Therapy for rejection sensitivity that softens the sting
Therapy for rejection sensitivity in New York, for people whose whole system reacts to criticism, silence or a change in someone's tone.
If a delayed reply can ruin your afternoon, or a small piece of feedback can feel like a verdict on your worth, you are not being dramatic. Rejection sensitivity is your nervous system working hard to protect you from a pain it has learned to expect. Together we can understand that protective response, calm it, and build a sturdier sense of self that does not rise and fall with other people's reactions.
“Your intense response to rejection is not a character flaw. It is an alarm that learned, for good reasons, to ring early and loudly.”
When we treat the reaction as protection rather than weakness, shame starts to ease, and there is finally room to work with it instead of against it.
When small signals feel enormous
Rejection sensitivity is a heightened readiness to perceive, expect and react strongly to rejection, criticism or disapproval.
People with rejection sensitivity often scan for signs of disapproval without realising they are doing it. A friend's short message, a partner's quiet evening or a manager's neutral expression can trigger a rush of fear, shame or anger that feels far bigger than the moment. Afterwards there may be hours of replaying, apologising or withdrawing. Therapy for rejection sensitivity helps you understand this cycle and interrupt it with more choice.
The reaction is usually fast and physical before it is a thought: a drop in the stomach, heat in the face, a tight throat. That speed is a clue. It tells us the response is coming from a nervous system that learned to anticipate hurt, not from careful reasoning. Working only with thoughts can therefore feel frustrating, which is why I include the body in our work.
Rejection sensitivity can quietly shape a whole life. It can lead to people-pleasing, perfectionism, avoiding applications or auditions, ending relationships before the other person can, or hiding opinions to stay safe. Gently unpicking those strategies opens up more freedom in work, love and friendship.
Rejection sensitive dysphoria and ADHD
Many people with ADHD describe an especially intense, sudden emotional pain in response to perceived rejection or failure, often called rejection sensitive dysphoria or RSD. It is not a formal diagnosis, but the experience is very real. As a psychiatric nurse practitioner, I can explore whether ADHD or other factors are part of your picture, and whether medication, supplements or practical tools might support emotional regulation alongside therapy.
Where the sensitivity often begins
Rejection sensitivity frequently grows from early experiences: criticism at home, unpredictable caregivers, bullying, or being made to feel different because of identity, neurodivergence, body or culture. For LGBTQIA+ people and others who have faced real exclusion, vigilance can be an accurate reading of past danger. We honour that history while helping your system recognise where safety now exists.
Does this sound familiar?
Rejection sensitivity shows up differently for everyone, but certain patterns are common. You might recognise some of these in your relationships, your work, or the way you talk to yourself after social situations. Recognising them is not about labelling yourself; it is about seeing the shape of what you are carrying.
- Replaying conversations for hours
- Panic over unanswered messages
- Feedback feels like a personal attack
- Constant people-pleasing
- Avoiding risks to avoid rejection
- Sudden shame or anger
- Ending things before others can
- Over-apologising
- Needing frequent reassurance
- Intense emotions linked to ADHD
Steadying the system, not just the story
I bring together relational therapy, somatic regulation and psychiatric insight. We work with the moment of reaction itself, the history beneath it, and anything biological that might be amplifying it, always at a pace that keeps you feeling safe enough to explore.
A safety-first relationship
Rejection sensitivity can make therapy itself feel risky. I aim to be steady, transparent and non-judgemental, and we talk openly if anything I say lands painfully. Repairing small ruptures between us becomes valuable practice.
Attachment-focused work
We explore early relationships and the expectations they left behind. Understanding why disapproval once felt dangerous helps you separate past threats from present relationships, where different outcomes are possible.
Somatic regulation
Because the reaction starts in the body, we practise noticing the first physical signs and using grounding, breath and orientation to settle them. Over time the surge becomes shorter and easier to ride out.
Skills for the moment
DBT-informed and CBT-informed tools offer practical ways to check interpretations, tolerate distress and respond rather than react, especially useful for workplace feedback and relationship conflict.
Psychiatric assessment
If ADHD, depression or anxiety may be intensifying your reactions, I can assess, diagnose and discuss medication options. Any prescribing is thoughtful, collaborative and carefully monitored.
Supportive lifestyle factors
Sleep, nutrition and stress load all affect emotional reactivity. We look at these practically, and may consider supplements that may support regulation, reviewed for safety alongside any medication you take.
