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On the last track we discussed the idea of empowerment as the foundation for healing and how to build it: through building a sense of responsibility and accountability; through developing his understanding of his power and its limitations; and through equipping the client with knowledge and empowering skills.
Many times, I have found that clients with low self esteem, especially those who suffer from pathological self criticism, seem to also suffer from some form of depression or anxiety. The first trouble we have in this finding, however, is the question of which is the primary disorder?
On this track, we will examine depression and anxiety co-occurring with low self esteem. We will examine primary depression and primary anxiety disorder. As you listen to this track, consider your client. Does he or she have a co-occurring disorder?
In conjunction with these symptoms, clients also manifest the tell-tale signs of depression. Some may sleep for long hours during the day. Many experience weight gain, listlessness, hopelessness, or the urge to cry at inappropriate times. Maxine was a client of mine who had originally been referred to me as a pathologically self critical client. However, her level of self criticism did not meet the criteria for pathological self criticism. Instead, many of her other symptoms such as her overeating seemed to affect her daily life more than her low self esteem.
I asked Maxine how she had been feeling lately and Maxine stated, "Actually, not so good. I just went through a terrible divorce, so I feel like a wreck. I don’t feel like getting out of bed in the morning. But then I feel like a slug for staying in bed. All I want to do is watch Maury and eat sugary stuff. This isn’t like me at all. I used to feel great about myself. Now, since there’s no one there that I need to look good for, I’ve stopped trying." As you can clearly see, Maxine fit the diagnosis for depression not pathological self criticism.
Primary Anxiety Disorder
Denise stated, "When my sister was sick for a long while in the hospital, I was feeling almost as sick with anxiety. I kept expecting that call with the doctor on the other end saying, ‘We couldn’t do anything for her.’ Even though I knew the cancer was in remission, I had this overwhelming feeling something awful was going to happen. This went on for about three months, and after a while, I felt like it was my fault." As you can see, as a result of her anxiety, Denise had developed low self esteem. I explained to Denise that this low self esteem was a symptom of her anxiety. Her body had been so overwhelmed by worry that it was starting to shut down emotionally.
Cognitive Behavior Therapy Technique: Best Case Scenario
I asked Denise to put this scenario in a place she could easily see it. Denise framed it and put it on her bedside table. Whenever Denise felt like staying in bed, she would look over to see her Best Case Scenario and her anxiety would be somewhat eased. Think of your "Denise". Could he or she benefit from a "Best Case Scenario"?
On this track we have discussed depression and anxiety co-occurring with low self esteem. We examined primary depression and primary anxiety disorder.
On the next track we will discuss encouraging commitment. This will include two methods for encouraging commitment. These two methods are creating commitment statements and commitment slogans.
Peer-Reviewed Journal Article References:
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