How therapy designed for autistic and ADHD people differs from traditional therapy

I’m an autistic/ADHD (AuDHD) individual who provides therapy for other AuDHDers.

I know many AuDHDers who had terrible experiences with therapy. I also meet many AuDHDers who feel that therapy was “ok,” but that it didn’t really help them that much.

People who come to me for therapy are initially weary because of their past negative experiences.

And I don’t blame them — traditional therapy isn’t designed for autistic/ADHD people. Yes, therapists genuinely want to help any client who comes to them, but that doesn’t mean the therapist’s skills, educational experience, and techniques are suited for neurodivergent people.

So how is therapy designed for autistic/ADHD different?

That can be a bit tricky to explain across the board because there is no one therapy modality (such as cognitive behavioral therapy, DBT, etc.) designed specifically for autistic/ADHD.

There is the term “neuro-affirming therapy” that simply means the therapy doesn’t stigmatize neurodivergence. However, what kind of therapy is actually provided varies significantly.

So I can’t provide a general explanation of how therapy for autistics/ADHD people is different.

What I can do though, is show you how therapy is different within my own therapy practice.

First off, I am AuDHD individual. I think this makes a huge difference. It means I get what it is internally like to move through life with a neurodivergent brain. I experience the ups and downs. I live the frustrating rumination, shutdowns, and social challenges. I also live all the wonderful parts of being AuDHD — like glorious creativity, excitement at little things, and an ability to accomplish incredible things when focused (which only comes in spurts).

My personal experience means I have an inbuilt understanding. When a client starts to shame themselves for something they did, I can proclaim, “Oh my gosh, I’ve done that, too!”

Traditional therapy often teaches that therapists need to be blank slates: that we shouldn’t share anything about ourselves and be as neutral as possible.

I couldn’t disagree more. AuDHD people need to know someone else gets it. And we need to hear examples and experiences. Our brains need context to understand.

My own therapist is AuDHD, and I absolutely love it when she shares about her own life. It makes me feel more sane, seen, and understood

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It also helps me to grasp a new concept. For example, she might point out a thought pattern I have that is trapping me. I’ll respond, “Okay, I see that, but what is the alternative??” She’ll tell me a new way of looking at things, but I still won’t grasp how to apply it. Then she’ll provide an example from her own life where she lived the thing she’s trying to teach me. That’s when I finally get it.

Another reason I think it’s important for AuDHDers to have AuDHD therapists is that for the majority of our lives, we haven’t been properly seen or understood.

It’s rare to fully connect with someone. Therapy with a fellow neurodivergent can provide that.

Another benefit is that it provides a space where we can ask, “Does that happen to you?” Many of us don’t have AuDHD friends. We don’t know what’s “normal” and what’s not. We don’t know which parts of us are due to autism or ADHD, and which are just part of being a normal human.

Much of the work I do in therapy is helping my clients to fully understand how autism and ADHD impacts them.

Why does this matter so much?

For one, it helps us to see and understand ourselves better.

For two, it increases compassion and self-love for ourselves. We suddenly understand why we behave the way we do. We see that we’re not a malfunctioning human — just a human who functions differently and therefore has different capacities and needs.

Some of the greatest damage we can do to ourselves happens when we’re struggling and then beat ourselves up for struggling. We fall into shame spirals that can quickly lead to harsh self-criticism, self-hatred, and suicidal ideation.

We can stop that dark plunge when we acknowledge our lived experiences are valid. When a client tells me about an experience that led to a meltdown, I frequently exclaim, “Oh my gosh, that is so awful, I would have melted down too!” This is not a trick I’m using. I genuinely mean it. Over and over again, I affirm to clients, “Yeah, that feels wretched because it is wretched!”

To put it more concretely, therapy for AuDHDers is about normalizing feelings, thoughts, and behaviors.

When I went to traditional therapy, my therapist wanted me to stop and challenge each thought I had. For example, she wanted me to ask myself, “Is this thought true, or am I just catastraphizing?”

While this approach works in theory, it was a disaster for my AuDHD mind that is constantly overflowing with thoughts. Trying to stop and examine each thought for its validity drove me crazy.

In therapy with my clients, I emphasize that a higher volume of thoughts is normal for neurodivergents.

So is a greater frequency of ups/downs. And those ups and downs are also much more intense than most people.

When we start with this reality, we can then examine how to support ourselves.

We’re not trying to stop our thoughts. We’re not trying to reduce how much we feel. Instead, we’re learning how to work with it. This is what I feel is truly “neuro-affirming.”

So how does therapy actually help us learn how to work with our lovely AuDHD brains?

Again, I cannot provide a general approach. I can only share what I do.

I start with helping clients identify their autistic/ADHD traits.

We then look at what they can change and what they cannot. They may not be able to change their high volume of thoughts, but they can learn new techniques to distract themselves when they’re ruminating. For example, I often teach AuDHDers that they need to double up on their distractions. For me, that often looks like having a tv show playing while I do a puzzle or paint.

In contrast, typical therapy might tell a client to stop and examine why they are ruminating. This often makes things worse for us as AuDHDers. A rumination spiral is not the time to try and think more (our brains will just find all the supporting evidence for our negative train of thought). We need to break the cycle with double distraction. Then later (usually the next day), when we are calmer, we can more effectively and accurately reflect on what happened. It’s usually painfully obvious where things went astray.

I say “painfully” because it’s almost embarrassing how obvious it is. I’m able to see, “Well of course I got upset about that, they were invalidating my lived experience.” But when I’m in that emotional rumination cycle, everything feels awful and I cannot see or think clearly.

I would hate to have to explain that to my therapist.

We shouldn’t have to educate our therapists about autism or ADHD.

I want my therapist to know far more about it than I do. I want them to point things out to me. I want them to educate and enlighten me. I want them to teach me new strategies and techniques.

It’s no surprise that so many clients who come to me are weary of returning to therapy. They have a litany of poor therapeutic experiences. They left thinking, “Wow, not even therapy could help me. I must be really messed up.”

We’re not messed up. And we’re not beyond help.

We just need the kind of help that is designed for us.