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Full Worth

“I know what the feeling is. It’s…” Batsheva took a deep, shuddering breath. “It’s like I can’t stand being in my own skin….”

Problem: Low self-esteem
Tools Used: Cognitive Behavioral Therapy


Her voice had started strong and confident on the phone, but when I asked Batsheva what she was seeking support for, she got stuck.

“I don’t really know what I need. I just feel low-level anxiety and bad about myself, and I don’t know why.”

We booked a Zoom appointment. I missed the energy of shared space with my clients, especially getting to see them in “real” for the first time. I let Batsheva in from my Zoom waiting room, and a young, stylish woman with a long, dark sheitel smiled back at me. After a brief hello, Batsheva launched right in.

“I feel unsettled most of the time. I have, and do, so much, but I’m always feeling… off.”

“Batsheva, it’s really good that you’re attuned to what you’re feeling, even if it’s difficult to identify exactly what that is. Can you tell me anything in general that you’d want me to know about you?”

“I’m 28 years old. Married for eight years to Akiva. We have three kids — all girls — and I’m expecting our fourth in a few months, iy”H. I used to work as a sheitelmacher, but as Akiva’s business has grown, and the girls are getting older, I don’t work that much anymore.”

We continued a general intake that included a genogram of Batsheva’s family and some general medical and personal questions. As our initial intake session was coming to a close, I asked Batsheva what she considers to be her strengths.

She froze.

“I, uh… I don’t know really. I try to be a good mother and wife. But sometimes, you know, I get really overwhelmed…” She trailed off hesitantly.

“Being a good mother and wife requires a lot of strengths and skills, Batsheva.”

“Well, I don’t think I actually pull it off most of the time. It always seems like everyone else does it more easily? Better?”

“Tell me more about that.”

“Let’s say I make a nice supper. I’m always missing an ingredient or don’t plate it well or don’t time it well, or something like that. The food is just an example, this happens with everything, and I just feel like…” Batsheva’s face clouded over. “Never mind. I’ll tell you another time.”

“Okay. I’m glad you stopped yourself if you didn’t want to share, Batsheva. If you say something you’re not ready to share, it might negatively impact treatment, so I’m so glad you drew that boundary.”

Batsheva’s face cleared in relief, and we wrapped up the session.

The following week, Batsheva described that she was feeling good albeit with that “off,” almost sad feeling in the background.

“How long have you been experiencing this feeling, Batsheva?” Batsheva was currently in the middle of her second trimester, and I wanted to rule out any peripartum depressive and anxious episodes, and see if I needed to refer her to a doctor.

“For as long as I remember, but sometimes it’s stronger than others. I think it never goes away completely. It’s just a lot of self-doubt. I remember it more at certain times, like when I started high school, or seminary, my first job in a salon, when I was dating.”

Batsheva paused thoughtfully. “When I was first married and we moved, it was bad, and I think also it gets worse around the time of being pregnant or giving birth. See?” Batsheva laughed, sweet and tinkling. “It’s like all the time.”

I smiled. “Actually, it sounds more like it’s during high stress times or times of transitions.” I paused to let that sink in.

“Yes! You’re right. Like new situations cause this feeling to flare up a lot. Like they — employers, family members — are going to find out I’m a big faker. I don’t remember it so much during the quiet day-to-day.”

“So you mentioned self-doubt. Would you also call this ‘off’ feeling ‘sadness’?”

“No. Not like a depression. More like… ugh. It’s this thing again. I, um, didn’t want to share it.” Batsheva blushed.

“No problem, Batsheva. I didn’t realize I was asking about that thing. Let’s…”

“It’s fine.” Batsheva cut me off. “I thought about it, and I want to say it, it’s just super embarrassing.”

“There’s no pressure to share.”

“I know, but like, this is what I came for. I don’t want to just talk about nothing. I know what the feeling is. It’s…” Batsheva took a deep, shuddering breath. “It’s like I can’t stand being in my own skin….” Batsheva looked sideways at me, awaiting a reaction.

“That’s really brave sharing, Batsheva.”

“It’s pathetic. It’s like I can sometimes feel so badly about things I say and do. It’s like that super-critical shvigger — although, for the record, my shvigger is amazing — but I have that voice all the time in my head. I’m not enough. Ever.”

