Hi all,
I'm Katie Jo Glaves, I'm a LMFT in WA and a senior lecturer at Antioch University Seattle. I'm also neurodivergent and have worked with neurodivergent clients my entire (13 year) career. I'm excited to connect with other MFTs who want to discuss neurodiversity.
I also teach a class on neurodiversity affirming therapy at Antioch in the CFT department. In service of this, I've created the following guidelines for my students and have presented this at IFTA. I'd very much like feedback and thoughts on these. They have come out of my clinical experience, the experience of other neurodivergent clinicians, and resources written about neurodivergent people by neurodivergent individuals and professionals.
I'd love feedback, thoughts and if you are willing, the resources you use that you think I should add to this document. I'd especially love to connect with people who teach this sort of class as well. I am always happy to share any resources I have created!
Towards Neurodiversity-Affirming Systemic Therapy: Suggested Best Practices
Katie Jo Glaves, LMFT
kglaves@antioch.edu
- Be educated on and embrace the neurodiversity paradigm
- Examine your bias and prejudice against neurodivergent people; if you are neurodivergent, examine any internalized ableism.
- Read books and articles/listen to podcasts by neurodivergent authors and creators and seek out resources by the same; question sources that are written by neurotypical parents or practitioners without input by neurodivergent people themselves.
- Put the therapeutic relationship first with an emphasis on multidirectional partiality
- Set collaborative goals for therapy, accepting that some desires and norms may look different for neurodivergent clients and families of clients; be aware that a neurodivergent family member's goals for themselves may differ from their family's goals for that person.
- Support clients in identifying their own strengths and help them find ways to leverage or use those strengths to help clients meet their goals; if working with a family, help family members see client's strengths
- Presume that all clients, neurotypical and neurodivergent, are experts on their own lives.
- Presume good intent, presume competence for all family members
- Recognize that all behavior is communication; presume a client is trying to meet a need or express distress with behaviors and help family of client understand this as well
- Presume that ND clients are competent to direct their own lives and respect their autonomy to the greatest extent possible; when working with families of clients, make sure goals are set with input from all parties
- Embrace each client's strengths and interests
- Be prepared to use client's unique interests to explain concepts to make the content more relatable to the client and client's family
- Help clients find activities that use their strengths and people in the wider community who praise and honor the client's contributions
- Honor a client's sensory needs
- Allow for the use of fidgets, stims and other sensory supports. If offering services in-person, have a variety of materials for fidgeting/stimming/sensory needs for clients to use.
- Discuss sensory needs as a basic human need and encourage clients to meet sensory needs as part of self care; help families normalize meeting sensory needs as a family and respecting each person's needs. Be aware of different presentations of neurodiversity within a family and offer support when needs conflict (for instance, a parent who needs quiet to focus and a child who needs to use noisey stimming to regulate)
- Distinguish sensory needs from anxious avoidance.
- Be aware of all sensory systems, including interoception, and be aware if an intervention you are proposing requires specific sensory awareness; be prepared to modify interventions based on sensory needs.
- Allow for all forms of communication and be prepared to modify your communication to meet the client's needs
- Offer a range of ways for clients to communicate (typing, speaking, drawing, acting things out) and accept all of them as legit ways of communicating thoughts, feelings and needs.
- Explore masking behaviors that clients may have had to develop to be safe/accepted by others and explore settings where clients can unmask, including therapy.
- Be prepared to modify language and explain concepts in several ways depending on client need
- Be prepared to add visuals to explanations if that is a support for client
- Understand the double-empathy problem and how that impacts NT-ND communications
- Support pride in a client's neurodivergent identity and connect clients/ client's family to wider neurodivergent community
- Provide psychoeducation on the neurodiversity paradigm and ND traits in a way that is digestible by the client
- Be aware of where neurodivergent people can find community in your area and support client and family in connecting to community
- Be aware that, as many types of neurodiversity are genetic or inter-related, you may need to support multiple family members in finding community. Later diagnosed adults who 'discover' their own neurodivergence often need support to challenge their internalized ableism; doing this in a family therapy context can be powerful and important work
- Advocate for your client(s) when larger systems (schools, workplaces, etc) are ableist; advocate for change in systems you are part of to make those systems more accessible
- Understand that neurodivergent clients and their families often struggle to engage with wider systems and may be subject to prejudice from those systems; there may be historic feelings of not being safe engendered by systems
- Understand both how to coach clients/families on how to successfully interact with systems and be ready to coach other systems on the needs of neurodivergent clients.
- Questions assumptions from your theory of choice
- When using a theory, question the underlying assumptions that may not be true of neurodivergent clients and the neurotypical 'norms' the theory might presume.
