The Treatment of Adult Patients with an Inner Critic - Self-Psychological, Integrative Relational, and Modern Psychoanalytic Approaches

An enduring state of self-criticism characterized by self-attack and feelings of worthlessness and shame has been conceptualized as an inner critic in the object relations literature. Fairbairnian object relations theory has described the inner critic as an internalized bad object often representative of an abusive or rejecting parental figure with treatment focused on helping the patient to separate from this internal bad object and the actual external object. We propose three alternative psychoanalytically oriented treatment approaches which might be more applicable for certain patients. The first is a self-psychological approach which aims to neutralize the inner critic by meeting the patient's needs for mirroring and idealization. The second is an integrative relational approach which helps the patient to realize and accept both good and bad aspects of the bad object. The third is a modern psychological approach in which the therapist helps the patient to express their anger toward the bad object while maintaining the possibility of improving the actual relationship. Clinical case material is presented in support of these approaches.