266 Working with Neurodivergent Clients

Welcome everybody. Again to the therapy show. This is episode 266. And today alas, we have no Bob, no Bob Cook, no Mr. Wonderful Bob Cook. Instead, we have a guest speaker Amy Peters. And together we'll be focusing on working with neurodivergent clients. So, welcome Amy. >> Hi Simon. >> Perhaps you could tell us a little bit about yourself. How you came to be interested in this subject that is of great interest I'm sure to to everybody listening of certainly of relevance to everybody listening. >> Yeah, of course. Yeah, hi Simon. My name is Amy Peters. So, I'm a counselor and I work down in Kent and I have my log cabin here. And I work have specialized in working with neurodivergent clients for some time now. Mainly because I am a late diagnosed autistic and ADHD person. So, I came to my diagnosis a little while ago and it's been a real sort of unpicking of things for me and understanding myself and also understanding the way that I am in the therapy room with specifically neurodivergent clients who I just seem to attract from the very beginning anyway. So, it was just something that kind of I ended up falling into. And really it's something that this sort of framework that I come from, which is the neurodivergent affirming therapy framework really, is one which has been for myself quite transformative to view myself in this way and I also find that it is generally for clients. So, this is something that I started to put that into trainings for counselors and therapists. I created resources. And there was a real thirst from the people that I was training and people and supervisees and so on. So, I then ended up writing a book most recently and yeah, put put all of that together really what that I'd learned because I wanted to produce the book I really needed when I came out of my training really and into placement. >> And the name of your book is? >> Oh, yes, [clears throat] Neurodivergent Affirming Therapy. There you go. And it's Rethinking Approaches for Autistic and ADHD Clients. >> Okay. Okay, thanks. I have not read all of it. I've skimmed some of it and um I'm was struck by one of the sentence one of the phrases in that and that was the the the traditional deficit-based model of therapy. Could you as as a contrast of with neurodivergent, could you explain what you mean by that? >> Yeah, of course. So, in terms if I talk about neurodivergence, neurodivergence is very broad, but um because I'm autistic and ADHD, if we look at it just for those things for a for a second, autism and ADHD have traditionally been seen through this lens of disorder and deficit, which is essentially the medicalized model. It's the medical medical model where um we've seen autistic people as having disordered communication or deficits [clears throat] in different areas in the same for ADHD. And that is where that is the pervasive model really that we've all grown up with, we've all had embedded into all of our systems, into our health system, into our education system, into our legal system. It's sort of made its way into these systems. And it really positions there being one right way of being almost, like one way of being healthy in inverted commas, or one way of having a certain kind of communication. And it really doesn't allow for diversity. So, that's the kind of medical model where we see them as So, it would position someone like me as having potentially All right, I'm struggling with eye contact, that would be seen as a deficit, just as an example. Whereas, the neurodiversity paradigm, which is the kind of approach that underpins all my work, the neurodiversity paradigm says that the difference is just a natural range of in our human life. It's just a it's just a natural range of diversity, if you like. And that's very much where the approach comes from, is actually seeing this as differences as opposed to deficits. >> Okay. >> And I do think when it comes to therapy, that actually really aligns with what we're doing with clients generally anyway, much more so than positioning certain ways of communicating as deficits. See what I mean? >> Yeah. Yeah. Yeah. Um I've worked a lot in in Japan where there is a sense that um some of the behaviors that people evidence in daily life are not uncomfortable for neurodiverse individuals in terms there's no touching, there's no eye contact is is is rare. However, um in schools and your your book's written from a Western perspective. In Japan, neurodiversity is seen as almost a discipline problem and no allowances are made. Um we all have to be Watashi tachi Nihonjin ja we Japanese, which means we are all the same. >> Mhm. >> And it's a it's can be Well, I haven't been there for some for 10 years or so. It's can be a quite a a a cruel way of of um of existing in the education system. Anyway, anyway, back to you. So, neurodivergent, it covers a broad range. >> Yes, definitely. So, neurodivergence essentially refers to natural differences in the way people might express themselves or experience the world or function within it. And the word neurodivergence is supposed to