Square peg in a round hole?
Private Practice, September 2024

Neurodivergent individuals bring valuable perspectives and skills to the field of counselling. However, they can encounter significant obstacles that hinder their initial training, professional advancement and full integration within the profession. This article will explore the challenges faced by four neurodivergent counsellors and the special abilities they bring to the profession, shedding light on the systemic, societal and individual challenges that can impact their career development and work.

Employment 

Neurodiverse counsellors can often feel like outsiders in their workplaces due to a variety of reasons stemming from their unique neurodivergent traits and the surrounding work environment. According to research, factors that can contribute to this feeling include communication differences, sensory sensitivities, social challenges, and lack of understanding and support.¹ For example, Maggi said: ‘During my induction, I walked into a room in which the majority of the other people were neurotypical, middle-class, middle-aged white women living in nice areas and married with children. As a black working-class neurodiverse single parent, I struggled with imposter syndrome for most of the first year.’ 

Neurodiverse counsellors often face stigma and discrimination from supervisors and employers due to misconceptions about their abilities, cognitive approaches and values. Laura said: ‘I used to get the feeling sometimes that managers were very iffy about giving me clients who presented really trauma-based issues because they felt I lacked the emotional sensitivity to deal with them.’ Maria said: ‘My ability to stay on point was sometimes belittled, so my early career was in constant flux because I would easily lose interest in jobs and would quit if I didn't agree with the way they were treating me.’ Emma said: ‘Integrity is important to me and sometimes I was unwilling to compromise with management and bosses when it came to morals and honesty. This led me into conflict during meetings and inevitably a walk out.’ 

Sometimes, the organisation can contribute inadvertently towards the ‘othering’ of neurodiverse counsellors, and their feelings of alienation and difference. Emma said: ‘When we discuss a neurodiversity issue, some of the staff seem to step on eggshells because of me, or put me on the spot with questions and use me like a spokesperson for the whole community.’

Neurodiverse counsellors may also encounter barriers to career advancement, such as limited opportunities for training and professional development, as well as biases and discrimination in promotion decisions based on the stereotypes associated with their neurodiversity.² Laura said: ‘Bosses thought I was lazy, chaotic and not trying hard enough, and because they thought it and refused to support or encourage me, I ended up believing it (for a while) so I stopped looking for better opportunities.’ Maggi said: ‘I’ve been told that although I had the experience for the post, I didn’t have the people-handling skills because of my autism, so I shouldn’t bother to apply.’ 

Respondents also suggest that even though discrimination is taking place, they faced a wall of silence or disbelief, so the impact of the experience was compounded by being gaslit. This can cause harm in a subtle way, and the stress can lead to physical and mental health disparities in minority populations, which has been well evidenced and documented in the research literature.^2,3 Maria said: ‘I think unhelpful stereotypes and misconceptions about ADHD... such as how autistic people can’t maintain consistent relationships or concentrate on one thing for very long, meant that I have been persuaded not to apply for promotions, or, when I have applied, I’ve been overlooked in jobs.’ 

Neurodiverse individuals with ADHD are often labelled with difficulties with organisation, time management or task prioritisation, which can impact their ability to effectively plan and structure counselling sessions or manage their caseload. This can result in attempts by managers to cage their ingenuity and creativity, and restrict their autonomy.⁴ Laura said: ‘Some managers have tried to micromanage me because of my ADHD, and give me ridiculously tight deadlines and targets which I could never meet. I felt like a square peg in a round hole and people were trying to hammer me in to fit one, and all they were doing was destroying the peg, so it didn’t fit anything, really.’ 

Problems with colleagues 

Some respondents highlighted challenges they faced in their professional interactions with colleagues, stemming from differences in communication styles, social interactions and sensory processing. One potential problem that an autistic counsellor can encounter is misinterpretation or misunderstanding of their communication. There may also be challenges with nonverbal cues, sarcasm or subtleties in language, leading to misunderstandings or miscommunications in workplace interactions.^4,5 This can impact the collaborative nature of teamwork or lead to conflicts with colleagues. Maria said: ‘I do tend to live life quite intensely and sometimes find it difficult to play the office games. Some people find this refreshing and some people find me a bit much. The frustrating part for me is not knowing how people are going to take me and what the long-term impact is going to be for me.’ 

