As a late-diagnosed AuDHD (autistic and ADHD) counsellor, I completed my training before there was much awareness of neurodivergence. My own therapists did not pick up on my neurodivergence, and so, for many years, I put all my social anxiety, overwhelm, black and white thinking, boom and bust ways of working etc down to a dysfunctional upbringing. I also learned how to be a ‘good client’, what was expected from me in therapy and how it was conducted, how to sit in a chair for 50 minutes and ‘feel my feelings’. As with every other social situation in my life, I quickly learnt the rules and how to fit in. Though there was a lot of healing that did happen, without my own and my therapist’s awareness of my neurodivergence, a huge piece was missing from my experience as a client.

Clients often come to me post-autism/ ADHD diagnosis, needing space and time to process what this means to them. There is very little support from services post-diagnosis, so we are left alone, or with each other, to make sense of it. I now mostly work with neurodivergent clients, and with much more awareness on board thanks to neurodivergent communities, current research and training led by neurodivergent individuals and from my own continuous reflection, I am able to offer a more neuro-affirming approach to counselling.

Here are  ways I practice this.

1. I validate and embrace the diversity in human neurology

My core principle in offering a neuro-affirming approach is to validate the neurodivergent experience. Often this sounds like, ‘It’s bloody hard’. And I get it. So often we’ve lived in the world covering up our confusion, masking our natural ways of being, finding so many coping strategies and working so hard just to show up and ‘look like everyone else’. Although neurodivergent people often experience similar ‘traits’ or ways of being, I work to understand each individuals’ unique set of challenges and strengths to help them thrive in the world, or at least make living feel a little less bruising.

2. I offer an evolving, collaborative space

This means working together to become aware of our needs and preferences as we move through the sessions. I regularly check in with clients about their needs and preferences for accessibility and communication. Some clients like an email to remind them of the session/ payment; some like to come to sessions with a pre-prepared list of things to talk about; some like to take notes as a way to help them process what they hear or speak; some like to use fidgets to help them focus and direct anxious energy. I also work hard to continuously develop awareness of my own different and divergent needs and to model voicing these. For instance, I let clients know my eye contact varies through the session (but that doesn’t mean my focus and attention is not on them), that I might need to move and shift my body in the session, or that I may be barefoot in sessions (it helps me stay grounded and regulated).

3. I see through the lens of the social model, not the medical model

This means that I do not see neurodivergence as an individual’s impairment, but look to see how we are disabled by the way society is organised through its systems and structures. Sometimes the ways we view our own neurodivergence needs to be challenged, for instance, if we expect ourselves to show up in the world ‘like everyone else’ this can cause further shame, pressure and burnout. Ableism (discrimination against people who are disabled) is heavily ingrained in our society, and we have all internalised it. The social model encourages us to start from the place where our needs are reasonable, because they are! We need to know what models live in our head and how they influence us.

4. I explicitly acknowledge neurodivergent trauma and systemic oppression 

Several studies highlight the high rates of PTSD within the autistic community. Neurodivergent people have so often experienced the trauma of being misunderstood, not fitting in, not being accepted for who they are, not being heard and not getting their needs met. Oppressive systems can lead to a feeling that there is no safe space to fully be oneself. This often leads to more masking (an unconscious attempt to fit in by hiding or covering-up parts of yourself), which can lead to self-blame, shame or feeling like there is something wrong with you (when you feel you don’t), which leads to more hypervigilance around not getting things ‘wrong’ again and which exacerbates the stress cycle/ burnout. I acknowledge this explicitly with clients, which often offers some relief that this feeling of unsafety is not imagined and a feeling of finally being seen. Dr Neff, a late-diagnosed AuDHD psychologist, writes more about this here .

