8 Ways to Recognize a Neuro-diversity Affirming Therapist

For Neurodivergent people seeking a therapist who has knowledge and understanding of Neurodiversity including in-depth knowledge and understanding of different neurotypes, while also practicing from an affirming lens can prove to be incredibly challenging.

So many Neurodivergent adults have tried multiple therapists over the span of many years coming away with more questions than answers:

• Whats wrong with me?

• Why doesn’t therapy seem to work for me?

For those of us lucky enough to learn there is a difference in the way therapy needs to be modified and applied based on our neurotypes and indivisuals needs - we then have the daunting task of finding a therapist who can support us in the ways our unique selves need.

Below are 8 of my first recommendations to consider when seeking a Neurodiversity Affirming and Inclusive Therapist:

1. Notice Language Used by the Therapist

First, when you click onto their directory profile or website - pay attention to the language they use when discussing Neurodiversity. While I am not encouraging being a perfectionist or judging someone on their ignorance - therapists directory listings and websites are our first introduction to who therapists are and how they practice.

A therapist who is well-versed in Neurodiversity Affirmative practices will have done their research and will know the difference between Neurodiversity, Neurodivergent, Neurodiverse - so on and so forth.

The language should also come off as affirming and inclusive and refrain from acting like Neurodivergence is something to fix, cure, or otherwise change. Ultimately the message should be about helping you in the ways you need without recognizing your neurotypes (or the traits and experiences you have as a result) as being the problem. Truly ND affirming and inclusive therapists recognize how systems are often the cause of a lot of our distress, etc.

This is not to say a therapist who doesn’t know the difference between certain terms, or who uses less affirming language is guaranteed to be a bad fit for your needs - it is simply the first thing I pay attention to in order to decide if I am comfortable reaching out to this therapist or not.

2. Notice the Areas of Focus Mentioned

If the areas the therapist claims to focus on seem like it would encourage masking your Neurodivergent traits/forms of expression, ‘hacking’ your natural way of being or any other obvious sign of trying to add more tasks to make you seem less Neurodivergent - I would say this person is not practicing in Neurodivrsity affirmative or inclusive ways.

Please note: as a multiply Neurodivergent person who has had to survive in a Neuronormative world, I do understand the need to mask our natural ways of being - and I talk to my clients about this in a realistic way. We have to find ways to be safe in the world we live in. However, this is different from the therapists who actively work with clients in Neuronormative ways (often unintentionally) causing clients to suppress and push through, rather than recognizing and honoring needs.

3. Notice the different Neurotypes (aka Diagnoses) Mentioned

Every therapist will have their areas of focus which often includes specific neurotypes. Not all therapists will have the ability to work with all neurotypes just because of the need to intensely study, train and have working experience in supporting certain neurotypes and common lived experiences related to each.

However, there is a misconception that only Autism and ADHD are “Neurodivergent” (even though the person who coined the term, Kassiane, has stated otherwise) it is fine for a therapist to only work with Autistic ADHDers so long as they aren’t excluding other neurotypes due to this misunderstanding. Many Neurodiversity Affirmative therapists will work with multiple neurotypes which commonly co-occur (ex: Autism, ADHD, PDA, OCD, PMDD, PTSD/CPTSD).

4. A truly ND Affirmative and Inclusive Therapist will also be:

• Anti-racist

• Anti-ableist

• Anti-diet culture/Fat liberatory

• LGBTQIAP2S+ Affirming and Inclusive

If anything in the therapists language used or communication with you seems to suggest otherwise, this therapist is not practicing what they claim.

5. Philosophies, Theories and Modalities, oh my!

Neurodiversity Affirmative practices are not widely taught in counseling programs (college/university) nor in the professional trainings we take in order to renew our professional licenses.

This means: ND affirming therapists have often sought out their own education, research, practice, etc. This means: there isn’t a standard of what we all learn to be able to claim this practice. Certificates and the like which are offered by large companies who provide training as their business are not what they seem to be (it’s really a therapist who took a bunch of hours of training - usually made in an ableist and neuronormative worldview, maybe did some supervision or homework on the topic and got a piece of paper).

Seeking information on our websites or even asking us about our philosophies, theories and therapy modailities used (and why) is perfectly acceptable and even expected. Any truly ND affirming therapist will be able to answer these questions (though if its on a call or a video consult - maybe give us a heads up that you plan to ask this as many of us experience executive functioning differences and you don’t want us to have a long pause as we try to engage that part of our brain to be able to answer you).

