Which approach should you choose?
“I’ve already tried therapy. It didn’t help / it made things worse.”
I hear this very often, and almost always, when we start looking into it, it turns out that the therapy may not have been bad, but it didn’t take neurodivergent traits into account at all, focusing on the idea that avoidance / cutting off communication / communication difficulties, fatigue, and anxiety are caused by trauma or a personality disorder, and that this is not normal. A person who doesn’t know about their neurodivergence may think the same way. That they need to change, need to go out and socialize, need to try harder, and then it will get easier. A therapist wouldn’t lie, right?
And the therapist wasn’t lying. They also didn’t know about the client’s neurodivergence. And they worked by protocol. And they may also have been wondering where all this resistance and worsening of symptoms was coming from. It’s just that it wasn’t what your brain needed, and it was protecting itself the best it could. So what do you do if you keep suffering from all of this, but now, after a bad experience, you’re no longer even sure that anyone can help you at all.
Today we’ll go through specific approaches that really can be adapted for a neurodivergent brain. With examples of presenting concerns, so you can recognize yourself and understand what exactly might be helpful for you.
First, what does a “neuroaffirmative approach” even mean
A neuroaffirmative approach says that neurodivergent traits are not a pathology that needs to be cured. They are part of how you are wired. And the goal of therapy is not to remake you to fit a neurotypical standard, but to help you live your life taking into account how your brain actually works.
In practice, this means: the therapist doesn’t say that you need to endure and tolerate riding the subway if you have panic attacks there because noisy enclosed spaces make you feel awful, but instead will suggest trying noise-canceling headphones and a specific action plan in case you get lost, so there won’t be panic. They don’t interpret lateness as resistance if you have ADHD. They don’t suggest making eye contact to seem more confident if that feels uncomfortable for you. They don’t treat your need for structure as anxiety that has to be eliminated.
Sounds like the bare minimum. But in practice, it’s rarer than one would hope. 😔
🧠 ACT: accept what cannot be changed, change what is within my power
What it is. ACT — Acceptance and Commitment Therapy. One of the youngest and best-researched approaches. The central idea: you do not need to get rid of unpleasant thoughts and feelings in order to live a good life. You need to stop letting them control your actions.
Why it suits neurodivergent people. ACT doesn’t ask you to challenge your thoughts and prove to yourself that they are “irrational.” This matters: our thoughts are often quite rational, they simply reflect real difficult experiences. ACT works with values — with what actually matters to you, not with what “should” matter according to social norms. For neurodivergent people who have been taught all their lives to want the “right” things, this is a special kind of liberation.
The adapted NeuroACT protocol, developed at the Karolinska Institute and tested across three research phases, showed significant improvement in quality of life, reduced stress, and reduced psychological rigidity in autistic adults, with an effect size of 0.70–0.90 — that is a good result.
Do you recognize yourself in concerns like these?
“I know I’m supposed to go to this meeting. But the anxiety is so intense that for several days I can’t think about anything else, and then I don’t go and feel guilty.”
“It matters to me to be a good mother / a good professional / a good friend. But every time I try, I become so exhausted that I can’t do anything at all.”
“I don’t understand what I even want. All my life I’ve done what other people wanted.”
What the work looks like. The therapist does not analyze how rational your fear is. Instead: what matters to you? What do you want to have in your life? How do anxiety or avoidance interfere with that? Can we move toward what matters, even when anxiety is present?
Mindfulness in ACT is adapted: if standard meditation triggers anxiety, we work through movement, through special interests, through metaphors. No “close your eyes and observe your breathing” if that triggers a panic attack. (🙈 familiar, right?)
Especially suitable for: anxiety, perfectionism, losing touch with your own desires, chronic people-pleasing, when you don’t understand what you yourself want.
🧠 DBT: when emotions overwhelm you and you don’t know what to do with them
What it is. DBT — Dialectical Behavior Therapy. Developed by Marsha Linehan initially for working with borderline personality disorder — a condition which, as we now know, very often masks unrecognized neurodivergence or coexists with it. A structured, skills-based approach with four modules: mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness.
