The Psychology of People-Pleasing: Models, Research, and Clinical Formulation
Updated: Sep 4
Some people notice another person's needs and reactions so quickly that their own response registers later. They may agree to a request before recognising that they wanted to refuse, or begin settling tension before asking themselves whether it was theirs to manage. These experiences are often gathered under the familiar term *people-pleasing*, although psychology does not recognise a single diagnosis or agreed construct by that name.
The same outward response can carry very different meanings. Agreement might protect against rejection, settle shame or guilt, prevent conflict, reduce a realistic threat, conceal neurodivergent characteristics or preserve a valued role within a family, culture or workplace. Several of these processes can operate together, and the balance can change from one relationship or stage of life to another.
A fixed label therefore tells us relatively little. A psychological formulation examines what the person expects accommodation to prevent, what changes immediately after they agree, how the response has been learned and reinforced, and what consequences it now carries.
If you are trying to understand the automatic yes, the guilt that can follow a boundary and how the pattern feels within relationships, you may prefer to begin with People-Pleasing: Why You Keep Saying Yes When Part of You Means No. A closer examination of the research and psychological mechanisms can then show why those experiences do not necessarily arise from the same process or require the same therapeutic response.
What does research mean by people-pleasing?
Researchers do not study people-pleasing as one consistently defined and measured phenomenon. Instead, several areas of psychology examine experiences that can sit beneath the everyday label: silencing oneself, becoming overinvolved in other people's needs, anticipating rejection, avoiding conflict, or adapting in order to remain accepted. Each body of research answers a different question. Reading them together can deepen understanding, provided no single construct is mistaken for the whole person.
Self-silencing
A person can have a clear view internally and still learn to withhold it once a relationship matters. Anger, reluctance and need repeatedly give way because expressing them seems likely to disturb intimacy. Research describes this pattern as self-silencing.
Jack and Dill (1992) developed the Silencing the Self Scale through work on women's relational beliefs and depression. The construct includes evaluating oneself through another person's standards, linking care with self-sacrifice, and maintaining outward compliance when inner experience differs.
This differs from ordinary consideration because the person repeatedly suppresses experiences that could place the relationship under strain. Over time, they may have less opportunity to express needs, test disagreement or notice the effects of remaining compliant. The origins of the research also matter. Gendered expectations, relationship power and the social permission to express anger or need all shape who is likely to remain silent. Applying the construct across genders and cultures therefore requires close attention to the person's actual relational and social context.
Unmitigated communion: care that excludes the self
Care can be a source of closeness and an important personal value. Unmitigated communion describes a different pattern: sustained attention to other people's needs while one's own needs are repeatedly excluded.
Across several studies, Fritz and Helgeson (1998) linked this tendency with self-neglect, reliance on others for self-evaluation and psychological distress, while distinguishing it from a positive caring orientation. Later work has continued to explore whether concern for others can coexist with concern for the self (Aubé, 2008).
Later research adds useful complexity. Longitudinal findings suggest that costly overinvolvement and relationship satisfaction can sometimes reinforce one another rather than following a simple pattern in which self-sacrifice only damages connection (Horne, Impett and Johnson, 2020). This helps explain why accommodation may persist: it can support closeness or stability while also carrying a personal cost. A formulation therefore needs to hold both sides rather than assuming that every act of prioritising another person is unhealthy.
Sociotropy, attachment concerns and rejection sensitivity
For some people, approval and signs of relational stability have a strong influence on whether they feel secure. Sociotropy refers to this pronounced investment in approval, closeness and positive relationships (Robins et al., 1994). Related attachment research examines how expecting abandonment, reduced warmth or unreliable connection can increase self-monitoring and reassurance seeking. A delayed reply or change in tone may then carry implications that are not apparent from the event alone.
Rejection sensitivity describes a more specific process: anxiously expecting rejection, detecting it readily in ambiguous situations and responding strongly when it seems to occur. Experimental and relationship studies show that these expectations can shape how ambiguous behaviour is interpreted and affect both partners' experience of a relationship (Downey and Feldman, 1996). It can make accommodation more likely, although people also respond to rejection through withdrawal, anger or other strategies. Conversely, accommodation can be organised around responsibility, conflict or power without pronounced rejection sensitivity.
Avoidance, safety behaviours and immediate relief
Cognitive and behavioural research helps explain why a response can continue even when the longer-term cost is familiar. Agreeing, overexplaining, apologising, seeking reassurance or repairing tension quickly may reduce anxiety and uncertainty in the moment. These actions can function as safety behaviours when they are used to prevent a feared relational outcome.
Relief usually arrives before exhaustion, resentment or lost time becomes apparent. That timing reinforces the response without requiring a conscious decision to repeat it. Concepts from research on anxiety, social threat and reassurance seeking can help identify the feared outcome and the behaviour used to prevent it (Clark and Wells, 1995; Shaver, Schachner and Mikulincer, 2005). Their relevance still has to be established with the individual: people-pleasing is not a standalone disorder with one validated cognitive-behavioural model or treatment protocol.
