The experiences of disabled people suggest that ableism insidiously and invasively impacts upon the practice of counselling and related therapies. This article critiques a particular account of psychotherapy with a child with the label of autism to illustrate how ableism can disrupt the process of empathy and negate the therapeutic experience. In so doing the article highlights the inherent difficulties in traversing different epistemic positions to make sufficiently informed readings of counternormative expressions of being. General principles of counselling practice are then proposed to support practitioners with providing effective therapy for all clients.