be a neutral term. It's a social term. It you can't be diagnosed with neurodivergence. It's not a medicalized term. And what it does is it encompasses many things like autism and ADHD, but also dyslexia, dyspraxia, Tourette's, Down syndrome, schizophrenia, personality disorders. Like there's such a huge amount under that umbrella in terms of neurodivergence. And really, we can kind of think about it as anybody whose experience or maybe their expression as well diverges from what the dominant societal norm is. So, it's interesting you're saying about Japan because their dominant societal norm would look quite different and the sort of standards that people are supposed to live to, those kind of unwritten social rules, will be quite different to maybe where we are in the UK. But essentially, what we're talking about is anyone whose experience don't um diverges from that dominant societal norm and therefore we find it perhaps more difficult to live up to those standards. >> Mhm. Okay. Um so, uh you talk about um one another feature of your book was the the phrase neurodivergent trauma. Could you Could you explain what you mean by that? Or, says he, with a pretty good suspicion about what you're going to say. >> So, neurodivergent people, it will come as no surprise probably to anyone listening, are more susceptible to that kind of big T trauma, the kind of the trauma that we think of. They're more susceptible to victimization, to bullying, to abuse. And that's for a variety of reasons. There's lots of risk factors there. But on top of that, being neurodivergent in a world that is not set up for you, can be traumatic in itself. Now, that could be where we have maybe diff- uh different experiences that our nervous systems as a neurodivergent person, my neuro- my um nervous system might experience that as traumatic. Whereas to the general population, quite possibly it might not be considered that. So, for example, it may be uh having a conversation with a shopkeeper or something. It wouldn't necessarily be considered as mis- if a miscommunication happened, it wouldn't necessarily be considered generally as being traumatic, but that can be experienced and and encoded by us as traumatic. And we get this reinforcement when these miscommunications happen. We have this reinforcement of it's not okay to be yourself. You need to basically pretend to be someone else or to pretend to be something else in order to get by and be accepted. So, we end up masking that neurodivergence in lots of different ways. Many of us do. Not everybody masks. But then, of course, that just increases that shame and self-blame and becomes a bit of a cycle because the more we mask, the more we feel we're only acceptable as someone else. And then, when miscommuni- communications happen again with other people, then that cycle just continues and we get this sort of cycle of unmet needs, really chronic unmet needs. And so, that's where I talk about neurodivergent trauma as being a very specific kind of trauma. And it's very similar to the minority stress model because it's things that are unseen by others quite often. And of course, that then means that can be minimized. Your experiences can be minimized as a result. So, I do think it's really important for therapists and counselors to sort of understand that neurodivergent trauma can be layered on top of the trauma that we would already be potentially seeing. >> Yeah, I hear um that there's that sense of the in-group and the out-group. And again, I go back to my experiences and my children's experiences of living abroad and always being on the out-group and not knowing the kind of the right cues and the right clues. But this is much more fundamental because these are with individuals are dealing with people much closer to home, parents, family, uh schools, shopkeepers, whatever uh on a consistent basis. >> Yes, so absolutely, like you say, it's reinforced because it's on that consistent basis. And for a lot of people, so particularly groups of women and people of color, uh we're not diagnosed when we were children, quite um quite commonly not diagnosed. It wasn't recognized. So, something like autism and ADHD certainly wasn't recognized in women and girls and people of color, as I say. And what's happening is there are sort of swaths of us now who are starting to understand ourselves now we have more knowledge, we have more access to information, we're identifying ourselves as such. And that comes with a a huge amount of kind of unpicking and realizing that these cycles have been happening all along. But we didn't know it. So, we were having to assimilate to a society, as we all do, all of us will will do that. But we were doing that sometimes feeling very different from other people, but not knowing why. >> Mhm. >> And of course, what we do if we don't know why, we tend to blame ourselves. >> Mhm. >> So, that we just have this huge amount of shame usually around being ourselves and and being that authentic self. >> Okay. And back bring it back to therapy and counseling, many therapists would describe themselves as neuro