Some respondents commented upon how social interactions in a professional environment can be challenging for autistic counsellors, such as navigating office politics, which can be overwhelming, confusing or frustrating, and potentially isolate them from their colleagues or create a barrier to forming strong professional relationships.^5,6 Emma said: ‘Sometimes I do find it difficult to get my head around some of the bull**** going on, and need to be direct and honest by expressing what I feel and how we can move on. This does create friends and enemies.’ 

Moreover, sensory sensitivities common in autism, such as sensitivity to noise, light, or touch, can create discomfort or distress in a typical office setting. This can lead to potential sensory overload, leading to difficulties in focusing, regulating emotions or maintaining concentration during sessions.^3,7 Colleagues may not be aware of these sensory issues and inadvertently contribute to the autistic counsellor’s discomfort, leading to increased stress or difficulty focusing on work tasks. Maggi said: ‘I have found my own ways of managing this by using headphones, sensory regulation techniques – such as deep breathing exercises and organising my calendar around scheduled breaks – but I’ve found negotiating these accommodations a struggle in some places I’ve worked because of the attitudes of some of the other staff members who seem to think that I’m being dramatic.’

Disclosure of neurodiversity 

According to my respondents, disclosure issues are complex on both sides of the argument. Some counsellors with neurodiversity may choose not to disclose it for various reasons, such as the stigma surrounding neurodiversity in many professional settings. Counsellors may fear discrimination or negative reactions from colleagues, clients or employers if they disclose their neurodiversity^1,6,7 There may also be concerns about competence, as some worry that disclosing may lead others to question their competence or ability to perform their job effectively.^1,3,5 Laura said: ‘Of course, I can’t prove this but I’m sure there have been times when I haven’t even been shortlisted for an interview because I disclosed that I had ADHD on the application form.’ 

Laura felt that disclosing her neurodivergence might risk neglecting other aspects of intersectionality, and that her neurodiversity was only one aspect of her identity: ‘I’ve always been conflicted over this transparency issue as I’ve never disclosed this because I think it’s part of my private life and because it’s not relevant to my professional role.’ Others believe that it’s important to disclose their neurodiversity in all areas of life and work. This can be because it can help to reduce stigma around neurodiverse traits and contribute to a more inclusive and accepting environment. It can also help to promote counselling services to hard-to-reach groups who have hitherto been discriminated against.^2,8,9 

According to Maria, it can also contribute to personal self-development and identity formation: ‘I don’t want to proselytise and pretend that being neurodiverse is easy and the best way to be, because that would be unhelpful. But I think recognising and disclosing it has led to greater self-acceptance, self-awareness and personal growth.’ She also mentioned how transparency can backfire: ‘Once a manager told me a client wasn’t coming back to me and wanted her money back because she wanted to see someone “normal” and felt she had been ripped off.’ 

Working with clients 

Some research suggests that if counsellors are neurodiverse, they may have difficulty interpreting nonverbal cues from clients, such as body language or facial expressions, which can impact their ability to accurately assess clients' emotions and needs, and also maintain appropriate boundaries with clients, which can impact the therapeutic relationship.^1,2,8 Some of my interviewees suggest, however, that these potential social communication difficulties are often exaggerated by employers because of their lack of understanding. Emma said: ‘There’s a lot of misinformation about neurodiversity, which leads people to bombard me with questions a lot. I have had people ask me if I consider the impact my condition will have on the therapeutic relationship; how I think my clients will be impacted; if being neurodivergent makes me less suitable to work with certain client groups, such as severely traumatised people, as I will find it more difficult to empathise.’ 

Laura said: ‘These sorts of textbook barriers are sometimes a bit overplayed by people. They are often based on assumptions that all forms of neurodiversity are the same and have the same characteristics.’ Maggi said: ‘I’m very aware of the potential barriers that my condition can create… I ask for feedback all the time from my clients, and I hardly ever get comments about how my neurodiversity has created barriers between me and my client.’  

