1

Worklng wlLh
Low SelfLsLeem
8ebecca Andrew
Cllnlcal sychologlsL
CnWL MenLal PealLh nPS 1rusL
!une 2010
Cvervlew
W eflnlLlons of low selfesLeem
W resenLaLlons of low selfesLeem
W AssessmenL
W CognlLlve model of self esLeem (lennell)
W lnLervenLlons
W LlmlLaLlons of cognlLlve model
W Shame selfaLLacklng (CllberL)
WhaL ls selfesLeem?
eflnlLlons of selfesLeem
lennell (1998)
Low selfesLeem negaLlve sense of self
W Cpenly expressed l'm useless l don'L maLLer
W or an underlylng sense of lnadequacy or
worLhlessness LhaL ls hard Lo puL lnLo words
lennel !enklns (2004)
1he Self evelopmenL 8evoluLlon
W Self worLh Self accepLance
W Self regard Self asserLlon
W Self respecL Self expresslon
W Self love Self reallsaLlon
W Self efflcacy Self esLeem
W Self confldence
W Self lmage
WhaL ls self esLeem?
8randen (1969)
W Self esLeem ls Lhe experlence of feellng
capable of meeLlng llfe's challenges and belng
worLhy of happlness
W lL ls a comblnaLlon of compeLency and worLh
2
WhaL ls compeLence?
W A sense of compeLence arlses Lhrough reallsLlc
and accuraLe selfappralsal meanlngful
accompllshmenLs overcomlng adverslLles
bounclng back from fallures and assumlng
selfresponslblllLy
WhaL ls worLh?
W WorLh ls abouL wheLher or noL a person llves up
Lo cerLaln fundamenLal human values lL dlffers by
person dependlng on Lhelr values eg
W SupporL of famlly
W Academlc compeLence
W hyslcal aLLracLlveness
W Codllness"
W Approval of oLhers
Self esLeem has a cenLral role
(8randen 1994)
W of all Lhe [udgemenLs we pass ln llfe none ls
more lmporLanL Lhan Lhe [udgemenL we pass on
ourselves 1haL [udgemenL lmpacLs every
momenL and every aspecL of our exlsLence Cur
selfevaluaLlon ls Lhe baslc conLexL ln whlch we
acL and reacL choose our values seL our goals
meeL Lhe challenges LhaL confronL us Cur
responses Lo evenLs are shaped ln parL by whom
and whaL we Lhlnk we are our self esLeem"
lngredlenLs for self esLeem
W CompeLence
W WorLh
W Self awareness (reallsLlc appralsal of our
selves)
W LnvlronmenL belng LreaLed wlLh respecL
W Meanlngful llfe relaLlonshlps purpose
ComponenLs of Self LsLeem
W 8ellefs
W LmoLlons
W 8ehavlours
W Speclflc l am a good cook
W Clobal l am a good person
W 1ralL versus sLaLe
Self lmage reflecLs self esLeem
W Pow you see yourself
W WhaL you Lhlnk you look llke
W Pow you see your personallLy
W WhaL you belleve oLhers Lhlnk of you
W 1he sLaLus you feel you have
3
SoclomeLer 1heory Leary (1999)
W SoclomeLer Lheory proposes LhaL Lhe selfesLeem
sysLem evolved as a monlLor of soclal accepLance
and Lhe socalled self esLeem moLlve funcLlons
noL Lo malnLaln self esLeem per se buL raLher Lo
avold soclal devaluaLlon and re[ecLlon
W Cues lndlcaLlng Lhe lndlvldual ls noL adequaLely
valued and accepLed by oLher people lower self
esLeem and moLlvaLe relaLlonshlp enhanclng
behavlours
Leary (1999)
W 1he selfesLeem sysLem ls an lnLernal gauge
LhaL monlLors Lhe degree Lo whlch Lhe
lndlvldual ls belng lncluded versus excluded by
oLher people Self esLeem Lhen ls noL a
person's own personal self evaluaLlon as much
as lL ls an lnLernal represenLaLlon of soclal
accepLance and re[ecLlon
ls Loo much self harmful?