- Understand that neurodiversity changes a family system and that this is neither good not bad, until the family expresses there is an issue
- Be humble and be relational
- Be aware expression of neurodiversity is mediated by culture, gender, etc and seeking out resources to educate yourself on how neurodiversity in your clients may intersect with other client identities
- Remember that neurodiversity is a spectrum and each individual will have different experiences, even if they have the same neurotype
Suggested Further Readings For Each Principle
- Be educated on and embrace the neurodiversity paradigm
- Walker, N. (2021). Neuroqueer heresies : notes on the neurodiversity paradigm, autistic empowerment, and postnormal possibilities. Autonomous Press.
- Neuroqueer Heresies is an excellent starting point to understand the neurodiversity paradigm, from a leading voice in the neurodiversity movement. The author comprehensively covers definitions and reasons for defining and using neurodiversity specific terms, as well as important information about accessibility and accommodations.
- McVey, A. J., Jones, D. R., Waisman, T. C., Raymaker, D. M., Nicolaidis, C., & Maddox, B. B. (2023). Mindshift in autism: a call to professionals in research, clinical, and educational settings. Frontiers in Psychiatry, 14. https://doi.org/10.3389/fpsyt.2023.1251058
- Discusses how to shift mindset about autism from a neurodiversity affirming lens; addresses research, clinical and education needs. Brings to the fore a focus on quality of life issues for autistic people, understanding supports and accommodations as a human right, and valuing the lived experiences of autistic humans. Addresses the tensions of working in an ableist system and how that impacts client outcomes.
- Sonuga-Barke, E.J. (2023). Paradigm 'flipping' to reinvigorate translational science: Outlining a neurodevelopmental science framework from a 'neurodiversity' perspective. Journal of Child Psychology and Psychiatry 64:1405–1408. https://doi.org/10.1111/jcpp.13886
- Discussed how a paradigm shift from seeing autism and ADHD as neurodevelopmental disorders to seeing them as facets of human neurodiversity might be a positive and fruitful change for research and practice, that lessens stigma and promotes client well-being. Uses as an example the involvement of a panel of neurodivergent people in developing a therapy model for neurodivergent people.
- Put the therapeutic relationship first
- Hume, R. (2022). Show Me the Real You: Enhanced Expression of Rogerian Conditions in Therapeutic Relationship Building with Autistic Adults. Autism in Adulthood: Challenges and Management, 4(2), 151–163. https://doi.org/10.1089/aut.2021.0065
- Discusses a study that shows the importance of authentic relationships with autistic clients, empathy without agenda, and clients feeling liked by their therapist. Also discusses the history of therapy manuals and researchers assuming that autistic adults would not be able to form bonds with clinicians, leading to many not trying to form those connections.
- Dundon, R. (2024). A therapist's guide to neurodiversity affirming practice with children and young people. Jessica Kingsley Publishers.
- Chapter 6 of this book is an excellent summary of the importance of relationship and attunement to neurodivergent children. The author discusses why it may be more difficult to build relationship with neurodivergent children and discusses various ways to work through the relationship process
- Kirby, A. V., Diener, M. L., Dean, E. E., Darlington, A. N., Myers, A., & Henderson, J. (2022). Autistic Adolescents' and Their Parents' Visions for the Future: How Aligned Are They? Autism in Adulthood: Challenges and Management, 4(1), 32–41. https://doi.org/10.1089/aut.2020.0061
- Highlights the importance of listening to both the autistic client and the parents and reminds therapists that there is danger in over-valuing parental perspectives as "these may not align with adolescent goals and likely are less independent than adolescent goals."
- Presume good intent, presume competence for all family members
- McVey, A. J., Glaves, K. J., Seaver, S., & Casagrande, K. A. (2023). The ethical imperative to honor autistic clients' autonomy in mental health treatment. Frontiers in Psychiatry, 14, 1259025. https://doi.org/10.3389/fpsyt.2023.1259025
- A plea for clinicians to see honoring autistic adolescent client's hopes and dream, as well as that of parents and caregivers. Gives a family therapy-centered example of using shared decision making to honor both adolescent and parent needs.
- Burke, M.M., Li, C., Johnson, A, & Terol A.K. Promoting Advocacy and Empowerment for Individuals with Intellectual Disabilities and Autism. In Bianchi, A., & Vogt, J. A. (Eds.). (2024). Intellectual Disabilities and Autism: Ethics and Practice. Springer International Publishing. https://doi.org/10.1007/978-3-031-61565-8
- This chapter discusses parental and individual advocacy and how goals of parents and I/DD or autistic individuals may differ or align. Discussed complexity of managing both perspectives.
- Embrace each client's strengths and interests
- Woods, S.E.O., & Estes, A (2023) Toward a more comprehensive autism assessment: the survey of autistic strengths, skills, and interests. Frontiers in Psychiatry 14:1264516. doi: 10.3389/fpsyt.2023.1264516
- Discusses how the current framing of autism as a disorder has lead to overlooking autistic strengths; discusses ways to add strength-based assessment to autism assessments.
