This blog post explores what happens when a client’s low self-esteem activates our own as therapists, from the perspective of countertransference and psychodynamic theory. It also features the important role clinical supervision has when self-esteem strongly enters the therapy room.

Want to explore more? Join us for our upcoming workshop – Self-Esteem: Working with the Negative Mind with Professor Julia Buckroyd on Friday 27th February 2026, 10am-4pm on Zoom with catch-up recording available if you can’t make it on the day.

In this workshop esteemed Professor Julia Buckroyd will address a number of key issues in relation to self-esteem in the hope that we can enable our clients to let go of their damaging narrative and find a more creative way of engaging with themselves.

Work with low self-esteem often unfolds quietly. There may be no dramatic rupture or overt enactment – just a gradual shift in the therapist’s internal state.

A sense of self-doubt creeps in.

The work begins to feel heavy, effortful, or strangely exposing.

We may notice a pull to reassure, to perform competence, or to subtly disengage.

Countertransference, low self-esteem and other theories

From a psychodynamic perspective, these responses are not incidental. They can be understood as countertransference – not merely personal interference, but meaningful emotional communication arising within the therapeutic relationship.

While early psychoanalytic thinking framed countertransference as something to manage or minimise (as seen in the work of Sigmund Freud), later theorists reframed it as a vital source of clinical information.

Paula Heimann famously proposed that the therapist’s emotional response is often shaped by what the client unconsciously evokes, particularly in work with shame, dependency, and low self-worth.

Clients with entrenched low self-esteem frequently carry internalised critical or rejecting relational patterns. Through processes described in object relations theory, these inner dynamics are not only spoken about – they are relived in relationship. The therapist may find themselves subtly positioned as inadequate, ineffective, or failing, mirroring the client’s own internal world.

From a relational psychoanalytic lens, this activation is co-created. The client’s negative self-beliefs are held not only intrapsychically but intersubjectively, shaping the emotional field between therapist and client.

The therapist’s self-esteem may be touched precisely because the client’s shame requires a relational container in which it can be felt, recognised, and eventually transformed.

Donald Winnicott offers a helpful frame here: when the therapist can survive these projections without retaliating, rescuing, or withdrawing, the client gains an experience of being met without collapse. This requires the therapist to recognise when their own self-doubt belongs to the relational process – and when it taps into personal vulnerabilities that need reflection or support.

Reflections for Therapist

Seen this way, moments of self-doubt in the therapist are not signs of failure. They are invitations to pause, reflect, and ask:

• Whose voice is this?
• What relational position am I being drawn into?
• What does the client need me to understand – not fix – right now?

Working with low self-esteem inevitably brings us into contact with our own. Attending carefully to countertransference allows the work to deepen — not by erasing the therapist’s humanity, but by using it thoughtfully, ethically, and with compassion.

Attending to the Therapist’s Experience

When a therapist’s self-esteem is activated in work with low self-esteem, the task is not to suppress or correct the response, but to reflect on it. Feelings of self-doubt or inadequacy can be understood as meaningful countertransference communications, particularly in work organised around shame and internalised criticism.

Clinical supervision provides a vital reflective space in which these experiences can be explored. Bringing moments of self-doubt into supervision can help the therapist:

• distinguish between what belongs to the client’s internal world, the relational field, and the therapist’s own vulnerabilities
• recognise parallel processes that may be unfolding within supervision itself
• reduce the likelihood of countertransference being enacted within the therapeutic relationship

Ongoing personal therapy also plays an important role, particularly where work with low self-esteem reactivates early relational experiences or internal critical voices. Alongside this, forms of self-care that support reflective functioning — such as embodied awareness, creative reflection, or journalling — can help therapists remain grounded and present.

As Donald Winnicott observed,

“The patient needs to be able to use the analyst, and the analyst must be able to survive the patient’s attacks.”

In work with low self-esteem, these “attacks” are often subtle rather than overt, taking the form of internalised criticism, relational withdrawal, or projected inadequacy.

When the therapist is adequately supported, their capacity to survive these dynamics without collapsing into self-doubt or defensiveness allows the therapeutic relationship to become a stable space in which shame and low self-worth can be held, understood, and gradually transformed.

Upcoming Workshop with Professor Julia Buckroyd

Want to explore more? Join us for our upcoming workshop – Self-Esteem: Working with the Negative Mind with Professor Julia Buckroyd on Friday 27th February 2026, 10am-4pm on Zoom with catch-up recording available if you can’t make it on the day.

In this workshop esteemed Professor Julia Buckroyd will address a number of key issues in relation to self-esteem in the hope that we can enable our clients to let go of their damaging narrative and find a more creative way of engaging with themselves.

This workshop is suitable for both experienced therapists and those new to working with self-esteem issues, and suitable for therapists of all modalities.

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