Change 3: How to Choose a Therapist
Change 4: Using Pain for Growth
Change 5: The Psychology of Spirituality and Religion
Change 6: Fear of Enjoyment: The Big Fist Theory
Change 8: Is Bad Self-Esteem a Mental Illness?
“Dear Dr-Rick,
Can you tell me more about “rigid patterns?” You used it in your info piece. Thank you.”
Cognitive Rigidity
You are referring to the practice information page, where I talk about a special interest of mine.
Rigidity means that something is inflexible and hard to bend.
Cognition means thinking.
“Cognitive rigidity” as a temporary state has to do with the effects of stress and crisis.
Stressful events set in motion old, automatic habits of thought, emotion, and behavior. This is a typical occurrence in just about everybody. We differ in terms of which stresses set us off, and which old patterns we each learned to go back to. Otherwise we are the same.
There is lots of research on this, and with brain imaging we can actually see two circuits: one for routine conditions and one for emergency, for a fast response. Of course, when the stress is social, a fast response is not always the best one.
It interests me because, once a way is found to interrupt these old, rigid patterns, then most people act and feel the way they would prefer. So, whether I’m working with cognitive focus, anxiety, depression, self-confidence, or communication problems, it will usually include this perspective.
As a psychologist, when you work on the stress-changes that people go through, you tend to fall through the theoretical cracks. A cognitive-behavioral therapist might think I was a humanistic therapist or even a psychoanalytic therapist compared with them, but a humanistic therapist would think I looked like a behavior therapist.
I call the model “bimodal” because of the two “modes” or ways the mind works: more flexible as pleasure and relaxation increases, and more rigid as stress increases.
Comparing this to the dominant model these days, the cognitive therapists are correct that thoughts often determine emotions, because of the way that our feelings are created by what we think is happening. On the other hand, feelings determine thoughts too because we are bimodal. So, I’m just not one-way about the relationship between feelings and thoughts.
Of course, this all matters a lot because our thoughts and feelings both finally create our actions. You cannot make changes without them.
Thanks for asking!
Dr. Rick Blum
“Hi Dr. Rick,
Can you tell me a little something about Bio feedback? What
happens if you undergo this treatment? Does it help people?
Technology”
Thanks for writing. You are raising a fascinating subject, which is whether technology exists that can help people change psychologically.
First, about biofeedback, which consists of machines that give people a signal (feedback) when they make a usually unconscious change. For example, your brain does not otherwise let you know when you move from more activated brain waves (beta waves) to more relaxed brain waves (alpha usually, though theta waves can be trained). By giving you immediate knowledge of a certain state, you can learn to produce it by choice. It can be useful when a person is wanting precisely the change they are using the machine for, and I cannot imagine how it could be harmful if used as directed. So, alpha brain wave training is a valid relaxation method.
The question is whether it is worth the expense and trouble. For instance, there are other forms of relaxation that are very effective also. So, if you find that, for whatever reason, you are either more motivated or more able to learn relaxation from the biofeedback machine, then it could be better for you specifically. Other effective methods include meditation, muscle relaxation, self-hypnosis, ritualized prayer, guided imagery, or some combination of these.
The second, more worrisome, limitation of biofeedback is whether you can expect it to generalize to other areas. Advertising aside, the training may not affect anything other than the exact behavior being trained. As an illustration, I once knew a biofeedback practitioner who could raise the temperature of his fingers at will, cooler finger temperature being a classic symptom of anxiety.
Nevertheless, the man appeared otherwise anxious to me, and he had high blood pressure. The problem is that stress changes how we function, so that our ability to modify our mood and thinking during a relaxed period does not automatically help us when we most need it. But, as long as you recognize this, there’s no harm, so you may enjoy it and you might even be one of those who finds it useful to your overall functioning as well.
