Clinical Tips: Help Your Clients Recover from the Pain of Rejection
By Jennifer KempHelp Your Clients Recover from the Pain of Rejection
The impact of rejection can be devastating, and it can last for a long time. Sometimes people become stuck in a state of dysphoria that lasts for months or even years. As a therapist, it can be challenging to know how to support clients who are struggling with the painful consequences of rejection and those who become sensitised to any negative experiences that could signal it.
Rejection sensitivity is the tendency to anxiously expect, readily perceive, and intensely react to rejection (Downey & Feldman, 1996; Romero-Canyas et al., 2010). This experience is common among Autistic people and ADHDers; however, it’s also an experience shared with other minority groups, including sexual and gender minorities. Many adolescents are highly attuned to rejection, too.
Rejection sensitive dysphoria (RSD) is the intense, long-lasting, and pervasive emotional pain that is triggered by real, imagined, or anticipated rejections (Bedrossian, 2021; Błaszczak, 2023; Ginapp et al., 2023). These unbearable feelings may include a sense of unease, dissatisfaction, low energy, sadness, and agitation. Your client may also have sudden changes in mood and disproportionate reactions, including anger, hostility, and aggression. This has the potential to damage their relationship with their intimate partner(s), family, friends, or colleagues. They may also lose enthusiasm for things they would typically enjoy, which could be mistaken for, or contribute to, depression. To avoid triggering these painful emotions again, many people choose to distance themselves from others and avoid socialising because they feel intensely anxious. This can often be interpreted as social anxiety, with rejection sensitivity as the underlying cause.
Getting stuck in the pain of rejection
It can take a long time to recover from rejections, and your client may become stuck in a state of dysphoria that lasts for months or even years. Many things can keep a person from feeling better, including:
- Having difficulty working out how they feel (alexithymia)
- Having intense emotions and finding it hard to soothe them
- Feeling confused about what happened
- Conducting an ongoing “social autopsy” to work it out
- Feeling ashamed because they believe the rejection was entirely their fault
- Criticising themselves for what happened
- Keeping their distance from other people to avoid the risk of further rejection
- Not having other relationships where they feel safe and accepted
Helping clients with RSD
There has been very little research on the therapeutic approaches that can help people experiencing RSD. Theoretically, repeated experiences of rejection could be viewed as a form of interpersonal trauma. If working with trauma is a core part of your therapeutic practice, you may prioritise helping your client recover from painful past rejections using approaches such as eye movement desensitisation and reprocessing (EMDR), prolonged exposure, or acceptance and commitment therapy (ACT). While this may help alleviate your client’s distress, there is no research currently that supports this approach for RSD. Trauma therapy alone may be insufficient to help clients stuck in the cycle of emotional dysphoria, particularly if factors are maintaining their distress, such as difficulties with emotional awareness and regulation. Clients will also need help if they’ve developed unhelpful patterns of avoidance, masking and people-pleasing.
To support clients with RSD, it can help to focus on three therapy domains: self-soothing and self-regulation, sense-making, and interpersonal safety.
Self-soothing & self-regulation
Alleviate chronic stress
The sympathetic nervous system gives us a fight/flight response intended to quickly react and then rapidly recover; however, confusion, rumination, and emotional regulation difficulties can keep people stuck in a cycle of ongoing distress. Help your client activate their soothing parasympathetic nervous system using compassion-focused therapy (CFT) strategies, such as soothing rhythm breathing. Encourage them to find helpful ways to stim, engage with interests they enjoy, and connect with safe and supportive people.
Build emotion regulation skills
Difficulties with interoceptive awareness of emotions and emotion regulation will interfere with your client’s ability to regulate their emotions. Help your clients learn to identify and label their emotions and teach them self-regulation techniques they can use to gently allow and soothe painful emotions when they occur.
Sense-making
Put together the pieces of what happened
Difficulties with executive functioning, particularly perspective-taking, working memory, impulse-control and self-monitoring, can make it difficult to fully appreciate what occurred. Fragments of conversations, arguments and other interactions become jumbled with painful emotions, and making sense of it all can be hard. The complete truth is often difficult to establish, keeping your client locked in analysis and rumination. Make sense of what you can by helping the client step through the rejection story, map out the contributing factors, explore each person’s contribution to events, and understand the eventual outcome.
