Self-Esteem, Relationships & Emotion Regulation
When self-worth, automatic relationship patterns, and emotion regulation keep shaping the same painful symptoms.
Low, fragile, or rapidly shifting self-esteem, recurring relationship difficulties, intense emotional reactions, shame, rejection sensitivity, perfectionism, and uncertainty about identity can significantly affect daily life. The Sheppe Group provides developmentally informed evaluation and psychotherapy designed to understand root causes: what sustains the patterns, and what kind of treatment may help.
These concerns impact personal flourishing.
Self-esteem, relationships, identity, and emotional regulation are central parts of psychological functioning. Difficulty in these areas may appear as chronic self-criticism, unstable confidence, intense reactions to rejection, recurring conflict, trouble trusting, fear of abandonment, perfectionism, shame, withdrawal, impulsivity, or feeling uncertain about who one is.
Some people function well in school, work, or public settings while privately struggling with self-worth, closeness, anger, jealousy, dependency, loneliness, or emotional exhaustion. Others experience repeated crises, abrupt relationship shifts, avoidance, self-harm, or difficulty maintaining treatment, education, work, or independence.
A careful formulation asks how these patterns developed, what triggers them, what functions they serve, how they affect the person and other people, and whether mood, anxiety, trauma, family systems, development, or personality functioning also needs attention.
The difficulty may appear across connected areas.
Self-worth, emotional regulation, identity, and relationships influence one another. Treatment becomes more useful when these areas are understood together rather than approached as isolated symptoms.
Low, fragile, or unstable self-esteem
Confidence may depend heavily on achievement, appearance, approval, relationships, comparison, or avoiding mistakes. Criticism or failure can trigger shame, anger, withdrawal, hopelessness, or a rapid change in how the person sees themselves.
Recurring relationship difficulties
Fear of rejection, mistrust, issues with dependency, jealousy, avoidance, conflict, people-pleasing, control, idealization, disappointment, or difficulty setting boundaries may repeatedly interfere with intimacy, friendship, family, work, and treatment.
Difficulty regulating emotion
Emotions may intensify rapidly, remain difficult to name or tolerate, lead to impulsive action, or be managed through suppression, detachment, reassurance, self-harm, substances, avoidance, overwork, or other rigid coping strategies.
Look for repetition, distress, and loss of flexibility.
One difficult emotion or relationship does not define a clinical problem. Evaluation becomes more important when the same pattern persists, appears across situations, causes meaningful distress, or interferes with safety, relationships, school, work, treatment, or independence.
Internal experiences
Relational and behavioral patterns
The same outward struggle can have different causes.
Evaluation considers development, current context, psychiatric symptoms, medical factors, trauma, family systems, personality functioning, relationships, strengths, risk, and prior treatment so the plan responds to the root causes of the difficulty.
How the pattern developed
Temperament, attachment, family experience, trauma, adolescence and adult transitions, culture, identity development, major losses, and how the person learned to understand themselves and other people.
Triggers, intensity, and recovery
What emotions become difficult, how quickly they rise, how long they last, what the person does to manage them, and whether coping creates additional risk or relational problems.
Recurring interpersonal expectations
Trust, closeness, boundaries, rejection sensitivity, dependency, anger, avoidance, empathy, conflict, repair, and the assumptions that repeatedly shape relationships.
Diagnostic overlap
Depression, bipolar-spectrum concerns, anxiety, trauma, OCD, ADHD, substance use, eating-related concerns, autism-related questions, medical factors, and personality disorders may overlap or require differentiation.
Impact on daily life
Self-harm, suicidal thinking, aggression, impulsivity, school, work, relationships, sleep, self-care, treatment participation, housing, finances, and the level of support or care that may be needed.
What has and has not changed
Previous psychotherapy, medication, testing, hospitalization, programs, family involvement, treatment ruptures, partial improvement, strengths, goals, and which treatment structures have been usable.
Treatment should connect insight with real change.
Psychotherapy can help identify and change troubling emotions, thoughts, behaviors, and relationship patterns. The specific approach should reflect the person’s formulation, goals, strengths, risk, developmental stage, and ability to use the treatment structure.
Understand the pattern as it happens
Psychodynamic psychotherapy may examine self-esteem, identity, emotional reactions, defenses, expectations of other people, and recurring patterns that become visible in current life and within the treatment relationship.
Explore Integrated Psychiatry & Psychotherapy →Assessment, TFP, and structured treatment
Personality assessment can clarify strengths, vulnerabilities, identity, relationships, emotional regulation, and treatment fit. TFP or another structured personality-focused treatment may be considered when patterns are severe, persistent, or closely tied to identity and relationships.
Explore Personality Assessment & Development →Address co-occurring barriers to progress
Medication consultation may help with co-occurring mood, anxiety, ADHD, sleep, or trauma-related symptoms. Family consultation and care coordination may clarify boundaries, support, safety, communication, and treatment roles.
Explore Family Consultation →Symptom relief may not change the underlying relational patterns and root causes.
A person may feel less depressed or anxious while continuing to struggle with shame, self-worth, emotional reactivity, perfectionism, issues with closeness, trust, boundaries, or recurring conflict. This does not mean prior treatment failed. It may mean the formulation and treatment goals need to include deeper patterns of identity, emotion, and relationships to address the root causes.
You do not need a formal diagnosis before asking for help. A consultation can begin with the patterns that keep repeating, the emotions that feel hardest to manage, and the relationships or parts of daily life that no longer feel sustainable.
