I write this article as one having great interest in self-esteem and the impact of avoidance on one’s sense of self. This interest has come from personal life experience growing up and professional experience as a clinician working with many different kinds of clients who have struggled with poor self-esteem. I write this article as one who has worked with many eating disorder patients over the last twenty years, most of whom suffered greatly from a poor sense of self and poor feelings of self-worth. They have taught me as I have made great effort to help them down that road to recovery. Those suffering from eating disorders most often have two things which are the common denominators of eating disorders. The first common denominator is poor self-esteem, the belief that they are not good enough, that they do not have much to offer the world, and the “felt need” to do something to “make up for that,” which is partially acted out in the eating disorder. Secondly, the eating disorder truly is a disorder of avoidance. It becomes a way for those so addicted and so trapped in its grip to avoid painful emotions, painful beliefs about self, pain that comes from a lost sense of one’s identity, and further, a way to avoid rejection and other painful experiences in life.
Why would I want to write about self-esteem? Firstly, understanding and remediating poor self-esteem is critical. Poor self-esteem is the thread of the deep woven fabric of an eating disorder. Regardless of failure or success, relationships or lack thereof, mental disturbance or mental health, poor self-esteem is a robber. It unconsciously puts a ceiling on the breadth and the depth of the joy in our lives and it puts an artificial and unnecessary limit on the depth or our experiences. Poor self-esteem erodes one’s confidence and it is often a quiet, insidious, and invisible thief. We do not seem to understand enough about it and all the while, millions and millions suffer from it. Secondly, it is personal. It impacts my life. It impacts my children’s lives. It impacts the lives of patients, clients, and employees with whom I work.
It breaks my heart to see those with eating disorders suffering from their poor self-esteem. This poor self-esteem is typified in the story of a patient who my friend, Dr. Frost, and I once worked with. This brief story typifies the poor self-esteem so often found in one suffering from eating disorders. Brenda came into a therapy session and described her previous night’s dream. She and her boyfriend were on an ocean beach. As they looked out to the ocean, there was a sign which read, “No swimming! Danger! Great White Sharks!” Despite the sign, her boyfriend grabbed her by the hand and took her ankle deep into the water. Brenda expressed her discomfort about being in the water and her boyfriend replied, “It’s okay, the water is too shallow for a shark to come.” Pretty soon the water felt so good and they were having such a great time in the sand, in the water, in the sun, and with each other, that they found themselves out to their knees. Again, she went away from the fun for a moment and remembered the sign. She expressed her fear of the sharks, to which her boyfriend said, “It’s all right. Nothing is going to happen.” Pretty soon they were up to their waists in the water. Her expression of concern and his reply were repeated. Then finally, up to their necks in the water, her boyfriend reassured her that, all was okay, ignoring her fears and her pleas for them to go back onto the dry land. Hard to see at first, but then clear and sure, there came the fin of a Great White Shark. Within no time, the shark came up underneath her and took half of her body in one bite. The Great White snapped her off at the waist, and swam away with half of her riddled body. In this unrealistic, yet terrifying dream, her boyfriend turned to her and said, “Oh, I am so sorry about what happened,” to which she replied, “Oh, it’s okay. It’s no big deal.”
As you can see this young woman’s low self-esteem was played out in this dream. It was her life to yield to the wants and desires of others and to ignore her heart, her sensibilities, her intuition, her mind, her best interest, and her feelings. To Brenda, her feelings did not count, were not worth listening to, were not worth following, and the only thoughts and feelings of worth were someone else’s. The daily lives of those so similarly suffering is dramatically typified in this symbolic dream, which is about a chronic, poor, and destructive belief about themselves.
What Self-Esteem Is
First of all, let us talk about what self-esteem is not. Self-esteem is not about, and does not come from “externals.” A model of self-esteem, according to many who are trapped in an addictive eating disorder, was conceptualized by a colleague of mine, Dr. Harold Frost. “Eating disorder patients most often become trapped in a belief about self which is: ‘I am nothing more than my appearance, my achievements, and what others think of me.'” It is these beliefs about themselves that keep the eating disorder alive and well. Therefore, a step to recovery, and then ultimately one of the blessings of recovery, is to once again learn that esteem and worth are much more than appearance, so much more than achievements, and everything more than what others might think and feel.
