Neurodiversity-Affirming Therapy for Adults: What It Can Look Like
Maybe you've spent years trying to figure out how you're supposed to act around other people.
You rehearse conversations before they happen. You worry about talking too much about something you love. You try to remember when you're supposed to make eye contact, even when looking away would make it easier to concentrate.
Or perhaps you've always felt a little different without having a clear explanation for why.
For some adults, learning about autism, ADHD, or neurodivergence offers a new way to understand experiences they've had for years. Others may already have a diagnosis but struggle to find support that respects how they experience the world.
Whatever brings you to therapy, you deserve a space where you can talk about your experiences without feeling that you have to perform a particular version of yourself.
That's part of what neurodiversity-affirming therapy aims to offer.
What Does Neurodiversity-Affirming Therapy Mean?
Neurodiversity describes the natural variation in how people think, learn, process information, communicate, and experience the world.
The term neurodivergent is often used by people whose neurological experiences differ from what society considers typical. It commonly includes autistic people and people with ADHD, although the broader term can encompass other neurological differences.
A neurodiversity-affirming approach recognizes that differences aren't automatically deficits.
That doesn't mean dismissing someone's struggles or suggesting that every difficulty can be resolved by changing their environment. Neurodivergent people can experience significant distress, disability, and mental health concerns that deserve appropriate support.
Instead, an affirming approach asks us to consider both the person and the environment they're navigating.
For example, someone who finds a busy social environment overwhelming may benefit from exploring what makes that setting difficult, what adjustments are possible, and whether participating in that environment is actually important to them.
The goal isn't necessarily to make someone appear more typical. It's to understand what matters to them and what might make their life more manageable or meaningful.
Importantly, neurodiversity-affirming therapy isn't one standardized treatment protocol. Therapists may draw from different clinical approaches while adapting their work to an individual's needs and preferences.
Therapy Should Make Room for How You Communicate
Traditional expectations about what a therapy session should look like don't always fit everyone.
Some people find it easier to explain their experiences through detailed stories. Others need time to think before answering a question. You might struggle to identify an emotion immediately but find it easier to describe what happened or how your body responded.
You may also find that eye contact makes concentrating more difficult, or that moving your hands helps you stay engaged.
These differences can become part of the conversation rather than problems that automatically need correcting.
In practice, this might mean asking your therapist to slow down, use more direct language, offer written information, or give you a moment to collect your thoughts.
The UK's National Institute for Health and Care Excellence (NICE) recommends that clinicians consider communication preferences, sensory needs, and adaptations to psychological interventions when working with autistic adults. Its guidance includes options such as clearer written information, structured approaches, and breaks when appropriate.
Those recommendations are specific to autistic adults, rather than a universal prescription for everyone who identifies as neurodivergent. Still, they illustrate an important principle: the way therapy is delivered matters, not just the techniques being used. (NICE)
A good therapeutic conversation leaves room to discuss what helps you participate.
You Can Talk About Masking Without Being Pressured to Unmask
Masking generally refers to efforts to conceal, modify, or suppress aspects of yourself to meet social expectations.
For some people, this involves carefully monitoring facial expressions or rehearsing responses. For others, it may mean avoiding conversations about their interests or hiding behaviors that might attract unwanted attention.
Sometimes masking happens deliberately. Other times, these patterns become so familiar that they're difficult to notice.
And masking isn't always a simple matter of choosing to stop.
There may be situations where adapting your behavior helps you navigate work, relationships, or environments that don't feel accepting. There may also be situations where those efforts leave you feeling exhausted or disconnected from yourself.
Therapy can provide an opportunity to explore these experiences without assuming that every form of masking is harmful or that complete unmasking is always possible or desirable.
We might look at the relationships where you feel comfortable, the situations that demand more energy, and the boundaries you'd like to establish.
You get to decide what authenticity means for you, including where and with whom you feel comfortable sharing different parts of yourself.
Your Interests Can Be Part of Therapy
One of my favorite things about working with geeks and gamers is how much meaning people can find in their interests.
Sometimes a fictional character helps you explain an experience that's difficult to put into words. A game might give you a way to discuss relationships, choices, or the feeling of belonging somewhere.
For someone who has spent years hearing that their interests are strange or childish, simply being able to talk about them without embarrassment can matter.
My approach is both geek-informed and neurodiversity-affirming. I welcome the games, stories, fandoms, and other interests that are meaningful to you.
But there's an important distinction: your interests are welcome, not required.
You don't have to play games during therapy. You don't have to explain your favorite fictional universe. And you certainly don't need to identify as a geek to work with me.
If an interest helps us understand something you're working through, we can explore it together. If you'd rather talk directly about what's happening in your life, we can do that instead.
You can learn more about this approach on my Geek Therapy page.
Affirming Therapy Still Takes Your Mental Health Concerns Seriously
An affirming approach doesn't mean that anxiety, depression, trauma, or difficulties with attention should be ignored.