W Plgh self esLeem can be harmful bullylng and
vlolence
W CulLural dlfferences
W WesL prlze an lndependenL self Lo percelve Lhe
self as poslLlve and havlng efflcacy (hlgh levels of
menLal healLh problems)
W LasL prlze an lnLerdependenL self wlLh goals of
prevenLlng LhreaLs Lo Lhe group and Lo have
relaLlonal harmony based on shared efflcacy
(1rommsdorff 8oLhbaum 2008)
Self LsLeem and MenLal PealLh
3 forms of presenLaLlon
1) aspecL of an axls l problem eg depresslon LreaL Lhe
problem and should resolve
2) a consequence of oLher problems eg healLh problems or
menLal healLh dlsorders (eg lngham eL al 1987)
3) vulnerablllLy facLor for developlng cllnlcal problems may
be longsLandlng (8rown eL al 1986)
Can be bldlrecLlonal
Can be addlLlve comorbldlLy lowers self esLeem
Low selfesLeem prevalenL ln many
Axls l lsorders
W epresslon
W 1S
W Soclal anxleLy
W LaLlng lsorders
W sychosls hearlng volces
4
Low self esLeem cenLral Lo several s
eg
Avo|dant ersona||ty D|sorder (8eck eL al 1990)
W Self lnepL lncompeLenL vulnerable Lo
re[ecLlon
W CLhers CrlLlcal demeanlng superlor
W As lL ls Lerrlble Lo be puL down
lf people know Lhe real me Lhey wlll
re[ecL me
W SLraLegy Avold rlsk of evaluaLlon by oLhers
Low SelfesLeem ln s
Dependent ersona||ty D|sorder (8eck eL al 1990)
W Self needy weak helpless lncompeLenL
W CLhers nurLuranL supporLlve compeLenL
sLrong
W As l need people Lo survlve/be happy
l need a sLeady flow of supporL and
encouragemenL
W SLraLegy CulLlvaLe dependenL relaLlonshlps
?oung (1990)
Schemas
W efecLlveness
W lallure
W Soclal undeslrablllLy
W Soclal excluslon
lmpacL of Low Self LsLeem
W lsLresslng dlsabllng
W negaLlve Consequences
Selfharm sulcldal beh (PawLon eL al 2002)
ropplng ouL of school (Culllon eL al 2003)
unemploymenL and lower earnlngs (lelnsLeln 2000)
W 8ole ln Lhe aeLlology perslsLence of dlsorders
W oor prognosls ln LreaLmenLs for depresslon eaLlng
dlsorders (8rown eL al 1986 lalrburn eL al 1993)
W redlcLor of relapse (8rown eL al 1990)
Consequences of Low Self LsLeem
W Lack of AsserLlveness
W need for approval
W Pldlng Self
W Pldlng Lrue feellngs anger eLc
W unrelenLlng sLandards (compensaLory)
W Sub[ugaLlon (compensaLory)
W noL a dlagnosLlc caLegory
W we mosL commonly encounLer lL as a
somewhaL nebulous background dlfflculLy
accompanylng or underlylng more preclsely
deflnable presenLlng problems" (lennell
1998)
5
CognlLlve Model of Low Self LsLeem
lennell (1998)
eflnlLlons of selfesLeem
e|festeem as a schema a gener|c cogn|t|ve
representat|on of the se|f
W Schemas are a producL of learnlng based on our
experlences we form concluslons (bellefs and
assumpLlons) abouL ourselves oLhers and Lhe world
W Cnce ln place schemas shape how a person percelves
and makes sense of subsequenL experlence Lhrough
cognlLlve dlsLorLlons and ways of lnLeracLlng wlLh
Lhe world
A Cognitive Model of Low Self-Esteem
(Fennell, 2004)
(Early) experiences
Lack oI praise, or validation, lack oI interest,'odd one out
Loss, rejection, negle ct, bereavement,abuse
Bottom line
Negative core belieIs about selI
Specific dysfunctional assumptions
Rules Ior living
Standards against which worth can be measured
Critical incident(s)
Situations which activate negative belieIs and rules Ior living
(more severe low SE, more pervasive)
evelopmenL of Low Self LsLeem
W evelop from early experlence (or someLlmes
laLer)
W Leads Lo developmenL of negaLlve core bellefs
uncondlLlonal and negaLlve
lnferlorlLy
lncompeLence
