Reasonable
adjustments.
What can change, and who should carry the cost?
A practical guide to flexible scheduling, format, communication and sensory adjustments in ordinary therapy practice, with the law in brief for Great Britain, Northern Ireland and Ireland.
What this is: a practical guide to making adjustments for disabled clients.
Why it matters: adjustments are often a legal duty, and almost always part of good therapy.
The sharpest reframe: the question isn’t whether the client deserves an adjustment, but what is stopping you offering it.
One thing to take away: ask, agree, record, try, review.
The short version
Most adjustments a therapy practice can make cost little or nothing: flexible times, online sessions, breaks, written summaries, a different chair, a quieter room. In Great Britain, Northern Ireland and Ireland, equality law places duties on service providers, including private practitioners, to make reasonable adjustments or accommodations for disabled people. Beyond the legal minimum, adjustments are part of good therapy. The process is simple: ask, agree, record, try, review.
This page gives general information, not legal advice. Check the law and your professional body’s guidance where you practise.
A simple process
Practice- Ask early and openly, without requiring reasons or diagnosis. See Accessible Intake and Consent.
- Agree what will change, with the client, in their words.
- Record it, so the client doesn’t have to ask again. The access request template and flare plan can help.
- Try it, and expect to adjust.
- Review it after a few sessions, and whenever the client’s needs change.
Common adjustments
Examples to offer, not a menu to impose. The client knows best what helps.
Scheduling
- A time of day that suits the client’s energy, medication or care routine.
- Shorter or longer sessions, or a break part-way through.
- Avoiding days after medical appointments or treatment.
- An agreed plan for flare days, including switching to online or phone on the day.
- Not charging for cancellations caused by symptoms, if agreed in advance.
Format
- Online, phone or in person, and the option to switch.
- Text-based or chat sessions, where you can offer them safely.
- Camera off, or audio only.
- Home visits, where feasible and safe for both.
Communication
- Extra time to respond, and comfort with silence.
- Written summaries or notes after sessions.
- Captions for online sessions.
- Sign language interpreters, and time for interpreted sessions.
- Supporting clients who use AAC or other communication methods, at their pace.
- Plain language, and checking understanding without testing.
Sensory
- Lighting, noise, temperature and scent.
- A choice of seating, and freedom to move, stand, lie down or stim.
- No requirement for eye contact.
- Fewer visual distractions online or in the room.
Physical access
- Step-free access, an accessible toilet, and room to turn a wheelchair.
- Accessible parking or drop-off, and clear information about the route.
- Seating with arms, different heights, or none if the client brings their own.
Between sessions
- Reminders by the client’s preferred method.
- Realistic between-session tasks, or none.
- Agreed ways to get in touch if something changes.
Common worries
“It will be expensive.”
Most adjustments in therapy cost little or nothing. In Great Britain, service providers can’t pass the cost of a reasonable adjustment on to the disabled person.
“It will compromise the therapeutic frame.”
The frame exists to serve the work. Adjusting it for access is part of the work. See Power, Access and the Therapy Frame.
“It’s unfair to other clients.”
Adjustments remove a disadvantage. They don’t give an advantage.
“They should tell me what they need.”
Many disabled people are tired of asking, or don’t yet know what would help. In Great Britain the duty is anticipatory: providers should think ahead about likely barriers.
The law in brief
General information, not legal advice- Great Britain: under the Equality Act 2010, service providers have a duty to make reasonable adjustments for disabled people. The duty is anticipatory, and providers can’t require disabled people to pay for the adjustments. (EHRC code of practice.)
- Northern Ireland: disability discrimination in services is covered by the Disability Discrimination Act 1995, which still applies there. The Equality Commission for Northern Ireland publishes guidance.
- Ireland: under the Equal Status Acts, service providers must do all that is reasonable to accommodate the needs of a disabled person, unless it would cost more than a nominal amount. What counts as nominal depends on factors including the size and resources of the provider. (IHREC guidance.)
When you can’t make an adjustment
Sometimes a practice genuinely can’t provide something. Say so honestly and early. Explain what you can offer instead, and help the client find someone who can provide what they need. Don’t let the client feel that their need is the problem.
Questions worth carrying
Therapist Reflection- Which adjustments do I offer without being asked?
- Do I ever require a reason or a diagnosis before adjusting?
- Which of my policies were designed for predictable attendance?
- When did I last review an access arrangement with a client?
- If I can’t offer something, do I help the client find someone who can?
Evidence & sources
Sources checked in October 2026, using targeted searches rather than a systematic review. “We have not located” means our searches did not find it.
The Equality and Human Rights Commission’s code of practice for services explains the duty to make reasonable adjustments in Great Britain, including that it is anticipatory and that disabled people can’t be required to pay for adjustments. EHRC code, chapter 7
The Irish Human Rights and Equality Commission explains reasonable accommodation under the Equal Status Acts, including the nominal cost limit. IHREC factsheet
The Equality Commission for Northern Ireland publishes guidance on disability discrimination in goods, facilities and services under the Disability Discrimination Act 1995. ECNI short guide
The process, the list of adjustments and the responses to common worries are this site’s synthesis for practice. They are not legal advice.
We have not located research on how often private therapy practices make adjustments for disabled clients, or which adjustments make the most difference to them.