Do you have clients who are so convinced they are unlovable that nothing you do seems to make a difference?

Perhaps you will recognise this from your clinical work. A client presents for treatment. They are delightful to be with in the room – engaged, polite, socially skilled. They ask how you are. They seem warm and easy to connect with.

As you get to know them, you are surprised to discover that their reason for seeking therapy is low self-esteem and chronic feelings of worthlessness!

When you explore their concerns more deeply, they tell you they fear what would happen if anyone were to really get to know them. Why? Because then they would be exposed as they believe they truly are – flawed, ugly, unwanted, utterly unlovable.

How can we make sense of this?

It is especially challenging when you already experience them as worthwhile and likeable. When you begin working to help them see this, everything you attempt seems to be blocked, minimised or dismissed.

Understanding these dynamics is central to attachment trauma therapy training, particularly when we are considering strategies for managing resistance in therapy.

Is self-worth really worth it?

This may seem like a counterintuitive question, but it can be a very useful one.

What if the client has unconscious reasons to maintain low self-worth?

What if their survival systems implicitly know that if they begin to feel they matter – that they deserve dignity, voice and choice – they may lose something that has felt essential?

The developers of Coherence Therapy (an approach grounded in the neuroscience and therapy practice of memory reconsolidation) have written about this1¹. Look through the list below, derived from their work, and notice whether you recognise any of the dilemmas your own clients may be facing.

Unconscious reasons to maintain low self-worth

• Maintain a connection with one’s parents to avoid:Realising that one is alone and invisible
• Maintain an illusion of empowerment to avoid: Realising the extent of past powerlessness
• Preserve safety from further abuse to avoid:Realising injustice and experiencing associated anger
• Avoid awareness of betrayal to avoid: Realising betrayal and feeling its pain
• Avoid awareness of living out only a small portion of potential to avoid: Experiencing grief
• Safety from criticism and rejection to avoid: Awareness of risks of criticism and rejection
• Avoid the weight of existential responsibility to avoid: Awareness of existential responsibility
• Maintain a ‘Good World Hypothesis’ to avoid: Existential crisis of accepting a not-so-good world
• Quest for accountability to avoid: Acceptance of wellbeing despite lack of acknowledgement of harm
• Quest for owed nurturance to avoid: Grieving unmet childhood needs
• Quest for owed childhood to avoid: Grieving the lack of a carefree childhood
• Pseudo-penitence to avoid: Adult struggles with authenticity and integrity
• Disidentification to avoid: Shame associated with identifying with an abuser
• Preservation of the familiar to avoid: Being immersed in the unfamiliar

When we view low self-worth through this lens, resistance begins to make sense.

What appears as a therapeutic blockage may actually be an attempt to preserve psychological balance.

Shame as a regulator in attachment trauma

When we look at these patterns more closely, we often find that shame plays a central organising role.

Understanding the function of shame is invaluable when working with pervasive feelings of being unlovable. In my own learning – influenced strongly by Janina Fisher – I came to appreciate shame as a powerful emotional regulator (and have written more about that here: Resolving Shame and Self-Loathing).

Shame can act like an ice bath or a wet blanket on experience.
It dampens emotional intensity.
It freezes connection.
It narrows possibilities.

But what is its purpose?

I like Jim Knipe’s2² definition. He describes shame, for the neglected child, as the lesser of two evils. The child may take on self-blame – ‘it is all my fault’ – because this creates an illusion of control.

‘If I become better, then they will love me’.

This protects the child from an even more devastating realisation – that they are without power or options, and are profoundly alone.

For many clients with attachment trauma, this pattern continues into adult life. As therapists, we may therefore need nuanced strategies for managing resistance in therapy rather than assuming that insight or reassurance alone will shift entrenched beliefs.

Building self-compassion little by little

One helpful starting point can be introducing clients to gentle self-compassion practices.

I have created a guided meditation designed specifically for people who struggle with shame and self-criticism. It offers a compassionate framework for understanding how experiences of powerlessness and neglect can shape self-concept.

You can access it here:

Small experiences of safety and kindness towards the self can gradually support deeper therapeutic work. Approaches such as EMDR for attachment trauma can also provide structured ways of working with the implicit memory networks that underpin these patterns.

When informed by contemporary social neuroscience, EMDR can help clients gradually process the experiences that made self-worth feel unsafe, rather than trying to persuade them cognitively that they are lovable or worthwhile.

Supporting clients to move from complexity to clarity

Over time, as traumatic material is integrated and emotional regulation improves, clients often begin to experience subtle shifts:

• Increased capacity for self-reflection
• Greater tolerance for positive relational experiences
• Emerging compassion for earlier versions of themselves
• Less rigid defensive responses

These developments are rarely dramatic or sudden. More often, they unfold gradually as safety and integration deepen.

As part of my commitment to continuing education for therapy practitioners, I share practical ways of working with these dynamics – particularly when therapy feels stuck.

If it’s a challenge that resonates for you, this resource will be useful:

Deepening clinical skills in attachment trauma therapy

If the themes in this article resonate with your clinical experience, you may be interested in further developing your skills through focused attachment trauma therapy training.

On May 22, I will be offering a workshop exploring practical EMDR-informed approaches for working with shame, resistance and entrenched low self-worth in attachment trauma presentations.

In this training, we will look at:

• Conceptualising resistance through a trauma-informed lens
• Integrating neuroscience into clinical formulation
• EMDR strategies for working with protective emotional systems
• Supporting clients to move from entrenched survival patterns towards greater clarity and self-compassion

You can also join my newsletter (scroll to the signup at the bottom) for ongoing clinical reflections, resources and training updates.

1. Ecker, B. & Hulley, L. (2019). Coherence Therapy: Practice Manual and Training Guide. Published Online: Coherence Psychology Institute LLC ↩︎
2. Knipe, J. (2018) EMDR Toolbox: AIP methods for treating Complex PTSD and dissociative personality structure. Workshop Presentation. Mooloolaba, Aug 3-5, 2018. ↩︎