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How can motivational interviewing (MI) be used in the context of compassion focused therapy (CFT) when working with people who are high on self-criticism?
People often feel very attached to their self-criticism. They might believe that self-criticism motivates them, keeps them on track, or stops them from being lax and lazy. If you try to tell someone to be less self-critical and more self-compassionate, they can sometimes argue with you, insisting that there is a range of reasons for holding onto self-criticism.
This can mean they convince themselves to continue being self-critical!
But sometimes, with careful, respectful, intentional listening, people can start to explore their intrinsic wisdom around self-criticism, and find that there is also the other side, the arguments against persisting with self-criticism and for a self-compassionate approach.
Such a conversation, incorporating MI, might sound something like this:
Therapist: Would you mind if we talked a bit about this part of you that can be super-critical of yourself? [asking permission to introduce the next topic of conversation].
Client: Yeah, sure, that's ok. [giving permission].
Therapist: Tell me a bit about your thoughts, one way or the other, about this part, about this self-critical side of you. [opening up the conversation, neutral exploring].
Client: Well, I know it's a problem [change talk, or arguments for change], but it keeps me going, keeps me trying with things, working hard and improving [sustain talk, or arguments against change].
Therapist: Ok. Yeah, that makes sense [validation]. You do see it as a problem for you, and yet at the same time it kinda' keeps you going [reflection of the ambivalence]. Tell me more about that side, and the way self-criticism keeps you going, keeps you improving [more exploring, this time exploring sustain talk].
Client: Well, for example at work...people take advantage of any weakness. It's just so competitive, and I've got to stay at the top of my game, one step ahead, you know? Take my foot off the gas, and someone for sure will slot themselves in. I mean, I'm barely able to really do my job as it is, I'm worse than most of them there, like, literally not as intelligent, so I gotta push myself and push myself hard. [sustain talk].
Therapist: It's a really tough environment, very competitive, ruthless to a degree, with everyone in it for themselves, and you feel like you've got to push yourself hard to survive there. [amplified reflection, choosing not to comment on the self-criticism in the client's statement at this stage].
Client: Yes...well, sort of. I mean it's not that bad. [clarifying]. There are actually a few people there who I work well with! But...I still feel like I have to push myself...I don't know..." [ambivalence emerging again].
Therapist: Yeah, there's a part of you that's not sure. Work is tough, and yet people can also be cooperative [reflecting ambivalence]. It's almost like the self-criticism is partly a response to the work environment, but also might be coming from somewhere else [complex reflection].
Client: Yeah, well, work is certainly not the only place I do it. I mean, I can be walking along a street, see my reflection in the mirror, and then bam, in come the thoughts, "You're ugly, you're stupid." Ridiculous, really. [elaboration].
Therapist: Ouch! It can get pretty harsh. [empathic reflection]. And I notice even in this conversation, you can be pretty harsh on yourself, calling yourself "not intelligent" before and "ridiculous" just now. [summary reflection, putting two examples of self-criticism side-by-side].
Client: Yeah.
Therapist: So, what about the other side of it all, the bit where you feel it is a problem. Tell me more about that side. [more exploring, this time exploring change talk].
Client: Mm. Well, when all those thoughts come in about being ugly or stupid, I can just feel so low. I literally feel my gut clench and my shoulders slump. It's this kind of heart sinking experience...I just end up depressed! [elaborating on change talk].
Therapist: I see. Sometimes you feel like self-criticism motivates you by keeping you at the top of your game, and yet often you notice that it really has the opposite effect. It de-motivates you or even leaves you feeling quite depressed. [complex reflection, reflecting both sides of the ambivalence, highlighting the discrepancy, putting the change talk second to encourage elaboration].
Client: Humph. Yeah. It's crazy, but yeah, especially the bad self-criticism, that just makes me feel worse. [confirmation, feels heard and understood, elaboration].
Therapist: Oh, that's an important point! I appreciate your wisdom and self-awareness there. [affirmation]. Not all self-criticism is the same. There might be a kind of constructive self-criticism that can help us improve, and there might be a kind of self-criticism that is really harsh, attacking or even condemning of ourselves that is really quite harmful. [complex reflection, putting into words the client's insight, incorporating psycho-education]. If we could tell them apart, that could be a place to start. [envisioning].
Client: Yeah! That'd be good, actually. [agreement around next steps].
Therapist: Great! So, would that be ok? Could we chat some more about different forms and functions of self-criticism and see what you think? [asking permission to introduce a next topic of conversation]
Client: Yeah, sure. That'd be good. [giving permission].
Here we have just a little snap shot of how the spirit and core skills of MI can be a part of a conversation in CFT when working with self-criticism.
The therapist is trying their best to listen well, with open questions, affirmations, reflections and summaries, to accept and validate the client's sustain talk, or arguments against change, and then gently guide them towards their change talk, or arguments for change. The therapist is also trying hard to avoid arguments and keep any discord between them and the client to a minimum.
Feeling heard and understood, accepted and respected, the client is then able to explore their own intrinsic wisdom about self-criticism, how it helps and doesn't help them, and gradually move towards an openness to make some changes. The conversation will persist beyond just what is written here, but MI can be a part of it throughout!
If you are interested in learning more about MI in compassion-based interventions, you can check out my paper on the topic, written with Drs James Kirby and Cassie Tellegen, here.