CBT Techniques for Building Client Self-Esteem

On the last track we discussed obstacles to change by examining the second category of obstacle.  This second category of obstacles to change is feelings of powerlessness.  The accompanying technique focused on overcoming feelings of powerlessness.  The four steps I used in implementing this technique with Joan were recognizing emotions, being consistent and organized, not forgetting the rest of your life, and accentuating the positives. 

On this track we will finish our discussion on obstacles to change by examining investments in maintenance. As you will see, this obstacle to change may be one of the most difficult to overcome, especially for a client with a history of abuse and may require extensive therapy, as you are well aware. Our Exercise focus for the obstacle of investments in maintenance will be asking the price of self criticism. As you will see Ben, needed to evaluate his self criticism in order to stop believing it was beneficial. As you listen to this track, consider your client. 

Could hearing how Ben overcame this obstacle to change help your client apply these principles to his or her self critic?

Obstacles to Change: Investments in Maintenance
A third reason why self critical patterns are difficult to change is that those who employ them often have strong investments in maintaining them.  For example, have you heard clients make statements such as "If I gave up my insistence on perfection, I would be settling for mediocrity."  Or, "If I don’t use very strong and severe measures to deal with myself, I’ll never change; being a more benign critic would be nothing more than a weak, ineffectual slap on the wrist."

Ben was one of these clients. The basic point is that with this third obstacle, the client’s destructive self critical acts are purposive. Ben engaged in them to accomplish important purposes in his life, and he was not ready to give them up as long as he believed that doing so would mean relinquishing the accomplishment of these purposes. Think of your Ben. What does your client think he or she gains from self criticism?

To help Ben see that his continued self criticism was not worth it, I gave him the tools to implement the asking the price exercise. As with the other exercises we have discussed, I encourage you to adapt this exercise for your practice and use it in a way that best benefits your client. With Ben, I felt that one of the best ways I could help him disarm his critic was to get him to think about the price Ben paid for those attacks.

3-Step "Asking the Price" Technique

Step # 1 - Write Down Costs
I asked Ben to take some time to think about and write down what his self critic costs him. Ben’s list included, ‘defensive with my wife, abusive toward my children, damaging to my friendships, tendency toward cold and distant, anxiety, thinking people don’t like me because I don’t like myself, and afraid to try new things.’ 

Step # 2 - Evaluate Costs
I could tell from Ben’s list that poor self esteem due to his indulgence in self criticism was costing him a great deal in many areas of his life. I asked Ben how he could justify insisting on perfection when it cost him so much. Ben responded by stating, "I honestly don’t think I can. It makes me defensive, afraid, I lose friends and I’m even harsh to my daughter. I can’t justify that. I have to change it."  In this way Ben had evaluated the cost of his critic. 

Step # 3 - Formulate a Summary Statement
After making the list of ways in which his self esteem had affected him in terms of relationships, work, and level of well being, Ben chose some of the most impactful items. Using these items from his list, Ben formulated a summary statement that he later used when his self critic attacked. Ben fought back by telling the critic, "I can’t afford this, you’ve cost me this, this, and that." 

On this track we have finished our discussion on obstacles to change by examining investments in maintenance. Would you agree that this obstacle to change may be one of the most difficult to overcome?  Our Exercise focus for the obstacle of investments in maintenance was asking the price. 

QUESTION 9
What is a technique for overcoming investments in maintenance?
To select and enter your answer go to Answer Booklet.