One of the factors that often seems to come with anxiety and depression for many is the experience of poor self-esteem, a distorted vision of ourselves or a devalued sense of worth reflecting what we believe other people think of us. For those individuals dealing with cognitive depression especially, the kind that comes with burdensome negative self-talk narratives, the self-esteem challenges are pretty much a given. Part of the work in therapy with these kinds of clients involves constructing (or reconstructing, if the absence of self-esteem is something that can be traced to a clear source of systemic erosion) a sense of intrinsic value, or unconditional human worth:

Howard?s Laws of Human Worth
Unconditional worth means that you are valuable as a person, important, because your essential core self is unique, eternal, precious, of infinite unchanging value and inherently good. You are as precious as any other person.

1. All beings have internal, infinite, eternal and unconditional worth as persons.
2. All have equal worth as people. Worth is not comparative or competitive. Although you might be better at sports, academics, or business, and I might be better in social skills, we both have equal worth as human beings.
3. Externals neither add to nor diminish worth. Externals include things like money, looks, performance, and achievements. These only increase one?s market or social worth. Worth as a person, however, is infinite and unchanging.
4. Worth is stable and never in jeopardy (even if someone rejects you). Worth doesn?t have to be earned or proved. It already exists. Just recognize, accept, and appreciate.
5. Worth doesn?t have to earned or proved. It already exists. Just recognize , accept and appreciate it.

Claudia A. Howard (1992) [as read here]

Low self-esteem generally manifests as narratives along the line of, “I’m not worth anyone’s time [attention/effort/love/desire/respect/etc.]”, and “It’s not worth taking an effort or risk because I won’t get it right, or the results won’t be worth it”, for example. We fear the repercussions of failed efforts because we tie our value, our self-worth, to external events like job or relationship success.

“When worth equals externals, self-esteem rises and falls along with events. […] for adults, the highs may come with promotions, awards […]. The lows may come with criticism, poor performance or when [you or] your team loses. If your worth equals your job or your marriage, how will you feel if you realize you have already gotten your last promotion or if you divorce? Your feelings would probably go beyond the normal and appropriate sadness and disappointment. When worth is in doubt, depression usually follows. If human worth equals market worth, then only the rich and powerful have worth. By this line of thinking, a Donald Trump or a Hitler would have more human worth than a Mother Theresa.”
Glenn Schiraldi, The Self-Esteem Workbook, p. 33

Working through self-esteem narratives with a cognitive-behavioural approach tends to help many, by allowing them space to introduce counterscripting that often starts with awareness and acceptance (we don’t leap immediately to attempting outright self-love, because that’s a difficult pinnacle to reach for people with self-esteem issues, and we try to avoid setting our clients up for failure right off the starting block). We begin with introducing a better understanding of intrinsic human worth, as with Howard’s Laws, above. These tenets become a working mantra to underpin the work that follows; everything points back to this developing understanding of intrinsic value.

We then begin to develop self-observation and reflection: what are the thoughts we’re aware of, and what feelings come along for the ride when we catch ourselves in those thoughts? We separate the thoughts from the feelings and challenge the thoughts: Is this true? What evidence do I have to support it? What evidence might I have to counter it? We introduce the counterscripts, like “I accept myself as being MORE than my weaknesses or mistakes”, and “Criticism is an external force; I can examine it for ways to improve WITHOUT concluding that being criticized makes me less of a human being.”

We also explore the feelings that are tied to these narratives. Sometimes we can get a sense of where they started and what they root in, but most commonly we work simply in the present experience: we feel bad now when we buy into the poor self-esteem narratives, but we assume we will feel worse when we receive other people’s evaluations of our low worth. Poor self-esteem, regardless of where it originates, tells us we are unworthy of love, especially unconditional love; our worth is tied ENTIRELY to our ability to adequately meet or exceed other people’s expectations. We often have a damaged sense of self-love, so we rely on input from others to validate us, and when those reflections are broken or distorted, we believe the worst about ourselves as undeserving beings.

Opening up to a belief that we are intrinsically valuable and worthy of love requires a heady degree of vulnerability. Often self-esteem work will sail or flounder on the individual’s willingness to wade into the weeds of that kind of experience. Trauma survivors, for example, will often find vulnerability exceptionally threatening. Pema Chodron, Buddhist nun, refers to sitting with the discomfort of our own emotional experiences as “leaning into the sharp things”, and this is a metaphor I use a great deal in this kind of work. We walk with the client into those internal places where the early emotional hurts are still festering underneath those “I’m not worthy” narratives. We strap on the armour of, “All humans are intrinsically worthy, therefore I am worthy”, and we face down the demons with a variety of weapons, the biggest of which is a cudgel labelled, “I am worthy of my own love”. And we bear witness while the clients learn how to hold that in themselves, awkwardly at first, and sometimes losing their hold on it completely. We all slip at times; it’s human. We sit with the failure and celebrate the attempt as a counterscript to the client’s default narrative, “I am a failure and therefore not worthy.” We can break down the experience into, “What did I attempt? What did I learn? What do I want to do differently?”, and consider the emotional ties to the answers of each question along the way. Unravelling fear of failure and its ties to external validation is a slow process; we take our time working on stages of self acceptance. We look at the notion of self-love, but in truth, some people will get there while others won’t get much further than an uneasy truce with self-acceptance. We work to the reasonable abilities of our clients, and while we try and expand the comfort zones (by pushing into discomforts as best we can), everyone’s limitations will fall in different places.

Ideally we get to a place where clients can at least make, and connect emotionally (with belief) to positive self-statements. How many statements, and how strong the belief that supports their growing self-esteem, is a very individual outcome. But it’s work that we *can* do to help clients grow out of a sense of being stuck in their own perception of non-value.