Pay Careful Attention To a Highly Sensitive Person’s Inner Life

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I’m not comfortable with labels. As a musician, I disliked the idea of categorising artists I listen to into genres. As a therapist, I’m rarely imposed a label or a DSM-V. We don’t like pigeon-holes. Even pigeons don’t like to be pigeon-holed.

Over time, I held this belief somewhat lighter. My encounter with thousands of people in therapy over the years have someone made me change my mind around the idea of using categorical labels. In the last few years, I’ve also thought about a particular personality disposition that applied to me I’ve shyed away from. More on that later.

This may explain why, as Annie-Murphy Paul describes in her book, there seems to be a kind of “Cult of Personality Testing.” People want to know where they fit in the scheme of things. Despite the lack of empirical grounds, organisations and executives seem to gravitate to things like the Myers-Bricks Type Indicator (MBTI; For more on the meaninglessness of the MBTI, see this article).

While the MBTI doesn’t hold much consistency and accuracy, I’m embarrassed to say that, after more than a decade in clinical practice, I’ve only recently found that the conceptual framework of the Big 5 Personality factors useful in understanding others (e.g., Openness to Experience, Conscientiousness, Extroversion/Introversion, and Neuroticism). I use this as part of my “Evergreen casenotes” (i.e., clinical notes that are not time-based on a session-by-session basis. For more on this see “Take Note of These 4 Perennial Factors of Your Clients“)

However, after learning about psychologist Elaine Aron’s work, I’ve come to appreciate a type of temperament that seems befitting of many of my clients–and myself.

Aron calls this the Highly Sensitive Person (HSP).

Turns out, a HSP is quite different from an introvert. In fact, you can be an extrovert and a HSP.

I hadn’t realised that before Elaine Aron, one of Freud’s predecessor, wrote about this. One of the founding fathers of depth psychology, Carl Jung, explicitly wrote about emotional sensitivity. Jung described this inward ability as “a certain innate sensitiveness prehistory, a special way of experiencing infantile events.” Forgive the obscure language. Jung went on to say that such people who were deeply in tuned with the unconscious were poised for exceptionally positive change, or as he called it “prophetic foresight.”

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Clients Who Are HSPs

In the general population, Elaine Aron estimate that 1 out of every 5 persons is a HSP. This sensitive trait is not exclusive to humans and can be found in animals as well. However, while it is about 20% of the general population that inhibit this quality of personality, In clinical practice, she reckons the actual occurrence rate is closer to 50%.

I wanted to see if this was true beyond availability bias on my part. As you’ve might experience after attending a workshop, every other client that you seem to fit the bill of what you’ve just learned from the training. Moreover, people who specialise in particular areas (e.g., BPD, OCD, ADHD) have a tendency to see this appear in their caseload more often than their colleagues. As a crude estimate, I collated the cases I’ve seen in the last few weeks. Out of 36 people, at least 13 (36%) of them match the working definitions of HSP. That’s not quite half of the people at my practice, but certainly more than 20%.

It’s noteworthy to point that HSPs are more sensitive to the environment and relational dynamics, and on the flip side, they might be more prone to emotional upheavals, thus more likely to appear in a psychological service like mine.

Elain Aron is quick to emphasise that HSP is not a weakness. To me, I see HSP as a superpower. I think of The Marvel X-Men. These so-called mutants, were hated, fear and despised by humanity for being different. They were outcast in society, until they were brought together by Professor Xavier, who ran a school for mutant children. He helped them see, that their peculiarities are embedded with gifts for humanity.

What are these gifts in HSPs? There are four, which Aron used the acronym DOES:

1. Depth of Processing
2. Overstimulation
3. Emotional Reactivity
4. Sensory Sensitivity

1. Depth of Processing
A HSP is likely to have the tendency to process information more deeply than an average person. They are reflective and thoughtful. Given that they are process more, they are also prone to rumination.

2. Overstimulation
Being overly-aroused is a trade-off for being sensitive, which means that you are more likely to wear out quicker than a non-HSP.

