 We demystify what goes on behind the therapy room door. Join us on this voyage of discovery and co-creative conversations. This is The Therapy Show behind closed doors podcast with Bob Cook and Jackie Jones. Welcome back to episode 60 of The Therapy Show behind closed doors with Bob Cook and myself Jackie Jones. And in this episode we're going to be looking at working with self-esteem issues in the therapy room. Gosh did I really hear what you said there in terms of did you say did you say this is session 60? This is episode 60. I'm 71 so we're moving nearer my decade. We'll be speeding past that very soon Bob. Oh my gosh now this subject is fantastic because I would say without a doubt nearly all clients that come in the clinical room are coming with issues around their sense of self. Yes I agree yeah yeah yeah yeah. So there isn't really anyone who doesn't come in the clinical room they who hasn't got issues or challenges around the sense of self. Now it may be not dressed up that way they may come for other things and we may deal with the other things however you know self-agency sense of self robust sense of self all these issues usually are there and even the people who come and I don't see many of them with narcissistic personality disorder or high up on the spectrum though some people might think the stranger I'm going to say here have huge problems around sense of self. Yeah. Now why is it strange because if you look into Google if you look at the treatment books and the ways of work with narcissistic personality disorder they talk about things like whether the client will present a great sense of entitlement that doesn't actually mean that they have a robust sense of self believe it or not I mean we've done I think we've done a podcast on narcissism so I won't go on about it but clients per se will come in with self-esteem issues whether they deal with it or not. Yeah increasingly so I've found particularly you know if because I work with parents and children a lot of the time particularly you know the the younger teens I'm seeing they were coming in with self-esteem issues and you know things that are impacting on them I think from a much earlier age than what it used to do. Oh well I don't know about you work with that population more I happen to think mainly is because psychotherapy and counselling is more popular accessible and 20 30 40 50 years we didn't see them. Yeah we weren't quite possibly yeah. So that's one way of looking another way is where you're talking about is that there's perhaps more you know more issues more stressful society XXX which which then causes problems in terms of a sense of self for the the young child or etc etc but certainly when we're talking about an injury to the self then it can often be quite young. Yeah yeah and I don't think the pandemics helped with a lot of this either. Oh no no no no absolutely absolutely and of course that pandemic was you might want to say a two-year trauma and inside that two-year traumas many many many many many other traumas. Yeah yeah and yeah I don't think well we'd none of us planned for it none of us have ever been through anything like this before so it was uncharted territories and you know I think even for parents that were trying to maybe offer reassurance to the children we didn't have the answers we didn't know what was around the corner. That's right and that's why I'm going to phrase it I'm sure this has been said before but I'm going to say this terminology we're in the middle of a mental health tsunami that has been triggered by the pandemic yeah and in that you know we have we have this genesis sense of selfishness. Yeah it's on the besides I think this the waves and the ripple effects of this are going to be seen for quite a few years to come. Or a generation. Yeah yes yeah. An absolute generation we've had a pandemic and we've had a major war in Europe and this war this major war is still going on yeah and we see on our television sets every night the vicarious trauma and that trauma is beamed into our living rooms and that itself causes psychological or may cause psychological issues to our sense of self. We live in particularly psychologically disturbing times in my opinion. Yeah and you know I were young people haven't really been you know opened up to anything like this before you know you were talking about robustness and resilience and things like that you know I know people talk about the snowflake generation and things like but you know my children haven't ever had to experience anything like what is going on now. I can remember when I had this conversation with my son I can remember I was I think I was 13 or 14 when the last threat from the cold war and all those sort of things were around and I know that my mental health took a severe knock at that time you know we were sent home from school with leaflets on how to make a nuclear bomb shelter and take the doors off its hinges and it frightened the BJs it's out of me you know so it's like going back 40 odd years the last time I think we'd experienced anything like the threats that we're feeling against humanity. You're absolutely correct and it is a mental health tsunami yeah there's no doubt about that. I still do a majority of the assessments at the institute and I also do all the assessments for the low cost placement. In the last three months I've assessed 40 to 50 low cost placements and a majority of them have come with the process around mental health and the challenges to mental health and a large proportion of those have been triggered off by the pandemic and the war that we're witnessing in Europe. Yeah which is understandable oh yeah but how sad yeah but yeah yeah actually this generation you're talking about this this generation has had more mental health challenges. In 1962 which is probably I can go back to because I'm 71 I was 12 at the time I think we had the Cuba crisis yeah maybe a lot of our listeners they'll have heard of the Cuban crisis but that was the time where you know it was Khrushchev who stepped back really from the possibly Italy of a nuclear catastrophe and now we need Putin to step back but we're in the we're in very psychologically difficult times. So what can we do about self-esteem? A sense of self which is a risk to trauma