Psychotherapy and the Highly Sensitive Person: Improving Outcomes for That Minority of People Who Are the Majority of Clients

248 Pages·2010·3.76 MB·English

by  Elaine N. Aron

PsychotheraPy
Highly
and the

Sensitive

Person
Improving
Outcomes for That
Minority
of People
Who Are the
Majority
of Clients
Elaine N. Aron
New York London
Routledge Routledge
Taylor & Francis Group Taylor & Francis Group
270 Madison Avenue 27 Church Road
New York, NY 10016 Hove, East Sussex BN3 2FA
© 2010 by Taylor and Francis Group, LLC
Routledge is an imprint of Taylor & Francis Group, an Informa business
This edition published in the Taylor & Francis e-Library, 2011.
To purchase your own copy of this or any of Taylor & Francis or Routledge’s
collection of thousands of eBooks please go to www.eBookstore.tandf.co.uk.
International Standard Book Number: 978-0-415-80073-0 (Hardback) 978-0-415-80074-7 (Paperback)
For permission to photocopy or use material electronically from this work, please access www.
copyright.com (http://www.copyright.com/) or contact the Copyright Clearance Center, Inc.
(CCC), 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400. CCC is a not-for-profit organiza-
tion that provides licenses and registration for a variety of users. For organizations that have been
granted a photocopy license by the CCC, a separate system of payment has been arranged.
Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and
are used only for identification and explanation without intent to infringe.
Library of Congress Cataloging‑in‑Publication Data
Aron, Elaine.
Psychotherapy and the highly sensitive person : improving outcomes for that
minority of people who are the majority of clients / by Elaine N. Aron.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-415-80073-0 (hardback : alk. paper) -- ISBN 978-0-415-80074-7
(pbk. : alk. paper)
1. Psychotherapy. 2. Sensitivity (Personality trait) I. Title.
[DNLM: 1. Psychotherapy--methods. 2. Personality. 3. Self Concept. WM
420 A769p 2010]
RC475.A76 2010
616.89’14--dc22 2009053531
Visit the Taylor & Francis Web site at
http://www.taylorandfrancis.com
and the Routledge Web site at
http://www.routledgementalhealth.com
ISBN 0-203-87908-2 Master e-book ISBN
Contents
Preface vii
1 Highly Sensitive Patients: Who They Are, Who They
Aren’t, and Why It Matters 1
2 Assessing for High Sensitivity 23
3 Two Issues Arising From Innate Sensitivity: Being
Easily Overaroused and Stronger Emotional Reactions 47
4 Three Common Problems: Low Self-Esteem, the
Wrong Lifestyle, and Overreactions to Criticism 7 1
5 Adapting Treatment to the Highly Sensitive Patient 103
6 Helping Them Establish Relationships: Meeting
Others, Shyness, and Fears of Commitment 125
7 Helping Long-Term Relationships: Working With
Conflicts, Degree of Temperament Similarity, and
Sensitive Sexuality 141
8 The Sensitive Person in the Workplace 169
9 Personality Variation in Highly Sensitive Persons 187
A The HSP Scale: Are You Highly Sensitive?: A Self-Test 195
B Distinguishing Sensitivity From DSM Disorders 199
iii
iv Contents
C Overview of Research on the Concept of High
Sensitivity 219
References 249
Index 261
Preface
Infants each have a unique temperament. We know parents are not imag-
ining things when they say “He’s such an easy baby,” or “She’s more active
than her brother was.” Obviously infants grow into adults, keeping their
temperament, but when we see an adult patient it is far more difficult
to sort out what is nature and what is nurture. We know the basic traits
are still there and deserve to be considered as an unchanging substrate of
patients, but how can we help them have a good relationship with their
genetic makeup, especially when it means being highly sensitive?
High sensitivity as defined in my research (Aron & Aron, 1997) is
found in about 20% of the population (Kagan, 1994; Suomi, 1991, study-
ing primates), so no doubt some of your friends and family members are
highly sensitive as well as a large percentage of your patients. They are
observant of subtleties and bothered more than others by high levels
of stimulation, such as loud noise, places like malls, extreme tempera-
tures, or a long day of sightseeing. They have strong emotional responses
and need more downtime. They are usually thoughtful and observant.
About 70% are introverts, and in certain ways may seem more vulner-
able, yet thrive in their own way. (For a more expanded sense of the
trait, turn to Appendix A, the Highly Sensitive Person [HSP] Scale.)
WHy A NeW TrAIT, NOW?
This trait is not new, of course. It is found in both humans and animals
(Sih & Bell, 2008; Suomi, 1991; Wilson, Coleman, Clark, & Biederman,
1993; Wolf, van Doorn, & Weissing, 2008), so it has been around a
long time. It has been given a variety of names, depending on the focus
of the research in which it has been studied—for example, in infants,
“low sensory threshold” (Chess & Thomas, 1987); “slow to warm up”
(Thomas, Chess, & Birch, 1968); “affective negativity” (Marshall &
Fox, 2005); “inhibitedness” (Kagan, 1994); “differential susceptibil-
ity” to both positive and negative environments (Belsky, Bakermans-
v
vi Preface
Kranenburg, & Van Ijzendoorn, 2007); “psychobiological reactivity”
(Boyce et al., 1995; Gannon, Banks, & Shelton, 1989); “biological sensi-
tivity to context” (Boyce & ellis, 2005). “Sensitivity” seems to provide
an umbrella that captures well the underlying innate survival strategy
behind the trait, a tendency found in the immune system as well as the
