Although there are differing definitions of self-esteem, most counseling clients would probably use the common cultural definition: a feeling of having respect for yourself and your abilities.

Of course, defining self-esteem isn’t the same as understanding the important role it plays in emotional health. It’s a role that many clients may underestimate.

“Self-esteem is at the core of everything we do,” says Stacey Chadwick Brown, a practicing licensed mental health counselor and a member of the American Counseling Association. “Low levels of self-esteem create a negative dialogue — an ‘inner critic ’— that can really get in the way of achieving goals.”

Brown, like a growing number of counselors and researchers, believes that dispelling the clouds of low self-esteem requires the cultivation of self-compassion. But to find that compassion, counselors and clients must first recognize and address the problem of low self-esteem.

Self-esteem is, in a sense, the narrator of the stories people tell themselves every day — a kind of spoken-word “soundtrack.” It informs the mind’s internal dialogue and dictates how people view their relationships, abilities and achievements.

The problem, says Brown, who also teaches future counselors at Edison State College in Ft. Myers, Fla., is that most people are not aware of the effect this internal dialogue has. Individuals can become so self-critical that they begin to blame themselves for everything, she says — even things that are clearly out of their control. The effect is overwhelming and can lead to a downward spiral resulting in significant depression and anxiety, she adds.

Of course, most people don’t spin out of control, but that doesn’t mean low self-esteem isn’t intertwined with whatever presenting issue brings them into a counselor’s office. “Many of my clients come in with self-esteem issues,” says Tina Gilbertson, an ACA member who is a licensed professional counselor and author. “I believe that low self-esteem is a silent epidemic.”

If low self-esteem is as widespread as Gilbertson asserts, then children are client(s) zero. The lessons and behavioral patterns people learn in childhood have a significant — and sometimes damaging — effect.

Planting the seed

“Children, from the time they are infants, get feedback about their behavior and how they learn, so if they don’t have the proper environment or an environment that allows them to grow and learn things about themselves, they are at risk. They don’t know the rules or what the boundaries are, and that makes them really vulnerable,” says Sandra Meggert, who contributed a chapter titled “‘Who Cares What I Think?’: Problems of Low Self-Esteem” to the sixth edition of Youth at Risk: A Prevention Resource for Counselors, Teachers and Parents, published by ACA.

“But if you think about a plant … if you give it proper nourishment and put it in the sun, it grows to be a healthy plant. A child is kind of like that. If the child is in an environment where there is lots of positive feedback, he or she can thrive,” explains Meggert, an ACA member who is a faculty member at Antioch University in Seattle and a former school counselor. “Getting positive feedback about how well one is liked will have an incredible effect on self-esteem.”

But other environments, such as those where children are expected to be perfect or where there are no boundaries or consistency, can result in a failure to thrive.

“We all need to feel like we belong somewhere,” Meggert says. “Kids want some kind of structure, some kind of security and reassurance that things will always be this way. So when there is a lot of inconsistency or mixed messages, it’s very confusing. They won’t know which way to go, and since they are learning about their own self-value from other people and other interactions, it will affect their self-esteem.”

“For instance, failure to listen and give positive feedback [to children and adolescents] is really damaging,” Meggert says. “So is being rejected or neglected. These things create an environment in which it is really hard for a child to learn about getting along with other people. Parents need to be able to admit mistakes and, if necessary, apologize to a child. Those are all role-modeling things that can teach a child how to get along.”

“Children are also learning from role models, and if their role models are maladjusted or have self-esteem issues, that will influence their interactions,”
she adds.

As author and researcher Brené Brown puts it in her book I Thought It Was Just Me (But It Isn’t), “Family messages die hard. And many times they are very insidious. The messages become part of the fabric of our families. Until we can recognize and understand why and how they influence our lives, we just keep living by them and passing them off to the next generation.”

The larger problem

Self-esteem isn’t just about “feeling good.” Research indicates that low self-esteem can cause significant health and emotional problems. In an article published in 2009 in the Journal of Abnormal Psychology, two large longitudinal studies found that low self-esteem is a risk factor for depressive symptoms throughout the adult life span. The authors noted that while their findings were based on nonclinical samples, participants in both groups who demonstrated symptoms of major clinical depression had significantly lower self-esteem than others, leading the authors to believe that low self-esteem is a risk factor for major depression as well.

Some have suggested that rather than low self-esteem causing depression, it is a case of depression eroding self-esteem. However, a recent article in the journal Psychological Bulletin detailing conclusions drawn from multiple research studies reported that although depression can influence self-esteem levels, low self-esteem is much more likely to precede depression than vice versa.

