The document discusses techniques for enhancing self-esteem and self-worth, especially after trauma. It outlines several key techniques: 1) Working through unresolved guilt, anger, and shame which undermine self-esteem; 2) Increasing differentiation of self to reduce reactivity and improve decision-making; 3) Increasing a sense of belonging through meaningful social connections and activities that help others. It provides details on using these and other techniques like affirmations, reframing negative beliefs, and acting as if one already possesses desired attributes to help individuals heal from trauma and develop confidence.

1. WORTH: NOTES ON SELF-ESTEEM and SELF-WORTH ENHANCEMENT
- Demetrios Peratsakis, LPC, ACS; March 2018
The treatment of unresolved trauma and emotional pain is a significant part of the counselor’s work.
While its effect can be varied, the leading cause of harm is a psychological injury to the individual’s sense
of Self-Worth, a complicated construct indivisibly tied to one’s capabilities and value in relation to others.
Every individual strives for competence and recognition; every individual strives for social acceptance
and social belongingness (Adler).
Background
Several factors may contribute to negative self-regard although most, including failure, abuse, tragedy,
loss and betrayal, are typically categorized as some form of trauma. In its broadest term, trauma is a
disruption to one’s sense of security and safety –one’s ability to protect oneself and others from harm,
protection by others, and the ability to recuperate and to heal. When found wanting, the individual will
experience feelings of guilt and shame, a devaluation in the estimation of their personal and social worth.
If the individual has been victimized, betrayed or blamed for inadequacy or failure they will also
experience anger and possibly resentment or rage. It is for this reason that guilt and shame are so closely
associated with anger. They form a corrosive triad that undermines one’s self-esteem and detracts from
one’s willingness to trust and be vulnerable with others, key requirements of intimacy and love. Often, the
anger is not readily apparent and may be suppressed in the form of anxiety, depression, or physical
illness. It may also express in more passive-aggressive ways such as failure and inadequacy or under the
pretext of self-blame or exaggerated remorse. In this regard, self-blame can be somewhat insidious,
deflecting the critique of others while conveying a sense of righteous indignation. For some, there may be
great “nobility” in the apparent struggle for repentance and forgiveness; “good intentions”, however,
often mask an unwillingness to change. This theme is common to chronic syndromes such as domestic
violence, depression and addiction.
To be instrumental, therapy should attend to stability and safety; reconcile guilt, anger and shame; and
restore confidence and competencies through engagement in meaningful activity with others. Treatment
of individuals with long histories of trauma or abuse may be complicated by ingrained, self-deprecating
beliefs and coping methods that exert power and control through helplessness and self-blame. See
https://www.ncbi.nlm.nih.gov/books/NBK207191/ for more on the effects of trauma.
Techniques
There is a broad range of guided as well as self-improvement technique helpful in healing trauma
including self-esteem and affirmation journals, boasting, gift-giving, reframing, and so on. I have found
the following indispensable and recommend their inclusion in every counselor’s tool-box:
1) Guilt, Anger and Shame (GASh).
To improve self-worth it is essential to work through unresolved issues of guilt, anger and shame;
even minor reductions in blame have immediate restorative value. Guilt, Anger and Shame are very
complex socio-cultural experiences inextricably tied to the opinion and judgement of others. They
fuel each other and are the root cause of anxiety and depression. Countering their effect requires more
than consolation and the untangling and reinterpretation of beliefs, it necessitates that existing power-
struggles be disengaged and redirected, that accompanying anger be reconciled, and that amends, or
even retribution, be enacted. This work can be challenging for the therapist, as well as the client,
depending on the level of comfort one has with anger and its expression. Treatment is especially
complicated with individuals who 1) express anger in passive or passive-aggressive ways –such
depression, physical illness, failure or inadequacy, and 2) employ guilt and shame as a means of

2. controlling others or as rationales for excusing misconduct or avoiding the necessities of change.
Alder first pointed to the “nobility” or sense of righteousness that may accompany feelings of guilt
and shame, the implicit message being that “I know that I am no good, but at least I feel bad about
it!”
