Neurodivergent Therapy
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Therapy with Autism & ADHD (especially Late-Diagnosed)

✨ Or gifted, or OCD, or complex PTSD, or bipolar, and on and on - oh, how the list goes on of all the things we’re learning these days were “a thing” all along, and not just us being “too much,” “too sensitive.” ✨

Well, first off, here’s what we mean by “late-diagnosed.” We mean recently, or at least recently in comparison to childhood. We mean you understood yourself and lived your life a certain way for most of your life, and now have a whole new lens on yourself and the world to consider yourself through.

Usually you’re gonna be navigating some pretty complex emotions that bubble up after a late diagnosis. Maybe a mix of grief for lost time or opportunities, relief at finally understanding yourself, and probably some anger or confusion (and why so often the billowing waves of needing to scream - right now - into the void . . .in the most inopportune moments??).

Sigh. We know personally 🙋🏽 that it can take some time, patience, and energy to sift through and untangle the impact of years of masking,  misinterpretations, and feeling misunderstood. And we are sending so much support and warmth to you right now.

The Hope Preserve team are fans of conserving precious executive function (mental and emotional energy), so here are some bullet points about some of the things we’ve learned to honor in this space. We’re still learning and open, but no matter what, always, what matters most is what you need, and in which ways it would be helpful to you for us to be with you in this.

Themes you might explore when working with a neurodivergent-affirming therapist:

• Life Changes:

  • Yep, this new understanding may affect how you view and interact with every aspect of your life (friends, family, partners, work, interests, grocery shopping, concerts, probably just about everything)

  • Exploring how your diagnosis (or potentially suspected diagnosis) impacts not just your relationships, career, etc., but your overall sense of self

  • Supporting you through major life decisions or adjustments that might come from your newfound (and ever-evolving) self-understanding

• Re-introduction to Self (Finding Your Identity):

  • Embracing your authentic neurodivergent identity and coming to terms with the internalized shame and self-doubt

  • Rediscovering your strengths, passions, and unique way of being in the world

• Executive Functioning:

  • Collaborating with you to find practical (and realistic for your unique situation) strategies and tools to navigate challenges with executive function - things like organization, time management, and task initiation

  • Offering a supportive space for body doubling to help you stay focused and motivated

• Self-Regulation/Coping Skills:

  • Learning personalized coping skills to manage overwhelm, sensory overload, and emotional dysregulation

  • Creating a toolbox of strategies that help you navigate daily life with more ease and confidence

• Therapy for Comorbid Diagnoses or Experiences:

  • Honoring the interconnectedness of your late diagnosis with other experiences like anxiety, depression, PTSD/C-PTSD, and sometimes with chronic physical pain, sensitivties, and illness, too

  • Providing a safe space to process the impact of years without adequate support or understanding

• Unmasking:

  • Exploring in an emotionally safe place how it feels to experiment with unmasking - like playing with fidgets, not giving eye contact, sitting “weird” on the couch, and not being judged for interrupting, info-dumping, going on tangents, etc.

  • Exploring what it means to live authentically and connect with others from a place of genuineness, at the speed and level that feels safe and right for you. We all know that unmasking is not necessarily safe just anywhere

• Boundary Work:

  • Developing sustainable boundaries in relationships, honoring your needs and communicating them effectively

  • Navigating changes in existing relationships and building new connections that feel more safe and supportive

• Self-Acceptance/Removing and Reclaiming Labels:

  • Cultivating self-compassion and acceptance for all parts of yourself, reckoning with internalized negative messages

  • Challenging societal labels and embracing your unique neurodivergent identity

• ADHD/Autistic Burnout:

  • Recognizing the signs of burnout and developing strategies for prevention and recovery

  • Customizing accommodations and support systems to help you manage your energy and avoid overwhelm

• Reckoning with New Levels of Awareness

  • You might have a growing awareness of ableism you’ve encountered that’s been harmful to you

  • You might bump into your own internalized ableism

  • Feelings of anger, injustice, grief, etc.

That is a lot! It’s not a prescription, and it’s not a to-do list. We just want to give you enough info to know that there are plenty of ways you deserve support in this world, and that you don’t have to figure it out all by yourself. Please let us know if you’d like our support.

One more thing we’d like to acknowledge that deserves its own set of bullet points. . . Most therapy techniques need to be adjusted a little for neurodivergent folks, and this isn’t stuff that’s widely taught in therapy trainings. So as you go to therapy, please know you can always ask your therapist to try a different way.

Therapeutic Mindset in Neurodivergent Therapy

• A therapist needs to be flexible-minded, not deadset and dogmatic that their technique is the only way, or the “right” way

  • Even (or especially? 👀) the strictly-administered evidenced-based techniques that doctors often suggest like Cognitive Behavioral Therapy (CBT) and other techniques that stem from it like Dialectical Behavior Therapy (DBT), and Acceptance and Commitment Therapy (ACT) need to be adapted or maybe not even used.