3. Emotional Reactivity
A HSP is sensitised to more an emotionally rich life. Both positive and negative experiences are going to affect you more than a non-HSP. In turn, a HSP is also likely to be more empathic to other’s feelings.
I wouldn’t go to the extreme to say that all HSP are empaths, a popular term used to describe people who absorb the emotions of others somatically. In my understanding, there are some overlaps and distinctions. For more on the differences, read this.

The Empathy Spectrum

4. Sensory Sensitivity
Finally, a HSP often senses what others miss. Not in an ESP sense, but sensory processing sensitivity sometimes manifests as a low threshold or a low tolerance for high levels of sensory input.

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This combination of 4 factors in HSP can be helpful in understanding why certain events have a profound emotional impact on someone and not others. For example, although there are other factors beyond being a HSP (i.e., prior adverse events), a traumatic event cannot be seen in isolation, as someone who is unaffected by an incident, while another might be emotionally rattled. After all, trauma is more less about what happened on the outside than on the inside.

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Tips for HSPs

Here are some implications when working with clients who might be sensitive by nature:

1. Be sensitive to your client’s sense of self.
   • Does your client match the four components (DOES) of HSP?
   • If it helps, a HSP questionnaire is availalble for use.
   • Does your client see being “emotional” as weak?
2. Harnessing Their Gifts
   • Take for a moment and think about this. What kind of profession do HSPs typically go into?
   • If they are harnessing their gifts, they thrive in domains like the arts, creative work, entrepreneurial roles (cos they see what others don’t), and they seem to gravitate towards social and helping professions.
   • So, as therapists, we need to be asking if they are tapping into their “burdens of blessing”
3. Wrong Lifestyle
   • Clients who are HSP need to understand their nature, rather than work against it.
   • If they keep putting themselves in highly over-stimulating without downtime to recuperate, they are likely to be depleted easily and may suffer from feelings of depression.
   • Moreover, stress is not the issue. The lack of recovery is. This is even more apparent for a HSP.
   • For more on this, see “We Don’t Know How to Rest,” and “What Burns You Out?“

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Carl Jung, a sensitive person himself, said this:

This excessive sensitiveness very often brings an enrichment of the personality. . . . Only, when difficult and unusual situations arise, the advantage frequently turns into a very great disadvantage, since calm consideration is then disturbed by untimely affects. Nothing could be more mistaken, though, than to regard this excessive sensitiveness as in itself a pathological character component. If that were really so, we should have to rate about one quarter of humanity as pathological.
~ Carl Jung, 1913

Not only were Jung’s prevalence estimates quite accurate more than a hundred years ago, his emphasis of not treating sensitivity as a pathology is discerning and worthy for us to contemplate. Besides, my guess is many therapists are HSPs.

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The Sensitivity of The Therapist

When I was a teen, I remember bringing a CD of Sheila Chandra to my mentor Fr Claude Barreteau, MEP (I dedicated the First Kiss book to him). I was rather disturbed and perplexed by the feelings it stirred in me. I couldn’t make sense of why I was feeling the way I felt. Besides, the song wasn’t in English (You can hear the song here ).

I felt silly asking him to hear the track. Thankfully, he obliged. I popped the CD into his Aiwa stereo. We sat there for 5 mins and 30 secs.

When the song ended, I looked up. He was in tears. So was I.

I didn’t know it then, but I had the feeling that, what I was feeling then, was allowed. He seemed to have felt it too. It was beyond words.

I bring up this memory because, compared to most males, I am easily moved by emotions. And sometimes, moved to tears. Maybe that’s what I was so pulled into the world of music and the practice of psychotherapy. I see this in therapists I meet around the world too. Maybe that’s why they are in the helping profession as I am.

But when I was a child, this was a hard thing to grapple with. I cried easily. Coming from a stoic Asian background, we had the whole “boys don’t cry” mantra going. I think my father had a hard time with me, because I wasn’t a typical boy. I played sports, but I wasn’t into martial arts, fishing, etc. When he raised his voice, I cried easily. When he tried to teach me Math, I cried easily. It probably even made him more anger because it rendered him helpless. Thankfully, my mother, who was acutely emotionally attuned, knew how to relate with me.

