“The most terrible poverty is loneliness, and the feeling of being unloved.”
– Mother Teresa
Eric had the hungry look of the chronically lonely. He needed to, as it were, chew my ear. Any ear would have done. He spoke all he had to say because now, at last, there was someone to listen.
So for a long time, I sat and listened. He didn’t actually tell me he was lonely. He didn’t need to. It was obvious in the way he talked about “people in the street”. The way he felt strangers might judge him in cafes or at his doctor’s surgery. His sad, faraway eyes. I could sense his disconnection.
“And do you live with anyone, Eric?” I asked.
“Not since my wife died.”
Eric was 67. His wife had died years before. His few friends had either moved away or, it seemed, moved on, from him. He was here for help with depression, and yet I felt much of his malaise might be solved through healthy social connection.
“The thing is,” he told me forlornly, “I like people. I never used to feel depressed, Mark, but since my wife died, and especially now that I’ve retired, I just don’t see anyone from one day to the next. The four walls close in on me and I go stir crazy.”
Of course, we often find out what’s really at the root of someone’s problems by what they talk about the most. Eric spoke again and again of his loneliness.
One thing that can sometimes, though not always, help is to tell the lonely that they are not alone with their experience.
All lonely together
We often roll out the cliché that being alone doesn’t mean we’re necessarily lonely. Of course it doesn’t. We can feel connected (perhaps to nature) when alone. And we can be lonely in a crowd if we feel misunderstood. But it’s also true that many people are not so good at being alone.
A recent study found that many people left sitting alone for 15 minutes chose to self-inflict (reasonably) mild electric shocks rather than just be with their thoughts!1 It takes a certain knack to be alone for any significant length of time.A recent study found that many people left sitting alone for 15 minutes chose to self-inflict electric shocks rather than just be with their thoughts! It takes a certain knack to be alone for any significant length of time.Click To Tweet
Feelings of loneliness may be worsened by an inability to sit quietly with our own thoughts, but of course, loneliness is more than that.
We may feel the pain of loneliness because we feel unable to connect to those around us, because we’re isolated and rarely see others, or perhaps because of a coalescing of both these conditions.
Ongoing loneliness tends to produce a sense of lost meaning. We need to feel life is meaningful, and deep relationships are a – perhaps the – vital way many people create and enjoy meaning in their lives.
We all have a need for human contact, to give and receive attention. And, like any need, its absence is like a hunger or thirst. Loneliness is the sensation of that unfulfilment. The signal we are ‘hungry’.
True loneliness can feel like a kind of non-specific sense of being rejected, even if no actual social rejection has taken place. Eric described his loneliness as a kind of “ache” in his heart. Sure enough, feeling rejected activates some of the same areas of the brain as physical pain.2 And the cost of loneliness, for any of us, can be huge.
Chronic loneliness is correlated with all kinds of physical and mental health risks,3,4 including suicide5 and early mortality.6,7 Ongoing feelings of loneliness even, according to one Dutch study, predict the onset of dementia.8
Any unfulfilled emotional need, if it becomes extreme, can make us feel desperate. And when we’re desperate, we do desperate things.
Meeting the need any which way
To help the lonely client, we need to help them find or reconnect with people they feel a mutual affinity with. Mind you, any company may feel better than none. Just as the attention-starved may blindly seek negative attention rather than risk no attention, so too lonely people may seek company anywhere.
Eric told me of conversations he’d tried to initiate with random strangers. “But people don’t want to talk nowadays,” he lamented.
When we’re truly starved of company, any social interaction provides an opportunity to try to meet the need for human contact, from unsolicited sales calls to strangers in the checkout line at the supermarket.
We should all, if possible, be kind when we sense that a stranger is starved for company, because one day it might be we who desperately seek smidgens of social solace and crumbs of company when and wherever we can get them.
As with anything, there are risk factors for loneliness.
For one thing, the prevalence of loneliness may vary across the lifespan. A 2012 UK study found those under the age of 25 and over the age of 65 were most likely to suffer loneliness.9 As I mentioned, Eric was 67.
But all age groups do better physically and mentally if they feel a strong sense of community and also intimacy with at least one other person. Someone they feel they can rely on. Someone who accepts them unconditionally.10
Not unexpectedly, it’s not the number but the depth of our friendships that counts.
How many people do you really feel a deep connection with? Who understands you the best? Who seems to accept you ‘warts and all’?
Most of us feel lonely at some time in our lives. And this can often be thanks to circumstances well beyond our immediate control.
