Self-Reported Low Self-Esteem. Intervention and Follow-Up in a Clinical Setting
Self-Reported Low Self-Esteem. Intervention and Follow-Up in a Clinical Setting
Søren Ventegodt 0 1 2 5 6
Suzette Thegler 0 1 5
Tove Andreasen 0 1 5
Flemming Struve 0 1 5
Lars Enevoldsen 0 1 5
Laila Bassaine 0 1 5
Margrethe Torp 0 1 5
Joav Merrick 3 7
0 Nordic School of Holistic Medicine , Copenhagen , Denmark
1 Research Clinic for Holistic Medicine
2 Quality of Life Research Center , Teglgårdstraede 4-8, DK-1452 Copenhagen K , Denmark
3 National Institute of Child Health and Human Development
4 Zusman Child Development Center, Soroka University Medical Center, Ben Gurion University of the Negev , Beer-Sheva , Israel
5 Interuniversity College , Graz , Austria
6 Scandinavian Foundation for Holistic Medicine , Sandvika , Norway
7 Office of the Medical Director, Division for Mental Retardation, Ministry of Social Affairs , Jerusalem , Israel
At the Research Clinic for Holistic Medicine in Copenhagen, 43 patients who presented with low or very low self-esteem were treated with psychodynamic short-term therapy complemented with bodywork. They received an average of 20 sessions at a cost of 1,600 EURO. The bodywork helped the patients to confront old emotional pain from childhood trauma repressed to the body-mind. Results showed that 60.5% recovered from low selfesteem (95% CI: 44.41-75.02%). Calculated from this, we have NNT = 1.33-2.25. Almost all aspects of life improved at the same time (p < 0.01): physical health, mental health, quality of life, and ability to function in a number of important areas (partner, friends, sexually, and socially). This indicated that we had successfully induced existential healing (Antonovsky salutogenesis). The strategy of improving self-esteem can be the key to a new life for patients presenting with low quality of life, poor health (physical and/or mental), and poor ability to function. The patients were strongly motivated and willing to endure strong emotional pain provoked by the therapy. The rate of recovery is comparable to the most successful interventions with psychological and psychiatric treatment. Clinical holistic treatment has many advantages: efficiency, low cost, lack of negative side effects, lasting results, lack of use of psychopharmacological drugs (often with side effects), and an important preventive dimension.
self-esteem; psychodynamic therapy; bodywork; holistic health; human development; Denmark; Short-term psychodynamic psychotherapy (STPP)
©2007 with author.
Published by TheScientificWorld; www.thescientificworld.com
The most fundamental problem of human existence seems to be how to love oneself[1,2]. The reason for
this is our triple nature[3,4]: having body, mind, and soul, each carrying its own representations of self: the
Id, the Ego and – Me! So who am I? When a patient starts to become whole, he subjectively recovers his
sense of coherence[5,6]. Looked on from the outside, he becomes more alive, more real, and solid. But
much more than that is happening: the patient is gaining health, quality of life, and ability on all areas of
life. Sexual and social ability are often radically improved with the ability to love and work also
rehabilitated. This process of gaining existential health was called salutogenesis by Aaron Antonovsky
(1923–1994)[5,6]. Taking the patient into such a process of existential healing might be the medical
strategy for the new millennium[7,8].
Psychodynamic short-term therapy[9,10,11] combined with “spiritual” mindfulness[12,13] and
] was used in this study in order to work with all aspects of body, mind, and spirit at the
same time, as conversational therapy is often mainly mind-work. From 1990 to 2004, we analyzed how more
than 2000 life factors affected quality of life and health in order to conclude that philosophy of life was the
single most important causal factor, which we afterwards have used in therapy. From 1997 to 2005, we
treated more than 500 patients using this new combined method, which we have called clinical holistic
medicine[18,19,20]. We have recently been able to demonstrate that this intervention is safe and efficient with
patients suffering from physical, mental, and sexual problems with the effect of therapy lasting for more than a
year. The clinic has an open-door policy and the patients all come “from the street” having read our
books[18,19,20,22,23] or, most commonly, by recommendation from other patients (word by mouth). They
entered this study if they rated 4 or 5 on the five-point Likert Scale for quality of life (QOL5): How do
you feel about yourself at the moment? 1, “Very good”; 2, “Good”; 3, “Neither good nor bad”; 4, “Bad”; 5,
“Very bad”. Eight therapists performed the therapy under supervision (by SV). There were four major
common themes in the therapy: sex and the body, consciousness and mind, love and spirit, and using your
own talents and true self to be of real value to others[18,19,20].
The patients were measured with a five-item quality of life and health questionnaire (QOL5) (five
questions on self-assessed physical health, mental health, relation to self, relation to partner, and relation to
friends), a one-item questionnaire of self-assessed quality of life (QOL1), and four questions on
self-rated ability to love, self-rated ability to function sexually, self-rated social ability, and self-rated
working ability (ability to sustain a full-time job) (together, QOL10). These questionnaires were
administered before entering the study, after the treatment, and after 1 year[20,21].
How Many Recovered Their Self-Esteem?
