Building Self-Esteem Through Therapy: A Practical Guide

Low self-esteem whispers constantly: You're not good enough. You'll fail. Everyone else is better than you. You don't deserve good things. You're fundamentally flawed.

And the cruelest part? You believe it. Not because it's true, but because these messages have been playing on repeat for so long they've become your baseline reality.

I've worked with highly accomplished people—doctors, lawyers, artists, parents—who genuinely believe they're worthless. Their achievements don't dent it. Compliments slide off. Evidence of their competence is dismissed as luck or deception.

Low self-esteem isn't a personality trait you're stuck with. It's a learned pattern of thinking about yourself—and what's learned can be unlearned. Therapy doesn't fix you (you're not broken). It helps you challenge the distorted beliefs that have been running the show and rebuild a more accurate, compassionate relationship with yourself.

This article explores what causes low self-esteem, how therapy addresses it, and what building genuine self-worth actually looks like.

What Is Self-Esteem (and What It Isn't)?

Real Self-Esteem

Genuine self-esteem is:

• Quiet confidence: Believing you're fundamentally okay without needing constant external validation
• Self-acceptance: Knowing you're imperfect and valuable anyway
• Internal stability: Your worth doesn't fluctuate wildly based on others' opinions or your latest success/failure
• Compassionate self-view: Treating yourself with the kindness you'd offer a friend

What Self-Esteem Isn't

Not arrogance or superiority Healthy self-esteem doesn't require feeling better than others. It's "I'm okay" not "I'm exceptional."

Not based on achievement Accomplishments might boost confidence temporarily, but if your self-worth depends on success, it's fragile. True self-esteem exists even when you fail.

Not constant positivity You don't have to feel amazing about yourself 24/7. Healthy self-esteem includes accepting difficult feelings and imperfections.

Where Low Self-Esteem Comes From

Self-esteem develops (or fails to develop) through early experiences and relationships.

Childhood Experiences

Criticism and judgment:

• Constant correction ("Why can't you do anything right?")
• Comparison to siblings ("Why can't you be more like your brother?")
• Conditional love ("I'll only love you if you're good/successful/quiet")

Neglect or emotional unavailability: When caregivers are physically present but emotionally absent, children internalise: "I'm not important. My needs don't matter."

Trauma or abuse: Physical, emotional, or sexual abuse teaches children that they're not safe, valued, or worthy of protection.

Bullying: Sustained peer rejection, mockery, or exclusion erodes self-worth and teaches hypervigilance to others' judgments.

Perfectionist or high-pressure environments: When nothing is ever good enough, you learn that your worth is tied to achievement—and you'll always fall short.

Later Experiences

Low self-esteem can also develop or worsen through:

• Toxic relationships (partners who belittle or manipulate)
• Workplace bullying or chronic stress
• Failures or rejections (especially if they confirm existing negative beliefs)
• Mental health conditions (depression and anxiety often erode self-esteem)
• Systemic oppression (racism, homophobia, ableism, poverty all impact self-worth)

The Inner Critic

These experiences create an internalised critical voice—what's sometimes called the "inner critic" or "harsh superego."

This voice:

• Attacks relentlessly ("You're stupid, lazy, ugly, worthless")
• Interprets neutral events negatively ("They didn't reply—they hate you")
• Dismisses positives ("They're just being nice; they don't mean it")
• Prevents risk-taking ("Don't try; you'll fail")

The inner critic isn't protecting you—it's keeping you small.

How Low Self-Esteem Shows Up

Low self-esteem doesn't always look like quiet self-loathing. It manifests in varied ways:

People-Pleasing

• Saying yes when you want to say no
• Prioritising others' needs over your own
• Fear of disappointing people
• Avoiding conflict at all costs

The underlying belief: "I'm only valuable if I'm useful/agreeable/nice."

Perfectionism

• Setting impossibly high standards
• Never feeling satisfied with achievements
• Procrastinating (if it can't be perfect, don't start)
• Fear of judgment or failure

The underlying belief: "I'm only acceptable if I'm flawless."

