.
This brings clients more empathically and directly in contact with their inner,
critical and normative voice. The following example is intended to clarify this.
Maria says she doesn't feel like investing in relationships anymore. The
therapist invites here to explore this further.
C1: I ask myself whether it’s still worth the effort (silence). I get the
impression that it has cost so much effort, but has never really
delivered. It’s exactly as if it’s not working anymore.
T1: I notice that I’m quite taken by what you’ve just said about yourself, that
“I’m not worth the effort to continue investing in”. That’s how it strikes
me when I hear you say that.
C2: Yes (laughs). I think that’s right at the moment. There’s such an
enormous emptiness associated with it, I think “I can’t get to know
anybody else, as they’ll find the same emptiness, they’ll just fall into the
same hole”. It’s like “why would anybody show some interest for
nothing?”
T2: Why should anybody want to make an effort for me, when I don’t
believe it’s worth the effort?
1.2. Distancing the inner critic
Once the inner critic has been identified the therapist needs to give a message
or instruction to help clients to separate themselves from the inner critic; the
therapist needs to help clients ‘dis-identify’ themselves from their critic and
negative self-thoughts. According to Leijssen (1998) a simple reformulation by
the therapist alone can sometimes shift the emphasis so that clients no longer
fully concur with their inner critic. For instance, when the client says: “my life’s
not worth living” the therapist can reflect this as follows: “something within you
thinks that your life is not worth living”. This installs a workable distance from the
inner critic (McGuire, 1984a, 1984b).
The therapist can also concretise the dis-identification by asking clients to
visualise the critic in front of them. According to Leijssen (1995) this is a very
helpful process for most clients – “they literally see someone or something in
front of them, leading this to gradually acquire more significance for them” (p.
164). In fact, the two-chair dialogue is intended to produce the same effect; by
putting the inner critic on a separate chair a physical distance is created whereby
clients are helped to distance themselves from their critic (Elliott et al., 2004).
In the next step the therapist can attempt to move aside the process
disruption. This can be done in an implicit way by negating or disregarding
messages from the critic (Müller, 1995). According to Gendlin (1996) it does not
make any sense to discuss or argue with the critic; the best way of dealing with
the critic is by not paying any attention to it. The therapist may facilitate this way
of dealing with the critic by constantly renewing contact with whatever the client
felt just before the critic started to attack (Gendlin, 1996). Another implicit way of
moving the critic aside is by accentuating healthy opposites. White (1988)
advises to over-emphasise the burgeoning, constructive self-aspects, particularly
the desire for self-acceptance and self-actualisation as an ‘antidote’ to the
disruptive impact of the inner critic. This empathic selectivity in favour of positive,
growth-promoting experiential elements was also established in Rogers’
approach to the inner critic (Stinckens & Lietaer, 2002). Relatively many of his
interventions appeared to be directed at accentuating the constructive counter
forces to the inner critic.
Jill (Rogers, 1983) is very dissatisfied with herself. She is constantly putting
herself down. She describes herself as her own worst enemy.
C: I am my own worst enemy.
T: You are very judgmental about yourself.
C: Yes. That’s right. I’m not a very good friend to myself.
T: No, you’re not a very good friend to yourself. Mmm. And it probably
wouldn’t occur to you to treat a friend the same way you treat yourself.
C: That’s true. I think it would be awful if I treated someone the way I
treated myself.
T: Mmm. But you just don’t like yourself.
C: Well, there is a part of me I do like.
T: OK. In certain respects you do like yourself.
However, it is important that the subtle setting aside of the inner critic happens
in stages and that the growth-promoting counter forces are only brought to the
fore at the point where the client is ‘at the edge of awareness’. When the client’s
critic is made the subject of discussion or challenged too brusquely there is a risk
that this will activate an enormous level of resistance in the client where he/she
will stubbornly attempt to prove that his/her self-schemes are true.