“That sounds like a difficult feeling. Are you comfortable sharing more?”

Batsheva nodded. “I’m also really scared about letting people down or making mistakes, so I thought that was codependency. I’ve read up on that, but it doesn’t really feel right to me. I even went to a Codependents Anonymous meeting online, and didn’t really relate.”

“Batsheva, I hear so much self-awareness from you. And so much insight.”

Batsheva squirmed uncomfortably. “Not really. That’s why I had to come to you. I don’t feel like I can deal with this anymore alone, and it’s really affecting my quality of life. I’ve heard about low self-esteem a lot, but I didn’t read much more, because I don’t think I have that.”

“I can’t say right now if you do or you don’t have it, but why do you think that you don’t have low self-esteem?”

“Because I had a good childhood. My parents are great. My husband is awesome. I honestly didn’t get far in researching that because it seems like it’s mostly an issue for abused or neglected kids. My family was normal, happy, healthy. Everything good.”

“So I don’t want to shock you, but low self-esteem can definitely happen in people who have great families and childhoods. You’re right that a more obvious causal link to low self-esteem could be a difficult childhood, but it doesn’t have to be like that.”

Batsheva stared, wide eyed.

“I just thought of a story I once heard from Rabbi Dr. Abraham Twerski ztz”l. Rabbi Twerski — who once said he wrote just one book on self-esteem, in 90 different ways — shared that he suffered from low self-esteem. Even though he was an accomplished psychiatrist, he didn’t even realize this until he was almost 40.

“He had this revelation when he couldn’t sit by himself while on vacation. He was so used to diversions from his busy practice, community, and family, that when he had no distractions, he realized he couldn’t remain there long, because he didn’t like the person he was with — himself.”

“How is that possible? Rabbi Twerski?”

“Yes — one of my heroes. And Rabbi Twerski reports having a really loving family, including wonderful parents, and having had huge success and achievements in school even at an early age.”

“How does that happen then?”

“There are different theories, but let’s back up a bit. You had said that you don’t identify with what you read about having low self-esteem. Is that because you don’t identify with the feelings? Or because of the whole childhood thing?”

“I guess the whole childhood thing. I don’t know much about the feelings.”

“Okay. Do you feel up to exploring some signs of low self-esteem?”

Batsheva nodded.

Seeing the Signs

“Alright, so I’m going to mention a few things, you can just say yes or no. You can also say ‘pass’ if you don’t feel comfortable answering or you can elaborate if you want.”

“Hold on.” Batsheva put up a manicured finger. “I just wanted to write this down.” She reappeared on the screen a few seconds later with her pen poised.

“One of the signs may be sensitivity to criticism. This can be from yourself or others, and it can sometimes feel like a confirmation of inadequacy.”

“Yes. I have this a lot. And my husband, um, he says sometimes he feels like he has to walk on eggshells around me. He learned really early on that I don’t do well with criticism.” I thought I saw her swipe at a tear. “Next please. I don’t want to talk about this one anymore.”

I nodded and moved along. “Sometimes people withdraw from social situations, like decline invitations, cancel scheduled plans last-minute, and generally do not want to be around others. This could also look like not taking up new opportunities. Conversations with others may further reinforce feelings of anxiety or sadness.”

“Yes. I have a couple of friends who I’m super comfortable with and generally enjoy hanging out with them. But I do get nervous just randomly hanging out in the park with other women, and it’s really hard for me to go to simchahs. Next….”

I moved along. “For someone with low self-esteem, lashing out or becoming aggressive toward others can be a defense mechanism. If you feel that you’re about to be exposed or criticized, attacking whoever might criticize you can be a sign of low self-esteem.”

“I don’t think so. When I feel criticized, it’s more like I get defensive, but not in a mean way, or I just get really sad and sort of go into myself.”

I nodded. “There’s also negative self-talk. And frequently comparing yourself to others.”

“It’s not normal to walk around saying ‘I’m amazing and the best person ever’ all day. Like if I do something stupid, why can’t I say, ‘I did something stupid’?”

