Background

I have a close friend with many great qualities. She has low self esteem probably because she was always expected to be the best (during school mainly) so even if she performs really well, she considers it to be average. She needs constant positive reinforcement and is very sensitive to criticism.

I think this is what results in her not being able to deal with failure. Even if it's only a board game, after losing she completely falls apart and starts saying stuff like "there's no point of my existence", "I'm worthless" and so on.

Problem

I'm the closest person to her and she really looks up to me. Still whenever I compliment her, or recognize her achievements, it doesn't feel like I'm actually helping her. It feels like I'm making her depend on positive reinforcement even more. When she hits a low point after a failure, I have no way to get her out of that state, other than distracting her with something else. She doesn't listen to reason or anything, she just gets into this loop of "I'm worthless".

There was a point when she decided to get help but then she changed her mind about it and I don't really want to push her.

Question

How do I make her realize that she is awesome and this doesn't change when she fails at something? How do I make her not dependent on positive reinforcement?

As a bystander, it can be tough to try and help people like this. I would know, I used to have terrible issues with self-esteem when I was younger. A few of my friends were very kind and tried to help when I opened up about it, but most of the changes that made me into a "better" person came from within. People like this (including younger me) are very hesitant to accept praise from someone else, as they think they are lying or mocking them. There are some things you can do to help though.

1. Be a good role model.

When I say this, I don't mean go and do everything and tell your friend about it, without including them. What I actually mean is to create goals with them and complete the activity with them. This is an important difference that can mean the difference between helping and hurting someone. Showing off your accomplishments to them can have a damaging effect as they might take this as

"They are so much better than I am."

and they could even start to resent the fact that you are sharing this with them.

Creating goals and completing them with the person shows them that, yes, they can do it too, or that they can do what this much more "successful" person can do. It made me personally feel better about myself when I was able to take a step back and realize that I can do the same things that my friends can, and that I am not the worst at everything in the entire friend group.

2. Don't tell them how to think.

If your friend says something like "I'm worthless", don't just say "No, you're not, because...". You might think this is a good idea, but believe me when I say this could possibly do more harm than good. As I mentioned above, your friend might think that you are just saying this "because". After all, "how would you know my life, right?" In addition, your friend will probably bring up a whole bunch of mistakes they made in the past, further harming the situation.

A better thing to do would be to ask them why they feel that way. Affirm their feelings and offer solutions or personal experience if you can. Whatever you do, don't ever say that it's not a big deal. It might not be a big deal to you, but it could be to them. Don't invalidate what your friend is thinking, just show them that it is normal and everyone goes through the same issues.

3. Problem solve with them.

This step does relate to the second, but it is more specifically tailored to when your friend is getting upset over an actual problem that they are having, not a feeling like "I'm stupid".

For many people like this, they think the problem is something unsolvable, something that they could never hope to fix. Giving them another angle can help them realize that, yes, the issue can be solved. Don't flat out tell them the answer, as they can internalize that as "I'm too stupid to figure it out", but instead let them take the lead with fixing the issue, and offer some thoughts of your own to move them along.

4. Suggest therapy.

If all else fails, you can suggest therapy to your friend as a means to help. I didn't actually need therapy for my case, so I can't speak on how effective it is. I do believe it can help however.

Mention gently that they could have a self-esteem issue, and that you think a therapist could help them explain their feelings and discover the underlying issue at hand. If you have any therapy experience, let them know how it helped you with your issues. Don't feel bad if your friend rejects this proposal immediately, but you have planted a thought in their mind that they can explore as they go.

Apart from what I listed, there isn't much else you can or should do. This is technically an intrapersonal issue with your friend, and it will be your friend alone who resolves this problem. Even saying that, a good friend by their side is a great step to recovery, and I'm glad you are willing to stand by them and assist them.

A handy link that you friend could use can be found here. It goes over some different steps that your friend might be able to use to help them. This isn't strictly IPS, but if they start to realize they have a problem and want to fix it, you can show them this. Hopefully this helps.

This is a simple technique, but can be effective with repetition. When I used to say negative things about myself, an older and wiser friend would tell me:

Hey, you're my friend. Stop picking on my friend.

When someone has deep issues with self-confidence, it's hard to break the cycle. It's much easier to expect failure and never try at all, than to expect success and possibly fail. And this is a common belief -- you'll find that many people are more than happy to tell you something won't work, but few will tell you something will, so it becomes easy to fall into the habit of using it on yourself.