neurodivergent friendly. What's the difference in your view between the neurodivergent friendly and genuinely neurodivergent affirming? >> I think therapists can be highly skilled, genuinely caring, giving UPR to all their clients. They can mean well, but if their knowledge about some of these things comes from an uninformed place and from that medical model I was talking about earlier, the impact can still be that a neurodivergent client is harmed in the process. And neurodivergent friendly might be something like we can think of providing fidget tools in our therapy room, we can think of adjusting our lighting or sort of thinking about the sensory environment or even adapting the therapy, but genuinely neurodivergent affirming also has to include the inner work for therapists, I think. And that includes looking at things like our own internalized ableism, how we've absorbed all these messages over the years. It includes thinking about intersectionality, so thinking through that intersectional lens about different cultural experiences and how that might impact somebody who's also neurodivergent and the other identities they might have as well. And also includes unlearning those biases and messages. And that takes a lot of work and I think can sometimes be uncomfortable, too. But that is the work that I believe we really need to be doing for our neurodivergent clients. >> And the idea of diagnosis, you've mentioned the word twice now. Your opinion, good, bad? Context depends on? Carry on. >> Yeah. So, diagnosis in terms of let's say autism and ADHD, as I say, that's that's where I'm coming from here. I think diagnosis is often necessary in the UK at least at the moment to get access to support, to understand ourselves, and also when we think about people who might be late diagnosed for various reasons, then we often might need that um affirmation or validation from the professional cuz we've always looked to people in those roles to be able to sort of give us the piece of paper, if you like, to say, "Yes, you are definitely autistic. You are definitely ADHD." Because there's so much doubt, self-doubt around this stuff. So, that often happens, I think. But equally, certainly within my practice, I work with a lot of people who aren't diagnosed. They might be self-diagnosed. And in the UK at the moment, our waiting lists are absolutely huge because so many people are playing catch-up because they didn't know this about themselves when they were younger. They learn as I say, they've got more information. So, the waiting lists are huge. If you want to go private, it's very expensive. So, that's prohibitive for a lot of people. Um so, certainly I feel self-diagnosis is valid. And also self-identification. And so, I work with a lot of people from that perspective. So, I really see it as a neutral thing. I see it as something that I know a lot of us need to still engage in that medical model in order to get the supports that we might need. Um and some people will choose to do it and some people won't choose to do it. Um so, yeah, the neurodivergent affirming approach certainly doesn't discount the diagnosis. It it really does affirm the need for those things when needed when when needed, you know. >> I work with a number of or I have worked with a number of individuals going through the criminal justice system, uh the legal system. And the diagnosis is really, really useful. And yet almost the people I see, few, if any, have one. And when you look at prison populations, the the percentage on that of neurodivergent individuals is much higher than it would be in the normal population. I think I've heard figures like 40% or 25% yeah. Yeah. >> Yeah, it it is and I think particularly ADHD um in prisons the the prevalence of ADHD is very high and specifically and as you say a lot of people will be undiagnosed so they won't even realize that that's happening and the criminal justice system is also another system which has these kind of we call them neuro normative standards embedded in them so those unwritten rules about how life is supposed to be how we're supposed to communicate how we're supposed to express emotion they're all embedded in our systems including the criminal justice one. >> Well they're they're in intimidating for neuro normative individuals. >> Absolutely. >> to be so for a neuro divergent person I would imagine well I've I've heard they're even worse. Okay um what about um uh neuro divergent therapists? >> Mhm. >> Uh can you talk a little bit about about that? >> Yeah so as a neuro divergent therapist myself I think I've had to adapt my of course my therapy for neuro divergent clients as we're talking about but I've also had to adapt my own working practices to accommodate for myself. That's something that's taken many years to figure this stuff out for me and I still am uncovering kind of new needs that I hadn't identified that had been suppressed essentially. >> Mhm. >> That do affect my business and do affect my practice and do affect the way that I work. And I think for neuro divergent therapists even if we we take it back to