Accommodating Client Preferences

Accommodating Client Preferences: A Counsellor’s Guide for Autism

When supporting autistic clients, counsellors need to create an environment that respects and accommodates the unique preferences and needs of neurodivergent individuals. Flexibility, understanding, and a client-centred approach are essential to ensure that therapy sessions are accessible, supportive, and effective. This article explores practical adjustments and considerations that counsellors can incorporate into their practice to accommodate autistic clients, guided by the principles discussed in recent resources.

Learning Outcomes

By exploring these insights, you will:

  • Recognise the importance of tailoring the therapeutic environment and approach for autistic clients.
  • Understand specific adjustments that can enhance comfort and communication during sessions.
  • Appreciate the role of structure, flexibility, and sensory accommodations in fostering a supportive space.
  • Be equipped to honour client autonomy and lived experiences, ultimately enhancing therapeutic rapport.

Creating a Comfortable and Respectful Environment

Setting the Scene for Respectful Engagement

Engaging respectfully from the outset is paramount. A recent BBC documentary showcased an insightful exchange between Christine McGuinness and psychologist Professor Kate Tchanturia, who began their conversation by asking, “How would you like me to sit? Is it okay if I make eye contact?” This simple yet powerful approach demonstrates sensitivity to the client’s comfort and autonomy. Asking such questions allows autistic clients to define aspects of the interaction that suit their preferences, building a foundation of trust and respect in therapy​.

Seating and Physical Comfort

Many autistic individuals may experience discomfort with traditional seating arrangements. Some may prefer sitting on a sofa, beanbag, or floor, as posture can significantly affect their focus and ability to engage in sessions. Counsellors should be prepared to offer flexible seating options, allowing clients to choose arrangements that make them feel at ease. This small adaptation can enhance client participation and comfort during sessions.

Flexibility in Scheduling and Session Length

Flexible Appointment Options

Given that energy levels may fluctuate throughout the day, some autistic clients may find it challenging to attend sessions later in the afternoon. Offering flexible scheduling, including video sessions, can be particularly beneficial for clients who struggle with travel logistics or strict timelines. When feasible, counsellors might consider a “mixed economy” approach—providing both in-person and online options—allowing clients to decide what suits them best at any given time.

Longer or Shorter Session Times

Some autistic clients may require extended time to feel comfortable, build rapport, and open up in therapy. Research highlights the value of 90-minute sessions for some individuals, allowing sufficient warm-up time. For others, shorter sessions may be more effective, possibly rescheduling unused time if energy levels become a barrier. Open-ended session structures and flexibility in timing can accommodate the unique processing needs of autistic clients​.

Sensory and Environmental Considerations

Many autistic clients experience heightened sensitivities to sensory stimuli. Adjusting the therapy environment to minimise sensory triggers—such as dimming lights, reducing background noise, and allowing the use of noise-cancelling headphones—can significantly improve comfort. Counsellors might encourage clients to bring sensory aids if helpful, acknowledging that these adjustments are not just permissible but encouraged to support the client’s well-being​.

Communication Styles and Preferences

Autistic clients often have distinct communication styles, sometimes using augmentative and alternative communication (AAC) methods. To respect these differences, counsellors should be willing to adapt their communication approach, using straightforward language, a more literal tone, or visual aids as needed. Flexibility in communication enables autistic clients to engage more fully and feel understood, which is crucial for a supportive therapeutic relationship​.

Structuring Sessions for Predictability

Importance of Structure

Predictability can help reduce anxiety and foster a sense of security for autistic clients. Establishing a consistent session structure—outlining what will happen in each session and maintaining a regular schedule—can provide stability. This structured approach supports clients in knowing what to expect, helping them feel more focused and relaxed during their sessions.

Accommodating External Support Needs

For some autistic clients, having a support person present in initial sessions can help them express their needs and process information. With careful contracting, counsellors can work with support workers or family members, ensuring clear boundaries and understanding their role in sessions. This inclusion can be invaluable for clients who require additional assistance in acclimating to the therapeutic setting.

Harnessing Strengths and Passions

Utilising Special Interests in Therapy

Autistic clients often have intense interests or “special passions”, which, when incorporated into therapy, can enhance motivation and engagement. For example, using a client’s favourite subject to explain therapeutic concepts makes sessions more relatable and engaging. These interests can also serve as grounding tools, helping clients regulate emotions and stay present in sessions, reinforcing self-esteem and resilience​.

Practical Implications for Your Practice

Adapting Therapeutic Practices

Practitioners must approach therapy with an openness to individualisation. Essential adjustments include clarifying what therapy entails, discussing silence and its potential discomfort, recognising the impact of routine changes, and actively seeking client input on adjustments that may ease their therapy experience. Above all, counsellors should avoid dismissing any lived experiences or insights shared by their clients; these experiences are valuable windows into the client’s world.

Final Remarks

Counselling autistic clients requires sensitivity, adaptability, and respect for individual needs. From flexible scheduling and seating options to sensory adjustments and tailored communication, these adaptations create an environment where autistic clients can engage meaningfully. By prioritising client autonomy, recognising lived experiences, and incorporating unique strengths into sessions, counsellors can build a therapeutic alliance honouring each client’s individuality.

References and Further Reading

These readings provide a further understanding of accommodating autistic clients in therapeutic settings, equipping counsellors to create an inclusive and responsive practice.

BBC (2023). Christine McGuinness: Unmasking My Autism – BBC iPlayer.

Hallett, S., & Kerr, C. (2020). ‘You need support, validation, good coping skills. You need and deserve acceptance’: Autistic Adult Experiences of Counselling. Autistic Mental Health.

Howard, P. L., & Sedgewick, F. (2021). Anything but the phone! Communication mode preferences in the autism community. Sage Journals.

Nicholson, E. (2016). What works when counselling autistic clients? Healthcare Counselling and Psychotherapy Journal.