and vicarious trauma. Self-esteem in itself is about you know you mentioned it in a way an antidote is resilience building up resilience bringing up you know building up a robust sense of self. We need to go and look at what drives the lack of self-esteem. You see we can have behavioural plans or I know you like plans behavioural poses of self-esteem in looking at the triggers looking for more healthy coping mechanisms looking at all these poses in the present which are all very useful and at the same time unless we look at what drives the lack of sense of self I believe it's the behavioural process has become more like a plaster yeah so we need to look at the etiology or what drives the lack of sense of self it's usually trauma one way or the other whether we call that neglect for the significant other people whether we talk about that is whether there's been some abusive attack whether we talk about that in terms of cumulative neglect which I've just said they're all gonna leave a person with low self-esteem. Yeah see when I think about self-esteem and working with clients I always refer to Richard Erskine's four domains of the self and the different areas and how for me being resilient or robust is you know the thinking and the behaviour the physiological and the feeling all being quite the same level rather than I'm a thinker and a doer that's what I do when I'm stressed I think a lot and I do a lot and I often neglect the feeling and the physiological stuff so I'm constantly working on processing my feelings and noticing changes in my body that's that's something I'm kind of well aware of but when I discuss that or talk to clients with that it's kind of a bit of an eye opener knowing what we do in stressful situations how do we cope when we're stressed and then looking at maybe the parts that we don't really pay much attention to would you agree with that or not? Yes that's certainly a good diagnostic model to look at the different senses of the self or like you've just said there so for example somebody who comes in highly cognitive but they actually want to express their feelings yeah then you may have that as a goal but you'll probably have to work through the major channel of cognition get to that part yeah yeah 100% I agree because I will trip anybody up if they get me to go straight to my feelings it's like who the hell are you get away but it's just having an awareness around how we all process things differently I think for me I'm all about awareness and once something's in my awareness then I have a choice that I can do something with it well then you are probably in exalted areas because that's what Freud said oh are you up? I'm Freud the father of psychology and certainly the father of psychoanalysis his position was that if a person develops awareness just like you're talking about uh that for him was cure because from a place of awareness they then got choices well there you go then that's what but seriously that's that's my big thing that I talk about all the time with clients so did Fritz Paul's so so did Fritz Paul's the originator of Gestalt psychotherapy which is his major position was awareness and contact yeah and most of his experimental work and Gestalt psychotherapy is all about that so you move in exalted company well I have no idea what that means but thank you very much yeah I agree with you awareness is is crucial because without awareness often motivation lacks without motivation you know certainly action is impeached so awareness is really very very very important and from that choices might happen and action might happen so many psychotherapies put awareness as top of their bill yeah and I think it yeah I just find it really interesting that you do you know what I mean up until I started my psychotherapy training I was pretty much walking around with blinkers on and not really paying much attention to my response or reaction to 99.9% of things that were going on in my life yes and you may unconsciously or consciously choose not to allow yourself to be aware yeah I think it was probably a conscious thing that I was doing a lot to the side whereas now I've got my blinkers off yeah I'm just thinking think of many clients who come in who aren't aware and then I think of somebody the other day who had a particular traumatic thing happen to them or they're involved in when they were a lot younger and they'd think often if they did think about it or was aware of it they stopped themselves thinking about it or being aware of it so therefore slipped into a different levels of unconsciousness but the problem was that that process still drove the organism so to help the person be aware or allow themselves to be aware is one of prime jobs of a psychotherapist yeah which is understandable that we would do that Bob because it's self-protection and self-preservation if we've been through a trauma it's our instinct to not want to think about it or not want to go there yeah absolutely and the trauma is put in a compartment yeah a honeycomb and you look at honeycombs you lift it up you'll see lots of little compartments in the honeycomb and that's my analogy for trauma we have the trauma and put into a honeycomb compartment and shut the door yeah and I think a lot of us do that with different things that occur in our life but then it does tend to come out at some point later on yeah and it certainly leads to a or may lead to a sense of self which is not particularly healthy in terms of the subject matter we're talking about in terms of self-esteem yeah yeah and you know I know we've discussed it in podcast in the past those those separate parts of ourselves that need integrating and bringing together to you know to heal really yeah integration yeah and I would say integration for me we've had a podcast on cure so it's a really big subject area but integration for me is the name of the game in therapy in other words that people can take back parts of cut off defended against disavowed that we can take ownership of again so we can become whole yeah from that place we can move on now that's a long-term process but that's I think the name of the game for a lot of class I used to work with yeah and again I know we've spoke about it in the past but another thing I think is quite important is