Have you ever sat in a therapy room and felt, deep down, that the approach simply wasn’t built for a brain like yours? Perhaps you were asked to challenge your thoughts or identify your feelings in a way that your brain never quite managed to do. Maybe you left session after session feeling more frustrated than when you arrived, wondering if something was fundamentally wrong with you rather than with the method.
As an Integrative Psychotherapist and Neurodiversity Coach, I work with a great many people who have spent years in therapy without it quite landing. Often, the missing piece is not motivation or effort. It is a mismatch between the therapeutic model and the way a neurodivergent mind actually works.
In this article, I want to explore why some of the most widely used therapy approaches can feel awkward or unhelpful for people with autism, people with ADHD and those with other forms of neurodivergence. I will also share what neurodiversity-affirming therapy actually looks like in practice and how you can get the most from any therapeutic or coaching experience.
The Problem with ‘One Size Fits All’ Therapy
The dominant models of talking therapy, particularly cognitive behavioural therapy (CBT) and traditional psychodynamic approaches, were largely developed without neurodivergent people in mind. This is not a criticism of the models themselves, which have notable strengths. It is simply an acknowledgement that they were designed for and tested on predominantly neurotypical populations. Here is where things can go wrong.
CBT and the Challenge of ‘Cognitive Restructuring’
CBT asks us to identify unhelpful thoughts, examine the evidence for and against them, and replace them with more balanced ones. For many people, this works well. For neurodivergent people, particularly those with ADHD or autism, the process can feel at odds with how their minds naturally operate.
People with autism often experience what is sometimes described as ‘monotropic’ thinking, a deep, intense focus that is a distinct cognitive difference, not a flaw. Being asked to quickly shift perspective, consider multiple simultaneous viewpoints or complete structured thought records between sessions can feel challenging, not because of resistance, but because of neurological wiring.
For people seeking ADHD therapy and coaching, the very structure of weekly homework tasks, consistent journaling and linear goal-setting can create a cycle of shame when executive function difficulties make these things hard to sustain. The therapy itself can inadvertently reinforce the sense of failure.
Psychodynamic Therapy and the Unspoken Assumptions
Traditional psychodynamic approaches rely heavily on open-ended reflection, free association and the exploration of unconscious processes. These elements can be valuable. However, for clients with autism in particular, the ambiguity of open-ended questions, the reliance on implicit communication and the expectation of understanding unspoken relational dynamics can create significant barriers.
Many people with autism, process language very literally and find implicit or indirect communication confusing. A therapist who responds to a direct question with a question of their own, or who uses metaphor without explanation, can leave a client feeling lost, dismissed or as though they are somehow doing therapy incorrectly. This is one of the reasons why neurodivergent coaching and neurodiversity affirming approaches can be so valuable, prioritising clarity, explicit communication and collaborative understanding.
For late-diagnosed neurodivergent adults who have spent years wondering why connection and communication have always felt effortful, sitting in a therapy that replicates those same relational challenges without naming them can be quite re traumatising.
Masking, Identity and the Therapy Room
One of the most important things to understand about neurodivergent experience is the concept of masking.
Masking and neurodivergence are closely linked: many autistic and ADHD people develop, often unconsciously, a carefully maintained performance of neurotypicality. They learn to suppress stimming, to mirror social expectations, to appear engaged and regulated even when internally overwhelmed.
The therapy room is not automatically a safe space to unmask. In fact, many neurodivergent people report masking heavily in therapy, working hard to present as the kind of client they imagine the therapist wants. This is exhausting, and it means that what the therapist sees is not always the whole person.
A neurodiversity affirming approach takes this seriously. It creates conditions in which masking is neither expected nor rewarded. This might mean being explicit about what is expected in a session, inviting the client to stim freely, allowing silence without interpreting it as resistance or offering a choice about where to sit or how to engage.
For many people, especially those working through identity after a neurodivergent diagnosis, the therapy room may be the first place they have been invited to take up space as they actually are. That is a profound and sometimes fragile experience and it requires a therapist who understands it.
