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Helping Clients Stop Self-Sabotagingwith Lisa Firestone, Ph.D.

Lisa Firestone, Ph.D.Director of Research and EducationThe Glendon AssociationSenior EditorPsychAlive.org(For Professionals)www.glendon.org(For the Public)www.psychalive.org

Poll #1:In what areas does self-sabotageaffect your clients?-WorkSchoolRelationshipsPersonal GoalsFamily Life

Self-Sabotage at Work A 2007 study showed that how people view their abilities in theworkplace impacts their success. People who thought of theirabilities as fixed were more likely to become anxious anddisoriented, causing their performance to suffer. A study from the Bureau of Labor Statistics showed that apositive self-image was strongly correlated with overall careersatisfaction, higher pay and better health.

Self-Sabotage in Relationships According to the American Psychological Association,about half of U.S. marriages end in divorce. According to data collected by WotWentWrong, an appthat tracks why people break up, the most commonreason for splits in couples who’d dated longer than sixmonths was “too much fighting.”

Self-Sabotage and Addiction“Giving up smoking is the easiest thing in the world. I knowbecause I've done it thousands of times.”- Mark Twain 90 percent of people who lose a lot of weight gain it back. 60 to 90 percent of smokers trying to quit relapse within thefirst year.

The Prevalence of Procrastination Procrastination has quadrupled in the past 30 years. 85-95 percent of students have problems associated withprocrastination. A 10-year study released in 2007 showed that procrastinationmakes people “poorer, fatter and unhappier.” 1 out of 5 people procrastinate so badly, it could jeopardizetheir jobs, relationships and health.

The Unconscious Fear of SuccessOgilvie’s five observations of why athletes may have“success phobia:”1.2.3.4.Social and emotional isolationGuilt over asserting themselves in competitionFear of discovering their true potentialAnxiety about the possibility of surpassing a previous recordestablished by an admired performer5. Pressure of constantly having to match or exceed one’sprevious best performance

The Unconscious Fear of SuccessOur observations of why people limit themselves:1. Fear of challenging one’s critical inner voice2. Fear of breaking a “fantasy bond”3. Fear of existential issues4. Fear of surpassing one’s parents/ breaking with family norms

Definition of the VoiceThe critical inner voice refers to a well-integrated pattern of destructivethoughts toward our selves and others. The “voices” that make up thisinternalized dialogue are at the root of much of our maladaptive behavior.This internal enemy fosters inwardness, distrust, self-criticism, self-denial,addictions and a retreat from goal-directed activities. The critical innervoice effects every aspect of our lives: our self-esteem and confidence,our personal and intimate relationships, and our performance andaccomplishments at school and work.

Common Critical Inner VoicesAbout Yourself:You’re ugly.You’re stupid.You’re not like other people.You’ll never succeed, so why even try?About Your Career:You’ll never be successful.No one appreciates how hard you work.You are under too much pressure; you can’thandle this stress.About Your Relationship:He doesn’t really care about you.You’re better off on your own.Don’t be vulnerable, you’ll just get hurt.

Poll #2:Do your clients commonly expresshaving these critical inner voices?-OftenSometimesRarelyNever

Part One:Where Do Critical Inner Voices Come From?

How Voices Pass FromGeneration to Generation

Separation TheoryRobert W. Firestone, Ph.D. Integrates psychoanalytic and existential systems ofthought Two kinds of emotional pain: Interpersonal Existential The core conflict Defended versus undefended lifestyles Formation of defenses in childhood The concept of the Fantasy Bond The concept of the Critical Inner Voice

Attachment TheorySir John Bowlby, Ph.D.Harry Harlow, Ph.D.Rene Spitz, M.DMary Ainsworth, Ph.D.Mary Main, Ph.D.Adult Attachment Interview:predicts the baby’s attachment tothe parent with 80% accuracy beforethe baby is even bornErik Hesse, Ph.D.

Where do voices come from?Patterns of Attachment in ChildrenCategory of AttachmentParental Interactive Pattern Secure Emotionally available, perceptive, responsive Insecure – avoidant Emotionally unavailable, imperceptive,unresponsive and rejecting Insecure- anxious/ambivalent Insecure - disorganized Inconsistently available, perceptive and responsiveand intrusive Frightening, frightened, disorienting, alarming

Attachment Figures Low Risk Non-Clinical Populations Secure55-65% Ambivalent5-15% Avoidant20-30% Disorganized20-40% (Given a Best Fit Alternative) High Risk, Parentally maltreated Disorganized80%

The Brain in the Palm of Your HandDaniel Siegel, M.D. – Interpersonal Neurobiology

9 Important Functions of thePre-Frontal Cortex1.2.3.4.5.6.7.8.9.Body RegulationAttunementEmotional BalanceResponse FlexibilityEmpathySelf-Knowing Awareness (Insight)Fear ModulationIntuitionMorality

Division of the MindParental AmbivalenceParents both love and hate themselves and extendboth reactions to their productions, i.e., theirchildren.Parental NurturanceParental Rejection, Neglect Hostility

Prenatal InfluencesDisease Trauma24Substance Abuse/ Domestic Violence

itySex25

Self-SystemParental NurturanceUnique make-up of the individual (geneticpredisposition and temperament); harmoniousidentification and incorporation of parent’spositive attitudes and traits and parentspositive behaviors: attunement, affection,control, nurturance; and the effect of othernurturing experience and education on thematuring self-system resulting in a sense of selfand a greater degree of differentiation fromparents and early caretakers.26