Strategies should include
a. Challenging skewed or faulty interpretations, rules and conclusions and exploring their origin and
how they help and hinder safety and obtaining one’s needs and desires.
b. Reframing the “nobility” inherent in guilt and shame as self-serving and “spitting in the client’s
soup” by neutralizing its underlying agenda or secondary gain. The best remedy for remorse is
change. The best form of retribution is success and moving forward.
c. Tapping into the anger and finding acceptable means of expressing it. There is a direct correlation
between guilt and shame, depression and anger. The importance of tapping into the underlying
anger cannot be overstated; doing so will lift the anxiety and depression. While a false sense of
empowerment, anger can be motivating and self-protecting so care must be taken on timing to
replace it with resolve and self-determination through activity and goals.
d. Involving the client in meaningful activity with others and activity with meaningful others.
Increasing meaningful belongingness or social interest increases one’s sense of self-worth;
helping others is the best antidote for depression and despair.
e. Working toward eventual forgiveness and redemption; moving from “victim” to “empowered”
2) Increasing Differentiation of Self. This term, coined by M. Bowen, refers to the complicated
process of understanding and acting on the relationship between thought and feeling and its role in
shaping belief and interpretation. It represents a progressive, life-long process of striving for
autonomy (independence) while remaining in intimate relationships with others (interdependence) –a
formulating of one’s own, personal identity out of the collective consciousness of the family unit of
one’s birth (Family of Origin’s Family Ego Mass). Clarity in defining and maintaining proper
boundaries is a measure of such fusion or “enmeshment”. It defines the degree of volatility, of
“reactivity” to events which in turn drives emotional responsiveness to others. Bowen rightly
contended that increasing differentiation reduces overall emotional reactivity; this greatly improves
decision-making and problem-solving capabilities, skills essential to competency in navigating life’s
tasks and adaptation to change. Most therapies do this as natural part of their work: 1) Identify the
issues, interests and perspectives; 2) Demarcate feelings from thoughts; 3) Distinguish between one’s
feelings and thoughts and those of another’s; 4) Trace the origin(s) of the beliefs and the purpose they
serve in shaping one’s interpretation of roles, rules, and their corresponding conclusions. Since
(inter)dependence breeds fusion, continuous demarcation of “self” and therefore reaffirmations of
one’s own values and beliefs is important to good self-esteem.
3) Increasing One’s Sense of Belonging. As social beings we rely almost exclusively on others for our
definition of self and our appraisal of the degree to which we feel valued and loved. Our sense of
worth, therefore, is directly tied to the quality of our intimate relationships, which is why therapy
strives to mend breaches with family or friends. It is also shaped to a lesser degree by the quality of
our relationships with neighbors and colleagues and those that we interact with throughout the day.
This is an existential issue, our connectedness to work and to the larger community and the sense that
we are contributing to its greater good; in essence, that we matter to the world. Inopportunely, we
tend to minimize the importance of being industrious, to work, go to school or volunteer. These are
critical to adding structure and prestige to our lives and more importantly to adding meaningful
purpose. Connecting to others in a meaningful way, with purposive activity, is immediately
restorative and of immeasurable clinical gain. To improve one’s sense of self-worth (re)connect them
to others or move them to meaningful goals and activities with social purpose. Helping others is

3. extraordinarily restorative and should be prioritized as a process for healing and continual
enrichment; it markedly improves one’s sense of value and purpose in the world.
