Clinical Work

Defensive Minds: harm across neuro-cognitive difference

On June 21, 2022 by sarmientoverano

 By: Lucia Sarmiento Verano 

Image credit: https://unsplash.com/@joshriemer

Disclaimer: Please know that I am in no position to talk about neurodivergent experiences. I can only write from my own perspective as a neurotypical therapist building therapeutic relationships with people who are fundamentally different from me. Hopefully, this will help other neurotypical people approach this work in safer ways.

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It wasn’t until I started following more neurodivergent people on social media, who generously share their thoughts and experiences with the rest of us, that I began understanding how much their experiences get reinterpreted through the lens of neurotypical views, distorted, minimised and even denied. In this sense and many others, neurodivergence sits on one axe of oppression, with all that this entails. This is to say, there is nothing inherently wrong with being neurodivergent, but it may sometimes seem so, solely because of how society and normativity tend to treat and exclude those who do not fit the image of “normality”, which is unnamed, but corresponds to the ways of being of a majority group.

Neurodivergence was never mentioned in my therapy training. Not even on the days we talked about difference. In fact, the one time I had a short conversation with a tutor about working with neurodivergent clients, I was advised to get more familiar with ableist theory, of the kind that states that neurodivergence, and in particular autism, are only the result of traumatic experiences. The reasoning behind this was the need to “get familiar with both sides of the debate”. Let’s be real. There’s no debate, only the affirmation or the denial of a group of people being who they are, and of their experiences.

This really incensed me and it sparked my interest in learning more about neurodivergent-affirmative practices.

I am no expert on the subject so I cannot talk about differences in neuro-cognitive functioning in detail. Besides, that is out of the scope of this piece. I can however, from my own standpoint of expertise, talk about oppressive and exclusionary dynamics behind pathologising discourses around neurodivergence, as well as the roots of this discourse and ways to address it. So, let’s begin.

Many pathologising views on autism and ADHD, either considering them illnesses, problems to be fixed, or denying their existence and believing they are just an effect of trauma, are damaging. They fundamentally deny people’s identity and experiences of neurodivergence, as well as the impact that masking (Pearson & Rose, 2021) and exclusion may have on their wellbeing.

There is also the fact that placing the problem onto neurodivergence by considering them pathologies or problems to be fixed, conveniently locates the problem in them and their functioning, instead of in our normative social system, or on Neurotypical’s unwillingness to be truly inclusive. Such a system does not accept difference and puts people who do not fit the norm in situations where they have to contend with chronic stress and related issues, physically and psychologically.

Lastly, placing the problem onto someone else then allows Neurotypicals not to see oppression and how they may be enacting and reproducing exclusionary dynamics. Thus unconsciously, it is for their own comfort and peace of mind. We will explore this dynamic in the following sections.

Oppressive dynamics in therapy

The need to pathologise difference stems from three things in my experience. These three points are connected of course, in a chronological way at times, and feed into each other.

One: majority mindset / normative superiority

A sense of superiority that comes from being part of the majority or the “norm”. Perhaps if we ask ourselves directly “do I feel superior?” the obvious answer to that is “no, I am no better than the next person”. And we would wholeheartedly believe that. Now the superiority I am talking about here is an ingrained, insidious and unconscious thing. We need to pay attention to the subtle (and sometimes not so subtle) dynamics where it manifests.

Let’s reflect. What does it really mean to be part of the majority, to be the ones considered widely as ‘the norm’? If we complete that idea then we could say: “the normal ones”. The others thus, if we follow this reasoning, are “not normal” “abnormal” “subnormal” “weird” etc. Descriptors with negative connotations and links to feelings and notions of inferiority, of being less than. In fact, our colonial, patriarchal and white supremacist system very strongly attaches notions of inferiority to anything considered ‘Other’ or outside of the normative centre.

This is all the more visible when we consider how Neurodivergence is often explained from a deficit perspective in regards to Neurotypical functioning. We talk about:

• A deficit in communication for example, instead of different ways to communicate
• A deficit in empathy instead of different ways to connect (see the Double Empathy problem (Milton, 2012))
• A deficit in organisation of thoughts instead of different ways to link thoughts together.

It is easier to regard these as a lack of something instead of a difference simply because our world, our systems, structures and processes are made to fit the way Neurotypicals function. This forces Neurodivergent people to adapt to a system that is not made for them and does not consider their  needs. If it was the other way around, Neurotypicals would run into issues and barriers, and this would make us seem like we lack important skills.

Now let’s go back to the notion of norm and normality. The world is adapted to the comfort and wellbeing of a majority group, (in this case Neurotypicals, but we can also talk about white peoples, middle classes, able bodied people, depending on the axis of oppression we are focusing on), who are regarded as normal. By contrast, all “others” are less than, are a problem or have a problem. Now we can start seeing how that may create dynamics of inferiorisation/marginalisation and othering quite naturally, negatively affecting Neurodivergent people’s wellbeing, self-image and mental health.

