Understanding Neurodiversity Affirming Therapy: A Guide

Neurodiversity is a growing movement that celebrates neurodivergent perspectives and the many different ways people think and engage with the world. As the cultural conversation around neurodiversity has expanded, some institutions have begun evaluating ways to better include and uplift neurodivergent people. These changes are desperately needed, especially in mental health services. Neurodiversity-affirming therapy offers neurodivergent people mental health support that recognizes our value and embraces our inherent strengths.

“Neurodivergent” is a non-medical term referring to individuals with neurodevelopmental differences from their peers. It is commonly used to refer to autistic and ADHD individuals, as well as people with learning and intellectual disabilities. Individuals with mental health conditions and significant trauma histories are also increasingly considered neurodivergent. 

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In line with the neurodiversity movement, neurodiversity-affirming therapy recognizes neurodivergent individuals’ unique perspectives and needs. Since we may process information and emotions differently than neurotypical people, we may also navigate conversations about our mental health differently. Neurodivergent people also face particular challenges maneuvering through environments, systems, and communities that do not understand how our brains work and treat us poorly because of our differences. 

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Because of these experiences, we are more likely to endure trauma and have co-occurring anxiety and depressive disorders. Neurodiversity-affirming therapy addresses these conditions in a holistic and nuanced way, recognizing their relationship to neurodivergent traits and experiences.

Approaches to neurodiversity-affirming therapy may vary depending on the provider, but are always grounded in a few key principles. One is a strengths-based approach to neurodiversity, which sees the value of neurodivergent traits and supports us in identifying the inherent strengths in our neurodivergence. A strengths-based approach is positive and validating. It recognizes that despite our strengths, we face significant challenges because of an overall structural failure to accommodate our differences.

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Overall, neurodiversity-affirming therapy is empowering. By recognizing both the intrinsic value of us neurodivergent people as well as our challenges, affirming therapy services can help us advocate for ourselves and take actions that support our immediate and long-term well-being.

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Additionally, a neurodiversity-affirming therapist is well-informed around autism spectrum disorder, ADHD, and other neurodivergent identities. They are trained to support neurodivergent patients’ specific needs, and they understand how to employ appropriate clinical approaches for this group.

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Neurodiversity-affirming therapy is also flexible. Clinical approaches that help a neurotypical person may be supportive for a neurodivergent patient, too, but may also require adaptation. For example, dialectical behavior therapy (DBT) can be helpful for some neurodivergent individuals, and shifts such as introducing visual aids to help patients track skills might increase its impact.

Most therapists want their patients to feel affirmed. However, without specific training and knowledge about neurodivergent people’s experiences, providers may fall short.

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The healthcare system at large exhibits enormous gaps in understanding neurodivergence, particularly in adults. Many autistic individuals report negative experiences of receiving medical care. Autistic people have described difficulties with scheduling appointments by phone, traveling to providers’ offices, coping with the waiting room environment, communicating with their care team, and receiving dismissive, disrespectful treatment from their providers after disclosing their autism. 

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Without up-to-date training on neurodiversity, even providers with good intentions may do and say harmful things to neurodivergent patients. In my own experience, I have seen therapists—including ones I had positive relationships with—tell me I probably wasn’t autistic because my social skills were “too strong,” which ultimately delayed my official autism diagnosis.

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For a long time, reducing outward neurodivergent behaviors has been a major goal when treating this population. Neurodivergent people may learn to camouflage or mask, our neurodivergent traits can't be erased, nor should they be. These more traditional approaches fail to address the root causes that contribute to the challenges we face, leaving us traumatized and without real support.

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Therapy sessions can be one of the most hurtful environments where we confront bias and misinformation. Mental healthcare spaces are inherently vulnerable settings, and opening up to a provider who doesn’t see or support us can be traumatic. These kinds of experiences can drive neurodivergent patients away from care and support, further worsening our long-term mental health outcomes.

