Working with the Highly Sensitive Client 

A Brief Introduction for Psychotherapists 

By April Snow, MA

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Working with Highly Sensitive clients

Up to 50% of clients are Highly Sensitive!  Here’s what you need to know to better support them.

What is High Sensitivity?

According to research by Dr. Elaine Aron, High Sensitivity, otherwise known by its research term of Sensory Processing Sensitivity (SPS), is an innate trait dispersed equally among all gender identities. It is a variation found in 15-20% of the human population (and in some animals) that allows the nervous system and brain to process subtleties and details that most miss.

How do I know if my client is a Highly Sensitive Person (HSP)?

An initial indicator that your client is Highly Sensitive is that they are eager to do the work and very conscientious.  You may notice that they rarely miss a session, are mindful of your time and pay promptly.  Highly Sensitive clients may also take longer to feel comfortable with you, but once they do are deeply and outwardly appreciative.      

Although there is no definitive criteria to determine whether a client is Highly Sensitive, a good starting point is to look for the following core characteristics along with reviewing the adult self-test or child self-test developed by Dr. Elaine Aron.  Since Sensory Processing Sensitivity is an innate temperament variation, these core characteristics will be present from birth and apparent in some form across the lifespan.          

D - Depth of Processing

The Highly Sensitive brain has a more active insula, the part of the brain that helps enhance perception and increase self-awareness.  HSPs are also wired to pause and reflect before engaging.  Therefore, HSPs are always taking in a lot of information around them and thinking deeply about it.  This may result in slower decision making and more transition time between tasks.     

O - Overstimulation

Since HSPs notice more subtle details in their environments and are more emotionally impacted by social stimulation, it makes sense that they are more likely to get overstimulated and exhausted by high levels of input.  

E - Emotional Responsiveness/Empathy

Brain scans have shown that HSPs have more active mirror neurons which are responsible for feelings of empathy for others and more activity in areas that are involved with emotional responses.  HSPs feel both positive and negative emotions more intensely than non-HSPs.    

S - Sensitive to Subtleties/Sensory Stimuli

HSPs notice subtle details that others miss such as non-verbal cues and small changes in their environment.  They are also more impacted by strong sensory input such as bright lights, loud noises, strong smells or rough textures.     

Highly Sensitive Man

Common Misperceptions

  • High Sensitivity is the same as Introversion
    • Truth: Approximately 30% of HSPs are extroverts while some are also High Sensation Seekers (HSS) who need higher levels of novelty to feel satisfied.  
  • Only Women are HSPs
    • Truth: This trait exists equally among all gender identities.
  • Sensitivity is a Disorder
    • Truth:  Sensory Processing Sensitivity is a normal temperament variation.
  • HSPs are inherently anxious, shy and neurotic.
    • Truth: Due to vantage sensitivity, when HSPs are in the right environment and getting their needs met, they tend to thrive and exhibit many valuable traits such as enhanced perception, empathy, creativity and detail-orientation.  
  • High Sensitivity is a Result of Adverse Childhood Experiences
    • Truth: Although difficult childhood experiences such as misattunement, neglect or abuse do not cause a person to be highly sensitive, HSPs are more prone to depression or anxiety, shyness and neuroticism when these conditions exist due to their differential susceptibility.

Sensitive Strengths

When Highly Sensitive People are living a lifestyle suitable for their temperament which includes adequate downtime, meaningful connections and time to integrate experiences, they are able to access many of the gifts that their highly perceptive brains and heightened emotional capacity afford.        

  • HSPs are very detail-oriented and notice subtleties that others miss.  Noticing the little things allows HSPs to be able to anticipate the needs of others at work and in relationships.
  • Due to vantage sensitivity, HSPs respond more to positive interventions and will progress quickly in therapy.  
  • Even the little moments can bring HSPs great joy, as they feel everything deeply and are easily moved.   
  • Sensitive people are often deeply spiritual and feel connected to nature and animals.      
  • Having a tendency to be conscientious and honest leads to a commitment to doing things the right way.  
  • HSPs are very caring, empathetic and emotionally responsive towards the needs of others.   
  • Heightened perception, insight and intuition allow the Highly Sensitive Person to notice nonverbal cues and pick up subtle nuances.   
  • Being creative and introspective with a tendency to have vivid dreams creates a rich inner world for HSPs.   

Common Challenges

Many of the struggles of being Highly Sensitive are due to being overstimulated and emotionally exhausted.  These challenges are easily remedied with more downtime and access to regulation tools.  