compassion for ourselves when we're looking at self-esteem and our sense of our self as well I think you know with with trauma there always comes guilt and shame and all those sorts of things so you know to be compassionate with ourselves that whatever we did in that moment was with the best of intentions we did the best that we could with what we had available at the time especially the last bit there you said of what we had available at the time the resources around yeah I go for I'm going to pick up on that and say therapy takes a very much longer you know if we can't find compassion for ourselves and really I think the hallmark of therapy is when we can start facilitating the client to be kind to themselves because without them being kind and friendly to themselves we the client's got a hard job on his hands because what what happens is they usually have a negative part which is attacking them yeah that part of themselves which can actually stand up to the attacker what happens then the self goes underground and certainly self-esteem goes underground yeah that's a really good way of putting it that yeah and it's true I think you know that that is one of the main things that we we do I was thinking when you were talking then there's there's something about if we show compassion to ourselves it means we can't be compassionate to others it's like we only have one bit of it and we've either got to point it inwards or point it outwards well that's an unhealthy position so they really work on that yeah there's a whole therapy movement called compassion focused therapy and I think it's a such a big part of the therapeutic process now the other side of this of course is that their business needs to be compassionate with themselves yeah they can't be compassionate with themselves how can they model that down to clients yeah is this still something out there with the general public or you know just general consensus that you know being compassionate and self-love and all those is selfish yeah you hear that all the time selfish self-indulgent particularly yeah hear those phrases and a therapist needs to combat that and reframe that whole you know to self-care to be friends with yourself yeah they need to frame those attacking defining sentence constructions which is usually come from a negative critical pair somewhere or something together which they've internalised because it is really important what you said for us to model that but in doing that you know showing compassion and self-love to ourselves we as therapists need to prioritise ourselves in the relationship as well you know that we're taking care of ourselves we're not burning out we're ready you know and open and willing to see the clients when we're going in though we're not taking on too many clients we're aware of our own mental health and all of the above yeah we talked about I think it was only about I don't know five podcasts again I lose track of this where we talk about compassion fatigue yeah exactly what we're talking about here so you know but I will go as far to say that unless we can get to a place where the client can utilise or be in touch with their compassionate self and then self-esteem is not likely to grow self-esteem will only grow in the daylight it won't grow in the dark unfriendly places Bob you never cease to amaze me in every podcast with your little gems of wisdom that you come up with I need to go back and re-listen to all of them because there's never an episode where you don't blow me away well it's true isn't it it is very true yeah very true yeah you see we're guilt shame negativity they all lie in wait in the dark unfriendly parts of the soul until we get some light on those parts they will inhabit that dark part of our soul so we need to use compassion and kindness and love to get a torch in there so that those parts of ourselves wither away because they are the destroyers of self-esteem yeah but the therapist has to help the client do that yeah and one of the best ways is by modelling compassion to make them a cup of tea when they come in say hello how have you been say what's been happening in your week say oh I was thinking about you I'm really curious after what you said last week say these sorts of things that's a really powerful thing that which to say to a client I was thinking about you earlier on or I was thinking about you that's that's a connection that I've been picked up on you know when a client said I never thought that you would do that outside of the therapy room there's a real connection when that happens yeah yeah I've been thinking about you you're important to me yeah that compassion isn't that love isn't that curiosity isn't that self-regard yeah and a therapist needs to go out of their way to make those transactions they have to model it downwards and of course we know that clients may actually defend against that because they've never had that in the first place so they may think it's a trick or goodness knows what the therapist needs to have that intent yes it's the intent which is as important as the action yeah and it's really powerful that Bob really powerful I know it is for me I've been on the receiving end of that in therapy and it is powerful yeah the intent is the bit and hopefully we can get the action but you know unless the therapists can come from that position how can the clients yeah never really take it on board they have to work together they're on the same journey not opposed to each other yeah that type of self-esteem may not thrive yeah that's lovely Bob thank you so much I really enjoyed this episode good and me and me so you take care I will do you as well what we're going to do and love to you Bob what the next episode what we're going to be looking at is working with the perfect client oh my god the people that set themselves up to fail the perfect client is the such a thing that's what we're going to be looking at next time Bob is there such a thing as a perfect human all right well what a wonderful subject area okay okay so until the next one I'll speak to you soon yeah take care bye bye you've been listening to the therapy show behind closed doors podcast we hope you enjoyed the show don't forget to subscribe and leave us a review we'll be back next week with another episode