Therapy When You're Neurodivergent: What You Need to Know

You sit across from your therapist. They ask, "How does that make you feel?" You draw a blank. Not because you don't have feelings—you have plenty—but because translating the complex, layered sensory-emotional-cognitive experience you're having into a simple emotion word feels impossible. You say "fine" or "I don't know," and you can see the disappointment flicker across their face.

Or maybe they suggest you keep a mood journal. You try. You really do. But executive function chaos means you forget, or you write three weeks' worth in one sitting and can't remember which day was which, or you get so absorbed in perfecting the format that you never actually record anything useful.

Or perhaps you're told to "just communicate your needs clearly" in relationships, but you genuinely don't know what your needs are half the time, and when you do, you can't figure out if they're reasonable or how to articulate them without either over-explaining for twenty minutes or saying nothing at all.

If any of this sounds familiar, you're not alone. Therapy designed for neurotypical brains often misses the mark for neurodivergent people—not because therapy doesn't work, but because standard approaches don't account for how your brain actually processes information, relationships, and emotions.

Let's talk about what neurodivergent-affirming therapy looks like and how to find it.

TL;DR:

• Neurodivergent brains (ADHD, autism, dyslexia, etc.) process emotions, sensory input, and social interaction differently
• Traditional therapy often assumes neurotypical communication styles and emotional awareness
• Neurodivergent-affirming therapy adapts to your brain, not the other way around
• Key adaptations: flexible formats, explicit communication, sensory considerations, executive function support
• Masking and trauma from living in a neurotypical world often need specific addressing
• The right therapist understands neurodivergence as difference, not deficit

What Is Neurodivergence?

Neurodivergent describes brains that function differently from the statistically "typical" brain. It's an umbrella term that includes:

• ADHD (Attention Deficit Hyperactivity Disorder)
• Autism (Autism Spectrum Condition/Disorder)
• Dyslexia, dyscalculia, dyspraxia (Specific learning differences)
• Tourette syndrome and tic disorders
• Synesthesia
• Some also include: OCD, schizophrenia, bipolar, acquired neurodivergence (brain injury, stroke)

Neurodiversity is the concept that neurological differences are natural variations in the human genome, not inherently pathological. Neurodivergent brains aren't broken neurotypical brains—they're different operating systems with distinct strengths and challenges.

This distinction matters in therapy because it shifts the goal from "fixing" you to helping you thrive as your neurodivergent self.

Why Standard Therapy Often Fails Neurodivergent People

Let's be specific about where conventional therapy struggles:

1. Emotional Awareness Assumptions

Therapists often ask: "What are you feeling right now?"

For many neurodivergent people—particularly autistic individuals—emotional awareness (alexithymia) is genuinely difficult. You might experience emotions as physical sensations, thought spirals, or overwhelming intensity without clear labels. You're not repressing or avoiding; you genuinely can't identify "sad" vs "anxious" vs "frustrated" in the moment.

Standard therapy assumes you can name feelings. Neurodivergent-affirming therapy teaches you how.

2. Neurotypical Communication Norms

Traditional therapy values:

• Unprompted emotional disclosure
• Reading between the lines
• Picking up on therapist's subtle cues
• Small talk and social niceties

Neurodivergent communication is often:

• Direct and literal
• Context-dependent (you might need prompts or questions)
• Low on performative social niceties
• Confused by indirect communication ("How are you feeling?" when they want specifics about your week)

Mismatches here can lead therapists to misinterpret honesty as defensiveness, literal interpretation as lack of insight, or need for explicit questions as passive resistance.

3. Eye Contact Expectations

Many neurodivergent people—especially autistic individuals—find sustained eye contact uncomfortable, distracting, or painful. It's not rudeness; it's neurological.

Neurotypical therapists may interpret lack of eye contact as disengagement or evasiveness. Neurodivergent-affirming therapists understand that looking away might help you think more clearly.

4. Sensory Environment Ignored

Therapy rooms often have:

• Fluorescent lighting
• Strong air freshener or cleaning product smell
• Uncomfortable chairs
• Clocks that tick loudly
• Background hum from ventilation

For neurodivergent people with sensory sensitivities, these aren't minor annoyances—they're significant barriers to feeling safe and being able to process emotionally. A neurotypical person might notice mild discomfort; a neurodivergent person might be in fight-or-flight mode before therapy even starts.

5. Executive Function Homework

"Between sessions, I want you to journal daily, practice this technique, and reflect on these questions."

For ADHD and autistic brains, which often struggle with executive function:

• Remembering to do homework is hard
• Initiating tasks without external structure is hard
• Estimating how long tasks take is hard
• Translating intentions into action is hard

When you don't complete homework, therapists may assume lack of motivation. In reality, it's neurological. You want to do it; you can't reliably execute it.

6. Masking Goes Unrecognised

Many neurodivergent people—especially women and AFAB individuals—develop sophisticated "masking": camouflaging neurodivergent traits to appear neurotypical.