Why it suits neurodivergent people. Emotional dysregulation is one of the key difficulties in both autism and ADHD. Only the mechanisms are different. With ADHD, emotions come quickly and intensely and leave just as quickly; this is called emotional lability, plus there is rejection sensitive dysphoria (RSD). With autism, emotions may build up unnoticed and then break through in a meltdown or shutdown.
A randomized controlled trial with 123 autistic adults showed: adapted DBT significantly reduces suicidal thoughts and behaviors, and depression compared with the control group. Importantly, it was specifically adapted, taking sensory profile into account.
Do you recognize yourself in concerns like these?
“Someone criticizes me or even just looks at me the wrong way — and I can’t recover for several days. I understand that I’m reacting disproportionately, but I can’t do anything about it.”
“I have states where I just lose myself. I yell, cry, say things I regret later. And then — it’s as if nothing happened, only shame remains.”
“I don’t know how to say no. I agree to everything, then I get resentful, then I snap, then I apologize again. The cycle is complete.”
“After any conflict I get physically sick. Nausea, shaking hands, I can’t eat.”
What the work looks like. You literally learn specific tools. How to lower the intensity of an emotion in the moment. How to survive acute distress without doing something you’ll regret later. How to notice that anger/tension is building up before it’s too late.
Adaptations for neurodivergent people: distress tolerance skills are chosen according to sensory profile, not from a generic list. The interpersonal effectiveness block focuses on authentic communication, not on what is “socially correct.” Mindfulness work proceeds through whatever works for the specific person.
Especially suitable for: intense emotional reactions, RSD, meltdowns, self-harm, relationship difficulties due to emotional swings, when you feel too hot-tempered and sensitive, there is self-harming behavior or suicidal thoughts.
🧠 RO DBT: when you control yourself too well
What it is. RO DBT — Radically Open Dialectical Behavior Therapy. Developed by Thomas Lynch as a separate approach, not a modification of standard DBT but an independent model. If regular DBT works with undercontrol (impulsivity, emotional outbursts, chaos), then RO DBT works with overcontrol. That is a completely different story.
Why it suits neurodivergent people. Here is a paradox that is hardly described anywhere: many autistic people, especially those who have masked a lot, do not have a problem with control, but a problem with hypercontrol. Rigid rules for themselves and others. Total suppression of spontaneous behavior. Inability to relax even when it is safe. Masking as a way of life. Perfectionism driven not by ambition, but by anxiety.
Standard DBT does not help such people very much, because there they teach you to restrain impulses. But for a person with hypercontrol, impulses are already locked behind seven seals. The problem is the opposite: how to feel anything alive at all, how to allow yourself not to control, how to open up to another person.
Do you recognize yourself in concerns like these?
“I never lose control in public. At home — that’s a different matter. But around people I am always composed, polite, proper. And I’m damn exhausted from it.”
“It’s very hard for me to ask for help. It seems like I should cope on my own. If I can’t cope — that means I’m weak or not trying hard enough.”
“I have very clear rules for how things should be done. If something doesn’t go according to plan — it’s not just inconvenient, it’s a catastrophe.”
“I don’t know how to be spontaneous. Any unplanned event causes anxiety, even if it’s pleasant.”
“Closeness scares me. Not because people are bad — it’s just that when someone gets close, I shut down even more.”
What the work looks like. RO DBT teaches radical openness — the ability to receive new experience without immediately controlling and evaluating it. It sounds simple and feels like something very difficult. The work involves body signals, facial expression (how you smile is information about your state), and willingness to be vulnerable in safe relationships.
For autistic people, adaptation is important here: work with facial expressions and social signals is not to help you mask better, but to give you access to your own signals. Those are different things, and a good RO DBT therapist understands that.
Especially suitable for: hypercontrol, perfectionism, chronic masking as a way of existing, difficulties with closeness and vulnerability, depression against a background of social isolation, eating disorders with a restrictive pattern, OCD.
