Supporting Therapy Clients' Identification as Neurodivergent

A few months ago, I facilitated a training group that included a mix of hypnotherapists and counselors. When the subject of autism came up, as it often does when discussing some of the issues our clients are facing, one of the group members laughed disparagingly and expressed their dislike of "labels." Despite the increasing numbers of people diagnosed with autism and attention-deficit/hyperactivity disorder (ADHD) and the growing number of therapists who identify as neurodivergent, alongside a rising awareness of neurodivergence amongst therapists, there are still some therapists who feel that it is unhealthy for their clients to seek out a diagnosis or identify as neurodivergent.

Going back about 10 years, one of my counseling tutors was of this opinion. Unless somebody very clearly struggled to the extent they were unable to live their lives independently, she refused to accept the validity of autism and ADHD in, as she put it, their "mild" forms. I regularly hear from clients that this attitude persists among some therapists.

It's an attitude that is extremely damaging to clients for the following reasons:

We can't find the root of our client's issues

Supporting a client requires a long-term commitment, and creating positive change can take months or years. As therapists, we often focus on helping our clients gain awareness about why they are experiencing issues, including exploring the roots of their problems. If we refuse to accept that our client may be neurodivergent, we run the risk of looking for the root of their current issues in the wrong place. We need to remain open to the fact that their current-day issues might have more to do with the fact that their brain processes things differently than it does to childhood trauma.

We explore unworkable solutions

If we refuse to accept that some people's brains work differently from most, we risk pushing our clients too far and adopting a one-size-fits-all approach to our client work. Simone experienced this with her cognitive behavioral therapy (CBT) therapist who, she felt, continually pushed her beyond her comfort zone.

"I was feeling out of my depth, and therapy was making me more anxious. I realised I wasn't responding in the way my therapist seemed to expect. I was starting to think that part of the reason I hadn't been getting far with therapy was because I was autistic. When I discussed that possibility with my therapist, she told me she didn't believe in labels and that 'all this autism stuff is a bit of a fad.'"

Validation and respect

When someone has experienced a lifetime of problems or feeling different from others, finally finding an explanation for why that is the case is inherently validating. It's upsetting, confusing, and stressful going through life with a sense that you just "don't fit in" or can't manage the things that most people can, and undiagnosed adults commonly experience issues with self-esteem. It's hugely validating when they finally make the link that they have a brain that processes the world differently than most people. Most therapists respect the concept of unconditional positive regard, which requires acceptance, support, and an empathic response, regardless of what your client presents to you. However, some therapists display a lack of regard for their clients' opinions and ideas when discussing the possibility of being neurodivergent.

Roger told me, "I'd been with my therapist for about two years, and it took me a while to open up to her about things I'd done in the past, which I was ashamed about. She was so supportive, even when it came to some really bad behaviour. Our therapy was all about trying to increase my awareness, but when I revealed what I'd learned about ADHD and how I felt it fitted with my experience, she refused to discuss or explore it further, saying that she didn't see me that way."

Exploring possibilities

If someone has a diagnosis, is seeking a diagnosis, or has chosen to identify as neurodivergent, they have done so for a reason. As a therapist, if you refuse to engage with your client's experience, you're shutting down an entire route for investigation and exploration. It might be that your client would not meet the diagnostic criteria for, for instance, autism or ADHD, but they may have traits that differ from most people. Being open to the fact that some clients process the world in a way that is different from most people opens up the possibility of new ways of working with them.

Elaine told me that she discussed the possibility of being autistic with her therapist, who was "very open to the idea, even though she knew very little about autism. Being able to feel supported while I explored things further was so helpful. I'm on a waiting list for a diagnosis, which could take years, but together, we've explored solutions based on the fact that I could be autistic, which has taken therapy in a different direction and has been really useful."

When I first started working as a therapist, it was very rare for me to come across a client who was diagnosed with autism or ADHD or who identified as neurodivergent. Over the last few years, it's become commonplace, and it's fair to say it probably represents one of the most significant shifts therapists have faced. Ruling out a client's curiosity or initial explorations into neurodivergence with skepticism or a refusal to listen to our clients means that we're going against the grain of the core belief that most therapists hold, which is that our clients are the ultimate experts on themselves.

Educating ourselves about the broad spectrum of people's experiences is essential, as is understanding the perspective of clients who identify as neurodivergent with or without a formal diagnosis. Acknowledging that someone may be neurodivergent does not mean forgetting all the work you have done together and other factors that have impacted them. For instance, if someone has a trauma history, that continues to be significant whether or not they are also autistic. But acknowledging that someone's way of processing the world may differ from most people's, and that there is "something else" that cannot be explained by their past experiences, allows you to continue to work in a way that is supportive, open and respectful of your client's opinion. Refusing to move forward in this way risks limiting the work you do with your clients.