Social Anxiety and Withdrawal

• Assuming people judge you negatively
• Avoiding social situations
• Ruminating over interactions ("I sounded so stupid")
• Difficulty making or maintaining friendships

The underlying belief: "I'm unlikeable. People will reject me."

Self-Sabotage

• Choosing partners who treat you poorly
• Leaving jobs or relationships just when they're going well
• Substance use or other destructive coping mechanisms
• Not pursuing opportunities

The underlying belief: "I don't deserve good things."

Harsh Self-Talk

• Criticising yourself constantly
• Holding yourself to standards you'd never apply to others
• Beating yourself up over small mistakes
• Inability to accept compliments

The underlying belief: "I'm fundamentally flawed."

How Therapy Builds Self-Esteem

Building self-esteem in therapy isn't about affirmations or forcing yourself to "think positive." It's deeper, more nuanced work.

1. Understanding Where It Came From

Therapy helps you trace low self-esteem to its origins:

• What messages did you receive about your worth?
• Who delivered those messages?
• How did early relationships shape your self-view?

This isn't about blaming parents or dwelling in the past—it's about understanding that your low self-esteem made sense given what you experienced. It's adaptive, not defective.

2. Identifying the Inner Critic

You learn to:

• Notice when the inner critic is speaking
• Distinguish its voice from objective reality
• Understand its function (often it's trying to protect you from rejection or failure by keeping you small)

One technique: Give it a name. "Oh, there's the Critic again, telling me I'm useless."

This creates distance—it's not you thinking you're worthless; it's an internalised voice.

3. Challenging Distorted Beliefs

Low self-esteem is maintained by cognitive distortions:

All-or-nothing thinking: "I made one mistake, so I'm a complete failure"

Overgeneralisation: "I got rejected once, so I'll always be rejected"

Mental filtering: Focusing only on negatives, ignoring positives

Mind reading: "They think I'm boring" (with no evidence)

Catastrophising: "If I fail this, my life is over"

Therapy helps you examine these thoughts:

• What's the evidence for this belief?
• Is there another way to interpret this?
• What would you tell a friend in this situation?

4. Experiencing Unconditional Positive Regard

In person-centred therapy, the therapist offers unconditional positive regard—complete acceptance without judgment.

For many people, this is the first time they've experienced being valued simply for existing, not for performing or achieving.

Over time, this external acceptance gets internalised. You start treating yourself with the compassion your therapist models.

5. Exploring Self-Compassion

Self-compassion (Kristin Neff's research) has three components:

Self-kindness: Treating yourself gently rather than harshly

Common humanity: Recognising that struggle and imperfection are universal, not personal failings

Mindfulness: Observing difficult feelings without suppressing or amplifying them

Therapy helps you develop these capacities through practice and exploration.

6. Reparenting Yourself

If you didn't receive consistent love, validation, or safety in childhood, therapy can offer a kind of emotional reparenting.

This doesn't mean your therapist becomes your parent—it means you learn to give yourself what you didn't get:

• Reassurance
• Permission to make mistakes
• Celebration of small wins
• Comfort when things are hard

7. Behavioural Experiments

Low self-esteem is maintained by avoidance. Therapy involves gently testing predictions:

Prediction: "If I speak up in the meeting, everyone will think I'm stupid"

Experiment: Speak up once and notice what actually happens

Outcome: Usually the feared catastrophe doesn't occur, which weakens the belief

These experiments build evidence that contradicts your low self-esteem narrative.

8. Values-Based Living

Therapy helps you identify your core values (not what you should value, but what actually matters to you):

• Relationships
• Creativity
• Learning
• Contribution
• Authenticity

When you start living according to your values rather than trying to earn worth through achievement or approval, self-esteem naturally strengthens.

9. Processing Trauma

If low self-esteem is rooted in trauma, therapy might involve:

• EMDR to process traumatic memories
• Somatic work to address trauma held in the body
• Narrative therapy to rewrite your story

Trauma-informed therapy helps you separate "this terrible thing happened to me" from "I am terrible."

