A therapist recently asked me: "If my work is already going well with neurodivergent clients, why do I need to know about neurodivergent consent?" It's a fair question, and a good sign. It comes from someone who cares about their practice.
If you are a therapist, coach or professional working with neurodivergent clients, and you want to serve them consistently to the best of your ability, but you are not sure where to start or how to reliably get results, this article will give you three key principles and one thing you can put into action.
Principle 1: You already have a map
Imagine you have a map that reliably gets people from A to B. It's been tested, it works, and clients arrive where they meant to go. The challenge is, as with all maps, the map only shows the terrain their makers surveyed. Most clinical frameworks were drawn from neuronormative territory.
Now picture a client who keeps returning to you session after session with the same sentence: "My feet got wet and I don't know why."
You ask your usual questions. What happened? What happened before? What were you feeling? What did you notice?
The client isn't sure. Neither are you.
So together you work towards accepting that sometimes feet just get wet, and that it's fine not to know.
Principle 2: Perhaps there is a bog and it's not on your map
That is kind to work towards acceptance, and it is sometimes the right thing to do. However, if there was a bog shown on the map, the wet feet would not be a mystery. Perhaps it is a gap in your map?
What could the bog be?
In our community survey of 40 neurodivergent adults, respondents described things that rarely appear on standard maps:
- alexithymia
- processing delay
- masking
- rejection sensitive dysphoria
- fluctuating capacity
- the pull of fawning and people-pleasing as survival responses (Mitchell, 2026a).
They also told us that being unable to answer a question isn't resistance. It may be a sign the terrain itself is hard to read.
So when a client can't say why their feet are wet, "reflect on what happened" may be asking them to describe a bog they can't see from where they're standing. A practitioner who knows the terrain can help them see it.
Warmth isn't a map
Some findings from our research really stood out to me. Respondents rated their therapists' understanding of their relational safety needs at around 3.3 out of 5. The understanding of ND consent averaged about 2.1, and of ND codependency about 1.9 (Mitchell, 2026a).
The practitioners were often warm and attuned, and still missing the specific knowledge. Empathy gets you walking alongside someone. It doesn't tell you where the ground is soft or wet.
If your work is going well, that is probably because you bring curiosity, consistency and genuine care, which respondents valued highly. That’s so good to know! It's also an invitation to add more detail to a map that is already good.
Principle 3: When you know the terrain, you can discuss wellies or a bridge
Once you can describe a bog, you can do something with it.
Some bogs need wellies: tools, language and strategies so a client can walk through with less distress.
Some need a bridge: a change to the environment, the relationship or the system, because the terrain is the problem, not the walker.
Without the map, everything gets framed as the client's difficulty to accept.
With it, you can tell the difference between what needs accepting and what needs changing.
Our research also found that recovery strategies were overwhelmingly self-developed. Clients are drawing their own maps, alone, and most were never taught them in therapy.
A note on limits
This is a small community sample, mostly white, female, mid-life, AuDHD or ADHD and UK-based, and findings are indicative, not generalisable (Mitchell, 2026b). Ratings of therapists reflect clients' experiences, not a measure of any individual practitioner. Treat the research as a sketch of some terrain, not an end point. That is exactly why more voices are needed.
So, why explore ND Consent?
Not because you're failing. Clearly you are not! Because the clients who keep returning with wet feet are telling you something, and a more detailed map means they get to name the bog, understand it, and choose how to cross it.
Become one of the few people who understand the bog, the mysteries, the joys and the challenges of it, and your neurodivergent clients will have breakthroughs you never expected.
One thing you can put into action right now
Take a moment to reflect on this article and notice one area you would like to explore or know more about. Let me know in the comments, or check out our Growing Guides on our website for further information.
Looking forward to hearing from you!
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