Self-criticism is a transdiagnostic process that has a highly detrimental, and at times lethal, impact on patients’ lives. Although self-help books of varying quality addressing the problem are common, an academic text on the issue is surprisingly hard to find. As a clinician and a researcher with an interest in the topic I was pleased to discover Shahar's book, Erosion: The Psychopathology of Self-Criticism. I should start this review by stating that this is not at heart a cognitive behavioural therapy (CBT) text. Shahar identifies himself as an integrative psychotherapist and thus his personal model and treatment approach are integrative in nature, although drawing on CBT principles and interventions. Nevertheless, readers of the journal of Behavioural and Cognitive Psychotherapy who have an interest in self-criticism will find Erosion a thought-provoking read.

In Part 1 (‘In Effect’), Shahar starts by defining self-criticism as ‘an intense and persistent relationship with the self characterized by (1) an uncompromising demand for high standards in performance and (2) an expression of hostility and derogation towards the self when these high standards are – inevitably – not met’ (p. 5). For Shahar, as for many influential researchers in the area, self-criticism is really a form of self-dialogue in which the inner critic attacks other aspects of the self. Part 1 provides an overview of some of the key literature on self-criticism. This is not exhaustive, but touches on the important issue of ‘Eliminating Other Suspects’, i.e. exploring whether self-criticism is a distinct clinical phenomenon from other processes such as rumination (spoiler alert: Shahar proposes that it is).

In reviewing the literature, Shahar draws on his own empirical findings to present his own model, neatly termed the self-critical cascade. Here he proposes that self-criticism leads to negative interpersonal events and reduces protective factors such as social support, thus leading to depression and then in turn further self-criticism, which perpetuates the risk of ongoing depression. He expands upon his own model and approach in later chapters, and I would not do it justice to attempt to summarize further here.

In Part 2 (‘In Theory’) the author reviews existing theories of self-criticism and expands upon his own. This is the first time I have seen of a range of existing theories of self-criticism from different modalities be presented, and it is helpful to have them outlined together. The critical evaluation of other theories is focused on presenting a rationale for the author's own approach. I would have been keen to have this section expanded and more details about other theories presented. For example, a reader's understanding of Gilbert's approach to self-criticism would be enhanced by including an overview of his three systems model and details of how self-criticism is directly targeted in compassionate mind training, in addition to the development of self-compassion.

In Part 3 (‘In Practice’) the author reviews existing treatment approaches to high self-criticism and overviews his own integrative approach. Some incredibly useful key issues and challenges in treating self-criticism are presented. Shahar's approach draws on, amongst others, the Trial-Based Cognitive Restructuring technique of de Oliveira et al. (Reference de Oliveira, Hemmany, Powell, Bonfim, Duran and Novais2012). CBT practitioners who are not familiar will be interested to read more about this technique, which creatively integrates drama and chair work by creating a mock court room whereby patients put their negative beliefs through a trial. The book helpfully draws on clinical case examples throughout. It would have been useful to have seen a full treatment case illustrated from start to finish, or to have an outline of the general structure of therapy and key interventions provided.

Erosion stresses the importance of ongoing research and treatment development to target high self-criticism. This important book takes an integrative approach and draws upon the extensive theoretical, clinical and empirical work of the author. It highlights how much more we have to do within the field of CBT to develop better, evidence-based treatments for highly self-critical patients who struggle to benefit from standard CBT interventions.