you do accomplish each day.
,.., 7. Yon think about a task in a self-
i-.
7. TIC-TOC Technique
7. You substitute task-oriented cog-
N
defeating manner.
nitions (TOGS) for task-interfer-
ing cognitions (TICS).
8. You feel overwhelmed by the mag-
8. Little Steps for Little Feet
8. Break the task down into its tiny
component parts, and do these one
nitude of everything you have to
step at a time.
do.
9. a. You eliminate "shoulds," "
9. You feel guilty, oppressed, obliged,
9. Motivation Without Coercion
musts," and "oughts" when
and duty-bound.
you give yourself instructions.
b. You list the advantages and dis-
advantages of any activity so
you can begin to think in terms
of what you want to do rather than what you nut do.
Table
Continued,
10. Someone else nags and harangues
10. Disarming Technique
10. You assertively agree with them
you. You feel pressured and re-
and remind them that you are
sentful, so you refuse to do any-
capable of doing your own think.
thing at alL
11. You have difficulty modifying a
11. Visualize Success
11. You maim a fist of the positive
habit such as smoking.
benefits of having changed the
habit. You visualize these after inf.
during a state of deep relaxation.
I-. 12. You feel unable to do anything on 12. Count What CounfS
12. You count the things you do each
07,
your
own
in
t
a
ve
bcause
you
day on your own initiative, using a
see yourself as "a procrastinator?
wrist counter. This helps you over-
come your bad habit of constantly
dwelling en your inadequacies.
13. You feel inadequate and incom-
13. Test Your Can'ft
13. You set up an experiment in which
petent because you say, "I can't."
you challenge and disprove your
negative predictions.
14. Write down any negative conse-
14. You are afraid to fail, so you risk
14. "Can't Lose" System quences of failure and develop a
nothing.
coping strategy ahead of time.
CHAPTER 6
Verbal Judo:
Learn to Talk Back
When You're Under the Fire
of Criticism
You are learning that the cause of your sense of worthlessness is your ongoing self-criticism. This takes the form of an upsetting internal conversation hi which you constantly harangue and persecute yourself in a harsh, unrealistic manner.
Frequently your inner criticism will be triggered by someone else's sharp remark. You may dread criticism simply because you have never learned effective techniques for handling it.
Because it is relatively easy to do, I want to emphasize the importance of mastering the art of handling verbal abuse and disapproval nondefensively and without a loss of self-esteem.
Many depressive episodes are set in motion by external criticism. Even psychiatrists, who are supposedly professional abuse-takers, can react adversely to criticism. A psychiatric resident called Art received negative feedback intended to be helpful from his supervisor. A patient had complained that several comments Art made during a therapy session were abrasive. The resident reacted with a wave of panic and depression when he heard this, due to his thought, "Oh God!
The truth is out about me. Even my patients can see what a worthless, insensitive person I am. They'll probably kick me out of the residency program and drum me out of the state."
Why is criticism so hurtful to some people, while others can remain unperturbed hi the face of the most abusive attack? In this chapter you will learn the secrets of people who face disapproval fearlessly, and you will be shown specific, concrete steps to overcome and eliminate your own exquisite
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David D. Burns, M.D.
vulnerability to criticism. As you read the following sections, keep this in mind: Overcoming your fear of criticism will require a moderate amount of practice. But it is not difficult to develop and master this skill, and the positive impact on your self-esteem will be tremendous.
Before I show you the way out of the trap of crumbling inwardly when criticized, let me show you why criticism is more upsetting to some poeple than to others. In the first place, you must realize that it is not other people, or the critical comments they make, that upset you. To repeat, there has never been a single time in your life when the critical comments of some other person upset you—even to a small extent. No matter how vicious, heartless, or cruel these comments may be, they have no power to disturb you or to create even a little bit of discomfort.
After reading that paragraph you may get the impression that I am cracking up, mistaken, highly unrealistic, or some combination thereof. But I assure you I am not when I say: Only one person in this world has the power to put you down—and you are that person, no one else!
Here's how it works. When another person criticizes you, certain negative thoughts are automatically triggered hi your head. Your emotional reaction will be created by these thoughts and not by what the other person says. The thoughts which upset you will invariably contain the same types of mental errors described in Chapter 3; overgeneralization, allor-nothing thinking, the mental filter, labeling, etc.
For example, let's take a look at Art's thoughts. His panic was the result of his catastrophic interpretation: "This criti-ism shows how worthless I am." What mental errors is he making? In the first place, Art is jumping to conclusions when he arbitrarily concludes the patient's criticism is valid and reasonable. This may or may not be the case. Furthermore, he is exaggerating the importance of whatever he actually said to the patient that may have been undiplomatic (
magnification), and he is assuming he could do nothing to correct any errors in his behavior (the fortune teller error).
