Working therapeutically with neurodiversity
By bringing greater awareness to autism and ADHD traits, therapists can better understand a client’s experience and create a more responsive, compassionate therapeutic relationship.
Like many therapists, I work with a wide range of clients, from neurotypical to neurodivergent. As my practice has developed, however, I have become increasingly aware of how important it is to bring an understanding of neurodiversity into the counselling room.
Clients do not usually arrive in therapy expecting to talk about autism or ADHD. More often, it emerges gradually: a client may tentatively mention traits they have noticed in themselves, wonder aloud whether they are “a bit ADHD”, or describe lifelong feelings of being different, overwhelmed or misunderstood. At other times, neurodivergence may not yet be in the client’s awareness at all, yet their way of experiencing and responding to the world invites us, as therapists, to think differently.
In these moments, it is not our role to diagnose or to impose a label. Rather, it is to remain curious and allow the possibility of neurodiversity to inform the way we work. Neurodivergence shapes how individuals perceive, process and relate to the world around them. When we hold this in mind, it can transform how we understand a client’s difficulties, how we interpret their experiences, and how we respond within the therapeutic relationship.
In this blog, I reflect on the nuances of working therapeutically with clients who may have undiagnosed autism or ADHD, and on how an integrative, relational approach can be particularly effective for this client group.
All clients experience and process their presenting issues uniquely, but by developing an understanding of ADHD and autism spectrum condition (ASC) traits, we can become more aware of the potential layers of challenge beneath the presenting issue.
When a client uses the word “stress”, for example, we might consider whether they are experiencing overwhelm. If repeated misunderstandings arise within personal relationships, we may wonder whether this reflects a “double empathy” problem rather than a social deficit. Missing these nuances can limit our understanding of the client and their lived experience.
In working with neurodiversity, whether diagnosed or undiagnosed, my focus is on self-actualisation and strengthening self-esteem and confidence. Working integratively allows me to be flexible, drawing on person-centred, cognitive and psychodynamic theory to inform the work. It enables me to use what is happening in the room to understand how the individual relates to others, to consider the impact of past experiences on their view of themselves—including areas of unmet need—and to help them use both cognition and felt sense to find a way forward.
Working with neurodiversity involves staying open to new perspectives and maintaining curiosity. I seek to understand what supports clients as well as what challenges them, noticing attitudes and behaviours that may function as coping strategies. In neurodivergent clients, these may range from rule-following or pacing themselves, to rehearsing responses or approaching things creatively.
At the more harmful end of the spectrum lies masking, along with restrictive or limiting behaviours that are detrimental to wellbeing. It is my role to normalise all forms of processing and coping, and to work with the client to explore where these strategies are helpful or unhelpful, and what their limitations might be.
For individuals experiencing low self-esteem or low self-worth, I explore what may be sustaining their critical inner voice whilst also encouraging self-kindness. In neurodivergent clients, this may involve examining what maintains feelings of separation, difference or exclusion, and gently questioning any labels they may have adopted for themselves or received from others.
Working cognitively and collaboratively creates space for these labels to be reframed, rejected or accepted.
Alongside this, I explore clients’ strengths and what they value about themselves, helping them to connect with their inherent worth and move towards greater self-acceptance. This can shift the focus towards identifying the conditions they need in order to feel secure and safe.
Self-care may be a new concept, and I explore what feels soothing and fulfilling for each client, normalising and reinforcing whatever methods they can draw upon. Therapy can give clients permission for this self-kindness, perhaps for the first time.
I often work with felt sense as the basis for my therapeutic approach, but this can sometimes be counterproductive for neurodivergent clients. If feelings are particularly difficult for a client to access, recognise or describe, it is important that this is noticed and brought into the room.
This allows us to work collaboratively to identify what emotions may be present—for example, by paying attention to physical sensations in the body and exploring what these might be telling us.
Above all, the relationship I build with a client underpins every intervention and approach. This relationship is the foundation of our work together and is particularly important for clients who may have concerns about how they relate to others or who perceive themselves as somehow “different”.
Through carefully considered reflections and interpretations, and by offering kindness, consistency and respect, I aim to foster trust and understanding, reinforcing the possibility of fulfilling relationships beyond the counselling room.
I believe it is part of our duty of care as counsellors not to assume neurotypicality when working with clients. Bringing an awareness of differences in cognitive, social and emotional processing into our work is not about judgement or stereotyping. Rather, it adds an extra layer of sensitivity to the therapeutic process and increases our capacity to build healing relationships.
Abbi Bradford is an integrative counsellor and psychotherapist practising at the Tunbridge Wells Centre. For more information: abbibradfordcounselling.co.uk
