Getting to Know Your Client Better: When Low Self-Esteem Means Something More

“Low self-esteem” is a very common phrase. We hear it said about children and adults. We use it personally and professionally. Therapists say it a lot, clients say it a lot, and the culture uses it as an explanation for all sorts of personal difficulties. But what does it really mean?

According to the Oxford Dictionary, self-esteem is confidence in one’s own worth or abilities, including self-respect.

What level of self-esteem is right?

In as much as we hear a lot about low self-esteem, we rarely hear anyone talk about high self-esteem. This suggests that low self-esteem is bad for us and we should want self-confidence to be higher. But, it would appear that high self-esteem is not necessarily what we should be looking for either, although most people would want to be more confident. The difficulty in knowing how much self-esteem is enough is an inherent weakness in the concept of ‘esteem’ itself and the vague answer seems to be that we need just enough but not too much.

How can we enhance self-esteem?

In spite of the difficulty in defining self-esteem and in knowing how much is enough, many therapeutic strategies set raising self-esteem as a key target. When examined carefully, this seems like an odd endeavor because there is often little exploration of why something so fundamental would be low in the first place and there is an assumption that if specific areas of a person’s life are changed, they will feel better about themselves at a fundamental level. But, this is almost never what we see in clinical practice. On the contrary, changing the fundamental level of respect we have for ourselves can take time and a lot of therapy.

Things become clearer and more realistic when we focus on the word ‘respect’ rather than on ‘esteem’. ‘Self-respect’ can never be too high and low self-respect inherently appears deeply troubling, limiting and not likely to be something easily changed. Most of our clients have very low or no self-respect and see themselves fundamentally as worth less, or of lower value, than others. Indeed, clients often feel that they don’t deserve love, kindness or success and believe that loneliness, disregard and failure are more rightfully theirs.

As you work through the concept of low self-respect, it begins to appear that respect is a more helpful term than esteem and that the more important piece of self-esteem after all was self rather than esteem. For many clients, appreciation and respect for the self is so low that one could only say that self-esteem is completely absent, rather than just low.

How to build self-respect

PBBT is highly focused on building respect for the self from the ground up. Positive affirmations, motivational phrases and meditations simply will not be enough. Absent or low self-respect comes from a deeply embedded painful negative self-identity that has been shaped by our experiences and learning histories. A person who says “I’m not worth much” is expressing a truth that they live everyday of their lives. Altering that truth, without negating the legitimacy of its development, requires highly precise and transformational clinical work.

In PBBT, our detailed work on self-respect begins with understanding the experiences that gave rise to who that child and later that teenager believed they were as a human being and getting to grips with the ongoing evaluations of that person’s worth and character. The world around us can easily give us the message “You don’t deserve this” regarding attention, love, affection, kindness, success, etc. It is a short psychological step from that place to the message “You don’t deserve anything good, but everyone else does.” By first understanding how this identity developed, we then can start helping the client build a new one.

Self-respect cannot be built by convincing someone they are worthy or good, or even just practicing that. PBBT uses the clinical work itself and the relationship with the therapist to create new experiences that carry the message “You are worth it.” Exploring experiences where self-respect was not fostered and building self-respect from the ground up are intimate, challenging and transformative, not because they directly tell the client they deserve more, but because they build a sense of self that actually believes this is true.

When a client comes in with the belief that their future is hopeless, our job is not to challenge this directly. It is to get close, understand them with precision, sit with the identity who says “I don’t deserve this” and explore what it means to be that person. And then, piece by piece, we help them to create new experiences that make a sense of being worthy and valued feel possible. In PBBT, therapy is not just about helping someone feel better. It’s about helping them become someone who knows they deserve better.

Want to learn more?

Join us for an informational webinar on the Professional Diploma in Process-Based Behaviour Therapy (PBBT).

Date: 11th August 2025
Time: 16:00 (Irish Time)

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