Creating a Self-Esteem Treatment Plan for Your Clients in Therapy

Self-esteem can be thought of as a person’s subjective view of themselves, influenced by factors such as their perceived attractiveness, skills, talents, and relationships. Individuals with high self-esteem often exude confidence and comfort in their own skin, which is noticeable to others. Keep reading to learn how to create a self-esteem treatment plan in your counseling practice, with a sample plan.

In contrast, those with low self-esteem may struggle with doubt, insecurities, and feelings of inadequacy. Low self-esteem is not limited to one mental health condition but can be present in individuals experiencing a range of mental health concerns. Since self-esteem is not fixed, it can change throughout different periods of our lives, and individuals with low self-esteem may struggle with mental health disorders such as depression, suicidal tendencies, eating disorders, anxiety, and substance use disorders.

Research indicates that self-esteem is a crucial factor in overall mental health. It is a significant predictor of happiness and can keep you motivated toward personal goals. Conversely, individuals with low self-esteem may struggle to recognize their capabilities and strengths, hindering their progress in various aspects of life.

One common therapeutic approach for treating low self-esteem is cognitive-behavioral therapy (CBT), which helps clients identify and change unhealthy or negative thoughts and beliefs contributing to maladaptive behaviors. Support groups can also provide a therapeutic environment where individuals with low self-esteem can connect with, relate to, and support others, fostering a sense of community, accountability, and validation. Additionally, some clinicians find that art therapy allows clients to explore and express their thoughts and emotions in new and creative ways.

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Setting Goals and Objectives With Clients in Your Self-Esteem Treatment Plan

Before developing a treatment plan for low self-esteem, it is essential to gather comprehensive information. As mentioned earlier, individuals with low self-esteem often experience various mental health conditions, such as depression, eating disorders, and substance use disorders, which may require intensive treatment to stabilize before addressing self-esteem issues. Their low self-esteem may need to be incorporated into a broader treatment plan that first focuses on other concerning symptoms.

While low self-esteem is not a clinical diagnosis in the DSM-IV, there are assessments available to evaluate its presence. These tools can provide an in-depth understanding of your client’s experience, helping you to formulate an appropriate treatment plan. Commonly used self-esteem assessments include:

  • Rosenberg Self-Esteem Scale (RSES)
  • Coopersmith Self-Esteem Inventory (CSI)
  • State Self-Esteem Scale (SSES)
  • Tennessee Self-Concept Scale (TSCS)
  • Beck Self-Esteem Scale (BSES)
  • Adult Self-Perception Profile (ASPP)

Depending on your client’s and symptoms, it may be a good idea to use the Mental Health Risk Assessment, available with TherapyPatron for mental health professionals.

What to Include in a Treatment Plan for Low Self-Esteem + Example

In the remainder of our article, we will be referencing our low self-esteem treatment plan example to walk through the different sections that are included in the customizable counseling treatment plan. Our treatment plan will focus on a client who has mild to moderate distress stemming from low self-esteem.

While you’re developing your treatment plan, you may spend time thinking about resources you could have on hand to use in future sessions. This can include related worksheets such as:

Jane’s story:

Jane is an 18-year-old freshman at college who recently sought help at her college counseling center. She reports struggling with low self-esteem, which has been affecting her academic performance, social interactions, and overall college experience. Jane does not have any underlying mental health conditions and denies having a history of mental health concerns, but experiences mild to moderate distress due to her self-esteem concerns. Jane noted that she does not use substances because she is worried that it will worsen her school performance. She reported being healthy, exercising regularly, and denied taking medications for health purposes.

Jane describes feeling inadequate compared to her peers and often doubts her abilities and fears that she chose the wrong major, and does not belong at college. Despite receiving positive feedback from professors and classmates, she constantly worries about failing and feels that her accomplishments are not genuine. Her self-doubt has led her to avoid participating in class discussions and social activities, further isolating her.