central nervous system, not only in humans but also in over 100 animal
species (Wolf et al., 2008), from fruit flies and fish to canines and rhesus
monkeys. This strategy allows one to process information thoroughly
before responding.
HOW DOeS THIS TrAIT relATe TO PSyCHOTHerAPy?
Although this trait is found in 20% of the population, the actual
occurrence is probably closer to 50% of patients in most practices.
Individuals display this trait mainly if they had a troubled childhood,
which makes them more prone than nonsensitive persons to depres-
sion, anxiety, and shyness; although those who had good childhoods
do not display these problems any more than nonsensitive persons
(Aron, Aron, & Davies, 2005; liss, Timmel, Baxley, & Killingsworth,
2005). Indeed, there is considerable evidence that sensitive children
benefit more than other children from good childhoods (for reviews of
this growing literature see Belsky et al., 2009; Boyce & ellis, 2005).
This is one of many reasons not to think of this trait as a disorder,
and why the title of this book is Psychotherapy and the Highly Sensitive
Person—not for.
An equally important reason so many highly sensitive people seek
therapy is because they may believe they have a disorder even if they
do not. They are a poorly understood minority and they do not even
understand themselves, so they come seeking an explanation for why
they seem to be so different.
They are also more likely to come to treatment and want more ses-
sions than other patients because they are more open and interested in
things psychological, more aware of symptoms and their long-term con-
sequences, and better able to see and overcome their initial resistance.
They also need to stay longer because it takes more time to establish
trust with them, and they need to understand and adapt to their trait
as well as work on their presenting problem. They also gain more if
they process their therapy experience longer, and probably they enjoy
it more. Overall, needing and appreciating more and longer treatment,
they will be a higher percentage of a general patient population at a
given time.
With so many sensitive patients coming to counselors for so many rea-
sons, it is crucial that we know how to distinguish sensitivity from the
many disorders that it could be mistaken for. At the same time, we need
to appreciate that sensitivity is often present along with other problems
and disorders, so we need to know how those problems look different in
Preface vii
sensitive patients and how understanding their sensitivity can improve
our work with them. The purpose of this book is to clarify these issues
while suggesting ways you can adapt to these patients’ needs.
WHAT WIll I GAIN FrOM THIS BOOK?
First, you will receive a speedy yet thorough education about high sen-
sitivity. Although this book is intended to be a solid academic and pro-
fessional book, it is written to save you time, with summaries at the
beginning and end of each chapter and “bottom line” summaries of each
section. There are also case illustrations and sample dialogues through-
out. The first chapter gives you a feel for the main characteristics and
the scientific research behind the trait (there is a fuller description of
the research in Appendix C), and the second chapter helps you with
the central task of recognizing when someone who comes for counseling
is highly sensitive. The third, fourth, and fifth chapters provide ways
to help these patients with their most typical problems and to adapt
your work together so that you have the best outcome possible. The
sixth, seventh, and eighth chapters focus on relationships and work,
with the final chapter’s focus on helping you identify sensitivity amid
the vast array of other possible personality variations, including varia-
tions among the highly sensitive.
More generally, from this book you will gain the ability to improve
greatly the quality of life of all the sensitive patients in your present
and future practice. you will be able to inform them about their trait,
validate it, and thereby permanently improve their self-esteem while
helping them separate their innate temperament from the rest of what
is going on for them. They will learn from you the advantages of this
trait and how to handle what could become disadvantages. With many,
your understanding of this core trait, so often overlooked or misunder-
stood by other professionals, will be the basis of their trust in you and
the success of your other treatment goals.
Perhaps your most satisfying gain will be in seeing many of these
patients benefit more than others from your psychotherapeutic efforts.
As I stated previously, there is a growing body of research showing that
sensitive children have a “biological sensitivity to context” (Boyce &
ellis, 2005) that allows them to derive more than other children from
a supportive, enriching environment. Although they are sensitive to
negative environments, children with a heightened sensitivity to psy-
chosocial processes “might also be better able to notice when social cues
denote encouragement and acceptance” (p. 420). It seems very likely
that excellent psychotherapy would have the same differentially posi-
tive effects on sensitive adults, helping them turn vulnerability into a
susceptibility to the good all around them.
viii Preface
STIll, ISN’T THIS “HyPerSeNSITIVITy”
AN IMPAIrMeNT?
The question naturally persists, largely because the above-mentioned
research on the normalness and benefits of the trait is not yet well
