What I Wish More Therapists Knew About Supporting Neurodivergent Clients

I’ve been thinking a lot lately about how easily neurodivergent people can be misunderstood in therapy. Not because they’re doing anything wrong, but because the models and expectations we often work within weren’t built with them in mind.

I’ve spoken with so many clients who’ve come into therapy already burnt out, hoping to finally feel supported, only to leave feeling worse. One person told me they’d been through several therapists, and each time they left more convinced that no one truly understood them. Their last therapist insisted they attend in person, even though they were in autistic burnout and struggling with sensory overwhelm. When they asked for flexibility, they were told they were being avoidant.

Another client had misophonia and found it unbearable to sit in a room where their therapist breathed heavily. Instead of being offered an alternative, they were left feeling like they were overreacting and being difficult. Others have been labelled therapy resistant simply because they forgot an appointment or couldn’t complete a homework task. In reality, they were overwhelmed and struggling with task initiation.

I’ve seen direct communication interpreted as being rude or oppositional, when for many clients, it’s just how they express themselves and no rudeness is intended. I’ve also heard monologuing described as attention seeking or even narcissistic, when often it’s a sign someone is trying to process out loud in the only way that feels natural to them.

Even my own child had a difficult experience. After a traumatic time at school, we tried therapy. The therapist assured me they understood autistic clients. After the session, I asked how it went and my child said, very simply, that the heater was buzzing, the light was in their face and the clock was ticking. That’s what they remembered. The therapist told me they were being resistant.

None of these are isolated situations. These stories are sadly far too common.

We have to be honest with ourselves and that is much of therapy is built around neurotypical norms. Expectations about eye contact, tone of voice, body language, pacing, or how insight should show up can all become barriers if we’re not careful.

Neurodivergence doesn’t happen in isolation. Many people are also navigating racism, homophobia, transphobia, chronic illness, poverty or other marginalised experiences. Therapy often fails to take this full picture into account.

If a therapist isn’t aware of how different forms of oppression overlap, they might focus on the wrong thing or even do more harm, without meaning to.

So what can we do?

We can start by pausing, listening more and being willing to adapt.
We can take sensory needs seriously, rather than seeing them as an inconvenience.
We can allow space for non linear communication, longer pauses or written reflections.

We can stop interpreting executive function differences as lack of care or motivation.
We can recognise that masking is often a survival strategy, not a sign that someone is doing well.

So many of us didn’t receive proper training on neurodivergence. That isn’t a personal failing. However, once we know more, we can choose to do better. We all have a responsibility to educate ourselves further.

Therapy should never be another space where someone has to explain themselves just to feel safe.

If you’re a therapist or mental health professional, I hope this offers something useful to reflect on. None of us get it perfect every time but we can keep unlearning and learning together. We can keep showing up better for our clients.

I would love to create spaces that truly meet people where they are and everyone’s individuality is honoured.