Neurodiversity affirming therapy
Say it louder for the people in the back.
Neurodivergent people cannot be learnt about in textbooks, but instead from direct reports of their lived-experiences.
To understand what neurodiversity affirming therapy is, you first must understand non-neurodiversity affirming therapy is. When I studied at university, neurodiversity wasn’t even a word that came up. Therapy strategies were primarily based on the medical model, which holds the basis of - people with disabilities have ‘problems’ which they come to therapists to ‘fix’. All intervention strategies were based upon the therapist helping the individual live a ‘normal’ life, which involved suppressing behaviours, masking, invalidation of personal experiences and encouraging the individual to behave in a non-authentic way. Therapy interventions were based primarily on the parent’s goals and very rarely focused on what the child wanted to work on themselves.
So what is the issue with this? Well. What happens to a child when they are constantly trying to act in a way that isn’t natural or authentic for them? They grow into adults who have had their personal experiences invalidated for most of their life and they start to feel the need to mask in certain situations leading to extreme burnout. They grow into adults who feel that behaving in their authentic way is wrong, doing things to please others rather than address their own needs. They feel guilty when they cannot live up to a neurotypical person’s standard of productivity and success at the same rate. They start to believe the narrative that they are the problem, rather than those around them who are not accepting of deviating neurotypes and the behaviour which comes with this. In any other scenario, it would be considered extremely outrageous for one person to ask another to act/look/behave in a way more pleasing, comfortable or familiar to them. For neurodivergent individuals, this is what their reality has been for a very long time.
Therapists were taught (and in some cases are still taught) to teach children how to communicate, how to learn and the ‘correct’ way to process their experiences. The belief behind this was that a child would not live a successful life if they continued to act the way they were acting. Teachers in schools were taught to encourage children to sit still, legs crossed and maintaining eye contact when learning otherwise they were seen as not listening, not learning and for this - reprimanded. What we know now, based on lived experiences of neurodivergent individuals is that they are able to actually focus better when they have the freedom to stim, move their body, change position and fidget while learning. Basically the polar opposite of what we were taught as therapists at university.
The Neurodiversity affirming movement is a social justice movement which acknowledges the unique ways that all people learn, behave and process experiences. The neurodiversity movement does not in any way try to change the way that neurotypical people behave, instead aims to educate and promote that all brains work in different ways and should all be respected.
What we know now, is that therapeutic interventions should not be based on generalised and pathologized information from medical textbooks but instead from the voices of lived-experience individuals, asking the client exactly what they would like to work towards, and basing interventions on this instead.
There are many ways that therapists now try to assist neurodivergent people reach their goals, such as focusing on strengths, promoting autonomy and having the flexibility to tailor intervention strategies to the individual. Intervention strategies which feel unnatural to the client are not sustainable in the long run. For example, if the parent’s goal for the child is to sit at the table while they do their homework, we now ask questions like “where are they most comfortable, can they complete their work there instead?”. There have been several cases where the child has had the freedom to complete their homework while laying on the floor in their bedroom, where they have then been able to receive the body pressure sensory input they require to focus and have in turn been much more successful with this goal. Goals should be based on what the individual wants to work on, what they believe feels more natural and what will work long term.
Neurodiversity affirming therapists now aim to remove the mindset that the client is the problem, and instead acknowledge that all neurotypes have different ways of communicating, understanding and processing the world around them. The only reason we are aware of this information is because of the lived-experience advocates who have used their voices to share their experiences and suggestions which they believe will help the next generation of neurodivergent individuals live happy, successful and meaningful lives. Disabilities are now understood to be disabling only at times but not all functioning is completely impacted by a diagnosis.
Goals set by therapists are now being re-worded to instead be neurodiversity affirming and remove ableist terms and lenses.
Non-neurodiversity affirming goal:
“client will learn phrases, responses and appropriate eye contact to develop friendships with their peers”
Neurodiversity affirming goal:
“client will learn about their own neurodivergent communication style and ways to connect with others in an authentic way, to encourage sustainable friendships”
Non-neurodiversity affirming goal:
“client will learn ways to sit still on the mat in class, look at the teacher and stay focused to assist with learning and not distract others”
Neurodiversity affirming goal:
“client will explore tools to assist with regulation and focus, using adaptive strategies and equipment if required, to assist with focusing in a way that feels most natural to them”
Neurodiversity affirming therapy still has a long way to go, however with acceptance, education and advocacy, this movement is starting to enhance the lives of neurodivergent clients through therapy.
The neurodiversity movement has been the catalyst for change in the therapy world and has already changed the experience of many neurodivergent people, navigating their therapy journey and other areas of life.