He unrealistically predicted he would be rejected and ruined professionally because he would repeat endlessly whatever error he made with this one patient (overgeneralization). He focused exclusively on his error (the mental filter) and over-120
FEELING GOOD
looked his numerous other therapeutic successes (disqualifying or overlooking the positive). He identified with his erroneous behavior and concluded he was a "worthless and insensitive human being" (labeling).
The first step in overcoming your fear of criticism concerns your own mental processes: Learn to identify the negative thoughts you have when you are being criticized. It will be most helpful to write them down using the double-column technique described in the two previous chapters. This will enable you to analyze your thoughts and recognize where your thinking is illogical or wrong. Finally, write down rational responses that are more reasonable and less upsetting.
An excerpt from Art's written homework using the double-column technique is included (Figure 6-1). As he learned to think about the situation in a more realistic man-Figure 6-1. Excerpt from Art's written homework, using the double-column technique. He initially experienced a wave of panic when he received critical feedback from his supervisor about the way he handled a difficult patient. After writing down his negative thoughts, he realized they were quite unrealistic. Consequently, he felt substantial relief.
Automatic Thoughts
Rational Responses
(SELF-cRatosas)
(SELF-DEFENSE)
1. Oh, God! The truth is out about 1. Just because one patient comme. Even the patients can see
plains it doesn't mean that I am
what a worthless, insensitive in-
a "worthless, insensitive individ-
dividual I am.
ual." The majority of my pa-
tients do, in fact, like me.
Making a mistake doesn't
reveal my "true essence."
Everyone is entitled to make
mistakes.
2. They'll probably kick me out of 2.*This is silly and rests on several the residency program. erroneous assumptions: (a) all I do is bad things; (b) I have
no capacity to grow. Since (a)
and (b) are absurd, it is
extremely
unlikely
my
position here is threatened. I
have on many occasions
received praise from my
supervisor.
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David D. Burns, M.D.
ner, he stopped wasting mental and emotional effort in catastrophizing, and was able to channel his energy into creative, goal-oriented problem solving. After evaluating precisely what he had said that was offensive or hurtful, he was able to take steps to modify his clinical style with patients so as to minimize future similar mistakes. As a result, he learned from the situation, and his clinical skills and maturity increased. This gave his self-confidence a boost and helped him overcome his fear of being imperfect.
To put it succinctly, if people criticize you the comments they make will be right or wrong. If the comments are wrong, there is really nothing for you to be upset about.
Think about that for a minute! Many patients have come to me in tears, angry and upset because a loved one made a critical comment to them that was thoughtless and inaccurate.
Such a reaction is unnecessary. Why should you be disturbed if someone else makes the mistake of criticizing you in an unjust manner? That's the other guy's error, not yours. Why upset yourself? Did you expect that other people would be perfect? On the other hand, if the criticism is accurate, there is still no reason for you to feel overwhelmed. You're not expected to be perfect. Just acknowledge your error and take whatever steps you can to correct it. It sounds simple (and it is!), but it may take some effort to transform this insight into an emotional reality.
Of course, you may fear criticism because you feel you need the love and approval of other people in order to be worthwhile and happy. The problem with this point of view is that you'll have to devote all your energies to trying to please people, and you won't have much left for creative, productive living. Paradoxically, many people may find you less interesting and desirable than your more self-assured friends.
Thus far, what I have told you is a review of the cognitive techniques introduced in the previous chapter. The crux of the matter is that only your thoughts can upset you and if you learn to think more realistically, you will feel less upset.
Right now, write down the negative thoughts that ordinarily go through your head when someone criticizes you. Then identify the distortions and substitute more objective rational responses. This will help you feel less angry and threatened.
Now I would like to teach you some simple verbal tech-122
FEELING GOOD
niques which may have considerable practical relevance.
What can you say when someone is attacking you? How can you handle these difficult situations in a way that will enhance your sense of mastery and self-confidence?
Step One—Empathy. When someone is criticizing or attacking you, his (or her) motives may be to help you or to hurt you. What the critic says may be right or wrong, or somewhere in between. But it is not wise to focus on these issues initially. Instead, ask the person a series of specific questions designed to find out exactly what he or she means. Try to avoid being judgmental or defensive as you ask the questions. Constantly ask for more and more specific information.
Attempt to see the world through the critic's eyes. If the person attacks you with vague, insulting labels, ask him or her to be more specific and to point out exactly what it is about you the person dislikes. This initial maneuver can itself go a long way to getting the critic off your back, and will help transform an attack-defense interaction into one of collaboration and mutual respect.
