Today’s episode is based on a listener question: Jenna wrote, “How do you go about finding a therapist as a neurodivergent person? Are there specific things to look for, or avoid?”
🎧 Rather listen than read this post? This Asked & Answered is based off of Episode 20 of the Neurodiverging Podcast! Listen on Apple Podcasts | Google Podcasts | Spotify
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Introduction to Episode
Thanks for listening, Jenna! I think this is a great question, and one I’m happy to take a whack at.
If you have specific suggestions for Jenna that I don’t cover here, please feel free to email me at firstname.lastname@example.org, and I can forward them on, or leave a comment here for her to see!
I’m going to start off by talking about some general basics about how to find a therapist who’s a good fit, and then I’m going to move into talking about finding someone to help specifically neurodivergent folks like us.
Throughout this episode, I’m mostly referring to mental health professionals when I say “therapist,” but most of these guidelines apply to most medical professionals or coaches that you may choose to work with. This is not medical advice, this is only my opinion.
Basics About Therapy
Make sure any therapist you are considering has the required credentials for their field, is licensed in your state, and works with the kind of situation you are dealing with.
If you need financial therapy, don't go to a therapist who specializes in substance abuse, for example.
You can use an advocacy website to help you find a therapist familiar with the kind of therapy that you need. The searchable database from the federal Substance Abuse and Mental Health Administration is a good place to start if you’re in the United States.
Or, if there’s a type of therapy you’re interested in trying, professional societies like the National Association of Cognitive-Behavioral Therapists can help find therapists who have specialized training.
You can check online reviews, though they aren't the be all, end all. They can help you avoid someone who's really not very good at their job, but remember that all experience is subjective, and one bad review may indicate a poor fit for that one individual, rather than the reality of what that therapist is capable of.
You’re looking for fit first.
Finding someone that you trust, have a rapport with, and click with, is probably the most important part of finding a therapist, based on the research on good therapy outcomes. In my personal experience, that's also sometimes the hardest part of finding someone to work with. It doesn't matter how many degrees or how much experience a person has - if you don't feel like they hear what you are saying, or you don't like the way that they approach the world, you will not be able to integrate their teachings into your life.
“[T]he therapeutic relationship is as powerful, if not more powerful, than the particular treatment method a therapist is using,” says University of Scranton professor John C. Norcross, PhD, ABPP, chair of the American Psychological Association task force on Evidence-Based Relationships and Responsiveness … “We now know that some of these therapeutic elements not only predict but probably cause improvement,” he says.
So, in many cases, a good relationship between you and your therapist is worth more than any other metric, and so it’s something I recommend prioritizing in your search.
Try to do a free screening or a 15 minute meeting in person or by phone or Skype if you can. This can give you a feel for what the person is like, whether you feel like you'll get along, and give you a chance to ask the most important questions you have. Most therapists offer this for free.
Evidence-Based Is Best (Usually)
Another high-priority issue: you want a therapist to be using evidence-based therapies.
There are literally hundreds or maybe even thousands of different kinds of therapeutic approaches. Some of these are backed by evidence from medical studies, but a lot of them are not.
Check with your therapist about which approaches they use most often, whether they are familiar with any evidence-based therapies, and how often they use those evidence-based therapies. If they say they are familiar with something evidence-based like CBT, but can't remember the last time they actually used it, that is a red flag that this may not be an appropriate therapist for your situation.
I am being general when referring to evidence-based therapies here because what therapy you want depends completely on who you are, your personal mental health journey, and your goals. If you’re not sure whether a therapy you’re interested in is evidence-based, the American Psychological Association is a great place to start your research.
All of that said, a lot of therapies have not been studied much, because there isn't a lot of money behind different types of therapy, like there are with different kinds of pharmaceuticals. So, keep an open mind, and if something sounds reasonable to you, do your research and see what you think.
I’d also just say that we do have some evidence that certain therapies that work well for neurotypical people can be ineffective or harmful for certain neurodivergent people, and since most research studies are probably favoring neurotypical people in their study pool, it’s hard to apply the research we do have to us neurodivergent people as a group.
Fit First: My Family's Story
When my son was diagnosed autistic, when he was two and a half, we were referred to an occupational therapist within the same health system. She was nice enough, good enough with him, and well-educated, but she didn't communicate very well and often we didn't know why she was doing the therapies she was doing.
She also recommended a certain kind of therapy that I couldn't find any information about online for autism, and despite many leading questions, I couldn't get her to give me any sources or further information about this type of therapy, which didn't sit well with me. I felt like the therapist and I wanted different things.