Self-esteem has more to do with what one believes in, what one thinks, feels and desires, the intentions of one’s heart, one’s sensibility, intuition, capabilities, and more. It has to do with passion and how one lives their life. Self-esteem has more to do with the internal than the external. For the religious, it has to do with deity and divinity, the meaning of being a creation of God. For others, it may include ideas of connection with others, self-respect, good intention, talents, whether developed or not, a sense of being rather than doing. It is about who we are. Who we are, and the intentions of the heart.
According to Bednar Wells and Peterson (1989), self-esteem is: “An enduring and affective sense of personal value based on accurate self-perceptions.”
It is my belief that children have at birth, as infants and toddlers, a positive sense of self. It is not until circumstances, experiences, and interactions which teach differently, that beliefs about self change and poor self-esteem “raises its ugly head.” Then, children begin to forget and disbelieve how wonderful they are. Part of overcoming poor self-esteem is to “come back to” that which you once knew about your value and worth before life’s negative experience began to teach falsehoods about the value of yourself.
Traditional Models of Self-Esteem
A person’s belief about where poor or positive self-esteem comes from depends on their model of human growth and development, and their model of personality and learning theory. It is the “filter,” the “sunglasses” we look through, which helps us find meaning in the world and also dictates our model of self-esteem. I present only a few of many traditional models of self-esteem, ways to help build self-esteem in each model, and finally, I will discuss some unanswered questions and concerns which remain after traditional models are rendered.
|Philosopher / Behavioral Scientist||Self-Esteem Model||Interventions Based on Model|
|William James||Setting goals and realizing them.||Baby steps structure for success, then generalize to other situations.|
|Sullivan||Reflected appraisals of significant others.||Cognitive restructuring.|
|George Herbert Mead||Winning approbation from significant others.||Seek positive feedback from trusted loved ones.|
|Gordon Allport||Coping with difficulties versus avoiding difficulties.||DBT: Dealing with different emotional states, “Feel the fear and do it anyway.”|
|Rollo May||Courage to allow all of oneself to exist.||Existential therapy and acceptance of being.|
|Scott Peck||Face adversity head on.||Desensitizations, Grandma’s rule, face things first, play or enjoy later.|
|Rosenberg||Self-confidence, the expectation of success amid challenges.||Plan to goal setting and success.|
|* Information adapted from Bednar Wells and Peterson’s (1989).|
In reviewing these traditional models and theories about self esteem, and the consequent interventions needed to overcome poor self-esteem, it is seen that traditional models have many strengths, and luckily, many of these models have been utilized in the current therapies, including cognitive/behavioral therapy and the “positive mental attitude” programs that people have used in self-growth, psychotherapy, and business consulting. But despite the good that has come out of these and other traditional models, many questions remain unanswered. That leaves room for new theories, hopefully more useful and practical in helping people overcome poor self-esteem and make gains in their journey of recovery from emotional and mental illness and from addiction. One of these new models will be presented later in this article.
Questions Remain from Traditional Models
Difficult and unanswered questions remain from traditional models such as these:
- What if young people growing up are treated well within family and social circles, and they still have poor self esteem? What does that mean about the old theories?
- What about those with loving and attentive parents who would give everything and anything for their children, and who have done their best, have done well, and still their children suffer with poor self-esteem?
- What about the resilient who suffer horrendous trauma, abuse, neglect, and abandonment, but yet seem to feel good about themselves?
- If self esteem is based on the appraisals of significant others, then why is it that all too often, our positive and expressed appraisals do not seem to make much difference?
(Questions were adapted from Bednar, Wells, and Peterson 1989).
The New Model of Self-Esteem
A new and practical way of looking at self-esteem is that no matter the source of low self-esteem, it is avoidance that maintains it. The ideas presented here come from my twenty plus years of clinical experience, personal life experience, and from the book Self-Esteem: Paradoxes and Interventions in Clinical Theory and Practice, APA, 1989, by Bednar, Wells, and Peterson.
The basic philosophy in this model is this: “One’s overall evaluation of self is the natural consequence of a person’s tendency to consistently cope with or avoid that which he or she fears. Low self-esteem is, therefore, both a cause and a consequence of disordered behavior”(pg. 4). Bednar et al., propose that “When there is a consistency in one’s tendency to cope or avoid conflict, there is a continuous basis for internal feedback from the self about the adequacy of the self.”