Consider both sides
The ‘double empathy problem’ describes how communication breakdowns can occur between different neurotypes due to each person having a different understanding and social expectation (Milton et al., 2022; Milton, 2012). Help your client to reflect on how they and the other person might have perceived the situation. Consider why the other person might have responded in the way they did from their perspective. Gently encouraging a degree of empathy for the other person has the potential to defuse destructive anger, hostility and aggression.
Defuse from painful self-criticism
Rejection often involves harsh self-criticism, regret and shame, and developing a pragmatic and realistic perspective on what happened can help to alleviate this. Address self-critical thinking patterns by helping your client learn how to offer themselves greater compassion using strategies from compassion-focused therapy (CFT). Help your client gain distance from painful thoughts using acceptance and commitment therapy (ACT).
Safe spaces & relationships
Foster interpersonal safety in therapy
People with rejection sensitivity are hypervigilant for potential rejections and can misunderstand other people’s intentions. This can apply in the therapy room, too. Build a therapeutic alliance that is strong enough to allow you to gently and compassionately help your client explore what happened, sit with their distress, and consider other perspectives when needed.
Build safe relationships for the future
Safe relationships are essential to lasting well-being, but they currently feel unsafe and difficult when you’ve experienced rejection in the past. Encourage your client to redirect anger, hostility, and aggression into self-soothing strategies. Support your client in forming new connections with safe and supportive people, even though they might fear rejection. Help them to find or create a community where they feel accepted and can unmask and be themselves. Teach essential skills that unwind people-pleasing habits and help them feel safe in their relationships, such as creating and maintaining appropriate boundaries and learning to say “no.”
References
Bedrossian, L. (2021). Understand and address complexities of rejection sensitive dysphoria in students with ADHD. Disability Compliance for Higher Education, 26(10), 4–4. https://doi.org/10.1002/dhe.31047
Błaszczak, A. (2023). The comorbidity of attention deficit/hyperactivity disorder and rejection sensitive dysphoria as an impediment in foreign language learning. Acta Humanitatis, 1(2), 93–106. https://doi.org/10.5709/ah-01.02.2023-01
Downey, G., & Feldman, S. I. (1996). Implications of rejection sensitivity for intimate relationships. Journal of personality and social psychology, 70(6), 1327–1343. https://doi.org/10.1037/0022-3514.70.6.1327
Ginapp, C. M., Greenberg, N. R., MacDonald-Gagnon, G., Angarita, G. A., Bold, K. W., Potenza, M. N., & Al-Yateem, N. (2023). “Dysregulated not deficit”: A qualitative study on symptomatology of ADHD in young adults. PLOS ONE, 18(10), e0292721–e0292721. https://doi.org/10.1371/journal.pone.0292721
Milton, D., Gurbuz, E., & Lopez, B. (2022). The ‘double empathy problem’: Ten years on. Autism, 26(8), 1901–1903. https://doi.org/10.1177/13623613221129123
Milton, D. E. M. (2012). On the ontological status of autism: The ‘double empathy problem’. Disability & Society, 27(6), 883–887. https://doi.org/10.1080/09687599.2012.710008
Romero-Canyas, R., Downey, G., Berenson, K., Ayduk, O., & Kang, N. J. (2010). Rejection sensitivity and the rejection-hostility link in romantic relationships. Journal of Personality, 78(1), 119–148. https://doi.org/10.1111/j.1467-6494.2009.00611.x
About Jennifer Kemp
BSc(Psych)Hons, MPsych(Clinical), GradDipApplSc(Psychology of Coaching), MAPS, FCCLP
Adjunct Lecturer, School of Psychology, University of Adelaide
Jennifer is a privately practising clinical psychologist in Adelaide, Australia. Her neurodiversity-affirming approach is founded on her own experience of being late-diagnosed with Autism and ADHD and the latest research. Jennifer listens deeply to the experiences of her neurodivergent clients, acknowledging the unique perspectives and strengths of people with different neurotypes.
In her therapeutic practice and when training other therapists, Jennifer uses acceptance and commitment therapy (ACT) with compassion-focused approaches to help her clients improve their mental health and develop greater self-acceptance, self-compassion, and pride in their neurodivergent identity.
Jennifer is the co-author of “The Neurodivergent Skills Workbook for Autism and ADHD: Cultivate Self-Compassion, Live Authentically, and Be Your Own Advocate” and author of “The ACT Workbook for Perfectionism: Build Your Best (Imperfect) Life Using Powerful Acceptance & Commitment Therapy and Self-Compassion Skills.”
