Verbalizing Your Inner Dialogue
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This document describes an approach to cognitive therapy called "verbalizing inner dialogue" to address mental health issues like anxiety, depression, and relationship problems. The approach involves identifying different parts of the self (a knowing, confident part and a negative, doubting part) and having the client verbally express the internal dialogue between these parts with guidance from the counselor. Examples are provided for using this technique with different personality disorders by identifying the central negative belief and strengthening the positive, healthy self through questioning and affirmation.
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Verbalizing Your Inner Dialogue
- 1. Daniel Keeran, MSW, President, College of Mental Health Counselling www.collegemhc.com College of Mental Health Counseling presents: Verbalizing Your Inner Dialogue A Cognitive Therapy Approach
- 2. 1 This new generation psychological technology can improve conditions in persons with normal or average cognitive functioning. The cognitive mental functions give humans a particular advantage in terms of creative solution development. Humans are constantly engaging in a process of internal dialogue across a variety of subject areas. Mental distress may be at least partly remedied by verbalizing, understanding, and perhaps modifying the internal dialogue. For persons suffering from chronic dependency as well as anxiety, depression, and relationship issues, the following technique may be useful: 1. Invite the client to talk about what they know will improve their situation and what could worsen their situation. 2. Identify the parts of the self as the knowing confident self and the unknowing negative self. 3. Ask the client to verbalize each part of the self in response to the other (like Golum in Lord of the Rings). 4. Discuss ways to strengthen the knowing confident part of the self. This is also the observer will part of the self that is able to evaluate and modify the dialogue and draw a conclusion that works best. The above technique can be easily learned, recorded through journaling, and repeated as a core process in therapy in order to make the inner dialogue most conscious and useful to the client. This psychological technology can improve conditions in persons with normal or average cognitive functioning. The therapeutic use of inner dialogue can focus on a specific issue or area of mental distress and invite the client
- 3. 2 to have a conversation between the knowing confident part and the negative self-doubting or unhealthy part. Here is an example of an exchange using this inner dialogue approach: Client: I feel so inadequate and lacking in self-confidence. Counselor: So, part of you feels inadequate and lacking in self-confidence. I wonder if there is another part of you, a knowing part, even a small part, that feels adequate and confident about some things. Client: Yes, there is. I moved out here on my own. I have a job and pay my rent (client smiles). Counselor: You are very resourceful, capable, and independent. You can strengthen the positive, capable part of yourself just by talking more about it. Tell me more. In this example the counselor further supports the knowing supportive self by adding to the dialogue. The counselor can also invite the client to verbalize the inner dialogue between the positive knowing part and the negative doubting part. Counselor: Now I want you to speak your negative thoughts and also your positive thoughts. An exchange with someone suffering from depression Counselor: If there’s a conversation inside you about the depression, how does it go? Speak the conversation out loud. Client: I am a failure. Nothing I do is good enough.
- 4. 3 Counselor: So that is the negative part of you that feeds the depression. There is another part of you, even if it is a small part, that knows more and that can see the big picture. What does that part say? Client: I have been resourceful, independent, and self- reliant. I pay my own rent, buy my own food, hold a job, moved far from home, and have travelled to Europe on my own. Counselor: Yes. Which part of you feels better than the other part of you: the negative part or the other part? Working with different personality disorders The beginning of the process is to identify the central issue defining the personality disorder. Personality disorders are understood as a pattern of behaviour beginning in childhood, causing subjective distress and affecting social and occupational functioning. The central issue of each disorder is actually the voice of the negative unhealthy self that is larger or stronger than the positive confident self. The goal of therapy is to strengthen the positive confident self and thereby relieve mental distress. This occurs by bringing the inner dialogue into conscious awareness and by focusing attention on the positive healthy confident self by talking about, elaborating, and affirming it. The negative unhealthy self is significantly fed by negative uncaring experiences during childhood, usually the parental relationship. A way to strengthen the positive self is to say, “What would you say or do if what happened to you happened to your own child?” and “If you were the healthy
- 5. 4 caring adult or parent in the situation you describe, what would you say or do for you, the child?” This approach utilizes the person’s own cognitive ability and sense of empathy to create and define healthy choices. Another approach is to say, “If you had power to change any three things about your childhood or family when you were growing up, what would they be?” and, “I wonder if you can imagine how you might be different today in some ways if things had been different as you describe.” This approach helps the person use memory to identify significant unresolved issues from childhood that require healing as well as visualization in order to identify and strengthen the positive healthy self. A key to moving forward is to hold two opposite realities simultaneously, the reality of loss of parental caring or other loss and also one’s power to make healthy choices in thought and action now: “Maybe you could not choose what happened in your childhood, and you can choose what you do now.” Paranoid Personality Disorder Central issue: No one can be trusted because they want to harm me in some way. Common associated major negative life experience: Loss of caring and closeness in the parental relationship during childhood. Possibly physical or verbal abuse. Therapeutic statements supporting the healthy self: What happened in your childhood or your past that you think has contributed most to your distrust of others?ood
- 6. 5 I wonder if part of you knows what someone would be like if they could be trusted. How much is your fear and distrust based on what you think about other people? If you could allow yourself to think differently about others, how might your fear be affected? How would you feel toward others if you could believe that people are generally sincere and well-intentioned? Schizoid Personality Disorder Central issue: No one understands me because I am different. I prefer to be alone. Common associated major negative life experience: Loss of parental caring. Therapeutic statements supporting the healthy self: When in your life did you first start feeling alone or of being lonely? What happened in your childhood or your past that you think has contributed most to your desire to be alone? I wonder how you might be different today if there had been something different in your life when you were growing up. What is your image of the person you want to be? Describe this person for me. Part of you prefers to be alone. Another part of you has a different need or different idea about people. What does that part say?
