If you’re Autistic or otherwise neurodivergent then finding a non-pathologising, neurodiversity-affirming therapist can be difficult. How many people have you heard say “I’ve tried counselling and I didn’t find it helpful”?
There are so many stories of people having bad experiences with pathologising counsellors who think there is something wrong with being Autistic, ADHD, or otherwise neurodivergent. They may view them as disorders or conditions to be cured. Others think their job is to ‘fix’ neurodivergent people and make us act ‘normal’.
So how can you find neuroaffirming psychotherapists who take a different approach?
If you’ve decided to give therapy a go then it’s worth spending some time finding a good match. Depending on the counsellor you choose, you could find counselling to be the best thing you’ve ever done — or believe it’s a complete let-down. Every counsellor is unique, and if you’re investing time and money it’s important you’re happy with what you’re receiving in return.
Don’t choose your friend who happens to be a counsellor
The first thing to point out is that a counsellor should not be your friend. This is the case whatever type of counselling you’re after. It’s against the ethical code of practice for most professional bodies for counsellors to have what is known as a dual role. If they are your counsellor, that’s all they should be. If you already know the person well or your social circles significantly overlap then they should advise you to choose someone else. You want to be able to be open and honest with your counsellor. If you’re talking about someone you both know then that isn’t likely to be possible.
Make sure they’re qualified
It’s entirely legal for anyone in the UK to set up a practice and call themselves a counsellor — regardless of their qualifications. A legitimate psychotherapist will be more than happy to tell you about their qualifications and experience, as well as which professional body they’re a member of (see below). Unfortunately, deciphering what their qualifications mean can be difficult as there’s no single way to qualify as a counsellor in the UK. If your prospective counsellor is a full member of a professional body such as the BACP or NCPS then you know they’ve reached a minimum standard of qualifications and experience. If they aren’t a member then you need to dig deeper. They should have a Level 4 Diploma in Therapeutic Counselling as a minimum. (I’m a member of the NCPS and you can see my qualifications here.)
Most training doesn’t teach counsellors about innate neurodivergence such as autism, ADHD, dyspraxia, dyslexia, or dyscalculia. If they are mentioned at all then it’s usually in pathologising terms and not from a neurodiversity-affirming perspective. Therapists are not usually taught how to work with neurodivergent clients and don’t tend to learn that neurotypical does not mean better. Some practitioners won’t have any lived experience of neurodivergence. They might advertise as being neuroaffirming when they have only done a short CPD course and have never heard of neuronormativity and have no idea about common neurodivergent experiences such as alexithymia, rejection sensitivity, or differences in sensory responsiveness.
Check for membership of a professional body
As there is no official definition of a counsellor, there is no governing body either. Numerous professional bodies exist but membership of these is entirely voluntary. Most counselling jobs are only open to counsellors who are a member of one of these, but counsellors in private practice can choose whether or not to sign up.
When counsellors join a professional body they agree to abide by its code of ethics, which gives you somewhere to complain if things go wrong. Your counsellor is likely to publish the name of their professional body, which means you can go to the body’s website and have a look at their standards and code of ethics. You can check on the Professional Standards Association site to see if the body holds an accredited register for counsellors.
If your counsellor is not a member of a recognised professional body then that should prompt you to dig a little deeper. Membership is expensive and is not a legal requirement, but the vast majority of counsellors are signed up with one so that their clients have some form of recourse. It’s possible to be a fantastic and highly ethical counsellor without being a member of one, but if you’re unhappy with the service you receive then you could find yourself without anywhere to turn.
Check the language they use
If you want autism affirming therapy then a big red flag is if a therapist refers to Autism Spectrum Disorder (ASD) or Autism Spectrum Condition (ASC). You may have noticed that I always use the terms autism and Autistic instead of ASD or ASC. I subscribe to the neurodiversity paradigm which views neurodiversity as natural. There is nothing wrong with being neurodivergent, and Autistic is not a dirty word.
Repeated research and surveys have highlighted that the Autistic community as a whole prefers identity-first language (Autistic person) rather than person-first language (person with autism) because being Autistic is not something that is separate from us; not something that we can put down; and not something to cure or fix. Research shows that the key to good self-esteem is developing a positive Autistic identity, not trying to get rid of it or pretend we aren’t Autistic.