In other words, it is believed that there is interpersonal (external) and interpsychic (internal) feedback which we all receive in life, which is ongoing, and there are basic truths about that feedback:
- 1. Everyone is going to receive, and might as well expect, plenty of negative feedback from the social environment.
- Many people receive a lot of favorable feedback socially, but tend not to believe it.
- Self-evaluative processes are ongoing for most, if not all of us.
- Self-evaluation is impacted by either coping or avoidance, and that choice impacts one’s sense of the adequacy. (pg 13)
In other words, we have two choices: We can cope, which is growth oriented, personal development oriented, and increases understanding. Coping involves facing and resolving life’s dilemmas. Or we can avoid. Avoiding means we stay away and hide from internal risk taking, or interpersonal risk taking.
“Whether people cope or avoid dictates the positive or negative nature of the personal psychological experience,” and “Avoidance leads to negative self-evaluations, while coping or facing leads to favorable self-evaluations” (pg. 14). In other words, it is not what ultimately happens in a situation, or how well someone does, but rather it is the understanding and the sense of self that one has either chosen to avoid or chosen to cope and do the best that they can that really someones their sense of self-worth and esteem. (Bednar et al.)
“In the self-evaluation process, people usually notice what they do, and they often notice how they feel. What they do not often enough notice is how they feel about themselves as a result of their choices and as a result of how they live their lives. If one gets in the practice of becoming aware of how they feel about themselves for doing, acting, facing, and “following through,” then they can develop a tool for improving their self-esteem. Feelings about oneself are deeper, more important, and more connected to the core, to the heart, and to the individual’s actual sense of self.
Steps Toward Improved Self-Esteem using the “Avoidance Model”
- Assess for preoccupation with peer approval and acceptance.
- Assess for proclivity toward impression management, which is “Denial of feelings and unquestioning conformance, followed by a diminished sense of self-respect.”
- Help the patient identify and label significant avoidance patterns used in anxiety arousing conflict situations.
- Help the patient identify and label the self-evaluative thoughts and feelings associated with those avoidance patterns.
- Learn to realistically break avoidance patterns.
- Learn to face and cope with intra personal conflicts.
- Help clients identify new behavioral responses to conflict.
- Help clients become aware of their feelings about self which are associated with the new behaviors versus feelings about self stemming from old avoidant behaviors.
*(Adapted from Bednar et al. (1989) (pg. 127).
In the process of these eight steps, the following principles can help increase the chances of success:
Ask hard questions which cause reflection.“How do you feel about selling yourself out?” “What was it like to go against what you felt was right?” “How did you feel about yourself after you said that?” “If you continue to act in life as you did in our session today, what will your life be like and how will you feel?” “How do you feel about being able to face that hard situation?” “Even though you are upset with yourself, how does it feel to be honest with yourself?” “Have you noticed that you have been acting differently in the last half hour?”
- Help clients learn to ask themselves how they feel and how they feel about themselves.
- Help clients notice and feel the emotion associated with negative and positive patterns which they enact in their lives.
- Focus on the process, not so much on the outcome.
- Hold up the mirror. Help them see the process that we see, and help them see the person that we see.
- Use the therapy session and the therapeutic relationship, along with the client’s patterns within the relationship, as a microcosm for the rest of life.
- Do not prematurely save them from negative emotion and negative meaning in their recognition of avoidance.
- Teach them through their own self-reflection that avoidance validates the fear of failure, and that it has a negative impact on self-esteem.
- 9Quit trying to convince clients that they are great. Instead:
- Help them see their goodness and notice the small evidences of their courage, their progress, and their willingness to avoid avoidance.
- Correct the incorrect and move on. In other words, if an eating disorder patient says, “I am fat,” say, “I see you as beautiful, and additionally you are in a normal weight range. I am sorry you cannot see that.” We correct and then move on instead of trying to convince.
- Help them change the approval management facade since they will not accept positive feedback from us on the outside, until they become more honest and real with themselves on the inside.
Avoidance: Center for Change Research Survey
In September 2005, I walked into a therapy group I was running and asked eleven women to help me prepare to teach other professionals about the impact of avoidance on self-esteem and on the process of recovery. They wanted very much to help.
The women in this group ranged in age from sixteen to twenty four years of age, were struggling with anorexia or bulimia, and were receiving intensive care in our residential treatment program. Approximately 65% of them had been sexually abused. 50% had a history of self-mutilation. 80% had a diagnosis of major depression. 40% had a diagnosis of a concurrent anxiety disorder, and half of those had been diagnosed with OCD.
