Therapy for a low opinion of yourself
Low self-esteem is a settled sense that you are less capable, less likeable or less deserving than the people around you. It can sit quietly behind good marks, a steady job and a full calendar, and still decide what you try and what you avoid.
Carolina Vintu, PhD, is a Registered Psychotherapist in Ontario, and difficulties with self-esteem are among the concerns she works with. Sessions are by video for adults and adolescents anywhere in the province. You can start with a free 15-minute consultation.
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What it can sound like on an ordinary day
Each line below is a made-up example. Many people recognise one or two of them, and that on its own says nothing about what you have.
"Everyone else seems to know what they're doing."
You stay quiet in the meeting, then replay on the drive home what you could have said.
"They're only being polite."
A compliment slides off within a minute, while one critical remark stays with you for days.
"If it isn't perfect, it isn't good enough."
A two-hour task takes the whole evening, and handing it in still feels like a risk.
"I'd better not ask."
You take on extra work and agree to plans you don't want, because saying no feels like it could cost you the relationship.
"I just got lucky this time."
A success goes down to timing or other people's help. A mistake goes down to you.
Why the belief survives good news
Cognitive behavioural therapy describes low self-esteem as a loop. This version of it was set out by the psychologist Melanie Fennell, and it is the model the review further down this page looked at.
A belief
Often formed early, from how you were treated or compared: "I'm not good enough."
A rule to live by
A way of keeping that belief out of sight: "If I never make a mistake, nobody will notice."
A test of the rule
A new job, a first date, feedback at work. Anything where the rule might be broken.
A prediction and a precaution
"I'll get it wrong." Then over-preparing, putting it off or keeping quiet.
What it seems to prove
If it goes badly, the belief looks right. If it goes well, the precaution gets the credit.
Either way, the last step leads straight back to the first. Therapy can work on several points of the loop: the rules, the predictions, the precautions and, over time, the belief underneath them.
How Carolina may work with it
Her approach is integrative, so the way of working is chosen with you. These are the approaches she uses, and the part each one can play with self-esteem:
In CBT, you write down the thoughts that come up in a hard moment and check them against what actually happened.
In ACT, the aim moves from arguing with the critic to doing what matters to you while it keeps talking.
In IFS, the critical voice is treated as a part that is trying to protect you, and you find out what it is afraid of.
With mindfulness, you practise catching a thought such as "I'm useless" as a thought, a few seconds before it becomes a mood.
What a review of this kind of CBT found
In 2018, a team at London South Bank University pooled the studies of CBT built on Fennell's model. Eight studies met their criteria and seven could be combined. The bars show the average change in self-esteem scores after treatment, as an effect size, for each format.
Depressive symptoms changed in a similar way. The scores were people's own ratings of themselves, and the authors write that it is still unclear whether this treatment differs from CBT aimed at low mood.
A separate analysis of 77 long-term studies from the University of Basel found that low self-esteem predicted later depressive symptoms more strongly than the other way round. In the 18 studies of anxiety, the effects ran about equally in both directions. Figures like these describe groups of people, and they cannot say what will happen for you.
When it comes with worry, low mood or a move
Alongside worry or a low mood
If constant worry or a flat, heavy mood is also part of the picture, the pages on anxiety therapy and depression therapy describe how Carolina works with each. If tiredness or poor sleep come with it, your family doctor is the place to check for a physical cause.
After a move to a new country
One move can take away a career, a language and a circle of friends, and with them many of the ways a person used to know they were capable. Carolina works with relocation and adaptation to a new country and culture, and the page on immigrant issues says more about it.
Starting with a 15-minute call
The first step is a free 15-minute consultation call. You can say what you've noticed, ask how sessions work and then decide whether to go on.
Individual sessions are $180 and take place by video, so you'll need a private room and a stable connection. The online therapy page covers the practical side, and individual therapy explains how one-to-one sessions are set up.
Carolina provides psychotherapy in English, Russian and Romanian. If talking about yourself feels easier in Russian, see therapy in Russian.
Questions people ask about therapy for self-esteem
No. Self-esteem is the way you see and judge yourself. It is not a diagnosis in itself, and you can bring it to therapy as the main thing you want to work on.
No. Telling yourself you're great is easy to dismiss when part of you believes the opposite. The work is closer to checking evidence: what you predicted, what really happened, and what you did in between to stay safe.
Carolina works with adolescents as well as adults. The teen therapy page explains how sessions for young people work, and the article on consent and privacy in teen therapy covers what parents are told.
There is no set number. It depends on what you want to change and how often you meet. You can talk about length and frequency on the consultation call and look at it again as you go.
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