Last time we explored why a neurodivergent client's yes isn't always a yes. This time, we ask the question that follows: what would make a genuine no possible?
Earlier this year I conducted a community research study with neurodivergent people exploring their experiences of therapy, coaching and support, particularly around relationships. I’ve since repeated similar research with professionals who work with ND clients. The research has demonstrated where some blind spots might be and what would help professionals support ND clients more effectively. Here, I’m sharing my perspectives that have been directly influenced by this research.
The room with no visible door
Picture a room where you can't see the way out. Maybe there is a door, but nobody has told you where it is, or whether you're allowed to use it.
Notice what happens in your body. Perhaps your shoulders creep up. Your breath might get shallow and sit high in your chest. Your eyes scan, but you keep your face still. Sounds get sharper: the hum of the lights, someone's chair creaking. Your jaw stiffens. Your mind starts working on a different question: what if I need to say no and can’t leave? You feel trapped.
So you decide to say yes. It's quick, practised and smooth, and from the outside it looks like willingness. From the inside, your body is bracing and it’s not an authentic choice when no didn’t feel like an option.
For many neurodivergent people, this isn't a one-off. Saying no has come at a cost throughout their lives. Perhaps it was called difficult, oppositional, rude or dramatic. Perhaps it was ignored altogether, so we learned that saying no changes nothing. Add in delays in processing discussions, especially when under pressure, and difficulty naming what we feel. A simple no requires us to connect with our truth, feel we can rely on it and be able to say it while feeling the risk of it.
The room with marked exits
Now picture a different room. Before you sit down, someone points out the door and says: "If you need to stop, or leave, or take a break, this is how. You can use it at any point, and nothing bad happens if you do”. You agree together what it looks like. A hand raised. A turned-over card. A word you both know. It’s not the same for each person. You decide together what will work for today.
Notice what shifts. Your shoulders drop. Your breath moves lower and slower. Your eyes stop scanning, and you can relax into looking at the person in front of you, or at your hands, or at the plant on the windowsill as you wish. The lights stop buzzing so loudly. You have more room in your head for the actual conversation.
Nobody has used the exit. It exists, it's been discussed, and the plan is shared. It may be some time before you use it, if you ever do, and yet the permission to be true to ourselves makes many things more possible.
What fire exits teach us
When there's a fire, most people don't head for the nearest door. Studies show people tend to leave by familiar routes, especially the way they came in, rather than spreading across the available exits (Kinateder, M et al, 2018). Likewise, intuition under pressure points to the familiar, not the safest option.
Signs alone don't solve it either. Even crowd safety experts, such as Fire Safety Experts, tell us that signs can be positioned too low, be too small or fail to indicate where the exit leads. What helps is information people already have. The results of our study reveal that a clear message had a significant impact on understanding what to do for a neurodivergent client.
So what does this mean for the therapy room? A client who has been trained to override their own signals won't find the door by instinct. They'll do what they know: stay, agree and carry on. So the exit has to be shown and talked through in advance, until it's familiar before it's needed.
That's the difference between kindness and structure. A practitioner who thinks "of course they can say no, I'm kind" hasn't marked the door. For a client who has learned that implied permission isn't safe, kindness without structure is still a closed room. The structure has to be explicit, not implied. Our research demonstrated that ND clients require clear expectations, consistent frames, patience and flexible ways to answer.
Here are three different ways to mark the exits, because different approaches resonate with different people:
1. Embodied: body first, words second, if the client has agreed to this approach
Before asking a question that needs an answer, invite the client to check in with their body first. Once they can feel what a yes or a no feels like on the inside, they can then explore how to express that. Agree on a simple non-verbal signal in advance, like turning a hand over, leaning forward or back, or pressing their feet into the floor for yes and lifting them for no. Say clearly that the signal can change, and that "I'm not sure" may have its own signal too.
Many of us override our bodies long before we reach for words. A body-first answer gives the signal a chance to arrive before the story we've been trained to tell. You may both notice it: the pause before a hand turns, the exhale when "not yet" is accepted without fuss.
Please note: embodied approaches can work very well with some clients and be very triggering for others, so make an agreement first about whether the client would like to explore embodied approaches.
We have a resource called ‘Creating Space for ND Consent: Practitioner Starter Pack’ to help with this if you are not sure where to start.
2. Creative: make your own response cards
In session, invite the client to make their own set of cards from paper, collage or drawing. Include more than yes and no: not yet, I don't know, ask me later, I need a break. Let the client choose the colours, textures and images.
Then agree how you'll use them, before you need them. Pointing at a card removes the pressure to explain, and "not yet" becomes as legitimate as "yes". Craft-based approaches were among the most valued by our respondents, because working with the hands reduces the pressure of verbal disclosure
Anyone who knits knows you can unpick a row without ruining the whole piece. Let your cards say the same: a yes today can be undone tomorrow, and the work carries on. The cards can also go home, so the client can use them with partners, family or colleagues.
3. Nature-based: the walk with forks
Neurodivergent individuals identified nature as one of the most reliable ways of regulating and finding their way back to themselves. If you work outdoors, or have the opportunity to, try a walk-and-talk where the path offers choices. At the start, say out loud what the plan is. At each fork, the client decides, and turning back, stopping or sitting down is always allowed. Then show it by doing it yourself sometimes.
Notice the difference outdoors: the ground under your feet, air on your skin, no one watching your face because you're walking side by side. A choice at a fork is a physical practice of choosing, changing your mind and nothing bad happening.
A note on limits
These are starting points, not a protocol. We spoke with a small community sample, which was primarily white, female, middle-aged and UK-based. So, what works will vary person to person. The fire exit research is an analogy, not specific evidence about therapy. Co-create the signals, cards and routes with each client rather than handing them over.
It’s also important to note that an exit only feels safe if what happens next is safe too. If a no is met with a sigh, a flicker of disappointment or an urge to persuade, the client's body will notice, and the door will quietly close again.
One thing you can do
Think of a recent session, with no names or identifying details.
- Was there an exit in the room, and had we talked about it, or was it just implied?
- What did my body and voice do when the client hesitated or said no?
- Which of the three ideas could I put in place before the next session, so the plan is shared in advance?
What's next:
Next time, we'll look at why ND consent is helpful to explore, even when your practice with your ND clients is going well. Tell me in the comments what you tried, with no identifying details, and sign up to the newsletter at www.untangleroots.org for a summary of the research with professionals.
Kinateder, M et al (2018) Exit choice in an emergency evacuation scenario is influenced by exit familiarity and neighbour behaviour. Safety Science, 106, 170-175
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