How to Improve Your Client’s Self-Esteem in Therapy: 7 Tips

When children first master the expectations set by their parents, the experience provides them with a source of pride and self-esteem.

As children get older, the origins of self-esteem shift to social comparison and internal standards (Larsen, Buss, Wismeijer, & Song, 2017).

Self-esteem is our sense of worth. It is a self-evaluation of who we are and is often neither fair nor objective. In turn, a negative relationship with ourselves can damage our relationships, careers, and overall satisfaction with our lives (Orth, 2017).

This article explores elements of therapy that can help clients with low self-esteem increase their self-acceptance and progress along their journey to self-worth.

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Self-Esteem & Self-Acceptance Explained

Self-esteem is vital because it ensures psychological survival. A heightened awareness of self, defined as “the ability to form an identity and then attach a value to it,” is what differentiates us from other animals (McKay & Fanning, 2016, p. 1).

And yet, self-esteem and our measure of self-worth can bring a great deal of pain. If we reject elements of who we are, the psychological structures required to maintain us can become damaged.

What do we mean by self-esteem and self-acceptance?

Self-esteem is typically understood as someone’s self-evaluation of their worth as a person (Orth, 2017). It is, therefore, a subjective construct. It does not “necessarily reflect a person’s objective characteristics and competencies” or even how others may see and evaluate them (Orth & Robins, 2019, p. 329)

Self-esteem refers to our feelings of self-acceptance and self-respect, unlike narcissism, which suggests feelings of superiority and entitlement and points to a lack of empathy (Orth & Robins, 2019).

After all, “a sense of belonging or feeling accepted, liked, and included by others is a fundamental human need” and is linked to both our perceived and actual belonging (Cameron & Granger, 2017, p. 1).

Self-acceptance, like self-compassion, involves relating to ourselves with care and support. And, as with self-compassion, we benefit from learning self-kindness, common humanity, and mindfulness (Neff & Knox, 2017).

Self-acceptance is intimately connected to an individual’s relationship with themselves and their deficiencies and weaknesses. It is very much a sense of allowing ourselves to be who we are and accepting our self-worth (Neff & Knox, 2017).

Changes between and within individuals

Self-acceptance, like self-esteem, is not fixed; it changes over time. Research into self-worth agrees that across a lifetime, self-esteem typically (Orth, 2017):

• Increases continuously from adolescence through to middle adulthood
• Peaks between 50 and 60 years of age
• Decreases in old age

Despite changing within individuals throughout our lifetimes, differences in self-esteem between individuals remain relatively stable throughout our lives. Those differences, however stable across a lifespan, show considerable variation between individuals (Orth, 2017).

Several factors influence self-esteem to differing degrees, including (Orth, 2017):

• Gender
• Socioeconomic status (indicated by income and education)
• Ethnicity
• Personality characteristics (including extraversion, emotional stability, and conscientiousness)
• Stressful life experiences (such as illness, serious accidents, and unemployment)
• Relationships

Some individuals experience more fluctuation in their degree of self-esteem than others. Influences include people’s reliance on external feedback and even the degree of cultural focus on self-esteem (Orth, 2017).

Situational and trait self-esteem

There are two types of self-esteem problems faced by clients attending self-esteem therapy: situational and characterological (or trait). Situational issues depend on the circumstances; the client may experience low self-esteem as a parent, sexual partner, or workplace. Low characterological self-esteem is more general and often has its roots in early experiences, including abuse, neglect, or abandonment (McKay & Fanning, 2016).

Why does it matter?

Self-esteem can have a very real effect on our lives. Our sense of worth influences our experience of careers, relationships, education, criminal behavior, and wellbeing (Orth, 2017).

In our personal lives, self-esteem researchers have found that levels of self-esteem can predict relationship satisfaction and quality of life. At work, it can indicate our degree of job satisfaction, performance, and career success (Orth, 2017).

How to Help Clients With Low Self-Esteem

“Judging and rejecting yourself cause enormous pain,” (McKay & Fanning, 2016, p. 1).

Low self-esteem can lead us to avoid anything that might increase our likelihood of experiencing suffering or discomfort from self-rejection, including taking few social, relationship, or career risks. As barriers get raised, we turn to blame and anger and rely on bragging, perfectionism, and excuses (McKay & Fanning, 2016).

The client can stop self-judging and increase self-esteem by seeing themselves differently. Cognitive restructuring techniques are practical and highly effective, especially for low self-esteem, whether situational or state (McKay & Fanning, 2016).

We can confront cognitive distortions, emphasize strengths over weaknesses, and develop specific skills to handle criticism and mistakes. Changing maladaptive thinking patterns in the situations they arise can boost self-confidence and self-worth (McKay & Fanning, 2016).

Characterological low self-esteem is more complex, deriving from feeling bad about ourselves. Changing thoughts alone is unlikely to be sufficient to change our underlying identity statement. Instead, it is necessary to quiet the inner critic before addressing “the negative identity that gives rise to negative thoughts” (McKay & Fanning, 2016, p. 2).

