The significance of the mental health crisis among autistic individuals cannot be overstated. A 2019 meta-analysis reviewing 96 studies found that psychiatric conditions are considerably more prevalent among autistic individuals compared to the general population (Lai et al., 2019). This crisis highlights the importance of shifting to a neurodiversity-affirming approach in mental health practices.

The neurodiversity paradigm, as defined by Walker (2021), recognises neurological variations, such as autism, ADHD, and dyslexia, as natural and valuable forms of human diversity. Rather than viewing these differences as “deficits” to be fixed, the neurodiversity paradigm challenges this outdated framework, promoting acceptance and understanding of how neurodivergent individuals navigate the world (Dallman et al., 2022). This perspective calls for moving away from pathologising language and instead focusing on creating environments where neurodivergent individuals can thrive based on their unique strengths and support needs (Moses, 2023).

Neurodiversity advocates are consistently championing acceptance and inclusion, advocating for a fundamental shift in how mental health is understood and approached. For counsellors, this shift demands more than awareness – it calls for adopting neuroaffirming practices that validate and support neurodivergent clients. Neuroaffirming counselling moves away from conventional therapeutic goals of ‘conformity’ and ‘normalisation’ instead focuses on embracing the neurodivergent client’s unique strengths and specific support needs. In a field that prides itself on inclusivity, adopting neuroaffirming practices is not just important; it is essential for creating truly safe, supportive and empowering therapeutic environments for neurodivergent clients.


Understanding Neuroaffirming Practice

The core principles of neuroaffirming practice centre around celebrating and respecting neurodivergent differences in thinking, learning an interacting without dismissing or minimising the fact that being neurodivergent also comes with its own challenges unique to each individual (Walker, 2021).

Respecting Differences – This means acknowledging and honouring unique ways neurodivergent individuals process information, communicate, and experience life. These differences are integral to a person’s identity and are not shortcomings (Jones et al., 2024).

Rejecting Pathology – This principle involves intentionally moving away from the medical model, which often uses terms like ‘symptoms’ or ‘deficits and frames neurodivergence as something to be ‘fixed’ or ‘changed.’ Instead, neuroaffirming practice promotes acceptance and fosters a genuine understanding of how neurodivergent individuals navigate the world (Barnett, 2024).

Emphasising Strengths – Focuses on identifying and nurturing each person’s unique capabilities whilst also recognising the individual’s unique needs and providing the specific support they require to thrive in environments that may not always be neuroaffirming, without imposing external expectations of change (Barnett, 2024; Pantazakos & Vanaken, 2023).

Client Autonomy – Aligns with empowering neurodivergent individuals to define their own goals, with the therapist acting as an ally in their journey (Naylor, 2023).

By adopting a person-centered approach, which is essential in neuroaffirming practice, counsellors avoid making assumptions of shared meaning and create a space for neurodivergent clients to communicate their experiences in their own words. This framework allows individuals to share their perspectives, helping them assign personal meaning to their experiences rather than having external interpretations imposed on them. Such an approach fosters understanding and respect for each client’s unique lived reality, ensuring that therapy is driven by their needs and goals and they are supported, valued, respected for who they are, as they are (Garvey, 2023)​.


Key Benefits of Adopting a Neuroaffirming Approach

Adopting a neuroaffirming approach in therapy brings numerous benefits, particularly in building a strong therapeutic alliance. By acknowledging and respecting neurodivergent experiences, practitioners foster trust and create a space where clients feel understood and validated. This practice reduces shame and self-criticism, which are often heightened in neurodivergent individuals who have faced societal pressure to conform to neurotypical standards (Walker, 2021)​.

Additionally, neuroaffirming practices enhance client well-being by validating the lived experiences of neurodivergent individuals, helping them feel less alienated and more accepted for who they are. This acceptance can lead to improvements in mental health, reducing the sense of isolation and improving self-esteem (Pantazakos & Vanaken, 2023)​.
Ethically, aligning with a neuroaffirming, person-centered approach is crucial, as it respects neurodivergent identities and honours their autonomy (Jones et al., 2024). By prioritising neurodivergent voices and focusing on their strengths, therapists ensure their practices are both supportive and ethically sound. This approach reflects a commitment to inclusivity and equitable care for all clients.


Practical Strategies for Counsellors to Implement Neuroaffirming Practice

Use Client-Preferred Language:
It’s essential to ask your client what language they feel comfortable using to describe their neurodivergence. For example, some may prefer identity-first language, such as ‘autistic,’ while others might prefer person-first language, like ‘person with autism.’ A simple, respectful way to approach this could be: “I want to make sure I’m using language that feels affirming to you. How would you like me to refer to your neurodivergence? Some people prefer identity-first language, like ‘autistic,’ while others prefer person-first language, like ‘person with autism.’ What’s your preference?”
This client-led conversation helps ensure the language used is empowering and comfortable for them.

Be Aware of Sensory Preferences:
Create an environment that accommodates sensory sensitivities. For instance, offer to adjust lighting, sound, or even room textures based on the client’s needs. You might say, “Would you like the lights dimmed, or is the current level okay for you?”

You can also suggest tools that aid in sensory regulation, such as fidgets, noise-cancelling headphones, or weighted blankets if the client finds them calming. If your client struggles to stay present in the session, you could say, “Some clients find it helpful to use fidgets or weighted blankets. Would any of those be helpful for you during our session?”

Tailor Communication Methods:
Use clear, direct language that avoids unnecessary jargon, and break down complex information into manageable steps. For example, instead of saying, “We’ll work through cognitive restructuring techniques today,” you could simplify it to, “Let’s look at how we can change some of the thoughts that may be making things harder for you.”

