Treatment of The Highly Sensitive
Tuesday, September 14, 2010

By: Cynthia Friedman, MFT, N.E.

When  during one's life you have been labeled  “too sensitive,” you have been treated unfairly.  The fact that you feel deeply is a measure of good mental health.  The difficulty arises when one is in reaction to their feelings, or the judgments, criticisms, and evaluations of others.

Take my 2sensitive4words questionnaire, at, to learn if you fit the profile of a Highly Sensitive Person (HSP).*  It is my experience that Highly Sensitive People begin therapy blaming themselves for being how they are.  The result is low self-esteem, poor self-confidence and other behaviors.

Mood disorders (like depression), anxiety disorders, eating disorders, alcoholism, and other addictions, may have some psychological roots in a lifetime of being told: “Don’t be so sensitive!”, “You shouldn’t feel that way!”  “Buck up!”

Trying to feel better, HSPs* may self-medicate with food, alcohol, drugs, and other addictions.  Some therapies fail to account for the HSP factor in treatment.  This can lead to further exacerbation of the problems, because HSPs don’t always respond to standard treatments.

In Self Acceptance training we experience ourselves authentically in the body.  We ask from our body not our mind:

- How do I feel?
- What do I need?
- How can I get it?

Lets take for example the case of Annette.  Annette is a thirty-two year old caseworker.  She is married to a man who she calls “big” in personality.  Sometimes it is too much for her and she has to retreat. She is the mother of a toddler. Recently she was diagnosed with Diabetes I and gluten intolerance.
She is also pregnant. She comes to therapy because she is overwhelmed, overtired, depressed and feels different.  She says “Why can’t I be like everyone else?”  I  should be able to work odd shifts, eat what I want and not have difficulty visiting the in-laws. “After all they are so fun loving and lively.”
Learning to communicate ones needs in a gentle but firm way whether it be with friends, family or employers is something an H.S.P may need help with.  You can try using the hamburger sandwich (peanut butter sandwich if your client is vegan). We start with saying something affirmative, then deliver the meat of the message, and again end with a loving statement.  I have found clients very responsive to this metaphor since most are familiar with this type of sandwich.

Annette was able to communicate to her in-laws her needs.  This included taking a walk alone to have some down time or not attending a family gathering at all if she felt like it.

I have found that addressing ones breathing is a useful tool to help the HSP enter their body.  Though we work with clients who have suffered all kinds of injuries, helping the client to self regulate, self monitor and self soothe through awareness of  breath is an invaluable tool to understand mood and emotions.
I have the advantage of being trained in yoga so I may ask the HSP if he or she is willing with eyes open to focus on a point eye level and just slowly inhale and slowly exhale.  You can try it yourself and see what you discover. You will then know the territory.  However, I caution you here to assess whether your client is ready for such an intervention as being in ones body can be threatening.  In the middle stage of therapy Annette was willing to experiment.  However, it was not long before she returned to her pattern of making a mental assessment of her feelings.  Growing up with an abusive step-father made it difficult to experience her vulnerability for too long.  We use this observation as an indication that a client has gone as far as they can today, always respecting the clients lead and holding the hope for tomorrow. 
Through long term work the client discovers that there is a body and there is a mind.  For H.S.P’s this is an essential awareness as it is imperative for the H.S.P to learn the language of their body which is often in conflict with their mind.

Sometimes I will ask, "Who are you if you are not your thoughts?"  This too can be threatening for some as ones survival may be based on their mind.  Again assess very carefully whether a client is ready for such an intervention.  For some it may be contra-indicated.  Others may feel perplexed but find it compelling.  Still others may experience relief. 

Now lets consider the HSP’s relationship to food.  You may say, "Whats food got to do with it?"
Being trained in Nutrition it is my experience that nervous systems calm down and depression may lift after years of treatment with this one intervention.  Although Annette had difficulty changing the way she ate.  She had a good deal of impetuous because of her pregnancy. 

I helped her educate her husband about food and navigate that slippery terrain of making changes in what she cooked for the family and ate herself.  Also exploration of this issue is an invaluable clue into family dynamics. The way mealtimes go can easily show the rules and roles in the family.  After all isn’t food a microcosm of our lives.

We now know the effect of amino acids which are found in foods on the neuro-transmitters of the brain which effect mood and mental health.  This element should be addressed in therapy especially with the H.S.P who generally has  Axis I diagnoses. A referral to a capable Nutritionist, Nutrition Educator, Nutrition Consultant or a  psychiatrist who specializes  in brain chemistry may be a good idea. Annette was referred to a Nutrition program for evaluation, recommendations and on going support in tracking her food, and mood.  Again please assess the readiness of your client for this intervention as some HSP’s can use this as further indication of being defective.

Clinical work with H.S.P’s  require a sensitivity on the part of the therapist in a non linear and multi-dimensional way. 

The therapists task is to help the client let go of  self-criticism, self-judgment, and self-evaluation. Additionally, the therapist must be tuned in to his or her own body as the H.S.P is hyper-vigilant with every gesture made by the therapist, the tenor of ones voice, and facial expressions  etc.  Also lets not forget that how we feel in our own bodies as we sit with clients helps us understand what is sometimes consciously not available to a client. As, clinicians our own bodies are a useful vehicle in treating our clients

In Conclusion the H.S.P will benefit from psychotherapy including:
      Self-Acceptance training,
      Relaxation training, 
      Assertiveness training,
      Communication skills,   
      Nutrition Counseling and testing 

Gathering ones toolbox is essential.

* the term H.S.P. was first developed by Dr. Elaine Aaron, Ph.D.

Author : Cynthia Friedman MFT and N.E.
Cynthia Friedman MFT, N.E. is a  psychotherapist in private practice  at The Center for Psychotherapy and Healing in San Rafael, Ca. She is a Nutrition Educator and Certified by four schools of yoga.  To contact Ms. Friedman or learn more about her private practice please visit her here on The Directory.