Clinical Diagnosis

Jane denied having a history of mental health concerns, and her clinical assessment did not indicate any overarching mental health concerns outside of her reported low self-esteem. Because of this, we do not need to include a diagnosis, as there isn’t an appropriate option for her case.

Example for Jane:

Diagnosis: None at this time

Current Medications and Responses

During her intake, Jane denied the use of medications and denied having any health concerns at this time.

Example for Jane:

Medications prescribed: None at this time

Presenting Problem and Related Symptoms

Your presenting problem section should include a case conceptualization that other professionals working with Jane can glance at, and understand the important details of her case. You can delve into specific concerns that are relevant to her current distress and her subsequent treatment plan goals and objectives.

Example for Jane:

Jane, an 18-year-old college freshman, recently sought support at her university’s counseling center, grappling with profound self-esteem challenges that are significantly impacting her academic performance, social interactions, and overall college experience. Despite no underlying mental health diagnoses and denying prior mental health concerns, Jane experiences moderate distress due to her self-esteem struggles. She abstains from substance use, fearing it could detrimentally affect her academic performance, and engages in regular exercise with  no medication use.

Jane articulates pervasive feelings of inadequacy compared to her peers, doubting her abilities, questioning her choice of major, and grappling with a sense of not belonging in college. Despite receiving positive feedback from professors and peers, she remains plagued by persistent fears of failure and perceives her accomplishments as hollow. Consequently, she withdraws from class participation and social activities, intensifying her sense of isolation.

The administration of the Rosenberg Self-Esteem Scale (RSES) at the counseling center highlights Jane’s low self-esteem levels, characterized by profound feelings of inferiority and a notable absence of pride in her achievements. Furthermore, a clinical interview underscores that her low self-esteem emanates from a pattern of negative self-talk and unrealistically high self-expectations.

Goals and Objectives

Your treatment plan should be specific to your client, their symptoms, and personal goals. Goals should be realistic, attainable, and fit in the period you have outlined. Improving self-esteem often comes in small steps, with learning to recognize unhealthy thoughts contributing to low self-esteem, and beginning to recognize personal strengths and attributes.

Example for Jane:

Goal 1: Improve Self-Esteem and Self-Perception

Objective 1: Challenge negative self-talk with the use of cognitive restructuring and homework related to reframing negative thoughts

Objective 2: Enhance self-acceptance and self-compassion with the use of self-compassion exercises, acknowledging her strengths, and developing a daily self-care routine

Objective 3: Foster assertiveness and positive self-expression through the use of role-play assertiveness scenarios and assertiveness training techniques

Goal 2: Reduce Avoidance Behaviors and Increase Engagement in Activities

Objective 1: Develop an exposure hierarchy and use systematic desensitization techniques for gradual exposure to challenging situations

Objective 2: Behavioral activation to disrupt her pattern of avoidance by developing a list of meaningful activities she enjoys

Objective 3: Social skills training including assertive and social skills through modeling, role-playing, and feedback.

Goal 3: Cultivate Realistic Self-Appraisal and Coping Strategies

Objective 1: Reality testing, which uses Socratic questioning to help Jane evaluate the evidence supporting her negative beliefs about herself and her abilities.

Objective 2: Introduce stress management and coping skills such as deep breathing exercises, progressive muscle relaxation, and problem-solving skills training

Objective 3: Enhance self-efficacy and goal setting by setting realistic and achievable short-term and long-term goals related to her academic and personal aspirations.

Specific Interventions to Be Used

This section of your treatment plan can serve as a reference point for you in future sessions by specifically identifying interventions that can be used to help Jane work towards accomplishing her therapeutic goals. Your goals should incorporate evidence-based practices, such as CBT, which is known to help individuals with Jane’s current concerns. This section can be updated as interventions are completed, to keep it relevant to the work she is doing in session. 

Example for Jane:

Intervention/Action:

Use an activity monitoring form to track her behavioral activation work and to identify experienced challenges and barriers. Bring this back to review for the next session.

