Having problems with self-esteem can be reflected in many aspects of a person’s social life. And one of the ones that most shows up in conversations is the lack of assertiveness: the ability to say what one thinks, even if it bothers others, maintaining a balance between respect for the interlocutor and the defence of one’s right to express oneself.

People with low self-esteem usually also have problems with assertiveness. Let’s see how this relationship between both elements of the personality is through an expert on the subject: psychologist Guillermo Orozco .

Guillermo Orozco: the relationship between self-esteem and assertiveness

Guillermo Orozco is a General Health Psychologist based in Las Palmas de Gran Canaria, where he treats many of his patients from his Psychological Care Centre. In this interview he talks about the relationship between self-esteem and assertiveness, and how problems in these dimensions are addressed from the Acceptance and Commitment Therapy.

How does having low self-esteem influence our relationships?

Self-esteem is the value, consideration and affection that each person feels for himself or herself. This value is independent of how we really are or how others see us. When our self-esteem is balanced, we perceive ourselves realistically and accept ourselves with our faults and virtues. This makes us feel valuable and worthy of being appreciated by others. Consequently, low self-esteem influences not only how we relate to ourselves, but also to others.

People who suffer from low self-esteem often have distorted thoughts that make them believe that everything bad that happens around them has to do with their behavior, which makes them feel guilty all the time.

This distortion of thinking also makes them believe that they do not deserve the consideration and praise that their friends, family, or even their partner give them. Therefore, they feel uncomfortable when they receive them, take them down, and sometimes feel rejected when they are shown affection. This causes a distance between people, since the desired effects are not achieved by reinforcing the virtues or behaviour of an individual with low self-esteem, causing frustration and rejection in friends, family and, especially, in the couples of people who suffer from it.

On the other hand, the insecurity they suffer about their behavior leads them to think that they are doing everything wrong, so they constantly strive to please and not bother other people. This can lead in many cases to very unbalanced personal relationships with a high emotional dependence, as they forget their own needs to cover those of others.

In order to maintain coherence with their mental schemes of little personal value, it is very common for them to relate to people who contribute to maintaining their low level of self-esteem. Their perception of not deserving anything better makes them feel “comfortable” in this type of relationship despite the great suffering they bring, since they are usually based on constant abuse and emotional imbalance.

Do people with low self-esteem often accumulate many psychological problems simply by not being able to express themselves freely?

People with low self-esteem do not feel respected. Obviously if I’m not worth anything, I don’t respect myself, and therefore no one is going to respect me. People with low self-esteem measure their words so as not to disturb, adapt to the needs of others, and ignore their own. What would happen if you didn’t tell your boss to stop yelling at you? How would you feel if your partner constantly decided what you would do together? How long would you put up with your mother controlling your life decisions? When would you tell your friends that you don’t like to drink alcohol?

These questions are easy to answer for people with balanced self-esteem, but people with low self-esteem tolerate constant abuse in their day-to-day lives, which turns into work stress, anxiety, distress, social isolation, family problems, substance abuse or depression, among others.

In my practice, for example, there are countless people with low self-esteem who still want, often unwittingly, to please their parents. Regardless of age, education or socioeconomic level, low self-esteem can affect anyone. Most of the time, when patients come for a consultation, they do not come because they have low self-esteem, but because of the problems mentioned, but after an initial evaluation, the lack of assertiveness in relating is detected.

An agreed definition of assertiveness would be the form of communication that consists of defending your rights by expressing your opinions and making suggestions in an honest way, without falling into aggression or passivity, respecting others, but above all respecting your own needs.

People with low self-esteem find it very difficult to express themselves in this way, so they do not defend their rights, leading them to have very unbalanced social relationships in which they often end up suffering and remaining silent, sometimes, and sometimes exploiting and having disproportionate aggressive behaviour.

In your experience treating patients, what do you think comes first, self-esteem problems, or assertiveness issues?

It is difficult to know what it was before, whether the chicken or the egg, but what is clear is that self-esteem and assertiveness are intimately related.

In my experience, people with low self-esteem don’t behave assertively because they don’t respect themselves, so they don’t need to be respected. In fact, they do not conceive that other people treat them with respect and value them because it goes against their mental schemes, so they are unable to assume such treatment.

On the other hand, it may happen that during our childhood we do not learn to have an assertive behavior, since it is usual to encourage in children submissive behaviors, in some cases, and aggressive in others.

Over time, it is common for these behavior patterns to become rigid and we may begin to suffer abuse or rejection by our family and friends, classmates or potential partners. This causes our self-esteem to deteriorate until we begin to believe that there is really something wrong with us and that we don’t deserve the affection, love and respect of others.

When working from psychotherapy to intervene in cases where there are problems of self-esteem and assertiveness, what is usually done?

As I mentioned earlier, when patients come for consultation they usually don’t come because of low self-esteem, more often than not they come because of problems with stress at work, anxiety, depression and sometimes with deficits in social skills and problems relating to relationships.

The most important thing before starting a psychological intervention is to make a detailed evaluation of the patient by means of an interview and, sometimes, using specific instruments for each case. For example, the Rathus Assertiveness Test or the Rosemberg Self-Esteem Scale are very useful in situations where we suspect that low self-esteem or a non-assertive attitude may be underlying the person’s problems.

Once the assessment is completed and the functional analysis of the problem behaviors is done, cognitive-behavioral psychotherapy begins with psychoeducation. It is essential that the patient associates his low self-esteem with the way he relates to others and to himself, as well as the involvement this has in his state of mind.

