270 Common mistakes working with Neurodivergent Clients

Welcome everybody. Welcome back to the therapy show with myself um Simon Bailey and back by popular demand we have Amy Amy Peters um who will be talking about working with neurode divergent clients again and um many people since we last spoke have been asking about her book. Could you just remind us about your book Amy please? >> Yeah. >> Sorry. Welcome. Welcome. I should say welcome. >> Yes. No. Thank you Simon. Thanks for having me back. Um, yes. So, my book, I'll hold it up for those that might be watching, is neurode divergent affirming therapy, rethinking approaches for autistic and ADHD clients. Um, and I wrote this, uh, this came out in May and, um, it's really about my work as a neurody diverent therapist, but working with neurodeivergent clients, specifically autistic and ADHD clients. Does it come do you are you do you have a basis in any particular modality here or does it work across? >> So I'm integrative so I've come from that approach but I do look at specific different modalities within it. Um but it's really because the approach is kind of a way to embed in I think in in any of our work as therapists then so it's more of an approach and a sort of mindset framework rather than a modality. So actually yeah it works across modalities. >> Yeah. Okay. Okay. So uh the subject of today I think is um common pitfalls in working with autistic and ADHD clients. >> And I'm aware that ADHD and autistic they're quite different approaches I would or quite different presentations. So approaches might be quite different. I don't know. >> Invitation. >> Yes. Yeah. Thank you. Yes. So I would say yes, you're right. They can present very differently and clients can present very differently. An autistic client versus a ADHD client. There is a huge prevalence of the crossover of the two. So some studies suggest that if you're autistic, there's a 70% likelihood that you might be ADHD as well. So there's this huge crossover that often is missed. So I think in terms of that in itself, it's worth looking at them in terms of to together, but also a lot of the approaches can be used for both. So I talk about both in the book, but um but also the approaches can be used regardless. >> Okay. >> Yeah. >> Okay. Okay. Um so what about pitfalls? What kind of pitfalls are we are we talking about? How how do you think therapists what kind of pitfalls and how do therapists fall into? >> So yeah and this is something that I've noticed mainly from clients that I'm seeing who have seen counselors therapists had different kind of therapies before often many many types of therapies. Um so the reason I think therapists fall into some of these pitfalls I think is two reasons really. One of them is that most for most of us our core trainings rarely cover autism and ADHD or neurode divergence in general. So we're kind of forced to pick these things up by the CPD we might choose to do or books we might choose to read. So generally sort of across the board there's not much that's covered. It is [snorts] starting to change now. Not as quickly as I'd like but it is definitely starting to to change. And I think for years we've framed neurody divergence um autism and ADHD particularly as disorders and from this sort of deficit based view. So our books have reflected that over the years. So books when I started out that I had my very first client was autistic. I was looking for books that would help me with this and actually they were all still framed in this disorder disordered way of thinking if you like about autism and ADHD. So that's one reason I think and secondly because we are all practicing within systems that have historically pathologized difference. So I think we often don't notice that we we often don't necessarily challenge that because we don't notice it and it can come out as kind of assumptions in the way we work with clients without realizing without meaning to. So I think that's that's mostly why therapists can fall into those pitfalls and often happens. Um do you want me to go on to sort of talk about a couple of things maybe? >> Yes, please. Yeah. >> That might help. Yeah. Um so I think those kind of pitfalls that often happens around communication. That's like a huge one within the therapy room. I think as counselors and therapists, we're trained to kind of read between the lines, aren't we? they pick up on body language and but if we make the assumption that communication is going to be delivered in one way in a kind of neurotypical way because that's the kind of dominant way we expect then that's when I think things can become a bit more of a problem. So, autistic ADHD clients might communicate much more directly, for example. They might need longer processing time. They may struggle to identify or verbalize emotions or express themselves in ways that don't fit those kind of expectations that we might have as the counselor or therapist. So, the risk there is that we might misinterpret the meaning of those responses sometimes. Um, so an example might be we might have we might have a a very direct response from a client or a very sort of blunt response from a client and view that as some sort of resistance maybe or some kind of avoidance maybe or some push back. Whereas actually for that client particularly maybe for an autistic client that could just be a need for clarity and wanting that just that kind of honest communication. So I think that can happen that these are the kind of pitfalls we can fall into and because neurody divergent people have had lots of miscommunications