- 7. 6 Schizotypal Personality Disorder Central issue: I have odd or delusional thoughts but I may not recognize them as odd or delusional; no one can be trusted. Possible abuse or abandonment experience in childhood. Common associated major negative life experience: Loss of parental caring; lack of social skill development in childhood. Therapeutic statements supporting the healthy self: Part of you thinks what you described (the odd thought) is true, and maybe you need to have those thoughts for now. Part of you believes no one can be trusted, and everyone wants to harm you in some way. There is another part of you that may have a different idea about your thoughts and knows what you need and who you can be. What does that part of you say? Antisocial Personality Disorder Central issue: I am willing to violate the rights of others to serve my own profit and pleasure. Common associated major negative life experience: Lack of parental discipline during childhood; loss of parental caring Therapeutic statements supporting the healthy self: Part of you is use to surviving on your own, believes sometimes you must take advantage of other people to look after your own interest, and that the end justifies the means. Is that accurate?
- 8. 7 There is another part of you that feels a little guilty about taking advantage of others to meet your own needs. What does that part of you say? Borderline Personality Disorder Central issue: I don’t have control over my emotions. “I hate you, don’t leave me.” I am afraid of abandonment. Common associated major negative life experience: Abuse and/or abandonment during childhood. Therapeutic statements supporting the healthy self: Part of you hates people, feels emotionally negative toward others, and also fears being left alone by others. Who was the first important person in your life who hurt or left you? Another part of you, perhaps a small part, believes that you are capable of being OK and surviving even if people leave you. What else does that part know? Maybe that you can manage your emotions, especially your anger? Histrionic Personality Disorder Central issue: I need the attention and approval of others in order to be happy. My worth depends on my physical attractiveness. Common associated major negative life experience: Childhood abuse and learning to believe that value is associated with sexuality or external appearance. Lack of training in healthy values and beliefs during childhood.
- 9. 8 Therapeutic statements supporting the healthy self: Part of you believes your worth depends upon your sex appeal and physical appearance. There is another wiser part, even if it is a small part of you, that knows more about you and your worth as a person. What does that part say? Narcissistic Personality Disorder Central issue: My ideas and abilities are superior to those of others. Common associated major negative life experience: Parental abandonment or rejection by the father. Therapeutic statements supporting the healthy self: Part of you thinks your ideas and abilities are superior, perhaps far superior, to those of others. Another part of you thinks you may be an imposter or feels very inferior to others. What does that part say? And part of you thinks others are capable of having important ideas and abilities. What does that part say? Avoidant Personality Disorder Central issue: I am afraid that others will criticize me in social situations. Common associated major negative life experience: Critical parenting during childhood or bullying by peers or siblings.
- 10. 9 Therapeutic statements supporting the healthy self: There is part of you that is afraid of criticism in social situations. Another part of you is able to reassure you or encourage you. What does that part say? Dependent Personality Disorder Central issue: I fear being alone and must subordinate my own needs and feelings to those on whom I rely. Common associated major negative life experience: Dominating parenting that makes obedience and subservience a condition of caring. Therapeutic statements supporting the healthy self: Part of you believes you must serve others in order to be accepted by them, and you must be accepted by them in order to be happy. Another, knowing part of you believes you are worthwhile even if others do not accept you. This part wants you to be true to yourself and to assert your own needs and feelings even if others are displeased. What else does it say? Obsessive-Compulsive Personality Disorder Central issue: I must control my environment and finances, because of my fear of chaos, disorder, or poverty. Things, working, and financial security are more important than people.
- 11. 10 Common associated major negative life experience: Poverty or financial stress or financial loss during childhood. Therapeutic statements supporting the healthy self: Part of you thinks you must achieve and maintain financial security even if you must sacrifice closeness and caring in your relationships with others. If that seems accurate, elaborate on this a little. Another part of you believes people and the quality of your relationships are more important than things or even than keeping order.
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