As long as you raise the question of technology, there is a machine that people report as helpful for another condition. Strong light machines, if at least 10,000 “lux” (candle-power) and safely shielded from UV rays, have been used to help people who have Seasonal Affective Disorder or SAD. This is the winter blues. I saw several studies on this when it came out.
Although I have not reviewed any research on this in recent years, the last I checked it was listed as an approved treatment for SAD in the protocols of the American Psychiatric Association.
The most fascinating technology for change does not come in the form of a machine, however. There consist of techniques we can learn to alter chronic distress feelings, to interrupt self-defeating thought sequences, and to reliably redirect our behavior. The key is to identify strategies to alter cognitive (mental) rigidity. That, to me, is the most exciting frontier in change technology.
Thanks again!
Dr. Rick Blum
Change 3: How to Choose a Therapist
Since you have already stopped the treatment, and since I have discussed the privacy issues in a separate part of this page, I will focus here on how I think you should choose the next therapist.
There is nothing wrong with getting referrals, but keep in mind that unless the person who is recommending a therapist has actually used that therapist, they have no personal experience with what it is like to receive treatment from them. So, whether you use the yellow pages, your PPO’s list, or another person’s suggestions, you still have to ask some questions.
First point: does the counselor call you back personally? If the answer is no, you are done with that one. If they do, then now you can find out about the rest.
Notice how the therapist treats you on the phone. Are you being talked down to, patronized, or does the person instead seem “down to earth”? In other words, do you feel comfortable with that person. And, don’t blame yourself if you don’t. By the way, you can expect people to act pretty much the same in their offices as they treat you on the phone.
Assuming that the therapist seems nice, next ask some question about strategy. It’s one thing to understand and quite another to know how to help. You could phrase this by asking if they take a practical approach or if they help direct you to your goals, or if they are strategic. Now, when you are listening to their answer, there are a couple of extremes to avoid.
Some people, although this is relatively rare, sound like they want to run your life. Better you should run for the hills. The more frequent problem is that the therapist will say something like that they will facilitate you or ask the right questions or guide you in coming up with your own answers. These are all passive approaches, with the result that they will not speak much.
Preferable, from my point of view, is someone who says that they can guide you, but that you’ll be in charge of the directions. In other words, they find out where you want to go, and are quite active in coaching you on how to get there. This is a more active approach, but still allows you to set your own goals (unless part of what you want is help in learning how to set goals).
These standards apply as much when choosing treatment for your child as they do when seeking your own therapy. It will weed out a lot of bad situations, but this is about as much as you can find out on the phone. Then it takes a visit, but only one, to see whether they can deliver what they promised.
Best wishes on your search,
Dr. Rick Blum
Change 4: Using Pain for Growth
“Dear Dr-Rick,
“It has come out that I have been having a secret relationship with a married woman. Neither of them are leaving the kids, so they have to work it out. I wish I could help her since I care about her (that sounds contradictory,
ha?) , and have ever since I met her. She and I wished we could have stopped before discovery (duh), so we could work on being just friends and be in each other’s lifes. I lost a lot all of a sudden. He is (was) a friend of mine and only now feel for him. I think I had to shut off part of me to do what I was doing.I lost being able to see her and the kids. She and I have contacted each other with him knowing. We haven’t seen each other since the discovery. I just wish we had deleted those emails so the burdens of this relationship would be just mine and hers. Now she’s left with a big mess and he is really destroyed. I lost a lover, two friends, self esteem (was already losing that). What I really want is to meet someone and have a family.”
Using Pain for Growth
Your account suggests to me that you are ready to learn some life lessons and, if so, you are getting a lot of prodding.
My major suggestion is to consider whether all this emotional pain could actually be your ally. This anguish may be your teacher. That’s why we have emotional pain. Think about it. Why do we have physical pain? It tells us when to move and makes us do it. Emotional pain must have the same purpose, since it has no other benefit. At first, emotional pain makes us feel really sick and gets in our way, so it is not useful immediately. Yet, ultimately, its lesson is the same as that of physical pain: it tells us when to move and makes us do it, if we listen.
