While reflecting on my clinical experiences with adult clients during my postgraduate internship, I discerned a common thread. The thread was that the feeling of being valueless was at the root of my clients’ depression, anxiety, anger and substance abuse, as well as the violence and verbal abuse experienced within couples.
Although the immediate cause of the perception of being valueless varied (e.g., pervasive childhood neglect or specific episodes of childhood physical, sexual or emotional abuse), the consequences were the same in each case — chronic dysphoria of one kind or another. It is simply not possible to esteem oneself, to be vulnerable with others, to feel able to positively impact the lives of others through relationships or achievements, or to expect an enjoyable and meaningful future when one is convinced that she or he lacks value.
During the past few months, I have been learning about and practicing a technique involving mindful self-compassion designed to increase my sense of personal value, and I have been working with willing clients to teach them the same technique. I have written this article to voice my perspective on how self-perceived valuelessness is the major factor in transdiagnostic client suffering and to share a technique for building belief in your clients that they possess value as human beings.
The meaning of value and valuelessness in human life
In common parlance, the word “value” signifies having such positive qualities as worth, goodness, merit, effectiveness, usefulness, importance, attractiveness and desirability. People who perceive themselves as possessing value are much more likely to have self-esteem, self-efficacy and life satisfaction than are people who appraise themselves as lacking value. Believing oneself to be valuable is associated with resiliency and posttraumatic growth because external hardships and adversities do not destroy value but, rather, reveal it.
To lack value means that one is not lovable, desirable or worthy of mattering to and belonging with others. There are few, if any, sources of emotional pain greater than believing that you lack value. I believe that clients who are convinced that they lack value are the ones most likely to suffer from depression and to engage in self-destructive behaviors such as alcohol or drug abuse, the self-sabotage of relationships, cutting, burning, eating disorders and suicide attempts. When you are certain you lack value, it is equally certain you will hate yourself and will consider or perpetrate acts of self-harm. You may even want to end yourself to stop the pain of living with this certainty and being your own worst enemy instead of your own best friend.
I understand that genetic abnormalities that cause bad brain neurochemistry, especially during times of stress, can trigger self-hate, depression and self-destructive behavior. However, I am convinced that most of the time distorted thinking about the self (as being bad, incompetent or certain to fail at everything) and maladaptive coping behaviors arise from our clients’ belief that they are valueless.
Believing that you are valuable but constantly berating yourself for being a piece of crap or sitting in a squalid room injecting heroin into your veins with a used needle are totally inconsistent. Believing that you are valueless also rears its ugly head in interpersonal relationships. People who know they are valuable can shrug off the unfair accusations, attacking comments, insults and rejecting behaviors of others by recognizing that they come from ignorance, mistaken assumptions, implicit biases, defensiveness or fear. On the other hand, people who see themselves as valueless will perceive dire threat and react with fight, flight or freeze when exposed to these things because they confirm their inner sense of valuelessness.
The association between value and triggering
A very common bit of psychological jargon that I hear today is the word “trigger.” It is used in the sense that some statement, action or inaction of one person set off an intense, immediate and automatic emotional reaction in another person who felt unsafe. This person responds with crying, threats of violence, actual violence, emotional contraction, fleeing the scene and the like.
When one spouse says “Shut the hell up” to the other, strikes the other or gets in the car and drives off to parts unknown following a dispute, we can say that he or she was triggered, but what really happened? I think what happened is that the spouse who acted out had a thin, fragile scab over his or her self-perception of being valueless and something the other spouse said tore it off.
Whether we remind ourselves that we are valueless through our own inner critic (the usual way) or someone else reminds us by their statements or conduct, it hurts just as much. And when that pain sets in, our self-esteem plummets from whatever shaky height we had lifted it up to. We then temporarily lose our effectiveness as people because we turn away from the world to soothe ourselves with substances or punish ourselves with self-attacking words or deeds.
Intrinsic versus extrinsic value
According to sources as diverse as the Judeo-Christian Scriptures, the philosophers Immanuel Kant and Martin Buber, and the Declaration of Independence, human beings have intrinsic value. Theologists may see intrinsic value as coming from people being created by a perfect Creator, whereas philosophers might see intrinsic value as coming from our possession of rationality and our capacity to act ethically by choosing the good.
To believe in the intrinsic value of the individual is to believe that our value is not contingent upon externals such as one’s most recent successes, the current size of one’s bank account or the current level of one’s physical attractiveness. For Viktor Frankl, value becomes evident when a person establishes an authentic meaning for his or her life. For Abraham Maslow, it is when a person self-actualizes his or her potential.
Despite so many sacred and secular voices in favor of intrinsic value, virtually none of the people I have met buy it. Rather, they engage in constant self-evaluation in relation to internal standards of achievement and attractiveness, as well as external comparisons with family members, friends, co-workers, professional colleagues and even star athletes, movie actors and celebrities.
Freud described this long ago as checking one’s self-evaluation in the mirror of one’s ego ideal and getting judged harshly by one’s superego for every discrepancy. Today we talk about the voice of the inner critic instead of the superego, but the process and consequences are the same. There is a constant need to reassure oneself of one’s value, and a failed attempt to do so is followed by self-attack, ego deflation and suffering. Kristin Neff, who has done pioneering research on self-compassion, has pointed out that self-attack is accompanied on a somatic level by release of cortisol and adrenalin, which make us feel sick.