I called around and got my son on a couple of other waitlists for occupational therapy, and we ended up with the therapist that we have now, at a different medical office. And this second occupational therapist ended up being such a better fit for us that we've been seeing her for maybe five years now, when you add both of my children's therapy periods together.
The experience with her was night and day. She is much more outgoing, answers all of my questions thoroughly, easily provides outside resources or more thorough explanations of what she is doing and why, and treats my child better, too.
Our first OT didn't really seem to understand autism at a visceral level. I don't know if she was relatively new to clinical practice, or just really stuck on the idea that autism is a terrible diagnosis to have and there was only so much therapy could do [/sarcasm]. But, our second therapist had clearly worked with so many different kinds of brains, and was ADHD herself.
Between my two children, we tried a lot of different therapies together, and she was always a partner to me and my kids. My experience with her really solidified how much fit matters - I was willing to try things that were much more based on her experience rather than scientific evidence because we had built the occupational therapy plan together, definitely had the same goals, and I trusted her experience because she did such a good job communicating with me. That's the difference good fit makes.
A couple of other really basic must-haves for a therapist:
- The good therapist should have a confidentiality plan, and should help you find the best fit for you, even if that's not them.
- A good therapist knows that you will meet with other medical professionals or health professionals to support you. Your therapist will not be everything, and if they try to be, they may not have your best interests at heart.
- A therapist should be good at setting boundaries and upholding them . This is good for you and for them.
- If they are defensive, won't answer your questions, or won't stray from a pre-designed course of therapy when things change, they are not a good fit for you. You need someone who will work with you, be flexible, and actually help you as you move toward your goals. You are looking for a partner to work with, not an authority figure to tell you what to do.
- And you should have goals! You shouldn't just be sitting in therapy chatting away for an hour . I mean, this happens sometimes, and it's not a terrible idea for your therapist to be caught up on what's going on in your life. But you are in therapy for a specific reason-depression, anxiety, addiction, whatever it is, and your therapy should include a plan for getting to your goals, with specific steps. If you feel like you're just in therapy meandering, you probably are not approaching your goal, and you should talk to your therapist about why that is.
Finding a Therapist as Someone with ASD
If you are looking for someone to work with as a neurodivergent person, it's really important to ask questions. In my experience, most therapists who don't specifically work with, for example, autistic people, don't have a great understanding of autism. This is especially true for me as a woman with autism.
If you're autistic and considering therapy, ask your autistic friends or your local autistic support group, or check out social media and see if anyone has a recommendation for someone near you. See if you can find someone who specifically states that they’re autism-friendly
And then, just because they say they are autism-friendly doesn't mean they actually are. It depends on how they were trained.
This is where that 15 minute initial meeting comes in. Ask them how many autistic people they've actually worked with, for example, and what kinds of things generally they've worked on.
How are they trained? What do they think about neurodiversity? What do they think about applied behavioral analysis? Think of some issues that are especially important to you personally, and ask your therapist their opinion. This will give you a good understanding of their background, blind spots, or problematic issues.
And I do want to say, just because a therapist says something problematic doesn't mean you can't work with them. If you like the person and you feel like you might have a good rapport, ask them why they said that problematic thing. Sometimes you can talk it out or ask them to research it further and come back.
I have worked with therapists who didn't know much about autism in the beginning of our work together, but they were still able to help me in other ways, and now they are more educated about autism for any future clients they might work right, so it ends up being a win-win in the right situation.
Sometimes Coaching Is Better for Neurodivergent Folks
Depending on what you're working for, I do want to mention that coaching can be a really good fit for a lot of neurodiverse folks. Full disclosure, I’m a life coach, and you can read more about that here if you’re interested in working with me.
Coaches work more with skill-building. Therapists can also do that, but most focus more on mental health concerns. So, for example, if your main issue is executive functioning skills, or if you have a learning disability like dyslexia or dyscalculia, then coaches are where it's at.
We coaches have very different training than therapists, and we are often more specialized in our clientele, have more specific training about certain issues, and are often neurodiverse ourselves. I have met a ton of ADHD executive functioning coaches, for example, and they know what they’re suggesting will work for ADHD brains, because they’re ADHD themselves.
I hope this has given you some tips to find a therapist or coach as a neurodivergent person! If you have tips that have worked for you in the past, please leave them for Jenna and other readers in the comments below!
Update 1/1/2021: I have one more episode coming out on Jan 14th, an interview from Sally, who runs the neurodiverse clothing line, ND Renegade. Then this podcast will be on hiatus for a couple of months while I work on new episodes. Sign up for my mailing list or join the Patreon to make sure you’re notified when the podcast comes back, and any articles I publish in the meantime.