Karemi Rodríguez Batista: "In cases of low self-esteem, the objective is not to ’raise’ it, but to improve self-acceptance".

The founder of Psico-K explains the therapeutic process in cases of low self-esteem.

There are few mental health professionals who are capable of dealing with thousands of cases in their private practice and who at the same time find time to devote to a noble vocation of dissemination.

Among this small and select group of psychologists we find Karemi Rodríguez Batistafounder of Psico-K.

Interview with Karemi Rodríguez Batista: how is low self-esteem treated in consultation?

With a wide experience in face-to-face psychotherapy sessions in Madrid, and also online, Karemi is a psychologist with a very interesting and multifaceted career. We wanted to share with you today a talk we had with her about self-esteem as a concept, and cases of low self-esteem in consultation.

Bertrand Regader: According to your experience working in therapy, what type of situations are the ones that most frequently generate self-esteem problems?

Karemi Batista: Complex question. In a quick and general way I would say that the problems derive from a lack of self-acceptance. It certainly influences if we have been raised in a highly critical and punitive environment, having little contact with our inner experiences and our needs. Some situations that trigger them are when the person goes through the loss of something valuable with which he/she has merged, or life crises.

The construct of "self-esteem" is generally understood as one's evaluation of oneself and one's self-concept. Then, the question we ask ourselves is, according to what this valuation would go up or down.

If through my learning history I have been valued based on my beauty, status, money, power, fame, etc.; or if my sense of worth is based on who I am with (my partner, my colleagues, my family, etc.) or if I weight one behavior of mine over others, evidently, when any of these attributes are missing (and this will happen sooner or later), my self-esteem will be damaged. And this is where we touch dangerous ground and it is for several reasons. The first is that they are external and changeable circumstances or attributes in which I place my overall worth, and in which I would not have much control, or because I merge with that concept of myself and lose sight of other aspects of myself that are more enduring and really significant in my life, such as my real values. For example, let's say that I dislike that person I like so much or that I fail in a task I was looking forward to, then I condemn myself and label myself globally as "stupid, useless, worthless, etc...".

That I made a mistake makes me stupid, that someone does not appreciate me marks my value as a person? Well, this is what often happens to us. Nor is it a question of rating ourselves positively in a global way according to achievements, because as soon as I do not obtain them, I return again to self-contempt and to the contempt of others.

In short, from my point of view, the most effective thing would be to move from the construct of self-esteem to that of self-pity, which does not depend on external circumstances. Moreover, if we do not accept ourselves and are not compassionate with ourselves, we will hardly be compassionate with others and this will be to the detriment of meaningful social relationships.

Does this type of psychological discomfort usually appears in childhood, or does it generally arise at any time in life?

In any situation that triggers what I mentioned above, although its origin is in childhood. It is there where we learn to have private (from me) or public (from others) control of our experiences. That is to say, to know what I really feel, think and want, and to act according to it or according to others.

If as children we have been criticized, demanded and punished a lot, this will be a very strong tendency that will condition our vision of ourselves, contributing to problems related to anxiety, depression, emotional dependence, biased thinking styles (focusing only on the negative, overgeneralizing, drawing hasty conclusions, etc.). ) and ineffective behaviors in relation to a life of value, such as blocking, avoiding, procrastinating, not setting appropriate limits, etc...

Other critical moments can be in adolescence, and here the social group in which we would include social networks, influence a lot. We can mold ourselves according to what they dictate with little or no discrimination of what I really want, and this is dangerous.

Do people with self-acceptance problems tend to see this as a treatable problem in therapy, or do they more often confuse it with their own identity and believe it cannot be remedied?

Very good question. You make reference to a key point, which is to confuse these partial aspects, whether negative or positive, with one's own identity. There are many people who come to therapy explaining specifically in the reason for consultation: "low self-esteem". I have yet to meet someone who tells me: "lack of acceptance or compassion for me," for example. It is then thought that once we "raise our self-esteem" (again, most of us think this is once we achieve certain goals or think positively about ourselves), our problems will go away. This is not the case.

