Therapists’ Inadequacies

Introduction

I started with a question on “what makes us tick” because of interest in why the undesirable and inadequate seemed to be at risk for unfair treatment (i).  As a result I read “How The Mind Works” by Steven Pinker (ix) over twenty years ago and have been reading on the subject matter ever since.  In retrospect, it was unreasonable for me to think I would get answers from therapists as they were misinformed, tact and willed a client base (vi).

But as someone whom has struggled with social anxiety and depression, I knew from my experiences and research that the nature and origins of these problems were misunderstood.  So I have decided to devote several posts to carefully explain thirteen conclusions that have an impact on how therapy is conducted as well as provide supporting evidence.  My questions were later answered not by therapists but by Herman Hesse’s poetry which says that life is a “struggle for position and a search for love”.


Contentions with Therapy

When it comes to the topic of low self-esteem, I contend that most therapists employ ineffective and even damaging methods to treat it [4].  The most obvious to criticize is the, quite frankly, foolish use of self-affirmations which cannot only backfire but evidence to support its efficacy is either weak or all together absent [4, 42].  In fact, I will argue that we can’t treat low self-esteem at all because it’s more of a feature of our personality, which is relatively stable over time and situation, than it is a learned way of perceiving that the glass is either half empty or half full [4, 8.1, 21, 38].

And when we think we are treating it, say by challenging negative core-beliefs and schemas, we are in fact treating a low-mood state due to negative social experiences but not global self-esteem [16].  Furthermore, targeting self-esteem per se with a cognitive approach has a very limited number of studies to show its efficacy and effectiveness and all studies have the glaring problem of not being able to control for the confounding variable of social acceptance acquired through the patient to therapist relationship, in which self-esteem is very responsive to [19].

I believe this difficulty in treatment stems from a failure to understand self-esteem’s purpose as well as what it means to have low self-esteem.  And, to be sure, self-esteem is dependent on what others’ think of us, despite therapists expounding that it’s an “inside job”, since its purpose is to assist us with social acceptance and to help place and navigate us within a social hierarchy [10, 26, 36, 40].  In fact, the ultimate function of self-esteem has even been termed as being a sociometer in that it monitors the degree to which others value and accept us, that is, our inclusionary status [26].

To be fair, the construct of self-esteem does have more dimensions to it than just desiring to be accepted by others and acquiring status and rank – which is known as self-acceptance (iii) and measured as global self-esteem (iii) – but the parts that have the greatest effect on mood states (iv) and wellbeing (ii) are in fact about how much others value us and where we stand in relation to them when doing unconscious self-comparisons, in which, I will add, therapists have little to no influence over [31].


Influences on Therapists

Some of these conclusions may not be explicitly stated within the field of social psychology; nevertheless, they can easily be shown to be true through inference.  Yet these ideas are largely rejected by a significant portion of current day therapists (vi).  I attribute this to the industry being influenced by the standard social science model [34], the codependency movement and from positive-humanistic psychology [28].

There are two ideas that have become axiomatic amongst therapists as a result: we are in control of our behavior and that we don’t need external validation.  To touch upon the latter, intrinsically motivated pursuits do foster autonomy and correlate with global self-esteem [1]; however, Maslow reminds us that order matters (x).  We should not be trying to self-actualize a person without looking at the patients’ interpersonal status amongst peers and family first.

And instead of implying that desiring approval is a weakness, it should be stated that looking for it incurs risk.  It’s a matter of strategy not absolutes.  In fact, all behaviors and endeavors, even those that are motivated to do work for the sake of it, are subject to a person evaluating the outcome relative to others’ standards as well as engaging in self-comparisons (xiii).  And for those that say they don’t need it, it is because they already have it, “as we are only as needy as our unmet needs” (xii), [29].

So the claim that we should be self-validating is pandering to a fiction that can easily be disproved as we are highly dependent on one another in countless ways, mostly unconsciously, and are wired to be emotionally connected to the extent that our happiness and well-being depend upon it [5, 26, 29, 30].  This myth is so pervasive that some biologists are at battle with therapists’ indiscriminate approach to diagnosing codependency, which if misapplied can have disastrous effects to an existing relationship [29].

These conclusions are not just academic points but points that matter for application that therapists should take heed to if they are to effectively treat low-mood states, depression, and social anxiety.  Because they are simply off the mark when trying to imagine the causes of many problems as witnessed by their inordinate focus on the ideas that early caregivers and dysfunctional learned thoughts and behavior explain everything [16, 20].


Notes

i) intrinsic worth, that is, humans possessing value by virtue of being human is just not reflected in our day to day experiences

ii) happiness is about fulfillment and satisfaction and wellbeing is about contentment but includes physiological health aspects

iii) global self-esteem is not state or specific self-esteem as it reflects the average feelings we have towards ourselves

iv) mood states are reflected in state self-esteem not global; global is a an aggregate and state is an instantaneous measurement

v) standards used to evaluate ourselves are not private because we imagine how our attributes come across to others

The attributes on which people’s self-esteem is based are precisely the characteristics that determine the degree to which people are valued and accepted by others (Baumeister & Leary, 1995). [28]

vi) sample size of n = 12 therapists and psychiatrists; claims are only for the treatment of depression and social anxiety

vii) it is a gross error to skip the interpersonal part to self-esteem in favor of self-efficacy as relational value needs come first [13]

viii) ones’ interpersonal status is primary; assessments on temperament, personality and attachment style to fine tune treatment

ix) as much disdain as many have towards evolutionary psychology, it provides a useful framework to view interpersonal problems

x) empirical support for the hierarchical arrangement of Maslow’s pyramid exists but self-actualizing is not a fundamental need [13]

xi) personality: neuroticism; temperament: inhibitedness; traits: high sensory-processing sensitivity, rejection sensitivity [38]

xii) dependency paradox says that once we belong and feel valued only then can we venture out with confidence and explorer [29]

xiii) we make self-comparisons to validate the outcome or process regardless if intrinsically or extrinsically motivated [14]


References

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