unlovable
CLhers as crlLlcal and re[ecLlng
evelopmenL of Low Self LsLeem
W 8ules/assumpLlons serve a compensaLory
funcLlon ln relaLlon Lo boLLom llne"
Clven LhaL l am noL good enough whaL l musL do
Lo survlve noL be re[ecLed ls
W leel okay as long as rules are meL
W Shaped by culLural norms and values
W roblemaLlc when rlgld and lnflexlble
evelopmenL of Low Self LsLeem
8oLLom llne learned global [udgemenLs abouL
Lhe self
W MalnLalned by
8lases ln cognlLlve processlng percepLlon
lnLerpreLaLlon and memory
unhelpful behavlours

ogn|t|ve processes and ma|ntenance of the bottom ||ne

(Ienne|| 2008)
Biased belief
am a useless failure,
others are critical
Biased expectations; if
get it wrong, others will
see the real me (and
reject )
Biased perceptions:
vigilant for mistakes,
screen out signs that
others are accepting
Biased interpretations:
discount signs of being
valued, assume that others'
responses are a rejection
based on worth
Biased memory:
remember all that goes
badly, forget +ve signs
that seen as worthwhile
and loved
Maintaining Factors
A Cognitive Model of Low Self-Esteem
(Fennell, 2004)
Critical incident(s)
Situation in which standards
Are not met May not be me t
Activation of the ~Bottom Line
Depression Predictions
Anxiety
SelI-critical Maladaptive
thinking behaviour
Confirmation of bottom line
,a|ntenance yc|es when ru|es m|ght be
broken (anx|ety)
W SlLuaLlons ln whlch rule mlghL be broken
W 1rlgger anxleLy lnhlblLs performance
W 8lases ln anxlous Lhlnklng ve predlcLlons
W Avoldance
W SafeLy behavlours Lo prevenL dlsconflrmaLlon
revenL dlsconflrmaLlon
May worsen slLuaLlon
W erson copes buL lnfo ls dlsLorLed
W WhaLever happens boLLom llne appears Lo be conflrmed
Maintaining Factors
A Cognitive Model of Low Self-Esteem
(Fennell, 2004)
Critical incident(s)
Situation in which standards
Are not met May not be me t
Activation of the ~Bottom Line
Depression Predictions
Anxiety
SelI-critical Maladaptive
thinking behaviour
Confirmation of bottom line
,a|ntenance yc|es when ru|es are broken
(depressed mood)
W When sense LhaL ve bellefs abouL Lhe self have been
conflrmed by experlence
W Leads Lo self crlLlclsm (self aLLack)
Calllng self names
l could do beLLer
CrlLlclse self for Lhlngs should be dolng and aren'L and vlce
versa
W Lowers mood
ConLlnued acLlvaLlon of ve Lhlnklng
8elnforces anLlclpaLlon of negaLlve ouLcomes ln fuLure
Lxerclse
W 8ead Lhe followlng llsL of words allowlng each Lo
slnk ln close your eyes and lmaglne Lhem applylng Lo
you
Dse|ess Dnattract|ve Incompetent
Weak Dn||keab|e Dg|y
athet|c Dnwanted tup|d
Worth|ess Infer|or Inadequate

Lxerclse
W WhaL effecL do you noLlce Lhls has?
W now counLerbalance Lhls wlLh a poslLlve
lmage of yourself
A Cognit ive Model of Low Self-Esteem
(Fennell, 2004)
(Earl y) experience
Lack oI praise, or valida tion, l ack oI int erest,'odd one out
Loss, rejection, negle ct, bereavement ,abu se
Bottomlin e
Nega tive co re bel ieIs about selI
Specific dysfunctional assump tions
Rul es Ior living
Stand ards against whi ch worth can be measured
Critical in cident(s)
Situationinwh ich standa rds
Are not met Maynot be me t
Activationof bottomlin e
Depression Predi ction s
Anxie ty
SelI-crit ical Maladapt ive
thinking beh aviou r
ConIirmationoI bottom lin e
Case example CS
CSis a 4 year old woman. She presented with a long history oI dysthymic mood, and recurrent d
depression. She was IromIreland, and had come to England at the age oI 20.
