Anyone working in the helping professions is bound to encounter individuals who are highly self-critical, continually describing themselves as flawed or deficient in some way. As massage therapists, we might hear clients say, "I'm horribly out of shape" or "I know I should stop being so lazy and take better care of myself."

There are two types of problems with this type of thinking. The most obvious problem is an emotional one. Having negative thoughts about oneself tends to generate negative emotions — sadness, frustration, hopelessness and even despair.

Less obvious are the practical consequences. When people blame or attack themselves, they make it more difficult to understand and resolve the challenges they're facing. Vague, accusatory generalizations like, "I've been irresponsible" or "I'm so out of shape," distract the person from the specific facts that they feel badly about, such as not exercising at all for the past week, or being unable to climb stairs without getting out of breath. It starts to seem as though they need to make a profound, global transformation either in their personality (somehow becoming a responsible person) or in their body (somehow becoming "in shape"). That's a daunting prospect.

In our role as health care practitioners, we have an opportunity to help our clients approach these issues in a more constructive way. To do that, we need to resist the temptation to simply disagree with them ("No, you're doing great") or to criticize their thinking ("You're way too hard on yourself"). These responses can either lead to an argument ("You're just saying that to make me feel better") or give the person more fuel to attack themselves ("You're right; I need to have a more positive attitude. I've always had low self-esteem").

Instead, our task is to refocus the conversation. Help the person to identify the specific facts that are bothering them, and then problem-solve what they could do about them. Suppose they've fallen behind on exercising. You might help them to consider which factors in their life have supported regular exercise (such as having a workout partner or setting a regular time to exercise each day), and which have stood in their way (perhaps their workout partner moved away, or a work commitment has interfered with their regular exercise time). With these specifics in mind, they'll have a much easier time coming up with solutions — such as finding a new workout partner, setting a new time to exercise and so on.

Encourage your client to come up with these ideas themselves rather than simply giving your own suggestions. In that way, you can help them shift from feeling helpless and ineffective to being empowered to make positive changes in their life. In my own practice, I've often found that gently guiding individuals to strategize about their problems — rather than simply blaming themselves for them — is one of the greatest contributions I can make to their long-term health and well-being.