Masking and social legibility
For some neurodivergent people, monitoring other people's responses is already part of navigating everyday social expectations. They may suppress visible characteristics, rehearse social behaviour or compensate for differences in communication. Research with autistic adults describes these strategies as **masking or camouflaging** (Hull et al., 2017). Repeated experiences of correction, stigma or exclusion can make this level of adjustment feel necessary.
Masking and people-pleasing can occur together while addressing different concerns. Masking specifically involves managing or concealing neurodivergent characteristics. People-pleasing includes a wider range of accommodation around approval, harmony, conflict or relational consequences. Camouflaging has been associated with distress, although newer longitudinal findings do not support a simple one-way account of cause and effect (van der Putten et al., 2025). Its function and cost need to be understood in the person's particular environment.
What the research can and cannot tell us
Together, these areas of research help distinguish experiences that can otherwise look the same. Care can continue while attention to one's own needs diminishes. Expectations of rejection can shape how an ambiguous interaction is read. Immediate relief can keep avoidance in place, and social environments can reward or require continued adaptation.
They do not establish one universal cause of people-pleasing. Much of the evidence is correlational, some constructs emerged from gender-specific or culturally bounded samples, and research on masking continues to develop. There is also no single evidence-based therapy protocol for people-pleasing as a diagnosis in its own right.
Formulation brings these findings back to the person's life. In which relationships does the pattern appear? What happens first in the body and emotions? Which identities, values and material circumstances affect the available choices? The understanding developed in therapy needs to be specific enough to guide the work and flexible enough to change when the person's experience points elsewhere.
A formulation map: what might be maintaining the pattern?
The map below sets out several processes that can keep accommodation in place. It is not a system for assigning people to types. Two people may both accept work they wanted to refuse, yet one is preoccupied with a manager's disappointment while the other faces realistic consequences in an insecure job. Another person may recognise their own exhaustion only after agreeing. Several processes can also operate together, so the map remains a set of questions rather than a conclusion.
Possible maintaining process | What accommodation may be doing | What would make us reconsider the hypothesis? |
Attachment or rejection threat | Preserving closeness, preventing withdrawal or restoring signs of warmth | The pattern remains equally strong where rejection is not feared, or is driven more by moral guilt, role obligation or practical consequence |
Conflict threat | Reducing the likelihood of anger, criticism, escalation or prolonged tension | The person can tolerate open conflict but struggles specifically with shame, disappointing others or losing a valued identity |
Shame and conditional self-worth | Protecting against feeling selfish, difficult, inadequate or unacceptable | Accommodation occurs without self-condemnation and is better explained by safety, masking, cultural meaning or material dependence |
Avoidance and immediate relief | Ending anxiety, guilt or uncertainty quickly, which reinforces the same response next time | The behaviour brings little immediate relief, or continues mainly because it is socially rewarded or genuinely required |
Trauma-linked appeasement | Reducing danger where compliance, emotional invisibility or monitoring previously helped prevent escalation | There is no relevant history or current sign of threat-linked arousal, and a less trauma-centred explanation fits the pattern more accurately |
Social reward and role identity | Maintaining recognition as reliable, caring, competent or undemanding | The role is not valued or rewarded, or the person accommodates even when doing so threatens rather than protects their standing |
Masking and social legibility | Reducing correction, stigma or misunderstanding by making social presentation easier for others to interpret | The accommodation is unrelated to neurodivergent characteristics and is organised more broadly around conflict, approval or family role |
Cultural, family or systemic conditions | Fulfilling meaningful responsibility, navigating hierarchy or responding to real differences in power | The person does not endorse the relevant value, or the same response persists after the social constraint has changed |
Reduced access to internal signals | Relying on other people's needs because personal preference, fatigue or reluctance is recognised only later | The person knows what they want clearly but feels unable to act because of a more specific anticipated consequence |
Any formulation remains provisional. Its value lies in whether it helps the person understand when the response appears, which relationships intensify it and what happens when they try something different. If later experience no longer fits the hypothesis, revising the understanding is part of the work.
When several processes interact
Maintaining processes often reinforce one another. Repeated social correction may increase masking and vigilance to rejection. A family role built around competence may be socially rewarded while also becoming part of self-worth. Earlier appeasement may reduce conflict, and the resulting relief may strengthen avoidance long after the original environment has changed.
The same process can also carry both meaning and cost. Accommodation may express loyalty while preventing a need from being voiced. Professional reliability may reflect genuine commitment while concealing exhaustion. A culturally responsive formulation does not force these experiences into a choice between healthy and unhealthy; it asks where there is flexibility, what consequences are real and whether the person can remain connected to their own position.
How does people-pleasing become automatic?
Many people describe agreeing before they experience themselves making a decision. This speed does not require a specialised people-pleasing system in the brain. Repeated attention to other people's reactions, rapid anticipation of consequences and the relief that follows agreement can make the response increasingly automatic and harder to notice in the moment.