You have been making choices guaranteed to work only in the moment and equally certain to hurt a lot later on. As you mention, the pain of your choices is affecting not only you. It is, of course, not to your credit that you caused this, but it certainly is a good sign that it hurts you deeply, since it shows your deeper character. Can you now start to see how the pain could be useful?
So, now you are in emotional payback mode. Don’t go through this suffering for nothing. Let it teach you what you want in life, what it feels like to miss the train toward the future you want to build, and how important this is to you. This can protect your future choices and even motivate them.
Then, you can move.
Best Wishes,
Dr.Rick Blum
Change 5: The Psychology of Spirituality and Religion
“Dear Dr-Rick,
My fiancé is religious, but I’m not. I think of myself as spiritual, but not religious in the way I grew up with. She tells me that she is not trying to change me, but that my life would be better (fuller) if I was like her. I’m not sure what to tell her, but I just know I’m happy to be alive every day and to be a good friend to other people, including her. Am I wrong?”
Special Report on the Psychology of Spirituality:
Or, “I think I’m spiritual but not religious”
This conversation you two are having can be a very loaded conversation, overflowing with both emotion and meaning. Perhaps if you can begin with a similar understanding of what you each mean by “spirituality” and the psychological difference between that and religion, i t will ease your struggle in this area. I’ve provided a special report below, because of my respect for this sincere and common dilemma.
Some People are More Naturally Awake to the Moment
When it comes to spirituality, some people seem to be “naturals.” If you are, it is probably easy to tell. You look around the world, and you are sometimes astonished that all of this exists, beginning with yourself. You are fascinated that, of all the things in the world, you somehow managed to appear in a form that gets to wonder about stuff like this. You are grateful for the opportunity of being conscious, alive, and subtle. Further, you are deeply appreciative of finding yourself in possession of some delightful talents, which can easily take a lifetime to explore. You probably take very little credit for the existence of these talents, but you experience a sense of inner mandate to develop them as gifts. Most important, despite the temporary nature of all that you see, you feel an intrinsic passion to deliver the fruits of these talents to everyone who might make use of them. It is just your nature.
Some people who fit this description participate in some kind of tradition that expresses similar sentiments. Others do not, but find that their nature tends in this direction even without the structure of a religious or philosophical system.
If you think that you have never felt even an ounce of this sense of wonder, I doubt that you would still be reading this page. On the other hand, if you are like most of us, you occasionally experience feelings of awe, but only in the form of infrequent lightning bolts. If so, you have an opportunity to expand and extend this capacity. Like all abilities, the tendency to experience grateful amazement is a gift that you can enhance.
What and Why is the Spiritual Dimension?
Why should we develop this? First, let’s define it, so we’re on the same page. You could define spirituality as “the sense of a grateful connection to that outside oneself, beyond personal, ethnic, and national identity.” Defined that way, research shows that it is central to a sense of satisfaction, especially in the second half of life. When spirituality is the connection to all humanity, we commonly call it universal love. Like a continuum, people can experience a spiritual connection as specific as a reverence for Mother Earth or as abstract as feeling connected to the vast something-nothing of the Cosmos. Defining it as “self-transcendence,” some psychologists (Cloninger and his colleagues) have established a strong connection between spirituality and satisfaction once people exceed 40 years of age. Given a hopefully long life, this is helpful to know.
Second, since it is a form of love, it is indispensable. Love is the chief source of joy. While we do not always have somebody to love, everybody has the “Everything” available to love if only we know how. When we do have close family or friends to love, the ability to transcend ourselves helps us achieve the kind of intimacy that makes love more than a fun but fleeting feeling.
Finally, don’t forget those lightning bolts. It would be sweet to spend more time amazed at being alive and filled with a sense of purpose.
Here is where the religion question comes up. Can the symbols and practices of a religion help us to capture more spirituality within our lives?
There Are Teachings to Guide Our Way.
