Embracing Neurodiversity in EFT

When Clare asked me to write a blogpost on Neurodiversity, my first thoughts were “oh, exciting!” – I have worked with autistic children and adults in various roles for the last 9 years, including a couple of years as a psychologist, but I’ve never really thought about sharing tips, or writing about what I have learned. A million things crossed my mind, including snapshots of different clients and people I’ve supported over the years. And then it occurred to me – “there’s TOO MANY things!” and then, I’d have to admit my enthusiasm waned. Afterall, if there was anything I learned from working with autistic children and adults across cultural contexts (I’m from Singapore), you never really become the expert! The old cliché adage rings true here, “if you’ve met one person on the spectrum, you’ve met one person on the spectrum”. While there are “general guidelines” to consider when working with neurodiverse people – I have found that even within neurotypes, people can experience the world very differently. Something that works for one of your autistic clients, may not work for another.

Prior to becoming a psychologist, I worked as a teacher aide, job coach and inclusion support assistant to my autistic students and clients. I did not know this then, but “person-centred care” was really what worked. I found, through making many mistakes that we cannot simply apply the same strategies for another autistic client, just because they are autistic too. Just like how you would not apply the same strategies that worked for your Caucasian client to another Caucasian client, simply because they are Caucasian (I deliberately used culture as an example, as neurodiversity as with the ethnicity that one is born with, is unchangeable and uncontrollable). Just decades ago, autism was considered a ‘disorder’, something one can (seemingly) be treated of, or made “less autistic”. We now know that you cannot treat autism, just like you can’t provide someone therapy to change their ethnicity. In fact, many autistic adults report that autism is inseparable from who they are, that the way they perceive the world is through autism. Research conducted in the UK found that autistic people prefer identity-first Language (“Autistic”), as opposed to people first language (“Person with autism”)(Kenny et al., 2015). Even though for decades before, professionals have preferred person-first language (How wrong can we get!). Although, I’d encourage you to still check the language preferences of your clients and respect their preferences. With that, I will attempt to give a definition of Neurodiversity and then some tips and things I’ve learned from my students and clients over the years that I have found helpful in the therapy room in emotionally focused therapy (EFT), or any modality really!

What is Neurodiversity?

Neurodiversity is the idea that there are different brain types in the world, just like there are different species of whales, flowers and even clouds. It is the idea that nature is inherently diverse, and that this diversity is necessary for balance in the world. Imagine a world where there is only one type of person, one type of flower, and one shape of cloud. How mundane and uninteresting.

Predictability

In general, autistic people benefit from understanding what is expected of them. In the therapy context, this can look like collaborating on an agenda at the start of the session. For some clients, verbally discussing this can be sufficient for others a visual check list that can be referred to throughout the session may be more helpful. In EFT therapy, perhaps a discussion of the stages or a “therapy roadmap” can be helpful. Again, check in with your client what is most helpful at different stages.

Sensory differences

Neurodiversity also means differences in how someone perceives (through their senses) and how they process the world. Humans have a total of 8 senses. Most of us are aware of the 5 typical ones (sight, sound, taste, smell, touch), but we also have 3 others. Our proprioception (the noticing of our body in space - the ability that allows us to touch our toes with our eyes closed), interoception (noticing internal bodily signals) and vestibular (sense of balance). Autistic people can have sensory differences in that they may be hyper- or hypo- sensitive, across different senses. For example, the same person can be hypersensitive to sounds (ability to hear unusual pitches or volumes) and be hyposensitive to touch (e.g., enjoy deeper pressures, higher pain threshold). Being mindful and considering someone’s sensory needs is important when you have a neurodivergent (ND) client in the room.

Environmental accommodations

As EFT therapists, creating safety is paramount to the therapeutic alliance and creating change. Part of creating safety, for the ND client, who can perceive environments differently is to check in and provide many avenues for their sensory needs to be met. One of the things I like to ask as my client enters the room is to ask “how does the temperature feel like in the room today? Let me know if it’s too warm or too cold, and we can adjust it”. You’d be surprised at how different people have different temperatures their body feels the most comfortable. I also like to provide sensory items (e.g., fidget toys, rocks, squishy toys, stress balls etc.) somewhere in the room. I make explicit the invitation to grab one whenever “their body needs it”, without needing to ask for my permission. Or allowing clients to bring in something that helps them feel safe from home. I normalise this, and model this.

