Self-esteem is a tender flower, first nurtured during infancy by the gift of unqualified parental love.  As we move through life, most of us will sustain a few bruises to our self-esteem, which may challenge our faith in ourselves and what we can achieve.  But if we're lucky, we are well grounded in our personal relationships, our accomplishments, and our hopes and goals for the future, and it's this foundation that enables us to pick ourselves up, dust ourselves off and carry on with life.  Indeed, most of us believe in our own strength and resiliency - our ability to survive whatever life may have in store. We celebrate our unique ways of coping with life, creating happiness, managing our relationships, and planning for and achieving our life's dreams. We believe that life is good.

This is very often not the case for a person with a cognitive disability, whether the disability is the result of a developmental disability, brain injury, disease or aging.

Most individuals with a cognitive disability go through the agony of "Awareness."  Aware they walk, talk or socialize differently from others or from the person they want to be. These deficits are huge hits to the individual's self-esteem, and with increased awareness comes depression - or, to be more accurate, a grief reaction to the awareness of differences or limited possibilities. Coupled with this is the feeling of disconnectedness with family and friends, whose lives go on while the person with the disability feels stuck in a life that doesn't feel like it changes or grows.

Add to the situation the frustration that comes with having to deal with memory, decision-making, judgment problems and social issues that are often associated with a cognitive disability. Emotional effects may include experiencing a crisis of identity and a hopeless feeling that life is "passing me by."  This matrix does not support a positive self-esteem, and we often see the person flailing about, trying to establish some sense of uniqueness or importance - even in a negative manner.  Our role is to help this person regain their self-esteem by starting where they are and gradually making small, celebrated gains.

I do not believe that people who feel badly about themselves make progress; those who believe in themselves and their abilities make progress. Therefore, it is our responsibility to create an environment in which people can feel good about themselves, their accomplishments and contributions, no matter how small.  The environment must be tailored to fit each individual's needs and interests, but the ingredients are similar:

1. Set up a system so people can earn what they get-no one feels good about being "cared for" over a long period of time. In fact, most of us become tyrants in such a situation, demanding more and more of the people around us while inwardly disliking ourselves. The good feeling of "earning" your way and taking pride in the effort and accomplishment is a basic ingredient to creating a healthy self-esteem.

1. Develop relationships through sharing all aspects of living-blur the difference between clients and staff, care receiver and caregiver.  Eat together.  Work together.  Play together.  Bonds will be formed that allow for the safe sharing of feelings, and consequently, individuals will feel more accepted and will become comfortable in their ability to give as well as receive support. Such an environment allows them to see that there is dignity in being who they are.  We see that when the people reach out and make contact with others, their world gets bigger and self-esteem is raised. 

I believe the tender flower of self-esteem can be nurtured back to health as we help the person with a cognitive disability continue to grow, learn and experience a life that is rich with meaning, opportunities and companionship.  You and I have the privilege of participating in this process.  We want each person to succeed, to feel good about themselves, to make plans, form relationships, and look forward to each new day.