“Batsheva, you’re right that having an inflated ego isn’t great either. In fact, that actually may also be a sign of low self-esteem. But let’s say someone does something impulsive, and it didn’t work out well. Instead of saying ‘I’m so stupid,’ it’s possible to say ‘that was a bit impulsive; I wouldn’t choose to do that next time.’ You see the difference? One is about the person and one is about the action.”

“I hear. Well, I answered yes to everything you said, so I guess I am suffering from low self-esteem.”

“If you feel like you relate, then it might be beneficial to actually be able to name it.”

“Yes. But what can I do about it? Is there like a treatment?”

“Sure, Batsheva. Usually cognitive behavioral therapy can be helpful with this. Let’s pick this up next week, and in the meantime, I can recommend a few books on self-esteem if you want to read on the subject to get even more clarity. Specifically, Life’s Too Short by Rabbi Twerski.”

Batsheva took note of the book, and we scheduled our next appointment.


Getting to Work

“Hi Batsheva.” I smiled as her face came into focus on my computer.

“Hey, Abby. I wanted to tell you, I actually got the book the next day. I finished it in three days, and it was really insightful.”

“That’s awesome, Batsheva. Fabulous follow-through. You may have read that self-esteem is comprised of two principal ingredients: feelings of competence and feelings of value. So any treatment would be directed toward changing that way you think about your worth and your abilities. You can actually overcome low self-esteem with a change of mindset and behaviors. Because self-esteem and happiness are interdependent, it’s difficult or impossible to have healthy self-esteem without being happy.”

“Okay, but if I could just change my thoughts and be happy, wouldn’t I have done that already a while ago?”

“It’s not a one, two, three thing, Batsheva. We’ll be looking at some cognitive behavioral strategies that can help — it’s mostly about you practicing different ways of thinking. Your self-image isn’t an objective reality. It’s based on who you think you are. It’s based on messages you received from your parents, siblings, friends, classmates, and everyone else you met in your life.”

“Now we’re back to that original discussion. I told you that my parents and family are awesome. My mother told me I was amazing like a million times a day.”

“That’s beautiful that your mom expressed her admiration for you so freely, Batsheva. But sometimes the most well-meaning and loving parents can contribute to low self-esteem.”

“How so?” Batsheva arched an eyebrow curiously.

“When we give exaggerated praise as parents, or when we make our kids feel like they have to be good and accomplished for us to accept them, that can lead to problems. It could be subtle; we’re super excited and loving when they bring home a great mark on a test and muted, neutral, or mad when they don’t perform as well.

“Sometimes we’re overcritical, and sometimes we don’t let kids try at all. You know when our kids are tying their shoelaces in slow motion, and we just bend down and do it ourselves? Doing stuff like that all the time for them — doing their projects, homework, phone calls for playdates, etc. can all give them the message that maybe they’re not capable.”

Batsheva groaned.

“What’s coming up for you?” I asked.

“Well, now I’m fairly certain that the one tiny thing I was hanging onto — being a good mother — has now been shattered.”

“I totally hear you. We can focus more on parenting and kids in a little bit, but how about refocusing back to you in the present? Does that sound okay?”

“Yep. I don’t really want to spend time going backward and trying to figure out why I am the way I am. And I assume anything I learn here will positively affect my kids, so let’s just move on, if that’s okay with you.”

“Absolutely. I think that’s a sound plan. Okay, some theory here. A psychiatrist named Aaron Beck invented a cognitive model that teaches that events aren’t responsible for how we feel, rather the interpretation of those events trigger our emotional responses. The model implies that we can change how we feel by changing how we think.”

“Okay.” Batsheva looked interested, her head cocked to the side, pony sheitel spilling over one shoulder.

“There are three levels of cognition: core beliefs about ourselves, others, and the world, like ‘I’m unlovable’ or ‘I’m incompetent.’ Then there’s what some call ‘dysfunctional assumptions.’ This can be ‘if-thens’: ‘If she trusts me, then she probably doesn’t really know me,’ and then, finally, the most superficial, automatic, often negative beliefs. These arise quickly and without any apparent effort throughout our day, often in response to specific events — or in response to other thoughts or memories. They’re not facts, and are often assumptions.”

“I have a lot of these automatic thoughts. Especially when I’m in a cycle of anxiety.”

