Restoring Self-Esteem

No child is born with low self-esteem.  Children come into the world expecting to receive certain essential messages:

• You are valued
• You are accepted
• You are loved
• You are understood
• You are respected

“When we are born, our whole being reaches out to continue our connection with the person who has been carrying us for 9 months. … Our brains are genetically hard-wired for attachment, seeking the interpersonal sustenance needed to structure our brains for personal well-being and healthy relationships.” (Badenoch, 2008, p.52)

A child who receives these messages, the basis for secure attachment, will develop self-confidence and a healthy sense of self-esteem, the situation we desire for all children.  “This internal model of security enables children to develop well and explore the world around them.  Secure attachment is associated with a positive developmental outcome for children in many areas, including social, emotional, and cognitive domains.”  (Siegel and Hartzell, 2003, p.101)

The absence of these essential messages tends to accompany a variety of insecure attachments:

• Avoidant:  The child’s emotional needs are generally not met, with the eventual result that the child learns to discount the value of emotional attachments altogether.  “With dismissing parents [the child’s] brain structure seeks to support emotional separation rather than closeness.”  (Badenoch, 2008, p.66)
• Ambivalent:  The child’s emotional needs are met intermittently and unpredictably, with the result that the child tends to be clingy, dependent, and unable to trust.  “It is easy to see how this pattern lays the foundation for a frightened and clinging adult response to overtures of attachment, sometimes in work situations as well as personal relationships.” (Badenoch, 2008, p.69)
• Disorganized:  The child encounters abuse from the very people who ought to be providing support and safety, with the result that the child exists in a constant state of fear and confusion.  “When infants … encounter a terrified/terrifying parent, they have an insoluble problem. …Everything in these children tells them to go toward the parent for comfort, but every approach yields new fear.”  (Badenoch, 2008, p.72)

From an adult perspective, we hold the caregivers responsible for the deficiencies that lead to these states of insecure attachment.  But children see things differently:  lacking the essential messages that they have been hard-wired to expect, children blame themselves.  “If my needs are not being met, there must be something wrong with me.”

Children who fail to receive the essential messages of value, acceptance, love, understanding and respect respond in a variety of familiar patterns:

• Numbing out:  Concluding that they are unlovable, they try to survive in a loveless world by attempting to deny their emotional needs.
• Becoming invisible:  to avoid abuse, they simply disappear, either physically or emotionally or both.
• Becoming perfect:  Believing their own deficiencies to be the cause of a loveless existence, they try to excel at school, sports or deportment, as if to say, “If only I can be perfect, they’ll have to love me.”

Children in all three cases have very little sense of their own inherent value. 

Children who lack a healthy sense of self-esteem have difficulty resisting powerful societal messages about conditional acceptance.  Women may have difficulty resisting the insidious ideas that their self-worth depends on pleasing others, particularly men; that they must conform to stereotypical female roles and appearances; that they must deny their own desires and opinions.  Recently even neuroscience has been enlisted in the campaign to preserve traditional stereotypes, with claims that the female brain is “hard-wired” to excel in certain areas and to falter in others.  “Gender stereotypes are legitimated by these pseudo-scientific explanations. …Neurosexism promotes damaging, limiting, potentially self-fulfilling stereotypes.” (Fine, 2010, pp. 172, 174)

Men may not be able to resist the notion that their human value must be measured in terms of material success or career accomplishments; that they must mistrust their feelings; and that intimacy is to be feared.  These lessons begin very early, in the different ways that parents treat girls and boys, and continue in the educational system.  Boys and girls have “dramatically different peer cultures to grow up in:  one emphasizing verbal negotiation, intimacy, and teacher approval; the other fostering physicality, competition, and a disregard for adult authority.”  (Eliot, 2009, p.153)

Moreover, willy-nilly we train people how to treat us.  If you comport yourself as one deserving respect, changes are that you’ll receive it.  Unfortunately, the converse also holds.  If you behave as if you don’t count, the world will discount you.  If you go about wearing an invisible sign that says “Kick me,” one way or another you’ll end up with a sore backside.  In short, the world offers myriad messages to undermine one’s sense of self-esteem and very few to bolster it.

