Transcription
In terms of self-perception or self-expression, the experience of self-loathing, which I think is a like I don't, it seems really abstract to me, and grandiosity, and how they cycle. Can you talk about what would be the function of self-loathing? It has to serve a function, or they wouldn't be doing it.
Yeah, there is the literature about this. Um, we do talk about this experience that patients describe to us sometimes in very painful details about how they attack themselves in different ways. It could be through self-shaming or self-loathing or criticizing every piece of themselves, many times with a lot of very strong emotions. It's an emotional process, not just a cognitive process. And what we do now is that when people try to reassure them and say, "No, that's not true, you're actually a good person," that doesn't really work. It falls flat. And sometimes therapists try to look for evidence, "Is that true? Is that not true?" And that falls flat. True, usually people feel very, very attached to that process for some reason, which is paradoxical and counter-intuitive and puzzles a lot of people. Um, and so one clinical approach to this is to examine together with the patient what may be the function of doing this. What, what maybe some of the reasons that they are doing this and involved in this process of putting themselves down and hating themselves and hitting themselves in so many different ways.
Inviting the patient to examine this is not an easy task because for a lot of them, it seems like an obvious thing to do. They feel like it's a go-to place. It feels like a familiar thing, and that may be one of the reasons that they're doing it because it's familiar. But it may also serve other functions, and it may take a while to invite people fully to reflect about this process. Sometimes people talk about this, this is a way for them to deal with regrets and punish themselves for things that happened. Or it could be a way to motivate themselves and feeling that if they failed by beating themselves up, they are holding themselves to a high standard. And in this way, proving that in fact, the failure was just a casual thing, and the next time there will be a destined for some big accomplishment. And that becomes a very difficult thing to give up because it, it serves so many functions. However, it also gives patients perspective about reasons that they're doing it and takes away the edge because now it's not, uh, no longer being experienced as, well, it doesn't work as well, right? It's being revealed. People see that this is not necessarily the reality. It's not reality at all, but this is just how they operate in this deserves a certain type of a function. Usually, it helps people move past that and see that there may be a different way of dealing with the same dilemma. Um, and in many times, it opens up exploration of early experiences that contributed to that.
I mean, I was going to say, just just alone, take the steam out of it because it's like it's been revealed and now it's possible to do something different. Yeah, it's possible to, to make some changes. And, uh, usually people see more developmental narrative. This is where it's coming from, and they could say, "Okay, I don't have to repeat this." So I guess like, is the lesson in something like that that if you're a treater, you're treating someone, there is a lot of power in speaking to the mechanisms behind a behavior and seeing if that gels with the person you're treating? I think at some point in treatment, those questions come up because the question of how people aggrandize themselves, for example, or engage in some type of a self-enhancement, um, on the one hand, or shame themselves, that usually comes up. And it's, it's just helpful to start asking questions about the function. Different patients are open to different degrees to that question, but it's just a question that's helpful. It leads them to the next level because then they feel they can do something about it. Some people may not really take it in, but usually, you know, you could continue asking and see at some point people might have enough curiosity to ask this question and and then they can really go further with that. Yeah, usually people are open to that question.