Masking is exhausting and contributes to burnout, anxiety, and loss of identity. But it can be invisible to therapists who don't know what to look for. You present as articulate, socially capable, making eye contact—so the therapist misses the immense effort you're expending to appear fine.

Neurodivergent-affirming therapists help you unmask safely.

7. Trauma Isn't Framed Neurodivergently

Growing up neurodivergent in a neurotypical world is often traumatic:

• Constant correction: "Sit still," "Look at me," "Stop that," "Why are you like this?"
• Social rejection and bullying
• Feeling fundamentally wrong or broken
• Chronic overstimulation
• Misdiagnosis or dismissal of genuine struggles

This isn't "trauma" in the classic PTSD sense—it's chronic relational trauma. Standard therapy may explore your anxiety or depression without connecting it to the lifelong experience of being neurodivergent in spaces designed for neurotypical brains.

What Neurodivergent-Affirming Therapy Looks Like

1. Explicit, Direct Communication

Neurodivergent-affirming therapists:

• Ask clear, specific questions rather than open-ended prompts
• State intentions directly: "I'm asking this to understand your experience, not to judge"
• Check understanding: "Does that make sense?" "Am I understanding you correctly?"
• Don't rely on subtext or "reading between the lines"

Example: Standard: "How did that conversation with your mum go?" Neurodivergent-affirming: "When you spoke with your mum this week, what did you notice about your emotional reactions? Or if you're not sure about emotions, what did you notice in your body or thoughts?"

2. Flexible Session Formats

Standard therapy format: 50 minutes, sitting in chairs, face-to-face

Adapted formats might include:

• Walking therapy (movement helps ADHD brains focus)
• Online sessions (reduced sensory overwhelm, comfortable environment)
• Side-by-side seating (less intense than face-to-face)
• Fidget tools available
• Adjustable lighting or permission to wear sunglasses
• Movement breaks
• Shorter, more frequent sessions if sustained attention is difficult

3. Sensory Accommodations

Good neurodivergent therapists:

• Use soft lighting (lamps, not fluorescent)
• Avoid strong scents
• Provide options for seating (firm vs soft chairs, cushions, floor seating)
• Minimise background noise
• Ask about your sensory needs upfront

They understand that if you're sensorily overwhelmed, therapy can't happen effectively.

4. Executive Function Support

Instead of generic homework, neurodivergent-affirming therapists:

• Break tasks into tiny, specific steps
• Set reminders during the session with you
• Provide written or recorded session summaries
• Use visual aids, diagrams, or apps
• Accept that homework might not happen and don't shame you

They recognise that intention ≠ execution for executive-function-challenged brains.

5. Validation of Neurodivergent Experience

Standard therapy: "Why do you avoid social events? Let's explore that." Neurodivergent-affirming: "Social events are exhausting for many autistic/ADHD people because they require constant code-switching and sensory management. That makes complete sense. Let's talk about how to navigate that without pushing yourself to breaking point."

The difference is normalisation. Your experiences aren't pathologised—they're understood as part of being neurodivergent.

6. Unmasking Support

Neurodivergent-affirming therapy actively explores:

• What does masking look like for you?
• What's the cost of masking?
• In what contexts can you unmask safely?
• What's underneath the mask?
• How do you reconnect with your authentic self?

This is delicate work. Unmasking can feel vulnerable, frightening, or even identity-destabilising. A skilled therapist helps you do this at your own pace.

7. Practical, Concrete Strategies

Neurodivergent brains often benefit from:

• Specific scripts for social situations
• Visual organisers or checklists
• Concrete coping mechanisms (not vague "self-care")
• Systems thinking: how to build routines that work with your brain

Theory is useful, but neurodivergent people often need actionable, specific tools.

8. Co-Occurring Conditions Addressed Holistically

Anxiety, depression, and trauma are common in neurodivergent people. Good therapy addresses:

• How does neurodivergence contribute to your anxiety? (Sensory overload, social confusion, executive dysfunction stress)
• How does your environment fail to accommodate neurodivergence, leading to chronic stress?
• How can we build resilience as a neurodivergent person, not by forcing yourself to be neurotypical?

Finding a Neurodivergent-Affirming Therapist

Green Flags:

1. They explicitly mention neurodiversity in their profile "Neurodivergent-affirming," "ADHD-informed," "autism-friendly," "experience with autistic adults"—these phrases signal awareness.

2. They understand the social model of disability They frame challenges as often arising from mismatched environments, not inherent brokenness.

3. They're open to adapting their approach When you ask, "Can I fidget during sessions?" or "Can we do therapy online?", they respond with "Absolutely, whatever helps you feel comfortable."

4. They don't pathologise stimming, special interests, or sensory needs They recognise these as neurodivergent features, not symptoms to eliminate.

5. They ask about your sensory needs and executive function challenges upfront

6. They validate masking and its costs They understand why you mask, recognise the exhaustion it causes, and don't pressure you to unmask before you're ready.

Red Flags:

1. "Everyone's a little bit ADHD/autistic" This minimises your experience and suggests lack of understanding.

