Your experiences: A Cognitive Behavioural Therapy (CBT) solution for self esteem problems

by Sarah Graham
Tuesday 12 May 2015
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Self esteem refers to your opinion of yourself, and most people's self esteem varies from day-to-day, depending on mood and circumstances. Self esteem problems occur, however, when you have a consistently low opinion of yourself. You may feel a sense of shame and frustration, and become very self critical or afraid of letting others down. Low self esteem may even lead to more serious mental health issues such as depression and anxiety.

The client's situation

Phil is 59 years old and has struggled with low self esteem for around 45 years, since he was a teenager. He has seen a number of different therapists since 1996, but first tried Cognitive Behavioural Therapy (CBT) when he found Registered Clinical Psychologist Charlotte Curran through RSCPP in 2013.

"I've been prone to depression in varying degrees so I went to see Charlotte primarily on that basis," he says. "We then switched the emphasis more to issues of self esteem, as I think that's the way she saw it. I had quite general low self esteem, but the main issues were specifically to do with relationships and long-standing health issues."

He adds, "I'm HIV+, which I'm fairly open about, and I am heterosexual, which is relatively unusual. The problem is that in every case where I've met a woman, once that's been discussed, then everything finishes quite quickly because they're not able to handle it, which is understandable, but when it happens time after time after time you do think 'well, I can't do anything about it'."

I felt I had nothing to offer anybody, and I felt a lot of loneliness.

After so many years, Phil describes feeling an accumulated sense of rejection and loneliness. "I felt that I had nothing to offer anybody, which was compounded by the HIV, and I felt a lot of loneliness. I spent years and years and years with no physical contact from anyone," he says.

Phil also felt his self esteem issues were rooted in emotional abuse from his childhood, which he'd previously explored with other therapists but struggled to move forward from. In fact, his unsuccessful experiences of psychotherapy were part of the reason he decided to try CBT instead, which he sought after coming out of a particularly toxic relationship with a woman he met through an HIV dating website.

"She was a bit of an amateur psychologist and so on some levels it was a very good time for about six months, but she actually set me back enormously by using her self-studied psychology on me, and that really upset me because I should have responded more confidently to her challenges," he explains.

 

The therapist

Registered Clinical Psychologist Charlotte Curran is registered by the Health and Care Professions Council (HCPC) and chartered by the British Psychological Society (BPS). She is also a Cognitive Behavioural Therapy (CBT) psychotherapist, accredited by the British Association for Behavioural and Cognitive Psychotherapies (BABCP).

Charlotte worked with Phil for 12 weekly sessions, between April and July 2013. "Phil initially presented with long standing low self esteem, holding on firmly to many negative beliefs about himself such as being a loser and being vulnerable. He reported that his difficulties were having an impact on his ability to form relationships and on his mood, causing him low mood and anxiety," Charlotte explains.

"His goals for therapy were identified as wanting to be more confident, wanting to make friends, to be open to the possibility of a relationship again, to be able to assert his needs with others, to feel less anxious, and to be able to think about a new direction in his life going forward."

 

The treatment

For Phil, CBT was initially a case of wanting to try something new. "I had been through many many sessions of psychotherapy over the years and, for me, I found it to be worthless and expensive. The reason I went to see Charlotte was because I was able to get the treatment paid for through my job, so that made it affordable. I was already aware of CBT, and I felt I needed a professional to help guide me through the process," he says. "We were using the Overcoming text books - there's an Overcoming Self Esteem book, which I bought and read, and we took it from there."

While first therapy sessions can often be daunting, Phil says: "I thought it was great actually. I felt an instant rapport with Charlotte, I felt she very quickly understood what was going on in my head. I'm a firm believer that we can talk ourselves in and out of psychiatric conditions, so my goal was to understand what techniques there were to address that."

Every human wants to understand why they think the way they do.

Having arrived with almost 20 years of experience in therapy, Phil was quite clear about what he was looking to gain from CBT. "I think every human wants to understand why they think the way they do, and that's what psychotherapy is very good at. I always summarise it that we all have baggage, and psychotherapy likes to dwell on that baggage, but CBT says 'ok, you can't change the fact that the baggage is there, however what you can do is to think about strategies for bypassing those negative thoughts or turning those negative thoughts into positive or constructive ones," he says.

"Obviously a lot of these strategies are almost off the shelf, and Charlotte's job was to understand how those various tools and techniques could be used in my specific case," Phil adds. "It seemed to be a much quicker way of changing the way you think [than psychotherapy]. I suppose I'm one of those people who's into science and I could understand why it would work, so I felt this was a far more practical, pragmatic approach that I could intellectually understand."

