Therapy is traditionally built around a very particular format: a 50-minute conversation, face to face, in a quiet room, with lots of open-ended questions and plenty of eye contact. For many neurodivergent people, that format is part of the problem. The good news is that it can be changed, and you’re allowed to ask.
What the guidance says
NICE guideline CG142, on autism in adults, recommends that psychological therapies for autistic people are adapted. Suggested adaptations include a more concrete and structured approach, greater use of written and visual information, regular breaks, and incorporating the person’s special interests where helpful.
The Equality Act 2010 also applies to service providers, including therapists. Providers have a duty to make reasonable adjustments for disabled people, and this duty is “anticipatory”: services should think ahead about what disabled people might need, rather than waiting to be asked.
Research in this series supports this approach. See “Adapting EMDR for Autistic Minds: A Case Study” for one example of adapted trauma therapy, and “Forgot Your Session? ADHD, Therapy and Reasonable Adjustments” for practical ideas around ADHD.
Adjustments you might ask for
Communication
- Direct, clear language rather than vague or abstract questions
- Written summaries after sessions
- Permission to not make eye contact
- Time to process before answering
Environment
- Dimmed lighting, a quieter room, or a seat near the door
- Fidget toys, or permission to move or stim
- Sessions online, with the camera on or off
Structure
- An agenda at the start of each session
- Shorter or longer sessions, or regular breaks
- Text or email reminders before appointments
- Flexibility around missed sessions
A grain of glitter ✨
Evidence on adapted therapies is growing, but much of it comes from small studies and case reports, and most research has focused on autistic adults rather than people with ADHD or other neurodivergences. Not every adjustment will suit everyone, either: neurodivergent people are incredibly diverse. The key is collaboration. A good therapist will work out with you what helps, and keep checking in as things change.
What you can do
- Make a list of what helps and what makes things harder for you.
- Raise it in your first session, or by email beforehand if that’s easier.
- If a therapist isn’t willing to adapt at all, that tells you something important.
It’s not about making therapy easier. It’s about making it accessible.
You wouldn’t ask a unicorn to squeeze into a horse’s stall. The stable should fit the creature, not the other way round.
Further reading
- NICE (2012, updated 2021). Autism spectrum disorder in adults: diagnosis and management (CG142)
- Equality Act 2010