There is a problem of expectations to work on as well, many "achievements" do not depend on us and it is difficult for many to delimit this. Here the culture of "if you want, you can" influences a lot. And if we combine this with a learned tendency to demand too much of ourselves, the frustration and suffering is even greater.

There are many individual factors that influence whether it is perceived as something "remediable" Landing the construct in self-acceptance or self-compassion, no doubt there are patients with more resistance to it, because of their own life history and current context, and this is where we must be much more careful, validating and patient as therapists. I believe that if we do not work on this aspect, the rest will most likely fail, but it is worth it.

What kind of strategies do psychologists use to help their patients with low self-esteem?

This will depend a lot on the particular characteristics of the patient and his or her context, in addition to the approach with which it is approached, of course. It is therefore crucial that we make a good conceptualization of the case, as well as a thorough functional analysis of the problematic behaviors that derive from it.

In very general terms, rational emotive behavioral therapy, for example, would help the patient to foster unconditional acceptance of him/herself regardless of the positive or negative "evaluation" (which is not resignation) and to redirect him/her towards goals. These objectives are shared by acceptance and commitment therapy, although with a different approach, where the focus would be to work on self-compassion, strategies directed towards the defusion of those "contents" (partial self-evaluations perceived globally) taking perspective, acceptance of oneself with his/her weaknesses and strengths, and from here help people to know what they really want and need to address goals according to their values, and to find more effective behaviors to do so. All this, depending on the case, can be expanded with powerful strategies derived from cognitive behavioral therapy (as long as they are consistent with our approach), such as training in problem solving, social skills, etc. ...

Once we achieve this, we help him/her to be more aware or more attentive in discriminating what was effective, when, where, how he/she did it, etc., thus generating a feeling of self-efficacy, if you will, more under his/her own internal control. And in this way we try to generalize this new behavioral repertoire to other areas of their life.

What about people with over-inflated self-esteem, what do you do in these cases?

If this self-esteem is too inflated to be something very rigid and stable in various contexts of the person from an early age, and from here derive dysfunctional behaviors such as a pattern of behavior directed towards excessive search for admiration, little empathy, exploitation of others to achieve their goals, etc., can lead to what is known as narcissistic personality disorder.

A relevant issue is that people with these characteristics do not usually ask for help, because the explanation of their problems is usually directed towards others, towards the outside; and they tend to think themselves at a much higher level than others, including the therapist if he or she goes, so why would he or she go? What can we teach him or her?

People with these patterns of behavior are very dependent on external social reinforcement, such as praise, admiration, excessive need for attention, etc. and if they don't get it, they run away from the situation as a way to avoid the Pain of not getting it. Imagine the challenge for the therapist.

As you can see, it is a very complex situation. It is true that all this has to be grounded on a case-by-case basis and there are exceptions, among them when what they depend so much on (the approval of others based on external and unstable attributes or circumstances) is no longer present. Here the recommendation would be to work on this "unstable self", on self-pity as a first point. A very effective approach to these problems is functional analytic psychotherapy.

Approximately how long does it take to go from having a very low self-esteem to having a more balanced one, thanks to psychotherapy?

There is no definite time, this would respond again to many individual factors and the context of the person as well as the approach with which it is approached. What I can tell you is that the best results and in the shortest possible time are being found in cognitive behavioral and/or contextual behavioral approaches.

How can friends and families of people with low self-esteem who are seeing a psychologist help?

By supporting them in this process. If necessary, the therapist will consider, with the patient's permission, of course, incorporating the family member as a co-therapist, and will indicate specifically how this can best be done.

There are no general guidelines, since problem behaviors have a different function in each person, what may be reinforcing for me may be aversive for you, and there we mess it up. The only thing that is clear to me that can be a more general recommendation is to be compassionate with him or her, helping him or her to be compassionate with himself or herself, constantly directing attention to what he or she is doing well, to his or her strengths, and reinforcing it.