What It Means to Actually Be a Neuroaffirming Therapist
What happens when the therapy meant to help you starts asking you to be a different person instead?
I used to use DBT and CBT in my practice. I don't anymore, and I want to explain why, because I think a lot of people are sitting in those modalities right now wondering why something that's supposed to help feels like it's working against them.
Before I was a therapist, I was a client. A late diagnosed autistic client, sitting across from several different therapists who all reached for the same toolkit. Skills. Worksheets. Thought records. Ways to interrupt the thought, regulate the behavior, get me closer to some version of functioning that looked calmer from the outside.
It did more harm than good. Not a little harm. Real harm. And it didn't do the one thing I actually needed, which was to help me understand my own underlying needs and appreciate how my brain worked in the first place.
DBT and CBT are built to change behavior and thoughts. Neurodivergent clients often don't need to change their behavior and thoughts. They need someone to finally ask what those behaviors and thoughts were protecting in the first place.
What It's Like to Be Handed the Wrong Toolkit
DBT and CBT share a basic premise. Something you're doing or thinking is the problem, and the work is interrupting it. That premise holds up reasonably well for a lot of people. It falls apart fast when the thing being interrupted was never actually a malfunction.
When a therapist used CBT to challenge my thought patterns, the underlying assumption was that my thoughts were distorted. Some of them probably were, the way anyone's thoughts get distorted under stress. But a lot of what was getting flagged as distortion was just accurate pattern recognition from an autistic brain that had spent years being told its read on a situation was wrong. Being handed a worksheet to challenge that read didn't correct a distortion. It just taught me to distrust myself more efficiently.
When a therapist used DBT to regulate my behavior, the underlying assumption was that the behavior itself was the problem to solve. A stim, a meltdown, a need to leave a room that had gotten too loud. None of that is a malfunction. That's a nervous system doing exactly what it's supposed to do in an environment that wasn't built for it. Teaching me to suppress the behavior didn't address anything underneath it. It just added another layer of performance on top of a body that was already working overtime.
What it Means to be a Neuroaffirming Therapist
Most of the people I work with now are neurodivergent, identified or in the process of figuring it out. Individuals and couples both. And being autistic myself changes how I hear what they bring into session, because I've sat on the other side of this exact chair.
I know what it's like to leave a session with a new skill and zero additional understanding of myself. I know what it's like to get better at masking a reaction instead of getting curious about what the reaction was actually telling me. I know what it's like to be handed a coping strategy for a problem that was never mine to cope with, because the problem was the environment, not me.
That's not a hypothetical concern for me. That's a few years of my own therapy history. And it's exactly why I don't run my practice the way those therapists ran theirs.
What I Do Instead
I don't come into a first session with an agenda already loaded. I listen. I get to know the person's story, their struggles, their wins, the shape of their life. Once we've had enough time together to figure out whether neurodivergence is part of the picture, a lot of the early work becomes education. Helping someone understand how their particular brain works, and why it doesn't need to be changed to be workable.
Where Even EFT and IFS Hit a Wall
For some of my clients I use IFS (internal family systems) and EFT (emotionally focused therapy) I want to be honest that EFT and IFS aren't a perfect fix either for neurodivergent clients. Both modalities lean heavily on a client's ability to locate and name feelings in their body, and that's exactly where a lot of neurodivergent people, myself included, run into real difficulty.
Interoception, the sense of what's happening inside your own body, doesn't work the same way for neurodivergent people. Asking someone to identify what they're feeling when their interoception is genuinely unreliable isn't helpful. It's just a different version of asking someone to perform an answer they don't actually have access to yet.
So I adapt. I encourage clients to express themselves through media, music, and art, because those forms let someone illustrate an experience without needing to translate it into the emotion vocabulary a traditional talk therapy session assumes everyone already has. Nobody gets forced into a box. If a client can show me what they're feeling through a song they keep returning to or an image that captures something words haven't caught up to yet, that's just as valid as naming the feeling out loud.
I also spend lots of time helping clients build gentle body awareness, slowly and only when it's actually appropriate for that person. This is not somatic therapy. It is helping people notice biological changes in their body to help clue them in on what might be happening inside.
This can look like:
Learning to notice early signs of dehydration before it turns into a bigger problem
Catching anger or irritation as it's building, rather than only after it's already peaked
Noticing physical signals like skin feeling hot to the touch
Recognizing when anxiety is getting louder in the body before it takes over
This is not a skill assigned to correct a behavior. It's a slow, optional way of building a relationship with a body that may have spent years being told it was reacting wrong.
Why IFS Works When EFT Often Doesn't
IFS survives the interoception problem in a way EFT usually can't, and I think it comes down to imagination.
Many autistic people I work with have vivid imaginations and can visualize complex ideas easily. Whole internal casts, layered images, characters with their own histories. IFS is built around exactly that kind of imagination. It asks a client to picture a part, an animal , a protector, a scared younger version of themselves, and work with that image directly, rather than trying to locate a feeling somewhere in the body first. The imagery does the work that interoception can't.
EFT asks something different. It asks a person to know what they feel, where they feel it, and process that information in real time, in the room, while another person watches. For a lot of autistic clients, that's not easy. That's asking someone to report data they genuinely don't have access to yet.
I want to be clear that I'm not saying EFT doesn't work. For plenty of people it offers something genuinely useful. Phrasing. Sentence stems. Scripts that hand offer a language they didn't have before. It has real value. It just doesn't serve the autistic clients I work with in the way it's designed to, because the design assumes an interoceptive fluency that isn't universal.
So What Actually Works?
First and foremost, I invite clients to use music, media, and other forms of expression to communicate what they're feeling, since that sidesteps the need to translate an internal state into spoken language on the spot. A song, an image, a piece of writing can say what a body scan can't.
I also do a lot of psychoeducation, because I believe knowing how your brain works is essential to vastly improving your life. Not managing around gaps you don't understand. Actually understanding the architecture underneath it.
The Honest Conversation Is the Actual Work
Here's the pattern behind almost everything I do differently now.
Start with the story, not the symptom. I want to know the person before I know the diagnosis or the presenting problem. The symptom makes a lot more sense once I understand the life it's showing up in.
Educate before intervening. A lot of clients have never been told how their brain actually works, only what's wrong with how it's showing up. That education alone does real work before any modality gets introduced.
Follow curiosity, not correction. EFT and IFS both ask what a behavior or reaction is protecting, not how to stop it. That's the shift that matters most.
Offer expression outside of language when language isn't reliable. Media, music, and art aren't a workaround. They're a legitimate way to communicate an internal experience.
Build body awareness slowly, and only with consent. Somatic work is not assigned. It's offered, and only pursued if a client has said they're ready for it.
Validate before you resource. A lot of what helps is simply someone believing the client's account of their own experience, before any resource or strategy gets offered on top of it.
Many modalities carry a predetermined agenda and a predetermined path from problem to solution. In my experience, that predetermined path is exactly what does the most harm with neurodivergent clients, because it assumes everyone's problem and everyone's path look the same. They don't. There is no template. Every person I work with works differently.
If this sounds like the therapy you've been looking for
If you've sat through DBT or CBT and left feeling more managed than understood, you're not imagining it, and you're not the problem. This is the work I do with neurodivergent clients, and it shows up constantly alongside the work I do around kink and ethical nonmonogamy, since none of these parts of a person live in isolation from each other.
If you want to talk about it, book a free consult.
Maya Attia, LMFT #139693
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