This, for instance, is apparent when working with children’s drawings. It is
important that the therapist simply shows an interest in the communication
channel chosen by the child and, in particular, does not express too much
praise about the drawing. If the child is very critical about his/her own
ability, praise from the therapist can be extremely disruptive and inhibit the
expression of inner experiences. The child may stop drawing or suddenly
start to cross things out in order to “prove” that he/she cannot draw very
well. It is helpful for the therapist to adopt the role of a naive observer and
to make an occasional blunder when describing the drawings together (T:
“This looks very much like a dog; C: No, silly, it’s a sheep!”). This enables a
child to feel he owns the drawing and the experiences expressed therein.
The child also indirectly receives the message that making a blunder is not
a bad thing.
The critic can also be set aside in a more explicit way. For instance, the
therapist may instruct the client to ignore his/her critic or send it away. According
to Leijssen (1998) these instructions are usually received positively by clients
with a ‘lightweight critic’. The therapist may also use her own personal
experience to send a vivid counter message to disarm the critic. Humour often
appears to be a powerful instrument in this process (Gendlin, 1996).
For instance, a client has been talking for fifteen minutes without her critic
intervening in a critical and destructive way. When she subsequently starts
to denigrate herself the therapist replies: “I was starting to get worried; I
hadn't heard from him (the inner critic) for fifteen minutes.
A playful method of ridiculing the inner critic and losing its strength, is by giving
the client a specific type of homework and asking him/her to describe one’s
favourite recipe to get into trouble (Stinckens, 2010) and to list the crucial
ingredients.
1.3. Attuning to the inner critic
Sometimes a radically different approach is opted for instead of setting aside the
inner critic: putting the critic in the spotlight. This approach appears to be most
appropriate when the critic has a protective role. Leijssen (1995) has commented
that: “when this involves a component that is evoked in order to protect a
vulnerable child part, the therapist needs to work very circumspectly and more
carefully” (p. 165). With the help of the therapist clients need firstly to discover
how the critic has come into their life and what function he is fulfilling or has
fulfilled. Only after this can there be an exploration of whether the inner critic's
function can be transferred to a more healthy and process-promoting entity.
Exploring the critic can be encouraged by inviting clients to visualise their critic
(Leijssen, 1998; Müller, 1995). Clients are asked to describe what they see in
front of them when they set the critic at a distance or they are asked to mould
their critic into a particular figure or personality. Sometimes the critic is visualised
as a real parental figure, but often these are imaginary figures that are symbolic
of the function the critic has served – school teachers, policemen, soldiers,
directors, old aunties, etc. Non-verbal forms of expression may also be employed
in order to better visualise the critic: clients may be invited to draw their critic, or
sculpt it in clay or use their entire body to visualise it (Leijssen, 1998; Stinckens,
2010).
Helen1 constantly expects to be evaluated and judged by others; it is
difficult for her to accept that others like her. The therapist invites Helen to
further explore her sense of distrusting others.
C: It’s about the little things that go wrong and then keep haunting me.
T: As if you’re still fixating on the trivialities that go wrong?
1 Excerpt in Leijssen (1995), p.36
C: Yes. And I also remember very well the little things others have said or
done. I almost have an infallible memory for that.
T: That voice within you or partially within you that's so particularly fixated
on the small things that go wrong, does it have a form or could you give it
a name or do you have a figure that would be suitable for it?
C: (silence) An old, English puritan spinster, something like that...who lives
next door to the pastor and sits in judgment of the village. Who can’t do
anything wrong herself, because she attends church every day and visits
the pastor. Yes, something like that...
In the two-chair method the spotlight is shone on the critic quite explicitly by
giving the critic its own chair and allowing it to speak extensively. As soon as
clients are in touch with their critical voice (refer to 1.1) the therapist will help
them to press on to the core of their self-criticism – the values and standards on
which the criticism is based. Clients will learn to differentiate between the values
and standards adopted from others and those which they consider to be “their
own” – the values and standards they can truly support. The therapist will also
attempt to find out what the critic intends to achieve with the criticism. Often this
results in the client’s underlying vulnerability coming to the surface (Elliott et al.,
2004).
Ben talks about his anxiety of being ridiculed, an anxiety which he
stubbornly tries to protect himself from. In therapy he discovers that the
inner critic’s function was to protect him against external attacks and
criticism.