4) Acting As If. As the name implies, this technique utilizes behavior rehearsal by suggesting that one
“acting as if” they already possess a desired attribute or characteristic. A more sophisticated
application can be achieved by the creation of a new pseudo identity or idealized self. Moreover, by
its creation, one establishes a new time-line demarcating the past from what is controllable in the now
and future. It encourages exploration into a new way of being through the creation of a new
personage that helps the individual bridge the gap from how they currently view themselves to how
-and who, they wish to become. For example: Chrissy sees herself as timid and passive and wishes
she could be more assert her sharing her feelings with other. The therapist challenges her to do so by
“acting as-if” and together they arrive at a name for this more idealized person or symbol. While
“Wonder Woman” or the name of some actress or fictional character like Lara Croft may be fine, I
prefer a personal nickname or modification of the current name that implies more maturity, valor, or
greatness such as “Christina” instead of “Chrissy”: “So, Chrissy, if you were capable of finally doing
this and being more like that very capable woman you describe, let’s call her “Christina”, the name
your favorite aunt would use when she helped you to feel more bolstered, could you tell me how
“Christina” would do this? How would Christina go about making this happen?” Now a “super-ego”
version of the self has been created that can serve as a “lighthouse” to help guide the individual
outside of session. The new visage can be added to as a means to encourage change through forward
moving suggestions, such as “that’s the old way, the way that “Chrissy” would do it; tell me how
“Christina” would go about it.” A method of further entrenching this technique is the use of
hypnotherapy or guided imagery to visualize the change and expand its use to specific roles and rules
for behavior.
Read Richard E. Watts’ excellent article on working toward this with Reflective Acting As-If or RAI:
http://ct.counseling.org/2013/04/reflecting-as-if/
5) “Spitting in the Client’s Soup” is a very sophisticate technique for making the underlying agenda of
a certain behavior “unpalatable”. (Reportedly, the term arose from a common practice by children in
boarding homes of using their spittle to have another resident surrender their meal). By making the
covert intent, overt, the hidden agenda or motive is exposed thereby neutralizing some or all of its
utility and power. The behavior can no longer be practiced without reference to the new
interpretation. This is a very powerful form of reframing; once the goal of the behavior is disclosed it
short-circuits the common tendency to find another means of obtaining it, or of symptom substitution
(Mosak, 1968). The technique is employed when the therapist suspects that the motive for the
behavior is a passive-aggressive expression of power and control. Passive-aggressive behavior,
especially of revenge, diminishes one’s sense of self-worth. While it may be highly effective, it is a
less than mature –“under-handed”, method of impressing our will or punishing others. Direct, more
assertive remedies are more empowering. A simple method of introducing this technique is to wonder
aloud at a possible explanation; for example
 “It seems like you are trying to make me feel angry. Is that so I can push you away and then you
can tell yourself that nobody truly wants you?”
 “You seem to be punishing her with your depression (inadequacy/incompetence); that’s a clever
way to get even. You must be very upset with her!”
 Turning to the wife in session: “I wonder if he brought you here so that I can take care of you
while he leaves and escapes the marriage!”
It should be noted that even under the best of circumstances the client is likely to become angry at
having some negative intent ascribed to their actions or may simply become frustrated at the
cognitive dissonance created by the reframing. Irrespective, it is important to 1) predict that residual

4. anger is likely and 2) pay close attention to the need to reconcile possible disruptions to the
therapeutic alliance.
6) Forgiveness and Revenge
Social interaction creates continuous opportunity for conflict and hurt. Even when “justified”, we feel
responsible for the pain we cause others and experience remorse and regret. If we cut deeply, we can
equally be scared by our actions. The process of seeking forgiveness, of “Fessing Up and Owning”
one’s own misbehavior, helps to remedy guilt and improve one’s moral standing. It redeems our
sense of honor and makes us feel proud for having set things right.
Tell-tale signs of “open wounds” include
a. emotional cut-offs, or acts of departure, withdrawing or expulsion as a form of revenge;
b. cross-generational coalitions, collusions and other subversive alliances to gain or counter power;
c. open discord, especially with a parent, partner, child or loved one;
d. passive-aggressive power-struggles, including depression, failure, procrastination and suicide;
e. betrayals, especially infidelity, incest, sabotage and other forms of treachery
When a simple apology is an insufficient remedy greater amends or “Acts of Contrition” should be
considered. These can include simple forms such as writing a letter, poem or newspaper ad of
apology; holding a “confessional” with relatives, children, peers or co-workers; allowing the victim to
formulate an acceptable form of “punishment”; fasting, sacrificing a favored activity, destroying or
damaging a favored possession, giving away a cherished belonging or similar acts of absolution.
More sophisticated remedies, such as a prearranged public “shaming” or a period of “indentured
servitude”, are high risk interventions that require considerable planning and expertise.