often in their life and and feel chronically misunderstood a lot of us here's just another place you know the therapy room just becomes another place where that happens. Okay. So, if I'm using uh like ambiguity or deliberately expecting my client to interpret as they wish, as they seem fit, you're suggesting that might not be the best way to go with a a neurode divergent client. So for some clients that's going to be quite anxietyinducing say not for everybody, not for every autistic client, not for every ADHD client certainly, but for a lot of people that that would be. And if I think of myself in that situation as a client actually as an autistic ADHD client, I'm going to be thinking, well, what are they expecting of me? What what's what does the perfect client look like in this situation? Because so many of us are used to masking that we'll be doing that in the therapy room most likely. So that ambiguity can just like create a lot of anxiety and actually you're less likely to get an authentic response from the client in that respect. So yeah, I think definitely ambiguity is something which >> about metaphor. >> So metaphors I think it I actually find a lot of my clients and I work solely with autistic ADHD or otherwise neurody divergent clients actually really like metaphor actually. >> Okay, >> that sort of creative way of working. So, but I think it just depends because you'll get that gauge from your client. I'll have clients which just come up with the most amazing metaphors and and often it's led by them and then we'll sort of take that further and >> yeah works for them and others you can tell from the outset that if I'm introducing those things or if I'm talking to them about metaphors that actually that kind of or abstract way of thinking or creative way of thinking in that respect is quite difficult. I actually find creativity, working creatively with neurodyiverent clients can be really helpful actually lot. >> And what do you mean by creativity? Creatively >> I think like if we took something like emotions for example if you've got somebody who is so there's something called alexia which is something that many autistic people struggle with and that is the difficulty identifying and naming of emotions. >> Okay. So that may be something that lots of autistic clients as I say may struggle with. So if we're asking the age old question, you how how does that feel or whatever or how does that feel in your body? It may just be a complete I don't know, I don't know. That's that's always sort of getting back. And that is a very valid answer obviously and it's one that I think is always worth exploring. But for somebody with alexia, it is just going to be an I don't know. I don't know what that feeling is. I don't know how to name that. And so we can do we can work on things. We might use emotion wheels and things like that. thinking of emotional vocabulary but actually if we can if a client can say to us don't know what the word is for that but there are some lyrics of a song that I know that encapsulate how I'm feeling perfectly or this line or this piece of music or this poetry or whatever it might be that can actually you know let's get the poem out let's play the song let's actually engage in that in that way and actually allowing somebody to express their emotions in a different way. So that could be one way of working creatively. But but things like sound trays as well I find really useful um and working creatively in that way in the therapy room just to sort of bypass the words often really. >> I regard myself as a fairly relational kind of therapist and I'm quite successful. I'm quite happy with my practice but I don't doubt that I carry some misconceptions about these issues about neurode divergent issues. Um I'm aware of autistic spectrum isn't one thing. There are different >> there are different types. There's a movement away from the idea that we're there's a spectrum of autism but it's actually discreetly different presentations. But I undoubtedly carried certain misconceptions. What are the most common to me a long round time to get around to this question. What what are the most common types of myths and misconceptions that therapists hold about autistic and ADHD individuals? Amy? >> Yeah. I think a big one, and it's not just therapists, sort of just people in general have a bit of a myth about particularly autistic people having a lack of empathy. >> Okay. Oh yes. >> You know, that's that's one that that often comes up, I think. And when we think about what I was just saying about emotional expression and different ways to express our emotions or have names for our emotions, empathy can be considered in the same way. And so actually for me, for example, I can I know I feel empathy for my clients in the room. Well, if you were to if I don't know if I was in a a workplace in an open plan office, I'm thinking of previous jobs and somebody was kind of started crying in the corner and they were somebody that wasn't a friend but kind of an acquaintance, I would be I might feel empathy for that person, but I'm going to feel, oh, do I go over to them? Do I put my arm around them? Do I do I do this? Is anyone else getting up? Do I offer them a tissue load? All of these kind of things going through my head. Oh, no, I can't do that because I've been told to sit down and do my work or whatever. So it it may look to from the outside that I'm not being empathetic with that person, whereas it's not that I'm not feeling the empathy. It's just I don't know what to do with that or I'm not expressing