If you were ND but didn't realise, and you went to see a psychotherapist and the suspected that you were - would you want to know?

[Blinn]

Name change for this.

I am a trainee psychotherapist and have a client who didn't declare any neurodiversity, however has strong ND traits. Struggles with worrying about "boring" people when talking about their special interest. Always aware if people are talking about their special interest then thinking a lot about how to talk to them about it. Always felt different, is always aware of how they 'present' to others, is a 'different person' in different social situations among other things. Gets overwhelmed and exhausted trying to 'fit in'in social situations.

I have talked to my supervisor and practice manager and they say just meet the client where they are and don't offer advice, which is what I'm currently doing.

I've done some CPD on neurodiversity but that was more about working with clients who are living with ND already.

I really value this client and want to do the best for them. They seem to enjoy the sessions and have told me how much they are helping.

I wondered what people who are ND thought about this?

Integrative - I work from a person centred foundation.

So far what I am doing is showing the client that they can bring and talk openly about the things they think makes them "weird" (their words). I have suggested we look at another way of phrasing "weird".

Hi OP, speaking as an ND therapist, I'd be discussing this with your supervisor because it seems that though they've said not to advise, you don't seem totally comfortable with this. Perhaps reflect on why you feel the need to suggest that they may be ND? I'd also be mindful of the ethical duty not to do any harm. And this is the hub of the challenge here; would it be harmful to the client if you were to ask whether the client had considered that they could be ND or not? I work with this cohort of clients and it varies from client to client as to whether I suggest this or not but whenever I do, its done very gently after a period of time when the therapeutic relationship is well established. Not everyone with ND sees being ND as a positive thing (internalised ableism for example) which is why it can take time for me to mention it to a client, if at all. All the best moving forward and its lovely you're reflecting on this because its this reflection that is central to being a good therapist.

Perhaps reflect on why you feel the need to suggest that they may be ND?

I don't have a need to do this. I am happy meeting the client where they are. I just wonder if it's quite fair to hear the client struggling and whether exploring the suggestion might be helpful.

I suppose my reflection is that it makes me sad to hear them describe themselves as weird. I feel that sadness comes from the client.

I'm a therapist and I have and always would say it if I saw it. But only after a long period of time getting to know my client and with the caveat that whilst I recognise traits of ASD etc. this doesn't mean they'll definitely get a diagnosis.

I think it's a bit wishy washy saying nothing and expecting clients to just figure it out for themselves all the time. There are times when that's appropriate though, obviously.

I don't just blurt out that I think they might be autistic. What I might say is that I recognise some traits, such as restrictive repetitive behaviours, sensory sensitivities and communication difficulties which suggest they might benefit from a screening for neurodiversity. I only suggest this at a time when I've got to know the client really well, built up trust and feel that they would be receptive or not closed off to the idea.
Every time I've suggested it, they've returned to say they did get a diagnosis, so I think I'm doing the right thing.

I think this is what I'd like to do. I'm not sure 12 weeks is enough though - it would have to be 9 weeks really to give us time to explore afterwards.

Maybe I have to accept I will have to live with not knowing whether this client gets a diagnosis or not.

I have two other ND clients and it's an area I love. I wonder if I am ND myself!

OP I think you’re right in questioning whether you’re ND or not. When I read your original post I immediately thought you were ND.

Completely agree. Though I'm not a professional in this field I know people who I suspect have autism and I've hinted about behaviors but they see it as a negative thing.

Also someone autistic once said to me they think I'm autistic. Whilst I have no issue with this I was confused for a while because I don't think I am. A few autistic traits don't always mean autism.

Integrative - I work from a person centred foundation.

So person centred therapy is an holistic approach that doesn't differentiate between different types of presentation or take a psychologising approach to the human condition. So from that perspective you'd work with the person in front of you without the need to label. However, being congruent with your client is one of the therapeutic conditions, which would suggest the potential benefit of sharing your persistent feelings/thoughts with your client - always done with care and offered rather than stated as fact and always owned by the therapist as theirs.

I'd be considering how long you've worked with them, what else might be happening for them (go back to Roger's theory of personality development), why you're struggling to sit with your feelings about them describing themselves as weird (is your desire to suggest neurodiversity more about easing your discomfort at being with your client in that feeling).