    • It can seem like evidence-based must work for everyone, but most studies don’t control for neurodivergence, so even if we rely purely on the numbers and not the person in front of us, we can’t just take the numbers at face value.

    • No matter what a study says, you’re the only you needing exactly what you need in this particular moment.

    • With neurodivergent and traumatized folks, challenging your beliefs/cognitions sometimes can be plain irrational or shaming instead of healing.

  • And even the generally more personalized mind-body trauma-focused techniques like IFS parts work, EMDR, Brainspotting, etc. need to be adapted for reasons we’ll list below.

• The one thing we don’t mind generalizing about research is that again and again, studies seem to suggest that beyond all methods, the one factor that most affects the therapy process is the relationship between the therapist and client. You feeling seen, heard, felt, and understood, and feeling supported by someone you can share with who really gets you - that’s what matters most. You matter most.

Neurodivergent Accommodations in Therapy

Some considerations a neurodivergent-aware therapist will be attuned to in personalizing your therapy experience and not assuming the same ol’ ways are helpful for everyone:

• Sensory-processing

  • The environment that therapy sessions take place in matters. Therapists need to be aware of sensory systems being both overstimulated and understimulated in therapy. We’ve got a list of some of those things on our home page.

  • Clients with tactile sensitivity may feel icky (or awesome) if they touch sand in sandtray therapy, or they may hate (or adore) the buzz of the EMDR paddles for folks who try that out.

• Auditory-processing - Why can’t we have subtitles on real-time conversations?

  • First off, in our office we do a lot to reduce competing sounds in the office, so you can focus on just the words being said.

  • And you’re invited to ask your therapist to repeat, to clarify, to turn off the white noise, or even to try one of our many styles of therapy that don’t require you to speak back and forth with your therapist much at all.

• Alexithymia - “And how does that make you feel [folded knuckles moving slowly to tilted chin]” - it’s the classic therapy question, right?

  • Some neurodivergent folks can’t identify or even describe a feeling, and a good therapist doesn’t force it.

  • If it’s a skill you want to learn, cool, we’ve got ways we can try to help, but we’ve also got ways to completely work around it so we can meet you right where you are instead of putting the burden on you to jump through our therapy hoops.

• Interoception - being able to feel and interpret a sensation in your body

  • A lot of our mind-body and mindfulness-based modalities ask you to notice something in your body, ask you where you feel an emotion in your body, or ask what happens in your body when you think of a situation or memory. This is a really cool way to work for people with high interoception. But sometimes we don’t have a connection to this innate ability, either because of neurodivergence, trauma, or just living in a mind-focused Western society.

  • So again, if you’d like to try to develop this skill, we can see if we can help. Or if you don’t want to do the modalities that rely on this ability, great, we have so many other ways to work. Or if you still want to do modalities like EMDR, Brainspotting, and IFS parts work that call on this ability, we’ve got workarounds and we don’t even have to use the interoception aspect for it to still be a great experience.

  • Sometimes people get criticized for not being able to “get out of your head and into your body.” First of all, criticism has no place in therapy. Second, it’s great to remember, especially with autism and some other expressions of neurodivergence, that logical, verbal, and cognitive experiences are not just legitimate but beautifully productive for healing.

• Aphantasia - limited or zero access to mental imagery or visualization

  • Mindfulness and meditation techniques, and modalities like EMDR, Brainspotting, and IFS parts work use this ability, and not everyone has it!

  • There is plenty of great work to be done without visual imagery, and a great therapist will be open to your experience and flexible enough to pivot to a way you do experience things.

• PDA - “Pathological Demand Avoidance,” (can we lose that pathologizing name yet?) or Pervasive Drive for Autonomy, and its gentler relative Demand Avoidance

  • If it feels like you’re being told what to do or being pushed into something, your nervous system may shut you down or set you off 😤, and it’s important that therapists honor that this isn’t a “behavior issue” but a nervous system you’re working with.

  • There are plenty of guidelines we’ve learned to stay aware of when working with PDA, and we do, but we think a lot of what is good for demand avoidant nervous systems is just respectful to and empowering of everyone, and something we aim to do with everyone with our trauma-attuned focus - always prioritizing client autonomy, choice, consent, and being curious and inviting rather than inserting our directives, agendas, or interpretations from the outside.

So again: even if a bunch of this resonates with you, you don’t have to do it all at once to start feeling better. And we know it may feel like it’ll take forever to feel a difference.

Even a little breather of feeling a tad better, or a tad more understood, can help so much - and then maybe even let you take the next tiny step that could help you feel even a little better.

We’d be honored to help you breathe a little easier any way we can.