I think we need to start having more honest conversations about what neuroaffirming care actually is and what it is not.
Recently, I’ve noticed an increasing number of neurodivergent clients arriving in my practice after working with therapists who identified themselves as neuroaffirming, yet leaving those therapeutic relationships feeling more confused, ashamed, burned out or disconnected from themselves. I want to be careful here, because I do not believe these therapists intended harm. I think they genuinely cared about their clients and truly wanted to provide affirming support. Good intentions, however, are not enough.
I am hearing the same themes repeatedly: clients being pushed toward productivity systems that intensified burnout while their nervous systems were already overwhelmed; masking being interpreted as “growth” because the client appeared more socially engaged, emotionally expressive or externally functional; autistic inertia being framed as avoidance; executive functioning struggles being interpreted as resistance or lack of commitment; sensory overwhelm being minimized; and relational differences being pathologized through conventional assumptions about reciprocity, communication or attachment. Clients also describe feeling pressured to maintain eye contact, communicate more verbally, respond more quickly or process emotions in ways that did not actually feel safe or regulating for their nervous systems.
These experiences are happening inside spaces explicitly calling themselves neuroaffirming and that is what concerns me. When a neurodivergent client enters therapy expecting safety and affirmation but still leaves feeling fundamentally misunderstood, they often internalize even more shame and begin questioning themselves more deeply because they think, “If this was the affirming therapist, then maybe the problem really is me.”
That is not neuroaffirming care.
For many neurodivergent people, traditional therapeutic approaches have been deeply shaming, pathologizing and harmful. It matters that more therapists are becoming aware of masking, burnout, sensory processing, executive functioning differences, trauma, identity and nervous system overwhelm, and are beginning to move away from approaches focused on making neurodivergent people appear more neurotypical at the expense of their well-being. The shift toward more neuroaffirming care is important and long overdue.
At the same time, I think we also need to be honest about how easily neuroaffirming care can become performative rather than transformative. Sometimes the language changes more than the underlying framework itself. A therapist may use affirming terminology, avoid functioning labels or describe themselves as neuroaffirming, while still interpreting neurodivergent experiences through largely neurotypical assumptions about communication, emotional expression, productivity, regulation, reciprocity and what “healthy functioning” is supposed to look like.
In those situations, neuroaffirming care can become more about appearing affirming than fundamentally rethinking the lens through which neurodivergent clients are being understood. The therapist may genuinely care and still unintentionally reinforce the same dynamics many neurodivergent people have spent their lives navigating: pressure to mask, pressure to appear more regulated, more socially reciprocal, more verbally expressive, more productive or more externally functional in ways that move them further away from themselves rather than closer to themselves.
True neuroaffirming work is not about placing neurodivergent clients into slightly modified versions of the same frameworks that have historically misunderstood them. It requires therapists to question many of the assumptions our profession has long treated as “healthy,” “normal” or desirable, particularly around communication, emotional expression, productivity, regulation and what progress is even supposed to look like.
Part of truly becoming neuroaffirming means understanding the historical and ongoing harm that has been done to neurodivergent people, particularly Autistic people, within medical, educational, relational and therapeutic systems. For decades, many Autistic people were taught that their natural ways of communicating, moving, regulating, relating or existing were wrong, disordered or in need of correction. Many experienced therapies focused more on compliance, normalization and behavioural control than emotional safety, autonomy or nervous system well-being, while others were chronically misunderstood, infantilized, excluded, bullied, misdiagnosed or forced into lifelong masking in order to survive socially. Those experiences do not simply disappear because the language inside therapy changes.
Becoming truly neuroaffirming also requires understanding how neurodivergence intersects with gender, race, sexuality, trauma, class, culture and disability. Many neurodivergent people, particularly those who are marginalized in multiple ways, have historically been overlooked, misdiagnosed or misunderstood because dominant diagnostic and therapeutic frameworks were largely built around narrow presentations rooted in white, male and neurotypical norms. The experiences of Autistic women, LGBTQIA+ individuals, racialized communities and people with higher support needs have often been minimized or excluded altogether.
Many neurodivergent adults grew up internalizing the belief that they were “too much,” “too sensitive,” “lazy,” “dramatic” or somehow failing at things that seemed to come naturally to everyone else. Others were repeatedly misdiagnosed without anyone recognizing the underlying neurodivergence shaping their experiences. Many learned very early that safety, belonging and acceptance depended on masking and adaptation.
The history and context are important because neurodivergent clients arrive in therapy carrying years of chronic misunderstanding, internalized shame, burnout, trauma and nervous system exhaustion. Without understanding this, therapists can unintentionally reproduce the same harms while using more affirming language.
True neuroaffirming work requires therapists to fundamentally reconsider many of the assumptions they were trained within regarding motivation, behaviour, communication, emotional regulation, productivity, attachment, trauma and relational functioning. A therapist may unintentionally interpret autistic inertia as avoidance, view executive functioning struggles as resistance, mistake masking for progress, push emotional processing beyond nervous system capacity or encourage productivity systems that intensify burnout. Often, these misunderstandings happen subtly inside the therapeutic relationship through repeated moments where the neurodivergent client begins reshaping themselves again in order to feel understandable, acceptable or emotionally safe within the room.
This dynamic is part of why so many neurodivergent adults arrive in therapy carrying profound confusion and self-doubt. Many have spent years trying to follow therapeutic advice that never fully fit their nervous systems. Some leave believing they “failed therapy,” when in reality the framework itself may never have been aligned with how they process, regulate, communicate or function.
True neuroaffirming work requires more than knowledge. It requires humility. Therapists must recognize that neurodivergent experiences cannot be understood through neurotypical frameworks of communication, consistency, motivation, socialization and emotional expression, while also slowing down enough to question assumptions about what healthy functioning is supposed to look like.
Therapists must also tolerate forms of communication, pacing, emotional expression and relational engagement that may feel unfamiliar, nonlinear or difficult to interpret through conventional clinical frameworks. True neuroaffirming work asks clinicians to relinquish the comfort of standardized ideas about progress, regulation and relational health while also examining how deeply neurotypical expectations are embedded within the profession itself.
Even within therapy, we often reward eye contact, verbal processing, emotional immediacy, consistency, productivity, relational reciprocity and behavioural follow-through in ways that may not account for neurodivergent nervous systems. Neurotypical styles of communication and regulation can unintentionally become framed as healthier, more mature or more evolved, and I think that is where real harm can occur, even inside spaces that genuinely believe they are being affirming.
For me, neuroaffirming care is about understanding context, recognizing nervous system realities and differentiating between skill deficits and nervous system overload. It is about recognizing the impact of masking, chronic burnout, sensory exhaustion, trauma and years of self-monitoring while helping people build lives that are actually sustainable for their brains and bodies rather than helping them perform wellness in ways that look acceptable to others.
I think therapists need far more training in this area than many currently receive. Not just a workshop. Deeper learning is needed around neurodivergent nervous systems, lived experience, trauma, identity, sensory processing, communication differences, autistic burnout, ADHD activation patterns, masking, relational dynamics and the ways neurodivergence intersects with gender, sexuality, attachment and culture.
The reality is that neuroaffirming therapy is a paradigm shift. If we are going to call ourselves neuroaffirming clinicians, we have a responsibility to ensure that our understanding runs deeper than the language we use. Otherwise, we risk recreating the very dynamics many neurodivergent people have spent their lives trying to survive only this time under the language of affirmation.