I often illustrate how to do this in a therapy session by role-playing an imaginary situation with the patient so that I can model this particular skill. I'll show you how to role-play; it's a useful skill to develop. In the dialogue that follows, I want you to imagine you are an angry critic. Say the most brutal and upsetting thing to me you can think of. What you say can be true, false, or partly both. I will respond to each of your assaults with the empathy technique.
YOU (playing the role of angry critic): Dr. Burns, you're a no-good shit.
DAVID: What about me is shitty?
YOU: Everything you say and do. You're insensitive, self-centered, and incompetent.
DAVID: Let's take each of these. I want you to try to be specific. Apparently I've done or said a number of things that upset you. Just what did I say that sounded insensitive? What gave you the impression I was self-centered?
What did I do that seemed incompetent?
YOU: When I called to change my appointment the other day, you sounded rushed and irritable, as if you were in a big hurry and didn't give a damn about me.
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David D. Burns, M.D.
DAVID: Okay, I came across in a rushed, uncaring way on the phone. What else have I done that irritated you?
You: You always seem to hurry me out at the end of the session—just like this was a big production line to make money.
DAVID: Okay, you feel I've been too rushed during sessions as well. I may have given you the impression I'm more interested in your money than in you. What else have I done? Can you think of other ways I might have goofed up or offended you?
What I am doing is simple. By asking you specific questions I minimize the possibility that you will reject me completely. You—and I—become aware of some specific concrete problems that we can deal with. Furthermore, I am giving you your day in court by listening to you so as to understand the situation as you see it. This tends to defuse any anger and hostility and introduces a problem-solving orientation in the place of blame casting or debate. Remember the first rule—even if you feel the criticism is totally unjust, respond with empathy by asking specific questions. Find out precisely what your critic means. If the person is very hot under the collar, he or she may be hurling labels at you, perhaps even obscenities. Nevertheless, ask for more information. What do those words mean? Why does the person call you a "no-good shit"? How did you offend this individual? What did you do? When did you do it? How often have you done it? What else does the person dislike about you? Find out what your action means to him or her. Try to see the world through your critic's eyes. This approach will frequently calm the roaring lion and lay the groundwork for a more sensible discussion.
Step Two—Disarming the Critic. If someone is shooting at you, you have three choices: You can stand and shoot back—this usually leads to warfare and mutual destruction; you can run away or try to dodge the bullets—this often results in humiliation and a loss of self-esteem; or you can stay put and skillfully disarm your opponent. I have found that this third solution is by far the most satisfying. When you take the wind out of the other person's sails, you end up 124
FEELING GOOD
the winner, and your opponent more often than not will also feel like a winner.
How is this accomplished? It's simple: Whether your critic is right or wrong, initially find some way to agree with him or her. Let me illustrate the easiest situation first. Let's assume the critic is primarily correct. In the previous example when you angrily accused me of sounding rushed and indifferent on several occasions, I might go on to say: "You're absolutely ri
ght. I was rushed when you called, and I probably did sound impersonal. Other people have also pointed this out to me at times. I want to emphasize that I didn't intend to hurt your feelings. You're also right that we have been rushed during several of our sessions. You might recall that sessions can be any length you like, as long as we decide this ahead of time so that the scheduling can be appropriately adjusted.
Perhaps you'd like to schedule sessions that are fifteen or thirty minutes longer, and see if that's more comfortable."
Now, suppose the person who's attacking you is making criticisms you feel are unfair and not valid. What if it would be unrealistic for you to change? How can you agree with someone when you feel certain that what is being said is utter nonsense? It's easy—you can agree in principle with the criticism, or you can find some grain of truth in the statement and agree with that, or you can acknowledge that the person's upset is understandable because it is based on how he or she views the situation. I can best illustrate this by continuing the role-playing; you attack me, but this time say things that are primarily false. According to the rules of the game, I must (1) find some way to agree with whatever you say; (2) avoid sarcasm or defensiveness; (3) always speak the truth.
Your statements can be as bizarre and as ruthless as you like, and I guarantee I will stick by these rules! Let's go!
YOU (continuing to play the role of angry critic) : Dr.
Bums, you're a shit.
DAVID: I feel that way at times. I often goof up at things.
YOU: This cognitive therapy is no damn good!
DAVID: There's certainly plenty of room for improvement.
YOU: And you're stupid.
DAVID: There are lots of people who are brighter than I am. I'm sure not the smartest person in the world.
125
David D. Burns, M.D.
YOU: You have no real feelings for your patients. Your approach to therapy is superficial and gimmicky.
DAVID: I'm not always as warm and open as I'd like to be.
Some of my methods might seem gimmicky at first.
YOU: You're not a real psychiatrist. This book is pure trash. You're not trustworthy or competent to manage my case.
The Feeling Good Handbook Page 14