Working with clients who are non-neurotypical 

In 2023–2024, 1.46 million referrals were made to talking therapies, and neurodivergent individuals experience mental health problems at a disproportionate rate.⁹ Some of my interviewees suggested that neurodiverse clients often prefer neurodiverse counsellors, and are attracted to them because of their listings on neurodiversity websites. This can be for several reasons. Neurodiverse clients may feel that a neurodiverse counsellor will better understand their unique perspective, experiences and challenges, or they are more likely to offer empathy and validation for the client's neurodivergent experiences, reducing the need to explain or justify their behaviours and feelings by providing a non-judgmental and accepting space.^7,9 

Emma said: ‘It can also be for more pragmatic reasons too. The client may feel that I’m better equipped to provide more customised therapeutic approaches based on our shared neurodivergent characteristics.’ However, according to Laura, the situation is more complex: ‘It’s fairly obvious that neurodiverse therapists themselves will carry some unconscious biases, and have grown up with the same prejudices and norms as neurotypical society… or that someone who has ADHD may not be able to understand someone who has Tourette’s.’ 

Emma suggests a counter approach: ‘Curiously enough, I’ve spoken to people from the neurodiverse community who say that if they needed counselling, they would go to a neurotypical counsellor because they might want a more objective view, or they might be seeking guidance from someone who can explicitly provide support and tools based on neurotypical experiences and norms.’ Research also suggests that therapists can counter the ‘double empathy’ problem which, indeed, might occur with any person, by immersing themselves within the flow of the therapeutic relationship in an ‘I-Thou’ stance.^10,11 

Although none of my respondents claimed to be experts in neurodiversity, some of their clients believed their expertise could be of use in checking out whether they were neurodiverse or not. Maria said: ‘Sometimes clients come to me because of what I have advertised and say, “I think I have Asperger’s”, or, “I’m a bit autistic”, and more often than not, they haven’t. Their disconnects and emotional detachments are due to a childhood trauma which we then start to unpack in therapy.’ 

Supervision 

Most respondents said that their own current personal therapists and supervisors were neurodiverse, but that they had also worked with neurotypical practitioners who understood their own ways of being and how this influenced their practice style. Maria said: ‘Having a supervisor with this kind of knowledge means we speak the same language. There’s no psychoeducation or translation requirement. My supervisor understands the importance of checking on my wellbeing as a therapist diagnosed with ADHD.’ 

Laura said: ‘It feels different, as there’s 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.’ According to Laura and Maria, some supervisors like working with neurodiverse counsellors because it helps them develop their own knowledge and skills. Maggie noted that some supervisors feel drawn to explore the possibility of their own neurodivergence:¹ ‘I’ve known this to happen where an ex-supervisor started to explore their own cognitive and social behaviours to find a greater self-understanding after working with me awhile.’ 

Support from the neurodiverse community 

My respondents all emphasised the importance for them of receiving support from the different neurodiverse communities via social media group threads, or in-person or online meetups, or even reading about other individuals in similar situations.^1,6

Maggie said: ‘When I log on, I feel like I’ve found myself and I identify with the neurodiverse community online so strongly, it feels like coming home… I don’t see the online communities as providing an echo chamber for my feelings and thoughts because I disagree with people all the time, but it’s good to feel welcomed and supported, especially when you feel that you’re the only person who thinks this way.’ 

Promoting a positive role 

Many researchers have found that developing a positive autistic identity can impact greater self-esteem and wellbeing for autistic people. Research has shown that anxiety, depression, distress and stress are found to be higher in autistic people who have not found ways to embrace and own their autism in ways that work for them and their lives.^3,12,13 

All the participants felt they have an important role in promoting a culture wherein people feel pride and acceptance in a minority group identity. For example, therapists could help clients with identifying positively with a neurodiverse identity. This could combat the mental health difficulties caused by an autistic diagnosis and discourage the ‘camouflaging’, and lack of self-acceptance that hinders autistic individuals from ‘coming out’.^2,5,13,19 

Maria said: ‘For me, it’s essential that I play a positive role in promoting neurodiverse identity to neurodiverse clients because embracing and celebrating this can help build their self-acceptance, empowerment and resilience… I know from practice that this can help them develop a sense of pride in their identity, build self-confidence, and navigate the challenges they may face.’ 