Anticipatory appraisal comes before the visible conflict
The visible conflict may never occur. A pause, a change in tone or a request from a particular person can still activate an expectation of anger, withdrawal, shame, misunderstanding or the loss of a familiar role.
The person may not yet be able to put that expectation into words. Their attention has already moved towards the other person's expression and likely response, while their own reluctance has had less time to register. What looks spontaneous has been shaped by repeated learning about relational consequences.
Immediate relief reinforces the response
From a behavioural perspective, accommodation often works in the short term. Agreeing may end uncertainty, prevent a difficult conversation or reduce guilt and physiological arousal. When a behaviour removes an uncomfortable state, negative reinforcement makes that behaviour more likely to recur. `Negative` here means that something aversive has been removed, not that the behaviour is morally bad.
The timing matters. Relief arrives quickly, while resentment, exhaustion or lost time may not become apparent until hours or days later. The immediate consequence therefore has more opportunity to shape what happens next. A person can understand the longer-term cost and still repeat the response because agreement continues to provide relief in the moment.
Safety behaviours can strengthen the same cycle. Extensive explanations, pre-emptive apologies, reassurance seeking and rapid repair may reduce anxiety while limiting opportunities to discover whether a relationship could tolerate a shorter explanation, an unresolved difference or another person's temporary disappointment.
Physiological arousal is real, but its explanation should remain proportionate
Anticipated relational consequences can involve bodily changes: tension, increased heart rate, agitation, nausea, freezing or difficulty organising language. These responses are clinically relevant even when the precise neurophysiological pathway is unknown. They may reflect learned threat appraisal, anxiety, shame, sensory or cognitive overload, trauma-related activation or several processes together.
Polyvagal theory is often used in therapy writing to explain shifts between social engagement, mobilisation and shutdown. Some people find its language helpful for organising experience. However, important physiological and evolutionary claims within the theory remain scientifically contested (Grossman et al., 2026). It should not be presented as the established biological mechanism of people-pleasing.
The scientific debate does not alter a familiar clinical experience: a person can know that a boundary is reasonable and still experience marked arousal when expressing it. Therapy may need to address both what the person understands and what happens in their body, without making neurological claims that the evidence cannot support.
Earlier learning and present conditions both matter
Automatic accommodation may have developed through earlier relationships, but developmental history is not the only explanation. Current workplaces, families or social environments may still reward availability, punish disagreement or require careful self-presentation. Neurodivergent and bicultural people may also have extensive experience of learning, through repeated feedback, which versions of themselves are more readily understood or accepted.
A formulation therefore asks two questions together: What did this response learn from the past? and What is the present environment still teaching or requiring? Focusing only on childhood can overlook current power and social consequence. Focusing only on the present can miss why a response is activated so quickly and feels difficult to revise.
Automaticity does not mean the pattern is permanent. It means that change requires more than a correct explanation. New choices become possible when the prediction is noticed earlier, the immediate function of accommodation is understood, and different responses can be tested with enough attention to context, consequence and emotional capacity.
Why people-pleasing can remain hidden beneath competence
People-pleasing does not always look insecure or dependent. It can be difficult to see because it operates through qualities that other people value: reliability, emotional awareness, conscientiousness and the ability to anticipate what a situation needs.
The person may be the family mediator, the dependable eldest child, the colleague who absorbs last-minute work or the professional who stays calm while everyone else is under pressure. These capacities can be entirely genuine. What needs attention is how much choice remains when they are used. If the person steps back, do they expect to lose approval, safety or a valued sense of who they are?
When social reward strengthens the pattern
An accommodating person often receives positive feedback. Work is completed, conflict is reduced and other people feel supported. Because the immediate outcome is useful, the effort required to produce it can remain invisible. Refusing or reducing that contribution may then threaten more than approval; it may unsettle a role on which a family, team or relationship has come to rely.
The concept of emotional labour is sometimes used here, but it needs precision. Hochschild (1983) originally developed the term to describe the management of feeling and emotional display as part of paid work. The term is now used more broadly in public discussion, including for unseen relational work. In the present context, it is most accurate when referring to the effort involved in monitoring atmosphere, containing visible reactions and presenting the emotional state a role requires, particularly within professional settings.
Research on unmitigated communion offers a related but distinct account. It identifies an orientation towards others that excludes the self and links this pattern with self-neglect and psychological distress (Aubé, 2008). Self-silencing research similarly examines the cost of suppressing one's own position to preserve a relationship. Neither body of research proves that every reliable or emotionally attentive person is distressed. They help locate the point at which care, role performance and external evaluation begin to leave insufficient room for the person providing them.
High functioning does not reveal the internal cost
External performance is a poor measure of how sustainable a pattern feels internally. Someone may continue meeting deadlines, caring for relatives and maintaining relationships while becoming increasingly irritable, depleted or dependent on time alone to recover. There may be no visible crisis that appears to justify doing less.
