What Neurodivergent-Affirming Therapy Actually Looks Like
The Therapy Wasn't Broken. It Was Built for Someone Else.
Here's a scene worth sitting with: you're in therapy. You did the exhausting work of finding a therapist in the first place — no small task — and now you're in session, and something is being asked of you that has nothing to do with why you came. Make more eye contact. Stay on one topic for the full fifty-five minutes. Stop moving your hands. Sound a little less intense about the thing you actually care about.
Maybe nobody says it that directly. Maybe it's quieter than that — the flicker of confusion when your brain makes a connection that felt obvious to you, the homework you cannot make yourself do no matter how much you want to, the way the hour always ends right when you finally got underneath the surface, the feeling of performing a session instead of having one.
If that's familiar, this post is for you.
The Model Was Never Neutral
Standard therapy — the clinical model most therapists train in and most practices are built around — was designed by and for neurotypical people. That's not a conspiracy. It's just a fact about who was in the room when the models were built, whose way of processing got treated as the norm, and whose nervous system became the invisible template.
The fifty-five-minute hour assumes a person can sustain focused verbal engagement on one topic for fifty-five minutes, at a pace that's comfortable for everyone, at roughly the same energy cost for everyone. For a lot of autistic and ADHD people, none of that holds. Some brains process best through movement, through writing, through circling a topic sideways instead of walking straight at it. A model with room only for linear verbal processing is a room built with the furniture bolted down at someone else's height.
Eye contact gets treated as a sign of engagement instead of what it often is for autistic people: genuinely uncomfortable, sometimes cognitively expensive. Homework between sessions assumes an executive-function style that doesn't match how a lot of ADHD brains work — and then non-completion gets read as resistance instead of what it is, a mismatch between the intervention and the brain trying to use it. Even the read on emotional affect is skewed: alexithymia, the difficulty naming an internal state, gets mistaken for detachment or defensiveness instead of a different way the interior is organized.
None of that is a clinical truth. It's a neurotypical cultural norm laundered through diagnostic language until it started looking like science.
A History Worth Naming
It's hard to talk about affirming practice without naming what came before it. Applied Behavioral Analysis has been the dominant intervention for autistic kids for decades, and in its classical form it used conditioning to train children out of stimming, out of limited eye contact, out of intense interest in the things they loved — not to support their wellbeing, but to make them look less autistic. Rates of PTSD among autistic adults who went through intensive ABA are real, and the way many describe it echoes conversion therapy: an intervention aimed at erasing an identity, not addressing suffering.
The diagnostic criteria carry their own bias. Autism research was built primarily on white, cisgender, male children, which means the framework still under-identifies autism in women, AFAB people, and BIPOC individuals — who instead often collect years of misdiagnosis, or get read through racial bias into conduct disorder and discipline instead of support.
This history is why the distrust a lot of neurodivergent people carry into therapy is earned, not paranoid. A genuinely affirming practice holds that history as context for the relationship, not as a footnote.
Accommodating vs. Affirming — and Why the Difference Matters
Accommodating neurodivergence means acknowledging a brain works differently and adjusting to reduce friction — letting someone stim in session, not requiring eye contact, flexing the exact fifty-five minutes. Those adjustments matter. They reduce harm. But the architecture underneath hasn't changed — the goals, the methods, the theory of change are still built around neurotypical cognition, and the neurodivergent person is a guest in a room designed for someone else.
Affirming means the practice is architected around neurodivergent experience from the ground up. Not a modification. The actual design.
This connects to what researcher Damian Milton calls the double empathy problem: the miscommunication between autistic and neurotypical people runs both directions. Neurotypical people misread autistic cues just as often as the reverse — the difference is that culture pathologizes one side of that mismatch and treats the other as invisible default. An affirming therapist isn't trying to make you more legible to that default. They're trying to actually understand your experience on its own terms.
What This Looks Like in an Actual Session
In practice, it starts before the first session — offering written intake instead of only verbal, letting questions come in asynchronously, not requiring a person to synthesize their whole history out loud on day one. Inside sessions, it means following a nonlinear thread instead of redirecting it, because the apparent tangent usually contains the actual logic. It means movement is welcome, stimming isn't managed, and in telehealth specifically, it means saying out loud, early: you can look away from the screen, change position, hold a fidget object, move through the space. That permission, given once, removes a layer of self-monitoring that was taking up cognitive bandwidth better spent on the actual work.
