Case Study


Case Study

“Nobody Knows!”: Helping Introverts Appreciate Their Strengths

By Michael Alcée

November/December 2018


It’s easy for introverts to fall under the therapeutic radar. They often come to us for help with anxiety, depression, and relationship difficulties, and we typically offer them our usual trusted treatments for these common issues without pausing to take their personalities—or more accurately, their temperaments—into account. But there’s a direct link between their mental health issues and how they’re misunderstood and alienated by a culture that expects and rewards extraversion at every turn.

This invisible pressure contributes to the introverts I’ve seen in my practice becoming discouraged with therapy, as session after session fails to get to the heart of their feelings of failure, inadequacy, and disconnection. And I can attest that it makes treatment, from the therapist’s perspective, frustrating as well.

Recently, Susan Cain’s popular TED talk, “The Power of Introverts,” and her bestselling book, Quiet: The Power of Introverts in a World That Can’t Stop Talking, have led some businesses and colleges to think anew about the strengths and contributions of introverts, a group, according to Cain, that makes up a full one-third to one-half of the population. But ironically, today’s psychotherapy world continues to pay introversion little mind, despite its first being named and popularized by our own eminent analyst Carl Jung and the mother-daughter team of Myers-Briggs, who created the personality type indicator.

Why have we lost sight of the fact that introversion, extroversion, or ambiversion (the middle ground between the two) are seminal parts of who our clients are and how they make sense of life? And how can we do a better job of shining a light on their personality types and helping them validate their own ways of being and belonging in the world? One particular young client on the college campus where I work started me on an unexpected and sometimes slippery journey to uncover the answers.


I’m Nobody

I first met my client Jessica when she was a first-year student in college. The oldest of three from a working-class Latino family, she was bookish, tech-obsessed (she’d happily tell you about the finer points of artificial intelligence), and prized in her family for being the first to attend college. She was also a bit of an outcast in her boisterous household—the inexplicably quiet one, who confused and concerned others with her need for time alone.

While her parents loved her, they didn’t understand Jessica’s sensitivities, like suddenly getting frustrated and running to her room during large family gatherings, or constantly diving into books and being uninterested in the kinds of fun that most kids her age seemed to enjoy. Worried that she’d ultimately squander opportunities for personal and professional success, her parents told her repeatedly that she needed to toughen up and be a bolder communicator. They saw her unnamed introversion as a problem in need of fixing—and by the time she’d gotten to college, she saw it that way, too.

Jessica had seen a variety of therapists from high school onward, all of whom quickly diagnosed her with social anxiety disorder. At school, she’d received a host of accommodations for the diagnosis, including testing in a separate space and extended time on assignments. It had become an article of faith that this was an immutable part of her personality to be managed, but not one that could be resolved.

She’d arrive in my waiting room and greet me with her head down, almost wincing as she crossed the threshold, as if she was being pushed to do something deeply uncomfortable against her will. Whenever she appeared, I got the sense that she saw me as a human interrogation lamp, eager to pry out her secrets for my own gratification.

Early on, I took to greeting her by nodding softly at the door, concerned that if I spoke too soon, she’d bolt like a deer. “I need another note,” she’d murmur as she walked in. We both knew what that meant. She was asking me to legitimize her social anxiety to the professors who expected her to speak up in class, take part in group projects, and otherwise take on work that would force her outside her quiet and solitary comfort zone. She needed me to assure them she was different from your garden-variety slacker, and to get them to keep this in mind when doling out grades.

There was always little doubt I’d eventually write these notes, but not before urging her to endure a handful of sessions focused on her corrosive self-criticism and crippling anticipation of being shamed, in which I’d use cognitive techniques like disputation and restructuring. She was so accustomed to this that by the time she appeared in my office midway through her sophomore year, she immediately sat down, crossed her arms, and beat me to the punch by cataloguing her ongoing symptoms.

“It’s the same as always,” she started, her eyes fixed on the carpet. “I can write the essays and take the tests; I just can’t manage to talk to the person sitting next to me. It’s embarrassing to feel so bombarded by the noise of the other students and the bright lights swirling around me. And I’m sorry. I know it’s your job to convince me I can change, but it’s just no use. No matter how much I try, I can’t outrun this fear of being around people. It’s just who I am.”

