by Christine Wells, Dip.HumCounselling.MBACP(Accred)UKRCP.
www.directionscounselling.co.uk
Email: christinewells@directionscounselling.co.uk
What is self-esteem? A good opinion of oneself . (Oxford Dictionary, 1990). In my experience as a counsellor in private practice, the type of clients that I see, have varying degrees of self-esteem. Some clients have never had a good opinion of themselves throughout their childhood into adulthood, whilst others may have felt okay within themselves for periods of time and then developed low self-esteem through life changes, situations beyond their control or stressful situations, to name but a few.
Self-esteem can be reflective of how a person feels overall, their values, judgements and self confidence.
Childhood Development of Self-Esteem
A philosophical belief central to TA is the notion that people are born OK. (Lapworth, Sills, Fish, 2000). As a baby enters the world, they are wholly dependent for their survival on parents/caregivers through infancy and childhood. Each child will grow up to become an adult and experience their own unique life journey where they will encounter many, many situations, experiences and messages both overt and covert from parents, caregivers, teachers, siblings and anyone else whom they may come into contact with. These experiences in the child’s life can be both positive and negative. It takes many years for a human brain to fully develop and whilst it is developing, children can make sense of their world and make decisions that they can live out during their adult lives which can be heavily influenced by their primary caregivers. Eric Berne the founder of TA is quoted for saying “People are born princes and princesses, until their parents turn them into frogs” (Steiner, 1990). These conscious or unconscious life decisions can be helpful or unhelpful to an individual. These life decisions in TA theory are called Script Decisions. Script theory is based on the belief that people make conscious life plans in childhood or early adolescence which influence and make predictable the rest of their lives. (Steiner, 1990).
Central to TA is the concept that we each have three Ego States being the Parent, the Adult and the Child. The Parent Ego-State is made up from behaviours, thoughts and feelings copied from parents or parent figures, the Adult Ego-State from behaviours thoughts and feelings which are direct responses to the here and now, and the Child Ego-State from behaviours, thoughts and feelings replayed from childhood. (Stewart & Joines, 1999). As shown in Appendix 1, which is attached.
The Ego-State Model
(Eric Berne)
First-order Structural Diagram
(I Stewart & V Joines), TA Today, 1999, Lifespace Publishing, Nottingham
Parent Ego-state:
Behaviours, thoughts and feelings
Copied from parents or
Parent figures.
Adult Ego-state:
Behaviours, thoughts and feelings
Which are direct responses
To the here-and-now.
Child Ego-state:
Behaviours, thoughts and feelings
Replayed from childhood.
We can all become aware at different times in our lives when we may feel as if we “sound like our parents”, (a person is operating from their Parent Ego State), or “experience the same anxiety as we did when we were a child”, although now an adult who is about to give a presentation or go for a job interview, (a person is operating from their Child Ego-State). These are general examples.
Throughout our lives we operate in any one of these Ego-States through our thinking, feeling and behaviour either on an internal basis of how we operate within ourselves, or externally being how we see the world and act within the world. There are more in-depth Second Order Structural Models in TA which look at Parent, Adult and Child messages but for the purpose of this assignment, I do not think it necessary to highlight.
From a person’s self-esteem point of view, their childhood can form the bedrock of whether that individual has a good opinion of themselves, or a deep-rooted negative opinion of themselves. Low self-esteem originating from childhood, is usually carried on into adulthood largely out of a person’s conscious awareness. But replayed out in their lives where they fundamentally can feel that they are “a failure”, “worthless”, “unlovable” or “a bad person”, etc. Counselling can be useful in helping a client to identify and work with any negative beliefs they may have about themselves and developing a stronger Adult Ego-State where a client can live in the here and now and challenge their own negative automatic thought processes and beliefs.
Whilst the child is growing up they will receive messages from their caregivers/parents giving them both permissions and injunctions about their abilities and self worth. An example of this is my own experience as a child when I must have been no more than 6 or 7 years old, experiencing a very high level of anxiety at school. I can recall it well to date even though I am now in my mid 30’s. I was shouted at by a young female maths teacher in front of my class because I did not get my adding up correct. I was further punished by being made to stay in class during playtime until I had finished the sums on my own. I could not finish them as I was too upset and traumatised by what had just happened. I can recall another child coming back to help me and she told me the answers. When I think back now, I can feel those old emotions rising, that sick feeling in the pit of my stomach, together with anger now as I would dearly love to speak to this teacher about my experience of her. Needless to say, maths to this day is not a favourite subject of mine. Looking back, if I had been given care and support and not criticism, then I believe I would feel a lot more confident about my abilities in mathematics. This is an example of how I through my own thoughts can move into my Child Ego State and experience archaic feelings from my past.
When I use TA with my clients, an important area is to help them develop their Adult Ego State creating autonomy, spontaneity, here and now awareness and freedom from any negative life script. Bringing their thinking, feeling and behaviour into the here and now and developing their overall awareness of their Parent, Adult and Child Ego-States.
