by Nik Stancil, LPCC, LCMHC
Most of my clients have been to therapy before. Many have tried therapy several times over their life, but they never felt it was that helpful or they found it difficult to find a therapist who was a good fit. There are plenty of reasons why this might be the case, and this post aims to explore one of the main offenders: a very common type of therapy practiced is CBT, and using CBT alone may not be a great choice for neurodivergent brains.
While talk therapy has proven to be an effective tool for countless people, it's important to recognize that one size does not fit all, especially regarding neurodivergent individuals. A skilled and competent therapist possesses the expertise to accurately determine the most appropriate therapy approach for each client, considering their unique goals and individual capabilities.
WHAT IS COGNITIVE BEHAVIORAL THERAPY (CBT)
Cognitive Behavioral Therapy (CBT) is widely considered the gold standard of talk therapy, thanks to its proven effectiveness in addressing a variety of mental health issues. With a wealth of research supporting its efficacy, CBT has consistently demonstrated its ability to produce positive results that clients continue to benefit from even after therapy sessions have ceased.
At its core, CBT revolves around exploring and understanding the interconnectedness of our feelings, thoughts, and behaviors. By examining these connections, clients gain a deeper understanding of how their emotional experiences, cognitive processes, and actions influence one another, ultimately paving the way for meaningful change. This approach empowers individuals to challenge unhelpful patterns of thought and behavior and cultivate healthier coping strategies.
One of the strengths of CBT lies in its ability to offer relief for clients in the initial stages of therapy, fostering a sense of progress and accomplishment from the outset. Moreover, the structured nature of CBT enables therapists to provide clients with a clear roadmap for their treatment journey, outlining goals and expectations while equipping them with the skills necessary to navigate their unique challenges.
It’s important to me that my clients feel like therapy is helpful right from the beginning, but also gives them a clear map of where we’re headed in treatment and what they can expect. CBT helps me do both, and I’m glad to have so much training and experience with this modality. However, as the majority of my work is focused on helping other people with neurodivergent brains, I’ve seen some major gaps that using CBT alone can leave behind.
WITHOUT A NEURODIVERSITY-AFFIRMING APPROACH, CBT CAN ENCOURAGE ‘MASKING’
While CBT can be beneficial for neurodivergent clients, there is a potential risk that it might inadvertently encourage masking, especially when the focus is on modifying behaviors to conform to societal expectations. Masking refers to the suppression of one's neurodivergent traits to appear more neurotypical. Masking can hide these traits from others, but can also hide them from the individual themselves, creating layers of confusion for people trying to understand themselves and create more safety and comfort in their daily experience.
As CBT can focus on modifying behaviors, it might inadvertently promote masking by focusing on changing the behaviors and thought patterns of neurodivergent individuals to better fit societal norms. Short term, this seems helpful and the client might be excited by the results, but long term the deeper anxiety and depression that result from masking will only get worse. The clients underlying needs are not being met, and without understanding and meeting our individual needs, no changes or growth is sustainable. When the client is feeling pressured to hide their authentic self, it directly leads to potential mental health issues like increased stress, chronic anxiety, depression, and a sense of disconnection from their identity.
Without understanding a client’s neurotype and needs, CBT can end up trying to hit moving targets (anxiety, depression, burnout) without actually understanding the cause of them. Therapy can still be helpful in managing these symptoms, but the client still ends up repeating the cycle and struggling with the same symptoms over time. It is only natural that when we struggle with the same thing for a long time, we might start to think it’s us that’s the problem, which only amplifies our shame.
It's important to note that the impact of CBT on neurodivergent individuals can vary greatly depending on the therapist's approach and understanding of neurodiversity. When therapists are aware of the potential risks and focus on helping clients develop coping strategies while embracing their neurodivergent traits, CBT can be a valuable tool in promoting mental well-being without encouraging masking. So while the possibility exists, a neurodiversity-affirming approach to therapy can help minimize this risk and ensure that clients receive support tailored to their unique needs and experiences.
THERAPY BASED IN CLIENT’S STRENGTHS AND VALUES
A huge theme I see for my neurodivergent clients is that they think they’ve somehow “failed” therapy in the past, because it didn’t help them feel better. The opposite is usually true: the client was failed by therapy. It wasn’t built for brains like theirs, so it didn’t fit authentically and it didn’t help long term. That’s why neurodivergent-affirming therapy is so important for autistic and adhders. Helping your client understand their strengths is the best place to begin when working with neurodivergent clients, and from there you can build ways to maximize their strengths to help them reach their goals.
Another main tenet of my work with clients is based in exploring and honoring their values. Working with clients through a value-based perspective involves helping them identify their core values and align their behaviors, decisions, and goals with these values. This recognizes that values serve as guiding principles in people's lives and can significantly impact their well-being and life satisfaction.
Neurodivergent people tend to have a pretty black and white view of what’s right and wrong anyway, but when we’re living out of alignment with our values it seems to cause us a greater level of distress than neurotypical people. This is particularly true when we’re in relationships or we work for employers that don’t share our values. It just doesn’t work out long term.
By adopting a value-based perspective, therapists aim to empower clients to make meaningful life changes, enhance their sense of purpose, and ultimately improve their overall well-being and life satisfaction.
NEURODIVERSITY-AFFIRMING THERAPY
All this to say, as long as it’s coming from a place of understanding the neurodiversity paradigm, I don’t know that there’s a clear “wrong” method of therapy for neurodivergent brains (ND-affirming approaches do not include things like behavior modification methodology). We have a similar understanding of “trauma-informed therapy”- we know that there are several types of therapy that are helpful for trauma, there’s not one right way to do it, but there is basic foundational knowledge that any provider working with trauma should understand.
It's essential to recognize the unique challenges and needs of those who think and process information differently, and understand how different therapy approaches can best support these neurotypes. By understanding the limitations of CBT and exploring alternative, tailored approaches, we can better support neurodivergent people in their journey towards improved mental health and well-being.
Read more about neurodivergent-affirming therapy here.
Read more about therapy with Nik here.