Not wanting to invalidate her feelings, I temporarily went along with this assessment. But as we kept talking, I started thinking of novel ways to shift her self-definition. I thought about how much she’d already accomplished in her life despite the power of her fear. “I see how profound and all-encompassing your anxieties are,” I said. “And yet, your fears seem like real bullies for not letting you speak. I wonder if we might get to know a bit about the you that feels attacked by these bullies. What would that Jessica share with people about who she is if she could?”

The silence that ensued made me immediately question my line of inquiry. Only one more week remained in the semester, and I knew she was panicked that the tsunami of uncompleted work was about to crash down on her. Sure enough, she bristled at my question.

“Maybe there are bullies in my brain. That’s great in theory, but I don’t have time to really think of that right now,” she said. “I need to get your note, or else I’ll fail these classes, lose my scholarship, and then what will I have?”

It was a good question. Jessica hadn’t really felt buoyed by much in her life, other than her intellectual achievements and the world of her imagination. She also knew that most other college students wouldn’t take the time to get to know her and learn what she truly thought, or why she didn’t go to parties much, or fiercely detested small talk, or turned bright red when called on in class. Sometimes it felt as if the whole world was shouting at her that she was just no good, so why even try?

“I’m just not cut out for being around people,” she reminded me.

I sighed, and we spent the rest of the session covering practical, in-the-moment solutions to her problems. We identified the most crippling forms of her self-criticism, which sounded like, “People are right; I’m really not likable,” and then disputed it with compassionate and affirming new scripts, such as “It just takes more time for me to feel comfortable with people so that they really know who I am inside.”

We role-played ways to increase her confidence in the social world, with me slowing down the kinds of small talk peers expected and her trying out ways of translating her deeper interests into a smoother, more polished response. Most importantly, we focused on how to speak frankly with her professors about her habit of self-medicating her anxiety with procrastination. We also established reasonable goals—like breaking down assignments into realistic parts, rather than a perfect whole—to keep her on track.

When we were done, I picked up my notepad and a pen. I understood that these efforts we’d made would be only marginally productive for her. As I signed my name to the note for her professors, it was perfectly clear to me that I was just stealing time, and that she’d be back, right where she was sitting, next semester.

I felt helpless when she left, but full of empathy, since I knew how drained and resentful I could feel in some social situations also. In fact, I thought that day, whenever Jessica would come in, it felt like the poet and famed introvert Emily Dickinson was sitting on my shoulder, whispering her famous stanza to both of us: “I’m Nobody! Who are you? / Are you—Nobody—too? / Then there’s a pair of us! / Don’t tell! they’d advertise—you know!”


Who Are You?

Our meetings went on in the same fashion until her senior year. That fall, I was fresh from reading Susan Cain’s book on introverts and primed to share with Jessica what I’d learned. Cain champions a quiet sensibility in life—one that’s rarely celebrated, despite the reality that many of our biggest contributors to the sciences and the arts, even business and politics, possess it.

Cain suggests that if introverts can be in tune with the particular gifts that accompany their personality type—emotional intelligence, a measured and deliberate work style, and a whimsical and imaginative sense of creativity—it can become the foundation for feeling like a “somebody,” regardless of how an extroverted society defines that. Clearly, Jessica was one of Cain’s unsung heroes. How could I facilitate the kind of attunement that would help her see herself in this new light? I needed a vehicle that would allow me to connect with her inner experience on a deep level, beyond mere words. I needed to spark her imagination.

Over the summer, I’d reacquainted myself with a tattered copy of The Little Prince that I’d treasured when I was college, and realized that the introverted main character reminded me a lot of Jessica. I considered that a book lover like Jessica might be willing to indulge me in such a comparison and perhaps even find it grounding. So, as she sat before me with her rounded shoulders and bent head, I described how we all start out like introverts as children, free to be consumed by the fascinations of our inner worlds. In fact, the narrator of the book remembers as a little boy delighting in his drawing of a boa constrictor swallowing an elephant. But he’s soon disappointed to find that the adults around him, the arbiters of the external social world, only see a hat in his drawing, despite his attempts to clarify his perspective. “Similarly,” I told Jessica, “introverts find it challenging to explain to the extroverts around them just what it is they’re making, how they operate, and why it’s of value.”

In the story, the boy soon abandons his enthusiasm for artistically sharing his internal world, and instead pursues a career as a pilot. As an adult, he ends up stranded in the Sahara Desert when his plane plummets to earth. Literally and figuratively out of fuel, he begins to reconnect with his introverted core, who arrives in the form of the Little Prince. In a culture that tends to prize extroversion, many introverts go through the same process, becoming alienated from themselves and feeling like failures when they’re depleted of energy and not thriving.

