Am I in trouble? Rejection sensitivity and starting therapy

Yesterday, I opened my inbox and saw the subject line of an email in big, bold, don’t-ignore-me text: Your first appointment: information and documents.

My stomach lurched. What appointment? Have I forgotten something? Documents? It sounds like there’s admin here; please don’t let there be admin. Am I in trouble? Then I looked again and realised that I had overlooked two crucial letters: RE: Your first appointment: information and documents

It was a reply to an email that I had sent. It was like jumping out of your skin because you didn’t know that someone was in the room, only to realise that you had been spooked by your own reflection. So that was a relief…sort of.

I had chosen this subject line carefully. I wanted it to be discreet, without words like counselling or therapy appearing where someone else might see them. The irony was that an email designed to make the first session feel less daunting gave me an administrative jump-scare.

I have ADHD, and am familiar with the phenomenon often labelled RSD, or Rejection Sensitive Dysphoria: the sudden sting when something seems to suggest criticism, disapproval, or the possibility that I have got something wrong. For many people, this can spiral and take over their lives.

I have managed to reduce the impact of RSD on my life enormously through working with a great therapist. I still get that sting, but most of the time I would describe it as like stubbing my toe. It is intense in the moment and completely stops me in my tracks. There is a significant amount of internal (or sometimes external) swearing, and then it passes, and I get on with my day.

What does rejection sensitivity feel like?

Rejection sensitivity is not a formal diagnosis, and is not (yet) part of the diagnostic criteria for ADHD, and the term RSD can sometimes be used rather broadly. But many people recognise the experience that it describes.

A short email can feel ominous, a delayed reply can feel like rejection, and a neutral facial expression can look like grave disapproval. I have sometimes heard it described as emotional sunburn: people without sunburn can take a gentle pat on the back, but if you have sunburn, the same thing can feel like an agonising slap. This is how small criticisms, or even imagined criticisms, can feel with rejection sensitivity.

It can often come as a searing, crippling emotional pain that arrives before there is time to think. It is often felt physically: heat, nausea, tension, or an urge to run away, hide, or try to fix everything immediately. After this, explanations often quickly arrive:"They're angry with me; I've disgraced myself; I've been found out; I've ruined everything!"

Sometimes, of course, people really are disappointed in us. Horrible as it is, rejection and criticism are inevitable parts of being human. We cannot make ourselves completely safe from either, and we may experience burnout or a sense that we have lost our own identities when we constantly try to avoid them. The possibility of rejection can come to feel as dangerous as rejection itself.

What happens when this comes into therapy

Counselling, almost by definition, involves vulnerability: when you enter counselling, you are seen by another person.

If you have spent many years or decades monitoring other people for signs that you are failing at some unspoken standard – that you are not enough, or perhaps too much – those fears will almost inevitably pop up when you enter the counselling room. They may even arise before you even get there.

Once in counselling, you may reveal things that you normally hide. You might not know what to say, or disagree with your counsellor. You might worry that you are boring them, or that they disapprove of you. You might go home replaying something that you wish you hadn't said.

If you are accustomed to thinking and feeling in this way, it is unlikely to disappear in the counselling room, and it often shows up there quite vividly.

A different kind of relationship

Counselling is not just a place to analyse whether your fears of rejection are rational. It can offer the experience of being in a relationship where you do not need to keep up the performance in order to feel welcome and valued.

Let’s say you notice your counsellor glancing at the clock and become afraid that you are boring them, or that being with you is so unpleasant that they want you out of the room. Perhaps you feel angry with them, ashamed, or suddenly convinced that they must think badly of you.

None of these feelings necessarily mean that therapy is going wrong. In fact, these can be the moments when some of the most important work begins. You can say, “I feel like I’m boring you” or “Do you actually want me to keep coming here?” And instead of smoothing it over with the usual social niceties, the two of you can stay with what has happened between you.

If rejection sensitivity has shaped your relationships for a long time, you may have learned to walk on eggshells, constantly anticipating other people’s reactions and acting quickly to prevent disappointment or disapproval. You might people-please, withdraw, avoid responsibility, lie to escape anticipated criticism, or retaliate with anger before rejection has even happened.

A therapeutic relationship can offer something different. You can misunderstand and be misunderstood, disagree, and have needs. You can disappoint another person and discover that the relationship is still intact. You can be uncertain what the other person thinks of you without having to resolve that uncertainty immediately.

This can help you to notice, understand, and label rejection sensitivity in a safe, non-judgmental environment, but over time it can become more than an intellectual understanding. You begin to have a different experience of relationship: one in which discomfort, difference and even rupture do not automatically mean abandonment.

Other people really are difficult

There is an existential problem in all this. The philosopher Jean-Paul Sartre famously wrote, "Hell is other people." He didn't just mean that other people are dreadful. Part of his idea is that, in relationship with another person, I become something in their world too. They see me, interpret me, and make judgments about me, and I cannot completely control what they see.

Other people matter to us, and at the same time they can misunderstand us, disapprove of us, or reject us. No human can ever become so perceptive, agreeable, careful, or unflawed that we can entirely insulate ourselves from the pain of the judgments of others.

Rejection sensitivity therefore picks up on something real that is core to being alive. The question is how much of ourselves we have to surrender to avoid the possibility of rejection. Therapy cannot make us safe from other people’s judgments. What it can offer is the experience of remaining ourselves in the presence of another person whose response we cannot entirely control, and discovering that uncertainty, disagreement and even rupture need not mean abandonment.

Progress can still sting

For me, therapy did not magically cure my rejection sensitivity. I still had that little jolt when I saw my own email. I am now not even sure that I would want it to go away completely, because I feel like I would be missing out on part of what it means to be connected with others.

What has changed for me is what happens afterwards – I can feel that sting without treating it as a verdict on my whole self. I feel it, recognise it, and can even be curious about it, without letting it determine what I do next or how the rest of my day goes.

After my nerves had settled from the self-administered shock of my own email, I looked at the subject line again: words like appointment, documents, and information are not unfriendly, but put together they start to look official and institutional. They belong to the lexicon of schools, workplaces, healthcare systems, social work, the Inland Revenue. I thought, if it alarmed me that much, how might it land with someone who is already nervous about their first counselling session?

So I changed the subject line. Instead of: "Your first appointment: information and documents", I will now write "Our first session: some practical details". It’s only a small difference, but small things can matter. They can touch deep fears about how other people see us, whether we are acceptable to them, and what happens if we get something wrong.

If small things sometimes hit you hard, that does not make your reaction trivial. Progress does not have to mean never feeling the sting. Sometimes it means accidentally frightening yourself with your own email, noticing what just happened, and thinking: "Ah. Maybe I could have put that differently".