From bracing for hurt to trusting yourself
The goal is not to stop caring what others think. It is to feel things without being knocked off your feet.
Living with untreated rejection sensitivity
- Reading rejection into neutral moments
- Spiralling after small criticism
- Hiding needs to stay liked
- Avoiding opportunities that might fail
- Feeling ashamed of your reactions
What therapy can help you build
- Noticing the alarm before it takes over
- Recovering more quickly after a sting
- Asking for what you need with less fear
- Taking creative and career risks
- Meeting your reactions with compassion
Beginning therapy for rejection sensitivity
Each step is designed to feel predictable and low pressure.
-
1
Free consultation 15 minutes
A brief, relaxed call where you can describe what happens when you sense rejection and ask any questions. I will explain how I work so there are no surprises, and we can see whether we are a good fit.
-
2
Comprehensive first session 90 minutes
We explore your relationships, history, work life, health and any previous diagnoses or treatment. If ADHD or mood symptoms may be involved, we begin to look at that carefully rather than assuming.
-
3
A shared plan
We agree what to focus on first. For some people that is calming reactions in relationships; for others it is workplace feedback, creative risk or a possible ADHD assessment. You stay in charge of the direction.
-
4
Ongoing support 60 or 90 minutes
Regular sessions let us practise new responses, reflect on real situations from your week, and adjust any medication or supplement plan gradually. Progress is reviewed openly and together.
Francesca Rome-Marie, PMHNP-BC
I bring together psychiatry, psychotherapy, somatic work and whole-body health, informed by years in primary care and further study in gender theory, feminist thought, culture and visual art.
I keep a deliberately small caseload so that every client receives consistent, unhurried and genuinely attentive care, held within one relationship rather than split across several providers.
Clear, upfront rates
I don't accept insurance. Modern Holistic Psychiatry is an out-of-network provider, so sessions are paid for directly. Depending on your plan, you may be able to claim reimbursement through your out-of-network benefits.
Find out how much your insurance may coverNeed urgent support? If you're in crisis or thinking about harming yourself, call or text 988 (Suicide & Crisis Lifeline) or call 911.
Therapy for Rejection Sensitivity FAQs
Is rejection sensitivity a diagnosis?
Rejection sensitivity is not a stand-alone diagnosis. It describes a pattern of expecting and reacting strongly to rejection, and it can appear alongside ADHD, anxiety, depression, trauma or simply a painful history. Part of our work is understanding what is contributing in your case, so that support is tailored rather than generic.
What is the link between RSD and ADHD?
Rejection sensitive dysphoria is a term many people with ADHD use for sudden, overwhelming emotional pain after perceived rejection or failure. Differences in emotional regulation are common in ADHD, and years of criticism for ADHD traits can add to the sensitivity. I can assess for ADHD and discuss whether treatment may help steady these reactions.
Can medication help with rejection sensitivity?
For some people, yes. If ADHD, anxiety or depression is amplifying your reactions, treating that may make emotional responses more manageable. Medication is never the only tool, though. We would discuss benefits, side effects and alternatives openly, and any change would be gradual and closely monitored.
How does therapy for rejection sensitivity actually work?
We work on three levels: the immediate reaction in your body, the beliefs and history that give it power, and the patterns of behaviour that grow around it, such as people-pleasing or avoidance. Over time you learn to notice the alarm earlier, settle it, and respond in ways that reflect what you value.
I worry I will feel rejected by my therapist. Is that normal?
Completely normal, and worth saying out loud. Many people with rejection sensitivity watch their therapist closely for signs of boredom or disapproval. I welcome you bringing those moments into the room. Talking through them safely is one of the most powerful parts of the work.
Do you work with rejection sensitivity in LGBTQIA+ clients?
Yes. For many LGBTQIA+ people, sensitivity to rejection is shaped by real experiences of exclusion, family conflict or discrimination. My practice is affirming, and I treat that vigilance as an understandable response to real harm, while helping you find relationships and spaces where you can relax.
Where do you see clients?
My practice is at 41 Union Square West in Manhattan, and I support clients across New York State. A free 15-minute consultation is the simplest way to check availability and talk about whether working together makes sense.
Feel things without falling apart
You do not have to keep bracing for hurt. Book a free 15-minute consultation and we can talk about calmer, kinder ways to meet rejection.