It means working to understand those concerns within the context of your experiences.
Consider an adult with ADHD who struggles to keep up with daily responsibilities. They may have spent years being told that they're lazy or that they simply need to try harder.
Therapy can offer a different starting point.
Rather than treating difficulty with organization as a character flaw, we can explore how attention, expectations, emotional experiences, and available supports affect daily life.
The National Institute of Mental Health recognizes that ADHD can continue into adulthood and affect work, relationships, organization, and everyday responsibilities. Depending on the person's needs, treatment may involve psychotherapy, medication, or a combination of approaches. (National Institute of Mental Health)
Similarly, someone who's autistic may be seeking therapy for anxiety, relationship difficulties, or experiences of trauma. Affirming their neurological differences doesn't mean overlooking those concerns.
The therapeutic approach should be appropriate for the person's actual goals and clinical needs.
At Tall Grass Therapy, my work may incorporate mindfulness or EMDR when those approaches fit what someone is looking for. We can discuss what each approach involves, make room for questions, and consider whether adaptations would be helpful.
No particular treatment is automatically right for someone simply because they're neurodivergent.
You Don't Need a Diagnosis to Start the Conversation
Some adults come to therapy with an established autism or ADHD diagnosis.
Others are beginning to wonder whether descriptions of neurodivergence help explain their experiences.
And some people aren't particularly interested in pursuing a diagnostic label.
You don't need to have everything figured out before asking about therapy.
You can begin by talking about what has been difficult, what you've noticed about yourself, and what you would like support with.
If you're interested in a formal diagnostic assessment, that's a separate conversation. A comprehensive evaluation may be appropriate, and the qualifications and assessment services available vary by provider.
Therapy can also be useful for concerns that don't depend on having a particular diagnosis.
Your experiences are worth discussing even when you don't have a name for them yet.
What Should You Ask a Neurodiversity-Affirming Therapist?
Finding someone who describes their practice as neurodiversity-affirming can be a starting point, but the label alone doesn't tell you how they work.
You can ask a prospective therapist questions such as:
How do you adapt therapy for different communication or sensory needs? Their answer may help you understand whether they offer choices and invite feedback.
What happens if a particular exercise or therapeutic approach doesn't work for me? Look for someone willing to discuss alternatives rather than assuming that discomfort always means you need to push through.
How do you approach masking and social expectations? You can ask whether therapy will focus on your own goals rather than simply making your behavior look more typical.
What experience do you have with the concerns I'm bringing to therapy? A therapist may be affirming while still recognizing that another provider has more appropriate expertise for a particular assessment or treatment need.
You don't have to ask every question during an initial consultation.
What matters is whether you feel able to ask questions, express preferences, and participate in decisions about your care.
What About Online Therapy?
Online counseling can offer some flexibility in how you participate in sessions.
For example, you may be able to arrange your surroundings in ways that feel more comfortable. You might prefer familiar lighting, a particular chair, or having a comforting object nearby.
For some people, meeting from a familiar space can make therapy feel more accessible.
For others, privacy, distractions, technology, or the demands of video communication can create challenges of their own.
Online therapy isn't automatically the best fit for everyone. The setting, the treatment being considered, and your individual needs all matter.
It's reasonable to discuss those considerations with a prospective therapist before beginning.
Finding a Therapy Approach That Fits You
You don't have to become a different person to deserve support.
Maybe you're trying to understand why certain relationships feel exhausting. Perhaps you're working through painful experiences or figuring out how to communicate your needs.
Or maybe you're beginning to recognize aspects of yourself that you've spent a long time trying to hide.
Therapy can offer space to explore those experiences while keeping your preferences and goals at the center of the work.
I'm Dr. Corrine Buchanan, the owner and therapist behind Tall Grass Therapy. I offer online psychotherapy for adults in Florida and Oregon, with a geek-informed and neurodiversity-affirming approach.
If you'd like to learn more about how I work, you can read about my background and approach.
I'm currently maintaining a waitlist for new therapy clients. If you're interested in exploring whether we might be a good fit, you're welcome to join the therapy waitlist.
You don't need a polished explanation of everything you're experiencing. We can begin with what you'd like help understanding.
References
National Institute for Health and Care Excellence. (2012, updated guidance). Autism spectrum disorder in adults: diagnosis and management (CG142). The guideline addresses collaborative care, communication adjustments, sensory environments, and adaptations to psychological interventions. Read the NICE guideline
National Institute of Mental Health. (2024). ADHD in Adults: 4 Things to Know. U.S. National Institutes of Health. This publication summarizes adult ADHD symptoms, assessment considerations, and available treatment approaches. Read the NIMH publication
National Institute for Health and Care Excellence. (2018, subsequently updated). Attention deficit hyperactivity disorder: diagnosis and management (NG87). The guideline addresses environmental modifications and psychological interventions for adults with ADHD. Read the NICE ADHD guideline