Value and secure attachment
Why is it that a handful of people seem certain that they possess value while everyone else sees their value as questionable, fluctuating or even absent? The work of John Bowlby on attachment helps to shed light on this phenomenon.
Bowlby said that how infants and toddlers were treated by their parents, especially their mothers, had a huge impact on their sense of self. Infants and toddlers who received a consistent flow of love, caring, warmth, gentle touch, soothing vocalization and affirmation would develop what Bowlby called a “secure attachment” composed of feeling welcomed, loved, valued and wanted. The secure attachment was the germ of self-acceptance and self-confidence that fueled these children’s exploration of their environment and their ability to self-soothe when they experienced fear, physical pain or other adverse consequences.
In Bowlby’s framework, infants and toddlers who received love, warmth and caring in an unstable, episodic and inconsistent manner would develop an insecure or approach-avoid attachment style associated with a reduced sense of personal value and trust in others. The most damaged infants and toddlers were the victims of pervasive abuse or neglect who received the message that their caregivers hated them or did not care about them. These children developed an avoidant attachment style in which they reacted to others by distancing themselves emotionally and physically.
Therapeutic approaches to correcting self-perceived valuelessness
If secure attachment is the foundation of the self-perception that one has value, then the most effective therapy for clients who doubt their value or regard themselves as valueless should be some form of reparenting that has the effect of strengthening a weak attachment to others. Unfortunately, this type of therapy is demanding, prolonged and expensive, and is by no means guaranteed to work.
Cognitive behavior therapy is great at showing the falsity of automatic, negative thoughts about the self, but until the deep-seated conviction (the core belief) that one is valueless is gone, these thoughts will continue to arise. Trauma therapies work to desensitize, contextualize and reinterpret memories of adverse childhood experiences, but the conviction that one is valueless, resulting from pervasive abuse or neglect, is very tenacious. This conviction can represent the foundation of personality and self-identity and the form the ego took from parental shaping in childhood.
If it is not possible to remove and replace the psychological foundation of self-image, what can be done to solve this problem? My hunch is that behind the conveyance of a sense of value to the infant/toddler through parental holding, touching, warmth and affirmation is a programming of the brain (“I know I am loved”) and the heart (“I feel that I am loved”). Abuse, neglect or inconsistent parenting can confuse the brain of the infant/toddler (“I’m not sure I’m loved and lovable”) or program it to believe that “I am neither loved nor lovable.” These things can make the child’s heart feel the same message.
So, how can clients in therapy reprogram their brains to know and their hearts to feel that they have value? At this point in my investigation, I have only anecdotal evidence and nothing like the kind of systematically collected empirical evidence developed in the course of a randomized, controlled clinical trial based on an experimental design. Thus, my proposal is based on isolated experiences in the therapy office and is nothing like the sort of evidence-based protocol that an insurance company would want to see. On the other hand, positive clinical experiences can be the germ of subsequent studies to confirm or deny a hypothesis about those experiences.
The method I have been trying out on myself and some of my clients derives in part from what Kristin Neff and Christopher Germer call “mindful self-compassion.” The basic practice is to combine deep, slow, meditative breathing with eyes closed; an attitude of genuine compassion toward the self; the tender placement of hands upon one’s body (e.g., placing one open hand over your heart); and the inward repetition of chosen affirmations in a soothing voice.
I have tried out such affirmations as “I am worthy,” “I am valuable,” “I matter,” “I know my own goodness,” “I feel loved and included,” “I love and include,” “I am connected with all other beings and they with me,” “I trust that the universe supports me” and “the universe is unfolding in and through me, and I have an important role to play.” Individuals using this practice can create and try out different mantras until they have found some that resonate in a deep and profound way with them.
The meditative breathing serves to produce a trancelike, mildly euphoric state in which the parasympathetic nervous system is activated, the voice of the inner critic is switched off and there is a sense of warmth and expansive possibilities. The role of tender self-touch is to provide mammalian comfort and reassurance — to put oneself in a place of safety and trust.
The combination of meditative breathing with eyes closed and self-touch enables clients to become attuned to themselves in a way that could not happen in the therapy office with the distraction of glances, conversation, pauses and concern over the counselor’s opinion. When imbibed in this atmosphere of self-compassion and self-attunement, the self-affirming mantras take on the ring of truth, not New Age phoniness. Doing this exercise with sincerity is a form of self-reparenting that features the three elements that Dacher Keltner considers essential in loving mammalian connection: warmth, gentle touch and soothing vocalizations.
At this point, I have no evidence that this particular practice by itself can convert individuals who are convinced that they are valueless to people who know and feel they possess value. However, I am observing in myself and my clients that combining this practice with another therapy has a powerful, synergistic healing effect and that this practice has clinical promise.
After 25 years of law practice, Harvey Hyman retired, studied Buddhism and world religions, and entered graduate school to obtain a master’s degree in mental health counseling. He graduated this past October and is now registering for a counseling internship in the Sacramento, California, area. He hopes to work in the field of trauma psychology. Contact him at firstname.lastname@example.org.
Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.