- Hsiang, C.H.T., Campbell, L. & Tavener, M. (2024) Clinicians' experiences and perceptions of family therapy in the context of autism. Journal of Family Therapy, 46, 423–441. https://doi.org/10.1111/1467-6427.12467
- Discussed how using strengths of autistic children/teens can be leveraged effectively in family therapy to support systemic change; also addresses larger systemic stressors as they relate to schools, workplaces and the like.
- Honor Clients' Sensory Needs
- Miller, L. J., & Fuller, D. A. (2007). Sensational kids : hope and help for children with sensory processing disorder (SPD). Perigee/Penguin.
- A book about sensory processing disorder that helps readers to understand how to support people who have sensory needs that are different from the mainstream; this book is an excellent starting point.
- Mahler, K. J., & Craig, A. D. (2016). Interoception: the eighth sensory system : practical solutions for improving self-regulation, self-awareness and social understanding of individuals with autism spectrum and related disorders. AAPC Publishing.
- A primer that should be required of all mental health professionals who work with neurodivergent clients, as many neurodivergent clients struggle to identify bodily sensations, leading to struggles to identify emotions and respond as expected to therapeutic interventions. Many things may make sense about your neurodivergent clients when you read this!
- Schaaf, R. C., Toth-Cohen, S., Johnson, S. L., Outten, G., & Benevides, T. W. (2011). The Everyday Routines of Families of Children with Autism: Examining the Impact of Sensory Processing Difficulties on the Family. Autism: The International Journal of Research and Practice, 15(3), 373–389.
- Discusses the family impact of sensory needs and ways families may be accomodating children with sensory needs. Offers ideas for discussing sensory needs with families, although lacks a systemic bent when addressing intervention.
- Allow for all forms of communication and be prepared to modify your communication to meet the client's needs
- Yu, B., & Sterponi, L. (2023). Toward Neurodiversity: How Conversation Analysis Can Contribute to a New Approach to Social Communication Assessment. Language, Speech, and Hearing Services in Schools, 54(1), 27–41. https://doi.org/10.1044/2022_LSHSS-22-00041
- Challenges stereotypes around how autistic people communicate and discusses how to better understand autistic communication; while written for Speech-Language Pathologists vs. therapists, it is nevertheless a useful read for family therapists thinking through how autistic clients might communicate differently. Case study involves a bilingual family, adding another dimension of the complexity of cross-neurotype communication.
- Hancock, S. Autistic Communication Differences: A Primer. From Reframing Autism. Accessed March 15, 2025. https://reframingautism.org.au/autistic-communication-differences-a-primer/
- A non-peer reviewed article, albeit one that cites over 20 peer-reviewed articles, that summarizes communication differences that exist between non-autistic and autistic people.
- Milton, D. (2017) A Mismatch of Salience: exploration on the nature of autism from theory to practice. Pavilion Publishing and Media: West Sussex U.K.
- A comprehensive book about divergent ways to understand autism; Milton discussed the double-empathy problem and ways defining autism from the "outside in" vs the "inside out" (defining autism by what others observe about autistic people vs what autistic people tell others about themselves) impacts autistic people.
- Support pride in a client's neurodivergent identity and connect clients/ client's family to wider neurodivergent community
- Cage E., Di Monaco J., & Newell V. (2018). Experiences of Autism Acceptance and Mental Health in Autistic Adults. Journal of Autism and Developmental Disorders, 48(2), 473–484. https://doi.org/10.1007/s10803-017-3342-7
- Discusses how feeling accepted by others, and acceptance/embracing autistic identity decreases depression risk in autistic adults; also found camouflaging autistic traits was linked to higher distress
- Cooper, K., Smith, L. G. E., & Russell, A. (2017). Social identity, self-esteem, and mental health in autism. European Journal of Social Psychology, 47(7), 844–854. https://doi.org/10.1002/ejsp.2297
- Discusses study that shows, while autistic individuals have poorer mental health than non-autistic controls, for autistic people, having a stronger sense of autistic identity and a more positive view of autistic identity as a whole is protective.
- Andoni, L., Eisenhower, A., Gudknecht, J., Levitt, H.M. (2024) Meta-Synthesis of Autistic Adults' First-Person Perspectives About Mental Health-Related Services. Autism in Adulthood: 00:00. https://doi.org/10.1089/aut.2023.0167
- A meta-analysis of autistic adult's experiences in therapy, this article offers practical advice to clinicians to improve their support of autistic adults, including encouraging providers to support autistic pride and community, and encouraging providers to understand the heterogeneity of autism and have humility about their knowledge.
