Forum: Educational Psychology 442, University of Alberta (Canada), March 1999
Although there is an abundance of self-esteem research, researchers and clinicians agree that self-esteem is poorly understood (Baumeister, 1993; Bednar & Peterson, 1995; Mruk, 1995). Nevertheless, self-esteem remains a major issue in psychotherapy, and some have even suggested that its importance extends to social and political levels (Battle, 1990; Branden, 1983; Mecca, Smelser, & Vasconcellos, 1989). It was not until the late 1980s that systematic therapeutic approaches were published (Mruk, 1995). Mruk reviews several approaches to self-esteem enhancement (e.g. Bednar, Wells, & Peterson, 1989; Burns, 1993; Frey & Carlock, 1989) and proposes his own group counseling approach, which has had subsequent empirical support (Hakim-Larson & Mruk, 1997). However, in order to enhance self-esteem beyond the scope of these approaches, knowledge is needed as to what constitutes its underlying structure or dynamics.
Although there is no widely held agreement on this issue, there are two clinically-derived theories that propose self-responsibility and self-acceptance as two of the fundamental and internal processes generating self-esteem. These two theories are (1) the six-practices model of Nathaniel Branden (1995), and (2) the coping response style model of Richard Bednar and Scott Peterson (1995). Although Bednar and Peterson offer therapeutic guidelines for enhancing self-esteem, their focus on clinical disorders makes their work ill-suited for the problems of everyday living encountered in counseling. Branden (1973, 1983, 1987, 1995), however, uses a therapeutic tool that is adaptable from clinical usage to enhancing self-esteem in a counseling relationship: the method of sentence completion. Though sentence completion has been traditionally used as a diagnostic tool (Rotter & Rafferty, 1950), it has been therapeutically useful in sex therapy (Gumina, 1980) and in cross-cultural group counseling (Aureliano, 1984). In exploring its uses in published studies and clinical evidence, discovering its adaptable elements for counseling purposes, and employing methodological creativity, sentence completion can be made to serve the counseling client’s self-esteem needs for self-responsibility and self-acceptance. As a demonstration of its potency in counseling, sentence completion is applied to the potential issues related to romantic relationships. By way of a three-stage process to enhance self-esteem, sentence completion can (1) create self-awareness or insight, and facilitate (2) self-acceptance, and (3) self-responsibility.
Branden was the first theorist to combine the dimensions of self-competency (or self-efficacy) and self-worth (or self-respect) to define the construct of self-esteem (Mruk, 1995). Branden (1995) defines self-esteem as “the disposition to experience oneself as competent to cope with the challenges of life and as worthy of happiness” (p. 27). Bednar and Peterson’s (1995) definition differs from Branden’s in that it excludes self-efficacy from the self-esteem experience. Nevertheless, they still consider self-efficacy as a necessary precondition to self-esteem. They define self-esteem as “a subjective and enduring sense of realistic self-approval” (Bednar & Peterson, 1995, p. 4). Thus, their definition focuses on the approval or worthiness component of self-esteem. Despite these differences in definition, these theorists agree on the constituents of self-esteem.
Both Branden’s (1995) six-practices
model of self-esteem and Bednar and Peterson’s (1995) coping response style
model share the premise that stable, healthy self-esteem needs to be primarily
based on internal, self-directed (i.e., volitional) cognitive processes.
Moreover, both models strongly suggest that external appraisals should not
determine an adult’s self-esteem. Appraisals may be supportive of our
self-esteem, i.e., respectful and dignified feedback regardless of whether the
feedback is complimentary or critical. An appraisal can also be an assault on
our self-esteem; that is, it can be disrespectful and denigrating feedback. In
either case, a person cannot directly control these appraisals. Autonomy
requires that a person’s internal, mediating self-evaluation
be the ultimate source of self-esteem. Thus, a person whose self-esteem is
based on external approval is externally dependent, rather than autonomous. No
theorist can deny the empirical research revealing the powerful effects a
parent’s characteristic mode of appraisal can have on a child’s self-esteem
(e.g. Coopersmith, 1967). In adults,
however, self-esteem that is dependent on external appraisals is inevitably
harmful because it is beyond the volitional control of the individual. So what
are these volitional, internal processes that contribute to one’s self-esteem?
As noted previously, two of the main practices generating self-esteem are
self-responsibility and self-acceptance.
