Self-Esteem & Confidence: who to see and what helps

Self-Esteem & Confidence · Kitchener, Waterloo & Cambridge

Self-esteem is the opinion you have of yourself: how much you value and respect yourself as a person. Low self-esteem is not a diagnosis, but in long-term studies it predicts how relationships, work and mood go, depression included. In the small body of research so far, self-esteem scores rose by a large amount over a course of weekly cognitive behavioural therapy, though most of those studies had no comparison group. At CARESPACE the first visit is with a counsellor, who is a Registered Psychotherapist or a Registered Social Worker.

What self-esteem is, and what it is not

Researchers define it as a person’s own evaluation of their worth. With healthy self-esteem you tend to feel positive about yourself and about life, and you are better able to deal with life’s ups and downs. With low self-esteem you see yourself and your life in a more negative and critical light, and feel less able to take on what life throws at you.

High self-esteem is not arrogance. Self-esteem is about self-acceptance and self-respect; narcissism is about feeling superior and entitled. Nor is it the same as confidence, which sport researchers define more narrowly, as your perceived ability to reach a certain level of performance. And low self-esteem is not a psychiatric disorder in its own right. It turns up as a feature of many, depression and eating disorders among them.

Three neighbours are easy to mix up with it. Imposter syndrome is doubt about achievements you have really earned. Perfectionism is setting impossibly high standards for yourself. Body image is how you feel about your body, where self-esteem is how you feel about your whole self.

What low self-esteem looks like

• A running commentary that is negative and critical of yourself
• Staying away from social situations
• No longer trying new things, and avoiding anything you find challenging
• Saying yes to things you do not want to do, then feeling overburdened, resentful or angry
• Finding it hard to notice good things about yourself
• Thoughts such as feeling useless at times, or wishing you had more respect for yourself

Avoiding hard things feels safe in the short term. Over time it can backfire, because it reinforces the doubts and fears underneath. Some people lean on unhelpful habits to cope, such as smoking or drinking too much.

Where it comes from

The NHS’s account is that low self-esteem often begins in childhood. Teachers, friends, siblings, parents and the media all send messages about who we are, positive and negative, and for some reason the message that you are not good enough is the one that stays. Later on, stress and hard life events such as a serious illness or a bereavement can pull it down. So can struggling to live up to other people’s expectations of you, or your own: a first year at one of the universities, or a new job in a fast-growing tech company, puts both on show every day. Personality can play a part as well, since some people are more prone to negative thinking and others set impossibly high standards for themselves.

The therapy studies described below rest on one clinical model, Fennell’s, which proposes how this holds together. From early experience a person forms a general picture of themselves, the “bottom line”. When it is negative, they adopt rules for living that keep it hidden from others, and anxiety, self-criticism and low mood then keep confirming it. The review of those studies notes that little research has tested the model directly.

How self-esteem changes over a lifetime

A 2018 analysis of long-term studies drew on 164,868 people in 331 samples. On average self-esteem rises through childhood, holds level between ages 11 and 15, climbs strongly until 30, keeps rising more slowly until about 60, stays at its peak until 70, and declines slightly after that. The drop in the early teens that is often assumed does not show in these averages. Few of the samples came from outside Western countries.

When it is more than low self-esteem

An earlier analysis of 77 long-term studies, with 35,501 participants, summarized in the 2022 review, found that low self-esteem predicts later depression, and a smaller set of studies found the same, more weakly, for anxiety. Feelings of worthlessness are also one of the symptoms of depression itself. CAMH’s description of depression is symptoms on most days, lasting most of the day, for more than two weeks, that interfere with work, school or relationships. If that fits, see a physician or nurse practitioner. In Ontario a diagnosis of depression or an anxiety disorder comes from a physician, nurse practitioner, psychiatrist or psychologist.

If low self-worth has turned into thoughts of suicide, or you do not feel safe, do not wait for an appointment: use the numbers below.

If you are in crisis or thinking about suicide, help is available right now.

• Call or text 9-8-8, the Suicide Crisis Helpline, at any hour.
• Call Here 24/7 at 1-844-437-3247 for addictions, mental health and crisis services in Waterloo Region, at any hour. here247.ca
• Call 911 or go to the nearest emergency department if you or someone else is in immediate danger.

The emergency departments in Waterloo Region are:

• WRHN @ Midtown (formerly Grand River Hospital), 835 King St. W., Kitchener
• WRHN @ Queen’s Blvd. (formerly St. Mary’s General Hospital), 911 Queen’s Blvd., Kitchener
• Cambridge Memorial Hospital, 700 Coronation Blvd., Cambridge

If you cannot get there safely, call 911.

What the evidence says about raising self-esteem

• Where this comes from. A 2018 systematic review of cognitive behavioural therapy (CBT) for low self-esteem, and a 2022 review of long-term studies on what self-esteem does for people.
• Weekly CBT: a large change from before to after, in a small body of research. The review found eight studies; the seven it pooled had 821 participants, about 80% of them women, all in the United Kingdom. Over weekly group or individual sessions running roughly two to three months, self-esteem scores rose by a large amount and depressive symptoms fell to a similar degree. That is the change from before the program to after it, not a comparison with people who went without: four of the seven studies had no comparison group.
• One-day workshops: smaller. After seven-hour workshops, the change in self-esteem measured three months later was small to medium. That is a before-and-after figure too.
• What is not known. Most of the weekly programs had no usable follow-up, drop-out was high at times, and only one study looked at individual therapy. The reviewers’ wording is that these programs “may be efficacious”, and they could not tell whether they differ from therapy aimed at depression.
• Self-esteem seems to matter, modestly. Across long-term studies, higher self-esteem predicts better relationships, school and work outcomes and mental health. The effects are small, and studies of this kind cannot prove cause.
• A caution. The same reviewers warn that programs could backfire if they end up raising narcissism instead.