In my clinical work, this is one reason role-organised people-pleasing can be missed. The person often arrives with substantial evidence of capability. What becomes visible later is the amount of monitoring, anticipation and emotional containment required to preserve that presentation. This is a practice-based observation, not a diagnostic rule: competence should prompt curiosity about cost, not an assumption that distress is hidden underneath it.
The distinction matters for high achievers. Being able to carry a responsibility does not establish that it is freely chosen or sustainable. At the same time, overwork should not automatically be formulated as people-pleasing. It may be driven by financial pressure, ambition, organisational demands, perfectionism, executive-function difficulties or other factors. People-pleasing becomes a stronger hypothesis when performance is closely tied to preventing disappointment, maintaining relational stability or protecting a valued identity as the person who does not need help.
The cost may first appear as reduced access to the self
When attention repeatedly moves towards other people's needs and reactions, the person's own response can arrive later. They may know what everyone else requires yet struggle to identify a preference while someone is waiting for an answer. Fatigue, reluctance or anger becomes clear only after the commitment has been made.
This does not mean that a coherent self has disappeared. External cues are simply being registered faster than personal needs and limits, which may require more time or distance to become clear. Resentment can sometimes indicate that giving has continued beyond willingness. It can also arise from unfairness, conflict or unmet expectations, so its meaning still depends on the wider relationship.
The research supports an association between self-excluding relational orientations and distress; it does not justify a simple causal claim that people-pleasing produces burnout. Burnout has occupational and systemic determinants that extend well beyond relational accommodation. The overlap is most relevant when guilt prevents rest, reliability prevents delegation, or fear of disappointing others keeps a person engaged beyond their available capacity. When Coping Becomes a Way of Living examines chronic adaptation more broadly.
Why boundaries can activate guilt, shame or anticipated threat
Some people know exactly how a boundary could be worded and can readily suggest one for someone else. Their difficulty begins after it is spoken: guilt, shame, another person's disappointment or the possibility that the relationship may change. Assertiveness skills can help when the language is unfamiliar. They are less likely to be sufficient when the anticipated emotional or practical consequences are the central problem.
Several experiences can feel similar at the moment a boundary is set. The person may have genuinely neglected a responsibility. They may be experiencing learned guilt because they have departed from a familiar role. Shame may tell them that having limits makes them selfish or difficult. In other circumstances, they may be accurately anticipating retaliation, withdrawal or loss of support. Therapy needs to distinguish among these possibilities because each one calls for a different response.
Guilt is information, not a verdict
Guilt can reflect a genuine conflict with personal values. It can also be activated because a limit departs from an established expectation, even when the limit itself is reasonable. If availability has long been equated with love or responsibility, another person's inconvenience may feel like evidence of wrongdoing.
Guilt deserves attention, but it cannot decide the issue on its own. What responsibility has actually been breached? Whose standard is being applied? Is repair required, or has the person acted outside a familiar role? These questions take the feeling seriously without treating it as proof that the boundary was wrong.
Shame changes what the boundary seems to say about the self
Where guilt concerns an action, shame concerns what the action appears to reveal about the person. A refused request may be interpreted internally as evidence of being selfish, ungrateful or difficult. Self-silencing research is relevant because it shows how preserving intimacy can become organised around suppressing thoughts, needs and anger that seem dangerous to the relationship.
When shame is prominent, technical knowledge about assertive communication may have limited impact by itself. This is not evidence that behavioural practice should always wait. It suggests that any experiment with a different response needs to attend to the self-judgement it activates and to whether the person experiences enough collaboration and choice to learn from the outcome.
Anticipated rejection and rapid repair
Rejection-sensitivity research shows that anxious expectations can influence how ambiguous interpersonal cues are perceived. A delayed reply or altered tone after a boundary may therefore acquire significance quickly, particularly when the person is already monitoring for signs of withdrawal. Excessive reassurance seeking has also been associated with attachment anxiety and relationship processes, although its effects vary across people and relational contexts.
Overexplaining, apologising or withdrawing a limit may reduce uncertainty in the short term. In cognitive-behavioural terms, these responses can operate as safety behaviours because they make it harder to discover what would happen without immediate repair. That does not mean the feared consequence is always inaccurate. Some relationships punish disagreement, and some workplaces or family systems impose real costs when a person becomes less available.
Context determines what a boundary can safely do
A boundary is not a context-free statement of psychological health. Its meaning and consequences depend on power, dependence, culture, material circumstances and the relationship involved. Direct refusal may be relatively safe with a friend and carry substantial risk with an employer, caregiver, financially controlling partner or family member who holds authority.
This is where formulation needs reflexivity. A psychologist's preference for independence or direct communication should not become the standard against which every relationship is judged. Equally, cultural respect should not be used to romanticise fear, coercion or chronic self-erasure. The task is to understand what the person values, what consequences are real and where additional choice might be possible without pretending that all choices carry equal risk.