In the survey I asked each patient to respond in writing to the following six questions:
- 1. What are the most important things you have avoided during your life and during your process of recovery?
- Why did you, or are you, avoiding those most important things in your life?
- What has been the cost of avoidance in the past or the present?
- When you have overcome the pattern of avoidance, and how did you do that?
- What has helped you stay out of avoidance the most?
- What, if anything, does avoidance have to do with your personal feelings of self-worth?
After the survey questions were completed, responses were reviewed. Much can be learned from these women about the role of avoidance in their self-esteem, and the role of avoidance or non-avoidance in the process of recovery from an eating disorder. In the following paragraphs, I give a summary of the conclusions which I derived from the participants’ responses. With each of the conclusions are one or two direct quotes associated with each item to illustrate firsthand one direct comments which led to each drawn conclusion.
Summary of Conclusions from the Center for Change Avoidance and Self-Esteem Survey
- Patients will recognize and take ownership for their own avoidance patterns when given a common language and a safe opportunity to talk about it.
“I have avoided working on my past issues, and I have avoided my emotions. I have avoided making friends and being close to people. In recovery, I have avoided getting better. I have been putting it off for seven years. I have avoided trying my hardest because I am terrified of failure.”
- Common areas for avoidance in life generally and in the process of treatment include:
- Assertiveness in relationships.
- Feeling, allowing, and accepting, emotions.
- Closeness and potential hurt from such in relationships.
- Painful feelings or memories related to past intensive experiences.
- Potential rejection.
- Potential failure.
- Potential loss of love from “changing or growing up.”
- Any interpersonal or intrapsychic conflict or turmoil.
“In my life I have struggled with avoiding any confrontation. That has allowed people the opportunity to walk all over me. I have also avoided talking about feelings related to situations that I am uncomfortable bringing up.”
- People embrace avoidance in an attempt to control others’ responses, especially in areas of acceptance or rejection.
“I have been avoiding my past issues because they are too painful for me to look at. They bring up hurt emotions. I try to avoid my emotions because I look at emotions as a weakness. Being weak is being a failure. I avoid getting close to people because I am tired of being hurt all of the time. I am terrified of rejection. I have put off recovery because I am so scared of getting fatter, and I am scared to live a life without my eating disorder.”
- Pretending is a common form of dishonesty with self and a common avenue for avoidance. Some admit that the loneliness following rejection is hurtful, yet pretend that loneliness from self-imposed hiding is not hurtful. Some patients avoid by pretending that they are still small and young.
“I have avoided growing up because I am scared to be alone. I am scared of responsibility. I am scared that I will mess something up. And more than that, I am scared that no one will love me anymore if I am not cute and little. I feel like I have nothing to offer the world, so why would anyone love me if I am not an adorable, curly-headed little kid anymore?”
- The price paid, or the cost of avoidance is high. Patients are most often aware of the external costs, and sometimes they are aware of internal emotional costs, but less often are they aware of the high cost to their self-esteem.
“The price I have paid for avoiding my past issues has been huge. I have never been able to escape being the victim because I never dealt with changing my mind set. People can see that and then take advantage of me. I have lost friends and relationships with family members. I have forgotten how to stay present and stay in touch with my emotions. I became so afraid of life.”
- Some of the patients have at least some recognition and understanding that one of the highest costs of avoidance is loss of feelings of self-worth. A few have begun to understand the reciprocal relationship between avoidance and self-esteem.
“I feel bad when I avoid because I feel like I am too weak to handle life.”
“I think avoidance makes my self-worth decrease because I feel as though I am not respecting my own wants and desires.”
- People can overcome the tendency and pattern of avoidance.
“I used to avoid friendships like they were a deadly disease. But now I am able to actively seek after relationships with others. With self-nurturing I have developed the inner strength I need to reach out to other people. And with goal setting, I have been able to take the steps necessary to add friends to my life.”
- Patients have many tools and methods for overcoming avoidance, and thereby increasing their self-esteem. They can use coping skills as an alternative to avoidance, and these include:
- becoming more open,
- actively seeking relationships,
- goal setting,
- taking small steps,
- talking about true feelings in a relationship,
- practice asking for what they want.