Like with many other forms of oppression, this superiority complex may also comes with other harmful dynamics such as saviourism and discounting of the person’s being and capabilities. Either through feeling we know better or we can “help”.

If we are unconsciously coming from the perspective that our way of functioning is the “normal one” then we cannot seriously work from a stance of respect and openness to our Neurodivergent clients. We might want to challenge ourselves to truly examine how we reproduce this thinking both in our inner process and in relationship.

I won’t develop this idea more since it’s not the focus of this piece, but there is definitely something to be said about how ideas of normality, norms and superiority/inferiority are intimately connected to colonial mindsets. These create oppressive social hierarchies along the axis of race, class, gender, ability etc. Centring the needs of groups considered ‘normal’ is the way in which majority groups can maintain power and access to resources or wealth accumulation without regard for marginalised people’s wellbeing.

Two: discomfort and fragility

Being in the ‘norm’ and having the world made for us is comfortable. As members of the majority group, we never had to adapt to other ways of functioning to navigate spaces. We are used to this comfort. What happens when we are confronted with difference? Well… discomfort. Simply put, we are not used to the kind of mental and emotional labour required to engage or adapt to a different neuro-cognitive functioning.

As therapists, if we are trying to understand the client’s perspective then such fundamental differences in how our minds work, in what we understand or not, are bound to create discomfort within us.

This is normal as we will face the shortcomings of our understanding as Neurotypicals and of our own training which has only taught us “the right way” to build therapeutic relationships with other Neurotypicals. In the face of a difference we are not familiar with, our usual ways of working are prone to fall flat and create misunderstandings or distance with clients. This, especially because our ways of creating connections and building relationships, which form the basis of our work, might not be adapted to our clients.

For example, some of the limitations of therapy in this western culture are:

• being reliant on verbal communication of emotional and cognitive processes (see alexithymia for example)
• an intense 1 to 1 presence and contact with certain defined markers to assess for quality of contact (sitting in front of each other, no fidgeting or stimming, eye contact, etc.)
• what are considered ‘healthy’ ways to express emotions and function in relationships
• what are considered ‘proper’ boundaries in the relationship (for example in regards to self-disclosure)
• what are considered ‘proper’ time boundaries and pacing

These are only some examples of what may or may not be working as intended when working with clients with different neuro-cognitive functioning. It is also worth reminding readers that these elements may also be inadequate when working across cultural differences. Therapists working across cultures might also be familiar with negotiating these aspects of our work, otherwise unquestioned.

All of the sudden, our usual ways of working may feel inadequate and the certainty in our capabilities as professionals can be questioned. This can bring feelings of inadequacy & confusion. We become uncomfortable with ourselves as therapists and are liable to project this onto clients as a defence mechanism.

Don’t let this make you retreat into what you know & defend against your client’s mind.

Three: defensiveness & re-establishing comfort

If you are familiar with the analytical theory that describes the process of splitting the parts of ourselves that we unconsciously deem unacceptable, to then project them onto another person, then you might already know where this is going.

Let’s take our feelings of inadequacy as therapists. If not totally aware of them, we are likely to reject them and project them onto the other person, in this case, the client. This is a textbook oppressive dynamic, which is why we need to deeply examine our own process in front of difference. Look out for it and discuss extensively with informed peers and supervisors.

It is of the utmost important that we take this seriously because it may lead to harm. At times, pathologising Neurodivergence is an unconscious process of projecting the problem outside of ourselves and into the client, in order to defend against awareness of our own inadequacy and limitations as therapists.

Moreover, as I mentioned above, placing the problem onto someone else allows us Neurotypicals not to consider oppression and our own way of enacting and reproducing exclusionary dynamics. Staying in a status quo viewpoint on this topic then saves us the labour of having to examine the painful reality of marginalisation, and what would be worse, the discomfort and the shame of learning about our own privilege and power.

Preserving our comfort and peace of mind then comes at a cost for our clients who may receive harmful messages about their own being, consciously or unconsciously.

A non-defensive stance

From my experience I have three pieces of advice to consider in order to address what I’ve described:

One: bravely step into the discomfort.

If you are trying to do doing a good job, it means that you are adapting your way of being to your client’s needs which are fundamentally different from yours and other Neurotypicals’ needs. Let’s be honest, like with much of our client work in which we need to examine processes of transference and confront our own material, discomfort is bound to emerge.

Our training might not have been good in terms of practicing therapy with Neurodivergent clients, but this is when it may come in handy. Use what you have learned to support yourself through this process, use self-care, supervision, reflective practices, and your emotional robustness to withstand whatever discomfort, shame, etc, you may experience while examining your own material. Trust me, working in anti-oppressive ways across many types of difference requires a process of transformation and is not always a walk in the park.

Then, consider your discomfort a lesson and be grateful for it. It can be seen as a very tiny snippet of your client’s experience of having to adapt and navigate a Neurotypical world constantly. You are only trying to adapt during this one piece of work. Respect that, and respect their experience. Never stop trying to figure out how to adapt to your clients, whatever process of reflections, learning or unlearning may be required. It’s our job and we owe this to them.

