First do no harm: don't counsel to increase self-esteem

I sit with another unhappy patient with low self-esteem and a catalogue of problems about which I am powerless to do anything. I wonder quite what I can do that the individual in front of me might find helpful. Of course I can listen and empathise, and I'm sure that this helps to an extent, but what would really make a difference? So, stuck with anything to suggest, I ask a question ‘What do you want from life?’. And the reply that comes back is, ‘I just want to be happy’. Blaise Pascal wrote: ‘All men seek happiness. This is without exception. Whatever different means they employ, they all tend to this end. The cause of some going to war, and of others avoiding it, is the same desire in both, attended with different views. This is the motive of every action of every man, even of those who hang themselves.’ 1 If Pascal is right, my next question must be, ‘Of course you do, but what …