Responsible Person: Jane

Intervention/Action:

Use systematic desensitization to help Jane work through her hierarchy of challenging situations, providing her with support and encouragement to reinforce her progress

Responsible Person: Counselor A

Intervention/Action:

Provide psychoeducation regarding effective communication skills and strategies, and encourage her to engage in low-pressure settings using these skills and strategies. Review her experience in the next session.

Responsible Person: Counselor A

Intervention/Action:

Use motivational interviewing skills to explore her values, strengths, and intrinsic motivations for the behavioral changes she is working towards

Responsible Person: Counselor A

Family Involvement

From the information we know, it does not appear that family involvement in therapy would be impactful. If you later learn that it would be, you can modify this section to reflect changes made.

Example for Jane:

No family involvement at this time

Additional Services and Interventions

Support groups could be a great treatment option for Jane if she feels comfortable doing so. This could give her an opportunity to connect with peers who have similar challenges, which can be a validating and empowering feeling. You could assist Jane in finding an appropriate support group, possibly on her campus.

Example for Jane:

Attend support group 1 x a week in addition to weekly individual sessions

Estimation for Completion

The American Psychological Association indicated that about half of individuals who engage in therapy tend to see noticeable differences in a short period, and can complete treatment after 15 to 20 therapy sessions.  This time frame could work itself out to be one semester of her college experience, as long as she does not experience worsening symptoms.

Example for Jane:

The duration of treatment will be 15 sessions, based on her clinical gains and progress. To be modified if needed.

Aftercare Plans

Aftercare plans should be read as directions if Jane were to end her therapeutic relationship today. Terminations can happen unexpectedly, and being prepared for this situation can make it easier to navigate if it does occur. Similar to other areas of your treatment plan, this should be adjusted as she moves through the treatment process.

Example for Jane:

Follow up with a local mental health professional for continued 1:1 therapy, and look for support group options in the local area

Final Thoughts On Creating a Treatment Plan for Low Self-Esteem

Working with clients facing challenges like low self-esteem requires a tailored and collaborative approach. By engaging clients as active participants in their treatment journey, you can ensure that interventions align with their unique needs and goals. A holistic assessment of their cognitive, emotional, and behavioral functioning, along with contextual factors, enables you to create an individualized treatment plan.

Using evidence-based approaches such as cognitive-behavioral techniques and mindfulness practices, you can empower clients to challenge negative beliefs, enhance coping skills, and cultivate self-compassion. Throughout the therapeutic process, ongoing monitoring of progress and outcomes allows you to support your client as they build resilience and work towards improved well-being.

TherapyPatron.com helps mental health professionals better serve their clients. Our (editable, fillable, printable PDF) therapy worksheets can help you streamline your practice, effectively deliver different types of therapy, and help your clients be their best selves.

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Resources:

  • American Psychological Association. “How Long Does Treatment Last?” APA, www.apa.org/ptsd-guideline/patients-and-families/length-treatment. Accessed 20 June 2024.
  • Michal (Michelle) Mann, Clemens M. H. Hosman, Herman P. Schaalma, Nanne K. de Vries, Self-esteem in a broad-spectrum approach for mental health promotion, Health Education Research, Volume 19, Issue 4, August 2004, Pages 357–372, https://doi.org/10.1093/her/cyg041
  • Niveau, Noémie & New, Boris & Beaudoin, Marine. (2021). Self-esteem Interventions in Adults – A Systematic Review and Meta-analysis. Journal of Research in Personality. 94. 104131. 10.1016/j.jrp.2021.104131.
Kayla VanGuilder, MA, LCMHC
Author: Kayla VanGuilder, MA, LCMHC

Kayla is a Mental Health Counselor who earned her degree from Niagara University in Lewiston, New York. She has provided psychotherapy in a residential treatment program and an outpatient addiction treatment facility in New York as well as an inpatient addiction rehab in Ontario, Canada. She has experience working with individuals living with a variety of mental health concerns including depression, anxiety, bipolar disorder, borderline personality disorder, and trauma.

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