How CARESPACE helps with low self-esteem

Counselling & Psychotherapy

In counselling for low self-esteem the work is usually on the picture you hold of yourself: where it came from, the rules you live by to protect it, and what happens when you test those rules and do not avoid. CARESPACE counsellors offer cognitive behavioural therapy (CBT). The studies above used CBT in one specific form, a program built on Fennell’s model. A counsellor can also notice when low self-esteem is sitting on top of depression or anxiety, which need attention in their own right.

See our counselling team →

Other services people ask about

Mental performance. Building self-confidence is a common aim of sport psychology work with athletes. A 2022 review of 41 studies and 3,711 athletes found that confidence and performance do go together, though the link is small, and stronger in individual sports than in team sports. It did not test whether coaching raises confidence, and it concerned confidence in sport, not self-esteem in general. If your confidence dips mainly when you compete or perform, ask about mental performance when you book.

Where most people start

With a counsellor. If your mood has been low most days for more than two weeks, see a physician or nurse practitioner too.

How your team works together

Low self-esteem is mainly a one-service matter at CARESPACE, and that service is counselling. If depression or an anxiety disorder is diagnosed, your physician or nurse practitioner looks after that side, medicine included, while counselling continues.

Browse by service: counselling.

What to expect at your first visit

1. It starts with your concern. A first counselling visit is for the counsellor to understand it and come up with a plan. How much you say is up to you.
2. You may be asked about the commentary. The criticisms of yourself that come up most, and when you first remember thinking them.
3. And about what it keeps you from. The people, tasks and chances you steer around, and where saying no is hardest: work, family or friends.
4. You leave with a plan. If your mood has been low on most days for more than two weeks, it may include seeing a physician or nurse practitioner.

What you can do on your own

This is the NHS’s self-help advice. The studies above tested therapy programs, not these steps on their own.

• Catch the beliefs and question them. Write down the negative things you believe about yourself, note when you first started thinking them, then write down evidence that challenges them.
• Keep a list of positives. What you like about yourself and the good things others say about you. Aim for at least five, and keep adding.
• Do more of what you are good at.
• Look at the company you keep. Spend less time with people who bring you down, or tell them how their words land, and more with people who appreciate you.
• Be kind to yourself. When you are being self-critical, ask what you would say to a friend in the same spot.
• Practise being assertive, and saying no. Assertiveness means respecting other people’s opinions and needs and expecting the same back. Saying no does not usually damage a relationship, though you may have to say it more than once.
• Set yourself a challenge. Something achievable, such as joining an exercise class or going to a social event.

Outlook

None of the sources gives a recovery time. The therapy programs that were studied ran for about two to three months, and the review could not say how long the changes last. The lifetime picture is encouraging, though: on average, self-esteem keeps rising well into middle age.

Help with self-esteem in Kitchener, Waterloo and Cambridge

Kitchener. Counselling in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.

Waterloo. Counselling in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.

Cambridge. Counselling in Cambridge. Location: Hespeler Road.

The city pages linked above show the locations and practitioners for each service, with their next availability.

Common questions

Is low self-esteem a mental illness?

It is not classed as one. Low self-esteem is a feature of several psychiatric disorders, depression and eating disorders among them, without being a disorder itself, so it is worth checking whether something else is going on.

Is self-esteem the same as confidence?

Not quite. Self-esteem is your overall opinion of yourself. Confidence, as sport researchers use the word, is narrower: your perceived ability to perform at a certain level.

Does low self-esteem cause depression?

It predicts it. In 77 long-term studies, people with lower self-esteem were more likely to have depressive symptoms later. The effect is small, and prediction is not proof of cause.

Does self-esteem drop in the teenage years?

Not on average. In an analysis of 331 samples it held level from 11 to 15 and then rose strongly through the twenties.

How many counselling sessions does it take?

The weekly programs that were studied ran for about two to three months. Your counsellor will suggest a plan at the first visit, and it may be shorter or longer than that.

Can I see a counsellor about self-esteem in Cambridge?

Yes. Our Cambridge location is on Hespeler Road, and Counselling in Cambridge lists who works there. Book online or call 519-208-2273 and our Central Reception Team will find the closest location with an opening.

Do I need a referral?

No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →

Sources

• Kolubinski DC, Frings D, Nikčević AV, Lawrence JA, Spada MM. A systematic review and meta-analysis of CBT interventions based on the Fennell model of low self-esteem. Psychiatry Research, 2018.
• Orth U, Robins RW. Is high self-esteem beneficial? Revisiting a classic question. American Psychologist, 2022.
• Orth U, Erol RY, Luciano EC. Development of self-esteem from age 4 to 94 years: a meta-analysis of longitudinal studies. Psychological Bulletin, 2018.
• NHS. Raising low self-esteem. Reviewed April 2023 (its next review was due in April 2026).
• Canadian Mental Health Association, British Columbia Division. Body Image, Self-Esteem, and Mental Health (info sheet). 2015.
• Centre for Addiction and Mental Health (CAMH). Depression. Undated; read November 2026.
• Lochbaum M, Sherburn M, Sisneros C, Cooper S, Lane AM, Terry PC. Revisiting the self-confidence and sport performance relationship: a systematic review with meta-analysis. International Journal of Environmental Research and Public Health, 2022.

Related conditions

• Imposter Syndrome
• Perfectionism
• Body Image
• Depression
• Social Anxiety

Ready to book?

Book online with a counsellor, or call 519-208-2273 and our Central Reception Team will match you with the right person and the closest location.

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