Online Counselling for Neurodivergent Clients

The following article is taken from our Autism-Informed Practice course.

As online counselling becomes increasingly prevalent in the therapeutic field, especially post-2020, counsellors must adapt their approaches to better serve neurodivergent clients, specifically those with autism. Recent research, including Howard and Sedgewick’s 2021 study, highlights distinct communication preferences within the autistic community.

These insights will help counsellors and psychotherapists to create a supportive, accessible, and effective therapeutic environment for neurodivergent individuals. This blog post will guide practitioners in understanding these unique needs, identifying preferable communication modes, and optimising online counselling to enhance client engagement and outcomes.

Learning Outcomes

By exploring the insights from this research, practitioners will:

• Recognise communication challenges faced by autistic clients in various modes and understand why certain methods may be anxiety-inducing.
• Identify preferred communication approaches for autistic clients and incorporate these into their practice.
• Enhance therapeutic adaptability, creating an environment that values client comfort and choice.
• Implement essential risk management practices, recognising the increased mental health vulnerabilities within the autistic community.

Adapting Communication Modes in Online Counselling

The Limits of Traditional Phone Communication

Howard and Sedgewick’s study underscores a strong aversion to phone communication among autistic clients, primarily due to the demands on auditory processing.

Autistic clients often experience difficulty processing verbal information in real time, which can lead to cognitive overload. The quick pace of phone conversations can exacerbate this challenge, leaving clients feeling anxious or misunderstood. For therapists, this insight suggests that alternatives to phone counselling may be essential for effectively engaging neurodivergent clients.

The Preference for Written Communication

The study found a pronounced preference among autistic clients for written communication modes such as email or text. Written communication allows clients greater “thinking time,” provides structured interaction, and reduces sensory overload. These factors make email, text, or other written formats ideal for clients who benefit from processing information at their own pace.

Optimising Video-Based Therapy for Neurodivergent Clients

While video-based therapy is generally more effective than phone calls for autistic clients, adapting video session protocols to respect client preferences is crucial. For example, some clients may prefer not to show their faces on screen or feel more comfortable engaging from a secure location, such as lying in bed. Such preferences can be linked to sensory needs and comfort, which are particularly relevant for neurodivergent individuals.

Understanding the “Disinhibition Effect” in Online Therapy

The “disinhibition effect,” common in online settings, refers to individuals feeling less constrained by typical social norms, potentially affecting their behaviour in therapy sessions. For autistic clients, this might mean they feel more comfortable engaging in therapy from unconventional locations or in unique settings (e.g. in bed, in a dimly lit room, or under a weighted blanket). Far from indicating a lack of seriousness, these choices may reflect their strategies for sensory management.

Managing Risk in Online Counselling for Autistic Clients

Research shows that autistic individuals face an increased risk of mental health challenges, including a heightened prevalence of suicidal ideation. This makes risk management especially critical when working with neurodivergent clients. Reviewing and clearly outlining an online counselling contract that specifies safety protocols, contact details, and emergency contact information is recommended.

Final Remarks

Counsellors working with neurodivergent clients online must recognise and adapt to diverse communication preferences, from prioritising written communication to supporting unique session environments. By having an accommodating and understanding approach, practitioners can significantly improve the therapeutic experiences of autistic clients. Adapting to these needs requires flexibility, sensitivity, and a commitment to ongoing learning.

This approach aims to empower practitioners to deliver effective and empathetic online therapy tailored to the unique needs of neurodivergent clients, ultimately contributing to a more inclusive and supportive therapeutic landscape.

References and Further Reading

Autistica. (n.d.). Suicide and Autism. Autistica. Available at Autistica

Howard, P.L., & Sedgewick, F. (2021). “Anything But the Phone!”: Communication Mode Preferences in the Autism Community. Sage Journals. Available at Sage Journals

Nicholson, E. (2016). What Works When Counselling Autistic Clients? Healthcare Counselling and Psychotherapy Journal.