Choosing a counsellor: what accessibility actually looks like

When looking for a counsellor, you might come across statements such as "I offer adaptations to meet individual needs" or "I aim to make my practice accessible". 

However, it isn’t always clear what these statements actually mean. What kinds of adaptations are available, and how do you know whether a counsellor can offer the support you need?

You don't need a formal diagnosis, to identify as disabled, or to explain exactly why something is difficult before asking about alternative ways of communicating. You might simply find telephone calls difficult, struggle to follow conversations when there is background noise, need additional processing time, or find that spoken communication isn't always the easiest way for you to express yourself.

Many counsellors offer adaptations primarily with particular client groups in mind. My primary client group – and one I also belong to – is the neurodivergent community. I started offering adjustments many years ago that were designed to support neurodivergent people, but over time I have realised that they may also benefit people who are deaf, have hearing impairments or experience auditory processing difficulties for other reasons.

Accessibility isn't always about having a separate provision for every individual need. Sometimes, it's about offering different ways of doing things and allowing people to choose what works best for them.

I have become increasingly interested in this wider understanding of accessibility, particularly in relation to communication. I regularly use subtitles when watching television, even in my native language, and frequently speed up voice notes and YouTube videos to 2x speed.

In face-to-face conversations, I can sometimes need someone to repeat themselves before I fully understand what they've said. Background noise, sensory overload and the amount of information I'm trying to process can all affect how well I follow spoken communication. I understand this particular communication challenge from a very personal perspective.

But when we think about accessibility and challenges with hearing or listening, this raises an important question: why do we assume counselling must always involve two people sitting together, talking and listening? Other ways of communicating exist, and some may make accessing support considerably easier.

What to look for when choosing a counsellor

If you experience difficulties hearing, processing speech or communicating verbally, here are some things you might want to consider when looking for a counsellor.

How can you make initial contact? 

Do you have to telephone to make an enquiry or arrange an appointment, or can you contact the counsellor by email or SMS? If telephone conversations are difficult, having a written option from the outset can make finding support considerably less stressful.

What options are available for an introductory session? 

Some counsellors offer an initial conversation to help you decide whether you would like to work together. Find out whether this can take place by email, text or another written format, rather than assuming that you will need to manage a telephone or video conversation.

Do sessions have to involve speaking and listening? 

Traditional counselling usually relies on verbal communication while sitting opposite one another in a private space, but that isn't the only option. Depending on the counsellor's training, experience and way of working, alternative formats might include:

• Real-time written communication, such as SMS or messaging.
• Email, where you and your counsellor exchange messages without needing to be online simultaneously.
• Video sessions with live subtitles or captions.
• Audio sessions, if you find these easier than video.
• Other agreed communication methods that better suit your needs.

Another option might be outdoor counselling. For some people, speaking and listening isn’t the specific issue; it’s more that sitting still prevents processing. Movement can help some people process both their own and others’ speech.

Not every counsellor will offer all these options, but it is worth asking what alternatives are available.

Can you use subtitles or live transcription?

If you struggle to understand speech, ask whether the video platform supports live captions or whether you can use your own software or apps to generate subtitles during a session.

You might also want to check whether the counsellor is comfortable with you using these tools and whether the chosen platform is suitable for your accessibility and confidentiality requirements.

What happens if you need to contact your counsellor between sessions?

Ask how they manage contact outside appointments. Is telephone contact the only option, or can you email or send an SMS?

This may be particularly important if you have difficulty making or receiving telephone calls, or if you need an alternative way to communicate about appointments and practical arrangements.

It is also worth checking what arrangements are in place for urgent situations. Remember that counsellors may have specific boundaries around availability and emergency contact, so make sure you understand what support they can and cannot provide.

Are their online resources accessible?

If a counsellor has videos, podcasts or other online resources, check whether captions, transcripts or written alternatives are available. Accessibility should ideally extend beyond the actual counselling session.

What can you reasonably ask for?

You shouldn't have to wait until your first session to discuss accessibility. If you find a counsellor whose approach appeals to you, but you're unsure whether they can accommodate your communication needs, ask before committing to working together.

You could ask:

• Can we communicate by email or SMS rather than telephone?
• Do you offer sessions that don't involve spoken communication?
• Can I use live captions or subtitles during our video sessions?
• Would you be comfortable with me taking additional time to process questions or asking you to repeat something?
• Do you offer longer sessions so I have more time for processing?
• Can you send a summary after the session of resources mentioned or key points?
• Can we adapt the way we work if I discover that something isn't working for me?
• Can we make changes to the lighting, background noise or other aspects of the environment?

You don't necessarily need to provide a detailed explanation or justify why you need an alternative. You can simply explain what would help you.

A counsellor may not be able to offer every adaptation, and some approaches may not be suitable for every type of work. However, they should be willing to discuss your needs openly and explore what might be possible.

Accessibility is about more than communication

Although this article focuses particularly on hearing and auditory processing, accessibility can encompass many other aspects of the counselling experience.

For example, you might benefit from:

• Adjustments to lighting, temperature or background noise.
• A quieter waiting area or the option to wait outside until your appointment.
• Written summaries of practical information.
• Clear information about what to expect before, during and after sessions.
• Additional time to process questions or formulate responses.
• Flexibility around appointment arrangements, where possible.
• Support with executive functioning, such as appointment reminders.
• An understanding of sensory overload, emotional overwhelm or rejection sensitivity (RSD).
• Longer or shorter session times, ad hoc sessions, or varying session frequency.
• Remote options, and switching between video and audio, or audio and written sessions, depending on your capacity.
• Creative options for sessions when spoken words feel difficult, such as drawing, writing, movement, or other methods.

You might also find that your needs change over time. Something that works well initially may become difficult during a period of increased stress, fatigue or sensory overload.

An accessible therapeutic relationship should allow room for conversation and flexible adjustments. You should feel able to explain when something isn't working and discuss whether an adjustment might help.

What does an accessible therapeutic relationship look like?

Accessibility isn't just about the practical options listed on a counsellor's website. It's also about how they respond when you explain what you need.

Do they listen without making assumptions? Are they willing to explore alternatives? Do they understand that different people communicate, process information and experience their environments in different ways?

You shouldn't have to spend your counselling sessions trying to overcome unnecessary barriers to communication. Ideally, the arrangements should allow you to concentrate on the reason you sought support in the first place.

You are not being difficult by asking for a different way of working. You are identifying what would help you access the support you are looking for.

Finding the right counsellor isn't just about qualifications, experience or therapeutic approach. It's also about finding someone you can communicate with comfortably and who is willing to consider how the counselling process can work for you.