What They Wish Therapists Knew

By Alisar Eido, LCSW and clinically reviewed by Teri Schroeder, LCSW

Long before I had neurodivergent clients of my own, I met my fair share of mental health professionals through my own counseling. A lot of those experiences were what I’d call a swing and a miss. This was not because they were not qualified and well intentioned people. They just didn’t quite understand my experience of the world.

A decade, a diagnosis, and a master’s degree later, I find myself working with the neurodivergent population as well as being one of them. I have been diagnosed with ADHD and have been told I will not be beating the Autism allegations any time soon. My lived experience has helped me greatly in understanding clients who don’t have the standard experience of the world. These are some of the considerations I’ve learned to take when working with neurodivergent clients and those with sensory sensitivities.

Ask the Questions

In my experience, clients rarely bring up sensory sensitivities themselves. For those clients who come in knowing they are neurodivergent, I like to make discussion of sensory issues a part of our first conversation. This signals to clients that it’s a safe place to bring up their needs and lets them know their discomfort won’t be dismissed. I’ve found it to be a good first step in building rapport.

What Neurodivergent Clients Notice in the Room

Scent

Because it is unlikely that I’ll know about sensory sensitivities before the first session, my preparations start at home. I skip perfume and use laundry detergent with little to no scent. As good as floral scents smell to me, they can be distracting and may even cause headaches for folks with olfactory sensitivities. I don’t want to have the overpowering scent of flowers and a migraine be the main takeaway from a session.

Sound

My next step is what I call my “early warning system.” I want the client to know I’m approaching before I pop into view. For me, this means selecting shoes that make a subtle tap as I walk. While this practice started as a consideration for the heightened startle response of trauma survivors, I find it is helpful with neurodivergent folks as well. My choice of shoes based on their sound helps avoid jump scares for my clients with inattentive traits who sometimes get lost in thought while in the waiting room.

I am also conscious of what I can hear in the counseling room. The tick of a clock, the whirring of fans, or the static of our white noise machines can be overstimulating and/or make it hard to focus on the conversation. It’s hard if not impossible to learn and retain new tools when it sounds like there’s a hive of bees humming in the corner of the room.

Lighting

Do not turn on the overhead light. It’s aggressive. This is the most frequently expressed preference. Natural light and/or lamps are much appreciated. For my clients with ADHD, and honestly for myself as well, I tend to angle the blinds so that light can come through but neither the client nor I are distracted by nature or people walking by outside.

Consistency

I do my best to keep the counseling room consistent each time we meet. Consistency can mean less distraction for someone with ADHD and be comforting for clients with autism who struggle with change. If we’re going to be meeting in a different room than usual, I try to give the client a heads up in the session before the change if at all possible.

If a client is curious about what they can expect out of a usual session, I will share the structure I use as a guideline for the hour. For clients with time blindness or those that struggle with transitions, I also try to provide warnings at the halfway point and the 10-minute mark before the end of a session. This helps conversations stay focused on the client’s priorities, while also making the end of a session feel less abrupt.

Flexibility

Be ready to adjust classic approaches and tools. Add art, color, movement, make space for stimming, and allow clients to sit in unconventional ways. I let clients know directly that stimming is welcome in sessions. For clients who are still hesitant to express themselves, I may even point out my own fidget. There’s a particular clipboard with a design at the top that helps keep me focused. It’s less of a risk for a client to be their full self when we’re both wiggling.

One of the more frequent adjustments I make is around eye contact. I do my best to mirror the client and at times I will expressly ask how they feel about eye contact. For clients who hate the sensation of being perceived, a common solution is doodling. I will provide them with some art supplies or small white boards and even offer to doodle in my own notes as we talk so they don’t feel stared down or interrogated. Even if eye contact isn’t an issue, allowing such an outlet is helpful for visual thinkers and those who need to move in order to focus.

Final Thoughts

Showing willingness to have direct conversations around client needs and demonstrating flexibility have been key to building and maintaining strong therapeutic relationships with neurodivergent clients. From the feedback I have received over the years, taking the time to consider and accommodate sensory issues helps clients feel comfortable being themselves without the fear of being labeled as difficult, resistant, or “too sensitive.”

Attuning to client needs signals that you are willing to meet them where they’re at. It doesn’t matter if your understanding comes from your own experience as a neurodivergent person, or because you have put in the time and energy to learn. Either way, it means a lot to the client and goes a long way towards building trust.

As a therapist, I love the differences and the endless variety of people who walk through our doors. Working with these clients helps me stay creative and it’s certainly never boring. I truly enjoy evolving, inventing, and learning from them.

Alisar sees clients at Just Mind in Austin. If this sounds like the therapy you’ve been looking for, here’s more on our neurodiversity-affirming therapy.