What to Know About Working With Highly Sensitive People

Do you know what it means to be highly sensitive?

About one in five people are considered highly sensitive, and some estimates are that up to half of our therapy clients are HSPs (highly sensitive persons).

Yet, many helping professionals don’t have a solid understanding of what it means to be an HSP—let alone how it might impact client retention, therapeutic modalities, and diagnosis. 

Chances are, you have HSPs on your caseload, and learning more about this particular type of neurodiversity will benefit your clients and you. 

What does it mean to be highly sensitive?

The HSP trait is often called sensory processing sensitivity (SPS). It’s not a disorder, a diagnosis, or a deficit. It is, however, a type of neurodiversity well documented with brain scans, which simply means the brains of HSPs aren’t the same as the majority of the population. Several areas of the highly sensitive brain light up more in response to emotional and environmental stimuli. Interestingly, more than 100 species, including fish and dogs, also display this high sensitivity. One theory is that we (and other species) have evolved this way to provide certain strengths to the collective species- it takes all types, and HSPs have many gifts to share, especially when in nurturing environments. 

Understanding a highly sensitive brain

Dr. Elaine Aron, who has done significant work in this area, uses the acronym “DOES” to help explain the characteristics of a highly sensitive brain. Below, I’ll go through each letter in detail and explore ways each letter might impact your work with HSPs.

Depth of Processing

 

The “D” stands for depth of processing. HSPs will notice more detail and spend more time processing input of all kinds—the decor in your office, your tone of voice, and all kinds of things from daily life that aren’t even necessarily in conscious awareness. This can be a gift, but it also can be exhausting! 

Bringing intentionality to your environment can help HSP clients feel more rejuvenated after meeting with you. This goes for telehealth, as well. What’s in your background matters, and you can encourage your clients to bring their own sensory soothing items to telehealth sessions too. Beyond sensory sensitivity, HSPs will likely spend plenty of time thinking about your work with them, conversations they’ve had with others, and other big and small ideas. Knowing this is normal can help to validate an HSP client’s experience and avoid misdiagnosis or inadvertently shaming them. 

Overstimulation

“O” stands for overstimulation. Because HSPs are processing even the small details deeply (basically doing double time, all of the time, especially in highly stimulating environments and social situations where details abound), HSPs run the risk of becoming overstimulated. 

Helping HSPs tune into their inner wisdom and take steps to minimize feelings of depletion is key. This often means helping with boundary setting, as HSPs can easily become people pleasers, keen to detect how others feel. This can also mean encouraging HSP clients to advocate for their needs and to take steps to soothe their nervous systems regularly. 

Another important piece in our therapeutic work is validating the HSP experience because often, HSPs feel like something is wrong with them because they are “too sensitive.” It can be helpful to remind HSP clients that there’s nothing wrong with them or their brains—it’s just how they’re wired, and they can use certain tools to move through the world accordingly.

Emotional Intensity

“E” stands for emotional intensity. HSPs often know how other people feel before they do. They can feel others’ emotional experiences as if they are their own, sometimes calling themselves “empaths.” In group situations, they’re not just aware of each individual, but they’re also processing relationships between all of the people there—making groups and larger outings a lot of work! This is certainly a gift if paired with plenty of time to recharge and lots of normalizing from you as their therapist. Again, boundaries are important here to avoid burnout, resentment, and unsustainable relationships. 

Sensitivity for Subtleties

Lastly, the “S” stands for sensitivity to subtleties. Background noise, an uncomfortable chair, or an overpowering candle can all be extra distracting for HSP clients. On the other hand, I love working with HSPs to help them intentionally connect with sensory stimuli that feel calming to them—both in session and out. 

Many of my HSP clients have benefited from bringing comforting things from home on trips specifically to benefit from this sensory sensitivity. HSPs will probably know what some of their favorite sensory experiences are, but some might be out of conscious awareness and worth exploring with them. Be sure to brainstorm all five senses, and also ways to integrate these things into the daily routine to give their nervous systems subtle and regular opportunities to recharge. 

It’s also important to remember—though often overlooked—that these sensitivities can work to HSPs’ advantage as well. Though HSPs are certainly more sensitive to the challenging parts of life, they are also likely to benefit even more when given the right support and healing in therapy. This is known as “vantage sensitivity,” meaning that highly sensitive people are sensitive to anything and everything that’s nearby. 

HSPs often thrive in a therapeutic relationship, finding it helpful and soothing. They are sometimes long-term clients who are a joy to work with, seem to always do their homework, and utilize tools in meaningful ways. HSPs are deeply affected by the hard stuff and the helpful stuff as well. 

Where to learn more

If you find yourself wanting to learn more about HSPs and how to best support them in therapy, Dr. Aron’s website is a great place to start.

There you can find a long history of research and new studies, book recommendations (including for parents and partners in romantic relationships) and a list of therapists by state who are well-versed in what it means to be a HSP. She also has a self-assessment to help people determine whether they are highly sensitive. 

If you’re reading this and realizing perhaps you’re a highly sensitive therapist (HST), I also recommend Dr. Aron’s website. HSPs can make excellent therapists and it’s no surprise many of us turn to this field. However, it can also lead to even higher burnout rates. Many HSTs find they need lower caseloads, more breaks in between sessions, or the chance to be their own bosses. April Snow, LMFT has some great resources specifically for HSTs on her website that you can check out as well. 

Working with HSPs can be incredibly rewarding work, especially if you honor and embrace this important part of who they are. Many HSPs have been labeled as “too sensitive” and have wondered why they couldn’t just fit in better or have more energy for the way things are. 

Part of our job as therapists is to validate client experiences. Similar to how we as therapists should know when a client is exhibiting signs of depression or understanding what it means to be an introvert or extravert, we should be able to recognize when a client might be an HSP. This acknowledgment might just be revolutionary for them. Accompanying HSPs on their journey to not only learning about and accepting this trait but actually embracing it—and making lifestyle choices that honor it—can truly be life-changing and an honor to witness.

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