C: I had a lot of these alerts even when I was a child, for instance, “make
sure you don’t make a fool of yourself!”. For instance, if I did something
wrong or I had to walk over to the school blackboard, I had panicky
anxiety like “oh, I hope this succeeds or works, because otherwise others
are going to laugh at me".
T: The point at which you become stuck is in itself very painful and anxiety
provoking, and becomes extremely bad if others are looking at you and
ridiculing you.
C: Yes. And there was always criticism or humiliation. There was never
anybody who just got hold of me and said “oh, it’s not really so bad”.
That’s why I've never allowed myself not to know or to doubt....I
automatically get this sense of “I won’t do it well and I’ll make a fool of
myself”.
By paying attention to the critic’s feelings and concerns and valorising these,
the critic will feel less of a need to constantly manifest itself; it will feel that it is
being observed and respected and will gradually start to relax more (Katz, 1981).
Weiser Cornell has argued in her book, "The radical acceptance of everything"
(2005) for an explicitly friendly and accepting attitude to be adopted towards the
inner critic. A transformation can be initiated by no longer judging, marginalising
or pushing the critic away, and by, in contrast, treating it to sympathetic attention.
The critic will feel encouraged to unfold its underlying emotions (those it is scared
off, or does not want, or wants to safeguard) and is therefore set into motion:
from a growth-inhibiting structure into a growth-oriented process where the
emphasis comes to rest on what the clients need and where they want to go.
1.4 Shifting attention towards the organismic experience
Once the inner critic has been sufficiently identified as a process disorder (1.1)
and set aside (1.2) or explored further (1.3), contact can be re-established with
the organismic experience. The therapist explores how the client feels to be in
the grips of such a harsh, demanding and critical character. The therapist uses
this to help the client come into contact with the experiences that have been
suppressed by the critic (Leijssen, 1998). Often this involves very painful feelings
(intense feelings of sadness, anger, uncertainty, despair, etc.) that were evoked
as a response to the inner critic's critical and negative voice - the so-called
reactive affects or secondary emotions (Elliott et al, 2004) - and subsequently
were warded off as they were not permitted by the critic. The therapist needs to
help the client to come to a standstill near these feelings and to look for accurate
symbolisation. This will allow new meanings to arise and other experiences may
be brought to light. In other words, the therapist initiates a transformation process
where reactive affects are translated into organismic needs and desires; this
enables the therapist to help the client to come into contact with what he/she
actually needs. This process is facilitated in the two-chair technique by setting
the experiential self on a separate chair and divorcing it from the critical opposite
(Elliott et al., 2004).
In the event of traumatic experiences the inner critic will often have undertaken
a protective role; it has been brought to life in order to help and protect the
vulnerable child or to hold unbearable feelings in check. Connecting with the
critic’s underlying experiences – its fears and concerns – also ensures that a shift
takes place: by paying attention to the critic’s feelings and concerns and
valorising these, the critic will feel less of a need to constantly manifest itself; it
will feel that it is being observed and respected and will gradually start to relax
more (Katz, 1981).
1.5. Integrating the various aspects of the Self
This strategy, in contrast to the above strategies, has been less fully developed.
The majority of authors have focused primarily on the removal of the process
disruption and the re-activation of the organismic experiential process. There are
only a few authors (Elliott et al. 2004; Leijssen, 1998; Mearns & Thorne, 2000;
Honos-Webb & Stiles, 1998) who have focused on the integration of the various
self-aspects and who have described how the therapist may bring about a
“collaborative agreement” between parts of the self.
Elliott et al. (2004) have argued for a negotiation approach in order to integrate
various self-aspects. The last stage of the two-chair technique is explicitly
focused on facilitating the integration between the critical and experiential poles.
Negotiation between both poles is encouraged by allowing the client to constantly
change between the two chairs and to allow each pole to justify its own
perspective. Sometimes an explicit negotiation will be required where each pole
is asked what its position is in respect of the other pole; sometimes a new
integration will spontaneously arise. The therapist’s attention is principally
focused on the shifts that arise between the two positions. By reflecting
systematically on these shifts the client will be able to experience how both poles
gradually grow towards each other and melt together into a shared perspective.