5. I explore procedures and sensory preferences

My neuro-affirming approach includes actively enquiring with clients as to their preferred procedures around counselling. For instance, we will speak directly about the angle of the chairs, the lighting in the room, any external noises, alternatives to phone contact (many neurodivergent people do not enjoy speaking on the phone, me included). The room from which I work at the Pimlico Practice Rooms https://www.pimlicocounsellors.co.uk/ now includes a state of the art cooling/ warming system for temperature regulation. Sometimes the work involves helping clients become aware of their own sensory profiles as well as developing the self-advocacy skills and confidence to ask for what they need.

6. I invite exploration and validation

Differences in interoception (our ability to sense what is going on inside our bodies – you read more here https://www.kelly-mahler.com/what-is-interoception/) for neurodivergent clients means that very often the questions, ‘How are you?’ and ‘How does that make you feel?’ can be confusing ones. Many autistic clients experience alexithymia (a difficulty identifying and describing emotions, you can read more about alexithymia and its connection to interoception here https://www.kelly-mahler.com/what-is-interoception/interoception-and-alexithymia/). Feeling words (angry, sad, excited) may not exactly match up to how we’re feeling or we may not immediately know how we feel. This is very common for the neurodivergent experience and just hearing this can offer some relief and reassurance that we are not strange or broken. There is no right or wrong way to feel. Often it takes longer to work out and we may explore using alternative methods such as checking in with inner sensations or images that come to mind. For instance, a client may tell me they feel like a spiky ball and we might explore what being spiky means to them or when they feel they need to be spiky. Often, we’re so used to over-riding our own feelings or inner sensations and trying to act like everyone else is feeling, we may not even know where to begin.

7. I welcome alternative and creative communication 

Neurodivergent clients can come with anxieties over what is or isn’t ‘allowed’ in therapy. Practicing in a neuro-affirming way means I explicitly welcome info-dumping, silence, movement, imagery, metaphors, lists, fidgets, memory aids, visuals, analogies, any and all questions. Sometimes it can feel easier to express a feeling through a drawing, music lyrics, movement, song, poem. Your way is welcome.

8. I offer regular feedback and reviews

So often neurodivergent clients come with an anxiety over how they should ‘do’ therapy and can spend the entire session guaging what is being asked of them and masking in order to please their therapist. My neuro-affirming approach offers time to settle and to sense if the space feels safe enough. I provide a space of ongoing openness for this feedback in regular reviews. Do you feel heard and understood? Do you feel like the space is safe enough to drop the mask a bit and begin to show more real parts of you? What do you/ don’t you like? What would you like more/ less of? Hearing from you in this way allows me to continually tailor the therapy to you.

9. I facilitate a space where you can get to know who you really are

When you’ve spent a lifetime masking, it is hard to know who you really are underneath the mask. Exploring who you really are, what your needs, interests, joys and passions are, what helps you feel regulated and how to create a life that feels good from the inside is usually part of the work we do together. Coming to know, accept and show up as your true self can be some of the most soulful and liberating work we ever do.

10. I am someone who gets it

The journey post-identifying or being diagnosed as neurodivergent person later in life (as so often happens for women) can feel a lonely or isolating one where, though with good intentions, the people in your life may not fully understand what this means for you. Some clients may not feel safe to declare their diagnosis to others. As a late-diagnosed Autistic and ADHD woman, I am on the journey of unpacking and discovering myself through this new lens too. Just knowing that your counsellor gets it without having to explain can be a huge relief. Where it feels like it may be helpful, I am happy to offer learning and lived experience.

           I meet you where you’re at 

Exploring or identifying with a neurodivergent way of being, self-diagnosing or receiving a formal diagnosis, is just the very start of the journey. I provide a space for you to process this and what it means to you as well as work with you to navigate an easier path forwards. Sometimes you may find yourself swirling in an overwhelming mass of new information about yourself, or caught up in trying to make sense of past experiences through this new lens, or in the grief of not having had any support for all the challenges you’ve experienced, or exhaling with the relief that there’s an explanation for the ways in which you struggle. This takes time and the journey can feel like a swirly, whirly one. Wherever you’re at, I’ll meet you there.