6. Modifying Therapy Modalities

Neurodiversity Affirming therapists have had to learn to modify ‘evidence-based’ therapy modalities to accommodate Neurodivergent needs, such as interoception differences (ability to sense and recognize internal body signals), alexithymia (difference in experiencing and recognizing emotions), aphantasia/hyperphantasia (inability to or difference in the ability to form a mental picture / extremely vivid and intense mental imagery), differences in habituation, processing, executive functioning, etc.

You can ask the therapist about their understanding of and experience with modifying certain therapy modalities for any of your known needs.

7. Accommodations Offered

When you reach out to this therapist, ideally you are given an explanation of what to expect as far as next steps in the process. ND affirming therapists may also offer specific accommodation in areas where the therapist is able to offer any.

The therapist also may wait until you request any related to certain types of needs as it can be overwhelming to receive a lot of information at once (especially if irrelevant if given when you did not ask…)

Please note: ND affirming therapists are often Neurodivergent themselves (most of the time, multiply Neurodivergent). Many ND affirming therapists also work alone or in a small group which means: there may only be certain types of accommodation the therapist can offer due to their own disability and access to resources. ND affirming therapists will do their best to find a way to accommodate different needs - there just may be some areas where we are unable to do so due to licensing requirements, local laws or abilities/access.

8. Is the Therapist openly Neurodivergent?

This is not a requirement to be a good Neurodiversity Affirmative and Inclusive therapist - however, a lot of Neurodivergent people prefer having a therapist with lived experience because there can be a foundational level of understanding and recognition it can be difficult to communicate to someone without any lived frame of reference.

Please Note: sharing neurotypes with your therapist cannot possibly guarantee you will instantly ‘click’ or understand each other. Your individual experiences living with your shared neurotype may be incredibly different. However, the more I learn about Neurodivergent client experiences in therapy with openly Neurodivergent therapists - the resounding preference seems to be fore a therapist with lived experience who ‘gets it’ and is able to practice from a level is understanding which is entirely different from what one can gain from school or training.

Mindfulness: trauma-sensitive practices

Mindfulness is a term which encompasses practices, such as grounding, attuning to our inner world, recognizing the environment around us, etc. 

One purpose of mindfulness practices include noticing what is happening within us (emotions, physical sensations, etc.) as well as noticing details about the world around us in an effort to help us ‘get out of our own minds’. 

Mindfulness practices are often recommended as a coping technique for emotional distress. 

Because of this, we want to be…mindful…of how we approach these practices so they do not unintentionally cause additional emotional distress.

The origins of mindfulness are often credited to Buddhism alone, however Indigenous tribes and various religions have been practicing mindfulness all across the globe for many centuries.

Trauma and Mindfulness 

In order to begin understanding why a trauma-sensitive approach needs to be taken when using mindfulness approaches with folks living with trauma - we must first recognize how people living with trauma (especially complex trauma) often require a level of dissociation in order to safely exist in the world.

When a person who must dissociate in order to feel safe as a means to continue existing it makes sense that the same person suddenly forgoing this level of dissociation by engaging in mindfulness practices may experience distress.

By encouraging a person living with trauma to attune to their inner world, or to concentrate on their environment - each with the purpose of accessing the ability to be more connected with onself, we can inadvertently induce severe distress, panic and trauma reactions such as flashbacks, or Fight/Flight, etc.

Challenges in Assessing for Trauma

It is there are people living with trauma who would never think this could be true for them. Unfortunately not all people recognize they are living with trauma, and/or complex trauma. 

The reason this matters is if someone seeks therapy (or another service) where mindfulness practices are utilized - it is essential for the practitioner to proceed with caution when it comes to mindfulness practices. 

Ultimately, every practitioner who uses mindfulness in their work needs to be as trauma sensitive in providing instruction on mindfulness as possible.

Mindfulness Can Help People living with Trauma 

Mindfulness practices can be helpful and effective for those of us living with trauma, and/ or complex trauma.  

This is where the responsibility of the trauma- sensitive practitioner to be educated, trained and experienced and how to best recognize and support people living with trauma in accessing mindfulness practices.

