People enter into psychotherapy, counseling or consultation for all sorts of reasons. Some don’t ever get past the “sounding board” stage in their work with us; many – if not most – are unclear about what their goals are; some improve substantially, others only moderately by not coming clean and really opening up, while yet others just simply quit.
One of the biggest challenges we face though is with willing clients whose self-esteem and self-image are so damaged, they’ve come to embrace the belief that they’re not worthy of the intervention strategies we’ve crafted for them. This places a roadblock directly in the path of successful treatment, because feelings of unworthiness fuel “why even try” thinking, as these clients don’t think they deserve better. This in turn, leads them to perceive themselves as failures and imposters, which inevitably manifests as some type of mental health malady or other form of escapism.
So why does this happen? How do people wind up in this position? For two reasons, I believe:
They play the same old tapes over and over. Some people are not able to get past the upbraiding, rebuking, chastising and berating unleashed on them by significant others throughout their lives – often beginning in early childhood. The constancy of harshness and criticism shapes belief systems that serve as springboards, launching them into an all-out assault on themselves. And even though they may be very different people now, these admonition tapes continue to play in their heads at off-the-chart decibel levels.- They find the dislike or disapproval of others uncomfortable and hard to accept. Many, many people think their worthiness is contingent upon having to continually prove themselves – to themselves and others. But when situations arise where they believe they are a disappointment, they tune in to the negative at the expense of the positive. That is, in spite of overwhelmingly positive outcomes, when they hear one bad thing about them or get one negative evaluation, the floodgates of negativity are unleashed: “See, I told you so!” “Why did I risk putting myself out there?” “Why did I think anyone would listen to me in the first place?” “When someone really good at this appears, I’ll be a goner!”
I’ve identified 16 esteem and image busters that people fall into, which in so many instances, are the “hidden problems” that have them finding their way to therapy or counseling services. Regardless of what any client believes their presenting problem(s) to be, I always begin by examining the condition of their self-esteem, self-image and personal fulfillment (before proceeding with specific intervention strategies) to determine the extent to which these issues are impinging upon what brought them to me in the first place. I’m discussing three of them in this newsletter edition with the rest to follow in future issues.
- They spew forth unempowered self-talk. Have them go out and purchase a simple, inexpensive recording device and then suggest they record their day. Instruct them to turn it on and just let it run throughout the day. Doing this will inform them as to what their language is like on the phone or with others they’re interacting with throughout the day. It will provide insights into how they’re actually speaking, as opposed to assumptions they’ve made about their communications. Then have them bring it in to discuss what they need to change about their self-talk to generate improved esteem and image. Have them record an “audio journal” at regular intervals to measure improvement.
- Teach them to stop saying “Yes” when they really mean “No.” Taking on and fighting every battle that comes their way all but ensures that they will lose most of them. Allowing themselves to be coerced into thinking and acting someone else’s way are surefire steps to diminish what’s important to them.
If someone is seemingly out to damage their reputation or is attacking their value system, they should push back in every reasonable legal and ethical way to get it stopped. But they want to ignore the nitpickers and those with a bent toward spouting off on anything – particularly if unsolicited. To be at their best to deliver value to those that mean the most demands putting themselves first. This is humility well-placed. Saying “No” isn’t self-serving; it is self-liberating because it helps them order and align their priorities. - Teach them to understand and appreciate their value. There is something special about them and their uniqueness that counts for something potentially big time and they need to believe this. Do they know what it is? If they do, are they connecting with and demonstrating this value to those who can benefit from it? They shouldn’t permit themselves to remain a best kept secret. If they really don’t know their value, instruct them to complete this exercise: Make a list of 5 things they consider themselves to be either good or great at. No self-censoring when comprising this list. After listing these, have them take a moment to reflect on how it feels to actually see their attributes, assets, skills and accomplishments staring back at them. Then have them take this list and employ it to its fullest possible potential. Personal fulfillment is at its most powerful when they set their sights on achieving something and then going about the business of doing it. Self-worth soars, confidence mounts and success begets more of the same.
What someone believes always guides the way they behave. Always. So when your client expresses their problem list – depression, anxiety, or whatever – before agreeing to and embarking upon a treatment plan, give them an esteem and image check-up. You just may find something that’s riding shotgun alongside the “problem.”
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Attribution Statement:
Joe Wegmann is a licensed pharmacist & clinical social worker has presented psychopharmacology seminars to over 10,000 healthcare professionals in 46 states, and maintains an active psychotherapy practice specializing in the treatment of depression and anxiety. He is the author of Psychopharmacology: Straight Talk on Mental Health Medications, published by PESI, Inc.
To learn more about Joe’s programs, visit the Programs section of this website or contribute a question for Joe to answer in a future article: joe@thepharmatherapist.com.