Psychologically speaking, religions can be viewed as symbol systems. They can seem very unscientific, but there is a good reason for that. Metaphors can come in very handy at times. You see, it is at the precise point where the direct language of scientific terminology starts to tremble beneath the weight of the profound, that the suggestive language of the metaphor begins to ascend. Therapists already know that certain insights can be more easily spoken of figuratively than literally. Moments of awesome communion, of liberating self-insight, of impossibly ambiguous emotions depend upon figurative expression for us to converse directly with experience. Symbols speak most audibly when concrete terms fall silent.
As a psychologist I often notice that powerful insights are usually conveyed more effectively with metaphors than with experimental data. Scientific terminology and traditional symbols each have their own type of clarity and concreteness. One cannot replace the other.
I have heard this difference discussed as the difference between symbols and signs. The usefulness of signs requires a one-to-one correspondence between the sign and that which is signified. For instance, we don’t want a stop sign to be ambiguous. For this reason, signs are useful in science. Symbols, on the other hand, owe their power to their ability to convey one-to-many correspondences, so crucial for the metaphoric expression of intuitive insights.
As one psychologist stated it (Royce), “The multiple meanings of the symbol make the task of empirical analysis extremely difficult, but they open up dimensions of reality which remain unavailable to sign language.” (Psychology would ideally incorporate both, according to Royce. Symbols would reveal insights that would be cleverly tapped for specific scientific formulations, which would then be tested in the form of signs.)
The Search for a Personal Set of Symbols
Inside every mystical or religious system are subtle teachings that interpret the content of the system in symbols rather than signs. This is not intellectualization. As Martin Buber wrote, the knack is to look at the religious symbols neither literally nor literarily, but as vehicles of insight. Sometimes these teachings are called the “wisdom literature.” In some religions, especially several Eastern systems, these transformational strategies are right there, on the surface. These traditions can emphasize their mystical side because their goal is transcendence of material life, and their most ideal setting consists of serene monks in secluded monasteries. In Western traditions, because their first goal is to provide meaning, comfort, and direction to householders (people living non-monastic lives), this deeper layer is often hidden. It is never missing, though.
Today, one ready source of information about these levels of meaning is by using the Internet, as you just did. Sometimes, the easiest way to learn how to connect to the essential web of your existence may be by connecting your computer to the Web of cyberspace. A few minutes of searching will often reveal both sources and seekers, which will lead to a more symbolic dimension within any tradition that you wish to explore. A search I just made on www.ask.com (of “ask Jeeves” fame) yielded 3.4 million hits in half a second for “Christian spirituality.” Meanwhile, the “related topics” frame offered to take me to Christian mysticism, Jewish mysticism, and others.
Of course, you may include the traditional browsing domains, such as bookstores and libraries. Local clergy may be helpful or disappointing. Nonetheless, many of the guides to spiritual development, including Carl Jung, suggest that we find our teachers within the tradition of our youth, the tradition that planted its symbols in our developing bones.
Each tradition has produced brilliant guides who either wrote or whose teachings were transcribed. Catholics can begin with Meister Eckhart and Thomas Merton. Protestants can read Paul Tillich and Reinhold Niebuhr. Jews can learn from A. J. Heschel and Zalman Schacter-Shalomi for a renovating perspective. For a traditional viewpoint with a vibrant and mystical element, look up Tzvi Freeman or Simon Jacobson. First, you can engage your mind in study, then you can engage your awareness in an experience of that which you study, and finally you can engage your heart in love with the source of that study.
