Neurotypical Psychotherapists and Neurodivergent Clients

December 3, 2014

I’m often asked if I have any words of advice for psychotherapists and other professionals, on working with clients who are autistic and/or otherwise neurodivergent

Why, yes. Yes I do. And I’ve been meaning for some time to type up some of those words of advice and make them publicly available.

The push that I needed finally came from Sarah Coenen and Helen Cha-Choe, two grad students pursuing their M.A. degrees in Counseling Psychotherapy at California Institute of Integral Studies (my own alma mater, where I currently teach in the undergraduate Interdisciplinary Studies program from time to time). Ms. Coenen and Ms. Cha-Choe are collaborating on an excellent research project, for a Research Methods course taught by my dear friend and colleague Eri Çela.

In this project, Ms. Coenen and Ms. Cha-Choe are exploring the attitudes and perspectives of clinicians who work with autistic clients, and the impact those attitudes and perspectives have on the clients and on the quality of the clinicians’ work. I was delighted to learn that Ms. Coenen and Ms. Cha-Choe are grounding this project in the neurodiversity paradigm – that is, they’re approaching this as a diversity issue, recognizing that treating autistic clients as deficient or “lesser” is a manifestation of prejudice and lack of cultural competency, and recognizing that the pathology paradigm creates condescending and dismissive attitudes which manifest as microaggressions toward autistic clients. 

After reading a couple of my essays on the neurodiversity paradigm (Throw Away the Master’s Tools and Neurodiversity: Some Basic Terms & Definitions), Ms. Coenen and Ms. Cha-Choe sent me a few follow-up questions as part of their research. I was happy to support their excellent research by answering their questions at length, provided that I could also publish my answers for public consumption. 

Below are three of the questions they sent me, and my answers, which I hope will help psychotherapists and other professionals – especially the next generation of professionals, like Ms. Coenen and Ms. Cha-Choe – to better understand what it means to integrate the neurodiversity paradigm into their work. 

Ms. Cha-Choe, like myself, has a particular interest in somatically-oriented psychotherapy, so all of you fellow somatically-oriented professionals will be pleased to note that the third question specifically addresses the somatic angle.

I’ll be writing more on these topics in the future. A lot more, eventually.

I commend Ms. Coenen and Ms. Cha-Choe for the great work they’re doing, and for asking all of the right questions. And I welcome similar questions from other students who are engaged in the work of generating research, theory, and praxis based in the neurodiversity paradigm.

Q: How would you address empathy deficits and poor communication skills in neurotypical people working with neurodivergent populations?

The 20th Century political scientist Karl Deutsch said, “Power is the ability not to have to learn.”

I quote this statement often, because I think it’s one of the most important truths ever articulated about privilege, oppression, and social power relations.

When a social system is set up such that one particular group is almost always in a position of social power or privilege over another group, the members of the privileged group never truly need to learn or practice empathy or understanding for the members of the disempowered, oppressed group. Nor do the members of the privileged group need to learn to adapt to the communication style of the oppressed group.

Neurotypical privilege means that neurotypical people interacting with neurodivergent people – particularly when the neurotypical people in question are in positions of professional authority – have the luxury of never having to address or even acknowledge their own empathy deficits or poor communication skills, because they can blame all failures of empathy, understanding, and communication on the alleged deficits of the neurodivergent people.

Anthropologist Mary Catherine Bateson, writing about learning and power relations in colonialism, observed that “People who don’t wear shoes learn the languages of people who do, not vice versa.”

Bateson’s wording of this insight is especially resonant for the autistic community, because, when autistic activists object to the pathologization and abuse of autistic children by neurotypical parents and professionals, or the murder of autistic children by neurotypical parents, neurotypicals often attempt to silence us by condescendingly admonishing us to “put ourselves in the shoes” of the perpetrators. Yet as neurodiversity activist Kassiane Asasumasu has pointed out, not only do these same neurotypical parents and professionals never seriously attempt to put themselves in the shoes of autistic people, they do not even “acknowledge that we have shoes,” metaphorically speaking.

Power – or privilege, as we now more commonly call the particular kind of power to which Deutsch was referring – is the ability not to have to learn. There’s a phrase, “check your privilege,” that’s often repeated but rarely understood or heeded by those privileged persons at whom it is directed. If we start from Deutsch’s definition of power or privilege as the ability not to have to learn, we can understand “check your privilege” to mean, at least in part, “Learn! Be quiet, pay attention, and learn. Learn, even though the learning process, and the level of profound humility it requires, is going to be uncomfortable. Learn even though, because of your privilege, this sort of learning and humility is a discomfort that you have the luxury of being able to avoid – a luxury that we didn’t have, when we had to learn your ways. Learn even though you don’t have to.”