Personal History
She grew up with her two older brothers, who are 3 and 4 years older than her. She described her
Mother as a very practical woman who is always on the go. BeIore CS was born, her mother had
a boy who had died at birth.She does not recall her mother giving her any attention, praise,
encouragement, or physical aIIection. Her Iather travelled a lot, and was an extravert. He was rarely
at home. CS recalls most oI childhood being very withdrawn. She would escape Iromthe Iamily
by going oII on her own on her bicycle. She recalls having thoughts about the dead baby, and
thinks her mother wouldrather have had this boy, than have her.
As a teenager she began to rebel against her mother. Her mother was never happy with any boyIriends
she brought home. She had a relationship with a man in her early twenties, however throughout this
relationshipshe believed that he would leave her. He eventually proposed, and she said no, as she
Couldnot believe that he truly wanted to be with her. She has not had a relationship since, despite
being a very attractive woman.
CognlLlve formulaLlon of CS
(Earl y) experience
%empe rament v ery sensitive
Mothe r cold ; brothe r preIerred; child died
Fath er ab sen t; not notic ed; no aIIect ion
Bottomlin e
I shou ld not exist; I do not deserve to be alive ; I am
unacce ptable; I am differe nt too thers
Specific dysfunctional assump tions
II I am kindtoothe rs, then I de serve to be aliv e
Peopl e wil l on ly likemei I I am Iunny & assertive
Critical incident(s)
Wo rk b ig group, strong wo men, Iunny joke s
Are not me t Maynot beme t
Activationo f bottomlin e
Depression Predi ction s wie rd
Anxie ty
Sel I-crit ical mind blank
thinking beh aviou r
Confirmationo f bottomlin e
I`m weird andun acc eptab le
ont|nuum of treatment d|ff|cu|ty
(lennell 2004)
ke|at|ve|y easy to treat
W LLd range of Lrlggers
W Mlld/moderaLe lnLenslLy
W Mlnlmal dlsablllLy
W Lasy Lo dlsmlss
W oslLlve alLernaLlves avallable
W Speclflc acuLe problems
W noL me"
ke|at|ve|y d|ff|cu|t to treat
W Wlde range of Lrlggers
W LxLreme lnLenslLy
W LxLenslve dlsablllLy
W lfflculL/lmposslble Lo
dlsmlss
W no poslLlve alLernaLlves
avallable
W MulLlple longsLandlng
problems
W 1he way l am"

ont|nuum of treatment d|ff|cu|ty

(lennell 2004)
ke|at|ve|y easy to treat
W Cenerally well ad[usLed
W no serlous lnLerpersonal
W problems
W Able Lo collaboraLe
W C1 raLlonale accepLable able
Lo decenLre
W Can focus on speclflc evenLs
ke|at|ve|y d|ff|cu|t to treat
W oor repeLolre of adapLlve
beh
W Marked lnLerpersonal
problems
W lfflculLles collaboraLlng
W Serlous doubLs re C81
W Pard Lo focus on speclflcs
(crlsls drlven)
ont|nuum of treatment d|ff|cu|ty
(lennell 2004)
ke|at|ve|y easy to treat
6oo/s
W Challenge nA1s uAs
W 8eesLabllsh sLrengLhen
+ve sense of self
W S1 C81 620 sesslons
W SlgnlflcanL lasLlng change
ke|at|ve|y d|ff|cu|t to treat
6oo/s
W CreaLe new +ve sense of
self
W Long Lerm 1824 monLhs
W CuLcome uncerLaln parLlal
or Lemporary galns
AssessmenL of Self esLeem
W 8osenberg Self LsLeem lnvenLory (8osenberg
1963)
W 8obson Self ConcepL CuesLlonnalre (8obson
1989)
W Schema quesLlonnalre for looklng aL domalns
(?oung 1990)
W ysfuncLlonal ALLlLudes Scale
ConLlnuum of self esLeem
(lennell 1998 2004)
W ,||d se|f doubt to constant |ntense se|f hatred
need Lo assess
1) lnLenslLy
2) 8readLh and senslLlvlLy
3) Level of lnvesLmenL ln areas where crlLlcal lncldenLs
occur
4) Level of dlsablllLy/dlsLurbance ln funcLlon
may have predlcaLed whole llfe on negaLlve self
vlew leadlng Lo problems aL school work
relaLlonshlps and lelsure
AssessmenL facLors conL
