Judgementalism as a Symptom of Mental Health Challenges

Understanding Judgementalism

As psychiatrists or psychotherapists, we often observe a significant difference between a mind in a state of non-judgment and one that is self-critical. The latter is often filled with fear of rejection and abandonment by others.

What type of judging am I referring to? It's the black-and-white, “all or nothing” thinking that many carry from childhood. This distorted thinking is at the heart of most anxiety and depression. Patients frequently judge themselves harshly, always wondering, "Am I..."

• Normal or abnormal?

• Adequate or inadequate?

• Successful or a failure?

  
  

Judgmental thinking is closed, defensive, blaming, and cynical. In this mindset, self-esteem must be earned, and worth is conditional. People feel they must wear a false front, fearing rejection if their flaws are revealed.

Non-judgmental thinking, on the other hand, assumes that no human being is worthless. Everyone deserves unconditional love and respect. This mindset fosters compassion and open-mindedness. You can be non-judgmental while still maintaining healthy boundaries, holding others and yourself accountable.

The Impact of Judgmental Thinking

Judgmentalism can manifest in various ways. Some individuals apply the same rigid rules to everyone, while others may be more lenient towards themselves or others. It contributes to procrastination. As clinicians, we frequently see patients suffering from anxiety and depression who are more compassionate and non-judgmental towards others than they are towards themselves. Conversely, those with personality disorders may be harsher towards others and less accountable for their actions.

Psychotherapy for Judgementalism

Identifying “Pathological Judgementalism” early in treatment is crucial. We can educate patients about:

• The suffering it causes.

• Their inconsistent application of judgmental rules.

• The origins of their judgmentalism.

  
  

Patients may agree with these points, but understanding the "what" and "why" alone does not lead to change. Real, lasting change comes from actively challenging distorted thinking, which traditional psychodynamic therapy often overlooks.

Psychodynamic therapies focus on past experiences—exploring memories, childhood trauma, and upbringing. While this approach can be beneficial, many patients do not attend enough sessions to resolve childhood conflicts completely. Furthermore, psychodynamic therapy only addresses the initial step of understanding distorted thinking without providing tools for daily challenges.

This is where newer psychotherapies come into play. They are generally more effective and yield quicker results. Empirical research shows that newer therapies, such as Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT), often lead to faster symptom reduction compared to psychodynamic therapy. Combining an SSRI with psychotherapy can enhance benefits beyond what either treatment can achieve alone.

Empirical scientific research comparing psychotherapeutic modalities has resulted in strong evidence to support the use of newer techniques, such as Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and other techniques; while Psychodynamic Therapy has less evidence to support its effectiveness. (The Society of Clinical Psychology has a useful tool to look up evidence-based treatments based on disorder *here)

Modalities like CBT and DBT require therapists to take a more active role than traditional psychodynamic therapy. Therapists provide psychoeducation and skills training, teaching patients how to change thoughts, feelings, and behaviors while focusing on the present moment. Effective treatment also requires good follow-up, holding patients accountable for their part in the process. For therapy to be effective and enduring, patients must actively apply what they learn in sessions to their daily lives:

• Completing homework assignments.

• Establishing new, healthy self-care routines.

• Sticking with these new routines.

  
  

As clinicians, we should educate our patients about the change process, emphasizing that change requires effort. We should begin with goal-setting, agreeing on objectives such as improving motivation, self-esteem, emotional management, and reducing anxiety symptoms.

Medications for Judgementalism

As I became more aware of judgmentalism in my patients, I began to observe the effects of psychotropic medication on this symptom. SSRIs often reduce anxiety within a few weeks, alleviating worrying, obsessing, and ruminating. These symptoms are closely linked to the “Judgmental State.”

Consider the case of R.S., a 35-year-old male who has struggled with anxiety for most of his life. His anxiety stemmed from feelings of inadequacy and fears of exposure. As he prepared to become a new dad, he wanted to overcome his anxiety, improve his focus and productivity at work, and be a better father and husband.

R.S. was open to trying both medication and psychotherapy. Escitalopram proved effective within weeks, significantly reducing his anxiety symptoms. In our therapy sessions, we explored the differences in his thought patterns with and without medication. He described a stark contrast; before medication, he lived in a "Judgmental world," while with medication, he experienced a "Non-judgmental world." This distinction became even clearer when he temporarily stopped his medication, quickly reverting to his judgmental mindset.

Having tasted life in a non-judgmental world, R.S. became motivated and dedicated to psychotherapy. He actively applied CBT, mindfulness, and DBT skills in his daily life. Thanks to his commitment in and out of our sessions, he is now a happy dad and has even reduced his dosage of Escitalopram. He has learned to identify and redirect distorted thought patterns and has gained a deeper understanding of their origins.

Past vs. Present: Finding Balance

To prevent judgmental beliefs from overwhelming us, we must make changes in our values and self-care routines. By learning new psychological skills—such as mindfulness practice, relaxation exercises, cognitive techniques, and emotion regulation skills—we can settle and refocus our minds on the present.

My inner psychodynamic therapist wonders, “If we address core emotions and impulses and allow patients to release them cathartically, would that lessen the need for active self-help practices? Would core beliefs haunt patients less in the future?” While it's a possibility, I also question the likelihood that a specific patient will attend enough sessions for resolution. Are there other modalities that may be more suitable for this disorder and this patient?

Mindfulness, a core component of CBT and DBT, teaches individuals to accept past events and emotions without blame. This approach can be liberating. Mindfulness helps individuals absorb past trauma and emotions, enabling them to live in the present. Non-judgmentalism is a cornerstone of mindfulness and can save our patients from significant suffering, especially when they grapple with feelings of blame, shame, or guilt.

In conclusion, addressing judgmentalism is essential for mental health. By utilizing effective therapies and medications, we can help patients navigate their thoughts and emotions, leading to a more fulfilling life.