Psychotherapy plan for SOCIAL DISCOMFORT and/or LOW SELF ESTEEM

[OrlandoDaHash]

I recently came across this great book called The Complete Adult Psychotherapy Treatment Planner. Since I find a lot of people on this board suffer from social discomfort and low self esteem I’m posting a structured plan of action to help address this issues.


SOCIAL DISCOMFORT

Long-term goals

1. Interact socially without excessive fear or anxiety.
2. Develop the essential social skills that will enhance the quality of relationship life.
3. Develop the ability to form relationships that will enhance recovery support system.
4. Reach a personal balance between solitary time and interpersonal interactions with others.
5. Terminate use of alcohol or chemicals to relieve social anxiety and learn constructive coping behaviors.

Short-term objectives

1. Identify and clarify nature of fears connected to associating with others.
2. Identify sources of low self-esteem.
3. Identify and replace negative self-talk that fosters social anxiety.
4. Identify and implement again successful social skills from the past.
5. Initiate one social contact per day with a familiar person for increasing lengths of time.
6. Verbally report positive outcomes of participation in social and support groups.
7. Initiate a social contact with a stranger.
8. Identify ways he/she is like other people and therefore acceptable to others.
9. Verbally describe the defense mechanisms used to avoid close relationships.
10. Implement assertiveness skills.
11. Verbally report and demonstrate a renewed send of trust in others.
12. Develop a written plan that divides non-workdays between social and solitary activities.

Therapeutic Interventions

1. Explore childhood and adolescent experiences of rejection and neglect that would foster fear of associating with others.
2. Assist the client in identifying fears tied to relating with others.
3. Probe childhood experiences of criticism, abandonment, or abuse that would foster low self-esteem and shame.
4. Assign the client to read the books Healing the Shame That Binds You (Bradshaw) and Facing Shame (Fossum and Mason), and process key ideas.
5. Assist the client in identifying distorted automatic thoughts associated with anxiety over social interaction.
6. Ask the client to read the »Social Anxiety« section in The Feeling Good Handbook (Burns) and process key ideas with the therapist.
7. Assign the client to complete and process exercises on social anxiety and thought distortion in Ten Days to Self-Esteem! (Burns).
8. Assist the client in developing positive self-talk that will aid in overcoming fear of relating with others or participating in social activities.
9. Ask the client to list and process positive experiences from previous social encounters.
10. Utilize a brief solution oriented approach to identify a time where the client socialized with enjoyment and little anxiety, then create a situation that involves the same elements and have the client use this social coping skill consistently in the following weeks.
11. Monitor the client's solution oriented approach to his/her social anxiety; reinforce success and redirect the failure.
12. Assign the client to initiate one conversation daily, increasing time from one minute to five minutes per interaction, and report results to therapist.
13. Ask the client to attend and participate in available social and recreational activities within treatment program or the community.
14. Refer the client to a self-help group and to self-disclose two times in each session; process the experience.
15. Refer the client to attend a communication improvement seminar or a Dale Carnegie course.
16. Monitor, encourage, redirect, and give positive feedback to the client as he increases his interactions with others.
17. Encourage and support the client in his effort to initiate and build social relationships.
18. Facilitate a role-play with the client around initiating a conversation with another person for the first time. Process the experience.
19. Read either »Jean and Jane« Or »The Wallflower« from Friedman's Fables (Friedman) to the client, then use the accompanying questions to process the fable with him.
20. Assign the client to read books on self-understanding (e.g.Born to Win by James and Jongeward, Pulling Your Own Strings by dyer, or I'm OK You're OK by Harris and Harris) to help him see himself more clearly and in a more hopeful light.
21. Assist the client in recognizing how he is like or similar to others.
22. Utilize a transactional analysis (TA) approach to undercover and identify the client's beliefs and fears. Then use the TA approach to alter beliefs and actions.
23. Train the client in assertiveness skills or refer him to an assertiveness training class.
24. Assist the client in identifying defense mechanisms that keep others at a distance and in identifying ways to keep defensiveness at a minimum.
25. Guide and encourage the client's use of new assertiveness skills providing reinforcement and redirect as needed.
26. Point out to the client incidents where he demonstrates and inappropriate sense of mistrust in others. Process situations to help the client identify and remove the barrier.
27. Assign the client to develop a plan for nonworking hours than contains both social and solitary activities; review plan and give feedback.