This connection between self-esteem and depression demonstrates the extreme consequences low self-esteem can have. According to the World Health Organization (WHO), more than 350 million people of all ages suffer from depression worldwide. In a fact sheet published in October 2012, the WHO also stated that depression is the leading cause of disability worldwide and a “significant burden to global health.”

Even in the absence of clinical problems, low self-esteem can significantly impede everyday functioning. “I think that a lot of people in general struggle with self-esteem,” says Carolyn Russo, a Seattle-based licensed mental health counselor in private group practice. “It’s something we always have to work on. If we don’t have good coping skills or don’t feel confident in our abilities or ourselves, that can manifest itself in multiple areas, such as in our family lives and intimate relationships, and in our interactions and functioning at work and school.” Someone with low self-esteem is also more likely to accept and internalize outside criticism, Russo adds.

Research from a 2010 issue of the Journal of Personality and Social Psychology supports Russo’s claim. It found that people with lower levels of self-esteem not only reacted to rejection with increased negative self-appraisals and self-blame, but also exhibited higher levels of the stress hormone cortisol.

Ultimately, low self-esteem may resemble something akin to what Brené Brown defines as shame in I Thought It Was Just Me (But It Isn’t): “The intensely painful feeling or experience of believing we are flawed and therefore unworthy of acceptance and belonging.”

As Stacey Chadwick Brown explains, “In some cases, I’m seeing situational [low] self-esteem, which is easier to work with because it is connected to a person’s situation or circumstances, such as someone who is going through divorce, has failed a very important exam or is financially stressed because the economy is bad. Many times, those issues can be addressed fairly quickly.”

“However,” she continues, “if I’m dealing with low self-esteem that is rooted in internal dialogue, clients usually feel that they are a bad person and they are not deserving of love. They may even have been a victim of sexual abuse or parental abuse, which raises questions such as ‘If my mom didn’t want to hang out with me, what good am I?’”

Although these feelings can be incredibly painful, clients must learn to face them and accept them before they can work through them. “I think there is a strong relationship between self-esteem and accepting your feelings,” Gilbertson says. “If you believe that you are unworthy of acceptance, how can you learn to accept and make sense of your emotions?”

Self-acceptance is not easy, particularly when someone is stuck in a cycle of self-blame and harsh criticism. People need help breaking the cycle, preferably sooner rather than later. Observes Russo, “I see clients at their lowest — or one of their lowest — points. By then, issues of self-esteem and self-worth have become a much bigger problem than if they had come in sooner.”

Clients need to know that they are not alone, that the struggle for self-acceptance is part of the human condition. “One of our biggest challenges as human beings is to tolerate what we feel,” says ACA member Deb Del Vecchio-Scully, a licensed professional counselor and trauma specialist based in Connecticut. “Avoidance increases suffering. If we can just learn to tolerate and accept what we feel, it increases our sense of self-compassion and can open the door to some kind of peace.”

Low self-esteem meets self-compassion

Just as low self-esteem can have negative consequences, the opposite is also true: Higher levels of self-esteem are often linked to increased life satisfaction and better mental and physical health. For instance, a 2012 article in the Journal of Personality and Social Psychology details a large longitudinal study of individuals ranging in age from adolescence to old age. Researchers found that higher levels of self-esteem were linked to higher levels of relationship satisfaction, job satisfaction, occupational status, salary and physical health.

Another study, published in a 2010 issue of the journal Cognition & Emotion, concluded that people with higher levels of self-esteem are less likely to feel distressed by rejection or negative feedback.

So, how can people raise their levels of self-esteem? “True self-esteem entails self-compassion,” says Gilbertson.

In a chapter in the book Wisdom and Compassion in Psychotherapy, psychologist and self-compassion researcher Kristin D. Neff explains self-compassion this way: “Compassion … presupposes the recognition and clear seeing of suffering. It entails feelings of kindness, care and understanding for people who are in pain, so that the desire to ameliorate suffering naturally emerges. Finally, compassion involves recognizing the shared human condition, fragile and imperfect as it is. Self-compassion has exactly the same qualities — it is just compassion turned inward.”

Ultimately, self-compassion is about acceptance. “When you accept emotions, you are accepting the parts of you that they are connected to,” Gilbertson says. “Embracing those feelings is an act of self-esteem. It is a way to say ‘I matter.’”

Acceptance increases self-knowledge, Gilbertson says. “You can’t esteem a person you don’t know, so how well do you really know yourself?” she asks.

When clients finally face themselves, they may be surprised by what — or who — is behind their inner critic, Russo says. “Most of the time I’ve found with my clients that the voice in their head isn’t necessarily their own,” she says. “Maybe there was a traumatic incident that just stays in their head. It could be their mom or a teacher who really reprimanded them and that stuck and they are allowing that to replay over and over again.”