It is important to recognize the role of remorse and revenge in ameliorating anger, and consequently
depression and despair. It is very difficult to forgive without some genuine expression of remorse. In
its absence, the desire for revenge as a form of justice will remain and fester. To reconcile anger, the
therapist must recognize the imperative for revenge.
Revenge, the desire to punish or see another suffer, is the counter-point to forgiveness. Despite the
discomfort it may pose, validating the desire for revenge and openly encouraging its discussion in
session provides a safer, more controlled venue for its expression. Moreover, formulating responsible
methods of “retaliating” or of achieving “revenge” may greatly reduce the likelihood of danger and
redirect the anger toward more constructive expression. While of potentially great therapeutic value
this should not be undertaken lightly and under no circumstances should the therapist “plot” or
collude to harm another; it is the simple recognition that “getting even” is important to our sense of
justice. The desire for punishment is greatest after acts of betrayal, especially treachery as sabotage,
domestic abuse, infidelity, or incest. It is the source of most rumination.
As a violation of the basic trust agreement, betrayal is the most complicated form of trauma.
Typically, only punishment and retribution will ameliorate the hurt which is the cause for continued
“arms” escalation through very active means such as threat of divorce or counter-affair or through
very effective, though passive-aggressive means such as depression or suicidality. These conditions
may not originate purely from anger, but unresolved, anger will fester into rage and rage fuels the
condition we call depression. It has been said that it is “never too late to right a wrong”. It is just as
true that it is “never too late to wrong another”; R. Belson rightly contended that “Only a primitive
solution can relieve the primitive feelings of hurt and betrayal…” Untreated, severe or chronic
offense will result in feelings of worthlessness and become relatively entrenched. If the breach is
serious, it may ultimately require some form of retribution, without which forgiveness will be
difficult and reconciliation less assured.

5. 7) Guided Imagery and the Empty Chair
Projective techniques are of tremendous benefit to the treatment of trauma. They are basic to behavior
rehearsal; exploring fears and dreads; anger, depression and anxiety management; mindfulness; and
contemplating revenge, retribution and other forms of unfinished business and moving forward.
The benefit is in direct proportion to the difficulty of the work undertaken. It is therefore important to
create an atmosphere of safe experimentation and to habituate the client to tasks that build on
relaxation, as well as imagination. Simple Guided Imagery involves a relaxation exercise coupled
with a suggestion or task; the greater the relaxation, the more profound the experience made possible.
More complicated tasks build on this simple premise, including hypnogogic work and “re-growth”
imagery techniques which are listed below for illustrative purposes. Please note that even under
proper conditions, these are intended for use by more experienced practitioners. Depending on the
level of relaxation induced they should only be practiced under direct supervision:
a. “Imagine that you are holding a baby, and the baby is you. Tell me how it is to care for you….?”
b. “You have become very, very small, entered your body and gone up to look through your eyes at
the world and at others around you. Tell me what you see?”
c. “Now that you have described you anger as a “black, spiky ball that is very cold”...let’s focus on
its coldness and make it just a little bit warmer. Now a little bit warmer still. And, now just a tad
bit warmer and hold. Now begin to move it back to its original temperature”
d. “Picture yourself having completed the task; now watch yourself in the process, like a movie,
running it backwards and forwards and seeing how you completed it, how you did it in a new
way, a way that now works”
e. “Pretend you are sleeping and when you awoke a miracle had occurred and everything was going
well in your life, exactly as you would want it…” Alternatively, “Time travel to a time in the
past or the future when everything was or is as it should be……”
f. “Fantasize the “evil” part of you…”; “…and now fantasize the “good” part of you…”
g. “Picture that you have met someone that genuinely likes you and wishes to befriend you; they
confide to you what they admire most about you and say…”
h. Milder versions include some form of autosuggestion, such as “When did you first notice that you
could…” or “How long have you been able to do such a thing?”
It should be noted that the more advanced methods referenced above require a level of comfort and
confidence with the emotional material that is bound to emerge and surface. It is, in fact, for this very
reason that they are employed. Responsible practice should be under very guarded supervision.