Boundary work is therefore broader than finding the correct wording. It may involve clarifying responsibility, recognising shame, testing predictions, tolerating uncertainty, addressing real power and noticing the urge to repair before deciding whether repair is needed. Which part matters most depends on the formulation, and the formulation should change if the person's experience points elsewhere.
How different therapies understand people-pleasing
There is no designated therapy for people-pleasing as a standalone condition. Different approaches attend to different parts of the experience. One person may need to examine a feared consequence; another may need to understand shame and self-criticism; someone else may first need a relationship in which disagreement does not threaten connection. Similar behaviour can therefore lead to very different starting points in therapy.
Integrative practice begins with the person's experience and asks which account currently fits best. The initial emphasis may be relational, behavioural, cognitive, compassion-focused, trauma-informed, neurodivergent-affirming or systemic. It can change as therapy reveals more about what the accommodation means and what keeps it in place.
Relational safety, congruence and the therapy relationship
Person-centred and humanistic approaches draw attention to the conditions under which a person can recognise and express an internal position without having to secure acceptance first. Rogers' concepts of empathy, congruence and unconditional positive regard are relevant when accommodation has become organised around being agreeable, low-need or emotionally convenient.
In this frame, change does not begin only with a more assertive sentence. It may begin when anger, reluctance, difference or uncertainty can be experienced in a relationship without being immediately corrected or withdrawn. Congruence refers to greater alignment between internal experience and outward expression, rather than saying everything directly in every context (Rogers, 1961).
The pattern can also become visible within therapy. A client may agree with an interpretation that does not fit, minimise a difficult week, apologise for taking time or present progress to avoid disappointing the therapist. Cooperation alone does not show that the work is well matched.
In my work, I pay particular attention when a client becomes very skilled at giving the answer therapy seems to reward. I try to make enough room for the client to notice what they actually think and to discover whether difference can be received without the relationship becoming unsafe. This calls for curiosity rather than an attempt to expose compliance or force disagreement. It also requires the therapist to remain open to the possibility that the formulation, pacing or intervention is wrong.
Predictions, avoidance and behavioural learning
Cognitive behavioural therapy (CBT) can clarify the beliefs, predictions and safety behaviours involved in accommodation. Therapist and client might trace what happened before the response, what consequence was expected, how the body reacted, what the person did, what changed immediately and what followed later. They can then examine how accurately the prediction fits the present situation and what may be preventing new learning, without dismissing the person's concern as irrational.
Behavioural experiments may test a specific prediction: for example, what happens if an explanation is shorter, a reply is delayed or a minor difference is left unrepaired for a limited period. The experiment needs to be collaborative, proportionate and safe enough to generate information. If the feared consequence is realistic, the work may focus instead on planning, support or changing the environment. An experiment is not a test of whether the client is brave or compliant.
Acceptance and commitment therapy (ACT) offers a related but different emphasis. It examines whether behaviour is moving towards an endorsed value or mainly away from guilt, anxiety and anticipated disapproval. Through defusion, a thought such as `I am selfish` can be recognised as something the mind is producing, with less power to determine behaviour. Values work can also protect against an overly individualistic goal. A person may want to care with greater choice while continuing to value connection and responsibility (Hayes, Strosahl and Wilson, 2012).
Dialectical behaviour therapy (DBT) contributes structured interpersonal and distress-tolerance skills (Linehan, 2015). Interpersonal effectiveness can support clearer requests and limits; distress tolerance addresses what happens afterwards, when guilt or another person's disappointment creates pressure to reverse the boundary. These skills may form useful parts of a formulation. People-pleasing is not itself a DBT diagnosis, however, and a skills protocol alone cannot explain or resolve the relational meaning of the pattern.
Shame, self-criticism and relational templates
Compassion focused therapy (CFT) is particularly relevant when self-assertion activates shame or harsh self-attack. Its threat, drive and soothing-system framework can help organise how a person responds to anticipated rejection, achievement pressure and the difficulty of receiving care (Gilbert, 2014). Compassion is not reassurance that every choice is correct. It is a way of relating to distress and imperfection without escalating threat through further condemnation.
Schema therapy offers language for longer-standing relational patterns. Self-sacrifice, subjugation, approval-seeking and emotional inhibition may all resemble aspects of people-pleasing. Mode language can also describe shifts between compliance, vulnerability, detachment and a more reflective adult position (Young, Klosko and Weishaar, 2003).
Schema concepts can give therapist and client a useful language, but they remain hypotheses. A label cannot explain on its own why the pattern developed, whether it appears in every relationship or how culture and current power affect its meaning. Imagery or chair work may help some people reach emotions and needs that have been difficult to express. Their use depends on the person's needs and the understanding developed together; there is no standard sequence that suits everyone.