“Many times,” Russo continues, “what I see is that [the voice] is a caregiver or parent. Home might be a shame-based place, and for years they may have parents telling them they are wrong. It’s about finding out who that voice is and differentiating it from the client. It’s a turning point for clients once they realize that it’s not their voice.”

Cultivating self-compassion

How can counselors help clients discover and start tapping into their self-compassion? It starts with recognizing when low self-esteem is linked to the problem a client is presenting with.

“Well-intended counselors are really wanting to help people, but sometimes we miss the forest for the trees,” Brown says. “We go and learn about how to help people with major issues such as experiencing depression or recovering from an accident, and these [take] very targeted interventions. Also, things are very time sensitive since we are often dealing with limitations such as insurance benefits, so we try to get in there and solve problems.”

The key, Brown says, is for counselors to step back, take a look at the big picture and ask why these issues keep coming up. In many instances, she asserts, the answer to that question leads back to a client’s low self-esteem.

Not identifying self-esteem issues early on in counseling can slow down the healing process, Russo says. “When clients come in, they really want relief. If they don’t start to get relief, they’re not going to want to work on the deeper issues.”

Most of the time, clients know that there is a behavioral and emotional pattern contributing to their problems, but they don’t know what it is or how to deal with it, Russo says. So, part of her process involves collaborating with clients to figure out what those patterns are.

“We’re so quick to identify a solution to the ‘problem,’” Gilbertson says. “[But] sometimes exploring and making sense of something untangles the problem and makes it less of a problem.” Helping people to understand their feelings — and convincing them that their feelings are normal and valid, not wrong or dangerous — is a very powerful counseling tool, she says.

“It’s hard to accept something you don’t understand,” Gilbertson continues. “That’s why [counseling] is uniquely suited to help people with self-awareness and acceptance.”

Gilbertson’s realization that she really needed to focus on self-compassion with her clients eventually led her to write a book, Constructive Wallowing: How to Beat Bad Feelings by Letting Yourself Have Them, which will be published by Viva Editions this spring.

“I kept having the same conversation with my clients over and over again about, as they called it, wallowing: ‘I will never feel better if I allow myself to feel what I am feeling. I can’t let myself slide down this hill to the bottom,’” Gilbertson says. “My book focuses on self-compassion, which I define as the absence of baseless shame. Shame gets started through even [functional] parenting and appropriate discipline because kids can’t make the distinction between themselves and their actions.” In Gilbertson’s view, nobody escapes childhood without a load of baseless shame.

Thankfully, just as clients did not build their shame alone, neither do they have to dismantle it alone. Gilbertson says that by providing her clients with acceptance and compassion, she is teaching them to apply these tools themselves. The process involves giving clients the freedom to express their feelings and letting them know it’s acceptable to have those feelings. By asking questions and pointing out patterns, Gilbertson guides her clients in examining their feelings, discovering what’s behind them and figuring out why they are always mad, sad, etc. “That gives them skills they can use when I’m not around,” she says, adding that it’s important to let clients know that their emotions are the result of many factors.

Different counselors use different tools to help their clients examine their inner lives. Brown likes to use journaling with her clients. “Journaling helps to give a realistic assessment of a client’s self-view,” she says. “The process is not so much about digging into the vaults of their minds but introducing the concept of the inner critic. Sometimes [in counseling], we ‘name’ the inner critic. It’s something that helps them think of the critic as separate from the self. We use humor, draw pictures of the inner critic and try to realize where the critic comes from. Is it your mother? Is it Martha Stewart?”

Brown is a firm believer that every client can benefit from journaling if they give it a legitimate chance. “If you can just convince people how important and helpful journaling is so that they will actually do it a few times, then they will understand the beauty [of it] is two-fold: You can just dump all the negative thoughts and feelings out on paper, and you can also look back on it and track those feelings, see what you were doing, where you were.”

“Of course, the counseling environment is a big part of the process,” Brown says. “It needs to be as relaxed and comforting and nurturing as possible. I’m there to support them — it’s almost a re-parenting. You need to show appreciation, point out strengths, have compassion.”

Russo also uses writing exercises to help clients struggling with self-esteem issues. “I have them write down ‘thought records’ to identify those most negative thoughts. Then we ask: ‘How we can reframe them? Make a list. What would a friend say about you? How would they explain you to another person?’ Sometimes that helps them to see outside themselves. Asking friends and family members how they would describe them [the client] can help build relationships and also let them see how other people see them, which may be different than they thought. This can help build esteem. It also helps me to get an idea of where they are and what the next step is — what do you want to be, what do you want to accomplish?”