8) Empty Chair. Empty Chair, a projective technique popularized by the Gestalt therapy group, is a
very effective method for improving self-worth by encouraging the rehearsal and practice of new
behavior and by providing a safe environ within which to express anger, guilt and shame and remedy
unfinished business. Given its familiarity, it should suffice to add some technical points. 1) The
greater the specificity and detail attached to the recollection (protagonist, symptom, role, rule,
disturbing event, etc) the more likely it is that underlying feelings will surface; the visage will
become more concrete and the reaction to it more genuine. 2) The “chair” serves as a “concrete
reminder” and therefore should be pulled out and put away as often as is helpful for the process. Its
symbolic intensity can be altered by its proximity; the closer the chair is moved to the client the more
intense the experience tends to be. Similarly, a frontal positioning of the chair is the most intense,
representing a more confrontational situation. The emotional intensity can be reduced by turning the
chair sideways or entirely around so that the client is facing its back. Once “contaminated” the chair
should never be used in session with the same client for any other purpose as it is now imbued with
symbolic content and power. 3) Lastly, it should be noted that the power and immediacy of the

6. technique can by increased by moving the task from mere reference (“If your dad was here, what
would you say to him?”) to an explicit, detailed image of the individual including their clothing, body
language, facial expressions and vocal intonations. For example, “Your father is sitting here in this
chair wearing his tattered green t-shirt and coveralls with the torn patch on his right knee; he’s got
that familiar scowl and cold-eyed stare of disgust on his face and a two-day stubble of beard,
wringing his hands and beginning to slowly, deliberately nod his head back and forth in disapproval
when he says….”.
While there are several variations, the common ones below are effective and easily mastered:
a. Use an empty chair as a “placeholder” representing an important member that perhaps should be
but is not in session. The individual may be living or dead.
b. Use an empty chair to as a repository for the client’s symptom, their depression or illness,
providing a temporary “vacation” from their problem that they can retrieve before they leave
session.
c. Exorcisms: refer to the person, rule, behavior, illness, or symptom as a “ghost” that will continue
to “haunt” the client until finally and fully exorcised. Have the client confront them as the source
of their misery or pain.
d. Use an empty chair to represent the client; invite the client to be your co-therapist and advise you
as to how to help the “client” to change.
The relevance of unfinished business to self-worth cannot be overstated. It is a source of continuous
grief and duress, a constant reminder that one has failed to achieve or remedy some important task or
piece of business. One cannot feel entirely whole or at peace and will judge themselves wanting until
such time as closure has occurred. Lack of closure thwarts progress in moving forward.

7. technique can by increased by moving the task from mere reference (“If your dad was here, what
would you say to him?”) to an explicit, detailed image of the individual including their clothing, body
language, facial expressions and vocal intonations. For example, “Your father is sitting here in this
chair wearing his tattered green t-shirt and coveralls with the torn patch on his right knee; he’s got
that familiar scowl and cold-eyed stare of disgust on his face and a two-day stubble of beard,
wringing his hands and beginning to slowly, deliberately nod his head back and forth in disapproval
when he says….”.
While there are several variations, the common ones below are effective and easily mastered:
a. Use an empty chair as a “placeholder” representing an important member that perhaps should be
but is not in session. The individual may be living or dead.
b. Use an empty chair to as a repository for the client’s symptom, their depression or illness,
providing a temporary “vacation” from their problem that they can retrieve before they leave
session.
c. Exorcisms: refer to the person, rule, behavior, illness, or symptom as a “ghost” that will continue
to “haunt” the client until finally and fully exorcised. Have the client confront them as the source
of their misery or pain.
d. Use an empty chair to represent the client; invite the client to be your co-therapist and advise you
as to how to help the “client” to change.
The relevance of unfinished business to self-worth cannot be overstated. It is a source of continuous
grief and duress, a constant reminder that one has failed to achieve or remedy some important task or
piece of business. One cannot feel entirely whole or at peace and will judge themselves wanting until
such time as closure has occurred. Lack of closure thwarts progress in moving forward.