Neurodiversity-affirming care
What is affirming care?
There’s a lot of talk nowadays about the importance of affirming care, specifically in the medical and mental health fields. But what exactly is this, and how do you know if you’re getting it?
When we talk about affirming in general, we mean treatment or care that truly focuses on you and your individual needs. Care that you don’t have to jump through hoops for, but that meets you where you are. From a provider who has a good understanding of where you are coming from and that you don’t need to explain everything to. This care takes place in a space free of microaggressions and feels safe. I want to focus specifically on what neurodiversty affirming care looks like in therapy.
Neurodiversity affirming care
First off, what even does this mean? Neurodiversity-affirming care (ND affirming) essentially means getting care that doesn’t force you to mask and meets you where you are. I’m going to specifically speak more towards autism in this post, although most of these things apply to any form of neurodivergence.
Wait, what is masking?
Masking is essentially hiding any traits that are not neurotypical. It is the way many autistics try to blend and fit in the world. Masking often looks like suppressing any traits that give away the fact that you are autistic, and it is EXHAUSTING. It often requires so much concentration and mental and emotional effort, that when you are finally free to unmask, you may feel like you’re falling apart. Excessive masking can absolutely lead to burnout, meltdowns, or shutdowns. It is hard, unnecessary work.
What does this have to do with therapy?
Well, sometimes people come to therapy exhausted from all the masking they’ve had to do. Or maybe they are just now realizing they’re autistic, and they’ve been masking so long that they aren’t sure how to take the mask off. Therapy should be a space where you can safely let down the mask and be who you are.
And this is where affirming care comes in. Historically, the field of mental health has been awful to autistic folks. There has been (and in many areas, still is) a push for behaviorally-based therapies that we now know are incredibly harmful to autistics. Things like ABA (applied behavioral analysis) that have been considered the “gold star” in treatment are actually incredibly harmful and traumatizing to autistic folks. The goals of many of these therapies has been to “teach” (and I use that term very loosely) autistic kids how to not look autistic. Therapies like ABA force masking, teach kids to not trust themselves, and force kids to suppress things that their bodies genuinely need. And all of these impacts carry over into adulthood. ABA is the antithesis of affirming care.
The tide is slowly shifting though. More and more providers are actually listening to autistic adults when they speak out about their experiences with these harmful therapies, and there is more information out there on ways to be ND-affirming. Affirming care may look slightly different from therapist to therapist, but the biggest thing that you should see is that you are not being told or forced to mask. Affirming care allows you to get your needs met in a way that works for you and your particular brain.
For adults, this can mean many different things. Autistic folks need to stim; it is a genuine need. An affirming therapist won’t shame you, or ask you to stop, or try to “redirect” stimming. They may actually help you explore new ways to stim, especially if you’ve been masking for a long time and have never explored those needs. Affirming care also accounts for speaking differences. Sometimes when autistic people become nonspeaking. How does your therapist work with this? Are they open to using the chat to communicate for virtual sessions, or being silent and communicating in other non-verbal ways in person? Therapists should also never force eye contact, or expect you to mask in any way at all. True affirming care meets you where you are, and allows you to be you.
Are there things that I should look for to avoid?
Of course! While there is no perfect way to know if a therapist is ND-affirming, there can be some hints that they are not. Puzzle pieces, “light it up blue,” or other signals that are linked with ABA are absolutely a sign that the therapist may not be affirming. And any references to “fixing” or “curing” autism or ADHD are a sign to avoid someone. And certainly anyone who talks about how hard it is to be a parent to an autistic child clearly does not understand how difficult it is to be neurodivergent in a neurotypical world.
Is there a way to find providers who are affirming?
Yes! One great place to look is the Neurodivergent Therapists website. They have listings by country and state of ND-affirming providers. You can also search on Therapy Den and filter by “neurodiversity-affirming.” While these directories are never a 100% guarantee, they both do their best at filtering out providers who are not affirming.
Finding a mental health provider you trust is hard. Finding one who is neurodiversity-affirming can be even harder. Hopefully this has given you some things to look out for when choosing a provider. If you’re looking for affirming therapy, you can book a free 20 minute consult here. And if you’re interested in an autism evaluation, you can find more information and book that here.