As psychotherapists, what can we do to restore our clients’ sense of self-worth, the loss of which frequently originates in early childhood?  EMDR (Eye Movement Desensitization and Reprocessing) offers an effective technique enabling clients to process early trauma that may lie at the root of their low self-esteem.  Francine Shapiro, the founder of EMDR, writes “My subjects shed their deep-rooted denial, fear, guilt, shame, and anger literally before my eyes and replaced these emotions with self-esteem, confidence, forgiveness, and acceptance.”  (Shapiro and Silk, 1997, p.18)

I also recommend a technique based on the theory of cognitive dissonance.  Briefly, the brain actively resists holding contradictory beliefs.  Since the beliefs underlying low self-esteem are often so well established, and societally reinforced, simply challenging them in talk therapy is unlikely to produce rapid results.  Instead, I instruct clients to take actions that contradict their negative self-beliefs, since when the brain sees one acting in ways that go against prevailing negative beliefs, it tends to surrender its allegiance to those beliefs.

What can clients do to restore self-esteem?

• Know what you want.  This may be a difficult exercise for someone whose working policy has always been, “I’ll have whatever you’re having.” 
• Announce what you want.  This instruction represents a real challenge for clients who believe that expressing any desire makes them selfish or controlling.  Often I confront them by asking, “Do you believe that everyone has a right to an opinion?  And do they have the right to express it?  Well, don’t you yourself have these rights?”  “The inability to ask others for what you want is a classic symptom of low self-esteem.  It stems from your basic feeling of unworthiness.  You feel that you don’t deserve to get what you want.”  (McKay and Fanning, 2000, p.173)
• Learn to say ‘no.’  The Disease to Please (Braiker, 2001) offers diplomatic techniques for extricating oneself from a habit of acceding to every request, at whatever cost.  Braiker’s “broken-record technique” and “sandwich technique” have even entered the popular lexicon.
• Challenge your “inner critic”  My clients have reported making major changes in their self-beliefs as a result of reading and doing the exercises in Self-Esteem (McKay and Fanning, 2000)  Shouting a refutation to the subtle and insidious suggestions of the “inner critic” represents yet another way of taking active steps on one’s own behalf.   I have also found When I Say No, I Feel Guilty (Smith, 1975) to be useful.
• In extreme cases, I require clients to fill an entire page with answers to the question, “What’s wonderful about me?”  With particularly reluctant clients, it may be necessary to carry out the exercise during a session.

Clients may experience apprehension that carrying out these exercises may make them appear “pushy” or “self-centered.”  I respond to their concern with the image of a pendulum swinging between the opposite extremes of passiveness and aggressiveness.  Having spent so long at one extreme, the pendulum may have to swing temporarily to the opposite extreme before eventually arriving at the desired midpoint of self-assertiveness.  Between the extremes of selfishness (I’m the only one who exists) and selflessness (I don’t exist at all) is self-affirmation (I matter).  “There is a big difference between being selfish and acting in your own enlightened self-interest.”  (Braiker, 2001, p.53)

A therapy based on action presents an immediate antidote to a lifestyle founded on passivity.  Moreover, when you take action that asserts, “I count; I matter,” not only does the brain reassess your self-image, the neutral world also responds.  Clients who start taking actions on their own behalf frequently report with surprise that “people are acting differently toward me:  what has made them change?”

It may not be possible to reverse all the effects of insecure attachment in childhood, but it is possible to restore self-esteem.

References

Badenoch, Bonnie (2008).  Being a Brain-Wise Therapist:  A Practical Guide to Interpersonal Neurobiology.  New York:  W. W. Norton

Braiker, Harriet B. (2001).  The Disease to Please:  Curing the People-Pleasing Syndrome.  New York:  McGraw-Hill.

Eliot, Lise (2009).  Pink Brain, Blue Brain:  How Small Differences Grow into Troublesome Gaps-and What We Can Do About It.  New York:  Houghton Mifflin.

Fine, Cordelia (2010).  Delusions of Gender:  How Our Minds, Society, and Neurosexism Create Difference.  New York:  W.W. Norton.

McKay, Matthew and Fanning, Patrick (2000).  Self-Esteem.  3^rd edition.  Oakland, California:  New Harbinger Publications.

Shapiro, Francine and Forrest, Margot Silk (1997).  EMDR:  The Breakthrough Therapy For Overcoming Anxiety, Stress, and Trauma.  New York:  Basic Books.

Siegel, Daniel J. and Hartzell, Mary (2003).  Parenting from the Inside Out:  How a Deeper Self-Understanding Can Help You Raise Children Who Thrive.  New York:  Penguin.

Smith, Manuel J. (1975).  When I Say No, I Feel Guilty.  New York:  Bantam.

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