it in a way that someone else might interpret as being empathetic. So I think that's something that often comes up, this idea of lack of empathy. And even I've heard from lots of therapists or therapists in training that they've been told in the past, oh, you can't be a therapist because you're autistic. So you don't have the empathy to be a therapist which you know it's complete complete myth. It's completely not true. And for many autistic people there's a hypermpathy actually. >> So and hypermpathy with with people also animals as well. And we can feel things incredibly deeply. Okay. >> It's just it's just not necessarily expressed in the way you might expect. >> Yeah. >> So I think that's it. That's a really common one. Um, but there's also one more that I wanted to mention which is quite topical if that's all right at the moment. This sort of the myth of overdiagnosis that we're hearing a lot in the news and this kind of narrative of both autism and ADHD being overdiagnosed at the moment. And I just kind of thought it would be good to address that because it's something we hear and and I certainly do hear from in the counseling world as well sometimes. But actually what I wanted to say about it is that we have rather than an overdiagnosis, we've had a historical underdiagnosis of people who are autistic and ADHD because largely criteria back in the day and research was based on boys, usually white boys actually. So you can imagine what therefore a girl who was presenting maybe presenting even with autistic traits that they could be recognized. It wouldn't have even been considered she was autistic. And the same for people of color. Often they're not picked up as autistic and ADHD. And really it's not until the last sort of 15 years that we've started to recognize it. So what we've got, of course, is people like myself as a late diagnosed woman actually realizing in their middle age or whenever that they can identify with autism, ADHD, whatever it might be, some kind of neuro divergence and never realized that before. So of course, we're going to be seeking out diagnosis to understand our health assessments, going on waiting lists, etc. And we have so much more information about this stuff anyway. It's all at our fingertips, isn't it? So I think it's understandable that we'd be identifying this more. So yes, so rather than being an overdiagnosis, which is one of the common myths and like I say topical at the moment, it's a historical underdiagnosis and we're just playing catchup right now. >> Yeah. Back in studying psychology back in the 70s, behavioral and cognitive norms were based on the results of experiments with American middle class, American high school um college students. Not very very applicable to the rest of us, >> but things have changed since then and things are changing still. >> They are absolutely and it's great that we have that information. Yeah. But of course that's going to mean an uptick in in in diagnosis and so on and assessments. Um and there is this narrative and there's political reasons possibly. You know, I'll let people have their own ideas about why that narrative is out there at the moment. But um yeah, it is a a common one. >> Are there any other any other myths that therapists harbor carry? Anything that interferes with the therapeutic relationship impacts on that? Yeah, I think um I mean there are many I in terms of like in the book I talk about the therapeutic relationship and how that can be impacted and I mentioned about communication that's a big one. So I I think it's also around things like maybe how we might interpret um literal thinking for example. So again for autistic people largely talking about here we can have quite literal thinking and that can come across as maybe rigid thinking that kind of black and white thinking and often it's seen that we might not be able to take on other perspectives that kind of approach. So that's sort of a a bit of a common myth that we have this rigid approach to things and I think that there is a there is a a kind of literal thinking that goes on for sure but it's more about where it comes from is more about our own need for predictability I think in a world that is anything but for us particularly when we think about the sensory world we take on a hell of a lot more sensory information we can't filter out as much as a neurotypical person Right? So therefore, we are taking in so much more of that. So of course, we're going to have different interpretations of the world and so on. And in order and of course the world's going to be unpredictable, unpredictable noises, unpredictable smells, whatever it might be that's going on. So in order to make life more predictable, we have routines. We have that sort of thing that that can look like rigidity from the outside. We also have what's been described more recently as the monotropic mind which is kind of being on one track if you like being able to have great attention to detail but being kind of locked into one way of thinking and it can be really hard for us to pull out of that and be able to move to the next thing the next activity the next task or the next thought so I think that's something that although it comes from a place of reality in terms of the literal thinking The myth is that that rigidity is just a kind of it's a fixed thing and it's not changing. I think we need to understand the reasons behind that and actually help the client understand the reasons behind why they're struggling with this or why they might feel stuck in this particular thought pattern or whatever