Russo also suggests activities such as yoga, relaxation exercises and meditation for clients as a way to show compassion toward mind and body by mediating stress. She also believes these practices encourage clients to focus on the here and now and cut out the extraneous, even if only momentarily, allowing them to focus on what they are feeling. Russo sometimes conducts relaxation sessions in the counseling environment.

Del Vecchio-Scully incorporates mindfulness and yoga into her practice and also uses art therapy. She sometimes has clients paint and decorate paper, putting down any words or pictures that make them feel hopeful and compassionate.

Meggert believes that cultivating our ability to laugh at ourselves is essential to developing self-compassion. “Being able to laugh at yourself allows you to have perspective,” says Meggert, who conducts humor seminars and is the author of Creative Humor at Work: Living the Humor Perspective. “When you have a situation that is causing you stress, looking for humor distances you and gives you perspective, which helps make things look less devastating.”

Meggert thinks everyone should have what she calls a “humor kit,” a mental collection of favorite jokes or sayings, silly songs, puns, wordplay — whatever makes you laugh — to draw from when needed. It’s harder to self-criticize when you’re busy laughing, she asserts.

“Laughter is important. When you’re just doing ordinary things, look for the humor around you. It only has to be funny to you; you don’t have to share it,” she says.

Not just for clients

Before tackling self-esteem issues with clients, counselors may first need to look in the mirror and conduct a self-evaluation.

“We have to do some work on ourselves before we are ready to help others,” says Brown, who will be presenting an education session on “Understanding and Improving Self-Esteem for Yourself and Your Clients” at the ACA Conference in Honolulu in March.

In doing that dirty work, counselors may discover that they engage in self-judgment and negative self-thought more than they previously realized, Brown explains. If that is the case, it signals an important area that needs to be addressed.

“Experience and intuition can be very valuable tools. The more we allow ourselves to feel comfortable with who we are and become aware of baggage, the better we will understand and treat our clients,” Brown says. “We want to focus on clients, but we need to take care of ourselves, because that is a very important part of the counseling process.” To do that, she suggests counselors make use of the same strategies they suggest to clients.

Counselors need to practice self-compassion too, maintains Gilbertson. “Counselors cannot be more accepting of their clients’ feelings than they are of their own,” she says. “If they don’t tend to their own feelings and feel and accept them, they will not be able to tolerate clients’ [feelings] as well as they would like.”

Russo provides the same advice to her colleagues in the counseling profession that she gives to her clients. “We are our own worst critics,” she says. “If we were our own best friends, how would we react? We need to focus on finding our strengths. What are the things we are really good at? How do we feel when we do them? We need to try to do more of what we are really good at.”

“It’s also important to establish a sense of community,” she adds. “When we have a better sense of community, we feel good about ourselves. It’s all about promoting those feelings of connectedness.”

Using the tools of self-care to encourage self-compassion is just as important for counselors as it is for their clients. “I think we all need our [self-care] practices — whatever they might be,” says Del Vecchio-Scully, who is also the executive director of the Connecticut Counseling Association, a branch of the American Counseling Association. “You have to take care of yourself to take care of other people. I set the tone for myself to be as mindful and present as I can be with clients and myself.”

Her tools for self-care include exercising and meditating each day, meditating with clients and engaging in various creative projects. Yoga is also an essential part of her life. “It’s different for everyone,” Del Vecchio-Scully says. “Do something that you enjoy, something that you know you will do regularly.”

“Laughing is one of the best things we can do for ourselves,” she says. “It releases endorphins and helps relaxation, so laughing is an act of self-nourishment. Some people need to release stress physically, some mentally, some emotionally. Self-compassion and nourishment are about matching the individual and who they are with the activity that will promote the most well-being for them.”

“We are looking for a transformative state,” concludes Del Vecchio-Scully.

 

****

For further reading:

Gifted Children: Not immune to low self-esteem: ct.counseling.org/2014/01/gifted-children-not-immune-to-low-self-esteem/

ACA member Michelle Muratori, a senior counselor and researcher at the Center for Talented Youth at Johns Hopkins University, explains why children identified as “gifted” are not immune to low self-esteem.

 

****

 

To contact the individuals interviewed for this article, email:

Stacey Chadwick Brown: Stacey.Brown@edison.edu

Tina Gilbertson: tinagilbertson@gmail.com

Sandra Meggert: smeggert@antioch.edu

Carolyn Russo: carolyn.russo@yahoo.com

Deborah Del Vecchio-Scully: cca_exec_dir@msn.com

 

****

 

Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.