I don’t consider autism or ADHD to be disorders or conditions (two terms which medically mean the same thing), so I choose not to use that language. I also find that saying Autistic is clearer because more people know what this means than understand the acronyms ASD or ASC. ASD and ASC are pathologising terms used by the medical model. The model views autism and ADHD as a series of deficits, while the neurodiversity paradigm recognises natural differences in bodyminds. There is no such thing as a neurodivergent condition, because this is mixing the language of the neurodiversity paradigm and the pathology paradigm.
I tend to refer to autism and ADHD as neurodivergences. If you’re looking for a professional or organisation to support you or a family member, the language they use can be a good indication of whether they align more with the medical model or neurodiversity paradigm. Medicalised language is sometimes required in official reports, but there are assessors, therapists and psychologists who still manage to use affirming language throughout.
So why might people still prefer to useASD/ASC? These are just a few of the reasonsI’ve heard, and I’m sure there are others:
📌 They’ve been told these are the terms to use, so they’ve adopted this language.📌 It’s what they’ve heard others say and they haven’t heard of alternatives.
📌 It’s what it said on their diagnostic paperwork.
📌 They think being Autistic is a bad thing and view ASD/ASC as softer terms.
📌 They believe in the medical model and choose to use its language.
📌 They consider autism to be a disorder or condition and so they use terms that reflect this.
📌 It’s what they’ve always used and they haven’t considered – or have actively rejected – alternatives.
📌 As a teenage act of rebellion against wider Autistic community preferences.
📌 Change feels too difficult.
Everyone gets to choose whatever language they want to use. It’s always helpful to be aware of the connotations of those choices and what people may infer from them. I still use ADHD because there isn’t an obvious alternative like Autistic. Some in the ADHD community have started using VAST which stands for variable attention stimulus trait and other names, but these aren’t widely adopted or understood yet.
Sonny Jane Wise (Lived Experience Educator) has published a checklist of some of the things to look for and avoid when searching for neurodiversity-affirming therapy.
Look at the type of counselling they offer
Counsellors work within dozens of different modalities. You may have heard of some such as cognitive behavioural therapy or person-centred counselling, or this may be entirely new to you. Some, known as integrative counsellors, work in different ways depending on the issues or problems their client is bringing and what suits you best. I’m an integrative counsellor. The way each counsellor works will produce a completely different experience for you so it really is worth reading the brief descriptions of some of the most common types of therapy. You can then decide which you like the sound of and which you want to avoid, and search for a counsellor who offers the ones that appeal to you.
If you want neurodivergent-affirming counselling then it’s really important to check this. Some types of therapy are always (or almost always) pathologising and reinforce neuronormativity. Society as a whole holds assumptions around neurotypes, with the default belief being that people are neurotypical and should comply with neurotypical ways. Anything else is looked down upon, and the ‘default’ and ‘correct’ way of being is constructed as a set of neuronormative values that are privileged over others.
The term ‘neuronormative’ appears to have been coined by John Lardas Modern in 2021 as a label for dominant societal standards which are shaped by neurological functioning. He emphasised how neuronormativity marginalises those who are neurodivergent.
Sonny Jane Wise defines neuronormativity as “a set of norms, standards, expectations and ideals that centre a particular way of functioning as the right way to function. It is the assumption that there is a correct way to exist in this world; a correct way to think, feel, communicate, play, behave and more.”
Adults impose neuronormative beliefs when they try to stop an autistic child from lining up their toys and instead play with them in the ‘correct’ (neuronormative intended) way.
Politicians impose neuronormative beliefs when they insist that all children are always better off in school, regardless of their needs and preferred ways of learning.
Society imposes neuronormative beliefs when it insists that adults must make small talk; communicate by phone call; feel and express emotions in a particular way; utilise eye contact in the prescribed way; and work from 9am to 5pm, five days per week.
There is a high crossover between neuronormative and ableist attitudes. The way non-disabled, neurotypical people communicate, socialise and exist in the world is seen to be the right way to do things, with everyone else being categorised as deficient, wrong or disordered.
Living a happy life as a neurodivergent person is likely to involve a level of awareness and rejection of neuronormative standards, and acceptance of neurodivergent ways of being as equally valid. If a therapist is trying to get you to act more ‘normal’ and to mask your neurodivergence then they are not neuroaffirming.
Would a specialist suit you best?
