Overcoming Low Self-Esteem Extract - Reading Agency (PDF)

DR MELANIE FENNELL is the author of Overcoming Low Self-Esteem and Overcoming Low Self-Esteem Self-Help Course. She currently works as the Director of an advanced cogni- tive therapy course, which is a collaborative venture between the Oxford Cognitive Therapy Centre (OCTC) and Oxford University. One of the first clinician researchers to intro- duce cognitive therapy to the UK, she was a founder member of the OCTC, an internationally recognized centre of ex- cellence in cognitive therapy and training. As a member of research teams in the Oxford University Department of Psychiatry, Melanie contributed to the development and evaluation of cognitive treatment for a range of emotional problems. A recognized expert on low self-esteem with an interest in depression, she has run many workshops and presented research papers at major international conferences. CR034 – overcoming low self-esteem prel:CR006 18/3/09 16:14 Page i  The aim of the Overcoming series is to enable people with a range of common problems and disorders to take control of their own recovery program. Each title, with its specially tailored program, is devised by a practicing clinician using the latest techniques of cognitive behavioral therapy – techniques which have been shown to be highly effective in changing the way patients think about themselves and their problems. The series was initiated in 1993 by Peter Cooper, Professor of Psychology at Reading University and Research Fellow at the University of Cambridge in the UK whose original volume on overcoming bulimia nervosa and binge-eating continues to help many people in the USA, the UK and Europe. Titles in the series include: OVERCOMING ANGER AND IRRITABILITY OVERCOMING ANOREXIA NERVOSA OVERCOMING ANXIETY OVERCOMING BODY IMAGE PROBLEMS OVERCOMING BULIMIA NERVOSA AND BINGE-EATING OVERCOMING CHILDHOOD TRAUMA OVERCOMING CHRONIC FATIGUE OVERCOMING CHRONIC PAIN OVERCOMING COMPULSIVE GAMBLING OVERCOMING DEPERSONALIZATION AND FEELINGS OF UNREALITY OVERCOMING DEPRESSION OVERCOMING GRIEF OVERCOMING INSOMNIA AND SLEEP PROBLEMS OVERCOMING LOW SELF-ESTEEM OVERCOMING MOOD SWINGS OVERCOMING OBSESSIVE COMPULSIVE DISORDER OVERCOMING PANIC OVERCOMING PARANOID AND SUSPICIOUS THOUGHTS OVERCOMING RELATIONSHIP PROBLEMS OVERCOMING SEXUAL PROBLEMS OVERCOMING SOCIAL ANXIETY AND SHYNESS OVERCOMING TRAUMATIC STRESS OVERCOMING WEIGHT PROBLEMS OVERCOMING WORRY OVERCOMING YOUR CHILD’S FEARS AND WORRIES OVERCOMING YOUR CHILD’S SHYNESS AND SOCIAL ANXIETY OVERCOMING YOUR SMOKING HABIT All titles in the series are available by mail order. Please see the order form at the back of this book. www.overcoming.co.uk CR034 – overcoming low self-esteem prel:CR006 18/3/09 16:14 Page ii  OVERCOMING LOW SELF-ESTEEM A self-help guide using Cognitive Behavioral Techniques MELANIE J. V. FENNELL Robinson LONDON CR034 – overcoming low self-esteem prel:CR006 18/3/09 16:14 Page iii  Constable & Robinson Ltd 3 The Lanchesters 162 Fulham Palace Road London W6 9ER www.constablerobinson.com First published by Robinson Publishing Ltd 1999, Copyright © Melanie J. V. Fennell 1999, 2009 The right of Melanie J. V. Fennell to be identified as the author of this work has been asserted by her in accordance with the Copyright, Designs and Patents Act, 1988. All rights reserved. No part of this publication may be reproduced in any form or by any means without the prior written permission of the publisher. A copy of the British Library Cataloguing in Publication Data is available from the British Library. ISBN 1–85487–725–9 Important Note This book is not intended as a substitute for medical advice or treatment. Any person with a condition requiring medical attention should consult a qualified medical practitioner or suitable therapist. Printed and bound in Great Britain 12 14 16 18 20 19 17 15 13 CR034 – overcoming low self-esteem prel:CR006 18/3/09 16:14 Page iv  Table of contents Foreword by Professor Peter Cooper vii PART ONE: What Is Low Self-Esteem? An Introduction to this book 1 What is low self-esteem? 