Therapy as a neurodivergent person: ensuring your needs are met

Neurodiversity describes the natural differences in how human brains work. Autism, ADHD, dyslexia and other neurodivergent experiences are not defects to be fixed or cured – they are valid and valuable ways of thinking, processing and experiencing the world.

Many of the difficulties neurodivergent people face don’t come from who they are, but from environments that weren’t designed with them in mind. Therapy is no exception.

If therapy isn’t quite working for you – or if you’re looking for a counsellor and wondering how to choose one – this guide is here to help you think about what you might need in order to get the most from your sessions.

Therapy works best when you feel safe, understood, respected, not judged and able to learn and reflect in your own way. If those things aren’t in place, it’s not a personal failure. It may simply mean your needs aren’t being fully considered yet.

Below are some areas you might reflect on – and feel empowered to discuss with a therapist.

Adjustments to consider in therapy

Session length: does 50 minutes work for you?

For some people, 50 minutes of focused talking and listening feels manageable.
For others, it feels overwhelming, exhausting or even frightening.

You might prefer:

• shorter sessions (e.g. 30 minutes)
• extra time at the beginning to settle and regulate
• extra time at the end to recap and ground before leaving
• a slower pace within the session

If therapy feels draining rather than productive, this could be part of the reason. It is completely reasonable to ask whether sessions can be adjusted.

Breaks and regulation

Do you notice yourself:

• Losing focus?
• Feeling physically restless?
• Becoming mentally foggy?
• Shutting down?

You are allowed to ask for a break. A few minutes of standing up, stretching, deep breathing or stepping outside for fresh air can make a significant difference. Therapy does not have to mean sitting still and talking continuously.

Movement and fidgeting

Some people concentrate better when their hands are busy. 

You might benefit from:

• a fidget item
• doodling
• holding something textured
• moving in your chair

If you feel self-conscious about this, you can raise it with your therapist. A neurodiversity-affirming therapist will understand that movement can support focus rather than distract from it.

Seating and eye contact

Many neurodivergent people find direct eye contact uncomfortable or overwhelming.

If sitting face-to-face feels intense, you might prefer:

• sitting at an angle
• sitting side-by-side
• looking out of a window or at pictures on the wall while talking

Therapy does not require constant eye contact to be effective.

Your sensory experience matters

Overstimulation can make it almost impossible to think, reflect or feel safe. Consider whether anything in the room affects you:

Sight

• Is the space cluttered?
• Are there too many visual distractions?
• Is the lighting too bright?

Touch

• Is the chair uncomfortable?
• Is the temperature too hot or too cold?

Smell

• Is there an air freshener or a scent that overwhelms you?

Sound

• Is there a ticking clock?
• Traffic noise?
• A humming heater?

If something feels “off” but you can’t quite focus, it might be sensory. You are allowed to say so, and work with your therapist to make this comfortable.

Changes and predictability

Unexpected change can feel destabilising.

It can help to:

• know in advance if the session time will change
• be informed if the room layout will be different
• be told about any unavoidable noises
• receive reminders about appointments

If you find change difficult, that’s important information to share. A therapist who understands this will see it as part of building trust – not as an inconvenience.

Language and communication

Therapy often involves metaphor, symbolism and sometimes humour.

If you:

• prefer literal language
• find metaphors confusing
• take things at face value
• struggle to interpret tone

...you can say so. It is not your job to decode your therapist. Equally, your own communication style might be more direct, highly analytical or masked, for example. A good therapist will explore meaning with curiosity, not judgment.

Organisation and practical support

Executive functioning challenges can make therapy logistics stressful.

You might benefit from:

• appointment reminders
• clear payment instructions
• written summaries
• predictable scheduling
• support planning travel routes
• a consistent time slot

Struggling with organisation does not mean you are not committed to therapy. It may simply mean you need reasonable adjustments.

Preparing for the first session

Starting therapy can feel overwhelming – especially if you prefer predictability.

You might ask:

• What will the first session involve?
• How will it be structured?
• What kinds of questions might I be asked?
• Can I see photos or even a video clip of the room beforehand?
• Where exactly is the entrance?

Preparing in advance can help reduce anxiety significantly.

If therapy isn’t working for you

If you are in therapy and something feels “off,” consider:

• Do I feel understood as a neurodivergent person?
• Are my sensory and communication needs considered?
• Do I feel safe enough to be unmasked?
• Am I constantly exhausted after sessions?
• Do I feel I’m trying to adapt to the therapist rather than the other way around?

Sometimes therapy doesn’t work because the fit isn’t right – not because you are “too much” or “too difficult.” You are allowed to ask for adjustments, give feedback, request a review of how sessions are structured and even change therapists if needed. You deserve therapy that works for you.