In order to experience self-competence and self-worth, we need to feel in control of our lives, perceiving ourselves as causal agents in our actions. In essence, this is what self-responsibility means: to experience oneself as a causal agent in one’s life and well being. Branden (1995) stresses that we are responsible for our happiness, our self-esteem, and in choosing the values that guide us. In other words, no other person can give us self-esteem and no other person can cause our happiness. To be sure, there is a rational boundary to that which we can control. As Branden states, “[t]he only consciousness over which I have volitional control is my own” (p. 109). Implicit in self-responsibility is that independent thinking, not recycling the opinions of others, is at the root of its practice. As we can see, the flip side of responsibility is passivity, blaming, and dependence, especially intellectual dependence. Bednar and Peterson’s (1995) coping response style also emphasizes that personal responsibility, that is, taking ownership of the causes and consequences of one’s behavior, is crucial to self-esteem.
The second element of self-esteem is self-acceptance. The term self-acceptance
is used to encompass both Branden’s (1995) idea of self-acceptance and Bednar
and Peterson’s (1995) notion of intra-psychic risk taking. Although different
in name, these terms have the same essential meaning: the risk of knowing
oneself. This risk entails accepting, though not necessarily admiring, one’s
unwanted thoughts, feelings, and motivations. Bednar and Peterson (1995)
describe it as a risk since in knowing what was previously peripheral to
consciousness, one is challenged to acknowledge imperfections, to initiate
change, and to grow as a person. Metaphorically, to grow means to situate
oneself in new and unfamiliar territory where there is bound to be uncertainty
in one’s future. For if one changes, how will this affect one’s relationships,
work, and life-projects? But before one can achieve growth, one needs the tools
to facilitate self-acceptance and to foster responsibility in constructively
using this acceptance.
In psychoanalytic theory, projection is “an ego defense mechanism in which the ego ‘projects’ feelings onto some other person or thing in the interest of protecting itself from conflict and anxiety” (Aiken, 1997, p. 131). Frank (1948) coined the term ‘projective technique’ to describe a method that evokes this projective tendency. Frank assumed that this technique revealed a person’s needs, desires, conscious and unconscious conflicts, and ways of perceiving and responding to the world. He defined a projective technique as “a method of studying the personality by confronting the subject with a situation to which he will respond according to what the situation means to him and how he feels when so responding” (Frank, 1948, p. 46). Sentence completion, as a clinical diagnostic method, arose out of Rotter and Rafferty’s (1950) pioneering work to create a reliable and valid projective tool. In brief, sentence completion consists of having a person complete an incomplete sentence with the first ending that comes to mind. For instance, in the Rotter Incomplete Sentences Blank (Rotter & Rafferty, 1950), such sentence fragments or stems as “I hate— ” and “The best— ” are used to elicit responses. The person is then asked to write down the first ending that is evoked. If the person writes “I hate—almost everyone,” the psychologist can assume the person has deep feelings of anger. In an innovative approach, Branden (1973) recognized that sentence completion could be taken a step further and modified it as a therapeutic device for self-awareness and self-understanding. From being a projective tool, it now becomes an objective procedure for uncovering subconscious material. By objective, it is meant that the uncovered material requires little inferential work from either the counselor or the client. In other words, sentence completion as a therapeutic modality can access potentially self-evident or factual information about the person’s psychic life.
Gumina (1980), impressed with the results of verbal sentence completion in a group workshop held by Branden in 1975, developed a list of incomplete sentences to be used in couple’s sex therapy. Gumina cites one case example of sentence completion with a couple who are struggling with mutual resentment and issues of trust and fidelity. The couple are sitting across from each other and asked to communicate to each other using the following stems:
T: If I weren’t so angry—I might listen to you
J: If I weren’t so angry—I wouldn’t pressure you. . . .
T: If I trusted you I might—be able to have an erection.
J: The good thing about not having sex with you—is that I don’t have to perform.
T: The good thing about not having sex with you—is that you won’t compare me to your lover (Gumina, 1980, p. 203).
As this dialogue reveals, self-awareness or insight is gained without analysis or interpretation by the therapist. As suggested before, the client has generated objective information of him or herself through this therapeutic use of sentence completion. All the therapist does is suggest the open-ended, yet provocative, sentences and the client generates his or her own answers. Thus, implicit in the process of sentence completion is the fostering of self-responsibility in one’s own psychological analysis! Here we note the two key elements of self-esteem—self acceptance (i.e., verbalizing motivations for sexual withdrawal) and self-responsibility (i.e., self-analysis)—being enhanced. Note, however, this emphasis on self-analysis does not mean the therapist can randomly suggest any sentence stem and achieve a positive outcome. As Gumina (1980) observes, the structure and timing of sentences comes with practice and experimentation. In agreement, Branden (1987) also suggests experimentation with the method in order to adapt it to one’s therapeutic needs.