3 PART TWO: Understanding Low Self-Esteem 2 How low self-esteem develops 31 3 What keeps low self-esteem going 61 PART THREE: Overcoming Low Self-Esteem 4 Checking out anxious predictions 83 5 Combating self-criticism 119 6 Enhancing self-acceptance 157 7 Changing the rules 201 8 Undermining the Bottom Line 251 9 Pulling it all together and planning for the future 303 CR034 – overcoming low self-esteem prel:CR006 18/3/09 16:14 Page v  Useful books and addresses 329 Appendix 337 Index 359 vi OVERCOMING LOW SELF-ESTEEM CR034 – overcoming low self-esteem prel:CR006 18/3/09 16:14 Page vi  Foreword Why cognitive behavior therapy? Over the past two or three decades, there has been some- thing of a revolution in the field of psychological treatment. Freud and his followers had a major impact on the way in which psychological therapy was conceptualized, and psychoanalysis and psychodynamic psychotherapy domi- nated the field for the first half of this century. So, long-term treatments were offered which were designed to uncover the childhood roots of personal problems – offered, that is, to those who could afford it. There was some attempt by a few health service practitioners with a public conscience to modify this form of treatment (by, for example, offering short-term treatment or group therapy), but the demand for help was so great that this had little impact. Also, whilst numerous case histories can be found of people who are convinced that psychotherapy did help them, practitioners of this form of therapy showed remarkably little interest in demonstrating that what they were offering their patients was, in fact, helpful. CR034 – overcoming low self-esteem prel:CR006 18/3/09 16:14 Page vii  As a reaction to the exclusivity of psychodynamic ther- apies and the slender evidence for their usefulness, in the 1950s and 1960s a set of techniques was developed, broadly collectively termed ‘behavior therapy’. These techniques shared two basic features. First, they aimed to remove symp- toms (such as anxiety) by dealing with those symptoms themselves, rather than their deep-seated underlying histor- ical causes. Second, they were techniques, loosely related to what laboratory psychologists were finding out about the mechanisms of learning, which were formulated in testable terms. Indeed, practitioners of behavior therapy were committed to using techniques of proven value or, at worst, of a form which could potentially be put to the test. The area where these techniques proved of most value was in the treatment of anxiety disorders, especially specific phobias (such as fear of animals or of heights) and agoraphobia, both notoriously difficult to treat using conventional psychotherapies. After an initial flush of enthusiasm, discontent with behavior therapy grew. There were a number of reasons for this, an important one of which was the fact that behavior therapy did not deal with the internal thoughts which were so obviously central to the distress that patients were experiencing. In this context, the fact that behavior therapy proved so inadequate when it came to the treat- ment of depression highlighted the need for major revision. In the late 1960s and early 1970s a treatment was devel- oped specifically for depression called ‘cognitive therapy’. The pioneer in this enterprise was an American psychia- trist, Professor Aaron T. Beck, who developed a theory of viii OVERCOMING LOW SELF-ESTEEM CR034 – overcoming low self-esteem prel:CR006 18/3/09 16:14 Page viii  depression which emphasized the importance of people’s depressed styles of thinking. He also specified a new form of therapy. It would not be an exaggeration to say that Beck’s work has changed the nature of psychotherapy, not just for depressions but for a range of psychological problems. In recent years the cognitive techniques introduced by Beck have been merged with the techniques developed earlier by the behavior therapists to produce a body of theory and practice which has come to be known as ‘cogni- tive behavior therapy’. There are two reasons why this form of treatment has come to be so important within the field of psychotherapy. First, cognitive therapy for depres- sion, as originally described by Beck and developed by his successors, has been subjected to the strictest scientific testing; and it has been found to be a highly successful treatment for a significant proportion of cases of depres- sion. Not only has it proved to be as effective as the best alternative treatments (except in the most severe cases, where medication is required), but some studies suggest that people treated successfully with cognitive behavior therapy are less likely to experience a later recurrence of their depression than people treated successfully with other forms of therapy (such as antidepressant medication). Second, it has become clear that specific patterns of thinking are associated with a range of psychological problems and that treatments which deal with these styles of thinking are highly effective. So, specific cognitive behavioral treatments have been devel- oped for anxiety disorders, like panic disorder, generalized