May I just add that this is an ongoing process that requires open communication about clients’ needs, and about how therapy is being experienced. Hopefully, we have held a space safe and open enough for our clients to feel comfortable speaking their minds.

Two: start problematising your own ways of functioning instead.

Turn the pathologising inquisitive eye onto Neurotypical norms of behaviour. We know how to navigate social situations and build relationships with others in what feels like ‘appropriate’ ways because unspoken or unnamed rules and norms exist. The problem is with these being precisely that they are unspoken and unnamed, but still enforced in oppressive ways when someone does not seem to follow them.

Even when they are enforced, they might not be explicitly named. The target then has to contend with aggression, being told off, exclusion, harassment, bullying or being ignored, simply for being themselves, and sometimes without fully understanding what is going on. All of this has consequences for the self-esteem and wellbeing of Neurodivergent people. However, do we, as Neurotypicals know and name these rules? Most likely not, as they have been so normalised and invisibilised. Nevertheless, they still guide our ways of being and relating.

I’m inviting you to do the work of trying to spot them. What makes certain response seem appropriate or not in our eyes? How do we know what topics of conversation are acceptable and where? What commonly shared verbal and non-verbal information or cues can we interpret to signal certain things in social situations? There are many other examples of everyday things we can question and reflect on.

For Neurotypicals it might be a question to see how these norms only fit our particular needs, but are enforced on everyone in this society. We need to openly ask ourselves: what makes them ‘the best way’ or even, ‘a good way’ of doing things?

For example, what feels oppressive or doesn’t make sense to your client? Why isn’t that considered a problem instead of your clients’ way of being? You will quickly see that the problem is located, not on your client’s behaviour, but on the way society responds to it.

Believe me, you’ll discover much about your client’s experience AND about your own blinkered spots at the same time as curbing that inherent superiority that comes with being in the majority. It is again, a necessary process when working across many types of difference. To problematise normativity and majority ways of being is to take our clients’ side instead of enacting further oppression.

More generally, what this society does is it tends to place the location of the problem onto people and communities that are deemed ‘other’ because of their difference, when the actual problem is the lack of acceptance and the unwillingness by the majority to hold that difference respectfully and adapt what needs to be adapted. In other words, the location of the problem is within the group, especially those from majority or dominant groups. I invite you to watch this video of a presentation made by Guilaine Kinouani to the Anna Freud NCCF, applying this logic to whiteness and racism. It provides a very thorough explanation of this phenomenon.

Three: listen to your client… radically.

And by radically, I mean trust your client’s words, their experience, and the needs they express in your therapeutic relationship above all else. And yes, that also means above the theories and practices you learned and use. Perhaps this will add to the discomfort and feelings of inadequacy by questioning what you hold as certain. In that case, back to our first point on stepping into the discomfort.

When the therapist starts feeling anxiety or threatened in their capacity then another possible defensive reaction is to enter a Colonising Process (Chinnock and Minikin, 2015) by which they try to regain safety and certainty through the theory they know. This may lead to missing the client’s experience, wrongly interpreting it through the lens of our therapeutic frameworks so we can easily make sense of it, and, in the process, robbing them of their thoughts, feelings and meaning making capacity.

Keep in mind that our theories and practices, like our social system, was created by and for a certain population, mostly white middle-class Neurotypicals. It is thus unlikely that it provides adequate conceptualisations, understanding and theorising of diverse groups. The problem comes when we become anxious and try to make clients’ experiences fit our theoretical frameworks instead of the other way around, or even just setting the frameworks aside in order to meet our clients where they are.

Practice trusting all that your client says about their experience, and listening even more attentively if you find that what you are hearing doesn’t fit what you already know neatly. This is especially important when speaking of therapeutic work and the relationship.

Concluding thoughts

I hope these reflections will provide other Neurotypical therapists with food for thought. Our practice is in itself normative as are our expectations on how therapy is supposed to work. Coming out of training and developing an anti-oppressive practice requires a whole journey of learning, unlearning and reflection. I invite everyone to always keep seeking information on Neurodiversity-Affirming practice and to distance yourselves from pathologising lenses.

I’ve come to these reflections through similar learning, through my own practice and knowledge about oppression and coloniality and of course, through listening to the voices of Neurodivergent therapists and clients. These are my own conclusions, subject to evolve with time. They are not universal truths. Perhaps yours will be different. What’s important is that you are doing the work to avoid reproducing ableist harm in your practice.

References & Further Reading

Chinnock, K. & Minikin, K. (2015) Multiple Contemporaneous Games in Psychotherapy: Psychodynamic and Political Perspectives. Transactional Analysis Journal, 45(2), pp141-152

Milton, Damian (2012) On the ontological status of autism: the ‘double empathy problem’. Disability & Society, 27 (6). pp. 883-887

Pearson, A & Rose, K (2021) A conceptual Analysis of autistic masking: understanding the narrative of stigma and the illusion of choice, Autism in Adulthood, Volume 3, Number 1