known. Plus, therapists do not see a cross section of all sensitive per-
sons because those raised in good environments are often adapting well,
blending in, and unobtrusively selecting to place themselves in the situ-
ations in which they perform best and avoiding the others. you hardly
notice them, even if you know them well. They are not the ones you
think of when you think of high sensitivity.
On the other hand, due to their heightened vulnerability, there are
more sensitive persons than others experiencing psychological distress
and these sensitive individuals stand out. Suffering and sensitivity are
paired in our minds. even among nonpatients, we tend to notice sensi-
tive people only when their feelings are being “too” easily hurt or “too
bothered by a little bit of noise.” Further, being a minority, they are not
normal in the sense of being like most people (and like most therapists).
The highly sensitive truly are different. On the HSP Scale there are
people who answer yes to every question and those who answer no to all
of them. That is a considerable range in behavior, but it is all normal.
Further confusion arises because high trait sensitivity can resemble
certain disorders. For example, the highly sensitive have stronger emo-
tional reactions, which could be mistaken for cyclothymia—and it does
become that in some sensitive people. Their desire to pause to check
before entering a novel situation can appear to be, or become, shyness.
Their preference to revise cognitive maps after a failure rather than
plunging immediately ahead again (Patterson & Newman, 1993) could
be mistaken for compulsiveness, or their desire to consider all the con-
sequences of a course of action could appear to be chronic anxiety—and
again, some sensitive people do develop these disorders.
Above all, the potential for becoming overstimulated that accompa-
nies the trait can lead to overarousal in the very situations most impor-
tant to anyone, and overarousal (or underarousal) in anyone leads to
discomfort and poor performance in the short run and reduced self-
esteem and risk taking in the long run. Hence, if one confuses some
natural consequences of the trait with the trait itself, it can seem to be
nothing but a disorder or syndrome. yet the trait itself is not an impair-
ment. Indeed, it can yield rich benefits.
IS THIS lIKe BeING BOrN SHy?
Sensitivity gives a more accurate sense of what underlies behaviors we
label as shy, anxious, inhibited, reactive, neurotic, or withdrawn. These
terms are applied after observing individuals, especially children and
Preface ix
animals, who are not doing anything unusual that can be seen, so we
try to hypothesize the cause of this inaction. But terms like “shy” do
not cover all the possibilities. Strictly speaking, shy means fearing social
judgment. How can we be certain that a child who hesitates before
entering a classroom is afraid? The term high sensitivity comes closer
to explaining a strategy of learning about one’s environment through
observing rather than exploring, while allowing for the fact that if a
sensitive child’s learning has been that rejection is likely to occur after
entering a classroom, that child is more likely to become shy.
The term sensitive is also hopefully less negative, or rather has at
least as many positive as negative implications. After all, the term for
a trait does determine how we view it, and there are no truly neutral
terms. For example, spontaneity as a trait is positively viewed, whereas
impulsivity is negatively viewed, likewise with persistence versus stub-
bornness or extroversion versus lacking boundaries. In the case of this
trait, most terms for it focus on what it sometimes but not always leads
to, social withdrawal, fear, rumination, low self-esteem, shyness, and
pessimism. In fact, none of these are inherent results of sensitivity, but
they can arise through an interaction of the innate trait with various
life experiences and difficulties. Since there are many sensitive persons
without these negative characteristics, using these negative terms misla-
bels them in a way that harms these individuals, misdirects researchers,
and confuses clinicians.
ISN’T THIS ACTuAlly INTrOVerSION?
Sensitivity and introversion are the same in the way that Carl Jung
(1921/1961) first used the terms: a preference to understand an experi-
ence subjectively, through comparison with other experiences, rather
than explore its objective qualities. Also, research on introversion
(Koelega, 1992) repeatedly finds that introverts are more sensitive in
many senses than extraverts. But all of us, even Jung, then proceed
to talk as if all introversion were social introversion. Although roughly
70% of sensitive persons are social introverts, 30% are actually social
extraverts who do reflect considerably on their experiences and need
more downtime than other extroverts in order to do this. They would
be left out by equating sensitivity with introversion, and this is a group
that especially needs to be understood.
Sensitivity appears to be more fundamental and innate, while
introversion results from various causes, sensitivity being only one.
Introversion and extroversion are still useful terms, but when sensitive
patients are called sensitive, their therapists grasp a little better their
underlying makeup. equally important, patients feel more understood
and helped because they recognize more of their experiences in this
term, beyond their social behaviors.