training some training is is inaccessible for neuro divergent people. Um and again systems that are kind of embedded with this stuff it makes it much more difficult for us to potentially access things so that might be in terms of academic work. >> Okay. >> I'm not having the supports we need, or it might be in terms of the social factors of adult learning. All sorts of things go into it. But, yeah, I think partic- particularly I love the fact that as a neurodivergent therapist with a neurodivergent client in front of me, there is a sort of shorthand often that can happen, and and the sort of way we communicate is is fairly similar, not always similar, obviously, but fairly similar. And that can be a real bonus, I think. And I have a chapter, sorry, at the end of each chapter in the book, I have a section which is for the neurodivergent therapist. >> Yeah, I noticed. >> Deliberately to kind of look at what are the challenges and things to do with that chapter and to do with what's going on and we've just discussed. What are the challenges? What are the things we can learn as the neurodivergent reader of the book, really? Because I really wanted to center neurodivergent people in the book as much as possible. >> Okay. Okay. Um back to models then. How do traditional therapeutic models sometimes fall short for neurodivergent clients? And can or should they be abandoned or adapted or you know, some rejected, some accepted? I thinking I was I was going to say I was thinking of Gestalt, which is not always particularly Um what's the word? Friendly. Uh Can be quite dark. Anyway, you you're the expert. You tell me. >> All right. I I think it's really interesting. So, I definitely think the majority of models I've ever come across, anyway, and modalities can definitely be adapted, for sure. Like, I don't think we we need to abandon them, but or reject them in any way. As I was saying before about these the systems, you know, in society, our modalities are shaped by those systems and by the dominant narratives at the time they were conceived really. They were the idea came about. So, things like ableism, things like racism are embedded in those modalities. And I think often we don't critique them enough. We don't kind of sit there and and think, well, how does this work for for these different clients we're working with? So, often within those frameworks, difference is pathologized. So, whether that's neurodivergence, whether that's cultural difference, so, you know, it might be all sorts of different things. Because they're often neurocentric kind of ideas that we've taken on in our modalities. So, for neurodivergent clients in particular, there might be ideas embedded about what healthy looks like, what normal in inverted commas looks like, what typical expression is, all of those things. So, I think for us, we need to be aware of how those modalities can take us down that path of pathologizing that difference. And just make sure that we are adapting them as best we can to really be able to affirm our neurodivergent clients and other clients, obviously. You know, this this applies to everyone, too. But to be able to critique them and adapt them in a way that is going to be genuinely effective for the majority of our clients, I think. >> Mhm. Mhm. Mhm. I started practice about 10 years ago and um on a number of occasions, I had clients come in the room and I would think, okay, so this individual is is has a schizoid process, unable to feel or this individual is coming from a chaotic background, completely chaotic background. And um later, they've had a diagnosis and I've understood that there's a neurodiversity issue. But actually I'm not wrong or I wasn't wrong because one feeds into the other. >> Yeah, and all of those things could be true. This is the thing. >> Yeah. >> And neurodivergence can sit alongside each other. So, there's often co-occurring neurodivergencies in there. So, there's that as well. We mentioned trauma earlier. So, trauma can sit alongside and and cause all sorts of different things going on with that presentation. So, yeah, absolutely. And I think for the majority of us we would have stories like that where we've seen people in a client in a particular way and then later realized potentially yes, there might have been some neurodivergence there or something that we've missed that they've missed and that's very common. And I really want to say actually that that we're doing this work and as I say it can be uncomfortable work. But it's about keeping learning. You know, often we can feel a bit of shame or a bit of worry about those things and then sort of looking back and realizing that oh, maybe we used language that we wouldn't use now with that client or maybe we've made an assumption that we wouldn't now. The whole point is we're learning and I think you know, we know more now and this is the information that I think is needed now to be able to adapt our practices really. >> Okay, good. I I Yeah, I love this job. I'm always I'm always learning. I'm always learning. >> Yeah. >> So, how how do you think therapists can start