Part 2/2: Negative outcomes, what you can do to avoid them, and some further resources
You’re likely here because you’ve read my previous post, ‘Therapists, are you harming your autistic and ADHD clients? (Part One)‘ and are interested in reading more. If you’ve just stumbled on this page, I recommend you check out Part One first.
Part One received a lot of support and resonated for many people. In response one person noted that, when handled effectively, silence can also be a positive thing for the autistic or ADHD client, as it allows time for differences in processing speeds. Someone else reminded me that supervision can also be a challenging environment for the ND therapist. Along with harm in therapy and harm in training, it feels like our industry needs to examine its approach to harm in supervision.
I know there’s a lot of talk of harm here, of damage, but we need to look deeply into this before we can start to build something better for our industry, for ourselves, and for our clients.
Of course, we’re therapists so we know that everything can be flipped on its head and reframed. And lateral thinking can absolutely apply. There may be moments where some of the interventions I describe in Part One, between a sufficiently attuned therapist and their safe-enough-feeling client might, in a particular moment, be okay and helpful. But we cannot count on it.
PLEASE NOTE
• This post is not a primer about autism, ADHD or any other form of neurodivergence.
• Please note that Autism and ADHD often co-occur, so you will see people increasingly describing themselves as AuDHD.
• The list of resources at the bottom is a starting place, an invitation to deepen your knowledge and find greater understanding.
• I do not endorse every word ever written by anyone I list here, or on the websites where these posts may appear.
• A list of red flag words, expressions, names and media output that you would do well to take care around is unfortunately beyond the scope of this post. [anyone?]
So what might the outcomes of harmful therapist behaviours, (however unintentional), be for the autistic and ADHD client?
(1) In one-to-one therapy
(a) The client leaves therapy without being helped.
Actually, simply not being helped may be the least harmful outcome. Someone may end up feeling as if this ‘failure’ was all their fault, confirming their sense that they are defective, broken, and beyond help. The therapy may have replicated how they have already been treated in other contexts.
(b) The client leaves therapy, never to return.
Their trust in people may already have been low – now it will be lower. Their internalised stigma may also increase. They may feel that getting support is just not worth the effort.
(c) The client remains in therapy but evolves strategies for pleasing the therapist.
This is of course no help to the client, but again they may be playing out a scenario familiar from the rest of their life. They mask in sessions and evolve ways to please the therapist by, for example (as I described in Part One), staring at the therapist’s forehead, or tolerating discomfort in the therapy room such as non-optimal seating arrangements, or tolerate amusement or judgements from the therapist about talking too much or getting angry about injustice, or wanting to stim. Ultimately, while this therapy might produce something positive, overall it will simply reinforce the status quo.
(d) Remember that the suicide rate is higher in autistic people and people with ADHD than in the neurotypical population.
The first of the two studies I link to there also highlights the presence of undiagnosed autistic traits in those who died by suicide. I wonder, in fact, just how many undiagnosed neurodivergent people attempt suicide. Perhaps they got labelled with ‘anxiety’ or ‘depression’ without anyone looking further, because they weren’t presenting like a ‘naughty little boy’. It is for this reason, on top of many others, that therapists need improved professional competence in this area.
(2) What happens to the parents of neurodivergent children (who may well be neurodivergent themselves), when accessing therapy and support?
Although these two posts do not focus on the specific experiences of children and young people, it’s worth looking at parents’ experiences when trying to get help – for themselves and their child. The original group discussion was particularly full of frustration and anger on this subject. It deserves a whole article on its own.
(a) Back we go to attachment theory!
This seemed almost a rite of passage for a parent trying to seek help for their child from local authorities. They would be labelled ‘enmeshed’ and pathologised as having ‘attachment issues’. Social workers, teachers, and therapists, (etc), may tell parents they are ‘overprotective’ of their children, or label someone an ‘anxious mum’ who is overreacting and ‘attention seeking,’ when the reason for them appearing to be this way is that they have had to fight for their child since they day they were born. This seemed particularly the case when the child had already been bullied or ostracised at school.