“You have to put yourself out on a limb. If you put yourself out there, you don’t always get what you want, but when you do, you feel great about yourself and others.”
- Patients can learn to notice and utilize negative and positive affective states related to coping and avoiding. When they are being taught, challenged, and gently invited to look at the truth by their therapist, this learning can be accelerated.
“What helps me avoid avoidance the most is trusting myself, others, and my Higher Power that everything will be okay.”
Two Interventions for Increasing Positive Coping and Decreasing Avoidance
I present the following interventions not as ones that anyone should replicate or repeat, but simply as an example of the kinds of interventions that can be done.
- Using the avoidance survey question as an intervention:
Remember, I asked the residents to complete the survey questions to help me prepare for teaching a professional seminar for therapists on avoidance. After they finished filling out their responses to the questions, avoidance became the topic of the therapy group. As those questions stimulated their own thoughts and feelings about the way they avoid and the impact of that on their lives, it led to a powerful group of self-revelation and honesty. Mutual sharing led to feelings of safety and then exploration about why they avoid things, what the impact is on their lives, how they are going to do it in the future, and eventually activity in group, which was the opposite of avoidance. This was powerful, reinforcing, and hopeful for them. The benefits that came from using the survey as an intervention in group were as follows:
- Patients were able to acknowledge and take ownership for the avoidance patterns that were hurtful to them.
- In discussing avoidance, they increased their understanding of its function in their lives, which lead to decreased self-judgment and increased self-compassion for the pain and suffering that avoidance has caused them.
- They were able to tell the truth about the cost’s associated with their eating disorder and the costs of avoidance in facing the pain, suffering, and sacrifice necessary in letting go of their eating disorder. Telling the truth about the cost and prices of having an eating disorder also helped them “take the eating disorder off the pedestal,” which was especially helpful for some anorexic women in the group.
- Patients were able to see that they have made progress in the decrease of avoidance in their lives, and an increase in coping in their efforts toward recovery.
- They acknowledged and shared skill sets in coping with one another.
- They were able to see a connection between their patterns of avoidance and coping, and their sense of self-worth.
- They began that process of understanding, which affects change from the inside out, increases a sense of control over how they feel about themselves, and gives more hope that they really can improve their self esteem.
In that one-hour-and-fifteen-minute process group which followed the survey completion, one patient said, “I really did not want to share. I am scared and embarrassed, but I need to since I have waited way too long.” She then shared with tears, facing her fears, and her sharing was followed by acceptance from the group. She challenged her shame and found not only acceptance from the group, but experienced self-respect and self-acceptance from having the courage to share what is in her heart, she knew she needed to share.
- An Intervention of Singing:
In a professional seminar I recently presented, I asked the participants to stand and to sing with me “Somewhere Over the Rainbow.” These are the instructions I gave them:
- Get out your song sheet: “Somewhere Over the Rainbow.”
- Stand together and we will sing together.
- Singing this song is not about singing, but it is about giving something to yourself. The message of this song is that it is time to “go for it.” Face your fears, refuse to fail, do not hide, do not quit, do not avoid. It is time to dream again, believe in your dreams, and believe in yourself again.
- Let us all sing this song with the intention to personally proclaim and give a gift unto ourselves that gift is about “going for it” and facing a fear that we have.
- Make singing the song symbolic of “going for it” and really “going all out” — “doing it your own way,” and facing the fears that you have in your growth process.
- Now let’s sing together.
After the group sang together, a few minutes were given to process the thoughts, feelings, and reactions of each to the request to sing and participate.
After the entire group had sung together and sat back down in their chairs, I asked for one volunteer, someone who was willing to sing this song a cappella, on their own, in front of the big group. I instructed the soloist and the entire group as follows:
- This person will come in front of the group and sing to you.
- This person is going to be singing to you, but for themselves.
- They will think of something that they want to create, have, dream, face, or overcome in their life that has been frightening to them.
- They will let this song, the way they do this song, symbolize their commitment to cease all avoidance and “go for it.”
- Remember that it is not about singing but it is about facing fear and transcendence!
Upon completion of the song, the soloist is asked to process what fear they were facing in singing that song, what they needed to accomplish in their life, and then talk about how they felt about what they had done. The theme of the song “Somewhere Over the Rainbow,” by Ely Harbor, and Harold Arlen, is believing in oneself again, embracing hope again — believing that faith is the motivation that drives us to challenge our fear and sends us into action. This song, in its lyrical content and in the singing of it, is a metaphor for what we are trying to teach in avoiding avoidance.