Trauma-linked appeasement and embodied arousal
A trauma-informed perspective becomes particularly relevant when appeasement developed in environments where disagreement, visibility or another person's dysregulation carried genuine danger. Compliance, emotional concealment and careful monitoring may then have reduced the likelihood of escalation. The central clinical stance is to recognise protection before asking the person to relinquish it.
The term fawn response is widely used in trauma-informed communities for appeasement under threat. Walker (2013) helped popularise it as an additional response alongside fight, flight and freeze. It can be useful descriptive language, but it is not a formal diagnosis or an equivalently established psychophysiological category. Using the term should open enquiry into what appeasement accomplished, not close formulation around a presumed trauma history.
Trauma-focused and body-oriented work may attend to arousal, shutdown, dissociation, sensory experience and the difficulty of finding words under relational stress. This does not make body-based work categorically more effective than cognitive or relational approaches. The relevant question is which way of working helps this person approach the experience safely enough to understand what keeps the pattern in place.
Pacing therefore requires clinical judgement. Safety does not have to become a completed stage before any behavioural change can begin. A small, collaboratively chosen action may itself increase agency and safety; at other times, challenge may reproduce pressure or overwhelm. The person's response helps both people judge whether the current emphasis is useful and whether the formulation needs revision.
Masking, culture, power and systemic reinforcement
From a neurodivergent-affirming perspective, apparent accommodation may include substantial effort to make communication, expression or regulation more acceptable to others. Therapy should not aim to improve a performance of normality. It may instead reduce unnecessary compensatory demands, recognise sensory and communication needs, examine internalised stigma and identify where masking remains protective or chosen (Pearson and Rose, 2021).
Research on autistic camouflaging provides important evidence about motivations and reported costs, but it should not be extended automatically to every neurodivergent person or every act of social adaptation. ADHD-related accommodation may involve overlapping but different processes, and the evidence base is less developed. What Masking Really Costs: Neurodivergent Masking and Exhaustion in Adults examines this area in greater depth.
Culturally responsive and systems-informed therapy examines what individualised accounts can miss. Harmony, duty, interdependence and restraint may express values the person endorses, within culturally shaped understandings of self and relationship (Markus and Kitayama, 1991). At the same time, migration, racism, gendered expectations, minority stress, workplace hierarchy or material dependence may make some accommodation necessary for belonging or safety.
The psychologist's assumptions are part of the formulation process. Direct communication cannot be treated as the universal endpoint of health, and cultural responsibility cannot be used to explain away coercion or exhaustion. In bicultural work, I try to hold both risks: pathologising relational competence and romanticising self-erasure. The distinction is rarely settled by theory alone; it is developed with the person and remains open to change.
What integration adds
No single approach needs to explain the whole pattern. A person may need a relationship in which disagreement is genuinely possible, a behavioural test of a feared prediction, language for shame, attention to embodied arousal and a serious understanding of cultural or material constraint. Integration becomes clinically meaningful when a shared formulation guides how these elements are brought together, instead of relying on whichever model feels most familiar to the therapist.
The absence of a people-pleasing-specific treatment protocol makes transparency especially important. The therapist should be able to explain what process an intervention is intended to address, what response would suggest it is helping and what would lead them to reconsider. The person's experience remains the test of the model; the person should never have to fit the model for it to appear convincing.
Formulation in practice: how hypotheses interact and change
A formulation is a working explanation, not a more elaborate way of naming the person. It draws together what tends to trigger the accommodation, what the person predicts, what happens emotionally and physically, how they respond, what immediate function that response serves and what consequences follow later. It also asks where the pattern is absent. Exceptions can reveal capacities, relationships or conditions that a problem-focused account would miss.
The psychologist and client develop the map together. A psychologist may initially wonder whether a pattern is organised mainly around rejection sensitivity, for example, while the client experiences moral responsibility or the realistic consequences of hierarchy as far more important. Such a difference tells us that the formulation is incomplete; it should not be interpreted as resistance.
Similar behaviour, different formulations
Consider two people who both accept extra work after wanting to decline. For one, a manager's brief reply activates a prediction of disapproval. Agreeing reduces anxiety and protects a valued identity as dependable. For the other, the request sits within insecure employment and a workplace where refusal has previously affected opportunities. Their behaviour looks the same, but the first formulation may emphasise threat appraisal and safety behaviour, while the second must address actual power and material risk.
The distinction changes the work. Testing a prediction may be useful in the first situation. Treating the second person's caution as a distorted belief could invalidate an accurate reading of their environment. Even this comparison remains provisional: the first person may also face real organisational pressure, and the second may carry shame or earlier relational learning. Formulation prevents one visible behaviour from being assigned one automatic meaning.
The dominant process may shift
Therapy can bring previously hidden processes into view. What first appears to be a skills difficulty may reveal intense shame once the person tries a limit. What looks like fear of rejection may lessen in secure relationships but remain powerful around family duty. Reduced masking demands may make personal preferences easier to recognise, changing what needs to be addressed next.