3) ChronlclLy
6) AvallablllLy of an alLernaLlve self lmage
Acute disorders acLlvaLed only under cerLaln
clrcumsLances [ob ls Lo help access exlsLlng
poslLlve and reallsLlc self vlew
chronic disorder negaLlve schemas conslsLenLly
acLlvaLed no poslLlve vlew need Lo creaLe
poslLlve self vlew from ground up
AsessmenL conL
7) lnfluenclng varlables
a) averslveness of formaLlve experlences
b) conslsLency of formaLlve experlences across
slLuaLlons and Llme
c) avallablllLy of rescue facLors early or laLe
d) power and conslsLency of currenL malnLalners

lnLervenLlons Alms
1) Lo dlsrupL malnLalnlng processes by Leachlng
people Lo ldenLlfy quesLlon and LesL slLuaLlon
speclflc negaLlve auLomaLlc LhoughLs
2) Lo work on bulldlng a more balanced sense of
selfeg monlLorlng poslLlve quallLles and learnlng Lo
LreaL oneself as worLhy of respecL and care
lennell !enklns (2004)
lour hases of 1reaLmenL
(lennell 1997 2004)
% Dnderstondinq the prob/em assessmenL goal
seLLlng formulaLlon psychoeducaLlon
2% ,ointenonce cyc/es learnlng Lo reevaluaLe
LhoughLs/bellefs Lhrough cognlLlve Lechnlques
behavloural experlmenLs
l% eevo/uotinq ru/es for /ivinq developlng more
adapLlve alLernaLlves
4% eevo/uotinq the "bottom /ine" formulaLlng a
more adapLlve alLernaLlve combaLlng self
crlLlclsm developlng self accepLance plannlng
for Lhe fuLure
hase Cne
undersLandlng Lhe problem
W AssessmenL
W LsLabllsh presenLlng problems
W Clarlfy goals for LreaLmenL
W ldenLlfy boLLom llne
W ldenLlfy malnLalnlng cycles
W Conslder severlLy S1 or L1 work
hase Cne
undersLandlng Lhe problem
W lormulaLlon and sychoeducaLlon
W evelop a shared undersLandlng
W Conslder how much of formulaLlon Lo share
W Lncourage a meLaperspecLlve (lennell 2004)
Lxerclse
W 1hlnk of a case Lo work on LhroughouL Lhe
lecLure
W use Lhe formulaLlon dlagram Lo concepLuallse
Lhem 3 mlns
W ln palrs 3 mlns ea
oes Lhls developmenLal sequence make sense
Are Lhere any gaps dlscrepancles?
oes ls explaln any dlfflculLles ln Lhe Lherapy?
Where on Lhe specLrum do Lhey fall?
hase 1wo
8reaklng MalnLenance Cycles
) Anx|ous red|ct|ons
l) 8ecomlng aware of predlcLlons and safeLy
behavlours 18
10
Anxio usP redi ction s and Precau tion s Record Sh eet
Da te/Time Situation
Wha t we re
you doing
when you
began to Ieel
anx ious?
Emotions
and body
sensations
(e.g . anxiou s,
pan icky ,
tense)
Rate 0-100
Ior intens ity
Anxious
Pre dict ions
Wha t exac tly was
going throughyou r
mindwh en you
began to Ieel
anx ious?
Rate 0-100 Ior
deg ree oI be lieI
Preca utions
Wha t didyou do to
stop your
predictions coming
true? (e.g. avo id the
situa tion; saIety
seekingbeh aviour s)
hase 1wo
8reaklng MalnLenance Cycles
) Anx|ous red|ct|ons
ll) Check ouL predlcLlons blases flnd
alLernaLlves 18 socraLlc quesLlonlng
lll) 1esL new perspecLlves
approach slLuaLlons
drop safeLy behavlours
hase 1wo
8reaklng MalnLenance Cycles
2) ombat|ng e|f r|t|c|sm
W Self crlLlcal Lhlnklng follows Lhe sense LhaL ve
bellefs abouL Lhe self have been conflrmed
W 1rlggers feellngs of shame gullL depresslon
hase 1wo
8reaklng MalnLenance Cycles
2) ombat|ng e|f r|t|c|sm
l) CosL beneflL analysls of self crlLlclsm
W 8eneflLs
CulLural bellefs
8oad Lo self lmprovemenL
W CosLs
lscouraglng
8locks learnlng/Lhlnklng/problem solvlng
hase 1wo
8reaklng MalnLenance Cycles
2) ombat|ng e|f cr|t|c|sm
ll) 8alslng awareness of self crlLlcal LhoughLs
(18)
lll) CuesLlonlng self crlLlcal LhoughLs (18
SocraLlc quesLlonlng)
lv) 8ehavloural experlmenLs Lo LesL ouL
alLernaLlves
hase 1hree 8eevaluaLlng rules
W WhaL rules for llvlng / condlLlonal assumpLlons have
developed as a way of coplng wlLh Lhe 8L?