This technique is also used in child psychotherapy. Santen (1991) believes it
is useful with children who are trapped within an inner conflict between
introjected norms and personal needs and desires, to allow this conflict to be
crystallised out on paper. A personal column (space) is given to both conflicting
voices providing both literally with a right to exist. The child is invited to allow the
voices to respond to each other on paper. Sometimes they may also be asked to
step momentarily out of the conflict and view from a distance what has been
written on both sides. What comes to the surface at this stage can then be
included by the child in a central window between both columns.
Wigle is 15 years old and he truants frequently. Although he constantly
determines to go to school again, nothing ever comes of this. With the
therapist’s help he visualises his inner conflict as a battle between two
opposing forces which he refers to as “the evil force” and “the restorative
force”. Both forces are written into a column and explored further. Thoughts
such as “I don't want to learn", "I want to do my own thing" and "It's a pity
that I can't pester the teacher anymore" appear in the “evil column”.
Counter arguments are included in the “restorative column”: “keep going to
school”, “you’re not learning anything like this”, etc. This column has
dominated Wigle in the past: He regularly yielded to the wishes and
expectations of the outer world and constantly let himself down in this
respect. In fact, this column includes the voice of the inner critic that urges
Wigle to keep to the imposed rules and expectations. This force was initially
positively labelled by Wigle (“the restorative force”). By allowing the forces
to argue with each other, Wigle discovers that the “evil force” is currently
feeling more powerful, and that he is gradually experiencing this more as
“Me” and the “restorative” force more as “Him”. He becomes aware that his
inner conflict is more a battle with the outside world: He wants to be able to
do as he pleases and not constantly have to do what the outside world
expects of him. Subsequently he becomes aware that the evil force is more
of a kind of self-protection: It wants to protect him against his old, trusted
interaction style of complying with the outside world and creating a facade.
This awareness brings about a relief. It also helps remove the confusion
that exists within him (Santen, p. 408).
A variant of this technique has been developed by De Pree (2010). She is
using the symbols of the angel and the devil, who are whispering opposite
messages in the child’s ears. By inviting the child (or the youngster) to articulate
the messages of the angel and the devil, the inner conflict is coming into
awareness and negotiation of the self-parts and resolution of the conflict is
possible.
Leijssen (1995) and Katz (1981) have not focused on the negotiations
between the self-aspects; they have attempted to help clients to develop an
alternative form of interaction with their inner critic. They invite clients to explore
to what extent they still need their critic. Alternatively they help clients to
differentiate when the protective function of the critic is helpful and when it is a
hindrance. This allows clients to escape the grips of their inner critic. The critic is
forced back into a less dominant position and is thereby more adaptable within
the entire self-system.
This is particularly well highlighted in the further progression of Helen’s
therapy (Leijssen, 1995, p. 36)
T: Could you imagine sending that old, English puritan spinster on holiday
or something like that? Could you imagine something like that?
C: I don’t mind her going (laughs).
T: Have a look at what that does to you if you try to imagine that happening.
C: I think I’d have to be careful doing that, because she has been the boss
for a long time; she’s dominated the parish within for such a long time.
So you can’t just set her aside like that. That would cause an uproar in
some parts of the community. I think that a number of people benefit
from a figure like this. But the majority have been quite restricted!
T: Yes. Can you think of any benefits you experience by having such a
figure?
C: She protects my weaknesses, having no pain from being trapped in the
small things that go wrong. If that goes away I’ll also be vulnerable!
T: Perhaps you need a different type of protection for this. Can you think of
a figure that would be more helpful than that old English, puritan
spinster?
2. Relational aspects
The task aspects described in the previous section remain constantly interlinked
with relational aspects. The relational environment is the prerequisite foundation
for the task aspects. Furthermore, the helping relationship offered by the
therapist may provide an corrective experience for the dysfunctional inner and
outer relationship the client has known in the past and which the client is tending
to continue in the present.