Once the patient knows the keys to their problem, the next goal is for the person to change their beliefs and misguided thoughts with the guidance of the therapist. In addition to the sessions in consultation, behavioural experiments are of great help for this change of attitude. These consist of the patient being exposed to different situations in his/her daily life and practising behaviours that have been previously agreed upon in therapy.

The result of these practices is usually different from that foreseen by the patients, since they foresee negative and unpleasant situations for them, which finally do not occur, contributing to break their previous mental schemes.

This work with the patient’s thoughts is transversal to the whole therapy, we must take advantage of all the opportunities that are given in consultation to confront the distorted beliefs that people with low self-esteem have.

It is very common for these people to make internal, global and stable attributions about the bad things that happen to them (I failed the exam because I am useless and I will never get the degree), and external, specific and unstable attributions for successes (I passed the exam because I was lucky that day). It is also important for the patient to be aware of their strengths and, little by little, to internalize them.

Finally, it is very important to train in assertiveness and social skills, as it is very common for people with low self-esteem to have deficiencies in these areas. The concept of assertiveness has become a fashion nowadays, it seems that if you become an assertive person you will be successful in business and an achiever.

Not far from this idea, and realistically, assertiveness helps us to relate to others as equals, without being below, but also not above, anyone. There are numerous techniques that help us move from submissive, or aggressive, behavior to the much-desired assertive behavior.

How do Third Generation Therapies differ in treating these problems?

Third generation therapies consider thoughts as another behavior, so they focus on their functionality rather than their content. In other words, it is not necessary to change the thoughts but their function and the suffering they cause us.

Acceptance and Commitment Therapy (ACT), the main representative of this group of therapies, uses an eclectic mix of metaphors, paradoxes and mindfulness skills. Like cognitive-behavioral therapy, they also apply a wide variety of experiential exercises and behavioral interventions, the difference here is the importance that ACT places on each person’s values. That is why the main objective of these therapies is to achieve a meaningful and full life, accepting the inevitable suffering that this entails.

Many people come to consultation with their life on hold, waiting to “cure” their emotional problems before they start living. Therapies such as mindfulness and ACT strive to get people to start building the life they want right away, despite the difficulties and suffering that the disorder causes. Focusing on individual values, not avoiding negative experiences, accepting the inherent suffering of life existence, experiencing all events without evaluating them as good or bad, or returning attention to the present moment, are some of the keys to third generation therapies.

Some techniques of acceptance and commitment therapy, such as “cognitive defusion”, are especially useful in cases of low self-esteem, as it helps us to weaken the control that thoughts exert over our behavior, so that even though they remain in our minds, they do not continue to be a barrier to acting on our values.

In other words, when the patient thinks, for example, “I am useless at my job”, he can diminish the importance of that statement by distancing himself from its meaning and realizing that it is not reality, simply a thought based on his low self-esteem. This causes the patient to be able to face his work in spite of these thoughts.

Mindfulness is also very useful in cases of low self-esteem, as it helps us to focus on the present moment, and not on past events that make us feel sad, or on future ones that cause us anxiety. Most of the rejections felt by people with low self-esteem do not conform to reality, and on many occasions, they avoid exposing themselves to these situations so as not to suffer. With mindfulness we learn to focus on the here and now, without evaluating or judging the present experience.

What advice do you think is important to follow so that we don’t fall into situations that hurt our self-esteem?

Something that seems very simple but is of great importance, and which underlies almost all psychological disorders, is that sometimes what you think does not correspond to what you feel. In the case of self-esteem it is very evident, on the one hand, there is the self-concept, which is the opinion that everyone has of himself, that is, what I think of myself. On the other hand, there is self-esteem, which is the emotional or affective evaluation of me. That is, what I feel about myself.

People with low self-esteem may have a proper self-concept about them, for example, thinking they are smart, but at the same time feeling stupid. Psychologists call this “emotional reasoning”, and it is one of the keys to change. Realizing that even if you feel that way, it doesn’t have to be true.

Another key to preventing our self-esteem from being weighed down is not to fall into constant comparison with other people, as the assessment we make will always be negative for us. This will inevitably lead us to feel more unhappy. The important thing is to set realistic goals and constantly improve as a person in the areas you want, rewarding you every day with your progress.

Focusing on activities that make us happy is also very useful, as it helps us develop skills in which we can improve and evolve without feeling too much pressure. Enjoying our free time also makes life meaningful and motivates us to face all the situations that make us suffer.

Although it sounds like a cliché, exercising is one of the infallible formulas for improving our mental health, and in the case of self-esteem for more reasons. Not only the well-being we feel when we do sport, thanks to the secretion of endorphins, but also the personal satisfaction of doing something for and with us, and the positive effects on our health.

Sometimes it is necessary to heal wounds of the past that burden us emotionally. Talking about it with friends, family, or a professional is invaluable. Learning to express our emotions and make ourselves known makes us feel more intimately connected to other people who are important to us.

People with low self-esteem find it hard to say no, as they are so focused on being accepted and valued by everyone. Setting limits on our family, bosses, friends or partners is very important to start being respected, and therefore respecting ourselves.

Constantly criticizing us with phrases such as “I’m not good for anything”, “I’m a mess”, “I’ll never get anything in life”, “I’m always bothering”, are undermining our self-esteem more and more. Being aware of this inner voice and remedying it, realistically with our abilities, is of vital importance to improve our self-esteem.

These are just a few small tips that help prevent low self-esteem, and even improve it greatly. There are cases in which it is so deteriorated that it is already part of the maintenance of a psychological disorder, for example, anxiety, depression, inability to relate, relationship problems or work stress. It is at these times that the help of a mental health professional becomes essential.