Personal Attitudes/Goals/ConscienceRealistic, Positive AttitudesTowards SelfRealistic evaluation of talents,abilities, etc with generallypositive/ compassionate attitudetowards self and others.BehaviorGoalsNeeds, wants, search formeaning in lifeGoal DirectedBehaviorMoral PrinciplesActing withIntegrityEthical behaviortowards self and others

Anti-Self System Unique vulnerability: genetic predisposition and temperament Destructive parental behavior: misattunement, lack of affection, rejection,neglect, hostility, over permissiveness Other Factors: accidents, illnesses, traumatic separation, death anxietyThe Fantasy Bond (core defense) is aself-parenting process made up of twoelements: the helpless, needy child, andthe self-punishing, self-nurturingparent. Either aspect may be extendedto relationships. The degree of defenseis proportional to the amount ofdamage sustained while growing up.28

Anti-Self SystemSelf-Punishing Voice ProcessVoice ProcessBehaviors1. Critical thoughts toward selfVerbal self-attacks – a generallynegative attitude toward self andothers predisposing alienation2. Micro-suicidal injunctionsAddictive patterns. Self-punitivethoughts after indulging3. Suicidal injunctions – suicidalideationActions that jeopardize, such ascarelessness with one’s body,physical attacks on the self, andactual suicide

Anti–Self SystemSelf- Soothing Voice ProcessVoice Process1. Self Soothing Attitudes2. Aggrandizingthoughts toward self3. Suspicious paranoidthoughts towards others4. Micro-suicidalInjunctions5. Overtly ViolentthoughtsBehaviorsSelf-limiting or selfprotective lifestyles,InwardnessVerbal build up towardselfAlienation from others,destructive behaviortowards othersAddictive patterns.Thoughts luring theperson into indulgingAggressive actions, actualviolence

Part Two:Challenging the Critical Inner Voice

Helping Your Clients Identify TheirCritical Inner VoiceHelp Clients:1.2.3.4.Recognize the events that trigger their Critical Inner VoiceRecognize the specific outside criticisms that support their Critical InnerVoiceBecome aware of times they may be projecting their self-attacks ontoother peopleNotice changes in their mood

Identify Negative ThinkingAre you ? Filtering: You magnify the negative aspects of a situationand filter out all of the positive ones. Personalizing: When something bad occurs, youautomatically blame yourself. Catastrophizing: You automatically assume and anticipatethe worst. Polarizing: You see things only as either good or bad.There is no middle ground.Source: Mayo Clinic

Exercise 1.1:Visualizing the Real YouAll exercises from Conquer Your Critical Inner Voice My physical abilities: My positive qualities: My interests and activities: My long-term goals: My short-term goals: Where do I stand in relation to my goals?

Exercise 1.2:Your Critical Inner Voice Attacks Self-critical attacks as “I”statementsExample: “I don’t think I’m anattractive person.” Self-critical attacks as “you”statementsExample: “You’re notattractive.”

Exercise 1.3:Keeping a Journal:Your Critical Inner Voice/The Real You My critical inner voiceas “you” statementsExample: “You’re so stupid.” The real meas “I” statementsExample: “Sometimes I strugglewith work, but I catch on quicklyand then usually do a good job.”

Exercise 1.4:A Plan for Action Actions dictated by my critical inner voice Actions to take that reflect the real meExamples:“Have another piece of cake.”“You should just be on your own.”“You can’t trust anyone, so don’t get tooclose.”Examples:“I want to eat healthy and take care ofmyself.”“I don’t want to be isolated and will seek outfriends”“I want to stay vulnerable in my closerelationships.”

Exercise 2.1:Seeing Your Parents RealisticallyA. Describing Your Parents’ Traits and Behaviors1.Did you experience any long-term separations from your parent orparents during your childhood? Through death? Divorce? Illness? Ifso, describe your reactions at the time.2.What do you think your parents offered you that has been themost valuable to you in your adult life? Describe these traits,values, or ideals.3.What faults or weaknesses did you dislike in your parent orparents? Describe these traits.4.Were your parents strict or overly permissive in their discipline ofyou and your siblings? Describe an example of how theydisciplined you.

Exercise 2.1:Seeing Your Parents RealisticallyB. Your Parents’ Behaviors That May HaveCaused You Shame or GuiltMotherFatherYes NoYes NoAs a child, were you beaten or scolded in thepresence of others?Yes NoYes NoDid your parents show with words andgestures that they liked you?Yes NoYes NoDid you ever feel humiliated by things yourparents did or said in front of others?Yes NoYes NoDid your parents begrudge you things youneeded?

Poll #3:Do you use homework assignmentsas an adjunct to therapy?-YesNo

Assessment Instruments Firestone Assessment of Self-Destructive Thoughts (FAST)Firestone Assessment of Suicidal Intent (FASI)Firestone Assessment of Violent ThoughtsFirestone Assessment of Violent Thoughts - Adolescents

Voice TherapyCognitive Affective Behavioral Approach

The Therapeutic Processin Voice TherapyStep IIdentify the content of the person’s negativethought process. The person is taught to articulatehis or her self-attacks in the second person. Theperson is encouraged to say the attack as he or shehears it or experiences it. If the person is holdingback feelings, he or she is encouraged to expressthem.Step IIThe person discusses insights and reactions toverbalizing the voice. The person attempts tounderstand the relationship between voice attacksand early life experience.