Beyond CBT: Adapting Therapy for Neurodivergent Clients

CBT (Cognitive Behavioural Therapy) is often the go-to intervention for anxiety, depression, and other mental health conditions. But when it comes to working with neurodivergent clients—especially those who are Autistic or ADHD—it’s essential we go beyond the standard CBT manual. Neurodivergent therapy adaptations aren't about discarding CBT altogether, but about delivering it in a way that honours the client’s neurotype, validates their lived experience, and doesn’t inadvertently pathologise difference.

As a psychologist trained in CBT who works almost exclusively with neurodivergent clients, I’m often asked: “Is CBT even appropriate for neurodivergent people?” The short answer? Yes—but only if it’s adapted thoughtfully. Let’s talk about what those adaptations actually look like.

1. Recognise That CBT Isn’t Inherently Affirming—Therapists Make It That Way

CBT, in its traditional form, is based on identifying and restructuring “distorted” thoughts. But many neurodivergent individuals report feeling dismissed or gaslit in therapy, particularly when their experiences are framed as irrational or needing to be fixed. That’s a red flag—and one that points to the delivery of the therapy, not the model itself.

💡 Neurodivergent therapy adaptations start with mindset. You must approach therapy from a stance that honours the client’s way of thinking, communicating, and processing—not one that seeks to normalise it.

2. Validate the Client’s Reality Before Challenging Their Thinking

Let’s consider the common CBT task of evaluating negative automatic thoughts.

Client thought: “I’m bad at socialising, so people must think I’m weird.”

A traditional CBT response might be: “Let’s challenge that. Just because you feel awkward doesn’t mean others see you as weird.”

While this seems helpful, it risks framing the problem as the client’s misperception—when in reality, they may be reflecting on repeated lived experiences of exclusion, masking, or social disconnection in neurotypical environments.

An affirming approach might explore:

• Is this a cognitive distortion or a valid reflection of neurotypical bias?

• How can we honour the pain behind the thought while helping the client problem-solve in a way that’s affirming?
  

This might sound like:

“It makes sense that you feel that way in certain environments. Let’s explore what kinds of spaces feel more natural or safe for you socially, and how we can reduce pressure to conform to neurotypical norms.”

3. Reframe the Therapeutic Goal: From “Fixing” to Self-Understanding

CBT should not be about teaching neurodivergent clients to mask better or “act more neurotypical.” Instead, our work is about supporting them to:

• Understand the context of their challenges (e.g. sensory overload, social fatigue, executive dysfunction)

• Develop strategies that suit them

• Increase self-compassion and self-advocacy

• Reduce internalised ableism and shame For example, instead of targeting emotional dysregulation as a symptom to be eliminated, we might explore how sensory overstimulation or chronic masking contribute to meltdowns or shutdowns—and build strategies from that place.

4. Adapt Language and Structure in Sessions

Therapy adaptations for neurodivergent people go beyond content—they include how we communicate, how we structure the session, and what assumptions we bring.

Some key considerations:

• Use literal, concrete language where possible. Avoid metaphor-heavy or abstract tasks unless the client has confirmed these are helpful.

• Be flexible with how you assign “homework.” Executive dysfunction, perfectionism, or burnout can make rigid tasks unhelpful.

• Use visual aids, written summaries, or collaborative whiteboarding when appropriate.

• Don’t assume eye contact = engagement. Focus instead on verbal content, or the client’s preferred way of expressing connection.

5. Offer Agency and Collaboration, Not Compliance

Neurodivergent clients have often spent a lifetime being told what’s “wrong” with them. The last thing therapy should do is reinforce that power imbalance. Make space for clients to say, “That doesn’t work for me.” Welcome that feedback. Collaborate rather than direct.

Ask:

• “How does that land for you?”

• “Does that strategy feel realistic for your brain?”

• “Would you like to approach this a different way?”

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This fosters trust, autonomy, and ultimately, better outcomes.

Final Thoughts: Affirming Doesn’t Mean Avoiding CBT—It Means Adapting It

Neurodiversity-affirming therapy adaptations are about nuance, flexibility, and empathy. When done well, CBT can be an incredibly affirming and empowering tool for neurodivergent clients. But if applied rigidly, or through a deficit lens, it risks reinforcing the very harm we’re trying to address.

If you’re a psychologist, therapist, or mental health professional wanting to adapt your practice for neurodivergent clients, I’ve created resources to help:

Want Support Adapting Your Therapy for Neurodivergent Clients?

Neurodiversity-Affirming Therapy Training

This comprehensive training covers:

✔ What neurodiversity-affirming practice really means

✔ Therapy adaptations for Autistic and ADHD clients

✔ Strategies for avoiding masking pressure in therapy

✔ Affirming ways to reframe cognitive distortions

✔ Practical examples for adapting your current therapeutic approach

👉 Learn more and enrol here