10 Ways to Create a Neurodiversity-Affirming Therapy Space

Much research exists examining professionals' perspectives on working with neurodivergent clients and even the insights of parents with neurodivergent children in therapy. Still, the experiences of neurodivergent clients in therapy have been an under-researched topic. Yet, if we are seeking to support the needs of neurodivergent clients, the perceptions of those clients are pretty important. With the therapeutic alliance being the best predictor of positive outcomes in therapy (Lambert and Barley, 2001), and neurodivergent individuals often struggling with social connection, the subject is valuable.

A recent mixed-methods study examining the lived experience of autistic individuals in therapy found that many reported difficulties talking in therapy and integrating the strategies discussed into their lives, sometimes due to neurodivergent-specific needs (Mauzek et al., 2023). Research evaluating a group intervention for adults with ADHD found that many experienced some burden given the demands of the group, but appreciated the shared experiences. In both studies, many reported benefits (Norby et al., 2021). Acceptance and understanding from therapists and willingness to accommodate individual differences were reported to improve the quality of therapy.

What follows are 10 ways therapists can improve therapy experiences for neurodivergent clients.

1. Listen to Understand

Many psychotherapy protocols involve some structure, yet the majority also emphasize the importance of making therapy contextual. Neurodivergent clients often present unique presentations, stories, and perspectives. It is key for therapists to listen to these accounts with a desire to understand rather than jumping toward challenging what might be mislabeled as cognitive distortions or unhelpful thoughts. It is essential to suspend judgment and to validate the client's outlook on their life.

An interview study of 15 autistic women and 12 parents of autistic individuals who participated in eating disorder treatment found that many felt their neurodiversity-specific needs like having a different experience of hunger cues and particular sensory sensitivities often went unacknowledged (Babb et al., 2021). A simple humility of listening to understand the world through the eyes of someone who may see it differently than one's self is critical to effective therapy for autistic clients.

A clinician living with Tourette's Syndrome also published an open letter to the psychotherapy community in 2021 calling for more understanding of Tourette's. Much misconceptions exist and to provide effective therapy to neurodivergent clients we must recognize that these clients are the best experts in their experiences (Simpson, 2020).

2. Create a Sensory-Friendly Space

Aspects such as clutter, the rumble of a white noise machine, music in the waiting area, or bright fluorescent lights can be especially intrusive to neurodivergent clients. On the contrary, a variety of fidget tools nearby (such as stress balls and sequin pillows), multiple seating choices at different distances to the therapist (possibly including some on the ground such as a bean bag), and muted lights (such as an option of fairy lighting) can provide a more welcoming atmosphere. I keep a swing in my office to give clients a space to move about as we talk if they wish.

3. Give Options of Breaks and Movement

Therapy can be intense and sometimes overwhelming, especially for neurodivergent clients. Sometimes an option to pace the room or even step outside the room for a silent walk until grounding is regained is helpful toward self-regulation.

4. Provide Multiple Options for Communication

Not everyone processes and communicates most effectively with words. Pens, pencils, a musical instrument, the option to share a song, or even digital communication tools can give meaningful alternatives. I have often encouraged clients who write to consider writing a list of topics to discuss or even bringing in writing to share. In education settings, visual supports are especially effective in helping autistic individuals learn new information (Hu et al., 2021). Those with ADHD often find it easier to communicate while moving about and so a walk and talk option is sometimes appreciated.

When problem-solving or discussing topics of psychoeducation, I have often found it helpful to draw a visual that the client can also alter. It becomes a concrete reminder that the person can take home and revisit, it keeps us focused, and it makes it easier for the client to correct misunderstandings shown visually.

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5. Don't Assume That Something Related to One's Neurodivergence Is a Problem

A neurodiversity-affirming stance takes a perspective that autism is in itself nothing to be treated, but that neurodivergent individuals may benefit from assistance in working through mismatches with their environment and accompanying social and emotional challenges. Many neurodivergent people find behaviors that others have historically pathologized, such as stimming (repeated motions/sounds for self-soothing such as hair twirling, rocking, or humming) to give a sense of comfort or fidgeting, to not be problematic at all. A qualitative study of seven adults who participated in applied behavior analysis (ABA) as children, a psychotherapy that has traditionally focused on decreasing neurodivergent behavior, found that these seven adults universally felt negative about the intervention (Anderson, 2023).

6. Focus on Empowerment and Self-Advocacy

Much of the distress reported by neurodivergent individuals often stems from systemic challenges. These difficulties can range from trouble gaining employment due to a different interviewing style to problems asserting one's needs in a relationship. Neurodivergent individuals are also at an unfortunate high risk for intimate partner violence. Interventions that empower the client to recognize and effectively communicate their needs in these areas are sometimes necessary. At times, this includes the therapist joining in advocacy efforts, such as attending a school education planning meeting with a client and their family. Self-advocacy may be especially important to neurodivergent clients who are attending college. Recognizing a need for, determining the process of, selecting, and applying for accommodations are daunting processes for anyone.

7. Listen to Neurodivergent Voices

One of the best ways we can learn about neurodivergent strengths and challenges is to listen to neurodivergent voices. The voice of the client in the room with you is important, however, attending training with neurodivergent clinicians, reading memoirs by neurodivergent writers, and otherwise accessing the perspective of other neurodivergent people can also go a way toward gaining a better understanding of what this means.

8. Avoid Stereotyping

It has been said that if you have met one autistic person, you have met one autistic person. The same goes for ADHD, learning disabilities, Tourette's Syndrome and the whole umbrella of neurodivergence. Avoid assumptions. While there are some common themes in neurodivergent experiences, the individual needs, strengths, and preferences of each client will vary. Utilize what you learn to gain awareness, but verify the relevance for any given person.

9. Ask for Feedback

Research shows that therapists' reviews of therapy sessions and the therapeutic alliance often vary quite a bit (Bachelor, 2013). It can only be imagined that when the therapist and client have different neurotypes, that gap is likely to be even larger. Asking how each session has gone and the relevance of the tools discussed to the client's life at the end of the session, and following up on the integration of these tools at the beginning of sessions, might help to bridge this.

10. Be Kind to Yourself

Your willingness to create a more neurodivergent-affirming experience for your clients is meaningful. Still, it can take time. Every client's needs are unique. Give yourself kindness as you learn and grow.