Ongoing therapy, including visualization and defusion techniques, can support the growth of self-esteem and help reinforce self-compassion and the commitment to nonjudgment.

3 Ways to Improve Self-Esteem in Therapy

Therapy is a powerful approach for increasing an individual’s sense of worth. Clients undergoing the therapeutic process typically begin to see themselves as “more okay, more deserving, more capable” (McKay & Fanning, 2016, p. 2).

Several activities can help therapists focus on the factors that influence our sense of self-worth, including the following:

Recognizing your ‘shoulds’

Like it or not, we have all been handed down many ‘shoulds’ – literally, things we are told we should do – from our parents. And the more our parents confound our own judgments, preferences, tastes, and issues, the more likely we are to have a fragile self-esteem (McKay & Fanning, 2016).

Such expectations can leave us captive to beliefs that we may be bad if we don’t follow the rules. Becoming enslaved to such opinions can damage our sense of self-worth and, in turn, our self-esteem (McKay & Fanning, 2016).

As a result, it can be a valuable exercise in therapy to understand the ‘shoulds’ we carry with us. The following four questions can help your client (modified from McKay & Fanning, 2016).

Ask your client to consider the following questions regarding a particular area of their life:

1. Do you feel guilty or experience self-recrimination?
2. Are you experiencing feelings of conflict? Perhaps you are torn between what you should or should not do.
3. Do you feel obligated or owing?
4. Are you avoiding something you feel you should be doing?

Feelings of guilt, avoidance, and obligation typically point to underlying ‘shoulds.’ For example, parents’ feelings of conflict regarding not spending all their free time with their children probably arise from learned ‘shoulds’ (McKay & Fanning, 2016).

Challenging your ‘shoulds’

Once identified, ‘shoulds’ can be challenged, often for the first time in a person’s life. While some such beliefs are healthy guides, recognize that others may be damaging to self-esteem. Spend time working with your client to reduce or remove the effect of an unwanted ‘should’ (McKay & Fanning, 2016).

• Help your client consider why the ‘should’ arose in the first place. Perhaps it originated in a very different situation from the one the client finds themselves in now.
• Encourage them to weigh up the benefits of the belief versus the negatives. What impact does it have on their own and others’ lives?

Understanding why the ‘should’ arose and whether or not it is beneficial will help the client manage it with more positive replacements, such as:

• Recognize the should – “I should have a more impressive job.”
• Replacement – “An influential career and corporate prestige was my father’s rule, not mine. I have job security and enjoy what I do.”

Improving awareness

Improved awareness can lead to a more realistic sense of self-worth and self-esteem. Understanding the likely consequences of actions can be an essential part of the client’s ability to handle the impact of adverse events on their self-esteem (McKay & Fanning, 2016).

The following questions help clients become more aware and avoid ill-thought-out decisions. Ask clients to reflect on a decision they are facing (modified from McKay & Fanning, 2016):

1. Have I experienced something like this before?
2. What were the negative consequences last time, and what can I expect this time from the decision I’m considering?
3. Are the consequences (negative versus positive) worthwhile?
4. Are there alternatives with less adverse outcomes?

Examining the potential consequences before making a decision and adopting a questioning mind can result in fewer mistakes or an increased acceptance that errors are essential to learning. In either case, there will be less risk of damage to the individual’s self-esteem.

Helping Clients Foster Self-Acceptance: 2 Exercises

Poor self-acceptance and lower self-esteem are often found together in individuals.

Like fostering self-esteem, learning to own weaknesses and mistakes can be valuable in improving self-acceptance (MacInnes, 2006).

Accepting who we are

We don’t experience reality objectively or with 100% accuracy. McKay and Fanning (2016) describe it as similar to a fuzzy image on a TV screen, where the picture we create in our head can lack details or be misleading.

To help your client understand that we all have an individual, possibly faulty, version of reality, use the image of a mental TV screen as a metaphor for our internal view (modified from McKay & Fanning, 2016):

• Everyone has one.
• Only you can see and experience your screen.
• You can never fully experience another person’s screen.
• You can never fully communicate what is on your screen; some of it is unconscious.
• You cannot be 100% sure of your screen’s accuracy.
• Your self-talk is internal and can create a negative interpretation of what you ‘see.’
• Often, when our screen is most distorted, we are most sure of its accuracy.
• You can control elements of your screen some of the time. Such as, closing your eyes, listening to your favorite music, etc.
• You can control all of your screen some of the time, such as when you successfully meditate.
• You cannot control all of what you see all the time.
• You can learn to see your screen more clearly, though it will never be 100% accurate. Self-help and therapy can improve your self-awareness and knowledge of how your feelings and beliefs influence how you see the world.
• Critics are criticizing how they see you on their screens. They never see the real you.
• How you perceive reality is shaped by many factors, including the environment and your physical and mental state.

