Friday, 24 Jun 2016
Psychodynamic Psychotherapy for Low Self-Esteem
By Private Therapy Clinic
By Paul Christopher Mollitt
From a psychodynamic perspective, the genesis of a person’s self-esteem is usually rooted in childhood experience. Several factors may contribute, from obvious criticisms or abuse from parents and bullying at school, to more subtle factors such as missing out on experiences that would build a sense of confidence in a growing child or inconsistent or no positive reinforcement for his accomplishments.
The adult with a fragile self-esteem, when confronted with challenges that we all face such as the breakup of a relationship, financial troubles or losing a job, will be seriously impacted by these events, falling back on familiar feelings of low self-worth and thoughts of, ‘this is your fault’, ‘you are not good enough’ or ‘you didn’t deserve to be happy.’ A person with a healthy self-esteem will also suffer in these moments, but they will usually recover pretty quickly. The person with low self-esteem however may become depressed and ‘stuck’, losing motivation and hope.
Psychodynamic therapy can help in similar ways to other approaches such as CBT in enabling the client to become more confident and assertive, positively reinforcing successes and, importantly, helping the client to find a sense of compassion for themselves that they will usually have for others but rarely feel for themselves.
Psychodynamic therapy aims to go beyond these very useful (but more practical) techniques by creating a close relationship between the therapist and client that seeks to understand and then rework possible deficits that the client had experienced in earlier relationships. The therapy encourages a dependency on the therapist and seeks to provide a relationship that is containing and trusting, whilst challenging and honest. This is why psychodynamic therapies tend to be longer-term, so that there is time to foster this deep connection and work through changes at this level.
Attachment theory is often an important aspect of psychodynamic work, particularly in regards to low self-esteem. Depending on a person’s childhood the adult client may be more anxious or more avoidant when it comes to relationships. Recognising a client’s particular attachment style in the work in important.
Someone with an avoidant attachment was often left to their own devices as a child. To deal with this they would cut off from their feelings, denying their need for anyone. As adults they prefer to go it alone, mistrustful of intimate relationships. Their low self-esteem makes them fearful of rejection and they find it hard to trust others. The impact of the therapeutic relationship in the room often creates a sense of dependency which, while leaving them feeling vulnerable, can then be explored. Ultimately, the idea is that this dependence on the therapist would allow them to rely on others in the real world and subsequently forge better relationships without fearing the worst.
The anxiously attached person, who usually had care as a child that was inconsistent, often needs help disentangling themselves from their close relationships. Their low self-esteem often causes them to cling to partners, fearing that they will be abandoned, constantly seeking reassurance which can push even the most patient partner away in time. The therapist’s job here, using the client’s external relationships past and present (and importantly, the relationship between therapist and client) is to help the client to recognise recurring, unhelpful patterns in their relationships and guide them through alternative ways of relating.
Much like a child, who will return to a mother or father when scared or hurt for comfort and reassurance, an anxiously-attached person with low self-esteem will find this comfort in a therapist that will be attuned to their needs where others might not have the capacity or desire to play that role.
Several therapeutic approaches can be useful in the treatment of low self-esteem, but the hallmark of the psychodynamic approach is the close relationship that develops between the therapist and client creating that secure base in an often frightening world from which the client can grow.
Psychodynamic therapy can be offered as a long term or short term treatment depending on the persons treatment goals and what would be beneficial for them. The short term version of Psychodynamic therapy is called Dynamic Interpersonal Therapy (DIT), you can read more about this approach here. You can read more about Psychodynamic therapy in general here.