creating more affirming spaces, Amy? >> [clears throat] >> So, if I if I were to go away today and and want to implement put something in in in place. >> I think there's there's lots of practical elements we can talk about, but I think one of the main things is learning from neurodivergent people. So, learning from lived experience. Rather than that when I talked about the medical model earlier, a lot of books and resources are were designed kind of from the outside in and the the idea of the outside expert rather than actually listening to the people themselves. So that's the biggest thing that I would say is listen to sort of lived experience. And so that could be through biographies, you know, it could be through different books and so on, but it could be through neurodivergent creators online and and so on. So there's lots of different ways you can do that. And I also think getting curious about our own assumptions, doing all of that stuff, which as you say like it's it's it's what we do, isn't it? We we learn so much about ourselves, so much about our clients as we go along. So I think continuing continuing to do that. But in terms of practical things, I think it is about collaborating with your clients, checking in with them a bit more. Particularly for autistic clients, we like clarity. We really need that clarity. And often I think in therapy we might be not left in the dark as such as a client, but but maybe we're not seeing behind the curtain, you know, we're not understanding why this approach is being used. And for some autistic and clients, it can be really helpful for them to be able to see behind that a little bit more. So they see why we're doing something, why we're leaving silences just as an example or why we're we're going down this particular approach. So just thinking in terms of what what does this person in front of me need? Do they need more clarity? Is it about this? And thinking also about even things like paperwork, you know, making sure that that is accessible to people, it's not going to be overwhelming to people. So there's sort of little things like that that we can do that kind of cuts across the whole of the practice, I think, the whole of the way we practice. And of course things like yes, having fidget tools and fidget aids in the room can be helpful, allowing for different accommodations. So people might need to move about, might need different seating. They might need different lengths of therapy sessions potentially. You know, all of these different things about being flexible, but the main thing is collaborating with clients to see how we can accommodate them. I think. >> So, um back to your book, if readers I'm sure readers will be stampeding out of the door to go and buy your book after this session, and there'll be a follow-up session later on in in in the year. If they having read your book, if they can take away just one key message from from the book, what would that What What do you What would you like that to be? >> I think that neurodivergent affirming therapy isn't just a tick-box kind of exercise, but it isn't something you can kind of take a quick course on and say, "Yep, that's me done." It is an invitation to kind of rethink the whole system, >> Mhm. [clears throat] >> which is big, and like I say, it can be uncomfortable. I hope that the book gives people confidence to do that work. And another just another quick point is that that this work is going to likely help all clients, not just neurodivergent ones. So, we're not doing anything that hinders other people, and in fact, that that this approach helps clients from marginalized groups as well, people with complex trauma histories, as well as neurodivergent uh as well as neurodivergent clients. >> Mhm. >> So, yeah, that's what I mean, that was two takeaways, wasn't it? But >> Well, that's all right. You want more more value. Um and there's also the element that that um you're not doing anything profoundly different. We've got the resources. Many of us we've got the we've already doing many of these things. It's just being into place. >> Yeah, and like I said, this approach really, I think, aligns so much better with our ethos generally as counselors and therapists, yeah, rather than the sort of medicalized model. So, all we're doing is bringing an awareness to this new type of model >> Yeah. >> and saying, "Yeah, collaborate with your client." And as you say, it's it's not a million miles away from what most of us are doing anyway. So, yeah. >> Okay. Um Amy, uh we're going to end there. Thank you very much. It's been a pleasure talking to you and um uh as ever, I learn learn a lot from these conversations. >> Probably. Thank you for having me. >> We'll be picking up the conversation uh later. Um I think we'll be working with What What is it? Uh common pitfalls in working with autistic and ADHD clients. Thank you very much. Um thank you very much everybody for listening and we'll be um we'll be with you next week probably with um the wonderful Mr. Mr. Bob Cook as well. Thank you. 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