it might be. >> So yeah, that's another one that kind of is more more about the what's going on behind what's actually happening for the person. And I think that's where a lot of these myths come from. It's seeing something from the outside. Whereas what my book's talking about is let's look at the lived experience. Let's look at the often hidden realities of what's going on underneath. >> Okay. And your book talks about neuronormative assumptions. What what what does that mean and why are they important? >> So we've got really what's called neuronormative standards which are the kind of unwritten rules that we all live by. So in the UK that will be our kind of societal norms and that will be across those standards are across our social spaces, our schools within our workplaces and so on. And it's really the default way of being if you like and some of us will find it easier to fit into those than others just generally. and neurody divergent people are likely to find it incredibly hard or a lot harder or even disabling a lot of the time to fit into those neuronormative standards. So then in therapy, if we're making assumptions based on those standards, yeah, so new in normative assumptions about what behaviors could mean, >> then what we run the risk of is pathizing those very understandable, I think, human responses. And of course, what's what that's likely to do is then there our clients as a result. So one of the sections in my book, one of the chapters takes those kind of common responses to neurode divergent issues. So it might be around self-care or it might be around anxiety or it might be around motivation for example. Take that I take those kind of neuronormative assumptions that are often made around those things explain why it's unlikely to work for autistic and ADHD people and then suggest some kind of more affirming alternatives. So definitely those neuronormative suggestions uh sorry assumptions come into our work um often without us even realizing it certainly. Uh yeah hopefully that >> okay interesting it's interesting. So um being so what you what you're saying that the while I as a counselor therapist believe the relationship is is no I'm not sorry I'm going to edit this bit out the the just put my hand up to so I can see where to edit sorry um okay so the cost being consistently missed in the in the therapy room, how does that make the the client feel? How is the how is that client supposed to respond? Do they do they walk away or do they grin and bear it? What what's or or others what what's >> Yeah. And this is interesting and I I spoke to I mean I speak to lots of neurody divergent people in the course of my work anyway but I specifically spoke to people about their experiences of of therapy and counseling um previous to them having kind of neurody diverent affirming types of therapy. And I think the biggest cost is that further harm to the client. And I I often hear clients will say oh I tried that type of therapy or or that was they were a lovely counselor or have you but they just didn't get me. you know, it just didn't feel understood by them. But I think what happens is rather than them, the the client say to themselves, okay, this this is this one therapist that doesn't get me, I'll try someone else or or I'll try a different type of therapy, what have you. Often they're going to blame themselves. That's the majority of the time that's what happens and they feel like they've failed at therapy. So, of course, the risk to that is that maybe they won't ever go back and try any other type of therapy again, which I think, you know, could be could something that could be really beneficial to them that they're not going to access because they feel like they can't do it. They failed at this. And I think when someone has their experience misread or misunderstood so many times, it just re reinforces that message they've already received really that their reactions and their needs, their ways of experiencing the world are somehow wrong or or somehow too much. And I think we can, you know, see how damaging that could potentially be to clients. And when you have a client who comes in and it's so um it's so apparent that they are neurode divergent and yet they've gone through the system and nobody's ever picked them up and they've >> their response is to just to withdraw and as they do live online or or whatever. >> It's it's it's heartbreaking. >> Absolutely. And as you say, lots of people are then unidentified and that's just kind of continued. And I can't tell you the number of people who were maybe late diagnosed, late identified that I speak to who say, I wish someone had told me, you know, I wished I think those people know or I think thought my teacher may have known, but nobody ever said anything. I wish I'd known because I think this can be a piece of information which just unlocks so much for a person. And it certainly did for me and yeah, it's something definitely that that then clients go away as you say, they might withdraw from that and that can be really detrimental I think. >> So what what um what changes would you like to see Amy in terms of in terms of our as a counselor therapists our exposure to this information or other think of wider uh field in teaching? social work or whatever, but primarily in counselors. What would changes would you like to see? >> Yeah, in counselors and therapy, I I really I'd love to see this kind of work, this approach being embedded into core training. Like that's my that's what I would really want more than anything because that that's where we want