The initial understanding may need to change when therapy reaches a plateau, an intervention adds distress without helping the person learn, or new history and context become important. The pattern may also appear within therapy in ways the existing account cannot explain. Even improvement can reveal something new, including grief about years of self-neglect or conflict with people who relied on the person's previous availability.
The therapist's response also needs examination. If a client repeatedly agrees, the psychologist should consider whether the pace, language, authority or cultural assumptions within therapy are making disagreement difficult. Formulation in Therapy: How a Psychologist Understands You Beyond a Diagnosis explains this collaborative method more fully.
What change may involve
Progress is difficult to measure by counting how often a person says no. What matters more is whether they can recognise what is happening earlier, register their own response alongside the realities of the situation, and choose in a way that reflects both care and available capacity. Refusal does not need to become another performance standard.
This may involve noticing anticipatory tension before committing, distinguishing responsibility from learned guilt, allowing another person's disappointment to exist without immediate repair, or giving an internal preference enough time to become clear. In an unsafe or exploitative environment, meaningful change may need to involve the environment itself. Greater tolerance is not always the answer.
Progress is unlikely to be even across relationships. Someone may set limits at work while remaining highly accommodating with family, or become more direct with trusted people while choosing caution where prejudice, dependence or authority make visibility costly. The return of an old response under stress does not by itself show that therapy has failed. The relevant questions are whether the response is more visible, whether alternatives are available and whether recovery requires less self-attack.
Warmth, loyalty and relational sensitivity can remain. The aim is to make connection less dependent on chronic self-exclusion. People-Pleasing: Why You Keep Saying Yes When Part of You Means No explores how this process can feel in everyday life and relationships.
Frequently Asked Questions
Is people-pleasing always a trauma response?
No. It may be shaped by attachment learning, family roles, shame, social reinforcement, masking, cultural expectations, current power or several of these together. A trauma-informed formulation is particularly relevant when appeasement developed amid danger, unpredictability or coercion, or when relational stress produces intense arousal, shutdown or dissociation. Trauma-informed practice means attending to protection, pacing and choice; it does not require assigning a trauma explanation to every accommodating behaviour.
What is the difference between people-pleasing and cultural interdependence?
Interdependence, harmony and family responsibility can be deeply meaningful values. How often someone prioritises others tells us very little on its own. Formulation asks whether the action is endorsed, flexible and reciprocated; whether refusal is genuinely available; what social and material consequences apply; and whether the pattern permits a continuing sense of self. For bicultural people, cultural meaning and psychological experience may both be present, creating a layered answer.
How does neurodivergent masking relate to people-pleasing?
They can overlap but are not synonymous. Masking concerns managing or concealing neurodivergent characteristics in response to social expectations. People-pleasing is the broader accommodation of needs, disagreement or behaviour around approval, conflict and relational safety. One may reinforce the other, but therapy needs to ask what is being concealed, what consequence is anticipated and whether adaptation is chosen, necessary or costly. What Masking Really Costs: Neurodivergent Masking and Exhaustion in Adults develops this distinction in depth.
Can therapy inadvertently reinforce people-pleasing?
Yes. A client may agree with an interpretation that does not fit, avoid reporting disappointment, present the progress they think is expected or become highly skilled at being an undemanding client. Therapy reinforces the pattern if cooperation is rewarded without curiosity about what remains unsaid. The psychologist needs to invite correction, notice relational pressure and respond constructively when the client disagrees. Permission to disagree matters, but the therapist's actual response determines whether that permission becomes credible.
What does formulation-led therapy look like in practice?
Therapist and client begin by developing a shared, provisional understanding of what happens and what may be keeping it in place. They choose a way of working that addresses those processes and observe what follows. If the result does not fit the hypothesis, the formulation changes. Relational, cognitive, behavioural, compassion-focused, trauma-informed, neurodivergent-affirming and cultural perspectives can contribute according to the person's needs; no fixed sequence is imposed.
Further Reading
People-Pleasing: Why You Keep Saying Yes When Part of You Means No, the narrative and personal companion to this article
What Masking Really Costs
Late ADHD or Autism Diagnosis as an Adult: What the Relief and the Grief Both Mean
Bicultural Work Stress: When You Feel You Must Prove Yourself Twice
Formulation in Therapy: How a Psychologist Understands You Beyond a Diagnosis
The High Achiever’s Body: What Chronic Stress Does When You Keep Performing
Working With Me
I work with adults whose competence may conceal relational over-responsibility, chronic accommodation, burnout, masking or difficulty knowing what they need while another person is present. My approach is integrative and formulation-led. Trauma-informed, neurodivergent-affirming and culturally responsive perspectives shape the work from the beginning.
Therapy begins by understanding what the pattern has been doing in your particular history and present context. The intention is to create more room for choice without turning change into another standard you have to meet. I work in English, Cantonese and Mandarin.
If what you have read feels personally familiar, People-Pleasing: Why You Keep Saying Yes When Part of You Means No may help you consider the pattern more closely in relation to your own experience. If you are considering psychological therapy, you can also book a free 15-minute enquiry call to discuss what you are looking for and whether working together may be a good fit.