 

[OrlandoDaHash]

LOW SELF ESTEEM

Long-term goals

1. Elevate self-esteem.
2. Develop a consistent, positive self-image.
3. Demonstrate improved self-esteem through more pride in appearance, more assertiveness, greater eye contact, and identification of positive traits in self-talk messages.
4. Establish an inward sense of self-worth, confidence, and competence.

Short-term objectives

1. Acknowledge feeling less competent than most others.
2. Increase insight into the historical and current sources of low self-esteem.
3. Decrease the frequency of negative self-descriptive statements and increase frequency of positive self-descriptive statements.
4. Identify negative self-talk messages used to reinforce low self-esteem.
5. Identify any secondary gain that is received by speaking negatively about self and refusing to take any risks.
6. Decrease the verbalized fear of rejection while increasing statements of self-acceptance.
7. Identify accomplishments that would improve self-image and verbalize a plan to achieve those goals.
8. Increase eye contact with others.
9. Take responsibility for daily grooming and personal hygiene.
10. Identify positive traits and talents about self.
11. Demonstrate an increased ability to identify and express personal feelings.
12. Articulate a plan to be proactive in trying to get identified needs met.
13. Positively acknowledge verbal compliments from others.
14. Increase the frequency of assertive behaviors.
15. Form realistic, appropriate, and attainable goals for self in all areas of life.
16. Take verbal responsibility for accomplishments without discounting.
17. Use positive self-talk messages to build self-esteem.
18. Increase the frequency of speaking up with confidence in social situations.

Therapeutic interventions

1. Actively build the level of trust with the client in individual sessions through consistent eye contact, active listening, unconditional positive regard, and warm acceptance to help increase his ability to identify and express feelings.
2. Explore the client's assessment of himself.
3. Help the client become aware of his fear of rejection and its connections with past rejection or abandonment experiences.
4. Discuss, emphasize, and interpret the client's incidents of abuse (emotional, physical, and sexual) and how they have impacted his feelings about himself.
5. Confront and reframe the client's negative assessment of himself.
6. Assist the client in becoming aware of how he expresses or acts out negative feelings about himself.
7. Assist the client in developing self-talk as a way of boosting his confidence and positive self-image.
8. Help the client identify his distorted, negative beliefs about self and the world.
9. Ask the client to complete and process an exercise in the book Ten Days to Self Esteem! (Burns).
10. Teach the client the meaning and power of secondary gain in maintaining negative behavior patterns.
11. Assist the client in identifying how self-disparagement and avoidance of risk taking could bring secondary gain (e.g., praise from others, others taking over responsibilities, etc.).
12. Ask the client to make one positive statement about self-daily and record it on a chart or in a journal.
13. Verbally reinforce the client's use of positive statements of confidence and accomplishments.
14. Help the client analyze his goals to make sure they are realistic an attainable.
15. Assign self-esteem-building exercises from a workbook (e.g., The Six Pillars of Self-Esteem by Branden, Ten Days to Self Esteem! By Burns); process the completed assignment.
16. Assign the client to make eye contact with whomever he is speaking to; process the feelings associated with eye contact.
17. Confront the client when he is observed avoiding eye contact with others.
18. Monitor and give feedback to the client on his grooming and hygiene.
19. Assign the client the exercise of identifying his positive physical characteristics in a mirror to help him become more comfortable with himself.
20. Ask the client to keep a building list of positive traits and have him read list at beginning and end of each session.
21. Reinforce the client's positive self-descriptive statements.
22. Assign the client to keep a journal of feelings on a daily basis.
23. Assist the client in identifying and labeling emotions.
24. Assist the client in identifying and verbalizing his needs, met and unmet.
25. Conduct a conjoint or family therapy session in which the client is supported in expression of unmet needs.
26. Assist the client in developing a specific action plan to get each need met.
27. Assign the client to be aware of and acknowledge graciously (without discounting) praise and compliments from others.
28. Train the client in assertiveness or refer him to a group that will educate and facilitate assertiveness skills via lectures and assignments.
29. Help the client analyze his goals to make sure they are realistic and attainable.
30. Assign the client to make a list of goals for various areas of life and a plan for steps toward goal attainment.
31. Ask the client to list accomplishments; process the integration of these into his her self-image.
32. Assign the client to read “What to Say When You Talk To Yourself” (Helmstetter); process key ideas.
33. Reinforce the client's use of more realistic, positive messages to himself in interpreting life events.
34. Use role playing and behavioral rehearsal to improve the client's social skills in greeting people and carrying a conversation.
35. Recommended that the client read Shyness (Zimbardo); process the content.

 

[tj]

six pillars of self-esteem is a great read!