  • Feeling easily overwhelmed or overstimulated can lead HSPs to have anxiety, stress, health issues, sleep deficits, trouble concentrating, discomfort being observed, social anxiety and so forth.  
  • Anxiety and depression are common. 
  • HSPs feel more emotional in response to both positive and negative events, as well as pick up on the emotions of others.    
  • Shyness or social anxiety, mostly due to the intensity of large gatherings, can be a problem.  HSPs typically enjoy one-on-one interactions and prefer meaningful connections.  
  • Setting boundaries and dealing with conflict is often uncomfortable.  Due to a high capacity for empathy, HSPs often feel guilt for saying "no" and are worried about hurting others.  
  • Since the HSP brain is wired to inhibit action, there is a struggle with transitions and difficulty making quick decisions.  There needs to be time to reflect before taking action.  Even positive transitions such as getting a promotion or starting a new relationship can be difficult to integrate.  
  • Boredom or disappointment in relationships can surface when connections are superficial or intimate partners are slower to reciprocate emotional attachment.      
  • Loneliness can also be a big struggle for Sensitive types.  A common experience is feeling misunderstood or different from family and peers which can lead to low self-esteem.   
  • Feeling behind or slower to hit milestones is often seen in Highly Sensitive People.  It is not uncommon for HSPs to go through several career changes or get married later in life.  
  • Feeling unfulfilled, overstimulated or burned out at work is a huge challenge for HSPs and can contribute to multiple career changes.  
  • Tendency to self-sacrifice and difficulty identifying needs leads to feelings of anger, resentment and frustration for the HSP.     
  • Sensory overload and exhaustion from too much screen time in addition to constant exposure to lights, visual input and sounds throughout the day is very stressful for HSPs.  

Helpful Interventions

Below are a few ideas of what could be helpful, but you can apply any modality or therapeutic orientation to your work with Highly Sensitive clients.  Most important is helping HSPs understand their trait, normalize the difficulties and create a supportive lifestyle so their Sensitive Strengths can shine through.  

  • Psychoeducation - build awareness of the trait, how to manage the difficulties and highlight the gifts.  
  • Lifestyle Assessment - help improve sleep hygiene, get more downtime, find more balance between workload or personal responsibilities and self-care.  HSPs need unstructured quiet time to process and integrate their daily experiences.  
  • Mindfulness Tools & Affect Regulation - help build awareness of body’s cues so the client can identify when they are beginning to feel overwhelmed.  This makes it easier to reduce input, decrease stimulation and manage intense emotions.  
  • Self-Acceptance & Self-Compassion - it is extremely important that HSPs learn to appreciate their Sensitive Strengths.  Help them see the advantages of being Highly Sensitive and transform their perception of Sensitivity as a weakness.  Self-compassion practices can help calm the inner critic and feelings of being different.  
  • Reframe Past Experiences - taking time to explore and reframe early life experiences through an HSP lens can be incredibly healing.  Clients can begin to realize their challenges are not synonymous with their true self.   
  • Setting Boundaries - help clients learn to set limits and say "no" while decreasing feelings of guilt. 
  • Relational Attachment - create a strong therapeutic alliance to help client feel a supportive connection and build self-esteem. 
  • Validation - normalize difficulties, areas of difference and help them feel understood.
  • Patience - HSP clients may move slower through the therapeutic process and will need more time to reflect before taking action and answering questions.  Be careful to distinguish rumination from detailed processing.      

Differential Diagnosis

The characteristics of Sensory Processing Sensitivity are often misinterpreted as a mental health disorder instead of being recognized as a temperament variation.  For instance, when the client is suffering from overstimulation it can easily look like anxiety or ADHD, but with adequate self-care these symptoms generally dissipate with ease.  Of course, a client can be Highly Sensitive and still meet the criteria for a diagnosis, but the characteristics of the trait are not synonymous with any disorder.  Therefore, HSPs may experience the effects of a mental health disorder differently than a non-HSP.  Below are a few common misdiagnoses to be aware of when working with Highly Sensitive clients.  

  • ADHD
  • Adjustment Disorders
  • Anxiety Disorders
  • Autism Spectrum  
  • Borderline Personality Disorder
  • Depression
  • OCD
  • Sensory Processing Disorder
  • PTSD

For a full list, see Appendix B of Dr. Elaine Aron’s Book, Psychotherapy and the Highly Sensitive Person.  

Highly Sensitive Person Support

How can I further support my Highly Sensitive clients?

  • Consider the physical space of your office.  Since HSPs are more aware of sensory input, it can be helpful to create a scent-free space, use dim lighting, have soft pillows, and reduce external noise.  Be sure to ask your client if they need anything adjusted at the beginning of the session.
  • Many HSPs are people pleasers and will be thoughtful of your needs, often at the expense of their own.  Be aware of how the client takes care of you or minimizes their needs/transference in an effort to be a good client.  Create a safe space to discuss conflict and look for subtle signs that the client may be in distress.  
  • Highly Sensitive People are highly intuitive and empathetic, meaning these clients are very likely to notice if you are not feeling well or there is something "off" in your demeanor and may express concern.  HSPs often get dismissed because others do not understand their perceptions, therefore it is important to honor your clients intuition if it is accurate.  Full self-disclosure is not necessary, just an acknowledgement of your client's accurate perception can be very validating.        
  • Give your clients time to process their reflections and space to transition between topics.  Since the HSP brain is wired to process details in depth, rushing your client may increase anxiety and overstimulation.      
  • Help clients advocate for themselves when interacting with other practitioners such as psychiatrists, medical doctors or dentists.  It is important for other providers to know about the trait and the differing needs of HSPs.           
  • Encourage your client to build relationships with other HSPs to normalize their experience and build like-minded community.   

What resources can I share with my Highly Sensitive clients?

Self-Tests

Books

Blogs

Groups/Courses

Video/Film

Where can I learn more about the trait and working with HSPs?  

 

Edited by Julie Bjelland, LMFT