Leaps of Faith Not Necessary
You may have a completely rational understanding of the source of your being alive, and it still compels love. As therapists know, gratitude and love are natural reactions to even the smallest streams of help that we receive. How much more psychologically natural for people to feel deep appreciation for the River ofEnergy that comprises and sustains our existence? Various traditions use very different symbols for this Source and for the relationship that is possible with It. At the same time, you will note that they all agree about three things:
• All the major traditional systems of transformation agree that there is a unifying principle to existence, a Ground of Being. If theistic, the image will be personal; if philosophical or mystical, it may sound a bit more like theoretical physics. The symbolism may place this principle as separate from the world and in charge of it, it may be a Force that is active within the world, or it may in fact be described as the only true reality that exists. At times (such as in Jewish mysticism), these three can be stated as simultaneously true, because the symbols speak on different levels at once.
• Second, all traditions agree that awareness of this Source of the world is the key to a full and meaningful life. We learn that isolation from the unifying principle is a causative factor in cruel behavior, addictive compulsions, and emotional despair. Similarly, when the Unifying Essence is symbolized as a personal and involved potter, molding the world, the sacred writings are clear that we need Him emotionally more than He needs us.
• Third, all of the systems agree that the experience of this Essential Source is naturally planted inside each person. Even very narrow-minded religious sects, those that teach that anyone with the wrong name for God and the wrong story will go to Hell, even those that say all the other churches in the same religion are also escorting their believers directly into damnation, still agree that they themselves do not give you the spiritual gift. They may believe that only they have the story right, but they also believe that the source of the spiritual experience is a gift of grace, freely given by the Higher Power. Of course, this is more explicit in the philosophically oriented traditions, yet absolutely no one is willing to take credit for owning the Spirit. So, it is inside everyone for the partaking.
Some people have theological beliefs and others don’t. Either way, you are not excluded from the same transforming experience. Why? Because we know that the experience exists and is readily accessible to everyone, in any tradition.
William James, the first person to write about this as a psychologist, first described the innate psychological capacity for this type of consciousness. So, people who believe that they are filled with the spirit of God have this experience. At the same time, people who believe that they have overcome the bounds of the ego and are unified with the cosmos experience it, too. Then again, people who say that they have surpassed the limited conceptual frames that keep people away from direct life experience will report similar states of mind. The truth is that the experience of cosmic perspective, release, and love is available to all. The choice of metaphor is up to you.
If William James got the ball rolling by explaining the psychology of spirituality, brain researchers like Andrew Newberg have now painted a picture for us. SPECT images literally show how self-transcendence works for people who develop those skills, and skills they truly are.
Your Brain High on Love
Most likely what happens when we feel spiritually moved is that two important areas of the brain are dampened. The quieting down is probably prompted by the brain’s switchboard/filing system, which is called the hippocampus. When the brain is stimulated by the repetitive and intense focus of prayer, meditation, or spiritual study, the switchboard turns down the noise in other areas. One of the subdued regions observed during brain imaging is the parietal lobe, which has the job of locating us in space and marking the separation between us and everything else. With a quieter parietal lobe, we start to feel an increased connection to the outside. Also quieter is the amygdala, which is the brain’s alarm system. A soothed amygdala quells fear, so we feel unafraid as we emerge to an unfamiliar sense of reconnection.
Meanwhile, with the boundary system and the alarm center resting, what is perking up? Well, the areas most sensitive to activity during a spiritual experience are the parts of the brain near the temples, the temporal lobes, which are where sound and speech arise and where our self-image evidently forms, especially on the left side. Among the evidence for this area as central to spiritual awakening is the long-known hyper-religiosity of patients with temporal lobe epilepsy.
Because the left temporal area is the area where sense of self takes form, external stimulation at such a time creates a strong experience of a hovering presence. Suppose the cognitive content of this external presence is spiritually oriented. Also suppose that this happens while our awareness of personal boundaries is dissolving, as mentioned previously. Explaining the physiology of any experience neither proves nor invalidates the object of the experience. We can similarly describe the brain’s way of processing the experience of eating your favorite meal or of falling in love. Just as with such events, the potential for our having spiritual experience appears to be wired into the “original equipment.”
