Working with the Highly Sensitive Client

Your client fidgets as she tries to explain what’s bothering her, and why she has come to see you. “It’s not that I don’t like my job,” she says hesitantly. “Facilitating groups is fun, but I’m doing it so many days a week, I just feel overwhelmed!” And it’s not just her work. “In my relationship,” she continues, “I’m distressed, because during the upcoming holiday season, we are supposed to go to three different parties on a single day, totalling 13 hours!” She admits that her fiancé is more extraverted than she is. “But that’s not it,” she insists. “I like people. It’s just that the thought of a whole day of noise and small talk – help! But when I suggest that I take my own car so I can go home early, I get accused of being a fussy party pooper! What do I do?”

Further enquiry into what troubles this client may very well turn up that she is not at all neurotic, shy, or even highly introverted, as she may sound. But what she describes above has all the hallmarks of someone who is highly sensitive, or technically speaking, has “sensory-processing sensitivity” (Aron, 2018). In this article we look at what that is, the traits that characterise it, and some tips to help you work with clients who are highly sensitive.

Elaine Aron and the Highly Sensitive Person

It all started when psychologist Elaine Aron just happened to have her psychotherapist tell her that she was a “highly sensitive person”; the phrase resonated with Aron. A few years later, her book, “The Highly Sensitive Person” was published (Aron, 1997). It began a flurry of excited recognition from mental health practitioners and lay people alike; they just knew (and much research has since validated) that this concept had validity for how they, a client, or someone close to them, had always been. Now, gloriously, there was a name for it! Moreover, the studies – especially ones completed since the advent of fMRI – have shown that high sensitivity is not pathological; it is a normal adaptive trait that an estimated 15-20% of the population (meaning, about 50 million people in the United States, and over 4 million in Australia) were born with (Aron, 2018). So, in what does it consist?

The characteristic aspects of HSPs

Aron (2014) describes four defining characteristics of highly sensitive persons, along with the observation that those who have high sensitivity did not acquire it. It is innate, like handedness or the colour of one’s eyes, in over 100 species: from fruit flies, birds, and fish to dogs, horses, and primates. Further, research has shown that high sensitivity cannot be equated with either neuroticism or shyness, although – as in the non-HSP population – there are individuals who are either neurotic (as in anxious or depressed) or shy, or both (Aron, 2018).

Depth of processing

HSPs process their experiences more deeply than non-HSPs. Quietly and thoroughly reflecting, they ponder the meaning of life, taking time to make decisions; this earns them the criticism of being unable to do so. In fact, the weighing-up of options is not so much ruminating (a neurotic trait) as a survival strategy. HSPs are said to be better than others at seeing both dangers and opportunities that others miss, and they can thus seem overly anxious. While some HSPs, particularly those with difficult childhoods, do focus more on negative experiences, the average HSP, contends Aron, tends to focus more on positive experiences than do non-HSPs (2014).

Easily overstimulated

The sense of overwhelm that many HSPs feel when either they have too much to do at once, or life seems to come rushing at them in a noisy, stimulating manner, can also seem neurotic, but what researchers and HSPs themselves have discovered is that HSPs need less stimulation to reach their optimal level and perform poorly when they are over-aroused (such as when someone is watching them perform). So having to speak to a stranger at a noisy party can trigger their silence, making them seem shy, when in fact they are just overwhelmed by all the noise, chatter, sights, and possible smells. Judgment by non-HSPs at this stage that the HSP has “failed” will be taken on board and create even greater anxiety or overwhelm in similar situations in the future (Aron, 2014).

Emotional reactivity and empathy

Non-HSPs react less intensively to situations than those with high sensitivity. Aron explains that emotional reactivity is connected to the trait of “depth of processing” in that the strong reaction to things motivates people to process them more deeply. HSPs have a rich inner life, and tend to think more about experiences (both pleasant and unpleasant) than others do. So, for example, an HSP who is heavily criticised will feel really crushed by the criticism (i.e., react with high emotionality), but then exhibit what is actually a robust survival strategy in processing the criticism deeply and (hopefully) learning from the mistake. The flip side of emotional reactivity is being able to pick up emotion and reactions generally in others; in fact, the HSP is able to feel those feelings as the other person is, making the HSP highly empathic (Aron, 2014).