“Everyone has hundreds of automatic thoughts every day. Sometimes the thoughts we have are facts, but other times they’re opinions. Sometimes they’re accurate and helpful, sometimes they’re the opposite. There’s a tool called a thought record. It’s a log that allows you to identify your negative automatic thoughts — let’s call them NATs — and challenge them. It can help you understand the link between thoughts and emotions. I’m going to share my screen for a moment and show you this PDF.” I quickly pressed a few buttons, and soon Batsheva could see the screen.

“Okay, you can see seven columns here. Would you like to go through it together with a recent example?”

Batsheva nodded.

“Column one: the situation. Can you think of a recent time when you felt a sudden change in how you were feeling?”

“Yes. I was at the park with my kids, and it was nice and relaxed. Then a few ladies came who I knew, they sat down near me on a bench, and I started to feel that feeling.” As Batsheva talked, I typed her words into the first column.

“Next column. How did you feel at that moment? What did you feel in your body?”

“I felt self-doubt. Fear. I felt it in my head and my chest. I always feel it there. I got clammy.”

“How strong was that feeling on a scale from 0 to 100?”

“80? 90? I dunno. Strong.”

“Column three: your NATs. What was going through your mind when you started to feel that fear and self-doubt?”

“I was extremely uncomfortable as they were talking about a chasunah I wasn’t invited to, and I felt stupid. I was thinking ‘I’m such a neb’ and ‘I’m a big faker….what a loser.’”  I typed as Batsheva spoke, saying little so she could get a full sense of the process.

“Column four. What facts or evidence support the truthfulness of this thought?”

“That I’m a loser? I don’t know. I, uh… well, I wasn’t invited.”

“Okay. Does that make you a neb?”

“No. I guess not.”

“In that case, moving on to column five, what evidence is there that doesn’t support your thought? If a good friend felt like you did, what would you tell her?”

“I’d say that it’s not true. You have plenty of friends, and who cares if you don’t know some random people who made a chasunah? I mean, I guess that’s true for me too. I have a solid group of friends. I don’t need to know everybody.”

“Great. Next column. So knowing what you know now — that in fact you’re not a loser because you didn’t get invited to a chasunah — what would be a more accurate way of responding to that triggering event? It doesn’t have to be the total opposite and super positive, but it should be realistic.”

“So, I can hear them speaking and I can think , ‘I don’t know who they’re talking about, but that’s okay because why do I need to know everyone? I have my friends.’”

“Good one. Okay, last column. With this new thought in mind, how do you feel about that situation now?”

“I feel calmer. Maybe a little unsettled, but not that self-loathing. I feel more neutral.”

“Great job, Batsheva. Do you feel comfortable filling this thought record out by yourself on several different occasions over the next week?”

“Sure. I like how it’s concrete. It’s logical and clear. I can do that.”

Due to the fact that cognitive change happens through reinforcing thoughts and mindful awareness of our cognitions, it happens over a span of weeks. Our sessions over the next few weeks started with a check-in on the previous week and a review of the thought record. One such session, about four weeks in, brought Batsheva even more clarity.

“I’m doing this thought record for four weeks now, Abby, and I’m seeing this pattern. My most consistent NAT is that I’m a faker. And I remember that feeling as a kid. My mom would like obsess over everything I did. She’s amazing like that, but I always felt like it wasn’t true. And sometimes it wasn’t! But I hate that this is coming back to my childhood.”

“Batsheva, your parents sound like wonderful, encouraging, loving parents. They did the best they could. Now you have the awareness of the situation, and clarity on what your true strengths are.”

We spent the rest of the session working on the concept of strengths and values.

“When I frame it like this, I don’t feel so artificial,” Batsheva said at the end. “I’m good at some stuff and bad at other things.”

“You sound so settled in the way you said that. I’m impressed!”

Batsheva and I continued to work on identifying her NATs and reframing them in order to establish a more accurate understanding of herself.

As the weeks went on, Batsheva was getting more insight. At the three-month mark, she wanted to better understand what was at the core of her low self-esteem. “It’s definitely getting better, Abby, but why am I still stuck here to some extent?”

