HSP – What a Therapist Needs to Know About High Sensitivity

High Sensitivity (HS) and Highly Sensitive People (HSP) are concepts elaborated by Dr. Elaine Aron beginning with her original publication in 1997 and popularized in her book “The Highly Sensitive person: How to thrive when the world overwhelms you (1996). Dr. Aron is a psychological researcher and a practicing Jungian analyst. Much of her research has been done in tandem with her social psychologist husband Dr. Arthur Aron, who is well known for his academic research into love and close relationships.

HSP is not a DSM-IV diagnosis.

It is instead a description of the experience of the 15 to 20 % of the population who appear at the top end of the human continuum for physical and emotional responsiveness stimuli. Like left handers in a world geared to right handedness, they often struggle physically and psychologically in a cultural environment which is geared towards the 80% who are less easily stimulated.

High sensitivity is a double edged sword.

HSP’s are highly sensitive to both danger and reward in the environment.

  • They appreciate subtlety and nuance and are often creative and empathic
  • But…. They are often overwhelmed by situations which others can take in stride

With prevalence in the population of 15 to 20% that makes almost one in five of our friends and relatives or clients “highly sensitive.”

HSP research suggests that High Sensitivity arises out of three predisposing factors:

  • Introverted Temperament: (MBTI Introversion)
  • Extra cognitive processing : Lower Latent Inhibition… lower ability to screen out stimuli
  • High Arousability or “reactivity”: (High BIS – low BAS, Gray, 1997)

These three factors create a particular configuration of strong responses to stimuli …

…which lead to behaviors…

……………which lead to experiences…

………………………..which can often, but not always , lead to psycho-pathologies…

……………………………………….which then bring these individuals to therapy.

The most common problematic responses are related to stress and chronic over-arousal, such as anxiety, panic attacks and psycho-somatic responses. These individuals are also susceptible to depression, feelings of low self esteem and feelings of vulnerability created by a lifetime of being “out of step” with their peers or misunderstood by those around them.

If a therapist is not aware of the existence of this natural variation in sensitivity, it is very tempting to see the sensitive response as “neurotic” In fact the client themselves, may not debate or object to this because they do not have an alternative explanation either.

15% of the population but probably more than 15% of psychotherapy clients….

It is rare that a client will seek therapy knowing that they are HSP’s. Very often they have no understanding that their problems emerge from their sensitivity rather than the reverse.

When High Sensitivity has been mismanaged for a lifetime the cumulative effect often leads to anxiety, depression and low self esteem. It is these psychological disturbances which bring individuals to therapy.

Not “mentally ill”

Having the concept of High Sensitivity in your therapeutic repertoire takes many clients out of the category of the “mentally ill” and makes them interesting and struggling human beings like oneself. They become a person with a difference that needs to be managed and deserves to be respected.

Ordinary therapy….

Once the understanding of their sensitivity is arrived at by therapist and client the work that needs to be done is the every-day work of therapy…

  • Construction of appropriate boundaries,
  • Developing communication skills,
  • Re-building self esteem,
  • Integrating or “working through” past traumas
  • Overcoming learned fearful responses.

This work is appropriately done in any therapeutic modality but when they overcome their fears and feel safe in therapy, these individuals do very well in psychodynamic or psychoanalytic therapies because they often have an unusually strong ability:

  • to be self-reflective,
  • to think deeply,
  • to be aware of their physical responses to their thoughts and feelings
  • to be aware of and interested in unconscious products such as fantasies, dreams and active imagination.

HSP’s are an “education” for their therapist.

There is an enormous amount that a therapist can learn through working with these clients.

  • Acceptance, respect for, and interest in a client’s difference is not just healing for the client but expansive for the therapist.
  • HSP responsiveness means that they react in ways that are strong enough to be undeniable to experiences that might also bother others but which less sensitive individuals succeed at repressing … sometimes to their cost.
  • The combination of responsiveness and a willingness to be reflective means that these clients can often shed light on thoughts and feelings which emerge from others with much more difficulty. They can expose and illuminate interpersonal dynamics in a way that is generally informative.
  • They are often sensitive to the leading edge of disturbances in their group, their society or their age cohort.

Sensitive rather than neurotic.

To suggest that someone’s response is “neurotic” is to imply that it is exaggerated or inappropriate to the circumstance. It is another way of saying that their experience is “not real.” It also implies that once the psychological “fix” is made that the problem will go away and that the individual will be “just like everyone else” in their responses to stimuli. Given that a temperament is a basic, inborn and “given” attribute of the individual which is almost impossible to alter, this proposition can only lead to frustration and a continuing feeling of being different and wrong in their experience of the world.

By contrast, when we approach an individual respectfully and curiously with the belief that what they are experiencing is “real,” we come with a more empathic point of view. Empathy and openness to individual differences are ideally the therapist’s stock-in-trade…the greatest tools for healing that we can offer. Therapeutic empathy is a big part of what makes the therapeutic relationship safe, healing and growth producing.

If you do not treat Highly Sensitive individuals as neurotic you will be better able to appreciate them as the responsive, reflective people that they are… and they may well become your favorite kind of clients!

Recommended reading for the curious therapist:

E.N. Aron (1996). The Highly Sensitive Person: How to Thrive When the World Overwhelms You, New York, Broadway Books.

E.N. Aron & Aron, A. (1997b) Sensory-Processing Sensitivity and Its Relation to Introversion and Emotionality, Journal of Personality and Social Psychology,73, (2), pp. 345-368

E.N. Aron (2004). Revisiting Jung’s Concept of Innate Sensitiveness.Journal of Analytical Psychology, 49, pp.337-367.