If you’re able to adjust the lighting in the room, that can be another one that can be adjusted based on your client’s preferences. Some ND clients have hypersensitivity to certain types of light (e.g., fluorescent), or the brightness of light. This can really impact their ability to feel safe and engage in the session. Allowing accommodations such as tinted glasses, or visors in session can be a workaround if you’re not able to adjust your lighting.

I tend to also normalise moving the body in session. I make explicit that we don’t always have to sit and face each other. There might be times you need to move, and that’s ok.

Therapeutic accommodations

Use of metaphors, visual imagery to enter world of emotions

In EFT, when we affect assemble or get our clients to notice their bodily signals, this may be difficult for the ND client due to differences in their interoceptive processing. In other words, some autistic clients may not be as sensitive to their internal signals and how this links with their emotions. The typical question of “What happens in your body as you say this?” may not necessarily get you the information you’re seeking to “deepen” emotion.

Once safety is established, I have found that inviting clients to share their experiences with me in whatever ways it occurs to them has been helpful. I would normalise and invite the sharing of images, songs, metaphors of how something their partner said had landed for them. Stay curious, and often there will always be attachment themes to be mined!

Use of concrete examples and numerical scales

Autistic people can sometimes struggle with abstract concepts sometimes used in EFT. For example, notions of “love” and “connection”. It can often be beneficial to discuss and clarify how each person in the relationship defines different terms. It is important to never assume that everyone understands common terms the same way. I will elaborate on this in the next section.

Numerical scales can be useful as an objective and concrete way of helping everyone in the therapy room “get on the same page”. I have found using scales helpful in learning about how my clients (ND and non-ND) experience different feelings, and how it lines up with the words they use. For example, one client’s “good” week could be a 5/10 while another client’s “good” week could be an 8/10. It also provides more nuance to their experiences and provides an avenue for benchmarking between sessions.

In a more EFT-esque example, numerical scales can also help each partner understand entry points into their cycle. For example, when tracking the cycle with a couple I was working with, we discovered that each person in the relationship had a different level of emotional intensity before they would enter the cycle. For the withdrawing partner, a 2/10 level of anger from their partner was sufficient to lead them into thoughts such as “I’ve done something wrong” and correspondingly trigger their withdrawing coping strategies (e.g., shut down, avoid partner). On the hand, the anxious partner would only sense that things were wrong when an 8/10 level of frustration/tension was coming from their partner. This led to an understanding of how their differences can often lead to over- or under-responding to each other’s needs.

Check, and re-check your assumptions

If you forget everything you’ve read so far – please remember this. Always CHECK and re-check your assumptions of what is “normal”, “typical” and “common”. I have found this mantra helpful when working with ALL clients, but especially so with my ND clients. As humans, we come in with lenses of our own- informed by our own values, upbringing attachment strategies. Being aware of what these are, and how they can impact the way you perceive your clients is important. Not making mistakes is not the goal, it is to recognise when you have made one and be willing to correct your viewpoints or perception. Be open, curious, and be willing to think and be outside the box. When you model openness to correction, different ideas, and alternative ways of thinking – your ND clients will feel safer and more inclined to invite you into their world.

Disclaimer: I have worked much more with autistic clients, than I have any other neurotypes within the neurodiversity spectrum. Although, significant overlaps may/may not occur, and it may/may not apply to other neurotypes. My thoughts above are also based on the clients I’ve supported over the years, and they do not represent every autistic/ ND client and may/may not help your autistic client. The key is to stay curious, open to checking your assumptions, and trying different things.

This blogpost was first posted on the 17th August 2022 on the website of The Brisbane Centre for Attachment and Relationships. Thanks to Dr Clare Rosoman for the idea that sparked this post!

This blogpost was also translated into Dutch on the 6th July 2023 by fellow EFT therapist Anlacan Tran for EFT Netherlands. Thanks to Anlacan for reaching out and spreading the message!

Reference: Kenny, L., Hattersley, C., Molins, B., Buckley, C., Povey, C., & Pellicano, E. (2015). Which terms should be used to describe autism? Perspectives from the UK autism community. Autism, 20(4), 442-462. https://doi.org/10.1177/1362361315588200