Chapter Ten
Self Esteem
Persistent
mental illness, substance addiction, and trauma all negatively impact
self-esteem. Whether it is the struggle
of overcoming difficult symptoms that limit functioning or facing the
unfortunate stigma of a diagnosis, the view of self suffers. This issue ultimately comes up in the ninth
or tenth session if not before. Low
self-esteem is serious in that it can lead not only to depressed mood but at
worst to self-harm including suicide.
People with low self-esteem often act in by withdrawing from social
interaction or act out by creating conflict with others. Targeting self-esteem starts with
assessment. Sometimes adults and
children will express how they feel about themselves, “I can’t do anything right,”
“I’m a bad kid.” More often the feelings
are expressed in behavior and demeanor such as slumping physical posture,
downcast eyes, and short stilted speech.
One big sign of low self-esteem is the client’s inability or refusal to
talk about their situation or desire to change the subject. Whether the issue is mental illness or
trauma, one common symptom is self-blame thus low self-esteem.
Several
interventions can improve self-esteem.
The first is naming it and normalizing it. Again, statements are more helpful than
questions: “You feel bad about yourself,” or “It sounds like you blame yourself
for your situation.” Because it is a
common feeling therapeutic joining is necessary. That means agreeing with the feelings and not
with the facts. A return to the initial
strengths-finding exercise can remind a client of their positive
characteristics. Once a therapeutic
relationship is established a continuing attitude of unconditional positive
regard and sincere pleasant human interaction set a tone from session to
session that helps the client see themselves in a different light. This is why, with families, I do not meet
with children alone and, in fact, put the parent in charge of changing in a way
that helps the child and the family. I
try not to make the child the subject of counseling or the target of
intervention in a direct confrontational way.
Sometimes people with low self-esteem cannot tolerate hearing positive
things about themselves. A compliment or
positive remark is likely to be knocked down or dismissed by a person with low
self-esteem. The child client and even
adults can hear and take in more positive perspectives of themselves if they
are delivered indirectly. I encourage
parents and partners to focus on and tell positive stories about the
client. At home, a parent saying
something positive about the child to someone else within their earshot or in a
way they will hear indirectly has much more influence and staying power than a
compliment delivered directly to the child.
The positive statement feels more valid.
A good rule of thumb is 10 positive statements for every negative
one. This at least will reduce the
number of negative comments made about a client if positive statements are hard
to find. It does mean we ignore negative
behavior but balance the person’s experience.
Using narrative therapy, parents may construct a “success narrative”, a
story putting the child in character with talents or “special powers”
overcoming obstacles to survive and win.
I also use the book Don’t Feed the Monster on Tuesdays (Moser, 1991) and
role play the child client “talking down” the big monster who spouts negative
thoughts as a way of helping the child develop positive self-talk. In this case, it is important not to go
lightly but to state the child’s worst fears about themselves, “Your birth
parents left you because you are too much trouble to love.” When the child comes back with, “I am easy to
love because my parents do,” you have hit pay dirt.
It
is imperative to distinguish between a person’s self-esteem and their core
belief system because they require different kinds of interventions. A person’s self-esteem is how they feel about
themselves. A person’s core belief
system is how they see the world.
Negative self-esteem is serious but can be corrected. A negative core belief system is more
pernicious and less likely to change.
For example, a child who is wanted, cared for and celebrated feels they
are important, adults are capable, and the world is safe. A child who is rejected, hurt, and shamed
feels they are bad, adults are scary, and the world is unsafe. The first child can tolerate failure. The second child expects it. The same goes for adults who have experienced
generally positive childhoods and those who have not. Because we behave in ways that confirm our
core belief systems, people with a positive view create, find, or interpret
situations to fit this picture and people with a negative view do the
same. Almost no amount of
strengths-finding, compliments, or positive self-talk will overcome a negative
core belief system. It requires a
paradox intervention. Confronting their
negative view of the world with our positive view is counterproductive and will
cause the person to dig in and feel unheard.
It is like a person who comes home at the end of the day complaining
about their work and their spouse either tells them it is not so bad or how to
fix it. The person feels unheard,
dismissed, and disconnected. Instead, we
agree with them and join in their view of themselves and the world. This is very difficult for parents of
traumatized children who see as one of their primary roles to raise happy
children. What gets in the way is the
parents’ guilt and shame about the child’s trauma and their feelings of
responsibility for the child’s feelings and the honorable desire to make “the
bad stuff” go away or pretend it did not happen. It is not easy, and can be quite aggravating,
to be with a person who sees the world so darkly. This is not the same as depression, but can
feel like a bottomless pit of negativity.
We have to get down in the muck with the person and not stand on the
edge of the hole calling down, “Pull yourself up!”
What
this looks like in practice is less talking and more experiencing. That means creating pleasant playful
experiences in session and out. Play
therapy and theraplay provide both. Taking
cues from the initial face mirroring and parallel drawing assessments in the
first session with the child, I teach, model, and coach parents to lead the
child into play and to follow the child through play. I use multi-colored feathers for parents and
children to blow off a table or to work together to keep one feather on the
table. I use play dough for a child to
create or for parents to “decorate” their child. Tin foil makes great hats, crowns, and bracelets. Lotion can be used to play “slippery hands”. Children and parents can create a mirror of
their own family or an imagined future using a doll house with figures and
furniture. A sand tray provides a
contained environment in which a child and parent may create a “world”
representing themes from their own lives.
Blocks and Lego’s, crayons and paint, colored paper and pencils are all
media for creative play WITH children. A
child or person with a negative core belief system needs help experiencing themselves
and the people around them as protective and positive. It is important to know that success in this
area can be very fragile. One setback,
like a failing grade or the end of a relationship, can send a person back to what
seems like square one. Reversing a
negative core belief system requires patience and perseverance.