So, if we suppose that an individual’s metaphor is “scientistic” (faith in scientific method as the ultimate source of truth), all of this can still work since gratitude springs up spontaneously from the healthy human psyche. Achieving this experience only requires permission from the rational mind for a person to accept it. This permission can certainly be obtained by an individual’s having childlike faith. But i t c an equally be gained in a state of mature unknowing, the humility of emptying oneself of certainty and conceptions.
Unknowing, which the philosophers call “negative theology,” is just as effective and is consonant with a scientific outlook. In other words, I can affirm my inability to define the essence of this universe and this life, yet I can gratefully love it. As soon as I let go of the need to define it, I am filled by a deep sense of it, as a lover is filled by a beloved’s embrace.
A Big Enough Room
So, the bottom line in resolving your question may be this: your fiancé can learn to see the meaning in your “natural” spirituality, while you could appreciate the assistance that religious symbols can provide her. Tha t c an enlarge the space of mutual regard in your relationship, making room for each of your choices as you build your lives together.
Best Wishes on Your Search!
Dr. Rick Blum
Change 6: Fear of Enjoyment: The Big Fist Theory
“Dear Dr-Rick,
I never feel excitement. Sometimes I “act” excited, just so people don’t think I’m odd, but inside, I feel little. I really dislike this about myself and I think it restricts me from feeling the good in my life.
Comments would be most appreciated…..Thanks.”
Fear of Enjoyment: The Big Fist Theory
Hi,
I think you have a really good point. As a result of painful disappointments in childhood, many people decide to not get excited in order to diminish the pain when things don’t work. The benefit is less disappointment, but the cost is as you noted. I think it is worth learning to choose to feel more of all feelings, the positive and negative, once we are adults and have more choices about where and how we live.
A variation of this is the ‘big fist theory,’ which is that we will suffer exactly because we first feel good, as if one causes the other. It’s kind of like our memories of “getting in trouble.” Imagine a child who does something natural for a child to do, but is then punished. Or perhaps a lot of things went wrong, and it started to seem as if it were inevitable. Of course this is not true. Really, pleasant times and painful events usually alternate in life. This happens no matter what we do.
Fortunately, we can have significant influence on the proportions of each by our efforts, and sometimes we can’t. Either way, we will get the whole show. Enjoyment and pain will alternate, and we do not cause the pain purely by virtue of enjoying the pleasurable times. If we give up on joy because we will eventually cry again, we are offering to pain much more than it can take from us on its own.
Again, I think it is worth it to learn to stay open to both the heartaches and the joys.
One way to change from the “big fist theory” is to reconsider the purpose of pain. We often think of pain as a punishment that makes us losers. Again, this may be exactly what we were taught as kids, as in “I’ll teach you a lesson.” Well, maybe it was the wrong lesson. Psychological pain is like physical pain — it makes us move. So, every time we hurt, we are not punished (in the parent-child sense) as much as motivated. Think of the word “e-motion,” which conveys the point. You could call it “emotivation.”
In my work, I continually rely on painful experience. Few of us are inspired to make changes until we are uncomfortable. I find myself frequently suggesting that “Comfortable equals stuck.” Accordingly, one expression goes, “When the pain of where I am exceeds the fear of where I’m going, then I’ll move.” This fits my daily experience, how about yours?
Thanks for writing,
Dr-Rick Blum
“Dear Dr-Rick,
“I just got an interview that I’ve been hoping for. I wanted to know if you have any words of wisdom to impart regarding preparation or actual interview techniques.
I will be doing as much research etc. as possible over the next week, and of course I’ll be buying a new suit or something else appropriate to the occasion.
Thanks.”
The Big Interview
I am fortunate in that I learn a lot from my clients, which I in turn can pass along. The people who come to my office do so out of a commitment to make the most of their lives. This same focus on personal responsibility and development has benefited most of them in the past with areas of excellence. In fact, often people call me with two forms of motivation: pain, of course, which provides the motivation to change, and comparing one part of ones life with another part that is working better — and wanting to match them up.
