“Of course, I wouldn’t say that to a friend!” My patient, Alice, has come to me for help with depression and procrastination, and we’ve identified her long-standing habit of calling herself “a lazy fuckup” when she gets stuck on an assignment. We’ve been using David Burns’ version of the “Double Standard” method of challenging this harsh negative self-talk. In this role-play method, I play an imaginary best friend who is a clone of her - with her same genetics, childhood background and adult circumstances - who has turned to her for help with her negative thoughts. She’s given me the name “Gina.”

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 “Alice,” I say as Gina, “I’ve been feeling so stuck on this work project and feeling down on myself about it. I’ve been telling myself that I’m a lazy fuckup. Isn’t it true, that I’m a lazy fuckup?”

 “Of course, that isn’t true!” Alice rises out of her slumped position and leans forward, almost as if she were going to lay a hand on ‘Gina’s’ knee. “You aren’t a lazy fuckup. That is such an unkind thing to say.”

“So, it’s not true? Are you just being nice to me because I’m your friend?”

Absorbed in the role play, Alice shakes her head without flinching. “Of course, it’s not true.”

I had a feeling this method would be helpful to Alice, as she has demonstrated plenty of compassion for the others in her life, reserving her harshness for herself, and she had already made progress identifying the distortions in her thoughts. But despite seeing that her thoughts were distorted, she wasn’t quite connecting with her positive, encouraging thoughts. Roleplay methods are often a powerful way to bring home a change at the gut level. I continue with the role play, encouraging her to get specific.
“But Alice, I’m so stuck on this project. What makes you think I’m not a lazy fuckup?”

This takes her a bit more time, and I can see her brain shifting gears, as she starts to engage the work of compassion, work that involves seeing what is there rather than reaching for a label.

“Well, it’s true that you haven’t gotten as far in on the email copy as you would like. And you spent most of the morning doing the New York Times crossword puzzle. It sounds like you are feeling pretty stuck,”

I nod along in character, encouraging her.

“But you did finally sit down to work on it. You haven’t given up,” she continues, “and that is important.”

We both smile.

Why are we kinder to our friends than we are to ourselves? Why do we poke at ourselves with hurtful labels and lash ourselves with should statements, those whips of the mind that create anxiety, guilt and shame? In TEAM therapy, “A” stands for “Agenda Setting,” or “Analysis of Resistance.” In this step, we walk with a patient to see what is positive about negative self-talk and the painful feelings it generates. Alice has come to see that the anxiety, guilt and shame that rise up when she starts to criticize herself for procrastinating, stem from deep-seated values to be productive, to move forward on projects she cares about, to engage instead of to withdraw. Telling herself she is a lazy fuckup is a way to keep herself from enjoying her procrastination too much, a kind of guard rail that protects her from the consequences of not getting her work done.

So, knowing that there are good reasons for her to stay stern with herself, I test her again, giving another one of her harsh thoughts, in my role as Gina. “But Alice, shouldn’t I just get over myself?”

“No, no,” Alice’s eyes are warm. “You want to move past this, I can see that. But name-calling and pressuring yourself won’t be helpful. You can get past this place where you are stuck. It’s going to be hard, and scary, and you might be tempted to believe you can’t do it. But I believe in you, and you can always call me for encouragement.”

“Wow,” I say, wanting to linger as ‘Gina,’ and bask in her kind encouragement, “that feels incredibly good hearing you say that. I feel so seen and supported and encouraged.” Reluctantly, I add, “can we hit the pause button?” She nods and sits back. She is calmer, sadder, tears in her eyes. She seems fuller.

“Wow, indeed,” she says. “I know where you are going with this. Can I talk to myself that way?” She considers this. “It should be a no-brainer. I mean, right now at this moment I feel so connected to you as Gina - it seems easy to want to stay present with her and encourage her. But somehow, when it comes to me, I feel hesitant.”

“Yeah, go on. There is something important in your hesitation. Why would you be hesitant to stay encouraging instead of punitive with yourself.”

“I really, really love to procrastinate. If I’m kind to myself the way I am with Gina, I will feel better, and then how do I know that I won't just get soothed and feel better and jump on the couch with another crossword puzzle? Being strict with myself is the only way I can stay on task.”

“So, your worry is that if you let up on yourself, that you’ll become self-indulgent?”

“Yes, exactly,” she nods.

“And what would your self-indulgent voice be telling you. What are the thoughts that tempt you to the couch?”

“Oh, I’d tell myself that I can totally do this tomorrow and that I deserve a break.”

“Can we go back into the role play?” She nods, and I resume again as Gina, “Alice, thanks so much for those kind words about my project. I feel so much better that I’m going to grab that crossword and go sit on the couch. I deserve this break.”

Alice starts to crack up.

“Oh no, you don’t my friend! I love you too much to let you do that. This project is really important to you! You won’t have time later, now is the time to do it! You can do that crossword after you finish this email copy and after you confirm your plans with Diana.” She breaks from the role play, “I get it now, kindness and accountability are all wrapped up together.” She sees me open my mouth, and beats me to it, “Now that’s something I would say that to a dear friend, and to myself.” 

File under: The Art of Psychotherapy