The founder of Psico-K explains to us what the therapeutic process is like in cases of low self-esteem.
There are few mental health professionals who are capable of treating thousands of cases in their private practice and who at the same time take the time to dedicate to a noble educational vocation.
Among this small and select group of psychologists we find Karemi Rodríguez Batista, founder of Psico-K.
Interview with Karemi Rodríguez Batista: How is low self-esteem treated in consultation?
With extensive experience conducting face-to-face psychotherapy sessions in Madrid, and also online, Karemi is a psychologist with a very interesting and multifaceted career. We wanted to share today a talk that we had with her about self-esteem as a concept, and cases of low self-esteem in consultation.
Bertrand Regader: In your experience working in therapy, what kinds of situations are the ones that generate self-esteem problems most often?
Karemi Batista: Complex question. In a quick and general way, I would say that the problems derive from the lack of acceptance of oneself. It certainly influences whether we have been raised in a highly critical and punitive environment, having little contact with our internal experiences and our needs. Some situations that trigger them are when the person goes through the loss of something valuable with which he has merged, or vital crises.
We generally understand the construct of ” self-esteem ” as the value that one has of himself / herself and his own concept. So, the question we ask ourselves is, depending on what this valuation would go up or down.
If my learning history has valued me based on my beauty, status, money, power, fame, etc; or if my sense of worth is a function of who I am with (my partner, my colleagues, my family, etc.) or if I weigh a behavior of mine over others, obviously, when any of these attributes are not there (and this will happen late or early), my self-esteem will be damaged. And this is where we hit dangerous ground and it is for several reasons. The first is that they are external and changeable circumstances or attributes in which I place my global worth, and in myself I would not have much control, or because I merge with that concept of myself and lose sight of other aspects of myself that are more durable and really significant in my life, such as my real values. For example, let’s say that that person I like so much dislikes or that I fail in a task that I was excited about, then I condemn myself and globally label myself as “stupid, useless, without value, etc… ”.
What did I go wrong leads me to be stupid, does someone not appreciate me, marks my value as a person? Well, this is what happens to us, frequently. Nor is it a question of qualifying ourselves positively in a global way based on achievements, because as long as they do not obtain them, we return to self-deprecation and contempt for others.
In short, from my point of view the most effective thing would be to move from the construct of self-esteem towards that of self-compassion that does not depend on external circumstances. In addition, if we do not accept ourselves and are compassionate with ourselves, we will hardly be so with others and this will be to the detriment of meaningful social relationships.
Does this type of psychological discomfort usually appear in childhood, or does it generally appear at any time in life?
In any situation that triggers what I mentioned earlier, although its origin is in childhood. It is there where we learn to have private (from me) or public (from others) control of our experiences. That is, to know what I really feel, think and want, and act based on it or based on others.
If as children we have been criticized, demanded and punished a lot, we will incorporate this and it will be a very strong tendency that will condition our vision of ourselves, contributing to problems related to anxiety, depression, emotional dependence, to Biased thinking styles (focusing only on the negative, over generalizing, drawing hasty conclusions, etc …) and ineffective behaviors in relation to a life of value, such as blocking, avoiding, procrastinating, not setting adequate limits, etc …
Other critical moments, can be in adolescence, and here the social group in which we would include social networks, greatly influences. We can mold ourselves based on what they dictate with little or no discrimination of what I really want, and this is dangerous.
Do people with self-acceptance problems tend to see this as a treatable problem in therapy, or do they more often mistake it for their own identity and believe that it cannot be remedied?
Very good question. You refer to a key point that is to confuse these partial aspects, whether negative or positive, with one’s own identity. There are many people who go to therapy specifically specifying the reason for consultation: “low self-esteem”. I have not yet met anyone who tells me: “lack of acceptance or compassion towards me”, for example. So it is thought that once “self-esteem rises” (again, most of us believe this is once we achieve certain goals or think positively about ourselves), our problems will disappear. This is not like this.