Person centred therapy places huge demands on the therapist in terms of their own self awareness and setting aside the desire to fix things as opposed to walking your clients path with them. I'd be working on that first, before thinking about introducing a label that might not be helpful and may not benefit the therapy. The potential is the therapy then becomes about the label rather than the client which is the exact opposite of what person centred therapy is about.

pathologising approach

I was in a similar situation a few years ago, however with my GP, who observed some ASD Signs with me. After years of suffering from anxiety, senory issues, poor eye contact ect. I was also curious myself as my friend has Previously been diagnosed and has similar difficulties.
I was asked if I wanted to explore the possibility of have ASD. And allowed to make the Decision in my own time, (over a few years). I'm now 40 with an ASD diagnoses, it wasn't a surprise to me, however I had to unpick a lot of my childhood ect.

I am a therapist - I think posting a query like this on an open forum is a terrible idea and as a client I would be really annoyed. If this is outwith your competence then seek more supervision (you can get specialist supervision in an area as once off if you don’t feel current set up is enough) do CPD, check what client would like, link in with local advocacy groups. Please don’t seek opinions on a very open widely shared forum. I imagine you haven’t asked her permission to do this and how can you tell if the info you get here is appropriate or not?

I would.

My cbt therapist suggested to me at the age of 38 that I may be autistic, and referred me for assessment. I was diagnosed as a result and then with ADHD later on. It’s been life changing for me. I’m very glad the therapist raised it.

My first thought on this was that it’s very general and non-identifying. But my second thought is that as a client, yes, I would be annoyed and consider it a breach of trust. And also that the responses aren’t necessarily going to be wise ones.

I was actually asking ND people whether this would have helped them or not as I was interested from their angle - as per the title.

I am not actually asking for advice on how to talk to my client. I have a supervisor and a manager and a tutor for that. I have also said I have done CPD, and "asking what the client would like" doesn't make much sense in this context.

Thank you for sharing.

Thank you - interesting!

I would love to be told there is a reason I find it so hard and exhausting trying to fit in rather than it's just because I am a bit crap at life.

Yes I do appreciate it is fairly anonymous so perhaps I’m being a bit harsh but more details came out in some of the OP responses (again all fairly general tbf) but the client will have been told about confidentiality and limits to it and this isn’t within that scope so we need to be respectful of what people tell us I think. I think if I recognised myself in this scenario I might not feel so comfortable sharing more details with my therapist.

And seeking clinical advice on Mumsnet doesn’t give me much confidence in their clinical judgement - I mean what are they expecting to get from posting? I could give my clinical opinion but that would be inappropriate as I don’t have full details - supervision is there to reflect and seek further guidance.

Ha thank you! Seems it's much easier to diagnose someone on an Internet forum than in real life therapy!

I am not seeking clinical advice, as I've said many times. I thought the title makes it very clear I was interested in knowing what ND people would want to experience, as I am interested to hear this.

There are many case studies and questions on Facebook forums as you will know, and nothing I have said here could be identifying in any way.

Thank you so much to those who have shared their experiences.

I would suggest going to one of those people and asking about your post on Mumsnet to see what they think. Having done CPD - do more, it isn’t a finite thing. And in terms of asking the client - you wouldn’t ask directly if they want to know if they have autism - as a therapist you’re very unlikely to be qualified to dx it anyway. But more having a conversation around if they’re open to exploring other things and who might be appropriate if they did etc. this is why checking on Mumsnet isn’t a good idea - it’s difficult to be nuanced - use all the avenues of support you have. And being defensive when you’ve done something a little dodgy isn’t a good look.

I have CPTSD and many people have suggested I’m autistic. I have many traits but all can be traced back to my trauma and explained. I wouldn’t suggest it to your client but guide things so they can explore for themselves. It’s not your job to diagnose and you are still only a trainee and I suspect the more experience you gain, the more you will see the slight differences between very similar symptoms and overlaps. Also sometimes labels are just unhelpful for some people (although helpful for others). I would suggest treading with caution.

I don't feel what I've done here today is in any sense dodgy. I wonder if this has triggered something in you and your need to be an 'expert' in this situation or to gatekeep knowledge?

There's always the chance that none of my post is true and I am just researching something - as you say, you have no way of knowing.

Thanks, I am taking it very carefully and as you say I am aware there can be overlaps with cptsd.

I am training - so still learning.