2.1. Prerequisite foundation
According to Elliott et al. (2004) the therapeutic relationship is crucial to effect
changes in the client and needs to be prioritised in task-oriented interventions.
Unconditional positive regard, authenticity and empathic attunement are the
foundations onto which task-oriented interventions need to be grafted. These
fundamental attitudes create the interpersonal safety required to initiate the
previously described strategies. The client needs to be able to feel safe enough
within the relationship with the therapist to allow the inner critic to relax; the critic
has, after all, been an important defence in coping with interpersonal security.
The authentic presence of the therapist is also very important; the therapist’s
strength is required in order to catch the harsh attacks from the critic and contain
the overwhelming emotions that have been suppressed by the critic (Leijssen,
1998). Furthermore, the fundamental relational attitudes also encourage the
client’s self-exploration; they help the client focus attention within him/herself and
to become aware of the maladaptive self-schemes (Elliott et al., 2004).
For some clients these fundamental relational attitudes – and the therapist’s
responses following from this – are sufficient to realise change. However, often a
combination of relational and process-directive task aspects is required to
promote the change process (Greenberg, Watson & Lietaer, 1998). This
combination ensures for a creative field of tension where the therapist is steering
the process on the one hand in order to transform the critic to a more adaptive
self-aspect and following the client empathically on the other. By constantly
returning to the client’s track, one learns again to trust one’s own inner authority
(Leijssen, 1998).
2.2. Medium for corrective interpersonal experiences
The relationship with the therapist does not solely function as a prerequisite
foundation, but it also works as a type of curative counterforce for the inner critic.
This can happen in an implicit way by the client introjecting the growth-promoting,
therapeutic attitudes and in this way to attain more self-empathy and self-
acceptance. The healing relationship with the therapist also encourages the
development of an active and integral ‘I’ which co-ordinates the interactions in
the self in a more balanced way. Through the empathic, accepting and
confirmatory reactions from the therapist the ‘I’ can be separated from the
process of self-condemnation where it had become lost and acquire an
autonomous meta-position once again (Bouwkamp, 1999).
However, the relationship with the therapist can also be used in a more
explicit way in order to change the critic and, in particular the dysfunctional
interaction patterns which flow from it. In this instance, the client’s interactional
style will also be explored and worked through via meta-communication. This is
particularly recommended when the inner critic has coloured the client’s
interpersonal functioning. In “Depression and interaction”, Van Kessel (1999)
devotes a significant amount of attention to the depressed client’s typical
interaction profile. Many of his descriptions join seamlessly onto the problem of
the inner critic. For instance, he sketches out how the clients’ habitual interaction
style with a negative self-image becomes actualised in the here-and-now
relationship with the therapist. He warns of the following pitfalls.
Clients with a negative self-image will not contribute any topics in therapy.
They would not dare to risk this and therefore leave the initiative to the therapist.
They want the therapist to help them and solve their problems, but at the same
time do not expect this to be successful for them. Their cry for help sounds like
this: “help me because I can’t go on like this or just leave it, because I can’t
actually be helped” (Swildens, 1997, p. 90). Also, they will not directly ask for the
attention and compassion which they are so dearly looking for – they feel too
insignificant for this; they will demand the therapist's attention by complaining and
profiling themselves as a victim. After all, they cannot accept that they will be
accepted; they can only accept that their complaints will be accepted.
This conflicting and indirect interaction often ‘distracts’ the therapist into
adopting a complementary position. It pushes the therapist to suggest future
perspectives or solutions that are, in fact, impossible; one will attempt to
convince the client that these are definitely worth the effort and that the self-
criticism is unfounded; one guarantees the client that everything will be in order
again. But this reassures the client only temporarily. In time interventions such as
these are contra-therapeutic – it confirms the client’s dependence and
strengthens his/her conviction that one cannot cope one’s problems.
Furthermore, this role of ‘omnipotent caretaker’ is wholly a thankless task;
despite the therapist's best efforts one will not succeed in enervating the client's
negative self-image. Van Kessel refers to this as a Sisyphean task where the
therapist has to deal with one frustration after another. This pushes the therapist
into the same negative spiral the client has ended up in: one has a sense of
failure and in time will start to feel as powerless as the client.