(b) Parents being accused of FII (Fabricated or Induced illness) to get their child some attention.
Given the existing scarcity of local authority resources, it is sadly unsurprising that those with the job of gatekeeping are going to try to find ways to keep people out of the system. But seriously?
(c) The mental health impacts of fighting the system.
The stress of this for the parents, and the impact on the child or children, may drive parents and whole families to burnout. This may then itself then be pathologised by gatekeepers as ‘inability to cope’. Also, as neurodivergence runs in families, these parents may be neurodivergent themselves, so they may be doubly struggling. The judgments inherent in these attitudes and the battle for basic services simply cause more stress, anger, guilt and shame for the parents which may in turn impact the child. (It is worth reading about the history of autism and the outdated idea of the ‘refrigerator mother’.)
(d) A reminder that the system is set up to be adversarial.
Just like the benefits system, the social support system seems designed to tire people out so that they either give up and go away; submit to whatever they are being told to do; or react strongly negatively which will then ‘justify’ rejection or disqualification from support or benefits, or sanctions.
(3) What about neurodivergent therapists who are being managed or trained by other therapists?
The experience of ND therapists is a whole other topic which needs a separate post. There are a lot of us around.
(a) Neurodivergent therapists may struggle in the workplace.
Their managers may assume that all ND therapists need the same workplace accommodations, and then may react badly when the therapist asks for something specific, such as no scented products or loud clocks in shared therapy rooms.
(b) Neurodivergent trainee therapists are likely to be treated differently.
Even if someone has a diagnosis, they may feel self conscious about asking for accommodations. If self-diagnosed they may have to debate this and struggle to be taken seriously. If the trainee is undiagnosed and unaware of it they may experience all sorts of unowned poor treatment from their training organisation.
Systemic factors
It is important to reflect on where patriarchy, colonialism and the medical model collude to influence healthcare systems and public understanding, causing neurodivergent people (and their children) to be seen as annoyances and anomalies.
Many gender variant people are neurodivergent, (and many GSRD identified people as a whole). If a therapist is not sufficiently aware of GSRD identities (and worse, holds prejudiced views about them), the likelihood of damage will be greater. Similarly, for example, in the case of a white therapist working with a client of colour who is also ND.
‘Oh gosh! We’re back at identities and labels again! Can’t we get beyond this, just for once???’
When people speak, you need to listen (which is kind of what therapy is about, no?). When a whole group of people speaks, who are united by a particular identity (or label), you need to listen extra hard, particularly if you are a therapist! This needs to change at root level, which means from training organisations who provide primary trainings upwards.
Therapy has traditionally been framed by patriarchal, white western thinking. I don’t necessarily say ‘throw it all in the bin’ (not all of it anyway) but it simply isn’t questioned enough from within. There is no getting away from this. It brings a top-down aspect to therapy which can engender harm (‘therapist knows best’), and a lack of consent. If you are working as a therapist, you need to keep the ultimate consent question perpetually in mind: ‘Who is this for?’
Equally, the ‘I don’t judge’ approach sounds nice on the surface, but it is clear that if a therapist doesn’t have a good handle on GSRD, (or race, or in this case autism and ADHD), as soon as they hcome across something they have no handle on, they are likely to do exactly that. Ditto ‘I just want to help people’ – your saviourism may also do harm.
What to do next
What you need to do now is check out the people who are talking about this publicly and LISTEN TO THEM. Listen to autistic people and ADHD people and all neurodivergent people who have been in therapy and had a negative experience – or a good one.
Particularly if you are in middle age and older, go online and read what younger people are saying. A lot of people are out there putting a lot of time into explaining their lived experience in the public sphere. That is where you will find current thinking on all this.
Some older therapists maintain a lofty distance from social media and therefore from social trends. This will not help your practice. If you cannot be online much, then talk to younger people. But please don’t use your younger clients as resources!
You can also attend one of the many trainings that are available. (See below.)
‘So are you saying we should treat our neurodivergent clients like helpless little snowflakes??’