Neurodiversity and ‘superpowers’ 

The respondents also felt that counsellors with neurodiversity were able to better facilitate positive role modelling because of the diverse range of special skills and abilities they may bring to counselling.¹⁴ Cope and Remington identified from their research, four themes of strengths in autistic people within the workplace: cognitive advantages, efficiency, personal qualities and a unique perspective.⁴ According to research by Nocon et al, the character strengths most frequently reported by autistic adults were honesty, appreciation of beauty and excellence, love of learning, fairness, and kindness.¹⁵ In addition, higher levels of life satisfaction were associated by autistic adults with character strengths of gratitude, hope and honesty.¹⁵ 

Research also suggests that some of these traits can be particularly effective when applied in the workplace. These can include the skill areas outlined overleaf. 

Unique perspectives 

Research suggests neurodiverse individuals may have a natural inclination towards divergent thinking, which allows them to explore multiple solutions to a problem, think outside the box, and consider unconventional approaches.^4,15,16 Their unique cognitive styles may help them to process information in non-traditional ways, leading to novel insights and creative problemsolving strategies. This can enable them to offer fresh perspectives and innovative solutions to clients' challenges, and tailor interventions to meet the unique needs of each client.^2,12 Maria said: ‘I think that I have a naturally holistic and systems-thinking approach, and tend to reflect on the way that different factors fit together like a jigsaw which impacts on clients' wellbeing… I think this at times helps me to address underlying root causes.’ 

Enhanced empathy and understanding 

Neurodiverse individuals may have a heightened sense of empathy and a deep understanding of the experiences of others, enabling them to connect with clients on a deeper level.^7,11,17 Cope and Remington found that autistic people in the caring professions felt that increased empathy enabled them to engage and connect with others who were deemed somehow ‘different’ compared to societal norms.^4.9 

Milton argues that this capacity to develop trusting relationships challenges the debunked myth that people with neurodiversity have less empathy, and suggests instead that shared interests can include emotional connection through common experiences of discrimination.^11,18 Emma suggested that this can also have its problems: ‘In my opinion, because I live in such intensity, I’m overly tuned to the environment at times, which includes all the emotions of the people I am interacting with – even the unspoken emotions on their part. The result can be an emotional rollercoaster ride for me as I try to deal with all this bombardment of information in addition to their words.’ 

Private Practice September 2024

Attention to detail 

Research suggests that many neurodivergent individuals have a keen attention to detail, which can be valuable in counselling settings where observing subtle cues and patterns is important. Mottron et al argue that autistic people have an enhanced local processing ability compared with neurotypical people, meaning they are more likely to focus their attention on small details before processing the bigger picture (making them more efficient at certain tasks).²⁰ Laura said: ‘I would say that attention to detail is a crucial skill because it allows me to perceive and understand subtle nuances in my clients' words, behaviours and non-verbal cues, and this can give me deeper insights into their needs, emotions and underlying issues, which in turn helps me tailor my interventions and support more effectively.’ Maggie said: ‘I think attention to detail enables me to create a safer and more supportive environment where clients feel seen, heard and understood, which can foster trust and facilitate a more meaningful therapeutic connection.’ 

Authenticity and honesty 

Neurodiverse counsellors may bring a greater level of authenticity and honesty to their interactions with clients, creating a safe and genuine therapeutic space for clients to explore their concerns because they can build trust, increase understanding, and cultivate a more open and personalised collaboration.⁷ Emma said: ‘One client said to me, “I sometimes feel like I’m being sorry for myself in the sessions, but you never made me feel like that. You always said there's a reason you're feeling like that.”’ Maria said: ‘Of course, it’s important to be congruent as a counsellor in a therapeutic relationship but people also say to me that I’m direct and that I shoot from the hip all the time, which some people like and others find off-putting.’ 

Support from the neurodiverse community 

My respondents all emphasised the importance for them of receiving support from the different neurodiverse communities via social media group threads, or in-person or online meetups, or even reading about other individuals in similar situations.^7,18 

Maria said: ‘When I log on, I feel like I’ve found myself and I identify with the neurodiverse community online so strongly, it feels like coming home.’ 

Moving forward, it’s essential to continue advocating for diversity and inclusion in the counselling field, championing the voices of neurodiverse counsellors, and fostering a supportive and accommodating work environment that celebrates neurodiversity. By recognising and embracing the strengths and talents of neurodiverse individuals, we can create a more inclusive and empowering space for both counsellors and clients alike.²⁰