There are many aspects to Transactional Analysis theory. For the purpose of writing this assignment, I do not believe it is necessary to go into them.
Low-Self Esteem and Concise Theoretical Approaches
TA can be effective in helping to treat a client with low self-esteem. It aims to highlight a client’s script beliefs, look at injunctions and drivers that a client uses in order to live their life and to bring these into Adult awareness. There is an emphasis on positive change during counselling by encouraging and helping a client to self regulate any negative views they have of themselves and their world, to generate positive beliefs and help the client to test positive beliefs out. In my view a core aspect of the counselling process would be “the development of the counselling relationship with the client”. By using the Humanistic approach of Carl Rogers’ three core conditions of congruence, unconditional positive regard, and empathy, these conditions can help to create an environment for a client that is safe enough for them to explore personal issues and difficulties and to help them to gain a better understanding of themselves and make life changes.
In Cognitive Behavioural Therapy when treating low self-esteem there are a set of principles. Opinions and Beliefs are not facts; To change how you feel, change how you think; Just “understanding” or “having insight” is often not enough for change; Action is necessary; Making changes requires certain attitudes; Certain behavioural strategies help in promoting change; The focus of cognitive therapy is on current thoughts, emotions and behaviours. (J Bennett-Levy, 2004).
In terms of my own experience and practice when working with clients who have low self-esteem I favour the CBT model over the TA theory. Whilst TA theory can create many new insights for a client and help them to work towards making changes, I believe this can fall short of being as effective as CBT. CBT as quoted above, emphasises the need for action, which when a person makes action changes, they are then presented with their own evidence of how they can think, feel and behave differently through genuine experiences and or experimental tasks. When a client is working in this “action area” and coming out of any “avoidance behaviours”, or their “comfort zone” I believe it is hugely important to have developed a safe, non-judgemental and supportive therapeutic working environment which in turn will give the client emotional support when making any changes.
CBT can help to elicit the “bottom line” of a client’s Schema (in CBT terms) or their Life Script (in TA terms), for example “I’m a failure”, when treating low-self esteem, by focusing on how a client perceives and interprets themselves within the world. I would when working with a client, be on the look out for any avoidance or safety behaviours they may have developed in order to avoid any anxious predictions from coming true. Using the above example as a client’s hypotheses, to explore with the client their current evidence which may hold this belief and bringing into a client’s awareness their own safety behaviours and avoidance they may have. With the example of “I’m a failure”, to ask a client “If they did not have this assumption, what would they be doing? What does this assumption hold them back from in their lives?” Following on from this, setting up agreed behavioural experiments with a client, which would be monitored to test out anxious predictions from coming true. To then help a client make firm a new rule by gathering evidence to support new positive beliefs through behavioural tasks, filling in automatic thought records, helping a client to identify their good points, helping the client to work towards self acceptance and learning to like themselves and see that they can have self-worth and can grow as human beings and develop new core beliefs, to mention but a few examples.
With regard to stress management training and developing self-esteem I think it is highly effective. Clients can come into stress management training having no outward self-esteem problems or low self-esteem. I believe when working through the 8 sessions with a client, any difficulties with self-esteem can be picked up by the counsellor/trainer.
From Session 1, by using S1.b1 (Coopers Life Stress Inventory), and S1.c (Stress Assessment Questionnaire), this will help the counsellor/trainer to get a good idea of the client’s overall problems, bringing out areas that are highly stressful for a client. Straight away, from session 1 the client will learn about their Fight or Flight response and take away the Passive Progressive Muscular Relaxation exercise to practice and monitor by using their Daily Relaxation Log. This gives a client right from the start some control and responsibility with their treatment.
Session Two is designed to elicit more information for the counsellor/trainer by using Form S2a (Subjective Level of Stress), Form S2b Subjective Measure of Change. These highlight problem areas and help the client to start to think about what would be a first step in them making a subjective change. This is helpful in that it builds an environment where the client and counsellor/trainer are working together equally. Form S2c (Coping with Stress) brings into a client’s awareness things they find useful in taking their mind off their problems. This is very helpful in determining how a client has been able to “self help” themselves or how severe their problem is if they are unable to find anything to take their mind off their problems.
Because each session provides a relaxation tape, an opportunity for self-monitoring and further thought provoking material, it means that a client will be active in between sessions and therefore take some responsibility and control over their own progress.
In Session Three by using S3a (Stress and Personality Type), this not only monitors a client’s level of stress but also brings out a lot of other potential areas to work with, with a client which they may be unaware of, that can cause high stress and self-esteem problems.
Self esteem can be situational in that people may have confidence in some things, but no confidence in others. By helping clients to identify their stress provoking thoughts which is the topic in Session 4, through Forms S4b, (Stress Thought Log and Example), together with S4c (How To Stop Thinking Negative Thoughts), these help to bring out how the client perceives and interprets themselves in the world, and can create healthier alternative ways of thinking and challenging those negative thoughts. This in Transactional Analysis theory is very much the same as helping a client to identify Parent or Child Ego State thinking with an emphasis on creating Adult awareness.
