Finding a suitable therapist if you are neurodivergent

I'm an ADHDer.* When I started out as a therapist, I worried that some of my ADHD traits would cause me difficulties in my work – distraction, forgetfulness, difficulties with routines, struggles with sensory overload – but I have my ways of coping with these.

When I needed a therapist, I was very fortunate to find a therapist that I clicked with immediately, who intuitively got me and communicated in a way that matched my own style. I have also had a few sessions in my life with therapists I just could not connect with, where it felt as if there was a chasm between us, that I could not traverse. The effort and time that went into trying to connect prevented me from being able to open up or be myself, so I felt exhausted, the sessions were pointless, and I ended them.

Having been a therapist for around 15 years, I now work solely with neurodivergent clients, and many of my clients have told me about previous (usually neurotypical) therapists who just did not understand them. For example:

• Many clients have been told to put up with bright lights or loud sounds, that they’re not changeable, or because they need to toughen up to cope in the outside world.
• ADHD clients have told me that they have been ‘told off’ for not focusing, for communicating in a tangential and seemingly distracted way.

I believe it is the job of the therapist to follow these paths and make sense of the rich landscape that is being created in front of them, finding the patterns that exist, and the discrepancies or conflicts in their client’s narrative. It is not for the client to try to communicate in a more linear or single-subject way.
 
I have had autistic clients tell me that they have been told to ‘imagine’ things or have been repeatedly asked about their feelings when their therapist knew they struggled with this, but believed they could ‘get it’ if they tried harder. Autistic clients tell me they’ve been scolded for being avoidant, when they don’t make eye contact.

I have a number of clients who regularly forget to pay or are late for sessions. Instead of assuming these are signs of problems within the therapeutic relationship (as traditional therapy training tells us), I am fully aware that for many ADHDers, forgetting things is just a feature of an ADHD brain, which occupies a different way of moving through time, and struggles to remember what is not a key focus. Yes, we still have boundaries around such things, but we also find solutions and agree on strategies to manage non-payment or lateness, should they arise, such as permission that I can send a small reminder or an agreement that they will set alarms.
 
We also inevitably end up covering issues around the neurotypical blueprints we have grown up around, and how there are limited blueprints available (if any) for neurodivergent adults, partners, or parents. We have to figure it all out ourselves, often with little support and, sometimes, with gaslighting from medical and educational professionals.
 
Self-disclosure is often vital, so clients know that they will be understood and not judged, that our operating systems will work well together, and we will not be shouting across a chasm of different lived experiences. Of course, who you work with is still important, not all neurodivergent therapists will be right for you, but I do believe there is a higher chance of connection if the wires connect more easily.

Tips for finding a neuro-affirming therapist

 If you want to work with a neurodivergent therapist, there are now many therapists that advertise as neuro-affirming, and many who disclose as being neurodivergent themselves.
 
If you are neurodivergent and have struggled with counselling or therapy before, never feeling that you are fully understood, or you worry you won’t find the right therapist, here are some tips for finding the right one for you:

• Ask for a free intro session, so you can spend some time just talking with your potential therapist.
  • Check if you feel they are able to adapt to suit your current levels of demand, either environmentally (especially if you’re in person) or the method by which you have therapy e.g. video, audio, SMS.
  • See if you feel they have expectations around how you communicate, or whether you are free to communicate in whatever way suits you best.
  • How do they react to neurodivergent eye contact? Is it an issue for them?
  • Do they mention anything about noises? How do they react if you ask them to change their headphones or turn off something in the background that is distracting for you? Are they supportive and positive, showing kindness; or do they refuse to make changes, or show annoyance?
  • Do you like them? This is very important, as important, I believe, as when you choose a partner or a friend.

• Ask about the therapist’s own experiences – both lived and in terms of education or training.
• Talk about things that haven’t worked with previous therapists. If you’ve never had therapy, talk about things that are difficulties in your day-to-day life, and that you worry may show up with your sessions. Ask how they would handle these things. Examples might include:
  • forgetting to pay
  • being late
  • struggling with regular session times
  • issues around eye contact
  • issues with noises or smells
  • whether they offer longer or shorter sessions than usual
  • whether they offer different frequencies of sessions (e.g. fortnightly or monthly, or even, ad hoc.)
• Think of the most difficult thing you have experienced with a therapist. If you’ve never had a therapist, think about the things you struggle with most with people in your life. Ask how they would deal with it, for example:
  • If you have RSD, ask how they might modify their ‘feedback’ so it doesn’t feel too harsh or painful for you.
  • How do they respond to an absence of eye contact?
  • How do they work with someone who is often criticised for tone of voice, accused of coming across as angry or defensive?
  • If you find it hard to remember or process verbal information, and you have talked about resources or strategies within your session, is your therapist willing and able to send you a note after your session? How else can they support you in this? Can they slow down the pace of sessions?
• Are they open to trying different ways of communicating, rather than requiring you to ‘bridge this gap’?
• Finally, you can change your mind, if you decide someone isn’t right for you.
  • My advice, if you feel OK to do so, would be to raise your concerns with the therapist first, either in writing or speaking, whatever works best for you.
  • See if they are able to respond in a way that brings you closer, rather than pushing you further away.
  • Their answer may reinforce your concerns and support a decision to find a new therapist, or you may feel that they responded in a good way, and you’re able to continue working with them.

You should never feel as if you have to mask or follow neurotypical rules when talking with your therapist. Sometimes turning the questions around can be very helpful – so “How does my therapist cope with my quirks or my way of communicating?” to see if they are able to work with you when you’re in your fully unmasked, most relaxed state. It shouldn’t be about whether you can reach or accommodate the therapist, but whether they can reach or accommodate you. The effort should be on their part in this sense. Your effort needs to be reserved for whatever it is you need to talk about or work through, not how you talk or work through things.

Your therapy sessions should always feel like a safe space for you – where you can be yourself without fear of being misunderstood, judged, or criticised.

Of course, you may sometimes feel sad or hurt or angry in your sessions, but you need to feel safe with your therapist so that this is a place where you can bring out the sides of yourself that perhaps usually remain hidden. You have the right to a space where you feel safe, and where you have the opportunity to learn and grow.