2. Focus on "fixing" neurodivergent traits E.g., "Let's work on making more eye contact" rather than "Let's explore why eye contact is hard and find what works for you."

3. Dismissive of self-diagnosis While formal diagnosis has value, many neurodivergent people—especially women, people of colour, and late-identified individuals—self-identify first. A good therapist respects this.

4. Rigid about therapy format "This is how I work; if you can't do it this way, therapy won't work for you." Hard pass.

5. Confused or defensive when you ask about neurodivergence expertise If they seem uncomfortable with questions about their experience with neurodivergent clients, keep looking.

Questions to Ask Prospective Therapists:

• "Do you have experience working with neurodivergent adults?"
• "How would you adapt your approach for someone with ADHD/autism?"
• "What's your understanding of masking?"
• "Are you flexible about session format—walking, online, fidgeting, lighting adjustments?"
• "How do you approach homework if executive function is challenging?"
• "What's your stance on eye contact and neurotypical social norms?"

Their answers will tell you whether they genuinely understand neurodivergence.

Specific Considerations by Neurodivergence Type

ADHD

Challenges in therapy:

• Attention wandering
• Difficulty sitting still
• Forgetting between-session tasks
• Time blindness (losing track during session, forgetting what was discussed last week)
• Emotional dysregulation (feelings spike fast and intense)

Helpful adaptations:

• Movement-based therapy (walking, fidgets)
• Shorter sessions or built-in breaks
• Session summaries sent via email
• Reminders set during the session
• Acceptance that homework might not happen

Autism

Challenges in therapy:

• Literal interpretation of language
• Difficulty identifying emotions
• Sensory sensitivities
• Social communication differences
• Masking exhaustion
• Need for predictability and routine

Helpful adaptations:

• Direct, explicit language
• Consistent session structure
• Sensory accommodations
• Focus on practical strategies over abstract emotional exploration
• Validation of autistic experience and communication style

Dyslexia/Dyscalculia

Challenges in therapy:

• Written homework may be inaccessible
• Reading therapy materials is slow and effortful
• Forms and assessments can be barriers

Helpful adaptations:

• Voice memos instead of written tasks
• Verbal processing preferred
• Patience with reading/writing tasks
• Provision of materials in accessible formats

Multiple Neurodivergences (Common!)

Many people are "multiply neurodivergent"—ADHD + autism, ADHD + dyslexia, etc. Each combination creates unique needs. A good therapist understands this complexity rather than treating you as a checklist of symptoms.

Therapy Goals for Neurodivergent People

Standard therapy goals (reduce symptoms, improve functioning) can feel deficit-focused. Neurodivergent-affirming therapy goals might include:

• Understanding yourself: How does your brain work? What are your needs?
• Building self-compassion: Unlearning internalised shame
• Developing accommodations: What systems and supports help you thrive?
• Navigating a neurotypical world: How to advocate for yourself, set boundaries, conserve energy
• Healing trauma: Processing experiences of rejection, misunderstanding, and chronic invalidation
• Connecting with community: Finding neurodivergent peers and spaces
• Unmasking safely: Reconnecting with your authentic self

The goal isn't to become more neurotypical—it's to live well as yourself.

Medication and Therapy

For some neurodivergences (particularly ADHD), medication can be transformative. It doesn't "cure" neurodivergence, but it can:

• Improve attention regulation
• Reduce impulsivity
• Enhance executive function
• Support emotional regulation

Combining medication with therapy often produces better outcomes than either alone. Therapy helps you build skills and process experiences; medication supports your brain's ability to engage with those strategies.

Not everyone chooses medication, and that's valid. A good therapist supports your informed choice.

Self-Advocacy in Therapy

You have the right to:

• Ask for adaptations (lighting, seating, session length, fidgeting)
• Request direct communication
• Question approaches that don't feel right
• Say "I don't understand" or "Can you explain that differently?"
• End the therapeutic relationship if it's not working

Neurodivergent people are often socialised to be compliant and not "cause trouble." But therapy is for you. If something isn't working, speak up. A good therapist will welcome it.

Final Thoughts

If therapy hasn't worked for you in the past, please don't assume therapy just "isn't for you."

It's far more likely that you encountered therapy designed for a brain that isn't yours.

Neurodivergent-affirming therapy exists. Therapists who understand how ADHD, autism, and other neurodivergences shape experience exist. Spaces where you don't have to mask, force eye contact, or pretend to be neurotypical exist.

You deserve support that meets you where you are—not support that demands you contort yourself into neurotypical shapes.

Your brain isn't broken. It's just running different software. And with the right therapist, that software can be understood, celebrated, and supported.

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Looking for neurodivergent-affirming therapy in London or online? I'm Annabel Kicks, a BACP-registered therapist with experience working with ADHD, autistic, and other neurodivergent clients. I offer flexible formats including walking therapy and online sessions, and I prioritise explicit communication and sensory accommodation. Book a free 15-minute consultation to discuss how we might work together.