Form S4a (Depression Questionnaire (By A Beck)), not only assesses a client’s state of mind, but can be helpful in signalling low self-esteem. 3.b I feel I have failed more than the average person, 7.b I am disappointed in myself 8.b I am critical of myself for my weaknesses or mistakes (Depression Questionnaire By A Beck).
Session Four also contains the work on Problem Solving. This is very helpful with treating low-self esteem. By teaching a client problem solving skills in a supportive environment, can enable the client to learn to tackle stressful situations as well as helping to bring down their levels of stress and their maintenance of low self-esteem. By brainstorming with a client and working through forms PS.b to PS.g will help to encourage the client to develop their thinking and possible solutions to a way out of a negative situation. This in turn can result in a client feeling they are working towards positive change.
Goal setting and time management are very helpful ways of treating stress management and self esteem issues, which are used in Session 5. By enabling clients to better manage their time and working to achieve positive goals in a structured way.
Cognitive therapy aims to challenge the thoughts which in turn affect the behaviour and the emotional outcome in many situations. (The Stress Consultancy, 2001). In Session 6 of Stress Management Training, a client will learn how to challenge negative thinking patterns by looking at their own subjective responses. Negative thinking is a huge contributory factor to low self-esteem. (The Stress Consultancy, 2001). Challenging negative thinking is very useful in helping to bring down levels of stress and also from a self-esteem point of view. By clients working with Forms S6a (Negative/Positive Mood Logs) these will help to create change in automatic negative thinking by focusing on positive beliefs, feelings and behaviour. Therefore creating “an alternative”, which helps clients out of any locked thinking patterns.
By working through Forms SE.a to SE.m with a client, can really challenge a client’s negative core beliefs or low self-esteem issues that are not so entrenched. It may be further helpful to follow on from this with action experiments and exercises to help clients who have adopted avoidance or safety behaviours. Although this is not within the Stress Management Training work, if it was, I think it would be quite useful.
Session 7 focuses on Positive Thinking, and offers techniques to bring a client’s awareness into the “here and now”. It helps a client to learn the skills of applying “brakes” to their automatic negative thought patterns. This is highly useful not only in stress management, but also from a low self-esteem point of view, when negative thoughts are in operation.
In my experience of working with people with low self-esteem, they often lack assertiveness. I have quite often found that people identify assertiveness with aggression, selfishness or rudeness. The work in Session 8 is very useful in my opinion not only to stress management, but towards helping a person with self esteem issues to learn to believe that it is okay for them to “have a voice in the world and have needs”.
In conclusion I believe I have just touched the tip of the iceberg in discussing self-esteem and theoretical treatments.
My own opinion is that low self-esteem comes under “Stress” as a subject and its related disorders. When a person experiences high levels of stress and feels an inability to cope, their self-esteem can become affected, which can result in negative thought, feelings and behavioural patterns.
A helpful way forward for clients who have situational low self-esteem problems or deep rooted low self-esteem issues is I believe CBT. TA does provide a very useful theory base for finding the root cause of low self-esteem and helping to strengthen a client’s Adult Ego State creating awareness and here and now thinking. My own training background as a counsellor is Transactional Analysis, Humanistic and Cognitive Behavioural. Personally I favour the TA route if the client needs to have their deep rooted core belief issues explored in a humanistic environment, moving on to CBT treatment or alternatively, if a client’s problems are situational in respect of low self-esteem, to use Humanistic and CBT techniques, addressing thoughts, feelings, behaviour, building on their pre-existing skills and assets, working with symptoms using behavioural methods to create positive changes.
I believe Stress Management Training is a well thought through CBT based treatment plan, which helps to create change with clients in an environment where they are able to participate in their own recovery programme.
Christine Wells
Dip.Hum.Counselling.MBACP
Ó Christine Wells 2005. All Rights Reserved.
Bibliography
R. E. Allen, The Concise Oxford Dictionary, 1990, Oxford University Press Inc., New York
P Lapworth, C Sills, S Fish, Transactional Analysis Counselling, 2000, Winslow Press Ltd, Oxon
C Steiner, Scripts People Live, 1990, Grove Press, New York
C Steiner, Scripts People Live, 1990, Grove Press, New York
I Stewart & V Joines, TA Today, 1999, Lifespace Publishing, Nottingham
J Bennett-Levy, Overcoming Low Self-Esteem Presentation Notes, 2004, EPB Ltd, Herts
A Beck, Depression Questionnaire, Reprinted by The Stress Consultancy, Session Four, 2001, Pinders Ltd, Sheffield
The Stress Consultancy, 2001, Session Four, Pinders Ltd, Sheffield
The Stress Consultancy, 2001, Session Six, Pinders Ltd, Sheffield