# Therapy for low self-esteem: when to seek help and what is worked on in therapy > You criticise yourself for everything, struggle to say no and nothing you do feels good enough. When to seek therapy for low self-esteem, what it involves and how to choose well. *https://mypsicotest.com/en/blog/therapy-for-low-self-esteem/ · Published: 2026-10-07 · 8 min read · MyPsicoTest team* In a meeting someone asks for your opinion and you stay quiet in case you say something stupid. A colleague makes a throwaway comment and you dwell on it all afternoon. You take on yet another task that is not yours because you do not know how to say no. And when something goes well, you put it down to luck. If that sounds familiar, you may have thought about looking for **therapy for low self-esteem**. The NHS sums it up like this: we all have times when we lack confidence, but when low self-esteem becomes a long-term problem, it can harm our mental health and our day-to-day lives. This guide explains when it is worth seeking help, what is worked on in therapy, what research says, how long it usually takes and how to choose a professional. ## When to see a psychologist about low self-esteem Low self-esteem is not a disorder but a way of seeing yourself that can be more or less harsh. According to the [NHS page on raising low self-esteem](https://www.nhs.uk/mental-health/self-help/tips-and-support/raise-low-self-esteem/), people with low self-esteem tend to see themselves and their lives in a more negative and critical light, and feel less able to take on life's challenges. Avoiding difficult things feels safe in the short term, but in the longer term it reinforces your doubts and teaches you an unhelpful rule: that the only way to cope is by avoiding things. It is worth seeking help if: - You have been hard on yourself for years and it does not change, however hard you try. - You avoid meetings, social plans or new challenges for fear of making a fool of yourself. - You find it hard to say no and end up overwhelmed, resentful or short-tempered. - Your mood rises and falls with what other people think of you. - It repeats in your relationships: you put up with things you should not for fear of losing someone. - Anxiety, persistent sadness or habits such as smoking or drinking more start to appear as ways of coping, something the NHS mentions explicitly. There is another reason not to let it slide. A [meta-analysis by Sowislo and Orth](https://pubmed.ncbi.nlm.nih.gov/22730921/), covering 77 longitudinal studies on depression and 18 on anxiety, found that low self-esteem predicted depression more strongly than depression predicted low self-esteem. With anxiety, the link ran both ways. The authors concluded that working on self-esteem might help reduce the risk of depression. If you would like to put a number on it before your appointment, the [Self-Esteem Test](https://mypsicotest.com/en/self-esteem-test/) gives you a score and a breakdown across three areas: self-worth and self-acceptance, self-criticism and comparison, and autonomy and boundaries. ## What is worked on in therapy for low self-esteem The approach with the most studies behind it is **cognitive behavioural therapy** based on the model developed by Melanie Fennell at the University of Oxford. It starts from an idea the NHS explains simply: low self-esteem often begins in childhood, when, out of all the messages we receive, the one that sticks is that we are not good enough. In Fennell's model, that bottom line ("I am worthless", "I am not good enough") is protected by rules for living ("if I do not do it perfectly, I will be rejected"). When a situation threatens to break those rules, anxious predictions appear, along with the precautions taken to stop them coming true and self-criticism, all of which keep the problem going. A brief eight-session programme based on this model, published in 2025, works through these steps: - **Where your low self-esteem comes from** and what keeps it going today. - **Anxious predictions** and the precautions you use to protect yourself, so that you can test them with small experiments. - **Self-criticism**, learning to spot it and answer it. - **Your strengths and good qualities**, which also belong in the picture. - **Your rules for living**, replacing them with more flexible ones. - **The bottom line**, building a fairer one. - **A plan for keeping well** once therapy ends. ![Young woman writing in a notebook in her living room with a cup of tea, as in the exercises used in therapy for low self-esteem](https://mypsicotest.com/assets/img/blog-escribir-pensamientos-autoestima-1200.webp) Many of these pieces match what the NHS suggests you can start doing on your own: noting down your negative thoughts about yourself, looking for evidence that challenges them, listing good things about yourself, learning to say no and setting yourself small challenges. If self-criticism is your weak spot, [Being too hard on yourself: when high standards stop helping](https://mypsicotest.com/en/blog/being-too-hard-on-yourself/) may help. ### Why repeating positive statements is not enough It is tempting to think the answer is to tell yourself nice things in the mirror. A study by Wood, Perunovic and Lee with people with low self-esteem found the opposite: those who repeated "I'm a lovable person" felt worse than those who did not. As the authors put it, repeating positive self-statements may benefit certain people, but backfire for the very people who "need" them the most. That is why therapy does not work with slogans but with the way you interpret what happens to you. ## What research says about therapy for low self-esteem A [meta-analysis by Kolubinski and colleagues](https://pubmed.ncbi.nlm.nih.gov/30201116/) brought together the studies of CBT based on Fennell's model. With weekly sessions, the effect on self-esteem was large, and with one-day workshops it was small; depressive symptoms improved in a similar way. The authors note that there are few studies and that it is unclear how far these treatments differ from those for depression. In young people, Gerhard Andersson's team at Linköping University has tested therapist-guided internet CBT. Seven weeks of it improved self-esteem considerably compared with a waiting list in adolescents aged 15 to 19 and, in a trial published in 2026, in young adults aged 18 to 25. Self-compassion, quality of life, depression and anxiety also improved. These are preliminary studies that will need to be repeated with more participants. ## How long therapy for low self-esteem takes There is no fixed number. The programmes studied range from a one-day workshop to several weeks of sessions: the Linköping online versions lasted seven weeks and the brief programme described above, eight sessions. If low self-esteem comes with other problems, such as anxiety, depression or a pattern of relationships that hurt you, the plan is adjusted to them. What matters is that the professional explains from the start what you will work on and how you will measure progress. ## Does online therapy work for low self-esteem? Both Linköping trials were carried out online, with support from a therapist, and both showed large improvements. For problems such as anxiety and depression there are also meta-analyses finding equivalent results for online and face-to-face therapy. If travelling is difficult or you find it easier to talk from home, it is an option with evidence behind it. ## How to choose a psychologist for low self-esteem These checks help you choose well: - **Licensing and registration.** The NHS stresses that if you look for a private therapist, you should make sure they are registered with a professional body. - **A clear way of working.** They should be able to explain how they will tackle self-criticism, the rules you impose on yourself and the way you see yourself. - **No magic recipes.** Be wary of anyone who promises to boost your self-esteem in a few days or with motivational phrases. - **Reviewing progress.** Measuring how you are doing makes it possible to adjust therapy in time. - **Attention to what comes with it**, such as anxiety, depression or emotional dependency. If you suspect the last of these applies to you, the [Emotional Dependency Test](https://mypsicotest.com/en/emotional-dependency-test/) can guide you. ## A psychologist for low self-esteem At MyPsicoTest we recommend [Xènia Capel Salcedo](https://psicologaigualada.es/en/therapist-psychologist-igualada/), a licensed clinical psychologist (COPC 14982) with a master's degree in Clinical Psychology and Psychotherapy. Self-esteem is one of the services at her practice in Igualada and in her [online therapy](https://psicologaigualada.es/en/online-therapy-online-therapist/), which she describes as therapeutic work to strengthen your self-esteem, improve your self-image and develop a healthier relationship with yourself. She works from an integrative, evidence-based approach: on her website she explains that she uses tools from cognitive behavioural therapy, EMDR, systemic therapy and person-centred therapy, adapting techniques to each situation and to each person's pace. Sessions last about 60 minutes and are available in English, Spanish or Catalan, how long the process takes depends on each case, and the first contact is a free, no-commitment information session by phone. She herself points out that in a serious crisis or psychiatric emergency, immediate in-person care is what is needed. ## Frequently asked questions ### When should I see a psychologist about low self-esteem? When the way you see yourself has been hurting you for a while: you criticise yourself harshly, avoid challenges or social situations, cannot say no or start to feel anxious or low. You do not need to hit rock bottom to ask for help. ### What does a psychologist do to improve self-esteem? They help you understand where the way you see yourself comes from and what keeps it going, test your fears with small experiments, answer your self-criticism and swap the rigid rules you impose on yourself for more flexible ones. ### What is the best therapy for low self-esteem? The one with the most studies is cognitive behavioural therapy based on Melanie Fennell's model. A meta-analysis found large effects when it was delivered in weekly sessions, although the authors call for more research. ### How many sessions does it take to improve self-esteem? It depends on the person. The programmes studied range from a one-day workshop to several weeks of sessions, and some brief programmes have around eight sessions. If there is anxiety or depression, the plan is adapted to it. ### Does online therapy work for low self-esteem? Yes. Two trials at Linköping University of therapist-guided internet CBT found large improvements in self-esteem in adolescents and young adults. ### Can low self-esteem cause depression? It can contribute. A meta-analysis of longitudinal studies found that low self-esteem predicts depression more strongly than the other way round, so working on it might help prevent depression. ### Do positive affirmations help with low self-esteem? For people with low self-esteem they often do not: one study found that repeating phrases such as "I'm a lovable person" made them feel worse. Reviewing the evidence for what you think about yourself works better.