CBT was a practical, pragmatic approach that I could intellectually understand.

Having started his career as a computer programmer, Phil explains that, "if you look at some of the diagrams you see in these books, it's almost like the processes involved in programming - you have a negative thought, which makes you feel worse about yourself, which gives you more negative thoughts, and so you get into these spirals. It was obvious that if you could stop those things happening, then you had a good chance of changing things," he adds.

 

Overcoming challenges

The biggest challenge during Phil and Charlotte's earlier sessions was helping Phil adapt to the CBT mindset. "Phil had had therapy in the past that he did not find helpful so an obstacle was to build up a trusting relationship and to get him on board with CBT and what it could offer him," Charlotte explains.

That said, Phil says he felt immediately at ease with Charlotte and her approach. "I think it's always difficult to try and move away from this idea of having to really understand how it was that things manifested themselves - I think there's a human tendency to do that," he says. "So I remember talking about it a lot, and Charlotte kept on taking me back and challenging me, so I got into the swing of [CBT] pretty quickly."

 

Breakthrough moments

Although Phil says he began to notice CBT making a difference "almost immediately", he says a major breakthrough in his treatment was, "understanding what emotional abuse was, and that my parents may have been partly or wholly responsible for it, but actually they had their own problems as well."

Mindfulness is about being compassionate to both yourself and other people.

He adds: "I'm very much into the mindfulness approach as well, and one of the key ideas there is that being compassionate to both yourself and other people - even those who you think have wronged you - is actually an extremely healthy thing to do. It was a combination of that sort of mindfulness and CBT that helped me understand the emotional abuse and that actually things in my life aren't my fault but there can be strategies to deal with them."

Phil has also seen a huge breakthrough in his confidence levels since completing CBT in July 2013. "My confidence levels have improved a lot. I was always wanting to be a people-pleaser - and again, I can understand why I was like that, with abusive parents. Now I still try to be nice to people and help people, but I don't do it just because I think I should do it, or because they'd like me more if I did," he explains. "That's the key - it's about being yourself more, and standing up for who you and are what your needs are. What my needs are."

 

Outcomes and the future

Phil says that not only have his closest friends noticed a difference in him since the CBT, he also feels far more confident about meeting new people and going on dates. Prior to starting therapy with Charlotte, Phil says, "I was feeling increasingly isolated and lonely, and I wanted a relationship. I've never had a relationship of any meaning in my entire life; I've had lots and lots of flings and things like that but I wanted, as I'm getting older, somebody to be a soulmate - somebody I could travel with, or go to the pictures with, that kind of thing."

He adds, "I have plenty of friends, but they tend to be pub friends, and there's life outside of pubs. I think part of the way to find such a soulmate is to be more confident, and to be assertive when you need to be assertive." So has CBT improved Phil's confidence with women? "Yeah, it has actually - in fact, I've got a date tonight as it happens!" he says. 

Part of the way to find a soulmate is to be more confident and assertive.

Charlotte too was really pleased with Phil's progress over the course of their work together. "Phil made fantastic gains during therapy and met his goals of starting to think about himself in a new, more positive way. He started to socialise more and was more confident to state his opinions," she says. "It was visible in the sessions that Phil was more confident in himself. He sat up taller, spoke about what he wanted to, and made decisions about the most helpful ways forward."

In their final session, almost two years ago, Charlotte produced a "blueprint for the future sheet, which summarised for Phil what he had learnt, and identified potential obstacles in the future and how to overcome them." Since then, Phil continues to revisit his CBT notes and textbooks as and when he needs to, but has also continued and developed his own self-help techniques for when he's struggling to cope.

Being able to understand what's happening in your head is power.

"One of my big things is meditation, again with the mindfulness sort of angle, which I think is a wonderful thing," he says. "I took that up before I saw Charlotte, and I continue doing that to this day. I go to the gym and try to be physically active and fit as well, because you know you're going to feel better after a damn good workout."

He also finds it much easier to catch himself thinking negative thoughts and be able to challenge them, rather than end up ruminating. "Being able to understand what's happening [in your head] is power," Phil says - an approach that he applies to both himself and his previously strained relationship with his parents. "The whole concept of being compassionate and understanding about why people are how they are is actually really empowering, because you can understand where it's all come from. You have to remind yourself that dwelling on things that happened in the past is totally futile."

The client's consent was provided prior to both interview and publication


Finding support


You can find out more about symptoms and causes of Depression and Self Esteem, including how to find a therapist. If this route is not appropriate for you, your GP can assess you and direct you towards support.

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Updated 12 May 2015