SelfEsteem in AtRisk Adolescents:

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Self-Esteem in At-Risk Adolescents

• Helping Teens Cultivate a Healthy Relationship
  with Themselves
• Nancie Tormey, Ph.D.

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This workshop will

• Define self-esteem and related concepts
• Explore the causes and costs of low self-esteem
  in teens
• Offer strategies for increasing self-esteem among
  at-risk adolescents

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Adolescent development A quick review

• The primary developmental task of adolescence is
  building a sense of self.
• This process occurs at a time of rapid
  physiological, emotional, and cognitive change.
• Goal is to develop positive sense of self that is
  flexible enough to adapt to new situations, yet
  stable enough to provide a sense of continuity of
  self.

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Clarifying Terms

• Self-efficacy the belief in ones own ability or
  competence to perform a specific task
• Self-concept a cognitive appraisal of the self,
  integrated across various dimensions
• Self-esteem ones sense of self-value or worth
  a result of evaluating ones self-concept.

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Distinction between Self-Efficacy and Self-Esteem

• Self-efficacy
• Judgment of self-confidence
• Context sensitive can be task/domain specific
• Made in reference to some type of goal
• A matter of Can I do this?
• Self-esteem
• Judgment of self-worth
• Not context sensitive, not task specific
• Cognitive appraisal independent of goal
• A matter of How do I feel about myself?

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How the Thoughts Differ

• Typical Self-efficacy statement
• I am confident that I can write an essay for
  college applications.
• Typical Self-esteem statement
• Thinking about college applications makes me feel
  inadequate.

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Teen Friendly Terms

• Self-esteem isnt about bragging or thinking how
  great you are.
• Its more like quietly knowing that youre worth
  a lot.
• Its not thinking you are perfect, but knowing
  you are worthy of being loved and accepted, just
  as you are.

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In Normal Adolescent Development

• Self-esteem tends to be relatively low during
  early adolescence.
• Overly self-conscious and self-critical
• During middle adolescence, self-esteem rises.
• Successful experimentation, developing competency
• In late adolescence, self-esteem becomes stable.
• Experimentation with roles and efficacy behaviors
  lead to integration into coherent self.
• (Newton, 1995)

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Where Does Self-Esteem Come From?

• It is a work in progress
• Self-esteem is largely developed during
  childhood.
• It is based on our experiences, how we interact
  with others, how we perceive our abilities,
  personality and appearance, and connectedness to
  the community.

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Childhood Experiences that Lead to Low Self-Esteem

• Being harshly criticized
• Being yelled at or physically abused
• Being ignored, ridiculed, or teased
• Being expected to be perfect all the time
• Experiencing failures in sports or school
• Being judged as unattractive by peers
• Having few social connections in community

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Effects of Low Self-Esteem

• Low self-esteem has a negative impact
• on these domains
• moods (depression, anxiety, anger, hostility)
• Thoughts (self-deprecation, negative
  expectations)
• behaviors (risk-taking, substance use)
• relationships (distrust, avoidance)
• goals (low expectations, fear of change)

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Three Faces of Low Self-Esteem

• The Imposter
• Masks happiness and success, but is terrified
  of failure and afraid of being found out.
• The Rebel
• Acts like others opinions dont matter. Lives
  with anger about not feeling good enough.
• The Loser
• Acts helpless and unable to cope, and waits to be
  rescued.
• (University of Texas at Austin, Counseling
  Mental Health Center, 1999)

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Childhood Experiences that Lead to Healthy
Self-Esteem

• Being praised
• Being listened to, and validated
• Being spoken to respectfully
• Getting attention and affection
• Experiencing success in school or sports
• Having trustworthy friends
• Feeling connected to neighbors, relatives, friends

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Correlates of High Self-Esteem

• A classic study of self-esteem in 5th and 6th
  grade boys found that boys with high self-esteem
  showed less conformity, more creativity, and
  better academic achievement. (Coopersmith, 1967)

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High Self-Esteem is Related to Low Social
Conformity

• Subjects judged the lengths of lines after a
  group of other children had all chosen the same
  incorrect line.
• Among boys with high self-esteem, 63 stated
  their own correct judgment even though it did not
  conform to the groups judgments, but only 12 of
  those with low self-esteem did so. (Coopersmith,
  1967)

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How Self-Esteem Affects Our Thinking

• Teens with healthy self-esteem have self-talk
  that is positive and reassuring.
• Teens with low self-esteem tend to have
  self-talk that is overly harsh, critical and
  judgmental toward themselves.

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Assessing a Teens Self-Concept

• Self-definition
• What are you like? What kind of person are you?
  What are you not like?
• Self-evaluation
• What are you proud of about yourself? What do
  you like most about yourself? What are you not
  proud of? What do you like least about yourself?
• Self-interest
• What do you want to be like? What kind of person
  do you want to be? What do you hope for in life?
  What do you think is good for you?

