Something a Therapist May Make Note of: Are you an Attention-seeker or an Attention-Avoider?

              Many times patients wonder what their therapist is analyzing about their speech or behavior. Am I bouncing my leg and that means I have ADHD? Am I avoiding eye contact and that lends itself toward low self-esteem? Let me share one characteristic we do look for that has some relevance to therapy work. Are you on the extremes with your comfort level with human attention?

As with many human characteristics, the degree to which you are comfortable with social attention lies on a spectrum. The bell curve proves true. Most fall somewhere in the middle of this spread. Those on either extreme can be a focus of therapists’ attention.

              Let’s consider attention-avoiders. This is a diverse group. We have socially anxious individuals whose nervous system goes into overdrive when around new people. They are under a spotlight in a crowd and have come to fear that they are being criticized in everyone’s mind. Imagine being a teenager walking through the lunch room and you whiff it spilling your lunch and making a crash. It’s all eyes on you. This is what it feels like for socially anxious people in social situations. This can be at a party, grocery shopping, attending a festival, going to a funeral, or participating in a work team-builder. Social anxiety inhibits one of the most important and (almost) universally integral pillars of happiness in life: relationships. Social anxiety can cause us to miss other humans that cross our path. Individuals that might have brought happiness and played an important role in our journey. This is a serious problem.

              Next we have harmony-seekers. This gets extreme when we are sacrificing our own happiness to maintain relationships at all costs. We lose ourselves in relationships to make the other happy. This can be a learned behavior. Consider women who grew up seeing their mother do anything to please her father but had no voice of her own. This occurs when someone has suffered through chaotic relationships and wants nothing other than calm. They cringe when approaching confrontation and can cower when others’ anger boils up. They are vulnerable to becoming a doormat in relationships. Often they play the role of helper in their social group but would never burden a loved one when they need help or support. They live a life of unbalanced relationships and often ignore their own needs. We attempt to convince these lovely people that they deserve a little attention too.

              Poor self-esteem also drives a desire to be invisible. If you are unsure of yourself, you are unlikely to put yourself out there. This includes attempting to succeed in your particular area of passion, from starting relationships, raising your hand when you know the answer to a question, or going for the promotion. This type of attention-avoider becomes a low risk-taker as the likelihood of failure seems inevitable so why even try? You can see for yourself how much this negatively impacts one’s quality of life.

              Attention-avoiders: we see you in session. You avoid eye contact, default to others’ wishes, are indecisive as you usually base your decisions on what others want from you. Get ready to be challenged. We want you advocating for yourself, taking risks to build the life you ultimately deserve, and to stop missing out on the beauty of personal relationships simply to avoid being anxious.

              Let us jump to the other end of the spectrum: attention-seekers. We see you too (hard to miss!). Let us discuss first those patients with a dramatic presentation. Our first session can seem like an acting audition. Your life story may sound like a harrowing novel but without an emotional expression that corresponds to the story. You can describe your worst trauma with a smile on your face. Often times, boundaries will be crossed with the therapist in terms of culturally appropriate social boundaries. This may mean a hug, commenting on something personal about the therapist before a relationship is forged, or perhaps a bout of annoyance at the therapist out of the gate.

              Dramatic attention-seekers can often be disingenuous. They might overplay their fragility, crying and insisting the therapist is the only one who can help them. There might be an exaggeration of their history or their symptoms. This serves an obvious purpose: don’t think of me as just another patient. I’m special. This may be to endear the therapist to them. Please love me and help me. This may be to stir up drama as a diversion from the stale day-to-day life. Living in a production in which there are persistent highs and lows helps us escape from our real lives. Also, being the victim of continued turmoil garners sympathy and support from loved ones. If any of these underlying motives are true of the attention-seeker, it is unconscious and automatic. This is not a referendum on their character, rather a learned method to survive in this turbulent world.

              Attention-seeking can also be a method of seeking support, care, and engaging in relationships. I can’t have a boring week or my therapist will tire of me. If people are pitying me, at least they care. If I get well and become calm, I become invisible. If I start to feel better, my therapist will fire me.

              There is even a personality disorder based on attention-seeking behavior: Histrionic Personality Disorder. Individuals with this personality disorder are excessively emotional, place themselves as the center of attention, and seek praise and approval. They often feel uncomfortable when they are not the center of attention. Often, early childhood experiences involving excessive praise, inconsistent praise, or neglect lead to this maladaptive coping strategy. These individuals are the caricatures of attention-seeking.

              Therapists do not often point out dramatic behavior when it is occurring, rather we often seesaw between validating their emotions and bringing them back to real therapeutic work. “I’m sorry I have ‘looked at my clock five times this session’. I do not wish to communicate I’m not present and I don’t care about you. What can we do today in service of your goals?” “It’s hard to continually be bullied at each workplace you join. Is there anything you or I can come up with to keep this from happening?” Validate, work, validate, work.

              You may be thinking that validation of an exaggerated presentation is playing along or even reinforcing this behavior. Trust me, this type of attention-seeker is apt to turn up the volume if you aren’t listening. If the therapist minimizes suicidal intimations, she may come with self-inflicted scars next session to show you she wasn’t bluffing. If the therapist challenges the veracity of a claim, the therapeutic alliance and sense of safety are ruptured. We look past the dramatic presentation to what we think is really occurring. If the therapist builds a strong enough therapeutic relationship, he may be able to share how he feels or responds to some of the patient’s behaviors. Thus, the therapist has created a safe space to discuss how others may interpret their behaviors and feel around them.

              Although attention-seekers and attention-avoiders couldn’t be more different in presentation, there is one similarity. Attention-seekers can feel just as uncomfortable not being seen as attention-avoiders are being seen.

Feel better, y’all!