The above technique helps break this cycle by changing this fundamental attitude. It can be spoken in a light and joking way to encourage your friend to see self-deprecation as abuse, rather than normal behavior. At the very least, it will get her to pause before doing it in front of you, and hopefully, eventually, help her to break the habit of doing it reflexively.

Your questions of "how do I make her realize.." and "How do I make her not dependent.." tell me very clearly that you are trying to change her.

Of course I realize you want to heal her, but you are effectively trying to change her thinking.

In doing so you might be risking some kind of dependency. You mentioned she's dependent on positive re-enforcement and also that you are the closest person to her so I've made perhaps a bit of a leap in concluding that she's dependent on you.

If so, I'm not sure that's healthy.

The best thing you mentioned is that she considered therapy but then changed her mind. I would not hesitate to strongly persuade her to take this route.

You may not realize this and you also may even embrace your current role here - but this is a burden on you. If you had the skills to handle this you would not have reached out (and again, your aims here are clear and commendable - I'm not picking).

Personally I think people only change when they want to and because she declined the route of therapy when it clearly seems like a good idea, it may be she even likes things the way they are. She might not even be aware of that, so getting a pro involved really seems like the way to go.

I think this job is too hard for someone in a friendship capacity. Try to get her to reconsider therapy.

While your friend is great at many things, one skill she still needs to learn how to develop is accepting compliments! This may seem like a social skill rather than a self-esteem tool. It is actually both. Of course, accepting compliments won't magically fix her low self-esteem, but it will help to put her mindset outside of the cycle of constant negative reinforcement and self-fulfilling prophecies that she is imposing upon herself.

Continue to encourage her to seek therapy. In the meantime, you must train her to not push back when you compliment her. Tell her gently that the reason you spend time with her and compliment her is because you love her and that you mean it! You should set a reasonable expectation that whenever you tell her that she exhibits X quality, she should say, "thank you", rather than "no I don't". That should be your constant refrain in this situation: "Say thank you." This technique doesn't mean that you're not available to listen to her insecurities, but it is a way of establishing a boundary. It tells her that you will not accept her fighting against the love that you offer her. It also communicates something important to her: if she needs validation in order to feel worthwhile, then she needs to rise up and meet the challenge of accepting it.

Another thing you should do is to keep her in perspective. As Cheryl Strayed once said in her essay, Write like a motherfucker:

You loathe yourself, and yet you’re consumed by the grandiose ideas
you have about your own importance. You’re up too high and down too
low. Neither is the place where we get any work done. We get the work
done on the ground level.

One way to keep your friend's troubles in perspective is to kindly diffuse any misplaced melodramatic pronouncements she has with humor. When she is debilitated with self-loathing after losing a board game, you can put an arm around her and say something like, "Really! Board game ability is what determines self worth! Who knew!"

If your friend does in fact have a mental disorder, it's true that it can make it more challenging for her to exist in the world. However, she must do the hard work of living with it, and learning to exist in spite of it.

This is a problem. Whatever you do, it might do nothing, it might help her, or it might damage her further. Google for "maladaptive behaviour" or "maladaptive coping strategies" to learn what you are up against.

Your friend copes with failure in a way that subconsciously she thinks is good for her, but it actually hurts her. You mention her going into a state where she just repeats "I'm worthless". That behaviour hurts her. But it makes you give her attention and compliments which she will like. If you look at her behaviour you will see that pattern: Her behaviour gets her positive attention, but it hurts her. (And at some point you may have had enough and leave her, and the positive attention is gone).

You realise that what you are doing for her is not actually helpful. It just re-enforces the maladaptive behaviour. She could very much use the help from a counsellor or therapist. That's in my opinion the best way you can help her.

On the other hand, take Andrew's "Hey, you're my friend. Stop picking on my friend". This says you don't like her behaviour. She doesn't get points for saying "I'm worthless", instead she is told off, but in a friendly way. That's a strategy that can work. If she loses a game, you can offer to practice with her, and if she repeats "I'm worthless" ask her what she is doing to change it. Give no positive attention when she plays being worthless. Offer help and withdraw your attention if it is refused. And keep it up for a long time.

TL;DR You can't make her view herself in a particular way, you can only encourage it.

If and when therapy comes up, promote it or stick in a short plug, but don't be too annoying. This is a larger problem than you should be trying to address. What follows is an approach to help her help herself, but it should in no way be treated as a substitute for therapy.

Prepare

By "help someone" you really mean "change someone". Let's be clear that this particular change is personal, and you are not that person.

The first step is to protect yourself. Accept it's ultimately up to her to change. Be careful not to have hopes or expectations of this working out in any particular way. If you can manage your hopes and expectations about this, you can proceed.