W Conslder Lhe orlglns of Lhe rule ln whaL ways dld lL
make sense f?
W WhaL has been Lhe lmpacL of followlng Lhls rule?
Conslder beneflLs cosLs / dlsadvanLages
Conslder ways lL ls unreasonable / unrepresenLaLlve of how
Lhe world works
W ldenLlfy a new more flexlble rule (advanLages of Lhe
old buL fewer dlsadvanLages)
W WhaL needs Lo be done Lo llve accordlng Lo Lhe new
rule?
W W8l1L l1 CWn! (llashcards lennell 1999)
11
hase 1hree 8eevaluaLlng rules
llashcard
W My old rule ls
W l know Lhe rule ls ln operaLlon because
W lL ls undersLandable LhaL l have Lhls rule
because
W 1he advanLages of havlng Lhls rule are
W Powever Lhe dlsadvanLages of Lhls rule are
W A more reallsLlc and helpful rule would be
W ln order Lo LesL ouL Lhls new rule l need Lo
hase 1hree 8eevaluaLlng 8ules
CollaboraLlve ldenLlflcaLlon of rules and how Lhey
developed
Conslderlng +/ use of conLlnua
ldenLlfy more reallsLlc and helpful sLandards and
rules and LesL Lhem ouL ln pracLlce
use of behavloural experlmenLs Lo challenge
negaLlve assumpLlons and Lo bulld an evldence
base ln favour of new (more helpful / balanced)
assumpLlons
Llnklng LargeLed cognlLlve / behavloural change
expllcLly back Lo wlder rules / assumpLlons and
bellefs
hase lour 1he 8oLLom Llne"
) Lnhanc|ng e|f Acceptance
W 1o change blas ln percepLlon and
lnLerpreLaLlon
W Lnhance everyday awareness of sLrengLhs
W 1o learn lLs okay Lo accepL self
hase lour 1he 8oLLom Llne"
) Lnhanc|ng e|f Acceptance
l) 8rlnglng poslLlve quallLles lnLo focus
make llsL of 10 quallLles
W Lach one brlng Lo mlnd Llme when showed
Lhls quallLy noLlce how Lhls affecLs mood
W 8e alerL Lo self crlLlcal LhoughLs and blases
CuesLlons Lo help you ldenLlfy your Cood olnLs
(lennell 1998)
W WhaL do you llke abouL yourself however small and fleeLlng?
W WhaL poslLlve quallLles do you possess?
W WhaL have you achleved ln your llfe however small?
W WhaL challenges have you faced?
W WhaL glfLs or LalenLs do you have however modesL?
W WhaL skllls have you acqulred?
W WhaL do oLher people llke or value ln you?
W WhaL quallLles and acLlons LhaL you value ln oLhers do you share?
W WhaL small poslLlves are you dlscounLlng?
hase lour 1he 8oLLom Llne"
) Lnhanc|ng e|f Acceptance
ll) use llsL everyday Lo learn Lo noLlce and accepL poslLlves
rouLlnely
W 8uy poslLlves noLebook
W Lveryday wrlLe down 3 Lhlngs dld LhaL demonsLraLed your
poslLlve quallLles
W Lg spenL several hours worklng on pro[ecL (hardworklng)
W Called frlend ln need (klnd LhoughLful)
W Lnd of day revlew llsL brlng back memory of lL
W 8ulld up Lo 4 Lhen 3 eLc
W 8evlew end of each week
12
Lxerclse 3 mlns
W WrlLe down 10 poslLlve quallLles use prompL
quesLlons lf needed
W 8rlng Lo mlnd memory of a few of Lhese ln
acLlon
W WrlLe down Lhree examples of when you puL
Lhese quallLles lnLo acLlon yesLerday
Lxerclse 10 mlns
ln groups
W WhaL dld you flnd helpful abouL dolng Lhls?
