How Overcontrolled Clients Get Stuck in a Cycle of Disconnection from Peers: A Case Study

Alexis, a 13-year-old musical theatre student, is overcontrolled. This means that musical theatre is the anchor of her life and the frame of her identity. She had recently approached her two theatre group friends to talk about why she had not been attending rehearsals and would be unable to participate in the next theatre festival.  She told them the reason for her absence was that she was receiving treatment for anorexia nervosa.

Therapist Nicole: Wow, we talked about how much you wanted to let people know what was going on for you—and here you are doing it. How did it go?

Alexis: It was really weird. No one ran away like I thought they would and my friends told me that they were relieved to hear I was getting help.

Therapist Nicole: Very cool!

Alexis: Yeah. The coolest thing is that people then started telling me what was going on for them! I had no idea. Jaime told me that she went to the same clinic, but for help with her anxiety. And Eric told me his sister has an eating disorder.

Therapist Nicole: Ah!  And did you feel closer to them after that conversation?

Alexis: Yeah, I did.

Therapist Nicole: And do you think you guys trust each other a little more by getting a bit more real?

Alexis: Totally.

Therapist Nicole: Well, I have some exciting news for you, Alexis. You just rocked the brain science in the therapy we are doing!

And she had. It was one of those beautiful moments in therapy that you could not have planned better yourself: the client shared a poignant exchange that sums up the theory behind your interventions. In this case, Alexis demonstrated the key mechanism of change in RO-DBT which is Open Expression = Trust = Social Connection.

Many overcontrolled (OC) people have learned—with good reason—that keeping their emotions in check, their vulnerability shielded, and their social signals neutral keeps them safe or looking like they are in control of themselves. But a poker face is only useful in a poker game. In relationships, inhibited expression cycles like this:

[From “The Skills Manual for Radically Open Dialectical Behavior Therapy”, Lynch, 2018]

The consequences can feel devastating as many people being treated with RO-DBT try very hard to do the “right” thing and can’t figure out why their habitual response of masking their feelings is not working.

On the contrary, Alexis was able to describe an interaction of open expression which cycles like this:

[From “The Skills Manual for Radically Open Dialectical Behavior Therapy”, Lynch, 2018]

Humans are expert social safety detectors. In the case of Alexis, the more she withdrew into anorexia nervosa and her overcontrolled ways of staying safe, the more her musical theatre classmates withdrew from her as well. In essence, when people are not forthcoming of genuine experience—positive or negative—the more we distrust them.  And this happens on a pre-cognitive level. Imagine how you felt last time someone you cared for was in distress but insisted “everything is JUST fine!” My hunch is you did not believe them or trust them. The research shows that even when we express negative feelings, people have an increased empathy and capacity to respond. The bottom line is that open expression translates to you are in my tribe, we are alike, we are in solidarity. Or, Hey! You are just like me!

Yet open expression does not mean letting it all hang out all the time. I teach my clients that being open is context dependent. In the case of Alexis, she approached two people she considered friends, and in turn, their intimacy deepened based on their mutual sharing. We did not discuss or encourage opening up about her struggles to the entire drama club or high school. Practicing vulnerability takes exactly that—practice. And we don’t always do it perfectly, which many overcontrolled people aim to do.

For many overcontrolled folks, being on the outside looking in is a painful, everyday experience. To be part of the tribe, however, requires revealing an element of vulnerability that is equally painful. But as we have learned, and research supports, we are always aiming to be included. To do so, it requires that we reveal some personal aspects of ourselves, whether positive or negative. And overcontrolled clients will find that the risk involved—seeming imperfect—is completely worthwhile.

About the author: J. Nicole Little, Ph.D., R.C.C.

Nicole is a therapist specializing in eating disorders and other conditions of overcontrol in Victoria, B.C., Canada.  She has also taught for 13 years at Universities and colleges.  Her passions are RO-DBT and animal assisted therapy.