In order to break through the habitual interaction patterns of clients with a
negative self-image, the therapist is faced with the heavy duty to offer a non-
complementary reaction, in order to reject the client’s appeal. The therapist offers
realistic treatment perspectives for the future instead of promising the impossible,
as well as displaying empathy and concern, and attempts to gradually confront
clients with the conflicts in their communication: their indirect approach to asking
for attention, the inhibited irritation and aggression, their desire for love and
affirmation, as well as their inability to receive these (van Kessel, 1999).
3. Research
The microtheory described in this article and schematic represented in Figure 1,
has been tested in a comprehensive and varied sample of therapy episodes (N =
75) in which the inner critic was manifested (Stinckens, 2001). The Category
System for Therapist Interventions (Lietaer, Leijssen, Vanaerschot & Gundrum,
1999) and the Category system for Therapist Strategies in modifying the inner
critic (Stinckens, Lietaer & Leijssen, 2002a) were used to assess the relational
and task-oriented aspects of the therapeutic approach that the therapists were
using in handling the problem of the inner critic.
The study demonstrated that the various strategies proposed in the
microtheory were all used to encourage the inner critic into motion. The
chronological ordering which permeated our initial microtheory to some extent did
not appear to align with the reality of therapy practice. It was very clear from our
case analysis that the various therapy strategies were used interchangeably.
This confirms that flexibility in applying these strategies, which has previously
been argued by clinicians, is a determining factor in the extent to which the client
process is facilitated. The most fruitful approach appeared to be that where
therapists constantly tailored their approach to the way in which the critic
subsequently manifested itself. A critic-friendly approach that is attuning to the
critic’s feelings and concerns and valorising these appeared to be more
beneficial when the critic manifested itself in a stubborn and intensive way.
Where the critic presented a milder manifestation or already appeared to be
“moving" then a more daring approach could be risked whereby the critic was set
aside at a distance or contact was made with the suppressed organismic
experience. Maintaining a uniform approach to the problem without any regard to
the way in which the critic was gradually appearing, generally produced little
effect.
Concrete therapist responses were not included in our microtheory. However,
in our opinion, they still form an important source of information; they clarify how
a given strategy is shaped. The case analyses by means of The Category
System for Therapist Interventions showed that the same strategy could be
realised in different ways. Although the underlying strategy was the same, the
effect of it on the client process appeared to be very different. Some therapists,
for example, used open, exploratory questions to softly identify the inner critic,
while other therapists used process directives or confrontations to make the
client keenly aware of his/her self-constraint. This demonstrated that therapy
strategies and concrete interventions should be viewed in combination in order to
evaluate the quality of the therapeutic approach.
6. Conclusion
As the inner critic presents itself in a kaleidoscopic multitude of manifestations in
concrete therapy practice, a flexible approach appears to offer the best chance of
success: the specific therapy approach should be tailored to the nature and
intensity of the inner critic. Hinterkopf (1998) warns against a uniform approach
to this process disruption: "different clients need a different approach to their
inner critic and an individual client will require a different approach at different
times” (p. 42). This was also apparent in our study: the most fruitful approach
appeared to be that where therapists constantly tailored their approach to the
way in which the critic subsequently manifested itself. In the successful episodes
therapists flexibly alternated between distancing the inner critic, attuning to it or
shifting the attention toward the underlying organismic experiencing, dependent
on the zigzag motion that the critic was making. Maintaining a uniform approach
to the problem without any regard to the way in which the critic was gradually
being expressed, appeared to delay the therapy process or even, in certain
cases, to be counter-therapeutic, particularly where the critic was quite intense.
With this microtheory we have attempted to provide the practising therapist with
some usable tools in modifying this process disorder. However, we want to
emphasise that this microtheory should not be applied in a technical and strictly
protocol way. In order for the strategies described to succeed in practice, they
need to be constantly based on an authentic, accepting and empathic
relationship which also allows space for spontaneous, intuitive and creative
responses.
.
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Figure 1. Microtheory for working with the inner critic