🧠 Schema Therapy (and STAND): when it all comes from childhood
What it is. Schema Therapy works with early maladaptive schemas — deep beliefs about yourself and the world that formed from unmet childhood needs. Schemas are patterns of perception, behavior, and relationships that once helped you survive, but now prevent you from living. If you feel that the same situations keep repeating in your life again and again and you cannot change your reactions to them, feel shame and guilt.
Why it suits neurodivergent people. We grew up in an environment that systematically did not take our needs into account. A school that punished us for things we could not control. A family that saw our pain and difficulties as whims. Peers who did not understand. Out of this grow schemas like “I am defective,” “I burden others,” “the world is unpredictable and dangerous,” “I must always try my absolute hardest, otherwise I will be rejected.”
In 2023, a group of Australian clinical psychologists developed the STAND model (Schema Therapy Adapted to Neurodiversity). The key innovation: two new modes that do not exist in classical Schema Therapy. The first is the “neurotypical advisor,” an adaptive inner voice that helps orient yourself in the neurotypical world without losing yourself. The second is the “ableist critic,” an analogue of the critical parent that reproduces internalized ableist messages: “you’re not normal,” “why can’t you be like everyone else,” “pull yourself together already.”
Do you recognize yourself in concerns like these?
“I have the feeling that I’ve been pretending to be normal all my life. And that if people find out what I’m really like, they’ll leave.”
“I don’t understand where my real desires end and what others expect of me begins. It feels like I don’t have a ‘self’ at all.”
“I need to always be productive, otherwise I feel useless. Rest is physically inaccessible — just lying there and doing nothing causes panic.”
“It’s very hard for me to ask for help. It seems like I should cope on my own, and if I can’t — that means I’m weak.”
What the work looks like. Schema Therapy combines cognitive work, body-based techniques, and imagery work. The therapist helps identify schemas, understand where they came from, and gradually give yourself what was missing: safety, acceptance, boundaries. It is not quick. But it is work with the root of the problems, not with the symptom.
In a neuroaffirmative version: the therapist does not try to “cure” autistic or ADHD traits. They help separate what is part of your neurobiology from what is the result of trauma and unmet needs.
Especially suitable for: a chronic sense of defectiveness, identity difficulties, relationship patterns that repeat in circles, perfectionism linked to shame, a difficult childhood history.
🧠 EMDR: when words don’t work, but the body remembers
What it is. EMDR — Eye Movement Desensitization and Reprocessing. A method for working with trauma through bilateral stimulation: eye movements, sounds, or tactile sensations. EMDR works with how traumatic experience is stored in the nervous system.
Why it suits neurodivergent people. Many of us carry trauma specifically from experiences of invalidation — from being misunderstood for years, punished for things we could not control, forced to be someone we are not. And classical trauma therapy runs into the question “how did you feel?”, which is difficult for us because of alexithymia.
EMDR gets around this: instead of naming the emotion — what is happening in the body? This is more accessible with reduced interoception. Tools like scales and visual images make it possible to work with inner experience without exact words.
Do you recognize yourself in concerns like these?
“I don’t remember most of my childhood. But I have a feeling that there was something there that affected me deeply.”
“People tell me I don’t have ‘real’ trauma. Just a difficult childhood. But I react as if I do.”
“Certain things — smells, voices, certain situations — knock me out of reality. It’s as if I’m there again.”
“I can’t talk about certain things. As soon as I start — that’s it, I can’t. Tears, shutting down, nothing.”
What the work looks like. Structured and predictable, which is important for us. The session is divided into clear phases. The therapist explains every step. The work proceeds in small pieces, without plunging into the hardest material right away. The pace is regulated together.
Especially suitable for: PTSD and complex trauma, flashbacks, dissociation, when words do not give access to what is happening, when the body reacts more strongly than the mind understands.
