Nobody can see the yelling that takes place on the inside. All they can see is how calm I am when they join the yelling. They see me smile, and they think I’m arrogant and rude. It isn’t that. I’m just comfortable being yelled at.

So writes Elena Dunkle in the Guardian yesterday about her battle with anorexia, a lead to her memoir Elena Vanishing which I haven’t read, but imagine will be pretty hard-hitting as is appropriate for describing an inner battle that sounds more like a war zone than a petty skirmish.

Elena, like many anorexics, contends with a vicious self-critic who sabotages her interactions with the world, including food of course. She is yelled at, called a ‘stupid bitch’ and probably a lot else that isn’t printed in a daily newspaper. I’ve met self-critics of this vile nature many times in my consulting room and even if they are less violent in their monologues, they can still serve to get in the way of living life to the full, or even with any semblance of joy. Telling yourself you aren’t good enough to apply for a job/talk to that person/wear that dress may not be as critical as telling yourself you will be fat and ugly if you eat anything, but it’s still a miserable way to experience life.

Therapy offers a potential space to re-configure a relationship with your self-critic. Left un-examined, it can remain in the driving seat and fuel our ‘threat systems’ where we are kept hyper-vigilant, anxious, of low mood, de-motivated, self-hating and under great stress. Our brains don’t know if we are being shouted at by an unpleasant other, or whether we are shouting at ourselves. As Paul Gilbert brilliantly describes in his Compassion Focused Therapy work, one good way of thinking about this further is to imagine a delicious meal – that’s all it takes for our stomach to rumble and our mouths to salivate. Shouting at ourselves will also elicit a neurological response in us – we will feel under threat and our bodies will respond accordingly – hence the visceral experience of anxiety and low mood.

I work a lot with the threat of an inner critic – there tends to be one lurking in the shadows of many of us, and indeed it can be the very impetus to seek help in the first place. We can’t extract or banish it (if only), but we can learn to pull away, see it for what it is (an event in our mind vs the ‘truth’) and – if all goes well – plant a growing wedge in between ourselves and its desires to sabotage. There’s always a good reason why a self-critic lodges itself in our psyche – Elena’s sprung from the shame of a brutal rape – but we must learn to give it a P45 – it served a purpose once, but is no longer needed. This is especially difficult when our instinct is to hate it for what it does, but hating it tends to add fuel to the fire – another self-critic on top of another.

It’s a challenge to approach our inner critic with a curiosity and openness, but often that’s what is needed for us to take its hands off the steering wheel and ultimately put it safely into the boot. Therapy can help us do this as sometimes our self-critic needs more than just ourselves to let go.