Out of 43 patients who entered the study (see Table 1), only three continued to feel bad about themselves
after an average of 20 sessions. Fourteen patients did not complete therapy or failed to fill in the follow-up
questionnaire. The therapy confronted the patients with their many repressed and often painful emotions
from childhood of anger, guilt, shame, hopelessness, despair, and anxiety. Two patients had severe
existential crises lasting for a few days, but soon recovered, and no patient was harmed from the
intervention or had severe side effects. Not all patients were sufficiently motivated to confront the painful
emotions from the past, which made them drop out. Success rate of treatment: 26/43 = 60.47% (95% CI:
44.41–75.02%). The Number Needed to Treat (NNT) of clinical holistic medicine with patients with
low self-esteem is therefore NNT = 1.33–2.25. As we have treated more than 500 patients with no patient
harmed, we estimate the Number Needed to Harm (NNH) to be >500.
Low or very low self-esteem
Very high, high, or intermediate self-esteem
Nonresponders or dropouts
Low or very low self-esteem, nonresponder, or dropout
What Happened to the Responders?
Most interestingly, the patients who responded to the holistic existential therapy and improved their
selfesteem (relationship with self) also improved all other areas of life: quality of life (both self-assessed with
QOL1[20,24] and measured by the validated questionnaire QOL5[20,24]), self-evaluated physical and
mental health, and self-evaluated ability to function. All these improvements were about one step up the
five-point Likert scale, making them both statistically and clinically highly significant (see Tables 2, 3, 4,
We found (Tables 4 and 5) that the 26 patients who recovered their self-esteem in the therapy also
improved their relationships in general (with self, partner, and friends), their self-evaluated ability to
function in general (love, sex, and social ability), and their quality of life as measured with QOL5. When
health, quality of life, and ability were combined (in the measure called QOL10 that takes the average of
these three domains), it was clear that the patients had healed their whole life (as measured by QOL10),
not only their self-esteem.
Tables 2 and 3 show that the 26 patients who recovered their self-esteem also improved their
selfevaluated physical and mental health, relationship with friends and partner, ability to love, ability to
function sexually, social ability, and self-assessed quality of life (QOL1). Please notice that the results
are both statistically and clinically highly significant (self-assessed physical health p < 0.05, working ability
is not improved significantly, all other results p < 0.01).
Although research has stressed the connection between health and self-esteem with development of
selfesteem often suggested as one of the most important ways to prevent illness, improve health, and fortune, it
has been difficult to understand, conceptualize, measure, or improve self-esteem[26,27,28,29,30,31]. Even
though self-esteem is strongly related to quality of life, health, and ability, the connection between them still
remains quite obscure[26,28,29,30,31,32].
It seems that in order to change a person’s self-esteem, the most fundamental dimensions of existence
must be analyzed and developed, and such a development of the person’s innermost layer seems to be a true
transformation of personality. We have induced this transformation with the patients in the clinic through
the development of sense of coherence by development of character and purpose of life, which actually
seems to be a very old strategy.
Relation to friends
Relation to partner
Ability to love
Quality of life
Physical health 0.4231
Mental health 1.4400
Relation to friends 0.6538
Relation to partner 1.5769
Ability to love 1.5000
Sexual ability 0.8846
Social ability 1.0769
Work ability 0.3077
Quality of life 1.6154
This healing of almost all aspects of life is often seen with clinical holistic medicine and is called
(Antonovsky-) salutogenesis after the researcher who discovered this type of immediate, lasting, and
allinclusive healing of the patient’s existence. The most remarkable thing is that this seems to be the kind of
healing that was induced by Hippocrates and his students 2,300 years ago on the island of Cos, where
recovery of the human character was the primary tool for this. Physicians have been laughing for centuries
about Hippocrates’ theory of “black and white bile” (the humeral medicine using the four elements), but it
can still work wonders today to recover the human soul and character. It is possible because this is the door
to the purpose of life, where we use our primary talents (often called our life-purpose or “mission of life”)
in order to be of value to others and give from our own gift to others.
Clinical holistic medicine, i.e., mindful psychodynamic short-term therapy complemented with
bodywork, seems from this study to be the perfect tool for helping patients to recover their self-esteem. This
can be done quickly, efficiently, cheaply, and without side effects. Most interesting, by successfully
inducing existential healing (salutogenesis), almost all aspects of life were improved at the same time —
physical and mental health, quality of life, ability to function in a number of important areas: with partner
and friends, sexually, and socially. Most importantly from a philosophical point of view, the patient’s
ability to love was recovered when the patient started to love him- or herself again. The strategy of
improving self-esteem can be the key to a new life for chronic patients who present the triad of low quality
of life, poor health (physical and/or mental), and poor ability to function. This combination is very difficult
to help, not to say cure, by traditional biomedical or psychiatric treatment.
A total of 43 patients entered the study with low or very low self-esteem, but after an average of 20
sessions, 26 persons (60.5%) were cured (95% CI: 44.41–75.02%). In clinical holistic medicine with
patients with low self-esteem, NNT was thus calculated to NNT = 1.33–2.25. As we have treated more than
500 patients with no patient harmed, we estimate the NNH as >500.
The rate of recovery was comparable to the most successful interventions with psychological and
psychiatric treatment, and as clinical holistic treatment seems to have almost no side effects, it seems to be
the choice of treatment for the patients who are able to endure the emotional pain it provokes. On average,
the patients received 20 treatments over a 14-month period at a cost of 1,600 EURO.
This study was supported by grants from IMK Almene Fond. The quality of life research was originally
approved by the Copenhagen Scientific Ethical Committee under number (KF)V.100.2123/91 and later
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