So, a lot of what I am going to write is what I have seen work for others.
There are also some books out on this subject, and it sounds like you are doing one of the things I always recommend. Doing research on the company allows you to walk in with some friendly expertise. You can find out both the successes and the struggles of the company.
Besides Google, also check out www.ask.com, since it uses a different algorithm. Also, you can go onto Google’s “groups” option and see the discussions going on regarding the company. If the business is too small to have such a presence, you can do the same about the type of business, e.g., “private practice psychologists.” You can then be prepared to ask informed questions about the company and to point out aspects of your past experience that fit these challenges.
Thus prepared, you can follow the most important rule: do not expect the company to be interested in you, no matter what they are asking you. They are really only interested in their business. They want to find out if you will be an asset, bringing energy and intelligence, and making work a better place to be. So, the first job you will be doing for them is to get hired, and you’ll do that by showing interest in them. No questions about benefits to you until they choose you. Even if they ask you what you want to get paid, I’d suggest you delay it, as in “I am looking forward to working out all those kinds of details together after you decide that I’d be a significant asset to the company.”
Speaking of details, here are a couple others to note: If you are not sure how people in this position tend to dress, you can visit a similar company and notice what they are wearing. Also, I hope you do not struggle with cigarettes, but just in case you do, it is very difficult to realize how easily non-smokers detect the off-gassing of cigarette smoke from clothing. So, that day, only smoke outside and only when walking in one direction, with the wind against you.
Finally, you might want to prepared a canned answer for an annoying but common question about identifying some flaw in yourself. Usually people pick something quite minor, like “I work too hard!” But, that’s too obviously canned. Instead, you can focus on something that you had to learn to change before a previous accomplishment. It allows you to answer honestly, since any past flaw is something we need to watch, but it also shows you successfully overcoming it.
Best of luck on the interview!
Dr.Rick Blum
Is Bad Self-Esteem a Mental Illness?
Dr Rick,
I have been experiencing low self-esteem for several years. I have made attempts to be successful in life (work, relationships, job-hunting), but everything has failed.
I have read that most psychologists never treat low self-esteem as an illness, but as a symptom of other illnesses.
Do you think that low self-esteem can be an illness in its own right?
You’re correct that self-esteem issues, in their own right, can severely limit the options in people’s lives. I think probably a lot of psychologists and other therapists may know that, but maybe the “illness” issue has to do more with diagnostic codes. There isn’t a formal code in the diagnosis manual (DSM-IV or ICD9-CM) for low self esteem. That’s partially because the diagnostic system avoids looking at causes of problems (called “etiology”), but instead creates categories of symptoms. So, if a person is often depressed, even if poor confidence is the cause, the official diagnosis will be about depression rather than poor self-image.
Here’s what really counts: no matter what we call a problem, how can we move past it?
The way I look at it, there are three sources of self-esteem, one from the past, one from the present, and one from the future. So, the first thing I would tend to do is look to correct each source.
Regarding the past, I recommend practice in identifying talents and gifts that have shown up, however fleetingly, so that a person can become realistically self-appreciating. If self-esteem is low and especially if one is feeling depressed, this evidence can be hard to find. Large parts of my therapist manual are devoted to correcting this. (See “self-esteem” in the index, which is available online if you choose “Click to Look Inside”.)
In terms of the present, you can learn how to create action plans that deal with uncertainty and confusion and reveal small steps that you can expect to accomplish. Keeping your word to yourself in the present increases self-esteem.
And, when it comes to the future, it helps for a person to create a motivating mission in life. This replaces aimlessness with valuable aims. Devoting myself to purposeful contribution of whatever I have to offer can really move me out of self-doubt and self-consciousness.
Now, in any of these areas, one may hit a barrier from ones childhood experiences that blocks success. This becomes the job of the therapist: to identify the sources of these barriers and to design strategies to move beyond them.
I hope this is helpful. Thanks for writing!