By the time I’d finished my musings on The Little Prince, Jessica had shifted forward on the couch, and her eyes had lifted from the carpet. A hint of a smile appeared on her lips. This was a first. “I think you’re an introvert, and that you often inhabit your own planet,” I said. “I also think it’s a rich and storied place, full of valuable gifts and interesting surprises. Despite what others may assume, I think it’s okay to be there. I wonder what would happen if you could just feel comfortable being there, rather than expending so much energy trying to be somewhere else.”

She nodded but her smile slowly disappeared. “I don’t understand. Why hasn’t anybody told me this before—that I’m really okay? I’ve been to so many other therapists. Wouldn’t they have known this?”

It was a good question, and I didn’t have a great answer. Why hadn’t they seen something so obvious? Why hadn’t I? I leaned in, careful to preserve her space by not moving my rolling chair. “Maybe we therapists get so focused on solving problems and changing things, that we don’t take the time to see what’s right there in front of us. We focus so much on nurture, we forget about nature,” I offered.

Jessica held eye contact, and I could sense her both accepting this explanation and processing the possibility that we were onto something. We sat together in this new, thoughtful silence for nearly a full minute. Finally, she spoke: “I’ve always thought I had some kind of defect, like a design flaw. I thought it must just be me.”

I knew that conviction firsthand. “Not at all,” I told her. “Introverts just drain faster because they’re processing so much around them, and they need to recharge in ways not so easily available in our culture. Think of it like this, if you’re an extrovert, you’re one of the many gas-powered cars on the road and can find fuel easily by getting in line at any of the crowded gas stations around the block. But if you’re an introvert, you’re a little rarer, like a Tesla, which requires a quiet charging station, and those are fewer and farther between. When you don’t find them, it’s no wonder you get anxious and depressed.”

“I honestly never thought about it that way,” she said.

We began to talk about what introverts need: healthy dosages of time spent reading, walking in nature, and reflecting. We went back over some basic principles of self-care and several mindfulness techniques I’d offered in previous session to help quiet her anxiety. This time, however, imbued with a new sense of self-compassion and awareness, she was eager to practice them. Instead of showing up only when she needed a note, she now took the initiative to schedule more sessions with me.


Are You—Nobody—Too?

As Jessica and I opened up these new ways of looking at things in the following weeks, her symptoms started to dissipate. She started noticing more quickly when she was becoming depleted, and saw anxiety as a messenger for her to take care of herself, rather than beat herself up.During one of our sessions, Jessica said, “I always thought my anxiety was a message that I couldn’t handle things, that I was messing up. But now it’s starting to make sense that it’s trying to help me.”

I held up both my hands to pantomime who knew? and said, “It’s easy for all of us to think of anxiety as an intruder, not a friend.”

We continued to talk about ways to gracefully exit social situations when she needed to refill the introvert fount, and how to transform small talk into more substantive and personally engaging conversations. Sometimes, we even noted her secret admiration for extroverts—their boldness and gregariousness—and how she might find a way to cultivate that side of herself a little more. In her own way and on her own timeline, of course.

Jessica began to relate to her introversion like the battery on her phone. When it was running low, she wouldn’t berate or denigrate it; she’d just charge herself up with the right things—reading, reflecting, retreating. “My three R’s” she started to call it.

She stopped shaming and judging herself for how she was built, and began to appreciate the strengths of being an introvert, noticing how perceptive, creative, and tuned in she was to herself, others, and the world, and—best yet—how many others were like her. We started a list of celebrity introverts we discovered between sessions. Her favorite, as a Harry Potter fan, was the actress Emma Watson, but she liked that Stephen Colbert, a talk-show host, was one, too. And she was thrilled when I discovered one of her heroes, Eleanor Roosevelt, had shared her personality type. She began to see that not only was she not defective, but a member of a very special club.

- - - -

My work with Jessica inspired me to start an unlikely group. I posted flyers across the campus that read in bold letters: “Introverts Unite! Occasionally. In Small Groups. For Limited Periods of Time!”

I wanted a place for other introverts to learn about their internal operating systems, and to see that not only were they not alone, but that they, too, could be social, connected, and empowered. I wanted them to have an embodied experience of what Cain had inspired in her readers—that they were somebodies, too!