We move to a new place and know few people. We lose a loved one. We move on from school to university. We lose our job and co-workers in one fell swoop. We become ill or disabled. Sadly, research has found that in the UK, half of disabled people feel lonely, and a quarter feel lonely every single day.11
So yes, circumstances can disconnect us from people around us. Life severs connections sometimes and, as the famous diarist Samuel Johnson once wrote (referring to himself):
“If a man does not make new acquaintances as he advances through life, he will soon find himself left alone. A man, sir, should keep his friendship in a constant repair.”
Some of us, of course, try to keep our friendships in constant repair via social media. And this can work up to a point. But we have to be careful how much of our social lives are levied behind the devitalizing effects of a screen.
How we use social media has been found to correlate with how lonely it makes us.12 For example, using it to keep connected with friends and arrange real-life get-togethers can counter loneliness. On the other hand, using it simply to seek approval (and feeling bereft when it doesn’t come) or viewing carefully curated images of the best moments of a friend’s (or stranger’s!) life can make us feel lonelier than ever.
One problem with social media spaces is a bias towards status raising, exaggeration of personal qualities, approval seeking, and almost exclusively upbeat posts about oneself. If life doesn’t feel so good, all this can seem inauthentic and disconnecting.
Anyway, Eric barely used email let alone social media. But if a client is lonely it’s worth exploring how, if at all, they use social media.
Here I want to focus on some research-based behavioural interventions for loneliness.
Behavioural intervention one: Help them find meaning through ritual
It may sound strange, but my first tip isn’t related directly to meeting or mixing with other people at all. Recent research has found that adopting simple daily rituals around, of all things, product consumption can help people feel less lonely.13
In a series of studies, the researchers found that engaging in even minimal rituals – dunking your tea bag in your cup a certain number of times, or eating a candy bar in a certain ritualized way – can help us cope with loneliness!
All this is starting to sound uncomfortably like OCD to me! But putting that reservation aside for a moment, this to me is one of those quirky research findings with huge potential ramifications. Many of us, I think, intuitively know that ritual is important for us, that it’s powerful, but perhaps it needs to be researched more fully.
Anyway, the researchers surmise that the reason product consumption rituals might help us cope with loneliness is because they provide that all-important sense of meaning. They don’t really elucidate on how or why, but I wonder whether a sense of meaning can perhaps come from a controlled and repeatable way of extending attention away from the self, even if it is only towards very simple activities.
Beyond that, ritual and routine can, I think, increase a sense of autonomy and control, which may also reduce the ache of loneliness to some extent. Though of course none of this can in any way replace human contact.
I didn’t want to suggest Eric count how many crumbs were on his plate or anything like that. But I did want to help him bring shape to his day.
I asked Eric what his average day was like.
“Well, it’s usually a big empty morass of emptiness that I have to get through.”
I pressed him for a few more details! He did rise at a regular time, but he didn’t have any particular rituals. So we devised a plan. Not only would he get up at a set time every day, he would also have set times for meals and exercise. Our goal was to bring some shape to the chaos of nothingness that consumed his days.
Being an ex-military man, and one of the wonderful clients who actually try what you suggest, Eric really related to this and began to adopt these new rituals.
But adding shape to his days was just the start.
Behavioural intervention two: Help them become a regular
A few years back I got into the habit of going into a particular cafe every day to work on my laptop. I didn’t make any efforts to socialize, but after a time I couldn’t help but notice a certain transformation in my relationship to the place.
After maybe a couple of weeks of going in every day, I found it was no longer me and them – other regular patrons, the manager, and the staff – but us. I had, through no effort other than just regularly showing up, risen to the status of… a regular.
I started sharing jokes with the manager. I knew about the waitress’ husband’s musical career and their plans to move to Spain. I talked sport with the short-order cook (who was actually pretty tall!) and passed the time of day with other ‘regulars’ as we enjoyed some easy banter. And something mystified me.
I couldn’t for the life of me ascertain at what exact point I had morphed from ‘some guy’ to ‘one of us’. Was I not a regular on Monday but suddenly a regular on Tuesday?
I recalled a piece of research I’d read (which I can’t for the life of me now find), which found that on average it takes around 7 or 8 visits to a place (presumably over a short space of time) to start being perceived as a regular, part of some kind of community. Of course, it depends on where you visit, and it helps if the people there are pretty friendly.
Anyway, it can be warming for the soul to go to a place where, as the old Cheers theme song puts it, “everybody knows your name.”
I asked Eric if there was a cafe or something similar near him. He told me there was and I asked him whether he could, as part of his daily ‘ritual’, start going there for his morning coffee.
“I’m not sure. I don’t know anyone there,” he said reluctantly.
“Well you don’t have to talk to anyone,” I offered, “just have coffee and read the paper. Just being around people might make you feel better.”
