Neurodivergence-Informed Supervision: Traversing the Training Gap

Over the past few years there has been an increase in demand from therapists and coaches looking for clinical supervision to support their neurodivergent clients. Historically, this is an area of knowledge that has been sadly lacking from counselling courses. Confusion and misunderstandings can damage the therapeutic work when incorrect assumptions are made that trauma is the main issue, or the therapist fails to recognise neurodivergence and concludes that some clients are just unwilling to engage with the therapy.

If traditional therapy, whatever the modality, is not adapted to the needs of neurodivergent clients, it can be difficult to access or, at worst, harmful.

My colleague Deborah, with whom I founded Aspire Consultancy, advised me of a situation where an autistic young person was told by their person-centred therapist that she was not interested in labels, just the person. The sessions were non-directive, and no adaptations were offered as the therapist did not understand the complexities of what the client was experiencing. The young student would endure long silences, which were excruciating and made her feel increasingly anxious and panicky. Without prompts and encouragement, she struggled to initiate a conversation about her difficulties, eventually leaving therapy feeling even more insecure.

Met by silence, a client who may already be sensitive to how others perceive them could easily assume their therapist is yet another person who doesn’t want to talk with them. Having an aversion to using a label may not be helpful for clients who wish to acknowledge their autism or ADHD, as this can invalidate a core part of them. As my own supervisor, Jennie Miller, points out, having the correct label can for some clients be positive, perhaps bringing relief that they are not going mad or have some type of personality disorder.

Person-centred work, along with other modalities, can be highly effective for neurodivergent clients, but only if therapists can be flexible, understand how to attune to their client’s needs, and recognise which adaptations could help.

Adaptations that can help autistic clients might include being a bit more directive. Finding out about a client’s interests can kickstart a flow of dialogue, creating a connection and platform for therapeutic work. Inviting clients to bring in their own poetry or artwork, or using creative materials or storytelling in session, is another way forward for some. Over the years I have worked with neurodivergent clients who have blown me away with the personal insights displayed within their creative work.
 

Why do therapists and coaches request neurodivergent-informed supervision?

I recently asked my supervisor whether she gets many requests from supervisees for support with their neurodivergent clients. Jennie tells me it is more likely to be the case that she is highlighting the possibility of a client being neurodivergent. In my experience of offering neurodivergence-informed training and supervision, there are several main reasons why counsellors and therapists seek this out:
 

• Recognition that some of their clients may require a more flexible approach and their own supervisor may not have the requisite knowledge.
   
• Feeling at a loss after trying interventions that are not making much difference.
   
• Realisation that it is essential to develop knowledge about neurodivergence during times when healthcare providers are required to make reasonable adjustments to ensure their services are accessible and adequately support the needs of the service user.
   
• Although this comes later, joining a network like ours can also bring a lovely sense of community and collaborative working, and therapists often find it energising to learn that a complex area of work can be so interesting and absorbing.
   
• Some practitioners may also feel drawn, and prompted by their new learning, to explore the possibility of their own neurodivergence.
   

In addition to the above, practitioners who are neurodivergent themselves may prefer to have supervision with someone who can understand their own ways of being, which influence their practice style. Anna Hall, a therapist and coach with ADHD who works almost exclusively with a neurodivergent client base, tells me, “having a supervisor with this kind of knowledge means we speak the same language, there is no psycho-education or translation requirement. My supervisor understands the importance of checking on my wellbeing as a therapist diagnosed with ADHD… It feels different, as there is an implicit, respectful, and gentle understanding given to how I balance my personal life and work, as an individual with ADHD, not just a therapist.”

As supervisors, we have a duty of care to educate ourselves on how to best support our supervisees to offer adapted, quality therapy to neurodivergent clients. This can change the trajectory of a person’s life, enabling them to feel validated and accepted. It provides an accessible therapeutic pathway to identify the client’s challenges and develop healthy ways of working, thus creating an attuned professional relationship.

I would like to thank my colleagues Deborah, Jennie, and Anna for contributing to this blog post. For anyone wishing to learn more about neurodivergence in general, I recommend a freely available podcast interview series called ‘Different Minds’. Aspire were sponsors of Different Minds during the lockdown period, and Deborah and I were interviewed on the topic of ‘Autism and Counselling’.