You could also discuss how to adapt communication methods to better fit the client’s preferences. For instance, some clients may prefer visual aids or written summaries after sessions, while others may find text-based communication between sessions useful. You could say, “Would you prefer if I send a written summary of what we discussed today, or is verbal feedback more helpful?”

Emphasise Strengths-Based Interventions:
Focus on helping clients explore their strengths rather than focusing the conversation around challenges. For example, if a client has hyperfocus as part of their neurodivergence, highlight how that can be a strength in achieving specific goals. You might say, “Your ability to focus deeply on a task can be a great asset. How do you think we could use that strength in our work together?”

Integrate strengths into the therapy process by using their unique problem-solving skills or creativity in collaborative goal-setting. An example might be: “I’ve noticed how creative you are when approaching challenges. How can we use that creativity to help with the obstacles you’re currently facing?”

Support Sensory and Emotional Regulation:
Offer grounding techniques that align with your client’s sensory and emotional regulation needs. For example, some neurodivergent clients may benefit from sensory breaks during sessions. You could say, “If you’re ever feeling overwhelmed, we can take short sensory breaks to help you regulate. How does that sound?”

Teach clients co-regulation and self-care strategies, such as using specific sensory inputs (e.g., textured objects or calming music) to manage stress. “Some people find certain sensory tools helpful, like calming music or a weighted blanket. Would you like to explore those options together?”

Avoid Enforcing Neurotypical Social Norms:
Allow for different forms of communication and interaction that feel comfortable for the client. For instance, if a client avoids eye contact, don’t insist on it. You could say, “You don’t have to make eye contact with me if that’s uncomfortable. I’m here to communicate with you in whatever way feels most natural.”

Encourage clients to embrace their unique social rhythms and interaction styles, and reassure them that they don’t need to conform to neurotypical standards. An example would be, “It’s completely fine if you communicate or interact differently. We’ll work with whatever feels right for you.”


Challenges in Adopting Neuroaffirming Practice

Counsellors may encounter several challenges when shifting towards neuroaffirming practices, beginning with addressing internal bias. Many practitioners unconsciously hold neurotypical biases, viewing behaviours such as stimming or lack of eye contact as maladaptive. Reflecting on these biases is essential for adopting a neuroaffirming stance (Walker, 2021). For instance, rather than perceiving stimming as ‘disruptive’, counsellors should recognise it as a valid form of self-regulation and encourage the behaviour during therapy sessions (Garvey, 2023).
 
Systemic challenges also present difficulties, particularly when neuroaffirming practices conflict with traditional therapeutic frameworks or external pressures from institutions such as schools or workplaces. Counsellors may need to advocate for adjustments that better align with their clients’ neurodivergent needs (Jones et al., 2024).
Finally, a commitment to continuous learning is crucial. Ongoing education about neurodiversity-affirming practices is necessary, particularly in terms of cultural sensitivity and the experiences of diverse neurodivergent clients. Engaging with updated resources and learning from neurodivergent voices are key steps toward maintaining an informed, inclusive practice (Moses, 2023; Pantazakos & Vanaken, 2023).


Conclusion
Adopting neuroaffirming practices can significantly transform therapeutic relationships by fostering trust, reducing stigma, and validating neurodivergent clients’ lived experiences. This approach enhances well-being by promoting acceptance and helping clients feel more understood, ultimately aligning therapy with ethical counselling practices that prioritise respect and inclusivity. To begin implementing neuroaffirming strategies, even small shifts in mindset and language can make a profound difference. By respecting client autonomy, focusing on strengths, and accommodating sensory needs, counsellors can create more supportive and empowering spaces.

Neuroaffirming Resources:

  • Neuroqueer Heresies by Dr Nick Walker
  • Supporting Autistic People in Therapy by Niamh Garvey
  • Training by Amanda Moses: Neurodiversity Affirming Management Strategies
  • The Neurodiversity Hub (neurodiversityhub.org) for further education and advocacy materials.

References
Dallman, A. R., Williams, K. L., & Villa, L. (2022). Neurodiversity-affirming practices are a moral imperative for occupational therapy. The Open Journal of Occupational Therapy, 10(2), 1-9. https://doi.org/10.15453/2168-6408.1937

Garvey, N. (2023). Supporting autistic people to develop a personalised self-care approach to their mental health and stress. Retrieved from https://niamhgarvey.com

Jones, F., Hamilton, J., & Kargas, N. (2024). Accessibility and affirmation in counselling: An exploration into neurodivergent clients’ experiences. Counselling and Psychotherapy Research. https://doi.org/10.1002/capr.12742

Lai, M. C., Kassee, C., Besney, R., Bonato, S., Hull, L., Mandy, W., … & Ameis, S. H. (2019). Prevalence of co-occurring mental health diagnoses in the autism population: A systematic review and meta-analysis. The Lancet Psychiatry, 6(10), 819-829. https://doi.org/10.1016/S2215-0366(19)30289-5

Moses, A. (2023). Neurodiversity affirming management strategies [PowerPoint slides]. Amanda Moses Psychology. https://www.amandamosespsychology.com.au

Pantazakos, C., & Vanaken, K. (2023). Three ideas in person-centered, neurodivergent-affirming therapy. Counselling and Psychotherapy Research. https://doi.org/10.1002/capr.12345

Walker, N. (2021). Neurodiversity: Some basic terms and definitions. In Neuroqueer heresies: Notes on the neurodiversity paradigm, autistic empowerment, and postnormal possibilities. https://neuroqueer.com/neurodiversity-some-basic-terms-definitions/