So he started going in for coffee at 11 each day. By the third week of our therapy he told me, “it’s the one thing I now look forward to.”
Soon Eric began talking to another man there. They both liked to fish. One day he told me cheerily he’d have to change our appointment time. He was going river fishing with this new friend from the cafe. This had taken maybe 6 weeks of simply going to one place most days. And yet he was now ‘part of the furniture’ there. Everyone knew him and he had acquired a friend, or at least a fishing buddy.
The point is, he hadn’t tried to make a friend – but he had exposed himself to the possibility.
So talk to your clients about how we can all become ‘regulars’, and it doesn’t have to take long. Of course, it does need to be the right place – in other words, a place where people are open, friendly, and welcoming.
If we feel or are isolated for a long time, we may lose a little social confidence. But shyness tends to wear away as we exercise our social muscles. “Use it or lose it'” might be true, but that doesn’t mean we can’t also reuse it to regain it.
But part of the reason Eric had lost confidence was that he feared people would not want to know him.
Behavioural intervention three: Help them relax with rejection
Our fear response tends to build around what we intentionally avoid. It’s as though the limbic system in the brain, taking its cue from your behaviour, concludes, “Oh, this must be really threatening, or else why would we be avoiding it?!”
Just as what we avoid we come to fear, what we intentionally seek out we can eventually come to feel calm about. This is the basis of ‘exposure therapy‘. If you know how to use clinical hypnosis , then you can help people feel calm in a situation (in their mind) before they do it for real.
For example, I helped Eric relax and observe himself going into the cafe, smiling as he bought his coffee, and reading his paper. Pretty soon he could feel completely relaxed with the thought of doing this, and was more easily able to actually do it.
By measuring electrical signals in the brains, researchers have found that lonely people are more prone than non-lonely people to strongly fear even small signs of possible social rejection.14 And that sensitivity can make them more prone to avoiding other people, even as their loneliness continues to hurt them.
Through his years of social disconnection I felt that Eric had developed some of this hypersensitivity to perceived social rejection. He would say things like “People won’t like me!”, “I get the feeling people look at me in the street and think I must be odd!”, and “I’ll probably stick out like a sore thumb in that cafe if I go in.”
I explored with Eric through Socractic questioning what social rejection actually is.
We touched on the possibilities that maybe some people just don’t ‘click’, that some people are shy or unsociable themselves and might only seem to be rejecting others, that many people are much more focused on themselves rather than us, and so on.
Through this exploration of ideas we began to loosen up some of the all-or-nothing thinking that tends to blight any troublesome emotionality. We even discussed and rehearsed different ways Eric could respond, chiefly by caring less, even if he was ‘rejected’.
But then again, if you aren’t trying to do something, how can you fail at it?
Such is the beauty of the ‘regular’ strategy. I had linked Eric’s daily cuppa in the cafe to the goal of giving greater shape to his day rather than of trying to build social connections. The increased sense of community was a byproduct of some other focus – so there was less pressure around it.
So often in life we gather friends as a byproduct of work or leisure rather than a conscious effort to make friends.
Anyway, I hope you understand that I’m not suggesting you simply suggest your client go to a cafe. What I am suggesting is that you:
- Remember the research on the importance of ritual and help your client create a meaningful sense of ‘shape’ in their day-to-day life.
- Help your lonely client ‘put themselves out there’ by becoming a regular somewhere, which can happen pretty quickly.
- Help your client fear rejection less by helping them visualize calmly being in social situations and also by helping them focus on shared experiences with others rather than on making friends. In this way, connections form and strengthen naturally, without undue pressure to make friends or force connections.
“I’ve met a woman!” Eric told me, as if he’d just won the lottery.
“Blimey, you old devil!” I said. (By this time we were both ‘regulars’ with one another!)
Turns out she was a friend of a friend of his fishing friend. They had been on a couple of dates and seemed to hit it off. I congratulated him, but also encouraged him to continue to widen his social circle – after all, putting all one’s eggs in one basket is always a risky strategy.
Eric let me down gently, but actually made me feel great.
“You know, Mark, I used to really look forward to seeing you every week. You were my only point of contact. Now… well… no offence, but I don’t think I need to see you anymore.”
It was the best kind of ‘rejection’ I could have hoped for.
Improve Your Reframing Skills
Is there a more important skill in therapy than the ability to deliver a carefully crafted, well timed reframe? The right reframe can change a client’s emotional set in an instant and make a profound difference that echoes into the future. Take a look at Mark’s Conversational Reframing course here.
- Lobel, J., & Scharff Smith, P. (Eds.) (2019). Solitary Confinement: Effects, Practices, and Pathways Towards Reform. Oxford University Press.
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