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Assessing Self-Esteem

• Explore teens perceptions about
• Their social sphere
• How do they feel about their friendships?
• Family
• To what extent do they feel accepted by their
  family?
• School experience
• In which areas do they feel capable and
  competent, and in which areas do they struggle?
• Physical appearance
• How do they feel about their size, shape, skin
  color, features?

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Strategies to Foster Healthy Self-Esteem

• Cognitive approach (rebutting the inner critic)
• Behavioral approach (increasing mastery
  experiences making a success file, connecting
  with community)
• Intrapersonal Compassion Skills
• Other teen friendly strategies

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Cognitive Approach

• Help teens notice their self-talk.
• Point out patterns in their thinking.
• Im starting to notice you can be pretty hard on
  yourself.
• When we talk about your ex-boyfriend, you seem to
  get down about how you look.
• Teach them to talk back to or rebut their
  critical self-talk.
• Thoughts are NOT facts.

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Teens With Low Self-Esteem May Have Self-Talk
Distorted By

• Over-generalization
• A single negative event is seen as a never-ending
  pattern of defeat
• Disqualifying the positive
• Positive experiences are deemed not valid
• Emotional reasoning
• Emotions are assumed to be accurate reflections
  of reality
• Unfair labeling
• Instead of describing an error, a global negative
  label is attached to oneself (Beck, 1976)

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Talking Back to Over-Generalizing Self-Talk

• The critical self-talk
• I failed the French test. Im an idiot. Im a
  failure. Why bother trying
• The rebuttal
• I did poorly on one test, but Ive done OK on the
  homework, and Ive done OK in some other classes
  that were hard. Maybe I can talk with the
  teacher about how to do better.

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Talking Back to Self-Talk that Disqualifies the
Positive

• The critical self-talk
• The coach is only saying Ive improved because
  its his job.
• The rebuttal
• Maybe there is some truth to what he saysIm not
  the best player, but I have practiced hard, and
  friends have noticed I am fastermaybe he really
  does think that Im getting better.

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Talking Back to Self-Talk Involving Emotional
Reasoning

• The critical self-talk
• I feel like an idiot everyone must think I am
  the biggest idiot in school.
• The rebuttal
• I feel like an idiot but its just a feeling,
  not a fact. Feelings change, so it will pass.
  Everyone gets embarrassed sometimes. People will
  forget about it I can shrug it off.

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Talking Back to Self-Talk that Unfairly Labels

• The critical self-talk
• I cant do anything right.
• The rebuttal
• I really dont like how I handled that situation
  with my friends. I want to work on other ways to
  let them know when I am upsetmaybe I will
  apologize.

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Behavioral Interventions

• Increase mastery experiences
• Help teens find opportunities to succeed at
  helping others, learning new skills, teaching
  someone etc.
• Make a success file
• Ask teen to make a file of their accomplishments,
  awards, small successes, achievements
• Help teen make connections
• Learn what interests and inspires the teen and
  help them find a local mentor, group, club, or
  team. Connectedness is essential for everyone!

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Educate Teens about Emotions

• Help teens learn to identify their emotions.
• Educate them about universal human emotions.
  Help them not to judge their feelings.
• Teach them to respect their emotional needs.
• (affection, attention, love, affiliation,
  respect, protection, excitement, etc.)
• Teach basic self-nurturing.
• Sleep, nutrition, exercise, filling ones own
  emotional tank

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Intrapersonal Compassion Skills

• For teens who have a difficult time actually
  liking themselves, this set of skills is aimed at
  helping them to increase their sense of
  self-worth and self-acceptance.
• These skills can be integrated fairly easily into
  most treatment or support settings.

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SACRED Self

• Softness with Self
• Find Five Positive Attributes
• Create a Kind Environment
• Radical Self-Acceptance
• Deeply Like Yourself
• (Used with permission from Juliet Nelson, PhD,
  LCP unpublished manuscript)

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Softness with Self

• Notice when you are being hard on yourself with
  words or actions and agree to be softer. Add a
  gentle tone to your inner-voice. Be gentle and
  loving with yourself.
• Practice soothing yourself with a gentle touch
  rub your tired arms, stroke your hair, softly
  touch your cheek.

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Find Five Positive Attributes

• Find 5 things you can reliably recognize as
  positive about yourself.
• Make sure you choose things you know are true
  about you, and that do not waiver, even when
  other things fall apart.
• Character traits, past accomplishments, physical
  attributes, relationships, etc.
• Think of these aspects when you are struggling
  with self-criticism.

