Living With Rejection Sensitivity as a Therapist
By Jennifer KempTherapists can be sensitive to rejection, too. If you’re someone who feels it intensely, working as a therapist can be exhausting in ways that are hard to name and even harder to talk about.
Rejection sensitivity is a complex experience when you sit in the therapist’s chair. You’re in a role in which you care deeply about your clients. Hour after hour, you stay attuned to their struggles and adapt your approach to their needs. You do this consistently, while absorbing any tension, ruptures, misunderstandings, frustration or disengagement that arises.
This kind of relationship creates unusually fertile ground for painful rejections. For therapists who experience RSD, there are many moments in therapy that can be hard.
It can hurt when your client:
- Doesn’t rebook after their first session, without giving a reason why
- Doesn’t show up to their scheduled appointment and never returns
- Tells you that your approach isn’t working for them
- Switches to another therapist, and you hear about it secondhand
- Doesn’t respond to attempts to repair after a rupture
These kinds of rejections can feel personal and have a longer-lasting impact than we’d like. We can experience a wave of self-doubt that takes days to settle and can be very hard on ourselves. It can be difficult to offer ourselves the kind of compassion that we’d offer our clients.
If this sounds familiar, you’re not alone. You’re human, and you are the human sitting in the therapist’s chair.
What rejection sensitivity can look like in a therapist
Fear of rejection can influence the way we deliver therapy, and this can show up in subtle and professional-looking ways.
- You ruminate after a session with a client who seemed distant or unresponsive
- You work harder than necessary to deliver good therapy to avoid their disapproval or disappointment
- You avoid raising difficult material with clients
- You tolerate behaviour that pushes boundaries, such as messages out of hours, or late cancellations
- You avoid triggering tension in over-explaining your formulation
And, it can also look like avoiding asking unidentified neurodivergent clients, “Have you ever wondered if you could be neurodivergent?”
The unique challenge faced by neurodivergent therapists
For those of us who are Autistic and ADHDers, there’s an added layer to this distress. Many of us have spent years navigating social environments with unspoken expectations and have experienced rejection without a clear cause or warning. This has primed our nervous systems to notice and respond to social threat, long before we entered the therapy room.
These personal histories don’t disappear in a clinical context. The therapeutic relationship requires us to read subtle cues, guide our clients through ambiguity, and hold space for the uncertainty of not knowing how the client is experiencing us. For someone with a nervous system already attuned to social threat, that uncertainty can be activating in ways that are hard to describe.
There’s also a particular irony for those of us who work specifically with neurodivergent clients. We often have deep empathy for the experiences our clients bring — because we recognise them. We identify with our clients’ pain and feel their outrage at injustice. That closeness can make it harder to maintain the kind of regulated, grounded presence the work requires, especially when the client’s pain echoes our own.
What doesn’t help
The standard advice for managing our reactions to rejection — supervision, self-reflection, keeping good professional boundaries — is all useful. But it doesn’t address the deeply painful impact of RSD.
Cognitive approaches can feel hollow when the self-critical response is physiological; instant, intense, and not amenable to reason. Telling yourself “The client probably just had a bad day” doesn’t help much when your nervous system has already registered the rejection and begun the social autopsy – you are replaying, interpreting, and finding ways you were at fault.
And there’s a particular kind of isolation in this. Therapists are trained to be reflective and self-aware. Admitting that a client’s disengagement sent you into a spiral of self-doubt for days can feel like a professional failure rather than a very human response.
What does help
What would happen if we applied the same principles that help our clients with RSD to ourselves? We are human, after all, and deserving of compassion.
Name what’s happening. You can get some immediate relief from recognising that what you’re experiencing has a name, a mechanism, and a logic. It can connect you to the common humanity that we all suffer, and we all seek connection. RSD is a pattern that emerged from personal experiences, and you can find relief.
Locate it in your body. RSD arrives as physical pain, a drop in the stomach, a tightening in the chest, a sudden heaviness. Recognising the signals early will help you respond rather than react.
Consider what happened from multiple perspectives. What you are feeling is real. However, your interpretation — that you failed, that the client doesn’t like you, that you’re not good enough at this — is a hypothesis, not a fact. Our minds are good at stories. With practice, you can hold the uncomfortable feelings and thoughts lightly without assuming that these stories are true.
Self-compassion over self-critique. Therapists are trained to analyse, and we are very good at it. However, when you apply this skill to yourself, you can get pulled into a complex web of self-criticism. By applying the skills of self-compassion, you can respond to your own distress with the same warmth you’d offer a client.
Supervision with someone you can be vulnerable with. Good, independent supervision creates a space to bring not just clinical formulations but your actual experience in the room. It’s hard to be genuinely vulnerable with a supervisor who is also your employer. If your supervision doesn’t feel safe enough to explore these personal challenges, you might need to find someone else.
Our work is personal, and can be painful
The therapists who are drawn to working with rejection sensitivity and RSD are often those who know something about it from the inside. If you are a neurodivergent therapist, your lived experience is one of the most powerful things you bring to a clinical relationship.
So, if rejection sensitivity is part of your experience as a therapist — whether or not you’ve understood it this way — it’s worth paying attention to these experiences. Not just for your clients’ sake, but for yours. You can’t support others from a place of chronic threat activation, unprocessed shame, or quiet dread about your clients’ reactions.
Your wellbeing deserves to be nurtured, and you can offer your pain gentle care.