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Many clinical approaches can support neurodivergent patients if they are employed in a responsive and relevant way. When working with a neurodivergent client, therapists should build flexibility into their approaches. Many therapeutic approaches used for neurotypical patients may also work well for neurodivergent people, such as cognitive behavioral therapy (CBT). These approaches, however, may need to be adapted when recommendations come into conflict with neurodivergent traits.

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Mindfulness, for example, can be of great help to neurodivergent and neurotypical individuals alike. However, some neurodivergent people may struggle with traditional mindfulness practices like meditation. This is especially the case for neurodivergent people who experience difficulty focusing and shifting their attention at will.

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Dr. Elliot Gavin Keenan, a multiply neurodivergent psychologist, has identified some mindfulness exercises for neurodivergent individuals who struggle with meditation, including grounding in the five senses, practicing mindfulness of stimming and how it feels, and dedicating time to drinking a hot beverage and noticing all the sensations that come along with it. This flexibility in traditional approaches allows them to work with and for neurodivergent people, not against us.

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Neurodiversity affirming therapy also incorporates techniques and content areas specific to the challenges neurodivergent individuals often face. These include work around masking and unmasking; building connection to neurodivergent communities; supporting self-advocacy and communication skills; coping with and managing sensory overstimulation; and, of course, growing an understanding of a patient’s strengths and identity as a neurodivergent person.

Numerous therapists today have specific training in supporting neurodiverse patients. Many have a great deal of experience working with neurodivergent people, and some are neurodivergent themselves. At Prosper Health, 80% of therapists are either neurodivergent themselves or have a close family member who is neurodivergent.

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Before starting work with a potential therapist, it can be helpful to identify what is important to you in a provider. Prepare some questions to ask in your first session to help you determine whether they are a good fit. These can be questions about the provider’s experience, training, and approaches to working with neurodivergent people. The right questions to ask will depend on what is important to you personally, but could include questions like:

• “How long have you worked with neurodivergent patients?”
• “What clinical techniques do you use, and how do you tailor them to neurodivergent patients?”
• “What have you learned from neurodivergent patients that has improved your work as a therapist?”
  
  

As you begin working with a new provider, it’s important to make sure they meet your experiences as a neurodivergent person with understanding and support. A neurodiversity-affirming therapist should never seek to suppress their patients’ neurodivergent traits or make a patient feel bad about their neurodivergence.

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Many other neurodiversity-affirming resources exist, which can be valuable for self-paced exploration across various media, including print, video, and audio media. Neurodiversity-affirming therapists can help each individual find the appropriate resources for them. Prosper Health’s blog is also a great place to start to find diverse resources on autism with a neurodiversity-affirming focus.

Neurodiversity-affirming therapy should strive to eradicate barriers between neurodivergent people and care, offering a well-informed, supportive approach to mental health.

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To support and affirm neurodivergent people, therapists and administrators should incorporate systems that make care more accessible to us. This means offering telehealth appointments and the option to schedule appointments online. A straightforward interface for messaging providers and administrators online can also relieve the burden of calling to ask questions or to reschedule or cancel appointments. 

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Therapists should also make sure they are familiar with current research and clinical approaches to work with neurodivergent people. There are numerous professional development resources that can support this learning. Therapists can keep their understanding of neurodivergent identity and experiences fresh and nuanced by incorporating neurodivergent writers and creators into their reading, listening, and social media feeds. 

Without access to neurodiversity-affirming healthcare, neurodivergent people can fall out of care, avoiding medical settings to eschew retraumatization. With high rates of anxiety and depression among neurodivergent people, it’s essential to eliminate barriers between neurodivergent individuals and mental health supports. The growth of neurodiversity-affirming therapy approaches holds promise to bridge this gap.

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If you are looking for neurodiversity-affirming therapy, Prosper Health can help. Prosper’s therapists specialize in working with autistic and multiply neurodivergent adults and have deep expertise in supporting autistic adults with the challenges so many of us face, like disclosure, unmasking, autistic burnout and meltdowns.