Unfortunately, as members of all oppressed groups discover, most privileged people just won’t do that. The states of profound and constant mindfulness, humility, openness to correction, and tolerance for uncertainty that such learning demands are too far outside of most people’s comfort zones. Most human beings simply won’t go that far outside of their comfort zones if they don’t have to. And privilege means they don’t have to.

The system is currently set up so that when neurotypical professionals work with neurodivergent individuals, the neurotypical professional is always in the role of greater authority: neurotypical therapist and neurodivergent client; neurotypical doctor and neurodivergent patient; neurotypical educator and neurodivergent student; neurotypical researcher and neurodivergent subject.

As long as this is the case, as long as neurotypical professionals only have regular, close contact with neurodivergent individuals in situations that are set up such that the neurotypical professionals hold greater authority and power, the neurotypical professionals will never have to subject themselves to the uncomfortable humility of checking their privilege, will never have to learn real empathy and understanding for the neurodivergent, and will never have to learn to understand and adapt to neurodivergent forms of communication.

And if they don’t have to, most of them won’t.

A related consideration is that when a person’s entire experience of an oppressed group consists of situations in which the members of that group are in “inferior” roles, it inevitably shapes that person’s perspective on the group in question. Just look at the Stanford Prison Experiment, for a glimpse of how quickly and powerfully this effect kicks in.

Anyone who understands this phenomenon will be unsurprised to learn that in my experience, the people who have the least empathy for neurodivergent persons, the least ability to communicate respectfully with neurodivergent persons, and the least genuine openness to learning from neurodivergent persons, are the neurotypical professionals who have spent their careers working with neurodivergent persons, in situations in which the professional always holds the authority, and the neurodivergent persons are always in the role of the patient, student, research subject, or “recipient of services.”

It’s nearly impossible for professionals of that sort to make the shift to the neurodiversity paradigm, to learn to check their neurotypical privilege, or to start respectfully listening to and learning from neurodivergent perspectives. They’ve simply become too entrenched in the habit of not seeing neurodivergent persons as equals.

So my answer to the question of how to address empathy deficits and poor communication skills in neurotypical people working with neurodivergent populations? Change the system, such that no neurotypical professional is permitted to work with neurodivergent populations unless all of the following conditions are met:

1.) The neurotypical professional must have received extensive training from neurodivergent teachers, using curricula designed or approved by neurodivergent experts. The neurodivergent teachers and experts in question must themselves be well-versed in the neurodiversity paradigm – and in realms of critical and liberatory theory like Critical Psychology, Liberation Psychology, Disability Studies, or Queer Studies – rather than tame, token neurodivergent persons (like Temple Grandin) who have themselves internalized and accepted the language of the pathology paradigm and the ableism of the dominant culture.

2.) The neurotypical professional must be licensed to work with neurodivergent populations, by a licensing board composed primarily of neurodivergent persons well-versed in the neurodiversity paradigm.

3.) The work of the neurotypical professional must be subject to supervision, input, and audit by neurodivergent representatives of the aforementioned licensing board, who have the authority to make recommendations to the board regarding the status of the neurotypical professional’s license.

None of these suggestions are likely to be implemented in the society in which we currently live, of course. But it’s a solution to the problems mentioned in your question – one of the only solutions to those problems that, if it were someday implemented, would actually work. And even when solutions seem a long way off, one must dare to dream.

Q: What advice and or suggestions can you offer psychotherapists working with neurodivergent populations?

Check your privilege.

Empty your cup, as the Zen Buddhists say.

Make the shift to the neurodiversity paradigm, completely. Throw out everything you’ve learned that’s in any way based in the pathology paradigm, all the messages about neurodivergence that you’ve been fed by the dominant culture. Be ferociously, eternally diligent about this: sociocultural programming is a constantly ongoing process, so breaking your sociocultural programming must also be a constantly ongoing process, and you’ll be swimming against the current. And it’s harder for members of privileged groups than members of oppressed groups: the status quo works in your favor, makes you the authority, lets you stay in your comfort zone, so it requires enormous ongoing commitment to stay mindful of the insidious and pervasive influence of the dominant paradigm, and to go against it.

The master’s tools will never dismantle the master’s house, but throwing away the master’s tools is hard – and it’s ten times harder if, within the current status quo, you’re one of the masters.

Recognize that nearly everything written or taught about neurodivergence by neurotypical “experts” is just plain wrong, and is harmful to your neurodivergent clients. The dominant culture’s stereotypes about any oppressed group are not more true just because you read them in a book or article written by an “expert.” Remember that there has been plenty of work published in the past by “experts” – including psychologists – that promoted sexist and racist stereotypes under the guise of “science.”