What Neurodiversity Affirming Therapy Actually Looks Like
Neurodiversity affirming therapy is not a single modality. It is an orientation, a way of holding the therapeutic relationship that is woven through whichever approach a therapist uses. Here is what it looks like in practice.
It Starts with Understanding, Not Pathologising
A neurodiversity affirming therapist understands that autism, ADHD and other forms of neurodivergence are neurological differences, not deficits. This shapes everything. Rather than working to help a client behave more neurotypically, the work focuses on understanding the person’s own experience, needs and values.
This is especially important for people navigating a neurodivergent sense of self, particularly those who have recently received a diagnosis. An autism informed psychotherapy approach holds space for the grief, relief, anger and wonder that can accompany late diagnosis, without rushing the person toward any particular emotional destination.
It Is Explicit and Collaborative
Many neurodivergent people flourish when things are clear, predictable and transparent. A good neurodiversity affirming therapist will explain their approach, invite feedback, check in on what is and is not working and adapt accordingly. They will not assume that silence means comfort or that nodding means agreement.
In neurodivergent coaching, this collaborative quality is equally essential. Whether we are working on ADHD emotional regulation, navigating a late diagnosis or building strategies for managing burnout and masking, the client’s own expertise about their experience is always centred.
It Integrates, Rather Than Fragments
Rather than applying a rigid protocol, integrative psychotherapy draws on a range of theoretical frameworks and adapts them to the individual. This is particularly well suited to neurodivergent clients, whose profiles, histories and needs are rarely neatly categorised.
A trauma-informed approach sits alongside this, recognising that many neurodivergent people carry significant trauma, often from years of being misunderstood, overlooked or pathologised. Integrating trauma-informed therapy with neurodiversity-affirming practice means that the work addresses the whole person, not just presenting symptoms.
How to Get the Best Out of Therapy or Coaching as a Neurodivergent Person
Here are some things you can do that can genuinely help.
- Ask questions up front. It is entirely reasonable to ask a therapist how they approach neurodivergent clients, what their experience is and how flexible they are willing to be. A good therapist will welcome this.
- Name the masking. If you notice yourself performing in the session, that is worth saying aloud. You might simply say: ‘I think I’m presenting myself rather than being myself here.’ That moment of honesty can shift the whole dynamic.
- Tell them what helps. Do you need more structure or less? Do you prefer direct language? Does ambient noise help you focus or does it overwhelm you? Your therapist can only adapt if they know.
- Give it time, but not forever. It can take a few sessions to find a rhythm. But if after six or eight sessions something still feels fundamentally off, it is worth saying so or considering whether the match is right.
- Consider coaching alongside or instead of therapy. For some neurodivergent people, particularly those working on practical strategies, navigating workplace challenges or exploring identity post-diagnosis, ADHD or neurodiversity coaching may be a more useful fit at a given point in time.
Finding the Right Support
Therapy can be transformative for neurodivergent people. But it works best when the approach is adapted to the person, rather than the person adapting themselves to fit the approach. Neurodiversity affirming therapy is not a luxury or a specialism reserved for a few. It is what good therapy looks like when the whole person is taken seriously.
If you have had difficult experiences with therapy in the past, I would encourage you not to let those experiences be the final word. A therapist who understands neurodivergent experience can make an enormous difference, and that experience is out there.
Whether you are navigating neurodivergence and identity for the first time, managing the aftermath of a late diagnosis, or simply looking for a way of working that feels less like fitting into a box and more like being understood, you deserve support that is actually built for you.
I am AuDHD myself, and I work with neurodivergent adolescents and adults, including those navigating late diagnosis, burnout, trauma and identity questions, through integrative psychotherapy and neurodiversity coaching.
Sessions are available online and in person. If you’d like to explore whether my approach might be right for you, you are welcome to click here.
If you feel ready to take the next step, you are welcome to book an initial session here. I offer a compassionate and collaborative space to begin making sense of your experience at your own pace.