There is a problem of expectations to work as well, many “achievements” do not depend on us and it is difficult for many to delimit this. Here the culture of “if you want, you can” influences a lot. And if we combine it with a learned tendency to demand too much of ourselves, the frustration and suffering is greater.
There are many individual factors that influence its perception as something “remediable” Landing the construct on self-acceptance or self-compassion, there are undoubtedly patients with more resistance to it, due to their own life history and current context, and this is where we must be much more careful, validating and patient as therapists. I think that if we don’t work on this aspect, the rest will most likely fail, but it’s worth it.
What kinds of strategies do psychologists use to help their patients with low self-esteem?
This will depend a lot on the particular characteristics of the patient and their context, in addition to the approach with which it is approached, of course. For this reason, it is crucial that we make a good conceptualization of the case, as well as a thorough functional analysis of the problematic behaviors that derive from here.
In very, very general lines, rational emotional behavioral therapy, for example, would help the patient to foster unconditional acceptance of himself / herself regardless of positive or negative “assessment” (which is not resignation) and redirect him to goals. These objectives are shared by acceptance and commitment therapy, although with a different approach, where the focus would be to work on self-compassion, strategies aimed at the defusion of these “contents” (partial self-evaluations perceived globally) taking perspective, the acceptance of one yourself with your weaknesses and strengths, and from here help people to know what they really want and need in order to reach goals based on their values, and to find more effective behaviors to do so. All this, depending on the case, can be expanded with powerful strategies derived from cognitive behavioral therapy (as long as they are consistent with our approach), such as training in problem solving, social skills, etc …
Once we are achieving this, we help them to be more aware or more attentive in discriminating what was effective, when, where, how they did it, etc., thus generating a feeling of self-efficacy if you want, lower their own internal control. And in this way we try to generalize this new behavioral repertoire to other areas of your life.
And what about people with overly inflated self-esteem? What do you do in such cases?
If this self-esteem is too inflated, it would be something very rigid and stable in various contexts of the person from an early age, and hence would lead to dysfunctional behaviors such as a behavior pattern directed towards excessive search for admiration, little empathy, exploitation of others To achieve your goals, etc., it can lead to what is known as narcissistic personality disorder.
A relevant issue is that people with these characteristics do not usually ask for help, because the explanation of their problems usually directs it towards others, outwards; and they tend to think of themselves on a much higher level than others including the therapist if he goes, then why is he going? What can we teach him or her?
People with these behavior patterns are highly dependent on external social reinforcement, call it praise, admiration, excessive need for attention, etc. and if they do not obtain them, they escape from that situation as a way of avoiding the pain caused by the lack of it. Imagine the challenge for the therapist.
As you can see, it is a very complex situation. It is true that all this must be ground on a case-by-case basis and there are exceptions, among them when what they depend so much on (the approval of others based on external and unstable attributes or circumstances) no longer occurs. Here the recommendation would be to work on that “unstable self”, on self-pity as a first point. A very effective approach to these problems is functional analytic psychotherapy.
About how long does it take to go from having a very low self-esteem to having a more balanced one, thanks to psychotherapy?
There is no definite time, this would respond again to many individual factors and the context of the person as well as the approach with which it is approached. What I can tell you is that the best results and in the shortest possible time are being found in cognitive behavioral and / or contextual behavioral approaches.
How can friends and families of people with low self-esteem who are seeing a psychologist help?
Supporting you in this process. If necessary, the therapist will consider, with the patient’s permission, of course, to incorporate the family member as a co-therapist, and will indicate specifically how he can do it better.
There are no general guidelines, since problem behaviors have a different function in each person, what can be reinforcing for me can be aversive for you, and there we mix it up. The only thing that if I am clear that it can be a more general recommendation is to be compassionate with him or her, helping him to be compassionate with himself, constantly direct attention to what he is doing well, to his strengths, and reinforcing it. .