Preparing the Therapeutic Environment

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

In contemporary counselling practice, the importance of preparing a therapeutic environment that respects neurodivergent needs—especially those of autistic clients—cannot be overstated. Understanding and accommodating the sensory and comfort-related preferences of autistic individuals can transform the counselling experience.

This article summarises the key elements of preparing an autism-friendly space and offers actionable recommendations for counsellors seeking to make their practice more inclusive and responsive.

Learning Outcomes

By implementing the guidance in this article, you will be able to:

• Recognise common sensory and environmental challenges autistic clients face in neurotypical settings.
• Identify and incorporate small yet significant adjustments to create a supportive therapeutic environment.
• Employ adaptive communication and sensory strategies to enhance client engagement and comfort.

Respecting Autonomy and Seeking Client Input

A cornerstone of ethical counselling practice is respecting client autonomy, a principle highlighted across professional codes of practice. For autistic clients, this means actively involving them in the environment-setting process. When clients disclose their autism, it is courteous and practical to ask if specific adjustments would make them more comfortable. The term to remember is reasonable adjustments—changes that enhance the therapeutic environment without being impractical.

The concept of ‘reasonable adjustments’ requires flexibility and creativity. For example, if a client finds the colour of a chair unsettling, instead of purchasing new furniture, simply covering it with a throw could be an effective solution. When preparing the therapeutic environment, practitioners should be mindful of balancing practicality with the client’s sensory needs to create an inclusive space without incurring unreasonable costs.

Sensory Considerations in the Therapy Space

Autistic individuals often experience heightened sensitivities to sensory stimuli, including sound, light, and scent. These sensitivities can fluctuate with stress or relaxation levels, making maintaining a flexible and accommodating environment crucial.

1. Sound Management: Some autistic clients are highly sensitive to background noise. The clock ticking or distant sounds outside the room can be overwhelming. To minimise distractions, consider removing noisy items or using white noise machines to help mask external sounds.

2. Neutral Scents: Strong fragrances from personal products or room fresheners can disrupt an autistic person’s focus.Maintaining a scent-neutral space can prevent discomfort. Ask clients if specific scents could affect their concentration or comfort.

3. Adaptable Lighting: Bright lights can cause sensory overload. Autistic clients may shield their eyes with hats, sunglasses, or even hoodies during sessions. Offering options such as dimmable lights, closed blinds, or curtains provides a more adaptable setting that clients can control according to their comfort levels.

Enhancing Comfort with Flexible Seating and Fiddle Items

Creating a comfortable seating arrangement and offering sensory tools can significantly benefit engagement for autistic clients.

• Flexible Seating Options: Autistic clients may find traditional seating uncomfortable or restrictive. Providing alternatives, such as bean bags, weighted blankets, or floor seating, can help clients feel more at ease and reduce distractions. The weighted blanket, for example, can offer calming pressure that many autistic individuals find soothing.
• Fiddle Items and Manipulatives: Small, manipulatable items like Rubik’s Cubes, magnetic construction toys (like Magnetix), or spinners can support focus by engaging proprioceptive senses, offering a constructive outlet for physical energy and reducing the pressure of maintaining eye contact.

Tone of Voice and Communication Style

Adapting verbal communication to align with clients’ preferences can help create a more supportive environment. Some clients may appreciate a calm, monotonous tone, which they find easier to process, while others might prefer an upbeat, expressive style. Observing and adjusting each client’s reaction to different tones will help build rapport and enhance the therapeutic connection.

A 30-minute preliminary introductory session can be particularly valuable for autistic clients. It allows them to familiarise themselves with the therapist’s tone, pace, and environment. This session provides for any necessary adjustments to be identified early on, making future interactions smoother and more effective.

Practical Tips for Implementation and Peer Collaboration

Building an autism-friendly space is an evolving process that benefits from peer insights and shared experiences. Here are some steps to facilitate this process:

• Audit Your Practice Environment: Examine your space for potential sensory triggers. Is the lighting too bright? Does the clock tick loudly? Are there any strong odours present?
• Seek Feedback from Supervisors and Peers: Discuss your peers’ adjustments and share ideas within professional networks. These discussions often reveal creative solutions that can be easily applied in your practice.
• Consider Tax Deductibility of Adaptations: In the UK, self-employed practitioners can deduct the cost of items like weighted blankets, bean bags, or fiddle items from their taxes. Keep receipts and consult a tax advisor to explore these possibilities.

Final Remarks

Creating a therapeutic environment tailored to the sensory and comfort needs of autistic clients enhances the inclusivity and effectiveness of counselling practice. While these adjustments are particularly beneficial for autistic individuals, many neurotypical clients may also find a sensory-considerate environment beneficial. Integrating these changes will ensure a more welcoming and responsive practice, ultimately creating a setting where all clients feel respected and understood.

References and Further Reading

Nicholson, E. (2016). What works when counselling autistic clients? Healthcare Counselling and Psychotherapy Journal, October issue. Available at: BACP Healthcare Counselling and Psychotherapy Journal

Elaine Nicholson MBE’s website offers further resources for counselling neurodivergent individuals.