For practitioners and supervisees, this topic can also be explored through clinical supervision, including how accommodation may be overlooked or inadvertently reinforced within therapy and supervision relationships. You can learn more about my clinical supervision and professional psychological services.
About the Author
Dr Tiffany Leung is a UK-based Chartered Counselling Psychologist and EuroPsy Registered Psychologist. She has over 14 years of experience across psychological therapy, clinical supervision, consultation, NHS services and independent practice. Her specialist interests include high-functioning burnout, relational adaptation, migration and bicultural experience, neurodivergence, emotional over-responsibility and workplace stress.
References of The Psychology of People-Pleasing
Aubé, J. (2008). Balancing concern for other with concern for self: Links between unmitigated communion, communion, and psychological well-being. Journal of Personality, 76(1), 101–134. https://doi.org/10.1111/j.1467-6494.2007.00481.x
Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia. In R. G. Heimberg, M. R. Liebowitz, D. A. Hope, & F. R. Schneier (Eds.), Social phobia: Diagnosis, assessment, and treatment (pp. 69–93). Guilford Press.
Downey, G., & Feldman, S. I. (1996). Implications of rejection sensitivity for intimate relationships. Journal of Personality and Social Psychology, 70(6), 1327–1343. https://doi.org/10.1037/0022-3514.70.6.1327
Fritz, H. L., & Helgeson, V. S. (1998). Distinctions of unmitigated communion from communion: Self-neglect and overinvolvement with others. Journal of Personality and Social Psychology, 75(1), 121–140. https://doi.org/10.1037/0022-3514.75.1.121
Gilbert, P. (2014). The origins and nature of compassion focused therapy. British Journal of Clinical Psychology, 53(1), 6–41. https://doi.org/10.1111/bjc.12043
Grossman, P., Ackland, G. L., Allen, A. M., Berntson, G. G., Booth, L. C., Burghardt, G. M., et al. (2026). Why the polyvagal theory is untenable: An international expert evaluation of the polyvagal theory. Clinical Neuropsychiatry, 23(1), 100–112. https://doi.org/10.36131/cnfioritieditore20260110
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.
Hochschild, A. R. (1983). The managed heart: Commercialization of human feeling. University of California Press.
Horne, R. M., Impett, E. A., & Johnson, M. D. (2020). Exclude me, enjoy us? Unmitigated communion and relationship satisfaction across the transition to parenthood. Journal of Family Psychology, 34(5), 527–538. https://doi.org/10.1037/fam0000620
Hull, L., Petrides, K. V., Allison, C., Smith, P., Baron-Cohen, S., Lai, M.-C., & Mandy, W. (2017). “Putting on my best normal”: Social camouflaging in adults with autism spectrum conditions. Journal of Autism and Developmental Disorders, 47(8), 2519–2534. https://doi.org/10.1007/s10803-017-3166-5
Jack, D. C., & Dill, D. (1992). The Silencing the Self Scale: Schemas of intimacy associated with depression in women. Psychology of Women Quarterly, 16(1), 97–106. https://doi.org/10.1111/j.1471-6402.1992.tb00242.x
Linehan, M. M. (2015). DBT skills training manual (2nd ed.). Guilford Press.
Markus, H. R., & Kitayama, S. (1991). Culture and the self: Implications for cognition, emotion, and motivation. Psychological Review, 98(2), 224–253. https://doi.org/10.1037/0033-295X.98.2.224
Pearson, A., & Rose, K. (2021). A conceptual analysis of autistic masking: Understanding the narrative of stigma and the illusion of choice. Autism in Adulthood, 3(1), 52–60. https://doi.org/10.1089/aut.2020.0043
Rogers, C. R. (1961). On becoming a person. Houghton Mifflin.
Robins, C. J., Ladd, J., Welkowitz, J., Blaney, P. H., Diaz, R., & Kutcher, G. (1994). The Personal Style Inventory: Preliminary validation studies of new measures of sociotropy and autonomy. Journal of Psychopathology and Behavioral Assessment, 16(4), 277–300. https://doi.org/10.1007/BF02239408
Shaver, P. R., Schachner, D. A., & Mikulincer, M. (2005). Attachment style, excessive reassurance seeking, relationship processes, and depression. Personality and Social Psychology Bulletin, 31(3), 343–359. https://doi.org/10.1177/0146167204271709
van der Putten, W. J., Mol, A. J. J., Radhoe, T. A., Torenvliet, C., Agelink van Rentergem, J. A., Groenman, A. P., & Geurts, H. M. (2025). Camouflaging in autism: A cause or a consequence of mental health difficulties? Autism, 29(10), 2604–2617. https://doi.org/10.1177/13623613251347104
Walker, P. (2013). Complex PTSD: From surviving to thriving. Azure Coyote.
Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy: A practitioner's guide. Guilford Press.
Comments