Here we come to the central issue. If therapists and their trainers mainly come from a homogenous and privileged group with little experience outside that group, they will assume their knowledge, experience, resources, and levels of resilience are the same for everyone else in society. This of course is not the case.
Remember, it is labour for a client in therapy to challenge and correct their therapist, especially when they are not sure what they are challenging them about. It’s easy for a therapist to say ‘But that’s the work, isn’t it?‘ I mean, sure, yes, in an ideal world! But there has to be trust. And if you as a therapist don’t work on your cultural competence, you are creating extra work for your minority and minoritised clients – clients who are already likely to be exhausted from navigating similar scenarios in the rest of their lives. It’s not your job to make this harder for them.
Work towards changing therapist trainings from the inside
I keep mentioning primary qualification trainings (ie Diploma, PGDip, Masters) because the way the trainers model the work will be replicated by the therapist in the therapy room.
A central issue here is the learning edge. This is the place, that is not too comfortable but also not too stressful, where we are especially open to taking in new experiences. Trainers aim to take us to this place and hold us there for just the right amount of time for us to benefit and take in the information.
But the learning edge is not a rigid boundary like a circle or square, along which everyone will have the same experience. In fact, everyone’s learning edge is different. Any individual’s learning bandwidth is going to be wider or narrower depending on many factors. One size does not fit all.
Once again, I hope this is helpful.
Resources
Below I have frankly infodumped some links. I have not read every word of everything here. If you know any good ones please tell me and I will add them – or if you think any of these are terrible.
You will notice the skew towards autism. This is due to the nature of my own existing resources. However, the more I learn, the more I find that the map of neurodivergence is a closely knit Venn diagram rather than, say, a flower. As I said above, a significant number of people with autism also have ADHD, and a fairly high number of people wth ADHD are also autistic. Hence a number of people calling themselves AuDHD. There will be much that is relevant here for many people.
Autistic and ADHD clients in therapy – experiences
• Autistic Adults Experiences of Counselling
• Autistic people should not have to educate their therapist
• An Autistic’s Vision for Neurodiversity-Affirming Therapy
• Neurotypical psychotherapists and autistic clients
• Autistic Therapy: 8 Things to Consider
Research and media
• ‘Autistic while black’: How autism amplifies stereotypes
• Black adults who live with ADHD
• Counselling Clients with ADHD
• ’No you’re not’ – a portrait of autistic women
• Silver linings of ADHD: a thematic analysis of adults’ positive experiences with living with ADHD
CPD TRAINING ORGANISATIONS
• Free2BMe, Neurodiversity training, specialist neurodivergent support
• Vanguard Neurodiversity Training
• Reframing Autism – Autism Essentials
PEOPLE TO FOLLOW ONLINE
There is a very large number of ND influencers who are producing a lot of content, particularly on Instagramand still on Twitter (X). This is a small selection and I have undoubtedly missed out some good ones.
autistic_callum_ (Tw and IG)
neuroclastic (Tw and IG)
neurodivergentrebel (Tw and IG)
autienelle (Tw and IG)
neurodivergent_insights (Tw and IG)
neurodivergent_researcher (IG)
autisticflair (IG)
annmemmott (Tw)
DrRJChapman (Tw)
• AJ Singh / AJ Singh LinkedIn
• Black Girl Lost Keys / @blkgirllostkeys
• The Thoughtspot: How being autistic is linked to ego death
BOOKS TO READ
• Edward M Hallowell & John R Ratey ADHD 2.0 New Science and Essential Strategies for Thriving with Distraction – from Childhood through Adulthood
• Eva A Mendes & Meredith R Maroney Gender Identity, Sexuality and Autism: Voices from Across the Spectrum (Foreword: Wenn Lawson)
• Anand Prahlad The Secret Life of a Black Aspie: A Memoir
• Devon Price Unmasking Autism: The Power of Embracing Our Hidden Neurodiversity (also on Instagram)
• Bianca Toeps But you don’t look autistic at all
• Pete Wharmby Untypical – How the World Isn’t Built for Autistic People and What We Should All Do About it (Also on Instagram and Linked In)
London Central Counselling 