How The Sheppe Group understands the whole pattern.
The practice brings psychiatrist-led evaluation together with psychodynamic psychotherapy, personality assessment, TFP, MBT-informed perspectives, medication consultation for co-occurring conditions, developmental context, family understanding, risk assessment, and coordinated treatment planning.
Alexander H. Sheppe, MD, FAPA, DFAACAP
Dr. Sheppe provides complex clinical evaluation, psychodynamic psychotherapy, psychoanalysis, TFP, medication consultation, personality-focused formulation, family consultation, and coordinated treatment planning for adolescents, emerging adults, and adults.
Aliza Spruch-Feiner, PhD
Dr. Spruch-Feiner provides psychological assessment and formulation, treatment planning, psychodynamic and integrative psychotherapy, and coordinated care.
The Sheppe Group Testimonials
“His guidance is much appreciated.”
MM · Zocdoc review · Read source“Very helpful! Great experience!”
Amy A. · Zocdoc review · Read source“His responses to my questions were so thorough, accurate, and reassuring…”
NS · Zocdoc review · Read source“Dr. Sheppe is honest and down-to-earth…”
RM · Zocdoc review · Read source“He is clear, coherent, and thorough.”
CB · Zocdoc review · Read source“Warm and comprehensive consult.”
YH · Healthgrades review · Read source“He was really patient with me and was so thorough.”
TP · Healthgrades review · Read source“His guidance is much appreciated.”
MM · Zocdoc review · Read source“Very helpful! Great experience!”
Amy A. · Zocdoc review · Read source“His responses to my questions were so thorough, accurate, and reassuring…”
NS · Zocdoc review · Read source“Dr. Sheppe is honest and down-to-earth…”
RM · Zocdoc review · Read source“He is clear, coherent, and thorough.”
CB · Zocdoc review · Read source“Warm and comprehensive consult.”
YH · Healthgrades review · Read source“He was really patient with me and was so thorough.”
TP · Healthgrades review · Read sourcePsychotherapy for self-esteem, relationships, and emotion regulation near Grand Central.
The Sheppe Group sees patients at 122 East 42nd Street, 32nd Floor in New York, NY 10168, near Grand Central. In-person psychiatric evaluation, psychodynamic psychotherapy, personality assessment, TFP, medication consultation, and family consultation may be part of care, with telehealth considered when clinically appropriate and legally permitted.
122 East 42nd Street, 32nd Floor
New York, NY 10168
(646) 859-8585
Midtown Manhattan near Grand Central
Psychiatry, psychodynamic psychotherapy, personality assessment, TFP, medication consultation, family work, and coordinated care.
Telehealth for New York and Other Licensed States
Telehealth may be available for patients located in New York, New Jersey, Connecticut, Florida, and California, depending on clinical need, licensure, privacy, safety, treatment structure, and whether remote care is the right setting.
Common questions about evaluation and psychotherapy.
These answers provide general information. A consultation is needed to evaluate an individual diagnosis, treatment structure, medication question, family role, safety concern, or level of care.
Further reading from national mental-health organizations.
Do low self-esteem or relationship problems mean I have a personality disorder?
No. These concerns can arise from development, relationships, trauma, depression, anxiety, ADHD, OCD, family dynamics, major life transitions, or other experiences. A personality disorder is only one possible explanation and should not be assumed without a careful expert evaluation.
When does low self-esteem become a reason to seek therapy?
Therapy may be useful when self-worth is persistently low, depends heavily on approval or achievement, changes sharply with criticism or rejection, contributes to shame or avoidance, or interferes with relationships, school, work, treatment, decision-making, or daily functioning.
What does difficulty regulating emotions look like?
It may involve emotions that become intense quickly, remain difficult to understand or tolerate, take a long time to settle, or lead to impulsive behavior, anger, shutdown, self-harm, substance use, reassurance seeking, avoidance, or conflict. Some people struggle more with emotional numbness or suppression than visible intensity.
Can psychotherapy improve relationship patterns?
Psychotherapy can help a person recognize recurring expectations, emotional reactions, coping strategies, communication patterns, and choices that shape relationships. Treatment may also use the therapeutic relationship directly to understand how these patterns emerge and to practice more flexible ways of relating.
What treatments may help with self-esteem and emotion regulation?
Depending on the formulation, care may include psychodynamic psychotherapy, TFP, mentalization-based approaches, dialectical behavior therapy, cognitive or interpersonal therapies, personality assessment, family consultation, and coordinated psychiatric care. The appropriate approach depends on severity, goals, risk, strengths, prior treatment, and treatment fit.
Can medication improve self-esteem or relationships?
Medication does not directly create stable self-esteem or change relationship patterns. Psychiatric medication may help treat co-occurring depression, anxiety, ADHD, sleep disturbance, trauma-related symptoms, or mood instability that makes psychological work and daily functioning more difficult.
Can adolescents and emerging adults receive care for these concerns?
Yes. Adolescence and emerging adulthood involve major changes in identity, relationships, autonomy, school, work, and family roles. Evaluation should distinguish expected development from patterns that are persistent, unsafe, unusually impairing, or interfering with the person’s ability to move forward.
Ready to take the next step?
A consultation can help determine whether the right starting point is psychotherapy, personality assessment, psychiatric evaluation, TFP, medication consultation for co-occurring concerns, family consultation, or collaboration with an existing treatment team.
Request a Consultation →