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Create a Kind Environment

• Try to spend time with people who are kind and
  gentle.
• Avoid people who tend to blame, criticize, or
  otherwise reinforce your negative self-talk.
• Arrange your room or locker to positively reflect
  yourself.
• Make plans with yourself that are special and
  follow through.

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Radical Self-Acceptance

• Willingly accept all aspects of self.
• Acceptance doesnt mean approval or agreement it
  is simply the acknowledgement of what is.
• Accept that you are human, that you have both
  failings and accomplishments in your life, and
  that you are inherently both flawed and gifted.
• Accept yourself wholeheartedly without fear that
  doing so will make you worse.

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Deeply Like Yourself

• Notice hatred or intolerance toward self.
• Step back from thoughts that are self-critical.
• Remember that liking yourself is a step toward
  recovery and is worth actively working on.
• It does not make you self-centered, but increases
  your ability to like and help others.
• Consider yourself one-of-a-kind, and therefore,
  sacred.

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Other Teen Friendly Techniques

• Against the odds
• Name the nerd
• The protective shell
• The positive ally

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Tell Teens About Famous People Who Have Succeeded
Against the Odds

• Beethovens music teacher told him he was a
  hopeless composer.
• Sylvester Stallone was a juvenile delinquent.
• Thomas Edisons teachers told him he was too
  stupid to learn.
• Michael Jordan was cut from his high school
  basketball team.
• Walt Disney was fired by a newspaper editor for
  lack of ideas.
• (Bernstein, 1996)

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Name the Nerd

• A good group exercise
• Teens are shown pictures of awkward looking
  adolescents who have become famous as adults, and
  are asked to identify them.
• A graphic illustration that appearances can
  change dramatically
• A springboard for discussion
• (Bernstein, 1996)

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The Protective Shell

• Identify an area of your body that feels safe and
  confident and imagine this feeling radiating out
  from the body and forming a protective shell
  around you.
• Imagine someone critical (or a critical thought)
  coming toward you that is hard to keep out
• But this time the protective shell creates a
  boundary that cannot be passed.
• (Wexler, 1991)

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The Protective Shell contd

• Next, imagine a person (or thought) whom you do
  welcome and to open a window in the shell that
  allows him, her, or it inside your boundaries.
  Then close the window again for self-protection.
• The shell can protect teens from thoughts that
  continue to intrude and denigrate.
• The imagery captures the themes of
  self-management, self-soothing, and self-efficacy.

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The Positive Ally

• The ally is someone of the teens choice who
  serves as a coach, guide, teacher, or special
  friend to the teen.
• The ally has a sixth sense about what the teen
  most needs at any given time.
• Teen is asked to consider who their ally might
  be.
• Could be an actual family member or friend, or an
  imaginary figure modeled after someone.
• (Wexler, 1991)

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The Positive Ally contd

• Teen is asked to check whether they have selected
  an effective ally, by noticing if the person has
  a soothing, calming effect on them when they
  imagine him or her.
• Next, teen is asked to imagine an upsetting event
  or think of someone who makes them feel bad.
• They observe the effect on their emotions and
  body cues.

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The Positive Ally contd

• Next, teen is asked to imagine and describe in
  detail their ally figure or experiences they have
  shared together.
• Teen is asked to observe how she/he feels.
• Invariably, they notice the difference.
• A powerful illustration that we all carry within
  ourselves ally figures who can calm and soothe us.

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The Positive Ally contd

• The ally is also a vivid way to help teens engage
  in more supportive self-talk.
• The teen is asked to imagine what their ally
  might tell them that would be more realistic,
  helpful, or supportive than their negative
  self-talk.

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Summary

• Self-esteem is an appraisal of ones self-worth.
• Many teens in early adolescence have low
  self-esteem, and the vast majority of those who
  are clinically referred struggle with these
  issues.
• Low self-esteem puts teens at risk to develop
  mood, anxiety, behavior problems, relationship
  difficulties, and academic underachievement.

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Summary cont

• Self-esteem can be fostered in a variety of ways
  including
• Teaching teens to talk back to their critical
  self-talk
• Increasing mastery experiences, community
  connections
• Teaching teens intrapersonal compassion skills
• Practicing imagery techniques

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We acknowledge with gratitude the Pennsylvania
Legislature for its support of the STAR-Center
and our outreach efforts. This presentation
may not be reproduced without written permission
from STAR-Center Outreach, Western Psychiatric
Institute and Clinic, 3811 OHara Street,
Pittsburgh, PA 15213. [phone] All
Rights Reserved, 2006
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• Nancie Tormey
• STAR-Center of WPIC
• Acct. 0931
• 46 slides
• Slides will be picked up at the Medical Media
  office at McKee Place
• For questions call Jamey Covaleski
• [phone] or covaleskijj_at_upmc.edu