- Advocate for your client(s) when larger systems (schools, workplaces, etc) are ableist; advocate for change in systems you are part of to make those systems more accessible
- Sandman-Hurley, K. (2021) The Adult Side of Dyslexia. Jessica Kingsley Publishers.
- This book features the voices of dyslexic adults who discuss their experiences in school, work and life, including how dyslexia effected their social-emotional wellbeing. They discuss accomodations and support that were meaningful and helpful and those that were not. Dyslexia is an often-overlooked neurodivergence and one that is quite common, so it is important to have an understanding of how to advocTe for dyslexic children.
- Bradley, E., Vogt, A.J. Engendering a Feeling of Safety as an Ethical Imperative in Preventing Emotional Distress and Behaviours that Challenge Services. In Bianchi, A., & Vogt, J. A. (Eds.). (2024). Intellectual Disabilities and Autism: Ethics and Practice. Springer International Publishing. https://doi.org/10.1007/978-3-031-61565-8
- Discusses how many services provided to clients with intellectual disabilities overlook the role of safety; explains that supporting clients in feeling safe while receiving care and support is a key to supporting client well-being.
- Hamilton LG, Petty S. (2023). Compassionate pedagogy for neurodiversity in higher education: A conceptual analysis. Frontiers in Psychology 14:1093290.https://doi.org/10.3389/fpsyg.2023.1093290
- Discussed how universities can support neurodivergent students and how neurodivergent students have often struggled to complete higher education. Offers ways to make neurodivergent students feel included and welcome in higher education settings.
- Dabbs, C. R., Hutchins, C. H., Baird, R., Scaer, A. J., Kosanovich, S. E., & Spitler-Nigh, B. (2024). Unmasking Bias: Autistic Perspectives in Mental Health Training. Autism in Adulthood. https://doi.org/10.1089/aut.2024.0210
- Looks at how ableism impacts trainees in mental health fields and highlights ways to reduce ableism in this profession. Article also highlights how many traits of autistic people can be strengths for therapists.
- Fallon, C. (2022) Seeing (Speaking) Through Her Eyes (Brain). In Cases on Organizational Communication and Understanding Understudied Groups. Business Science Reference: Hershey, PA.
- An informative case study on ableism in the workforce; will be helpful to clinicians seeking to understand how to advocate for ADHD clients in the workforce.
- Questions assumptions from your theory of choice
- Pennant, A. (2025). SFT for ASD: A systemic intervention for neurodiverse families. Journal of Family Therapy, 47(1). https://doi.org/10.1111/1467-6427.12475
- Presents an integration of structural family therapy with critical disability theory; this is a good example of a way to integrate neurodiversity-paradigm aligned practices into therapy with families.
- Sohn Ma, A., Zhao Lmsw, J., & Tadros PhD Lmft, E. (2024). Integrating Structural and Experiential Family Therapy in Neurodivergent Families: A Case Study. Issues in Mental Health Nursing, 45(5), 477–487. https://doi.org/10.1080/01612840.2024.2328260
- A case study focusing on how integrating structural and experiential family therapy supported a family with several neurodivergent family members; the integration allowed tailoring of interventions to individual needs with the family and allowed the therapist to address systemic stressors in a sensitive way.
- Be humble and be relational
- Chapman, R., & Botha, M. (2023). Neurodivergence-informed therapy. Developmental Medicine and Child Neurology, 65(3), 310–317. https://doi.org/10.1111/dmcn.15384
- Discussed how clinicians need to practice "relational epistemic humility" to be neurodivergence-informed. Also emphasizes neurodivergent pride and how the "pathology" assumed to be part of neurodivergence is more a mis-match between the neurodivergent person and their environment or others. Writen by a neurodivergent researcher.
- Kroll E, Lederman M, Kohlmeier J, Kumar K, Ballard J, Zant I & Fenkel C (2024). The positive impact of identity-affirming mental health treatment for neurodivergent individuals. Frontiers in Psychology: 15:1403129. https://doi.org/10.3389/fpsyg.2024.1403129
- Discusses outcomes for high acuity neurodivergent clients when affirmed as part of treatment; study shows affirming neurodivergent clients' experiences gets better treatment outcomes.
- Andoni, L., Eisenhower, A., Gudknecht, J., Levitt, H.M. (2024) Meta-Synthesis of Autistic Adults' First-Person Perspectives About Mental Health-Related Services. Autism in Adulthood. https://doi.org/10.1089/aut.2023.0167
- A meta-analysis of autistic adult's experiences in therapy, this article offers practical advice to clinicians to improve their support of autistic adults, including encouraging providers to support autistic pride and community, and encouraging providers to understand the heterogeneity of autism and have humility about the limits of their knowledge.
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Katherine Glaves MA
Clinical Director of Child and Family
Seattle WA
(281) 682-5556
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