Ask your client to bear these points in mind and recognize that we may mistake others as they mistake us. We ca be aware that we all have a partial view of reality, be more accepting, and practice compassion to ourselves and others.

Making mistakes

While we all try to avoid making mistakes, some are inevitable. The following steps help clients accept mistakes as part of everyday life; they do not make us wrong or bad people (modified from McKay & Fanning, 2016):

• Recognize that everyone makes mistakes
  From doctors to ministers, everyone is imperfect. Things go wrong, and failures are inevitable. Yet, mistakes are important; they lead to growth and learning.
• Recognize that you are no different
  The client needs to understand that like everyone else, they make mistakes. Ask the client to list their top 10 biggest mistakes. Consider what needs, wishes, and circumstances led to the decision that caused the mistake.
• Forgiveness
  No matter how painful the consequences, self-forgiveness is key to maintaining self-esteem and feelings of self-worth. Reflect on the following points to help:
  • Most likely, the decision was the right one at the time, based on the knowledge available.
  • The mistake has happened, and the price has been paid.
  • Mistakes are unavoidable.

Dwelling on mistakes once lessons have been learned serves no purpose and is ultimately damaging.

7 Tips for Supporting Clients in Their Journey

Self-esteem plays a valuable role in mediating between shyness and loneliness. And equally, shyness has a part in low self-esteem and lacking confidence in our social behaviors (Zhao, Kong, & Wang, 2013).

The following actions help clients overcome shyness and offer a boost to self-esteem (modified from Larsen et al., 2017):

1. Start by showing up
   When shy or suffering low self-esteem, we can overestimate how uncomfortable a situation may be, and it becomes tempting to hide away. And yet, things are rarely as bad as they first seem.
2. Don’t be your worst critic
   Give yourself credit for how you perform and the person you are. Don’t blow mistakes out of proportion.
3. Baby steps are better than nothing
   If you aren’t ready to take the plunge and begin something new or take on something you have previously failed at, start with small steps. Experience every partial success.
4. Give unto others
   When we have issues with self-esteem, self-acceptance, or shyness, we focus too much on ourselves. Focus instead on others and what they say. Offer encouragement and support and move your attention off your discomfort.
5. Exude warmth
   People low in self-esteem or shy can be unfriendly or tense and may be challenging to engage with. Try to create a more positive, warm, and friendly demeanor. Smile and make eye contact.
6. Anticipate and accept failure
   All of us make mistakes. Failure is a part of life and a vital part of learning. If you do or say something wrong, learn from it and move on.
7. Join the crowd
   When we lack self-esteem or self-confidence, small talk can seem terrifying. However, when you observe it, you begin to realize it is nothing more than light chat. Don’t expect too much of yourself.

If your client can see that life is a little like a school science project, they will realize there are many unknowns, and things don’t always work out as planned. When we learn from our mistakes and don’t take ourselves too seriously, we can begin to enjoy the small successes in life, accept who we are, and understand our self-worth.

Helpful Resources From PositivePsychology.com

For even more self-esteem tools that will help your clients strengthen their self-acceptance and self-image, check out the following worksheets, handouts, and exercises.

• Shifting Codependency Patterns
  This handout explores drivers of codependency, such as low self-esteem, by comparing and contrasting examples of codependent versus adaptive thoughts and behaviors.
• Designing Affirmations
  This worksheet helps clients design positively focused, goal-oriented affirmations that they can regularly practice to encourage greater self-esteem.
• Self-Esteem Journal For Adults
  This worksheet presents a series of journaling prompts that inspire reflection on one’s best attributes and positive aspects of life.
• My ‘Love Letter’ to Myself
  This exercise helps clients recognize and consider the applications of their many great qualities as a means to strengthen self-esteem and resilience.

If you want to guide others in cultivating self-compassion and emotional wellbeing, our Self-Compassion X© training program is the right tool for you. Designed for practitioners to use anywhere, it is filled with ready-to-use practices.

Lastly, if you’re looking for more science-based ways to help others develop self-compassion, check out this collection of 17 validated self-compassion tools for practitioners. Use them to help others create a kinder and more nurturing relationship with the self.

A Take-Home Message

Our self-esteem begins to form in early childhood and develops and fluctuates throughout our lifetime. What we are told by our parents and society, our personality, stressful life experiences, and our gender impacts the development of our self-worth as we grow (Orth, 2017).

And it’s important, not only to our general psychological wellbeing, but also to the success of our relationships, education, and career (McKay & Fanning, 2016).

Low self-esteem can cause enormous pain, making life satisfaction appear out of reach for many. We may hide behind barriers that we put up, make excuses for not taking part in life, and respond with anger to hide how we truly feel.

It doesn’t have to be this way. Therapy is remarkably helpful at increasing self-esteem, focusing on strengths over weaknesses, using cognitive restructuring techniques to favor positives, and sharing skills for coping with criticism and handling mistakes.

Try out some of the exercises and tips within this article with your client. Work toward increasing their sense of self-worth and accepting who they are.

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