Lots — probably most — counsellors are generalists and assist people with a wide variety of problems. Counsellors are never there to give advice, but some people still prefer to go to one who is experienced in a particular field such as bereavement, addiction or couples counselling. If this applies to you then make sure you include it in your search so that you don’t end up settling on someone who has never dealt with the topic. You may also want to look for a counsellor who shares your neurodivergent or other identity, or is at least an ally and appears to have a good understanding. I specialise in supporting people who want to explore or understand their neurodivergent identity, and to build a life that works with their brain and nervous system.
Check the cost
Free counselling services can be high quality, and are very helpful for a lot of people. Unfortunately waiting lists can be long and you won’t get much choice (if any) over which therapist you see. You’ll probably be limited to around six sessions and you’ll almost certainly need to meet a threshold for depression or anxiety. They won’t offer tailored support to build your happy neurodivergent life. Low cost agencies are springing up all over the country, and they charge what you can afford based on your income. Again, they may be a fantastic fit for you, but your choice of counsellor could be limited and they’re likely to only offer you a fixed number of sessions. They may be staffed by students who are completing their diploma.
If you want non-pathologising autism-affirming or neurodivergent-affirming counselling then it’s likely that the best counsellor for you will be in private practice. This means they work independently and need to charge clients a fee in order to make a living. Qualifying as a counsellor is expensive. Any counsellor who is a member of a professional body will have to pay for regular CPD courses to update their skills, as well as paying a supervisor to ensure they are doing their best for their clients. They also need to fund premises, insurance and business costs, and to cover their holidays, sickness and pension costs, so it’s easy to see how the fees they charge can escalate. A counsellor’s charges should be clearly displayed on their website. Fees vary enormously depending on where in the country the counsellor is; their experience; and the type of counselling they are offering. It’s usual to pay at least £60 per hour or £50 for 50 minutes, rising to hundreds of pounds for top counsellors and therapists who are in serious demand.
Search online directories
As well as running a search for counsellors in your area, there are several directories which list counsellors. I am listed on Neurodivergent Practitioners by Thriving Autistic; Autistic Therapists; ND Therapists; and the NCPS directory.
Read the counsellor’s own website
Almost every counselling agency or private practitioner will have a website and/or a social media presence. Read it thoroughly, because it will give you an insight into the way they approach counselling work and whether you think it will work for you. If they only offer daytime, weekday sessions and you work 9am to 5pm then they’re not going to be able to help. Maybe the counsellor will write articles like this one which will give you an idea of the way they think and work. They may have a world view which either resonates with you, or immediately puts you off. If it’s the latter then look for someone else!
Ask for an introductory session
Most counsellors will offer an introductory call with no commitment. This allows you both to see whether you think you want to work with each other before the client or counsellor commit to anything. You may decide that they aren’t the right fit for you after all; or they may say that they can’t help with your particular issue. The counsellor should go through a contract with you setting out the boundaries and what you expect to gain from your work together, as well as letting you know about practical things such as confidentiality and whether there is a charge for missed sessions. Some counsellors offer this session free or half price, while others charge full price. Some will talk to you on the phone or online first. Ask your prospective counsellor how they operate and what you can expect.
You can see how I work here. Autistic, ADHD and other neurodivergent behaviours are very welcome here. You can stim and move in sessions, and make as much or as little eye contact as you want. I will not try to reduce neurodivergent traits or encourage you to mask.
When you have an introductory videocall, you might like to ask a potential therapist about their experience with your neurodivergences; how they view those identities; or how they can accommodate your needs. You could ask them if they are neurodivergent too. If, for example, they use pathologising language or suggest that they work with all ADHD clients in the same way instead of adapting to individual needs then that could alert you that they aren’t the best counsellor for you. They need to be willing to look at your own strengths and challenges instead of thinking every neurodivergent person is the same.
Don’t be afraid to change counsellor
After all that effort and the belief you’ve found your perfect match, it can be hard to admit things aren’t working out. Many psychotherapy sessions are not fun or particularly pleasant as you’re likely to be talking about difficult topics. Admitting things to yourself and vocalising them to another person can be challenging and painful — but your counsellor should be able to hold the space for you and not make you feel judged or shamed. If you aren’t happy with the way things are going then you can raise it with your counsellor, but don’t be afraid to move on if you realise they aren’t the right fit. Research shows that the relationship between the client and therapist is the most important thing in determining whether therapy will be successful.
If you wanted someone who takes a non-pathologising approach to autism, for example, and it turns out they treat you like there’s something wrong with you or they are trying to make you comply, you are allowed to go and find a non-pathologising autism therapist instead.
Jade Farrington - Neurodivergent Counsellor and Rewind Trauma Therapist 