Sensitivity to subtlety and nuance

Capacity to discern subtlety and nuance goes hand in hand with being highly sensitive. Of course, particular individuals may have certain senses very well developed, but often it is not that the sense organs are more responsive, but that there are higher levels of thinking and feeling which notice and make subtle discriminations. Studies of brain activation (seeing which parts of the brain light up under certain conditions) have confirmed that HSPs’ brains were far more active than non-HSPs’ when looking at subtle differences (e.g., in photos with obvious differences versus those with subtle differences).

Much research validates these four distinguishing traits of HSPs. It is outside of the scope of this article to report on it, but check our reference list to see Aron’s website and click on the “Research” tab. As a practitioner, you may be curious about the kinds of behaviours that manifest from these differences (Aron, 2014).

Traits/behaviours of HSPs

Different writers outline these differently, but Ni Preston’s schema (2017) is useful; he breaks the signs of an HSP into three categories: sensitivity about oneself, about others, and about one’s environment.

Sensitivity about oneself

There is a formal (validated) test which you can easily and quickly have your client take in order to determine if s/he is a highly sensitive person. Go to:    If you prefer to just ask informally about it as part of the therapeutic conversation, here are signs in the first category. Your client:

  • Often has difficulty letting go of negative thoughts and emotions
  • Frequently feels physical symptoms when something unpleasant happens
  • Often has bad days that result in eating and/or sleeping in an unhealthy way (too much or too little, or eating the wrong foods)
  • Often experiences tension or anxiety
  • Tends to “beat up” self when falling short of own expectations
  • Fears rejection, even in minor situations
  • Compares self with others often and experiences unhappy feelings from negative social comparison
  • Often feels anger or resentment about situations that seem unjust or annoying (Preston, 2017)

Sensitivity about others

In the second category, you can ask if your client:

  • Often is concerned about what others are thinking
  • Tends to take things personally
  • Finds it difficult when triggered with minor unpleasantness with others to just “let it go”
  • Feels hurt easily
  • Often hides negative feelings, believing that they are too strong, turbulent, embarrassing, or vulnerable to share, so keeps a lot of negative emotions inside
  • Alternatively, may be the opposite of the trait above, discussing negative emotions with chosen others because there’s a lot of “drama” in the person’s life
  • Has a hard time accepting critical feedback, even when it is given constructively
  • Often believes people are judgmental, even without evidence
  • Overreacts to real or perceived slights and provocations
  • Feels awkward in group situations; feels uneasy or unable to be him/herself
  • Feels self-conscious in romantically intimate situations and worries a lot about partner’s approval, fearing judgment or rejection by romantic partner (Preston, 2017)

Sensitivity about one’s environment

Finally, you might enquire if your client:

  • Feels uncomfortable or overwhelmed when having too many things occurring simultaneously
  • Feels uncomfortable when exposed to bright lights, loud sounds, or certain strong scents
  • Startles easily by sudden noises, fast traffic, or other unpleasant surprises
  • Feels upset when watching or reading negative news in the media; dislikes scary or violent shows
  • Often feels unhappy when following people’s posts on social media (Preston, 2017)

HSPs are deeply moved by the arts and music and have a rich and complex inner life. They are attuned to inner bodily sensations and readily notice sensory changes (say, in lighting or other aspects in the environment), and they recognise others’ discomfort. They are conscientious, work well in team environments, and have above-average manners. But the high level of sensitivity and emotional reactivity also means that they can be easily overwhelmed. They “choke” under observation, get “hangry” (angry or irritable when hungry), retreat from loud noises (needing to spend time alone or in an under-stimulated space: say, a darkened bedroom), and are sensitive to pain. They cry more easily and do not function well in open-office plans (Chan, 2017; Morin, 2016; Azab, 2017; Preston, 2018).

So how do we help highly sensitive clients survive this noisy, critical, insensitive world?

Tips for guiding highly sensitive clients

Susan Biali, a medical doctor and self-declared HSP, offers this advice for highly sensitive persons. You may be able to have a conversation with your client about which of these tips will be the most promising for him or her:

Get enough sleep. Fewer than seven hours (for most people) ushers in a state of moodiness, irritability, and decreased concentration. For the HSP, with those “senses-on-steroids”, this noisy, intrusive, crowded world becomes almost unbearable. Sufficient sleep helps to soothe the senses for better coping.

Eat healthy foods regularly throughout the day. Recall the point above about the HSP tendency toward becoming “hangry”. Again, mood and concentration are even more affected in HSPs than in normal people when blood sugar levels fall and/or hunger pains dominate. Well-balanced meals and appropriately-timed snacks can do much to alleviate this effect. Biali also recommends taking Omega 3 fish oil supplements for cognitive and emotional benefits.