It means treating interoceptive differences as expected rather than a problem — building in scaffolding like “what are you noticing in your body” or “is there a color or texture that fits” instead of assuming “what are you feeling” will land cleanly. It means sensory experience — the lighting, the background noise, the texture of the chair — counts as session content, not a distraction from it. And it means session length and frequency are actually negotiable where that's possible, even though — worth naming honestly — that flexibility is genuinely constrained by what insurance will cover. That tension is real and unresolved, and any practice that says otherwise is selling you something.
Most importantly: affirming therapy is not aimed at making you more functional in neurotypical terms. It's aimed at reducing genuine suffering, supporting real self-understanding, and building a life that fits the brain and nervous system you actually have. That's a different goal than “more like the norm,” and it produces different work.
The Cost of Masking
Masking is the practice of suppressing or covering neurodivergent traits to look more neurotypical — the eye contact you force, the stimming you swallow, the small talk you push through, the facial expression you perform instead of the one your face wants to make. It's not a character flaw. It's an intelligent, adaptive response to real consequences: rejection, being called weird or too much, and — for a lot of people, especially AFAB and BIPOC folks trained from childhood to perform “nice” — safety.
It's also functionally the constant performance of a second language while trying to navigate your first language underneath it, and that performance is not free. Chronic masking is one of the primary drivers of autistic burnout — the exhaustion, skill loss, and sensory overload that comes from running that second system indefinitely. One of the things affirming therapy is for is giving you somewhere the performance isn't required. Not eliminating masking from your whole life — that isn't always safe. Just making sure you have at least one room where the cost of maintenance gets to pause.
If You Were Diagnosed Late
Learning as an adult that you're autistic or have ADHD is its own kind of grief work — relief at finally having a framework, grief for the years spent without it, for the relationships and jobs that were hard for reasons you couldn't name. That often calls for what functions as retrospective reinterpretation: going back through your own history with new information, not to re-traumatize but to revise the story — trading “I failed because something was wrong with me” for “I was navigating systems that weren't built for my brain, without knowing what my brain was, and I did an extraordinary amount of work just to get here.” That's not a small reframe. It changes your relationship to yourself going forward, and it deserves a therapist who can sit in the grief of the missed years without rushing you toward a silver lining.
If Therapy Hasn't Worked For You Before
That's not evidence you're too complicated to help. It's evidence of a mismatch — a room that wasn't built for your brain. What you're looking for exists, and it's worth looking for.
Soma Roots Therapy is a somatic, neurodivergent-affirming telehealth practice serving Oregon and Washington, newly in-network with Cigna, with sliding-scale spots held for folks who need them. Free 20-minute consultations are open — come find out if it's a fit.
Del Knight (they/them), PsyD, LPC, LMHC, NCC, CCTP-II, ACS, CGP, CSTFP is a licensed psychotherapist and the founder of Soma Roots Therapy, a somatic, queer and trans-affirming, neurodivergent-affirming, decolonial telehealth practice serving adults in Oregon and Washington. Del is also a Certified Body Trust Specialist and Approved Clinical Supervisor.
If you're in Oregon or Washington and curious what slow, somatic, body-liberation-rooted therapy can look like, Soma Roots Therapy is accepting new clients. Schedule a free consultation here.
🌿 Slow. Embodied. Rooted in liberation.
FAQ — Episode 10
What does “neurodivergent-affirming” actually mean, beyond a buzzword?
It means the practice is built around how divergent brains actually process, communicate, and regulate — not modified from a neurotypical baseline. It's the difference between being accommodated as a guest and being the person the room was designed for.
Do I need an official autism or ADHD diagnosis to book a session?
No. Plenty of people come in exploring whether they're neurodivergent, self-identified without a formal diagnosis, or somewhere in between. The work doesn't require a paper trail to be legitimate.
Will I be expected to make eye contact or sit still during sessions?
No. Movement, stimming, looking away from the screen, changing position — all welcome, and named explicitly at the start of telehealth sessions so you don't have to spend energy wondering if it's allowed.
What's the difference between “accommodating” and “affirming” neurodivergence in therapy?
Accommodating adjusts around a neurotypical baseline — letting you stim, flexing session length. Affirming rebuilds the baseline itself around neurodivergent experience, so those aren't modifications — they're just how the room works.
What is masking, and why does it matter in therapy?
Masking is suppressing neurodivergent traits to appear more neurotypical, and it's exhausting — a major driver of autistic burnout. Affirming therapy is one of the few spaces designed for the mask to come down.
Is Soma Roots Therapy covered by insurance?
Yes. Soma Roots Therapy is in network with a variety of commercial insurancers. You can learn more about which and other payment options here.