If you cannot manage yourself, if you become or think you'll become too invested, then do not take this on. Doing so runs the risk of damaging the relationship.

Probe

(From what I can tell, it's safe for OP to skip this step. I'm including it for completeness.)

If your friend doesn't talk about this, then the first step is to start the discussion. When the behavior comes up, try to talk about it. Depending on the behavior, you may be able to talk about it while it is active; alternatively, it should always be safest to talk about it afterwards when they've had time to cool/normalize.

The goal here is to simply open up territory for future discussion. Ask about the behavior, the trigger, the feelings, her feelings towards it—whatever is easy, safe, or convenient to talk about.

Your friend retains the right to stop the probe at any point: from before you even start to mid-sentence, it's all fair game. This can be frustrating; expect it. You may need to probe (gently) at the same thing multiple times. You may not get anywhere. Remember, change is their choice. You volunteered your time and effort to go down this route—don't expect a return on your investment.

Confirm

Confirming can and should be done as you probe. Whereas the goal of probing is to open up territory, the goal of confirming is exploring the same territory.

Your friend has a different opinion of herself. You need to acknowledge that and understand it. Echoing is appropriate. This is an issue with her relationship to herself. She might not truly understand the basis of her opinion, and this steps serves to bring the logic—whatever it may be—to light.

Identify

Warning: Before you proceed with Identify, your friend should be in a level-headed state. Some people aren't interested in being level-headed, so you might not get to this step. If your friend stops being level-headed, don't try to push through. Wait for the next opportunity.

There are zero or more contradictions in your friend's logic. You need to identify them. In fact you may need to take a break after confirming to really analyze and think it through.

There may be zero contradictions; it is possible. This means there's a difference in assumptions or values. Do not assume/impose your own values or assumptions. You may need to go back and confirm her underlying assumptions and/or values.

If this is the case, you may be done. You can discuss the values backing her logic, but you must respect her values. You can try to repeat this approach for one or more values. The same warnings and precautions apply. Warning: Success with an underlying value does not correspond with direct success in changing a behavior, so don't expect it to.

If there is a contradiction, bring it to her attention. She may not see it as a contradiction. Strive to understand her point of view. Again: Do not assume/impose your own values or assumptions. You can compare with your own view, but hers trumps. Reevaluate whether there are any contradictions.

Warning: Your involvement may end here. The rest of the steps need to be driven by your friend. She may involve you, but understand that she should be the driver, not you. I include the next steps for completeness.

Evaluate

This step is personal. Going through the prior steps hopefully incites your friend to take this step. I cover this for completeness, but also because these steps can be self-administered in which case the hope is that you will reach this step.

You should now have a solid understanding of the why driving the behavior. You may have instigated the investigation, or a concerned friend may have led you to this point. At this point there's one question you should answer:

Should I change?

Make sure you answer the right question. "Should I change?" is different from "Do I want to change?" We're seeking to align our self with our core values. This can be difficult. Allow yourself time to think through and process it. Try to avoid shelving the question. This may be appropriate, but it's not appropriate as a habit.

Ideally the answer is "no". "No" is an acceptable answer. In this case it means your behaviors are already be in line with your values.

The alternative is "yes". If this is the case, you've got a lot of planning to do.

Plan

Whether the answer is yes or no, you should plan. You went through a lot of effort to get to this point, you should now fortify your position.

Examine your relationships. These will either erode or support your position. There is no middle ground. Not being supportive signals your position is unimportant, and this does have a long-term impact, so weigh it appropriately.

If your answer was yes, then you need to maintain a focus on this change and applying it to your daily life for an extended period of time. Some people or changes can be quick, but it's best to assume this is not you. There are many resources on making changes, and I encourage you to seek them out.

Note: Success (with making a change) is a road often littered with failure, something we'd expect the OP's friend to struggle with more than most. It's a bit ironic. Mentally prepare for and accept failure.

Disclaimer: I Am not a therapist or professional and this is not advice of any kind.

But your friend appears to have what has been described as "pass-or-fail" mentality.

They think failing once is proof they are don't have what it takes, but this is wrong and detrimental as you have noticed.

The best you can do is keep being a positive influence with her while helping her realize that failure is a natural part of success. This TED talk by Carol Dweck might be worth looking into. She describes a "growth" mindset, that encourages coping with failure and not letting it stop people from keeping improving/learning/trying. She probably could benefit from some actual professional counseling/therapy to get thru her mental blocks.

This makes me recall the famous Thomas Edison quote about his many attempts to invent the lightbulb:

“I have not failed. I’ve just found 10,000 ways that won’t work.”