W WhaL dlfflculLles dld you have ln ldenLlfylng and
monlLorlng poslLlves?
W 1ry Lo ldenLlfy bellefs/values LhaL goL ln way
W Pow mlghL Lhese relaLe Lo cllenLs wlLh low SL?
W Pow could you help a cllenL overcome Lhese
barrlers?
hase lour 1he 8oLLom Llne"
) Lnhanc|ng e|f Acceptance
W Allowlng oneself pleasure and glvlng credlL for
day Lo day achlevemenLs
W LlfLlng mood reduces self crlLlclsm
lll) ally AcLlvlLy lary
Pow spend Llme
Pow saLlsfylng dally acLlvlLles are
hase lour 1he 8oLLom Llne"
WhaL you dld
8aLlngs of leasure and masLery
8evlew of day
W WhaL do you noLlce whaL worked whaL dldn'L work
whaL would you llke Lo change hlgh spoLs low spoLs?
W Are self crlLlcal LhoughLs geLLlng ln way?
hase lour 1he 8oLLom Llne"
W lnLroduclng changes
W CeL balance of p and m
W lan ahead
W 8evlew your plan
W roblems whaL do oLhers do whaL done ln
pasL look aL whole range blg and small
eveloplng and sLrengLhenlng poslLlve
sense of self
W Llfe revlew (successes)
W 8ulld on preexlsLlng skllls asseLs
W CreaLe successes
W 1each selfpralse selfreward developlng reallsLlc
sLandards
W Learn Lo noLlce accepL and seek +ve feedback from
oLhers
W racLlce encouraglng selfLalk lmages
W lsLance self from Lhe crlLlcal volce
13
hase lour
1he 8oLLom Llne
W evelop MeLaperspecLlve
re[udlce model (adesky 1991)
lnLernal bully (Mckay lannlng)
W LsLabllshlng a new boLLom llne
Mooney adesky 2000)
W 8reak down absoluLes
ConLlnuumwork ple charLs (adedsky 1994)
W 8elnLerpreLlng early experlences
PlsLorlcal LesL
8eframlng chlldhoodmemorles lmagery
Lxerclse 10 mlns
W WhaL lnLervenLlons mlghL be helpful Lo use wlLh Lhe
cllenL you broughL Loday
W evlse a LreaLmenL plan of lnLervenLlons Lo Lry ouL
W WhaL mlghL be some of Lhe barrlers?
W WhaL mlghL help wlLh some of Lhese barrlers?
W WrlLe an acLlon plan of whaL you need Lo do Lo make
Lhls happen
Lxerclse
ln palrs 10 mlns
W WhaL do you conslder Lo be Lhe sLrengLhs and
llmlLaLlons of Lhls model?
LlmlLaLlons of C1 model
W 1hese lnLervenLlons work well wlLh some
people however for oLhers lL does noL help
W l undersLand wlLh my head buL l don'L feel lL
wlLh my hearL"
W Lack of self
W 8eslsLance Lo change
8rewln (2006)
W Self represenLaLlons comprlsed of represenLaLlons of
memory from pasL (Conway 04)
W 8uL also selves are also based on wlshes or
asplraLlons (posslble selves Markus nurlus 1986)
W Carver eL al (1999) suggesLs boLh anxleLy and
depresslon are sLrongly relaLed Lo feellng Loo close Lo
a feared or undeslred self and sLrlvlng Lo avold
experlenclng lL
W Also key Lo CC (lerrler and 8rewln 2003)
AlLernaLlve vlew of self esLeem
W aul CllberL lnLrapersonal model self
crlLlclsm as example of selfLoself relaLlng
14
Soclal MenLallLles Soclal MenLallLles
(CllberL 1989 2000) (CllberL 1989 2000)
e|fre|evant |nformat|on processed through systems
(soc|a| menta||t|es) or|g|na||y evo|ved for soc|a|
re|at|ng
e|ffocused th|nk|ng and fee||ngs are forms of
|nterna| se|ftose|f re|at|ng
Ab|||ty to exper|ence and e|aborate |mag|nat|ve
|nterna| wor|d that affects our phys|o|ogy
Interna| ko|es Interna| ko|es
1wo key types of |nterna| se|f to se|f re|at|onsh|p
nost||e dom|nant se|f fearfu| subord|nated se|f
ar|ng empath|c se|f cared for soothed se|f
,ed|ated through and ref|ected |n offect behoviour and se/f
to/k
{Pou/ 6i/bert 2005%
Interna| ko|es Interna| ko|es
1wo key types of |nterna| se|f to se|f re|at|onsh|p
nost||e dom|nant se|f fearfu| subord|nated se|f
ar|ng empath|c se|f cared for soothed se|f
,ed|ated through and ref|ected |n offect behoviour and se/f
to/k
{Pou/ 6i/bert 2005%
1ypes of AffecL SysLems 1ypes of AffecL SysLems
(aul CllberL 2003) (aul CllberL 2003)

Incentive/resource
focused
Seeking and behaviour
activating
Dopamine (?)
