Low Self-Esteem Formulation

When to Use

Use when low self-esteem is a significant clinical feature but a full Fennell model formulation may not be needed or appropriate. This general low self-esteem formulation captures the key cognitive and behavioural maintaining factors without prescribing a specific theoretical framework. Useful for clients where self-esteem intersects with depression, anxiety, or other presenting problems.

How to Introduce

Frame collaboratively: 'Your self-esteem seems to be playing a big role in your difficulties. Let's map out how negative beliefs about yourself connect to your feelings, behaviours, and what keeps those beliefs in place. This will help us work out the best way to tackle this.'

Adaptations

For clients with limited insight into their self-esteem difficulties, use behavioural indicators such as avoidance, reassurance-seeking, and social withdrawal as entry points into the formulation. For those with comorbid presentations, show how the self-esteem component interacts with other maintaining cycles.

If the client meets criteria for a specific low self-esteem presentation, consider using the Fennell model formulation instead for greater specificity. Avoid if the client is not ready to explore their self-view in depth. Not a substitute for risk assessment if low self-worth is linked to suicidal ideation.

Clinical Tips

Identify the specific content of the negative self-belief early, as this determines intervention targets. Map both the internal maintaining processes such as self-criticism and filtering, and the external ones such as avoidance and compensatory strategies. Link the formulation to specific intervention choices so the client understands the therapeutic rationale.