What Building Self-Esteem Actually Looks Like

Progress isn't linear. It doesn't look like waking up one day loving yourself. It's subtler:

Early signs:

• Catching the inner critic more quickly
• Occasionally offering yourself compassion
• Setting a small boundary and surviving
• Not apologising compulsively
• Accepting one compliment without dismissing it

Intermediate progress:

• Choosing relationships that feel good rather than ones where you have to prove your worth
• Taking risks without catastrophising failure
• Tolerating imperfection without spiralling
• Prioritising your needs sometimes without guilt

Deeper shifts:

• Genuinely believing you're worthy of love and respect
• Your mood and self-worth becoming more stable (less dependent on external validation)
• Treating yourself with consistent kindness
• Making choices based on what you want, not what will make others approve of you

This takes time—months to years, not weeks. Be patient with the process.

Different Therapeutic Approaches for Self-Esteem

Cognitive Behavioural Therapy (CBT)

Focus: Identifying and challenging negative automatic thoughts

Techniques:

• Thought records
• Behavioural experiments
• Evidence gathering

Best for: People who like structured, practical approaches

Person-Centred Therapy

Focus: Experiencing unconditional positive regard and self-acceptance

Techniques:

• Non-directive exploration
• Therapist empathy and acceptance
• Focus on present experiencing

Best for: People who need to feel deeply accepted before they can change

Psychodynamic Therapy

Focus: Exploring how early relationships shaped self-esteem

Techniques:

• Examining patterns
• Working with transference
• Insight-oriented exploration

Best for: People who want to understand the roots of their self-esteem issues

Compassion-Focused Therapy (CFT)

Focus: Developing self-compassion to counteract shame and self-criticism

Techniques:

• Compassionate mind training
• Imagery work
• Understanding the threat system

Best for: People with high shame and harsh inner critics

Integrative Therapy

Many therapists (including myself) combine approaches, drawing from CBT, person-centred, and psychodynamic work depending on what you need.

Practical Self-Esteem Building (Alongside Therapy)

Therapy is the core work, but these practices support it:

1. Notice and name the inner critic

When you catch yourself in harsh self-talk, simply notice: "The critic is here."

2. Speak to yourself like a friend

Ask: "Would I say this to someone I care about?" If not, adjust your self-talk.

3. Celebrate small wins

Your inner critic dismisses achievements. Actively notice and acknowledge what you did well, even tiny things.

4. Practice saying no

Start small. Say no to one thing you don't want to do.

5. Limit comparison

Social media is designed to trigger comparison. Reduce exposure.

6. Engage with your values

Do one thing this week that aligns with what matters to you, regardless of whether it impresses anyone.

7. Physical care

Moving your body, sleeping, eating adequately—these aren't superficial. They send the message "I'm worth caring for."

How Long Does It Take?

Building self-esteem isn't a quick fix. Depending on:

• How entrenched the patterns are
• Whether there's underlying trauma
• Your support system and life circumstances

Expect:

• Short-term focused work: 12-20 sessions for noticeable improvement
• Moderate issues: 6-12 months
• Deep-rooted, complex self-esteem problems: 12+ months

Some people continue therapy long-term as ongoing personal development, which is also valuable.

Final Thoughts

Low self-esteem feels permanent, but it isn't. It's a learned way of seeing yourself—and you can learn differently.

You don't have to become arrogant or delusional. You don't have to pretend you're perfect. You just have to stop treating yourself like you're fundamentally flawed and start treating yourself like a flawed human being who still deserves kindness, respect, and good things.

Therapy won't give you self-esteem (that has to come from within). But it creates the conditions where self-esteem can grow—safety, compassion, challenge, and a relationship where you're valued simply for being you.

If you're in London and struggling with low self-esteem, I offer person-centred, humanistic therapy both in-person in Fulham and online. I work integratively, drawing from CBT, person-centred, and psychodynamic approaches to tailor therapy to what you need.

Building self-esteem is possible. It just starts with one small, brave step: believing you're worth the investment.