“Let’s look at some of your rules and assumptions, Batsheva. Sometimes we retain our beliefs because we have certain rules that we accept as true. For example, if someone thinks she’s stupid, and then someone else criticizes her, it may reinforce her assumption that she’s stupid. The problem with these rules is that they’re often excessive and unreasonable: They’re not real rules about how the world works, but assumptions that keep us stuck in unhelpful ways of thinking and behaving.”

“So how do I get unstuck? The same way that I’ve been noticing my NATs?”

“Yes, that same cognitive identification. What main assumption do you feel dominates your thinking?” I brought up another worksheet on my screen share.

“That I’m not deserving.” The answer was quick and thoughtful.

“How does that assumption affect your daily life?”

“I feel worthless and feel bad about myself. I look for things to go wrong.”

“What are the origins of this assumption?”

Batsheva thought for several moments. “I have no clue. But I have some sort of vague memory of me as a little girl. I was sleeping on a mattress on my sister’s floor.”

“What happened to your room?”

“Not sure. I know my parents did renovations. I can hardly place this memory, but maybe it was before the renovations and there wasn’t room for me? Or maybe it was during? Or maybe I just chose to sleep there. I don’t know.”

“Okay. What are the advantages of this rule — that you aren’t deserving?”

Batsheva was thoughtful once more. “I don’t get disappointed.”

“Excellent insight, Batsheva. And what are the disadvantages?”

“That I feel terrible about myself and resentful.”

“What are some alternatives to this rule that would make it more flexible?”

“That I’m deserving.”

“Beautiful! Does it feel like you could go there and challenge your thinking with that when you get stuck?”

“I could try. It’s definitely easier to do that now, after we’ve been doing so much practice.”

Batsheva smiled as she dutifully took notes. Shortly after this session, she gave birth to a healthy baby boy. She was thrilled — and overwhelmed — for the first few months after the baby’s birth. When Batsheva called, she reported she was feeling more confident and self-aware in general. She chose to resume treatment on a bi-weekly basis, after her postpartum fog began to clear.

“You know what’s crazy?” she said at our next session. “It’s been about seven months since we started. I mean three of those were taken up by this little guy.” She smiled at the sleeping newborn next to her. “But my brain thinks in columns. I run through if the thought is helping or hurting me. I don’t really write stuff down anymore, but it’s like an automatic response.”

“That’s so cool, Batsheva. You have awareness of any destructive ingrained thinking patterns or self-doubt that’s humming in the background. It sounds like with this awareness, you’re able to challenge old, negative thought patterns.”

“It’s such a shift. With the baby and COVID — it’s been such a weird vortex, but also such a good opportunity to focus inward without too many distractions.” Batsheva grinned, green eyes sparkling. “I feel like I’m ready to stop regular sessions. I’ll reach out when I need some cheerleading, but I have this calm inside me that I never thought was possible.”

“You’ve worked really hard, Batsheva. You can be very proud of yourself.” I smiled back.

“Want to hear a ‘full circle’ story? I was at the park with the kids yesterday, and some neighborhood women were there. They were talking about which camps they were sending their kids to. They kept name-dropping and schmoozing on and on.

“I saw a sweet-looking woman on the other side of the bench looking wistful. She was trying to keep pace with the conversation, but at one point, I saw her blush and clam up. I could almost feel her self-doubt and awkwardness. Guess what? I picked myself up and sat down next to her, and we had such a good chat!” Batsheva laughed.

“Incredible, Batsheva.” As we said our goodbyes, I couldn’t help but wonder if Batsheva’s small gesture healed something inside that woman in the park. I marveled at how we’re all so connected, so similar in our strengths and our weaknesses, our sorrow and our joy.


Foster Healthy Self-Esteem in Kids

Pointers for raising kids with a solid and positive sense of self

  • Do show unconditional love and focus on strengths.
  • Don’t give artificial and/or exaggerated praise.
  • Do allow kids to develop self-esteem by doing things that are appropriately challenging for them.
  • Don’t be a helicopter or lawnmower parent — allow your kids to make mistakes and problem-solve. Healthy struggles are important for building resilience.
  • Do teach problem-solving to foster resilience.
  • Don’t let kids “excuse” themselves out of responsibility.
  • Do parent the kid you have, not the kid you wish you had.

Abby Delouya maintains a private practice for individuals, couples, and families.

(Originally featured in Family First, Issue 750)

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