I was asked recently what to do when we hear clients criticizing themselves. What is a motivational-interviewing-consistent way of addressing this phenomenon?
I’ve inadvertently allowed
my inner critic to have a voice.
And you know what? She’s a bitch.
Jen Lancaster
We can love and accept ourselves and still
work like mad to change ourselves.
Dave Ellis
It may sound like:
- I don’t have any discipline.
- I’m disgusting.
- I’m a failure at this dieting thing.
- I’m lazy.
- I’m sorry I’m late. I can’t seem to get it together.
- I have done so much else in my life, why can’t I do this?
- I’ve been bad this week.
These statements may make us uncomfortable. They are often not logical, and we know they are usually ineffective and hurtful to the client. They seem so absolute and final, with no wiggle room. We know that when the client holds onto these beliefs, making changes will be very difficult.
So, what to do? First, what not to do. It is natural to want to argue with a client’s inner critic. For example, you may have seen that the client who calls himself a failure has actually made many healthy changes. It is tempting to bring that up as soon as you hear, “I’m a failure.” Arguing directly with inner critics will likely be ineffective. Careful observational research has shown that this causes the client’s critics to persist and even strengthen.
Side-step these statements, and look for efforts and strengths to affirm. In MI, we usually ignore any statements that do not support change and instead reflect and evoke change talk. For more on side-stepping sustain talk, review Tip #101. We focus on finding efforts the client has made and strengths he has, and we reflect them. Check out these Tips that go into more detail about affirming: #63, #152, #159, #168, #170.
Here is an additional way to look at these critical voices that is based on Internal Family Systems (IFS). One of the reasons arguing will not be effective is that the client likely identifies with these statements. In other words, the client experiences the critical part of her as fully blended with herself. Notice that the critical statements usually begin with, “I am….” These critical voices can be very entrenched, and many clients don’t notice them. They just seem true.
It will be useful to both you and the client for you to remember that it is a part of the client that holds these critical beliefs. Many call this an “inner critic.” What can you, as a nutrition counselor, do to help your client who has strong internal critics that take over? If the client has a therapist, you can suggest that the client bring this into therapy. In order to heal the beliefs that underlie the critical statements, the client will likely need to work on it in therapy. Much of Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), and Internal Family Systems (IFS) are designed to address these inner critics.
In the meantime, you can help the client gain some space between his inner self and his critic. Gently bring in awareness by using language such as:
- “A part of you sees your process here as a failure.”
- “That hopeless thought came up again.”
- “Hmm, a part of you is very hard on you.”
- “A part of you believes that…”
- “How often do you notice that thought pop up?”
If the client seems to have some distance from the critical thoughts, you could remind him that just because we think something doesn’t make it true. Thoughts can be considered and let go.
It may be useful to invite other parts of the client to question the critic’s reasoning. In this way, you are not arguing with the client’s critic, another part of them is. For example, you hear, “I’m fat, so I don’t need any food.” That is a thought, and you can point this out. “Hmmm, a part of you believes you don’t need any food while you are at this body weight and that our body can just use stored energy.” Once you sense some separation from this thought, “what else do you know about what happens when you miss meals or deny yourself?” This will likely evoke other internal parts of the client that know about the need for daily food. There is another example in Tip #174.