Psychotherapy for neurodivergent people: you are the expert in your life
Psychotherapy for neurodivergent people is rarely a topic in psychotherapy training. Neurodivergence is a way of talking about how we humans are neurologically different and have different characteristics and abilities. In exactly the same way, we can talk about how our body height varies. That is, about 68% of us are within the norm and the rest of us are outside when you look at a normal distribution curve. Some scientists believe that this variance has had an evolutionary advantage, especially in groups. Neurodivergent is something you are your whole life and includes labels such as Highly Sensitive Person (HSP), ADD, ADHD, Autism (ASD), Asperger's and dyslexia. Neurodivergent people typically have a very uneven, "spiky" skill profile, meaning neurodivergent people can be extremely good at some things and be really challenged at others. Your neurotype can influence how you perceive and sense the world around you, how you think and learn, and how you relate to other people. There is a growing consensus that neurodivergence is something biological you are born with and not a result of how you were raised or from trauma (including PSTD or C-PTSD). This "what causes it" discussion is ongoing and there is no clear conclusion other than that the physiological and the psychological are connected.
If we assume that neurodivergence is something biologically innate, then there will be a lot of psychological theories and conversational practices that are inaccurate or do not apply to the neurodivergent group.
This has implications for how psychotherapists and psychologists, for example, can best help with psychotherapy for neurodivergent people.
Steph Jones has just published a book: "The autistic survival guide to therapy" (2024), where she explains how psychotherapy can hurt or miss the mark when it comes to people with autism. This is despite the fact that a large proportion of clients seeking therapy may well have autism or be neurodivergent. Many of her perspectives are relevant to the neurodivergent community. In the book, she summarizes that psychotherapy for people with autism should best assume that "you are the expert in your own life and you must develop a way of living your life that is good for you". The therapist should therefore not necessarily "fix" the client, but help the client discover if the life situation and environment the client is in is good for the client, or help the client discover good life strategies. A therapist who believes that a person's sensitivity or attention disorder should only be explained and treated from a trauma perspective from early childhood may make the client feel wrong and not get help for their mental health. This is not to say that there can't be developmental trauma, dilemmas, crises, self-esteem issues and other issues that need to be addressed as well. Steph Jones encourages people with autism to be wary of therapies that don't help them and highlights the benefits of choosing a therapist who has the same neurotype as you. An important benefit can be that you have the opportunity to talk to someone who is well placed to understand your situation and can speak to you with a common language. Steph Jones recommends that psychotherapy for neurodivergent people should be very much client-driven, but can also include counseling, as long as the "client is the expert in their own life".
Existential psychotherapy is a form of therapy that focuses on how you live your life and what is good for your mental health. You are the expert in your life. The approach is not based on psychological models or general advice that fits the average person. Existential therapy is therefore a gentle approach that can be used for all neurotypes, including psychotherapy for neurodivergent people. The therapist will invite you to different considerations, but you know best.
You can help your therapist by sharing a little about how communication works best for you. Maybe you need to draw? Maybe it's good for you to express an emotion by sharing a piece of music with your therapist. Maybe the light in the conversation room is too bright? Maybe you feel most comfortable in online conversations where you can also communicate in writing? Maybe the temperature in the room isn't right? Perhaps you need to bring your instrument or knitting? The therapist will usually help you so it can be good to be you. The more you are clear with you, the more you allow the therapist to meet you right where you are.
Steph Jones mentions that she has benefited from Existential Psychotherapy and also mentions the benefits of short-term therapy. You should choose to only see your therapist for as long as it benefits you. You are the one who knows what is good for you. Longer sessions can be beneficial, but Steph Jones encourages you as a neurodivergent to notice if you feel met and seen by your therapist. We know from other research that it's the relationship that benefits clients. People with autism are familiar with the Theory of Mind and the Double Empathy Theory. These theories indicate that it can be harder to feel met and seen by a neurotype that is different from yours. If you are familiar with feeling understood by a more diverse group of people, I would be careful to choose your therapist based on their neurotype. Many psychotherapists have worked with many aspects of themselves as part of their training and will often be able to recognize themselves in many of your experiences. If this is not the case, you will quickly recognize it and can act on it. To add to Steph Jones' perspective, I would like to add that it can have a positive effect to be with a person who does not immediately understand your experience from the inside: you are forced to step forward as you are and practice explaining yourself so that your experiences become clear to everyone in the room. In psychotherapy for neurodivergent as well as neurotypical people, this "not understanding" can be used to create clarity. In general, it is in being with other people that we become clear to ourselves.
If you have any questions, feel free to contact me.
Selected sources:
"The autistic survival guide to therapy" by Steph Jones (2024)
Podcast: The agile roots, episode 43: Confidence in being yourself - and other benefits of embracing neurodiversity
Youtube: Autism From The Inside on trauma vs. autism
Autism (ASD) is one of several neurotypes.