Adult Treatment Planner
23: Low Self-Esteem
SNOMED Terms
- Atypical depressive disorder
- Bipolar II disorder, most recent episode major depressive
- Chronic bipolar II disorder, most recent episode major depressive
- Depressive disorder
- Generalised social phobia
- Mild bipolar II disorder, most recent episode major depressive
- Mixed anxiety and depressive disorder
- Moderate bipolar II disorder, most recent episode major depressive
- Severe bipolar II disorder, most recent episode major depressive with psychotic features
- Severe bipolar II disorder, most recent episode major depressive without psychotic features
- Severe bipolar II disorder, most recent episode major depressive, in partial remission
- Severe bipolar II disorder, most recent episode major depressive, in remission
- Single major depressive episode, severe, with psychosis
- Social phobia
Goals
- Elevate self-esteem.
- Develop a consistent, positive self-image.
- Demonstrate improved self-esteem through more pride in appearance, more assertiveness, greater eye contact,
and identification of positive traits in self-talk messages.
- Establish an inward sense of self-worth, confidence, and competence.
Behavioral Definitions
- Inability to accept compliments.
- Makes self-disparaging remarks; sees self as unattractive, worthless, a loser, a burden, unimportant; takes
blame easily.
- Lack of pride in grooming.
- Difficulty in saying no to others; assumes not being liked by others.
- Fear of rejection of others, especially peer group.
- Lack of any goals for life and setting of inappropriately low goals for self.
- Inability to identify positive things about self.
- Uncomfortable in social situations, especially larger groups.
Diagnoses
- Social Phobia
- Dysthymic Disorder
- Major Depressive Disorder
- Bipolar I Disorder
- Bipolar II Disorder
Objectives and Interventions
- Acknowledge feeling less competent than most others.
- Actively build the level of trust with the client in individual sessions through consistent eye
contact, active listening, unconditional positive regard, and warm acceptance to help increase
his/her ability to identify and express feelings.
- Explore the client's assessment of himself/herself.
- Increase insight into the historical and current sources of low self-esteem.
- Help the client become aware of his/her fear of rejection and its connection with past rejection or
abandonment experiences.
- Discuss, emphasize, and interpret the client's incidents of abuse (emotional, physical, and sexual)
and how they have impacted his/her feelings about himself/herself.
- Decrease the frequency of negative self-descriptive statements and increase frequency of positive
self-descriptive statements.
- Confront and reframe the client's negative assessment of himself/herself.
- Assist the client in becoming aware of how he/she expresses or acts out negative feelings about
himself/herself.
- Assist the client in developing self-talk as a way of boosting his/her confidence and positive
self-image.
- Identify negative self-talk messages used to reinforce low self-esteem.
- Help the client identify his/her distorted, negative beliefs about self and the world.
- Ask the client to complete and process an exercise in the book Ten Days to Self Esteem! (Burns).
- Identify any secondary gain that is received by speaking negatively about self and refusing to take any
risks.
- Teach the client the meaning and power of secondary gain in maintaining negative behavior
patterns.
- Assist the client in identifying how self-disparagement and avoidance of risk taking could bring
secondary gain (e.g., praise from others, others taking over responsibilities).
- Decrease the verbalized fear of rejection while increasing statements of self-acceptance.
- Ask the client to make one positive statement about self daily and record it on a chart or in a
journal.
- Verbally reinforce the client's use of positive statements of confidence and accomplishments.
- Identify accomplishments that would improve self-image and verbalize a plan to achieve those goals.
- Help the client analyze his/her goals to make sure they are realistic and attainable.
- Assign self-esteem-building exercises from a workbook (e.g., The Six Pillars of Self-Esteem by
Branden, or Ten Days to Self Esteem! by Burns); process the completed assignment.
- Increase eye contact with others.
- Assign the client to make eye contact with whomever he/she is speaking to; process the feelings
associated with eye contact.
- Confront the client when he/she is observed avoiding eye contact with others.
- Take responsibility for daily grooming and personal hygiene.
- Monitor and give feedback to the client on his/her grooming and hygiene.
- Identify positive traits and talents about self.
- Assign the client the exercise of identifying his/her positive physical characteristics in a mirror
to help him/her become more comfortable with himself/herself.
- Ask the client to keep a building list of positive traits and have him/her read list at beginning
and end of each session.
- Reinforce the client's positive self-descriptive statements.
- Demonstrate an increased ability to identify and express personal feelings.
- Assign the client to keep a journal of feelings on a daily basis.
- Assist the client in identifying and labeling emotions.
- Articulate a plan to be proactive in trying to get identified needs met.
- Assist the client in identifying and verbalizing his/her needs, met and unmet.
- Conduct a conjoint or family therapy session in which the client is supported in expression of unmet
needs.
- Assist the client in developing a specific action plan to get each need met.
- Positively acknowledge verbal compliments from others.
- Assign the client to be aware of and acknowledge graciously (without discounting) praise and
compliments from others.
- Increase the frequency of assertive behaviors.
- Train the client in assertiveness or refer him/her to a group that will educate and facilitate
assertiveness skills via lectures and assignments.
- Form realistic, appropriate, and attainable goals for self in all areas of life.
- Help the client analyze his/her goals to make sure they are realistic and attainable.
- Assign the client to make a list of goals for various areas of life and a plan for steps toward goal
attainment.
- Take verbal responsibility for accomplishments without discounting.
- Ask the client to list accomplishments; process the integration of these into his/her self-image.
- Use positive self-talk messages to build self-esteem.
- Assign the client to read What to Say When You Talk to Yourself (Helmstetter); process key ideas.
- Reinforce the client's use of more realistic, positive messages to himself/herself in interpreting
life events.
- Increase the frequency of speaking up with confidence in social situations.
- Use role-playing and behavioral rehearsal to improve the client's social skills in greeting people
and carrying a conversation.
- Recommend that the client read Shyness (Zimbardo); process the content.
Index