Affiliative focused
Soothing/safeness
Opiates (?)
Threat-focused
safety seeking
Activating/inhibiting
Serotonin (?)
1wo 1ypes of self aLLack proposed
) se|f|mprov|ng]correct|ng se|fattack|ng
W Lo make self Lry harder and sLop mlsLakes
oLherwlse Lhey wlll fall and be re[ecLed
2) se|fpersecut|ng se|fattack|ng
W ConLempLuous and selfhaLlng selfaLLacklng
recrulLs dlfferenL emoLlons Lo Lhose of self
lmprovlng more complex Lo work wlLh
Compasslon versus selfesLeem
W SelfesLeem bellefs abouL ablllLles Lo achleve goals
W oes noL address accepLance for fallures self
sooLhlng
W SelfesLeem seeklng does noL necessarlly lead Lo
poslLlve affecL (Crocker ark 2004)
W Self esLeem and compasslon lnvolve dlfferenL
neurologlcal paLhways
15
8eslsLance Lo Change
WhaL Lypes of reasons may Lhere be
for reslsLance Lo change?
8eslsLance Lo change
etter safe than sorry dom|nates |n humans
espec|a||y re soc|a| re[ect|on
W ALLack Lhe self flrsL before oLhers do
W Low selfesLeem people anxlous abouL self
lmprovemenL makes Lhem more vulnerable Lo oLher
people's aLLacks
W MlghL noL be able Lo susLaln lmprovemenL ln Lhe
fuLure expecLaLlons from self and oLhers lncrease
W Safer Lo dlsmlss poslLlves and remlnd oneself LhaL
one ls lnferlor Lry Lo noL Lake rlsks
8eslsLance conL
W used Lo ellclL sympaLhy reassurance
W lf glve up self aLLacklng fear wlll lose a self
regulaLlng process how Lo acL or be"
becomes much more uncerLaln fear loss of a
sense of selfldenLlLy
8eslsLance conL
kebe|||on and d|s|oya|ty
W lear LhaL lf Lhey sLand up agalnsL a powerful
oLher knowlng Lhere may well be a counLer
aLLack and re[ecLlon lmmensely LhreaLenlng
W Lo acL dlfferenLly means Lo dlsobey eg Lold
sex was dlrLy Lo have sex wlLh husband
dlsobeylng
8eslsLance Lo change conL
W need Lo punlsh self
W lf you relax and leL your guard down Lhen bad
Lhlngs wlll happen
W Crlef for losses and hopes and aloneness
W WarmLh has become condlLloned wlLh fear
from abuse experlences
Summary of reslsLance and funcLlons
W 8een so used Lo experlenclng Lhemselves ln Lhese
Lypes of relaLlonshlp wlLh self and oLhers LhaL Lhey
can worry abouL whaL Lhey wlll feel or who Lhey may
become wlLhouL Lhem lL ls a challenge Lo self
ldenLlLy
W Many of Lhe processes LhaL we see as paLhologlcal
are acLually efforLs aL selfproLecLlon
W 8epalrlng mood ls efforLful and requlres moLlvaLlon
(Pelmpel eL al 2002)
1
Concluslons
W Self esLeem ls a complex consLrucL
W need for Lhorough assessmenL and lndlvldual
concepLuallsaLlon