Remember that an author, teacher, researcher, or other “expert” who refers to autism, for instance, as a “disorder,” is no more of a trustworthy, unbiased, “objective” authority than an “expert” who refers to homosexuality as a “disorder,” or than the “experts” who used to describe non-white peoples as “savage.”

Remember that if you use the language of the pathology paradigm, you are reinforcing a social paradigm that harms your clients, and thus you are working against your clients’ interests.

Seek out neurodivergent teachers, supervisors, and consultants who are well-versed in the neurodiversity paradigm. And pay them for their work. It’s remarkable how many neurotypical professionals and organizations are happy to pay neurotypical “experts” to talk about neurodivergent people, but balk at paying the same rates for the harder-earned expertise of actual neurodivergent people.

Listen to neurodivergent people, and read what we write. Read neurodivergent scholars and activists like Remi Yergeau, Kassiane Asasumasu, Amy Sequenzia, and myself. Read Yergeau’s Authoring Autism and Clinically Significant Disturbance, the Typed Words, Loud Voices anthology, and Michael Scott Monje’s novel Defiant.

Never attempt to cure your client of being neurodivergent. When you have an autistic client suffering from anxiety and depression, for instance, remember that your job is to treat the client for anxiety and depression, not for autism.

Professionals who truly understand the neurodiversity paradigm would no sooner attempt to “treat” a client’s autism than attempt to “treat” a client’s homosexuality, or attempt to “treat” a client’s membership in an ethnic minority group.

Familiarize yourself with the field of Liberation Psychology, and be continually aware that many of the psychological issues with which your neurodivergent clients struggle will be issues created by social injustice and oppression, rather than by the client’s innate qualities. And remember that a good treatment plan is likely to include helping a client recognize this fact – helping the client understand their own oppression, both external and internalized, as a cause of their suffering.

Indeed, remember that your client may have completely bought into the pathology paradigm and may be ignorant of and even resistant to the neurodiversity paradigm. In which case, in order to support your client’s psychological well-being and liberation, it may be your duty as a therapist to introduce your client to the neurodiversity paradigm, and to educate your client by pointing them to writings like the ones mentioned above.

And above all, check your privilege.

Q: How does your training in somatics (both as a therapeutic orientation and your aikido background) factor into your work in the Neurodiversity Movement?

I see cognitive liberty as a core value of the Neurodiversity Movement.

The term cognitive liberty was coined by Wrye Sententia and Richard Glen Boire, the founders of an excellent organization called the Center for Cognitive Liberty and Ethics. Cognitive liberty as an ethical value boils down to the idea that individuals have the right to absolute sovereignty over their own brains and their own cognitive processes. The good folks at CCLE, and other advocates of cognitive liberty, often break this idea down into two fundamental guiding ethical principles:

1.) Individuals have the right to not have their brains and cognitive processes tampered with non-consensually.

2.) Individuals have the right to tamper with their own brains and cognitive processes, or to voluntarily have them tampered with, in any way they choose.

Those of us who are deeply involved in transformative somatic practices or in the field of Somatic Psychology understand that the psyche is somatically organized, which means that each individual’s distinctive neurocognitive processes are intimately entwined with that individual’s style of movement and embodiment. Changes in movement and embodiment create changes in cognition.

This means that to tamper with a person’s unique individual style of movement and embodiment (for instance, through the Behaviorist techniques that are frequently used to make autistic children suppress the outward signs of autism) is to tamper with that person’s cognition, and thus to violate their cognitive liberty.

In other words, freedom of embodiment – that is, the freedom to indulge, adopt, and/or experiment with any styles or quirks of movement and embodiment, whether they come naturally to one or whether one chooses them – is an essential element of cognitive liberty, and thus an essential area of focus for the Neurodiversity Movement. The freedom to be neurodivergent necessarily includes the freedom to give bodily expression to one’s neurodivergence.

For somatically-oriented psychotherapists, one important implication of all this is that neurodivergent clients will often have acquired habitual unconscious tensions (what Wilhelm Reich referred to as character armor) that prevent them from giving full expression to the movement style that is natural to their particular neurotype. These tensions will tend to be especially severe and deep-rooted in clients who, in childhood, were frequently shamed or otherwise abused for their physical expressions of neurodivergence, or who were subjected to Behaviorist “therapies” or other forms of coerced physical conformity.

An integration of the neurodiversity paradigm into the field of Somatic Psychology would include the recognition of these habitual tensions as somatic manifestations of internalized oppression. And it seems to me that somatically-oriented psychotherapists, once they have embraced the neurodiversity paradigm, are uniquely qualified to assist neurodivergent clients in the task of liberating themselves from the bonds of such tensions, and thus recovering their capacity for giving full expression to their divergent potentials.


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