Wear noise-reducing headphones. Ear-protecting headphones (used by construction workers) help control unwelcome external noise and give the wearer some control over an otherwise intrusive environment.

Plan in decompression time. HSPs do less well than others in noisy, crowded, or high-pressure environments, so if your client anticipates being in one of those – say, a concert, a parade, or a crowded mall – the “antidote” is to plan to have several hours afterward to come to a private, quiet space, preferably alone, to relax and recover.

Have at least one quiet room or space to retreat to at home. Especially for those HSPs who live with others, it is essential to create a quiet safe place in the home to retreat from people and noise. This could be a bedroom, study, or even just a temporary space such as a bathtub (with a lit candle, of course). Relaxing music can also help drown out external noise.

Allow time and space to get things done. Because HSPs get overwhelmed with a back-to-back schedule, they need to plan in ways to counteract the relentless busyness. Biali says she works an afternoon shift as a doctor so that she can get up in the morning at leisure (sans alarm clock), have an unhurried breakfast, and slowly ease into the day. The extra calm carries her through the whole day. Some people who work more of a regular 9 to 5 day may prefer to get up a bit earlier than the rest of the household to get that peaceful time early in the morning.

Limit caffeine. Biali claims that HSPs are sensitive to caffeine and that she, for example, can’t even handle the traces of caffeine found in decaf coffee! So coffee drinkers and dark-chocolate addicts who recognise themselves in the HSP description, can be warned: life might be calmer and more do-able if the person can learn to do without this universal stimulant.

Keep the lights down low. Try using only soft lighting at night and patronising shops that use that during the day rather than the large, highly illuminated shops.

Get things done in off hours. For those HSPs who are lucky enough to have schedule flexibility, or who are always free during off-hours, it makes sense to hit the banks, the retail shops, and other places (such as restaurants and movie houses) when others are not normally there. The noise is reduced, crowds are not pressing and jostling, the waiting time is hugely decreased, and one can usually find a park – yay!

Surround oneself with beauty. Because HSPs are so profoundly affected by their surroundings, it makes sense for them to try to put themselves into environments of beauty and harmony (such as places in nature) whenever possible.  This means that the HSP may wish to pay special attention to home décor which is beautiful to him or her (not necessarily expensive, just beautiful!), with minimal clutter. Walking or being in nature is advised, as is finding other places of special beauty or calm, such as temples or sanctuaries (Biali, 2011).

It may seem at first like a highly sensitive client is simply being a “wimp” or a fussy, hard-to-please complainer making narcissistic demands on everyone in their life sphere. But now we have brain imaging studies and other research (more on that in future writings) to validate what Aron, and probably many of you as well, have always known: that some people really do require a bit of “kid glove handling”. We can use that knowledge to be more compassionate and understanding of such clients.

Moreover, once we help them tune into their sensitivity, they can more easily and unashamedly regulate themselves and their environment. This not only creates a therapeutic climate that will be maximally productive, because they can arrive calm and ready to engage the therapy; it also allows our sensitive clients to live more in the fullness of themselves, offering their best to the world.


  • Aron, E. (1997). The highly sensitive person: How to thrive when the world overwhelms you. New York: Broadway Books.
  •  Aron, E. (2014). The highly sensitive person in love: Author’s note. Retrieved on 11 March, 2018, from: Hyperlink.
  • Aron, E. (2018). The highly sensitive person. Retrieved on 8 March, 2018, from: Hyperlink.
  • Azab, M. (2017). Are you a highly sensitive person? Should you change? Psychology Today blog. Retrieved on 6 March, 2018, from: Hyperlink.
  • Biali, S. (2011). Top 10 survival tips for the highly sensitive person (HSP). Psychology Today: Prescriptions for Life. Retrieved on 8 March, 2018, from: Hyperlink.
  • Chan, A. L. (2017). 16 habits of highly sensitive people. Healthy Living. Retrieved on 6 March, 2018, from: Hyperlink.
  • Morin, A. (2016). What mentally strong people don’t do: 9 common traits of highly sensitive people. Psychology Today blog. Retrieved on 6 March, 2018, from: Hyperlink.
  • Preston, Ni. (2017). 24 signs of a highly sensitive person. Psychology Today blog. Retrieved on 6 March, 2018, from: Hyperlink.
  • Preston, Ni. (2018). 10 signs of high environmental sensitivity. Psychology Today blog. Retrieved on 6 March, 2018, from: Hyperlink.