🧠 IFS: when inside it feels like several different people
What it is. IFS — Internal Family Systems, or the systems-based therapy of inner parts. A model in which the psyche is viewed as a system of parts — each with its own history, its own function, and its own needs. There are no “bad” parts. There are parts that are stuck in the past or trying to protect us in less-than-ideal ways.
Why it suits neurodivergent people. Many neurodivergent people describe their inner experience exactly this way: different voices, different parts that want different things. One part wants to isolate, one part demands productivity, one part is angry, one part is afraid. IFS gives language to this experience and makes it normal, rather than a sign of “fragmentation.”
In addition, IFS does not require direct access to emotions through the body. The work can proceed through images, metaphors, imagined dialogue. For those with alexithymia, this is often a more accessible path to inner experience.
Do you recognize yourself in concerns like these?
“One part of me really wants to connect with people. Another just wants everyone to leave me alone. And they are constantly in conflict.”
“I have an inner critic that never shuts up. It says I’m not trying hard enough, that I’m lazy, that others cope better.”
“Sometimes I act from some place, and then I look at it and think: was that even me? Why did I do that?”
What the work looks like. The therapist helps you come into contact with different parts. To understand what each part is trying to do for you, even if its methods are not great. To give the parts stuck in the past something different. This is quiet, slow work, and at the same time sometimes very powerful.
Especially suitable for: inner conflicts, self-sabotage, a harsh inner critic, dissociation, the feeling of “I don’t understand who I am.”
🧠 Skills trainings: when what you need is not talking, but concrete tools
A separate story is skills-based programs. Structured, with homework. For some neurodivergent people this works better than individual therapy, especially if the concern is specific: “I don’t understand how to plan,” “my emotions overwhelm me,” “I want to connect with people, but I don’t know how.”
An important difference from classical group therapy: there is no “let’s sit in a circle and share our feelings” here. This is training. Structure, predictability, concrete techniques. For us, this is often a safer format.
Group formats: when it matters to be among your own
Separately, about the group format itself. I know that for many neurodivergent people, the very word “group” immediately causes anxiety. Group dynamics, unpredictability, other people’s emotions, the need to respond quickly. (🙈 I personally had a panic attack at my first group session, I wrote about that.)
But there is a fundamental difference between a classical psychodynamic group, where you have to hold hands and share, and a neuroaffirmative skills group. The second format: a predictable structure for each meeting, a clear program in advance, and you can choose not to speak if you don’t want to.
A neuroaffirmative group is also a place where your behavior will not be interpreted as a symptom. Where you can stim. Where lateness is not “resistance.” Where silence is not “avoidance,” but the time you need for processing.
Do you recognize yourself in concerns like these?
“I want to connect with people, but I don’t understand the rules. It’s like everyone knows some kind of code, and no one gave it to me.”
“It’s hard for me to make friends. Not because I don’t want to — I really do. I just don’t understand how it’s done.”
“I always felt like an alien. And then I ended up in a space where everyone was the same kind of alien — and it was the first time in my life that I felt normal.”
🧠 Art therapy: when words are not needed at all
Here’s the honest answer to the question “is there evidence”: yes, but with caveats.
A 2024 systematic review analyzed 80 studies of art therapy and music therapy for ASD and ADHD and positions them as promising non-pharmacological alternatives for improving social, cognitive, and emotional skills. Studies show reduced anxiety and improved emotional regulation. The sensory and nonverbal nature of the creative process is well suited to neurodivergent experience.
A major caveat: almost all studies are on children. For adults, the evidence base is still modest, mostly qualitative data and clinical descriptions.
Why this makes sense for us:
First — nonverbal access to experience. For those with alexithymia, drawing, sculpting, collage can provide contact with an inner state where words do not work. Not because this is the “magic of art,” but because the process of creating something engages different channels than talking.
Second is sensory regulation. Working with materials — textures, smells, visual patterns — can be both regulating and grounding. For some of us this is literally a bodily resource. (I, for example, absolutely love coloring — it works better than any breathing technique 🙈)
Third — special interests as an entry point. A good art therapist does not wait for you to “open up through creativity.” They go through what is already interesting to you: photography, scrapbooking, embroidery, digital art.