An interesting observation by Gumina (1980) is that it is not necessary to have a person pursue non-threatening material first before proceeding to more painful or anxiety-inducing material. For instance, in a clinical example, Branden (1983) suspects that a 31-year old man, who is experiencing feelings of anxiety, confusion, and incompetence in relationships with women, is suffering from an Oedipal complex. This is not to say Branden believes all men go through this psychosexual stage, unlike Freud (1961), yet on occasion he believes it does occur. In testing his suspicion, and after some previous sentence completion work, Branden suggests the client try the following: “If I could have sex with mother—” (p. 115). The client responds without hesitation: “I would have liked it; I would have known she loved me. . .; Father would have felt I betrayed him. . .; I might have been able to let go of mother; Perhaps I would free to fall in love today” (p. 115).
What is particularly powerful in this example is how the client rapidly moves from exploring unresolved feelings (e.g., sexually desiring his mother) to future action potentials (e.g., letting his romantic feelings go and allowing himself to fall in love with a woman in the present). Some discretion may be called for not to force highly suggestive sentence stems if the person seems particularly emotionally unstable. But if it is a counseling relationship, and we are not dealing with any form of psychosis or other clinical disorder, then challenging the client early in the sessions to attain insight through sentence completion seems reasonable. Important in this example is that we see the pattern of self-acceptance of subconscious material leading to self-awareness and motivations for change.
An innovative example of its use in counseling is Aureliano’s (1984) list of cross-cultural sentence stems for multi-ethnic group work. There are eight stems in total and a few examples include “Cross-cultural experiences make me feel—; . . .Jewish people are—; . . .Never call me a—; . . .If I could change my ethnicity, I would be—” (Aureliano, 1984, p. 133). Aureliano claims that the stems (a) uncover preconscious and unconscious material, (b) spur intense participation from the group members, (c) assist in the shift from the introductory to the middle, working through stage of group therapy, and (d) establish foundations for further in-depth and long-term group sessions. One case example can illustrate vividly some of these elements. Ms. Q, a young, Mexican American, reveals through early sentence completions how she denies her own cultural identity, while she accepts other ethnic groups. This paradox is resolved when she gains the following insight with further stems: in order to feel accepted, she acts self-sacrificially to please others. She subsequently re-gains her lingual and cultural identity based on this increased self-awareness. Again, we see the same pattern as exemplified in Branden’s Oedipal-fixated case: increased self-acceptance and self-awareness leads to changes in cognitions, and subsequent receptivity to change. As well, Ms. Q. develops greater self-responsibility by fostering independence from being a people-pleaser. These case studies are dramatic, yet what are the elements or principles of sentence completion that make it a potent therapeutic tool?
In Branden’s (1995) therapeutic
model of sentence completion, there are three main premises. First, most people
know a great deal more than they are immediately conscious of and have more
potentials than what typically reveals itself in behavior. Second, over time,
the act of just noticing one's responses to sentence completion stems can lead
to spontaneous integration, healing, and personal growth. Finally, people grow
in self-esteem when they listen to themselves and act on what they know. In
other words, when a person takes responsibility for what their increased
awareness means in everyday action, the person’s self-esteem increases. These
are the principles, but what do they mean in practice?
In the counseling process, sentence completion can be used in a three-stage fashion: (1) as a tool for uncovering unconscious or preconscious material (self-awareness), (2) as a means to accepting and integrating this material (self-acceptance), and (3) as a method to generate action-plans (self-responsibility). In introducing the method to a client, a simple example like, “When I look at the sky, I see—,” will help the client understand the process experientially. The client is then asked to give a spontaneous, yet grammatically correct ending. To lower levels of anxiety and defensiveness, it may be helpful to communicate to the client that he or she not place expectations on what endings the exercise will generate. The counselor may even suggest that the client treat it as a fun experiment. Finally, the generation of several different endings for each stem allows penetration to deeper levels of awareness. Branden (1995) suggests at least six endings, and no more than ten. Thus, the client is asked to repeat the sentence stem several times and to verbalize different endings as quickly as possible. Let us now explore two typical examples of counseling issues—procrastination and romantic relationships—where the efficacious use of sentence completion can be realized.
