How to find the right therapy for your neurotype

Anxiety is something we all experience and is a normal part of being human. Given the fact that everyone experiences anxiety, why is it that some groups of people are more likely to be anxious than others?

It is estimated that whilst just under 9% of neurotypical people (people who are not neurodivergent) experience anxiety, the figure for someone who is autistic is more than double at 20% (Nimmo-Smith Et al, 2019) 

Both neurotypical and autistic people live in the same world, so what explains this difference, and why is it relevant to the type of therapy a client receives?

Let’s first consider what autism is. Even now, there are a great many myths posited about what autism is. On a basic level, it can be understood by considering the different neurobiology of an autistic person compared to that of neurotypicals. This difference affects how an autistic person experiences the world, and also impacts the thought process and behaviours of that person.

So, what is it about the neurobiology that makes autistic people more likely to be anxious? As human beings, as we grow from birth into adulthood, the brain undergoes synaptic pruning. In other words, the pathways that we don't use, we lose, so our brains can become more efficient. When we are growing up, we are experiencing everything for the first time, so we need all of these synapses, but as time goes on, we find that we don't need them all, so the ones that are used less get pruned, whilst the ones used more regularly become more efficient.  

By the age of 25 years old, an average neurotypical person has lost up to 50% of these synapses. In contrast, an average autistic person has lost only 16%. Given the fact that the function of these synapses is to help us experience the world, you can begin to imagine how a hyper-connected brain might impact a person’s senses and, therefore, how they experience the world.

So, given this difference in experiencing the world, and the fact that most therapies were designed by neurotypical people for neurotypical people and do not account for this difference in experiencing the world, it is perhaps no wonder that autistic clients tend to fair worse in terms of therapeutic outcomes unless therapy is designed for their neurotype.

As a client, therefore, if you are autistic, what difference might you want and expect to see that would tell you the therapist was tailoring the therapy around your neurotype?

The first thing you would want is for your therapist to consider, 'What does anxiety actually look like for my client?' The question might sound obvious, for example, you'd expect, being fidgety, not being able to make eye contact, and being jumpy if there is a loud or unexpected noise, as common symptoms of anxiety. The trouble is that this discourse of what anxiety looks like has come from the dominant narrative which, as you may imagine, tends to come from a neurotypical perspective. Given the fact that they make up the majority of the population (85%), this makes sense. Unfortunately, however, whilst it makes sense, it is not necessarily helpful for autistic clients.

What might look like anxiety from an outside perspective might be just a way of navigating and managing a neurotypical world for someone who is autistic. For example, if someone is fidgety, they may have hypo awareness of their vestibular and proprioceptive senses, so what may look like fidgeting is actually a way of self-stimulating (stimming) to help maintain awareness of their body in space and sensory seeking, be soothing and functional and therefore not something that needs to and be worked on in therapy. Your therapist needs to consider the function of behaviour rather than just the behaviour. It is never just what you see; they need to always consider the why as well as the what.

You would also want your therapist to try as hard as they can to hold no assumptions and listen to your narrative, which will inevitably be different from the dominant neurotypical narrative. If your therapist is doing this, spending time questioning their own assumptions and being aware of their own process, it is going to be helpful in making sure you, as the client, truly feel heard and the therapist understands you from your perspective. 

As well as listening to the client’s narrative, you might want your therapist to introduce some psycho-education on the eight senses. Whilst some clients are aware of the eight senses and how they experience the world differently compared to neurotypical people, the chances are that for most clients, they are unaware of how they experience the world differently from the majority of the population. After all, it is all they have ever known and is their normal.

When experiences are normalised in therapy and the narrative updated, a great deal of positive change can happen. Imagine, as a client, having gone your whole life feeling that you were somehow different to others and therefore deficient in some way, but you couldn't quite work out why. Now imagine that light bulb moment that might be experienced when a client realises, for example, that they have a hypersensitivity to certain noises which they can manage with noise-cancelling headphones, and that this is OK and doesn't mean they can't cope but are just managing their sensory needs.

In a nutshell, autistic people experience the world in a different way; this does not make them deficient or defective, just different. Being autistic and living in a neurotypical world can create challenges that are often misunderstood or minimised by the neurotypical majority. Tailoring therapy is essential to achieve the best outcome for clients. When this is done, it helps the client to reframe their experiences as their normal and helps them look for, identify and use their strengths rather than seeing themselves as deficient or less than.