anxiety disorder, specific phobias and social phobia, obses- sive compulsive disorders, and hypochondriasis (health Foreword ix CR034 – overcoming low self-esteem prel:CR006 18/3/09 16:14 Page ix  anxiety), as well as for other conditions such as compul- sive gambling, alcohol and drug addiction, and eating disorders like bulimia nervosa and binge-eating disorder. Indeed, cognitive behavorial techniques have a wide application beyond the narrow categories of psychological disorders: they have been applied effectively, for example, to helping people with low self-esteem and those with marital difficulties. At any one time almost 10 per cent of the general popu- lation is suffering from depression, and more than 10 per cent has one or other of the anxiety disorders. Many others have a range of psychological problems and personal diffi- culties. It is of the greatest importance that treatments of proven effectiveness are developed. However, even when the armoury of therapies is, as it were, full, there remains a very great problem – namely that the delivery of treat- ment is expensive and the resources are not going to be available evermore. Whilst this shortfall could be met by lots of people helping themselves, commonly the natural inclination to make oneself feel better in the present is to do precisely those things which perpetuate or even exacerbate one’s problems. For example, the person with agoraphobia will stay at home to prevent the possibility of an anxiety attack; and the person with bulimia nervosa will avoid eating all potentially fattening foods. Whilst such strategies might resolve some immediate crisis, they leave the underlying problem intact and provide no real help in dealing with future difficulties. So, there is a twin problem here: although effective treat- ments have been developed, they are not widely available; x OVERCOMING LOW SELF-ESTEEM CR034 – overcoming low self-esteem prel:CR006 18/3/09 16:14 Page x  and when people try to help themselves they often make matters worse. In recent years the community of cognitive behavior therapists has responded to this situation. What they have done is to take the principles and techniques of specific cognitive behavior therapies for particular prob- lems and represent them in self-help manuals. These manuals specify a systematic program of treatment which the individual sufferer is advised to work through to over- come their difficulties. In this way, the cognitive behavioral therapeutic techniques of proven value are being made available on the widest possible basis. Self-help manuals are never going to replace therapists. Many people will need individual treatment from a qualified therapist. It is also the case that, despite the wide- spread success of cognitive behavioral therapy, some people will not respond to it and will need one of the other treat- ments available. Nevertheless, although research on the use of cognitive behavioral self-help manuals is at an early stage, the work done to date indicates that for a very great many people such a manual will prove sufficient for them to overcome their problems without professional help. Many people suffer silently and secretly for years. Sometimes appropriate help is not forthcoming despite their efforts to find it. Sometimes they feel too ashamed or guilty to reveal their problems to anyone. For many of these people the cognitive behavioral self-help manuals will provide a lifeline to recovery and a better future. Professor Peter Cooper The University of Reading Foreword xi CR034 – overcoming low self-esteem prel:CR006 18/3/09 16:14 Page xi  CR034 – overcoming low self-esteem prel:CR006 18/3/09 16:14 Page xii  PART ONE What is Low Self-Esteem? An Introduction to This Book CR034 – overcoming low self-esteem text:Layout 1 19/3/09 10:26 Page 1  CR034 – overcoming low self-esteem text:Layout 1 19/3/09 10:26 Page 2  1 What is low self-esteem? What do we mean by ‘low self-esteem’? Self-image Self-concept Self-perception Self-confidence Self-efficacy Self-acceptance Self-respect Self-worth Self-esteem All these words refer to aspects of the way we view ourselves, the thoughts we have about ourselves, and the value we place on ourselves as people. Each has slightly different shades of meaning. ‘Self-image’, ‘self-concept’ and ‘self-perception’ all refer to the overall picture a person has of him- or herself. These terms do not necessarily imply any judgment or evalua- tion of the self, but simply describe a whole range of characteristics. For example: CR034 – overcoming low self-esteem text:Layout 1 19/3/09 10:26 Page 3