Meanwhile, going to the Army for National Service as a Singaporean for 2.5years is a no-surprise. However, for as long as I could remember, even since the day I knew I had to be enlisted around 18 years of age, it wrecked havoc in my mind. I didn’t know how I was going to survive. Plus, I was against the idea of even taking up arms (So I prayed to God not to let me take up arms. My prayers were answered. I didn’t have to take up arms; I was recruited to be a combat engineer. I dealt with bombs.)

Even when I was playing in a band, I was often the first to leave after a gig. Most of my friends would wanna hang out, but I just wanted to head home. I was over-stimulated. Not only my ears were ringing, but I was just spent by then. Meanwhile, my friends were just getting ready to party.

Learning the research of Elaine Aron on HSP has reinforced one thing for me: Nurture my nature. I have to cultivate it the way a garden needs tending to. And often times, lots of de-weeding.

This is how it looks like for me:

1. I need time between clients.
   I used to see clients back-to-back for many years, both at the institution I was working in, and in private practice. This caused a kind of fatigue that often rendered me useless when I got home.
   Now, I park 15mins between clients, and I make sure I have a full hour lunch break at noon when I’m at my practice. I try to walk around the area at least once, just to clear my head. Doesn’t always happen, but I try to make it.
   This type of spacing between clients does hurt my bottom line, but I can’t see it any other way. If I cramp more clients in a day without breaks, not only I suffer at the end of the day, my clients wouldn’t get the best of me, and my family are left with crumbs when I get home.
2. Interval Work
   When I am at a writing project, I have a tendency to be hyperfocus and lose any sense of space and time. While this is good for productivity, I can feel the strain later on. So much so that now, in my daily notes, I have a line that says, “DON’T OVERSTRAIN BY WORKING STRAIGHT FOR LONG PERIODS OF TIME. TAKE MINI-BREAKS.”
   I use an app to countdown every 60 mins, and then it goes to a 5 min break interval.
3. Solitude
   I love being with people. I love my work, I love being with my wife and kids, I really enjoy making music with others… and I need to be left alone too.
   It seems to be my way to recharge and re-compose.
   I love teaching as well. When I’m conducting workshops, I’m often on high-energy to keep the audience engaged. This could be a day-long training, or sometimes 2-5 days straight.
   However, come night times, I need to be left alone in the hotel room. I need to ground myself again. I wish I would be able more social, but the truth is, I’m usually spent after dinner.

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The Gifts of Sensitivity

When legendary comedian Dave Chappelle was giving his speech for being honored the Mark Twain Prize, with his mother in the audience, he shared the following story:

A griot is someone in Africa who carries the stories orally… When a griot dies, it is as if a whole library has been burned down.
My Mom told me that I should be a griot… And she told me this
”Son, sometimes you have to be a lion so that you can be a lamb that you really are.“

My hopes for writing this piece is two-fold:

1. For your clients: I hope practitioners like you recognise HSP in others when you are trying to help them, and help them harness their precious gifts from the inside out.
2. For you: I know that many of you are a HSP, which is why you are called to help others who are facing some of the most difficult times in their lives. I hope you take care of both your inner and outer lives. Our job is to mother nature.

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I highly recommend the following on HSP:

1. The Highly Sensitive Person book by Elaine Aron. This is the key text.
2. Sensitive, the documentary: I was surprised to see Alanis Morissette in this.
3. Psychotherapy and the Highly Sensitive Person: Improving Outcomes for That Minority of People Who Are the Majority of Clients

There are more recommendations. For more about HSP and other related topic relevant to your clinical practice (e.g. Emotions, Grief, Trauma, Deliberate Practice, Clinical Supervision) subscribe to the Frontiers Friday Newsletter, where we provide Five curated recommendations to help you at your bleeding edge of professional development.