Highly Sensitive Persons (HSPs) are estimated to represent 50% of clients in therapy

Patricia Young, MSW, LCSW on Jan 01, 2019 in Mood and Feelings

clicking hereIt is estimated that 50% of the clients we see in therapy are Highly Sensitive Persons (HSPs).
Why is this important for therapists to know this?

Is being a Highly Sensitive Person really a thing?

The clients who come to therapy, and are conscientious; arrive on time; let the therapist know when they’re running late; do the homework the therapist suggests; always have things to talk about, and take the therapist’s feedback to heart are probably Highly Sensitive Persons (HSP). HSPs are deep thinkers; they are more reflective and they think about their relationships, and want to explore them. HSPs feel things (both positive and negative) more deeply than non-HSPs, and it’s harder for them to let things go. They are empathic and compassionate, and often know how to make others feel more comfortable. They are more easily overstimulated by crowds, noise, bright lights, scratchy clothing. HSPs often experience overwhelm (think overstimulation and overarousal). They have been told that they are too sensitive, worry too much, think too much, can’t take a joke, take things too personally, are too emotional, and are too dramatic.

It’s not uncommon that the HSPs that come for therapy to have wounding from childhood, which gets mixed in with being an HSP, so the perception of sensitivity appears to be very problematic.

What is an HSP

Sensory Processing Sensitivity is a newer (and more research-based) name for Highly Sensitive Person. The term Highly Sensitive Person was coined by researcher Dr Elaine Aron, and is marked by 4 characterstics—D O E S which stand for Depth of Processing, Overarousability/Overstimulation, Emotional Responsiveness and Sensory Sensitivity (which is NOT the same thing as Sensory Processing Disorder).

Being an HSP is an innate trait. It is NOT a result of trauma, having a poor childhood, and it is not a diagnosis. There is nothing wrong with the person, and they don’t need to be fixed. It is estimated that 20% of the population are HSPs, and the trait has been identified in 100 animal species (it is a survival instinct. These animals are more cautious, aware, responsive and have higher rates of survival). The trait shows up equally in men and woman. Approximately 70% of HSPs are introverts and 30% are extroverts.

Confusing wounding with the traits of sensitivity

The place where I see the most misunderstanding around HSPs has to do with wounding being confused with HSP traits. Research shows that HSPs that are raised in supportive environments (caregivers that are attuned to the HSP), have excellent outcomes as adults. It’s the HSPs who have caregivers that are not attuned. Maybe the caregiver is a non-HSP, or is a single parent, or there’s addiction. It’s these HSPs that have higher rates of depression and anxiety. These HSPs generally have more trouble with self-regulation, and they get negative messaging around their traits. They begin to believe that something is wrong with them, and it gets mixed in with their sensitivity; consequently, they hate being sensitive.

This is why it’s crucial for therapists to be HSP knowledgeable. When a therapist is not aware of the traits and needs of their HSP clients, it is very possible that the therapist inflicts additional wounding unintentionally by trying to get the HSP to be like the other 80% of non-HSPs--believing that the traits around being an HSP are undesirable, and are the cause of the client’s problems.

Differential Susceptibility is an important key when working with HSPs. Differential Susceptibility means that HSPs respond better than non-HSPs to a positive environment and to positive interactions. HSPs also respond more strongly to negative environments and to negative interactions. Effective therapists keep this in the forefront of their interventions in practice when working with their HSP clients.

Unintentional therapeutic ruptures

The other factor to consider when working with HSPs is that HSPs pick up on subtle details (facial expressions, body language, emotional undertones, etc.). The therapist may (or may not) be having a reaction, but the HSP picks up on any subtle changes in the therapist. If the therapist is not aware of this dynamic, and is not attuned to their HSP client, it is very likely that the HSP client will be attaching meaning to the reaction they just observed. What this would look like is client Mary is recounting an interaction that she had with her husband where he communicated that she was overreacting. The therapist may perceive Mary as dramatic, and this shows up non-verbally, and Mary picks up on it and it creates distance in the therapeutic alliance, but no one talks about it. The other possible scenario is that the therapist is thinking of something else, or is having indigestion, but Mary still picks up on something. Due to Mary’s wounding, she tells herself that the therapist also believes she is being dramatic, and there is a crack in the therapeutic alliance and in each case, the therapist is entirely unaware.

If the therapist is HSP knowledgeable, this very common dynamic will be addressed in the first session with the client to create a safe space for the client to address reactions/responses he or she is aware of.


It’s not uncommon for HSPs to be misdiagnosed not only by psychiatrists, but also by therapists, who are not aware of the traits of being an HSP. Overarousability, overstimulation, overwhelm, having a more active insula and more mirror neurons means that HSPs are not always neurotypical, which means they are more easily misdiagnosed with anxiety, depression, ADHD and even Borderline Personality Disorder.

What to do, and where to get resources

There are many excellent resources to learn about Highly Sensitive Persons. I would encourage you to stick with the pioneers in the field since many people are generating content about HSPs that is not accurate.

Dr. Elaine Aron has written a number of books including The Highly Sensitive Person. If you’re curious to see if you’re an HSP, there’s also self-test on her website. Dr. Ted Zeff has also done research about HSPs and has written many books including a book called Strong Sensitive Boy. There is a movie called Sensitive—The Untold Story is available to rent. I have a number of videos on my website about being an HSP, and there are links to my youtube channel where I have more videos.

I also have a podcast called Unapologetically Sensitive. You can find it on your favorite podcast player or by clicking here

Patricia Young, LCSW specializes in working with Highly Sensitive People. She has a podcast called Unapologetically Sensitive. She is passionate about providing education about HSPs so that sensitivity is viewed as a superpower. www.patriciayounglcsw.com

Patricia Young is a Licensed Clinical Social Worker in San Diego, CA.

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