A Therapist’s Guide to Working With Highly Sensitive People

Published March 13, 2024 by Zencare Team

A client who spends their sessions talking about their concern for their friends or family members. A client who completed their out-of-session homework and can clearly describe their insights. A client who seems to notice everything happening internally for them and who sometimes checks to make sure that you’re doing alright. These clients, often called “highly sensitive people,” are often a joy to work with and make being a therapist feel easy and rewarding.

Highly sensitive people, also endearingly called HSPs, make up a high proportion of therapy clients, which makes sense if you think about the kind of people who are more likely to reach out for help from a mental health professional. Who are HSPs, what are their defining characteristics, and how can you best support them as their therapist? We’ve got the answers for you below.

What does it mean to be highly sensitive?

The term “highly sensitive person” was coined by clinical research psychologist Dr. Elaine Aron, who wrote a book called The Highly Sensitive Person in 1996. Since 1996, Dr. Aron has written several more books, manuals, and workbooks for both therapists and the general public on the topic, as well as academic research articles that further establish how high sensitivity impacts a person’s well-being.

In her first book, Dr. Aron outlined the common traits of HSPs, which include both sensory and emotional sensitivity. Using the acronym DOES, Dr. Aron discusses the various ways that high sensitivity shows up in people’s lives:

• Depth of Processing. According to Dr. Aron, HSPs have a heightened sense of self-awareness. This includes regularly noticing what’s happening internally for themselves as well as what’s happening in their immediate environment. They might note that they’re feeling anxious, happy, or tired throughout the day, that their neck muscles feel tight, or that they’re too hot or cold. HSPs are also self-aware in the sense that they regularly notice what’s happening around them, including who is nearby and what they’re doing. This constant scan is both a strength and a challenge, as it leads to a deeper understanding of themselves yet can be a debilitating source of stress or anxiety. People who are highly sensitive also tend to take longer when making decisions because of the amount of information they gather due to their self-awareness, though their decisions tend to be thoughtful and thorough. HSPs’ depth of processing leads them to many successes in their relationships and at work, but it can also become difficult when practiced around the clock and lead to exhaustion.
• Overstimulation. A downfall of being highly self-aware is frequently becoming overstimulated. Because HSPs’ brains naturally pick up on the small details of their internal and external worlds, they often find themselves overstimulated as they process high amounts of information. This can have negative emotional and relational impacts, as they might find themselves being short with others, avoiding certain situations like exercise classes or busy cafeterias, or fatigued at the thought of leaving home. Instead, they might prefer to be in their own space with minimal stimulation as they recharge.
• Emotional intensity. One of the most striking traits of HSPs is their deep sense of empathy. Empathy is the ability to take on other people’s emotional experiences, and it is an incredible trait and the foundation for connected, meaningful relationships. HSPs are highly empathy in a way that makes them amazing friends, family members, and partners. They are thoughtful and often go out of their way to make sure that those around them are comfortable. Yet when empathy is overdone, HSPs can find themselves challenged by their deep emotions as they readily take on the negative emotional toll of others. This emotional intensity can quickly translate into anxiety or depression, which can be detrimental to their overall well-being.
• Sensitivity for subtleties. Lastly, and similarly to their heightened self-awareness, HSPs have a strong sensitivity for the small details. They might notice things like bright lights or loud noises, which can interrupt their train of thought where others can block out those details or even fail to notice them. HSPs also read body language like it’s a large print book, noticing when people display discomfort. When they see someone shifting their weight, they might think that person is anxious. When they see someone with the trace of a frown on their forehead, they might assume they’re mad at them. These subtleties result in emotional or behavioral impacts for HSPs.

In general, being highly sensitive is a superpower as it leads to a deep, emotionally attuned life. However, high sensitivity can also be a hindrance for finding peace, balance, and connecting to others in healthy ways. Many HSPs begin to work with therapists when their sensitivity becomes more of a hindrance than a source of power.

How to support a highly sensitive client

To best support a client who is a highly sensitive person, it’s important to change your approach to be mindful of their specific way of thinking about their internal world and how they relate to their external world. Here are four tips for working with highly sensitive clients:

1. Give them space. HSPs are innately drawn to introspection and reflection. They often pause before speaking or acting, as they want to comprehensively think through their response as a way to ensure that they’re responding in the right way or the way most aligned with their needs. By giving them space in therapy sessions — which might look like longer pauses or greater transitions between topics — you’ll give them the time they need to really think through what you just said and how it applies to their lives.
2. Validate their feelings. People who are highly sensitive tend to notice that they’re different than others, which can be a cause for stress. They might see their friends breeze through social interactions while they’re stuck awake at night replaying each minute detail of what happened, wondering why they have to put so much emotional energy on processing their experience. They might also feel lonely, like they’re the only people who experience the world in this way. By validating their feelings, you’re communicating that it’s okay that they feel that way — and that being sensitive can be a huge personal strength. Validating their decisions is also important, as they can struggle with decision making in the face of high volumes of information.
3. Encourage them to set boundaries. Being sensitive can take a toll on overall well-being, especially if the information taken in is conflicting or surpasses that person’s comfort zone. To avoid overwhelm, encourage your clients to find ways to honor their limits. You may need to help them find those limits, but once they know what’s outside of their comfort zones or what leads to negative emotional reactions, you can support them to set strong boundaries at work, in their relationships, at home, and even with themselves. It’s important to remember that setting boundaries with others might be a challenge to their natural empathy, so validating this dissonance can be helpful. They might benefit from grounding or mindfulness practices too, which can help them regain a sense of calm when faced with the stress of enforcing boundaries. They might also benefit from extended downtime to give themselves time to process through their feelings, particularly after needing to enforce their boundaries.
4. Honor their sensory needs. Because HSPs receive endless sensory input — as well as pick up on emotional data through their self-awareness and deep empathy —  they may need therapy to be a safe haven empty of distractions. People with high sensitivity may prefer the therapy environment to be physically comfortable before they dive into the conversation, so you might consider how comfortable your furniture, lighting, and soundscape is for people who tend to notice the small details. It might even be helpful to talk about how to set up a comfortable environment so that your HSP clients can achieve comfort at home or at work.

Conclusion

When provided with the right environment, HSPs can thrive in therapy and share their empathy, creativity, and kindness with all people they come across. They tend to progress quickly in therapy, which can be rewarding for their therapist. Many therapists enjoy working with HSPs because they take their mental health journey seriously and have a huge capacity for internalizing what they learn in their therapy sessions, and adjusting your sessions to better support their sensitivity is a way to help them effectively reach their therapy goals.