My idea was met with playful jibes from my colleagues, who wondered if anybody would come, or even talk if they did. But their skepticism was based on the greatest misconception we all have about introverts—that they’re loners, misanthropes, and, like they saw Jessica, just socially anxious.

Students did in fact show, and Introverts Unite! became one of the most well-attended, diverse, and cohesive groups I’d ever run. True to the Cain’s mission, we were starting what she calls a “quiet revolution,” a new space to reintegrate the value and place of introverts in the culture, and in so doing, to reframe the collection of symptoms that had long been explained away as depression and anxiety.

Unfortunately, Jessica didn’t get a chance to participate in this experiment, having graduated a semester before its inception. But each group session, as I’d watch formerly reserved students share their experiences, I pictured her enjoying this newfound company and winking conspiratorially with Dickinson: “Don’t tell! They’d advertise—you know!”


CASE COMMENTARY

By Steven Stosny

In this fine case presentation, Michael Alcée raises a vital issue for practicing therapists. The lack of attention to temperamental factors in some clinical training programs can lead to misdiagnoses and even to iatrogenic treatment, as may have been the case with Jessica before she came to Alcée. Failure to address temperament, especially in young people, can lead to alienation from the true self in efforts to maintain a social self that meets the expectations of others. Alcée is to be commended for sparing Jessica the emotional burden of self-negation, by helping her appreciate the strengths of her temperament.

Equally commendable are his efforts in establishing the “Introverts Unite!” group. Discussions of temperamental qualities in empowering ways are invaluable. If we want to promote diversity, inclusiveness, and social harmony, I believe that middle school education should address temperamental differences. Although introverts suffer more pain and are likely to become overly sensitive, ignoring the role of temperament can increase the risk of extroverts becoming insensitive to those unlike themselves.

Alcée’s intervention is likely to help Jessica in her future intimate relationships as well, making her more accepting of her partner’s temperament, as well as her own. In my work with couples, I long ago recognized the importance of addressing temperament. We tend to seek out partners with qualities that balance our own and bring a different emotional tone to a relationship. Even when partners both test as introverted or both extroverted, they almost always score at opposite ends of the category. Put simply, introverts calm the extroverts and make them more reflective, while extroverts energize the introverts, increasing their “battery life,” as Alcée might put it.

After we fall in love, and once the hormones that bring us together wear off, temperamental differences are likely to be misinterpreted. The extrovert feels rejected when the introvert needs downtime, while the introvert feels overwhelmed and inadequate, often concluding that the way he or she loves isn’t good enough. Instead of fitting their different temperaments together in harmony, partners often demand changes in each other’s temperament, which is like the violin demanding that the cello become a violin in a duet. The most common conflict in relationships begins with the demand that our partners be more like us, see the world the way we do, think like us, and have the same feelings. A great many arguments can be reduced to “You have to be more like me.” Appreciation of temperamental differences not only reduces these futile arguments, but enhances our ability to love someone who’s different from us.

***

Michael Alcée, PhD, is a clinical psychologist and speaker with a background in music, literature, and art. He helps individuals, organizations, and schools make innovative connections to create systemic change. Contact: drmichaelalcee.com.

Steven Stosny, PhD, is the director of Compassion Power. He’s the author of Living and Loving after Betrayal and Love without Hurt, and the coauthor of How to Improve Your Marriage Without Talking About It.

ILLUSTRATION BY SALLY WERN COMPORT

Check out our video interview with Michael, where he shares more about helping introverts uncover hidden strengths!



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2 Comments

Saturday, October 12, 2019 9:04:09 PM | posted by ellenfox
Dear Doctor Alcee, Right on! This is exactly how I (an introvert) work with my introverted clients. It is such a relief when the find out that there is nothing wrong with them. I give them material on introversion, and on the Highly Sensitive Person. I love the idea of the group. Maybe I'll do one like that. I feel that my own introversion is especially helpful to these folks as I truly understand them and thus they grow to understand themselves. Thanks for the article.

Saturday, October 12, 2019 4:14:55 PM | posted by Kate Cohen-Posey
This is a good example of therapy needing to fit the person not visa versa! Studying the Enneagram has become an invaluable tool for me. I currently have a case of an introvert who thinks he has "social phobia." In the Enneagram he is a type 5--independent, easily does things on his own and prefers to observe rather than experience life. I have challenged his belief that he should be more engaged with people by asking him if he WANTS to be more interactive. In a group setting, I suggested that he ask himself if there is anything he wants to know about/from the people there and only push himself to interact if he is lead by his curiosity.