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Treating Male Suicide & Depression
Male Suicide & Depression continuing education Nurse CEUs

Section 8
Self-Esteem, Insecurities and Relationship among Depressive Disorder

CEU Question 8 | CE Test | Table of Contents | Depression
Counselor CEUs, Psychologist CEs, Social Worker CEUs, MFT CEUs, Nurse CEUs

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As we discussed in the previous track, some depressed males have difficulty feeling empathy for their partners.

Have you found, like I , that male clients, who cannot understand the feelings of others, are sometimes narcissistic? My working definition of "narcissism" is when my client denotes extreme self-love, or at least an appearance of self-love.

Have you found, like I, that extremely narcissistic clients have low self-esteem and use bragging to protect themselves against the fear that they are defective and unlovable? Narcissists focus completely on themselves and thus do not have empathy for others; they have both a low self-esteem and are self-centered.

According to Depression, Suicide, and Human Existence, depression which can lead to suicide in men is mainly the result of conflicts and problems related to their identity. Earlier phases of doubt and feelings of inferiority are activated by interpersonal conflicts within the family or work situation. As you know, the narcissistic client is usually depressed. He is depressed because he feels insecure. Agree? He hides behind a pretense of arrogance and hyperindependence. In relationships, narcissism is extremely problematic, as in the case of David.

On the last track, we saw how David had problems feeling empathy for Amy's emotions, until he felt empathy for himself. He didn't recognize that his fear of her anger was rooted in his own insecurity. David was narcissistic. He was so consumed with his own feelings that he thought his wife had to agree with him.

Three Self-Esteem Concepts
After watching himself in the Fishbowl, as we discussed earlier, David was ready to work on his self-esteem. Here are some Self-Esteem Concepts that I give to clients like David:

-- Concept #1. Focus on your strengths when evaluating yourself. I asked David, "Try to recall some people at work who have had failures." After he recalled a couple people and situations, we discussed the fact that that even colleagues whom he viewed as very successful have had failures. This helped David to put his failures in perspective.

-- Concept #2. Decrease the gap between your expectations and reality. I asked David, "Do you expect to have a good day, or is it your choice to make it a good day? By accepting responsibility for your happiness, you can make choices that result in positive outcomes. In short, you'll feel more positive."

-- Concept #3. The third self-esteem concept I give to clients is...and I feel this is the most important factor... Pay attention to your self-talk. I told David, "Listen to whether you are mentally patting yourself on the back or kicking yourself. Increasing your positive self-talk can result in increasing your self-esteem."

Along with having a low self-esteem, David was self-centered. Until Amy threatened to leave him, he was entirely absorbed in his own needs. His needs focused on his status and feelings about his job. When David did finally recognize Amy's pain, he tried to stop her pain as a means to prevent himself from having more pain.

As you know, becoming less self-centered requires that your client become aware of his self-centered thoughts and behavior, which can be the next step to developing more empathy for others. Thus, the client perhaps becomes more willing to meet the needs of others instead of only his needs.

Technique: Pay Attention to Self-Centeredness
To help David become aware of his self-centeredness, I told David to pay attention to his self-talk. For instance, David would often make comments like, "Who cares what they think? I know I'm right!" These statements limit what David can feel for others because they are so completely self-centered.

Do you have a client that you feel would benefit by recognizing that his low self-esteem and his self-centeredness are getting in the way of his empathy for a significant other? Here's how I helped David to grow out of his self-centeredness.

3 Steps Used to Grow Out of Self-Centeredness

-- Step # 1 - I suggested first that David really concentrate on listening to what Amy had to say, not what he thought she should say. Listening to her would assist in preventing Amy from being merely a narcissistic extension of David.

-- Step # 2 - As David was beginning to get in touch with his own fears, he was starting to separate from Amy's fears. Thus, he became more aware of his own insecurities.

-- Step # 3 - Finally, I told David to consciously remind himself that Amy's anger was not a threat to him. I suggested that, if it helped, he might consider reminding himself that he was still a man, even if he wasn't in control of the situation at that moment. He said later that little reminders of his self-worth helped him keep the anger of the moment in perspective.

David was beginning to see conflicts as a natural part of relationships. He was starting to see the possibility that conflicts are not a threat to his masculinity.

Think of a male depressed, possibly at risk for suicide, that you are currently treating whose significant other has relegated to the role of a narcissistic extension of themselves. Would it be beneficial to introduce the esteem building concepts of strengths, expectations, and self-talk into your next session?

As you can see, shame-based narcissistic clients can thrive on conflict in relationships. In the next track, we will discuss working through power struggles.

Peer-Reviewed Journal Article References:
Cole, B. P., & Davidson, M. M. (2019). Exploring men’s perceptions about male depression. Psychology of Men & Masculinities, 20(4), 459–466.

Davis, H., & Turner, M. J. (2019). The use of rational emotive behavior therapy (REBT) to increase the self-determined motivation and psychological well-being of triathletes. Sport, Exercise, and Performance Psychology. Advance online publication.

Dyar, C., Feinstein, B. A., Zimmerman, A. R., Newcomb, M. E., Mustanski, B., & Whitton, S. W. (2020). Dimensions of sexual orientation and rates of intimate partner violence among young sexual minority individuals assigned female at birth: The role of perceived partner jealousy. Psychology of Violence, 10(4), 411–421

Ein-Dor, T., Mikulincer, M., & Shaver, P. R. (2011). Attachment insecurities and the processing of threat-related information: Studying the schemas involved in insecure people's coping strategies. Journal of Personality and Social Psychology, 101(1), 78–93. 

Johnson, M. D., Galambos, N. L., Finn, C., Neyer, F. J., & Horne, R. M. (2017). Pathways between self-esteem and depression in couples.Developmental Psychology, 53(4), 787–799.

Rank, J., & Gray, D. E. (2017). The role of coaching for relationship satisfaction, self-reflection, and self-esteem: Coachees’ self-presentation ability as a moderator. Consulting Psychology Journal: Practice and Research, 69(3), 187–208. 

Online Continuing Education QUESTION 8
How can narcissistic depressed male clients hide their insecurities? To select and enter your answer go to CE Test.

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