Somewhere over the rainbow,
Way up high,
There’s a land that I heard of
Once in a lullaby.
Somewhere over the rainbow,
Skies are blue,
And the dreams that you dare to dream
Really do come true.
Someday I’ll wish upon a star
And wake up where the clouds are far
Where troubles melt like lemon drops
Away above the chimney tops,
That’s where you’ll find me.
Somewhere over the rainbow
Blue birds fly.
Birds fly over the rainbow,
Why then, oh why can’t I?
If happy little blue birds fly
beyond the rainbow
Why oh why can’t I?
Self-esteem is not a place you get to, it is not a level you rise to, it is a choice you make at any moment by choosing to treat yourself with respect, to treat yourself as if you can do, to treat yourself as worthy of being listened to in your heart and being willing to go forward in the moment. Patients being willing to take risks in a group, whether it is singing, dancing with a hoola hoop, or standing up and making a statement, is an expression of self-acceptance, commitment, and power. A willingness to follow one’s heart or take needed action becomes symbolic of treating oneself as if they are of incredible and transcendent value, which is true. This builds a sense of self-esteem and the hope of having control long-term over feelings about oneself.
Guidelines, Themes, and Principles for Using “Avoiding Avoidance” as a Vehicle to Overcome Poor Self-Esteem
- Make the theme in therapy “Go for it!” In other words, in therapy hold nothing back. “Feel the fear and do it anyway,” and give it everything you have got.
- Practice less talk therapy and more doing therapy. Instead of saying, “What would you say to Dad?” say “Let’s talk to your dad right now, using this empty chair.”
- Do not avoid emotion or save patients from emotion in therapy. Emotion is best accepted, embraced without judgment, learned from, and then managed as a friend.
- Support clients to to give themselves permission for thoughts and feelings without judgment.
- In therapy, address self-love. Notice it, point it out, and label it.
- Reframe facing fears as internally and externally congruent and as evidence of self-love and self-respect.
- Address love that you see between a patient and others directly by pointing it out to them when you see it, since many times they cannot see when they or someone else is loving.
- Help the patient separate the difference between thoughts, feelings, and impressions of the heart, since they are all different. Recognize and avoid blame and self-deception. Discuss the difference between victim versus choice, and help the patient trust and honor their heart.
- Point out progress. Help them notice and see the positives of what they are not used to noticing, such as courage, love, compassion, and success. We can point these out and help them begin to see.
- Help them become confident in one thing and help them see and find their own evidence of competence in that thing.
- Teach the difference between love and approval, because as long as approval is needed for self-esteem, they will always have poor self-esteem. Approval does not last. Love does last.
- Teach them to validate themselves, and then as a therapist or loved one, agree with their validation
- Work on positive self-identity to help with self-esteem. Help them look at their progenitors, their legacy, the meaning and mission of their life, and their style and personality. Help them understand the principles that they live by and to see when they are congruent and in harmony with the things that they believe in. Help them find those things in life that they care most deeply about.
- Help them see and experience the emotion which accompanies living for or against the principles they believe in and then learn from that emotion.
Avoiding avoidance requires great courage. It requires great faith. It is a choice we make, and therefore it is something that we can impact in any moment. By engaging in this pursuit, one can improve their own self-esteem. Again, faith in oneself is a cornerstone of good self-esteem.
Recently, on an airplane ride, I read in USA Today an inspiring story about a man who avoided avoidance at all costs by facing his fear, holding onto his integrity, and following his heart. It was inspiring to me, and I share it with you.
– USA Today, Friday, November 11, 2005
Here is a story of a great man in sorrow who retained his integrity and refused to concern himself with what others would think. He avoided nothing. He listened and then followed his heart with great courage and resolve. This approach in facing life’s challenges without avoidance is a powerful means to help women recover from their eating disorders.
Avoiding avoidance sets us free. I hope you, and I, each one of us, will not allow fear to stand in the way of growth, and that through that example, we will help our clients live the same way. It’s best in life to avoid only avoidance.
Self-Esteem: Paradoxes and Innovations in Clinical Theory and Practice, American Psychological Association, Washington D.C., 1989.
An Inspiring Story, USA Today, Friday, November 11, 2005
Written By: Michael E. Berrett, PhDShare