How willing are your clients to acknowledge unhelpful attitudes and beliefs that they may have? Some of these may be unexamined ways of thinking about themselves and their lives that were given to them by parents and other early caregivers. They may not really be the clients’ attitudes and values, but they were put there so early on, it is hard for clients to tell that they do not belong with them. You can recognise them because they are often distorted, exaggerated, highly self-critical, or self-defeating “tapes” that re-play over and over again in the client’s head, causing personal anxiety, self-doubt, depression, and of course, major stress.

As a therapist, you can initiate the discussion by asking clients about negative, unhelpful attitudes. Which attitudes or beliefs do clients identify for themselves as problematic? Provide them with a copy of the list below and invite them to go through by describing how often they engage these attitudes/beliefs. How does the client currently deal with these distortions? How stressed does the person make him/herself as a result of them?

Questionnaire – how often do you engage these attitudes/beliefs?

(Assign one of the following options: “Not Much”; “Sometimes” or; “Frequently)

• Rigidity
• Perfectionism
• Intolerance for myself and others
• Compulsion to overwork
• Messages of unworthiness (e.g., “I don’t deserve __”)
• Obsession with envy
• Feelings of incompetence
• Phobias
• Fear of committing
• Non-acceptance of myself
• Non-acceptance of others
• Bitterness
• Unprocessed regret
• Sense that the world “should” be a certain way
• Distorted sense of control (either too much or too little)
• Lack of perspective
• Placing conditions on my happiness
• Lack of gratitude

Cognitive Distortions

If the client discloses that he or she has harboured some of the above attitudes, your task as a mental health professional is that of putting the unhelpful beliefs into context; few human beings escape dealing with these altogether; most of us struggle with a few of the above demons! As with all of these unfortunate mental “glitches” in our wiring, however, we do not have to choose to keep hanging onto them. A powerful antidote is to strongly challenge these as we identify them.

We do this by making a “disputing statement” or rebuttal which gives a kinder, more realistic evaluation of ourselves or our situation. The rebuttal doesn’t limit us so much or place such stringent conditions on how things “should” be. It helps us to solve problems where the original statement, a “cognitive distortion”, would tend to keep us stuck (AIPC, 2012).

Some types of cognitive distortion stressors have been identified. How many of these does the client believe that s/he uses?

• Overgeneralisation: You make a universal rule from one isolated event. If you failed once, you will always fail. With this one the critic uses unbalanced, absolute words like “every”, “always”, “never”, or “all”.
• Global labelling: You automatically use pejorative labels to describe yourself, rather than accurately describing your qualities (any clichéd statements about your appearance, performance, or intelligence give this one away).
• Filtering: You see the world as through coloured glass, but not rose-coloured. With this distortion-stressor, you only let in rejection, unfairness, loss, or other negative stimuli. You are a biased reporter of your own experience, paying attention to the negative but not the positive.
• Polarised thinking: You lump things into absolute black-and-white categories, with no middle ground. You have to be perfect or you are worthless.
• Self-blame: You consistently blame yourself for things that may not really be your fault. You can spot this one by observing if you are always apologising.
• Personalisation: You assume that everything has something to do with you, and you negatively compare yourself to everyone else. Personalising has a narcissistic component, and makes you react inappropriately: forever comparing yourself with others, perhaps getting your feelings hurt, and possibly even picking fights over non-existent issues.
• Mindreading: You assume that others don’t like you or are angry with you without any evidence for your assumptions.
• Control fallacies: You either feel that you have complete responsibility for everyone and everything or feel that you have no control, that you are a helpless victim.
• Emotional reasoning: You assume things are the way you feel about them (adapted from McKay & Fanning, 1987).

Get the client to rebut the critic, reduce the stress

If your client engages some cognitive distortions, the exercise below can help him or her self-regulate in regard to critical attitudes and distorted self-perceptions. For this work, the goal is for clients to catch their inner critic displaying an unhelpful attitude or critical or distorted perception of them. Give the client a copy of the template below and explain that, for each distortion discovered, s/he is to note the day/time and the triggering event. The client should summarise the harsh (stressful) thought, attitude or perception that his/her critic displayed.

Then the person should generate a rebuttal: a statement that counters the distorted, highly critical thought or attitude. In the example below, we have put the distorted thought and also the stress-reducing rebuttal into the second person – that is: as if someone else were addressing the client – but the first person can also be used, with the client saying, for example, “I am competent”. The last section is for the client (perhaps jointly with you) to identify the type of cognitive distortion that it was (if it was). This is optional, but will help clients to identify patterns in their way of stressing themselves through their self-perceptions.

Here’s the example:

Date/time it happened: 9 June 2016 @ 1pm.

Triggering event: I forgot to bring materials with me that I needed for my work.

Critical or distorted through or attitude (critic self): “You idiot! This was so simple. You are always so disorganised!”

Stress-reducing rebuttal (kinder, more realistic self to self): “You had a lot to remember this morning. You don’t generally forget things. You normally are a competent organiser.”

Type of cognitive distortion (optional): Overgeneralisation and global labelling.

Talking back to the critic inside

In the exercise above, we advised you to encourage clients to come up with their own language, their own way of silencing the critical inner voice that can stress us so much by instilling extreme, distorted, and irrational attitudes and perceptions. For additional “ammunition” against the critic, here are some statements which can be used to put the critic in its place.

• For overgeneralisation: “What evidence have I got for that conclusion?” “Do I really have enough data to make a rule?”
• For global labelling: “No more labels – be specific.” “I refuse to call myself by names.” “Labels are mistaken opinions based on limited experience.”
• For filtering: “Wait! Open your eyes and look at the whole picture.” “You can choose to stop blanking out the good things.”
• For polarised thinking: “No more absolutes; nothing is totally anything.” “There are infinite gradations of good and bad in all I do.”
• For self-blame: “Everyone makes mistakes; it’s just human.” “I always do my best according to my awareness at the moment.”
• For personalisation: “Hold it: no comparisons!” “Most of the universe has nothing to do with you; don’t be so paranoid!”
• For mind reading: “I have no way of knowing what they’re thinking.” “What else could that mean? Why assume the negative?”
• For control fallacies: “I got myself into this mess and I can get myself out.” “I’m not in charge of others and don’t need to blame myself for their behaviours.”
• For emotional reasoning: “There is nothing automatically true about my feelings.” “What am I telling myself that makes me feel so sad, so anxious, so angry?

(Adapted from McKay & Fanning, 1987)

References

• Australian Institute of Professional Counsellors (AIPC). (2012). Mental Health Social Support, an online course. AIPC.
• McKay, M. & Fanning, P. (1987). Self-esteem. New York: St Martin’s Press.