There are few mental health professionals who are capable of handling thousands of cases in their private practice while taking time to devote to a noble vocation of disclosure.

Among this small and select group of psychologists we find Karemi Rodríguez Batista , founder of Psico-K.

Interview with Karemi Rodríguez Batista: How is low self-esteem treated in consultation?

With a wide experience performing psychotherapy sessions in Madrid, and also online, Karemi is a psychologist with a very interesting and multifaceted career. We wanted to share today a talk we had with her about self-esteem as a concept, and cases of low self-esteem in consultation.

Bertrand Regader: Based on your experience working in therapy, what kind of situations are the ones that most often generate self-esteem problems?

Karemi Batista: Complex question. In a quick and general way I would say that the problems would derive from the lack of acceptance of oneself. It influences, without a doubt, if we have been raised in a highly critical and punitive environment, having little contact with our internal experiences and our needs. Some situations that trigger them are when the person goes through the loss of something valuable with which they have merged, or life crises.

The construct of “self-esteem” is generally understood as one’s assessment of oneself and one’s concept of self. Then, the question we ask ourselves is, depending on what this valuation would go up or down.

If my learning history has valued me based on my beauty, status, money, power, fame, etc.; or if my sense of worth is a function of who I am with (my partner, my colleagues, my family, etc.) or if I weigh one behavior of mine over others, obviously, when any of these attributes are gone (and this will happen sooner or later), my self-esteem will be damaged. And this is where we touch dangerous ground and it is for several reasons. The first is that they are external and changeable circumstances or attributes in which I deposit my overall worth, and in me I wouldn’t have much control, or because I merge with that concept of myself and lose sight of other aspects of me that are more lasting and really significant in my life, such as my real values.
For example, let’s say that I dislike that person so much or that I fail in a task that I had hoped for, then I condemn myself and label myself globally as “stupid, useless, worthless, etc..

What was wrong with me that makes me stupid, that I am not appreciated by someone who marks my value as a person? Well, this is what happens to us, often. Nor is it a question of rating us positively overall on the basis of achievements, because as long as I don’t get them, I go back to self-deprecation and contempt for others.

In short, in my view the most effective thing would be to move from the self-esteem construct to that of self-pity which does not depend on external circumstances. Moreover, if we do not accept and are compassionate with ourselves, we will hardly be compassionate with others and this will be to the detriment of meaningful social relationships.

Does this type of psychological discomfort usually appear in childhood, or does it generally arise at any time in life?

In any situation that triggers what I told you before, even if it’s in childhood. That’s where we learn to have private (from me) or public (from others) control of our experiences. That is to say, to know what I really feel, think and want, and to act according to it or according to others.

If as children we have been criticized, demanded and punished a lot, we will incorporate this and it will be a very strong tendency that will condition our vision of ourselves, contributing to problems related to anxiety, depression, emotional dependence, to biased thinking styles (focusing only on the negative, over generalizing, drawing hasty conclusions, etc.). ) and to ineffective behaviours in relation to a life of value, such as blocking, avoiding, procrastinating, not setting adequate limits, etc…

Other critical moments can be in adolescence, and here the social group in which we would include the social networks have a great influence. We can be moulded according to what they dictate with little or no discrimination of what I really want, and this is dangerous.

Do people with self-acceptance problems tend to see this as a treatable problem in therapy, or are they more likely to confuse it with their own identity and believe that it cannot be cured?

Very good question. You refer to a key point which is to confuse these partial aspects whether they are negative or positive with one’s own identity. There are many people who come to therapy explaining specifically in the reason for the consultation: “low self-esteem”. I have not yet met anyone who says: “lack of acceptance or compassion for me”, for example. Then it is thought that once “self-esteem rises” (again, most of us believe this is once we achieve certain goals or think positively about ourselves), our problems will disappear. This is not so.

There is a problem of expectations to work with as well, many “achievements” do not depend on us and it is difficult for many to delimit this. Here the culture of “if you want to, you can” has a lot of influence. And if we combine it with a learned tendency to demand too much of ourselves, the frustration and suffering is greater.

There are many individual factors that influence whether it is perceived as something “remediable”. Landing the construct in self-acceptance or self-pity, there are undoubtedly patients with more resistance to it, because of their own life history and current context, and this is where we must be much more careful, validating and patient as therapists. I think that if we don’t work on this aspect, the rest will most likely fail, but it’s worth it.

What kind of strategies do psychologists use to help their patients with low self-esteem?

This will depend very much on the particular characteristics of the patient and his or her context, as well as the approach with which it is approached, of course. Therefore, it is crucial that we make a good conceptualization of the case, as well as a thorough functional analysis of the problematic behaviors derived from it.

In very, very general terms, rational behavioral-emotional therapy, for example, would help the patient to foster unconditional self-acceptance regardless of positive or negative “assessment” (which is not resignation) and to redirect him/her to goals. These objectives are shared by acceptance and commitment therapy, although with a different approach, where the focus would be to work on self-compassion, strategies directed towards the defusion of these “contents” (partial self-evaluations perceived in a global way) taking perspective, the acceptance of oneself with one’s weaknesses and strengths, and from here to help people to know what they really want and need in order to address goals according to their values, and to find more effective behaviours to do so. All this, depending on the case, can be extended with powerful strategies derived from cognitive behavioural therapy (as long as they are consistent with our approach), such as training in problem solving, social skills, etc..

Once we achieve this, we help you to be more aware or attentive in discriminating what was effective, when, where, how, etc, thus generating a feeling of self-efficacy if you will, more under your own internal control. And in this way we try to generalize this new behavioral repertoire to other areas of his life.

And what about people with overinflated self-esteem? What do you do in these cases?

If this self-esteem is too inflated, it will be very rigid and stable in various contexts of the person from an early age, and from here it will lead to dysfunctional behaviors such as a pattern of behavior directed towards excessive seeking of admiration, little empathy, exploitation of others for the achievement of their goals, etc, can lead to what is known as narcissistic personality disorder.

A relevant question is that people with these characteristics do not usually ask for help, because the explanation of their problems usually directs it towards others, towards the outside; and they tend to think on a much higher level than others including the therapist if he or she goes, so why should he or she go? What can we teach him or her?

People with these patterns of behavior depend a lot on external social reinforcements, call them praise, admiration, excessive need of attention, etc. and if they don’t get them, they escape from that situation as a way to avoid the pain that the lack of this causes them. Imagine the challenge for the therapist.

As you can see, it’s a very complex situation. It’s true that all this has to be landed on a case-by-case basis and there are exceptions, including when what they depend on so much (the approval of others based on external and unstable attributes or circumstances) no longer occurs. Here the recommendation would be to work on that “unstable self”, on self-pity as a first point. A very effective approach to these problems is functional analytical psychotherapy.

Approximately how long does it take to go from having a very low self-esteem to having a more balanced one, thanks to psychotherapy?

There is no defined time, it would again respond to many individual and contextual factors of the person as well as the approach with which it is approached. What I can tell you is that the best results in the shortest possible time are being found in cognitive-behavioral and/or contextual-behavioral approaches.

How can friends and families of people with low self-esteem who are seeing a psychologist help?

Supporting him in this process. If necessary, the therapist will consider, with the patient’s permission, of course, incorporating the family member as a co-therapist, and will specifically tell you how you can do better.

There are no general guidelines, since problem behaviors have a different function in each person, which can be reinforcing for me, and can be aversive for you, and there we mess it up. The only thing that I am clear about that can be a more general recommendation is to be compassionate with him or her, helping him or her to be compassionate with himself or herself, constantly directing attention to what he or she is doing well, to his or her strengths, and reinforcing it.