A trauma-sensitive practitioner will assess:

• Which types of mindfulness practices are most likely to activate our nervous system based on past experiences with similar practices. 

• Which mindfulness practices help to regulate our nervous system based on past experiences with similar practices. 

Trauma Modalities Integrating Mindfulness

Many trauma therapies rely on somatic experiencing, grounding, visualization, compartmentalization, controlled dissociation and other techniques meant to help us cope with, and regulate our nervous system and thereby our emotional state.

The challenge working with someone living with trauma becomes knowing which specific practices are appropriate for what the client needs in that moment.

Practitioners using mindfulness need to be taking a full assessment of: 

• sensory needs

• access needs

• support needs

• trauma history (as applicable by modality and service)

• experiences with mindfulness practices up to that point

• current capacity

• current headspace

• physical needs/ abilities

• current emotional state (as can be assessed - recognizing Alexithymia and interception differences) 

and more before proceeding with mindfulness techniques.

Because so many trauma modalities rely heavily on the ability to create pictures in our minds through the use of “visualization” techniques for use as coping skills, we need to have an understanding of the clients experience of visualization.

Mindfulness techniques not accounting for Aphantasia (the inability to form pictures in one's mind) or the opposite experience for those of us who have such vivid imagery in our brains that it can cause distress, exhaustion, confusion, and more due to the nature of the intensity of the pictures our mind creates (Hyperphantasia).

Self-Directed Trauma-Sensitive Mindfulness Practices 

For those of us who seek to learn how to best support our needs, as people living with trauma, and /or complex trauma it can be genuinely challenging to find accurate information which represents our lived experience as the vast majority of information out there does not account for the different ways, our brains and bodies react and receive mindfulness practices.

To learn more, I recommend the book:

• Trauma-Sensitive Mindfulness: Practices for Safe and Transformative Healing by David A. Treleaven

As well as the books listed on this blog:

• Reading List Understanding trauma, healing and mindfulness by Indigenous & BIPOC authors

https://www.jessicabarudin.com/blog/reading-list-unpacking-trauma-healing-indigenous-authors

Attachment Theory and Neuro-diversity

If you are seeking an in-depth, detailed comparison of Neurodivergent needs and attachment theories - that will be a later writing (which may require more than a single blog post or series could contain).

For now, this blog on Attachment Theory and Neurodiversity will cover some of the foundational ideas of how current attachment theory does not include a full and necessary understanding of Neurodivergent needs with attachment.

1. Neurodivergent folks operate outside of expected ‘norms’: Neurodivergent humans connect with other humans in ways not expected or often accepted by general Neuronormative society.
   
   

2. Neurodivergent humans are more likely to be on ‘extreme’ sides of the spectrum of need for human connection:
   
   First Example of Neurodivergent Difference in Attachment: A person who genuinely has their social connectivity needs fulfilled by a weekly Dungeons and Dragons virtual campaign is not experiencing avoidant attachment or anxious attachment. If this fulfills this persons needs, that’s healthy for this person and does not need to be compared to or discriminated against due to this being a different level and way of meeting the same type of need.
   
   Second Example of Neurodivergent Difference in Attachment: On the opposite end, say someone genuinely has a need for near-constant human connection. For this example, this level of need is not due to a lack of healthy and appropriate attachment or connection at any time in this person’s development. They really and truly have a higher level of need for human connection and co-regulation of their nervous system. This does not make this person anxiously attached - though they may have developed heightened levels of experiencing social anxiety and rejection trauma due to Neuronormative standards and expectations of attachment needs being less than this person’s happens to be (even though this experience can be a perfectly natural difference in human need for connection and co-regulation).
   
   

3. We need to shift away from Neuronormative Standards for Early Childhood Attachment: Instead of focusing so heavily on the way in which caregivers connect with children in infancy and beyond within a Neuronormative understanding of how we are ‘supposed’ to healthfully attach to each other - we could focus on how each individual needs to feel connected. How often each of us needs to experience rituals of connection. How we attach to other humans and how we can support this.
   
   

4. We also would do well to recognize: attachment and connectedness fluctuate. Our capacity and need for human connection are not static, instead they vary depending on so many factors. There cannot be a general understanding and expectation of how to form and maintain health attachment without factoring in an understanding of Neurodiversity.

