neuro-what?
What does "neurodiversity-affirming" even mean?
Recently I've started working with private therapy clients, which means I've had to face one of modern therapy's strangest necessary evils: writing SEO-friendly copy in order to sell my services as a therapist. I find "marketing" myself to be quite a dissociative, out-of-body experience – and perhaps there's a whole other post in that. But one thing in particular I've been thinking about during the process of doing this is how the language we use as therapists doesn't always align with the language of those searching for therapists. In particular, I've been sprinkling the phrase "neurodiversity-affirming" into my copy a lot, but asking myself, does the average person know or care what that means?
The language of therapy can be deeply insular. This is self-defeating. Sometimes, we therapists can get so lost in the weeds of our own psychoanalytical, existential, or relational meanderings, we forget to look up and outwards, and invite in the very people we're trying to support.
Therapy-related buzzwords like "neurodiversity-affirming", "client-centred", and "safe space" feel like the beige clouds of midges that haunt the edges of your vision on a summer's day. They're simply everywhere on therapist directories and websites, making the haze of their presence feel constantly known. But when you try to look directly at them, you can't quite make out their shape.
In the spirit of accessibility, I think it's important to be clear about what we mean when we're talking about therapy, and to not assume knowledge. To me, it's especially important to define what I mean when I talk about being "neurodiversity-affirming", because it's such a foundational part of the way I practice as a therapist and the way I try to live.
What is neurodiversity?
The word "neurodiversity" has hit the mainstream in recent years in a big way, being used everywhere from NHS leaflets to corporate diversity and equality slide decks. Its rapid explosion in popularity has meant that a lot of people, exposed to it in passing, have mistakenly perceived it as a "polite" or even "woke" way of talking about autism or ADHD. I've had people apologetically refer to me as "neurodiverse" rather than autistic, and while this is really well-meaning, it's not necessary, nor exactly accurate.
The concept of "neurodiversity" was born from discussions among autistic people on the internet in the mid-1990s, and popularised by the sociologist Judy Singer in 1999. It literally means that among human brains ("neuro-"), there is a range of differences ("diversity").
A person can't be "neurodiverse", in the same way that a person can't be "diverse". But a person can be "neurodivergent" – this is someone who "diverges" in some way from what society considers "normal". Neurodivergence could include being autistic, or having ADHD, dyspraxia, dyslexia, a personality disorder, schizophrenia, or multiple other mental health difficulties or disabilities. You can be born neurodivergent, or you can acquire neurodivergence later in life.
Crucially, neurodiversity and neurodivergence aren't just newer, more "politically correct" medical terms. They represent a broader, less medicalised way of thinking about differences in our brains. The whole ethos of neurodiversity is that diversity in ways of thinking and being is just a natural feature of humanity.
Other writers and thinkers have written much more extensively before me on the question of defining neurodiversity. For a seminal linguistic deep-dive into everything neuro-different, read Nick Walker's definitions of neurodiversity, neurodivergence, and the neurodiversity paradigm.
What isn't "neurodiversity-affirming"
The boom in neurodiversity awareness has led to a lot of uses of the phrase "neurodiversity-affirming" that leave a bad taste in my mouth. I have seen, in the wild, professionals who profess to support "people with neurodiversity". This kind of phrasing immediately makes me skeptical of how well this professional would actually be able to support me, as a neurodivergent person – through their syntax, they've made clear that they see "neurodiversity" as a synonym for disorder or disease.
To say that you support "neurodiverse people" would be a better way of showing that you support people with a range of ways of thinking. To say that you support "neurodivergent people" would much more clearly signal that you're able to work with people whose ways of thinking diverge from the norm.
To be neurodiversity-affirming means more than having completed some training in autism and/or ADHD. For a start, it means making an effort to understand and accept a wide range of behaviours and presentations of neurodivergence, including often maligned and stigmatised cases like personality disorders.
We should also expect those labelling themselves as "neurodiversity-affirming" to be discerning about the sources of their knowledge. In the spirit of the origins of the neurodiversity movement, as a neurodiversity-affirming practitioner, I approach neurodiversity through a non-medical, non-pathological lens. I aim to embrace all differences as a part of the natural spectrum of human variation – this means trying my hardest not replicating the ableism of medical institutions as part of my practice. To me, being "neurodiversity-affirming" means breaking free of the medical model and cultivating an understanding of neurodiversity that's led by the experiences of neurodivergent people.
I've attended conferences and trainings – even some held by neurodivergent practitioners – that have claimed to be neurodiversity-affirming, but have repeated ableist medicalised ideas about neurodivergence that have left me feeling alienated. In particular, I often encounter the idea that autistic people lack "Theory of Mind" or cognitive empathy in these spaces. When I hear these ideas about autism as a defect or deficit being repeated uncritically, I know that what I'm hearing isn't truly neurodiversity-affirming.
What "neurodiversity-affirming" means to me
To me, neurodiversity-affirming care is the direct opposite of this uncritical, unimaginative cleaving to medical views of the neurodivergent mind. Neurodiversity is expansive, imaginative, and liberatory – these are the values that I hope to capture in my practice, and in the ways I work with clients.
To me, the fundamental part of being a neurodiversity-affirming therapist is to not pathologise the people I work with. While I have some core understanding of the traits and presentations associated with various forms of neurodivergence, I'm more interested in discovering what the world looks and feels like to each individual client that I work with. I believe that being neurodiversity-affirming is about being open-minded and non-prescriptive in this way.
I also think that being neurodiversity-affirming is about simply believing people's experiences: when a neurodivergent client tells me that the crowded school cafeteria makes them feel like dying, or that seeing an injured bird in pain leaves them so devastated they can't get out of bed, or that they are overwhelmed with both love and hatred for the same person in a day, I believe them. Mental health professionals can make a powerful difference by simply believing in and exploring their clients' realities in good faith, with humility, and without measuring them against mental notes taken from the DSM-5. Perhaps controversially to some, I also believe that self-diagnosis or realisation is entirely valid, and that everyone has the right to make meaning of their own existence however they want to.
Most of all, being neurodiversity-affirming in the therapy room, to me, means that therapy itself is malleable. Who I am to each client, and what the therapy space feels like, is necessarily different – because my clients are all vastly different.
This is partly about making accommodations for neurodivergent clients to show up in the ways that feel authentic to them. They might want space to move around, play games, make art, talk about special interests, or take breaks from the therapy room.
But it's also about the actual relationships that I try to build, and how those might take a different shape with each and every person. In this way, my neurodiversity-affirming approach is inseparable from my approach as a foundationally person-centred therapist (one who believes that the client is the expert in their own life, and should lead the therapy process). I think therapy should be as diverse and divergent as our brains can be. Neurodiversity-affirming therapy, in this way, is full of wonder and possibility. With each new client, with each new mind that we encounter, what can therapy become?