Gumina (1980) notices that words such as “if, when, and the good/bad thing [can be] used repetitively since they lend themselves well to the method” (p. 203). The stem, “A good thing about [issue] is —” is adaptable to many areas of living. It can be quite potent in revealing subconscious motivations for activities that are objectively detrimental to the client’s well being. We can take the classic example of a student who procrastinates. Although the student’s marks are suffering for it, the punishment of low grades is not sufficient to motivate a change in habit. By exploring the possible “beneficial” motivations, the client may uncover the internal logic of why the procrastination persists. To the stem, “A good thing about procrastinating is—,” the author generated the following endings: “I don’t have to work hard; my life would be easier; I can blame myself if I fail; I can excuse myself and say I didn’t have enough time; I never have to succeed or prove to myself I have to succeed.” Thus, the author’s implicit benefits of procrastination include the avoidance of self-responsibility, self-handicapping, and the avoidance of feelings of failure. This example illustrates the notion that the uncovering of implicit material can be ideal for further exploration and behavioral change. Let us now explore a more explicit example of the suggested three-stage growth process amenable to sentence completion.
Often in romantic relationships, there is the implicit motivational schema that is based on parental modeling, values, and beliefs regarding how a relationship “ought to be” (Branden, 1980; Feldman, Gowen, & Fisher, 1998; Roberts, 1992). So if a client presents with romantic issues such as intimacy (sexual or otherwise), trust, fidelity, and so forth, it might be useful to explore how internalization of parental influence may be fostering the problems. A few stems that would allow this kind of exploration are: “Mother/father gave me a view of women/men as— ,” (where a slash [/] indicates using both alternatives). Further issues that can be substituted in the stem for ‘women/men’ may include love, sex, and trust. As can be surmised, it is only the counselor’s imagination (and perceptive judgement) that limits the types of issues involving parental internalizations. This kind of exploratory work can be considered part of stage one in sentence completion: self-awareness.
The client and counselor can then pursue
how these internalizations seem to be directly affecting how the client is
interacting with his or her partner. Since the client generated the
responses, the counselor is spared the guesswork of hypothesis generation
and checking these hypotheses with the client. Instead, the client can
then elaborate on what these endings mean and come to his or her own
realizations. However, for reasons of resistance perhaps, the client may
not trust the sentence completions to be legitimate self-knowledge, i.e.,
the client may not own these cognitions. The client is not required to
state endings that he or she knows to be true, and may even state endings
he or she knows to be false. Many of the endings may not be true,
and the client needs to learn how to distinguish true endings from those
generated just to say something. To facilitate self-acceptance (stage
two), stems may be also employed to facilitate integration. A few stems
that could contribute to this process include: “To see what I see, and
know what I know—; I am slowly becoming aware—; If I were more accepting
of what I said—.” The use of the hypothetical ‘If’ statements could
facilitate less resistance and more spontaneity in the
responses.
Finally, in the third stage of
fostering self-responsibility, the client can synthesize all the uncovered
material into implications for future behavior. The counselor and client could
collaborate in developing new ways of behaving given what they know, but even
this can be brainstormed within the vast, untapped knowledge of the
client. Here we can recall Branden’s
(1995) first premise: we know a great deal more than we are conscious of.
Suggested stems to develop potential goals include: “If anything of what I said
is true, then it might be helpful if I—; If I bring 5% more responsibility
toward my [issue], I—; One thing I could possibly do to help my situation is—.”
Branden (1995) found that using an innocuous suggestion such as ‘5 % more’
lowered resistance. Moreover, improving one’s self-esteem can only start with
small, achievable tasks. By succeeding
at these tasks, the client is positively reinforced and thus expands his or her
sense of self-efficacy. So suggesting a small increment in increased
self-responsibility may be all that is required to increase self-esteem.
Both Gumina (1980) and Branden (1995) stress sentence completion is not a replacement for regular counseling dialogue, nor is to be used to the exclusion of any other counseling interventions. However, as a compliment to the counseling process, it affords the counselor and client a powerful tool for generating insight, integration, and developing goals. If self-esteem enhancement is to be a major goal for the client, then we have seen that sentence completion can be used wisely to engender the two practices of self-acceptance and self-responsibility. Its adaptability to myriad uses is only limited by the imagination of the counselor. In reviewing three case studies and applying sentence completion to two counseling issues, we have seen its potential therapeutic efficacy. As a final note of precaution, however, before adopting sentence completion as part of one’s therapeutic arsenal, the counselor would be advised to begin with Branden’s (1987, 1995) and Gumina’s (1980) clinically validated sentence stems. Then building from this experience, experimentation and creativity can take over to suit the individual needs of the client or clients.
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