Do you recognize yourself in concerns like these?
“It’s very hard for me to talk about what I feel. But if I draw or make something with my hands — something happens, and afterward it gets easier.”
“I don’t understand what’s happening inside until I start creating something. It’s like my hands know before my head does.”
An important caveat about format. If you are offered art therapy in a group where you have to show your work and discuss it in front of everyone — that’s one thing. If it is individual work at your own pace, without evaluation and without interpretations “from the outside” — that’s something entirely different. For us, this difference matters.
🧠 Body-oriented therapy and somatic approaches
Here the situation is similar: the theoretical logic is strong, but there are few strict RCTs on neurodivergent adults. But the mechanism is well described.
Somatic Experiencing (SE) — a method developed by Peter Levine for working with trauma through the body. The logic: trauma is stored not only in the narrative (what happened), but also in the nervous system as unfinished defensive responses. SE works with physiological regulation through titrated contact with bodily signals, stabilizes dysregulated autonomic nervous system activity, and increases resilience, without requiring a detailed account of what happened.
For neurodivergent people, this is especially relevant for several reasons.
Many of us have cPTSD: not one big event, but years of chronic mismatch with the environment, misunderstanding, invalidation. This gets stored in the body as chronic tension, hypervigilance, a sense of unsafety that does not go away even in objectively safe situations.
Somatic therapy for neurodivergent clients works through slow, consent-based movement to build interoceptive awareness. The key principles: move slowly, center consent, and allow the body to lead when words do not work.
Sensorimotor psychotherapy, Trauma Sensitive Yoga, SE — all of these work “bottom-up”: from the body to meaning, not the other way around. This is fundamentally different from “top-down” cognitive approaches, which go from thought to behavior.
A major caveat about body therapy and neurodivergence: physical contact, intensive body practices, breathwork — all of this requires special caution and a prior conversation about sensory profile. What regulates a neurotypical person may dysregulate us. A good body therapist knows this and asks about it at the beginning.
Do you recognize yourself in concerns like these?
“I am constantly tense. Even when everything is fine — my body seems to be waiting for danger. I don’t know how to relax.”
“I often feel as if I’m not in my body. I watch myself from the outside. Or I don’t feel what’s happening below my neck at all.”
“I have chronic pain / constant fatigue, but doctors don’t find anything. And I suspect that it is somehow connected to what is happening inside.”
What is worth avoiding. Body-oriented therapy in formats where there is a lot of physical contact with strangers, intensive breathing practices without checking sensory profile, or groups where hugging at the start is customary — for many neurodivergent people this is not a resource, but a burden.
📖 How all this works together
None of these approaches exists in a vacuum. A good neuroaffirmative therapist usually works integratively: they take tools from different methods for a specific person and a specific concern.
For example: if your concern is emotional regulation plus difficult relationships plus childhood history — the work might involve DBT skills helping in acute moments, EMDR processing specific traumatic episodes, and Schema Therapy working with deeper patterns.
And with any approach, a neuroaffirmative stance means one thing: the therapist adapts to you. Not you to the protocol.
👌 How to understand that a therapist works neuroaffirmatively
Not everyone who writes “I work with neurodivergent people” actually works neuroaffirmatively. Here are markers you can watch for:
A good sign:
- At the start of the work, they ask about sensory profile, about how you best take in information, what helps you feel safe
- If something is not working — they change the approach rather than increasing pressure
- They do not interpret lateness or silence as “resistance” without talking to you about it
- They know the difference between burnout and depression
Cause for concern:
- After sessions you regularly feel worse than before
- You are shamed for “avoidance” or “resistance”
- Your sensory reactions are called “irrational”
- The therapist insists on a technique that does not suit you
- You leave with the feeling that something is wrong with you
Finding such a therapist may not be easy. But knowing what exactly to look for is already half the journey. 💙