to catch people, isn't it? When they're training and um understand this. But I think the main thing is to for counselors, therapists to understand neurodyivergence from the inside out. as I was saying those kind of the hidden realities. let's understand the lived experiences of people so we can recognize that others don't necessarily share our communication patterns you know it maybe may be something different and and sort of think about those assumptions that might be happening so I think that is something and and there is a piece of work here for the counselor of unlearning our biases and thinking about things like internalized abbleism for ourselves you know that's quite a a big piece of work that um can continue throughout our our development really as a as a therapist. I think wider than that I think the medical model is still so pervasive that sort of idea of autism and ADHD being a disorder or a deficit. And I really think it's important for us to see that there are other ways of viewing this and there are other ways that are far more compassionate and far more affirming. And I've seen the results of that. I see that in clients, not just my clients, but you know, across the board with other people doing this kind of work. I've seen how transformative that is. So, I think if we can help people understand and and kind of raise up the neurodyiverent voices so that people are heard more, I think that can only be a good thing, >> you know, in general. >> Uh my question maybe you can't answer and wider. So, I'm thinking about when people come in the room and they've got dyslexia or dyspraxia and these presentations that never come in singles, do they? There's always something else. >> Yeah, absolutely. There's there's often co-occurring neurodyiverencies. There's a really high rate of that. So, um autism and ADHD together, there's often dyslexia in the mix. There might be other things in the mix, too. So, yes, absolutely goes wider than that. certainly wider than autism and ADHD. And I think this is where this approach can really help all clients. Like it's not it's not going to hinder anyone else. It's actually something that's going to help people with complex trauma histories, people who are from marginalized groups certainly. So this is an approach that I certainly believe in and I think can be really useful just across the board really. >> Okay, [clears throat] good. Good. Um, and are you are you optimistic? Are you are you um Yeah, tell me how you how do you feel about [laughter] >> I'm really optimistic about what's happening. I think there is within the community of of neurody divergent community especially there is so much good work being done and people advocating unfortunately as with most marginalized communities the education falls down to the neurody divergent people themselves to do that which is tricky because we also have finite energy levels and are very prone to burnout and so on but I do think there's there's a huge amount of work going on um so I'm very optimistic about it. I think there is a sort of political move slightly the other way maybe which you know I'm still hopeful that um things may may still sort of improve in that area but >> be explicit a political move slightly the other way. Go on. I think what I was saying earlier about that kind of overdiagnosis and the narrative of that those things being pushed >> what we're seeing in America as well where rights are being stripped from people and I think yeah we we this this includes neurody divergent people too you know this is something that um and disabled rights and women's rights and trans rights and so on um it's yeah all a bit of a political movement at the moment and I think in terms of neurody divergence if certainly people who are listening to this can engage with neurody divergent voices and other minority voices marginalized voices I think that's going to go a long way certainly in our profession >> good we're going to we're coming to to the end of you got is there anything else that you want to add um Amy uh anything else to say to advise to recommend that we therapists do to ensure that um communication relationship is stays at the forefront. >> I think just really working with your clients, collaborating with your clients and actually helping them to feel safe at the beginning as we all try and do with all our clients, but being aware that safety for neurody divergent clients can look a bit different. we might not get the same cues that we normally would that somebody's feeling safe because they might be masking. So just ensuring that we can put things in place as much as we possibly can that we're asking about that safety. You know, we're we're collaborating with them and asking about what that person needs because that might be the first time they've actually had that. It might be the first time they've ever kind of had their needs explicitly asked for in that way. >> Yeah. Yeah. Yeah. Amy Peters, thank you very much. Uh, it's been very entertaining. It's been very informative. Uh, I will go back and and finish reading your your book. Um, >> yeah. Thank you. Thanks, Simon. >> And I hope uh I hope it does well. Um, so thanks very much. And um uh just to everybody, thank you for listening. We'll be back with um me and myself, me myself and Bob Cook next um next session. Thank you very much. Goodbye. [music] >> You've been listening to the Therapy Show Behind Closed Doors podcast. We hope you enjoyed the show. Don't forget to subscribe [music] and leave us a review. 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