There are things we are rarely taught in conventional psychotherapy training that make a real difference when we work with neurodivergent people.
We could talk about this for a whole series of meetings. For now, I’ll try to keep it brief and outline the main points. Above all, we need to remember that neurodivergent brains process information from the surrounding world differently. Responses to everyday sensory signals—sounds, sensations, smells—may be more intense. Responses to stressors may also be stronger. These differences relate to the nervous system’s innate characteristics, rather than something being “wrong” with the person.
Stress and self-regulation
Neurodivergent people often experience high levels of stress, and standard meditation or relaxation practices may not be enough. The source can lie deeper, in autonomic nervous system functioning and the balance of excitation and inhibition in the cerebral cortex. These processes cannot simply be controlled through willpower or self-reflection. A comprehensive approach is needed: assessment, including medical assessment, physical therapies, and sometimes medication. Psychotherapy alone, without considering the medical history, is often insufficient. After assessment, the next step is to learn ways of regulating that suit this particular person. This deserves an entire course, so I will only outline it here. Many of these methods involve physical therapies or sensory integration, areas that conventional psychotherapy does not usually address.
The therapist’s first task, then, is to understand where the stress is coming from.
Because of difficulties with self-regulation, neurodivergent people may struggle to recognize their emotional state, bodily sensations, and boundaries. Burnout, relationship problems, and difficulty organizing a sustainable life often follow, because basic sensitivity to oneself is disrupted.
If the therapist treats these difficulties as primary and relies on conventional tools such as awareness exercises or emotion and body-sensation trackers, both client and therapist can get stuck. Here, these difficulties follow from problems with self-regulation. Limited emotional understanding may also be part of the picture: how can it be easy to understand others when it is difficult to understand oneself? The underlying difficulty needs attention first.
When neurodivergence has not been recognized
Another challenge follows from the first. Many neurodivergent people without intellectual disability have no diagnosis. Yet they may spend years feeling that something is “not right” about them. Intense responses to events, experiences of stress, and difficulties with relationships and mutual understanding can create persistent background emotional pain. Some compensate through strengths such as intellectual or logical abilities. Others experience depression, which here is a consequence rather than the underlying cause, and may also use substances or alcohol to numb their current state. This isn’t unusual among people who struggle with overwhelming experiences and intense nervous system responses.
This is why we need to look at the whole picture: medical assessment, assessment of sensory processing difficulties and self-regulation, and identification of the person’s strongest stressors. The aim is to adapt daily life and improve quality of life. An individualized “sensory diet” may be useful. The topic is too extensive to describe fully in a single article.
There is another difficulty: some people fall close to the threshold for a diagnosis. They have adapted well enough that their differences are hard to recognize, yet they struggle with many of the same things as people who have a diagnosis. Finding an attentive physician who recognizes these nuances can be challenging. Medical assessment is important in determining whether medication or other medical support is needed.
So psychologists and psychotherapists need to understand something of the fields alongside their own. Ideally, they should be able to collaborate with physicians, understand nervous system physiology, and take at least a basic initial medical history.
In practice, we too often see neurodivergent people moving unhappily from one practitioner to another without receiving support that addresses their needs. Given the sharp increase after COVID in births of children with various health problems, we will soon see a surge in the number of neurodivergent people in the population.