Tl:dr - Current and generally accepted attachment theory is stuck in Neuronormativity. It is not inclusive of Neurodiversity. This needs to change.

More to come on the topic of attachment theory and Neurodivergence as it’s a much needed topic to be better understood and an area of passion for me.

-

Notes: The term Neurodiversity was created by the broader online Autistic community as well as Neurodivergent community and was brought into wider consciousness and use by Judy Singer due to her publishing a thesis which was available to a wider audience than niche oniine forums.

The term Neurodivergent was created by Kassiane Asasumasu, a Hapa and Asian American Autistic rights activist and blogger from Oregon. The term was specifically created to be an inclusive term, not one that excludes folks who technically fit into it. While there are both innate and acquired Neurodivergences - all those with brains which diverge from the expected ‘norm’ are included within the term and understanding of being Neurodivergent.

Neuronormative is a term used to describe the “usual way a brain is expected to work.” The standards and expectations within a Neuronormative culture which is not inclusive of Neurodiversity is harmful to Neurodivergent folks.

Is it perfection-ism or meeting a nervous system need?

Many times I thought I was being a perfectionist, when really: I just needed to know what to expect.

Being able to anticipate changes and have an idea of what to expect supports my nervous system needs.

I used to think I was “too particular” or “ridiculous” for stipulating specific information I needed to feel capable of a task or attending an event.

I was called a perfectionist. Type A.

I was told to stop. To go with the flow.

(Trust me; I’d love the ability to do so).

I’ve worked on my anxiety and OCD.

I’ve worked on my biases and judgments.

I’ve worked on my mindset and attitude.

Still; these needs persisted.

So then, when I learned how to apply the (actually) Neurodiversity Affirmative way of approaching and practicing therapy and applied it to how I live - it dawned on me:

All of that initial thinking was putting Neuronormative expectations on me - and they didn’t work.

I was working ON (suppressing) my anxiety and OCD when I really had nervous system needs.

I was working against my very real needs in order to meet the expectations of the majority understanding of how a person “ should be” in the society I exist within.

It’s taken quite the paradigm shift to change this understanding.

Now, I can work WITH my needs, recognizing I don’t always have to focus on changing what’s naturally me.

Just wanted to share in case this is relevant for anyone else.

Disclaimer: while I am a therapist, I cannot offer advice or therapy via my blog.

This is not meant to be used as a diagnostic tool and is not therapy.

What is Neuro-divergent Affirming Therapy?

Neurodiversity: all brains have differences.

Neurodivergent: a brain that diverges from the expected ways a brain develops and functions. Neurodivergent people range from those of us living with Anxiety, Depression, Epilepsy, OCD and the more well known to be Neurodivergent neurotypes: Autism and ADHD.

Neurodivergence can be inborn (you were born with a brain that is already uniquely wired) or acquired (something occurs in your life to cause your brain development, processing and functioning to change significantly enough to impact how accessible a Neuronormative world is for you).

Neuromormative is the term we use to recognize the systems and structures of expectations and requirements certain cultures and societies have which are not accessible or possible for many Neurodivergent people.

Affirming and inclusive therapy for Neurodivergent folks requires us to challenge the Neuronormative beliefs and standards we bring into our practices.

Being an affirming and includive therapist to Neurodivergent folks requires consistent mindfulness and awareness of when Neuronormative ideas, beliefs and expectations are present in the therapy we are providing.

In order to actually be affirming and inclusive, we must actively divest from the pathology paradigm and medical model of disability - which can seem impossible or at least improbable within a mental health system.

Essentially, Neurodivergent affirming and inclusive therapy recognizes unique needs in our clients and actively works toward making therapy modalities work for the client, not the other way around.

Learning from folks who live with the neurotypes you work with is the best place to start. Then, learning more about different models of disability (more than the medical model vs. social model - look into the human rights model, the holisitic model by AutisticTic and more). Read books about Neurodiversity, its movement and paradigm. Essentially immerse yourself in learning and shifting the way you think, what you believe and it will alter how you approach therapy.

Terminology notes:

The term “Neurodiversity” was created by online communities of Neurodivergent folks and was brought to wider awareness by Judy Singer.

The term “Neurodivergent” was coined by Kassiane Asasumasu, a Hapa and Asian American Autistic rights activist and blogger from Oregon.

The term Neuronormative has unknown (to me) origins.