As an Autistic/ADHD therapist working with neurodivergent clients, I’ve noticed that I tend to structure my intake sessions differently to make future sessions smoother for everyone involved. If you’re a therapist working with Autistic, ADHD, or other neurodivergent clients, here’s what to keep in mind.
Note: This information is meant to complement your standard disclosures, like informed consent and confidentiality.
Introduce Yourself Clearly
When meeting your client for the first time, keep it simple. A direct, concise intro works best:
“I’m Alondra. It’s nice to meet you. I’m a clinical social worker, and I specialize in therapy with neurodivergent people.”
Skip the Small Talk
Small talk can be uncomfortable or feel unnecessary for neurodivergent clients. Instead, smoothly transition into the conversation:
“I’ve reviewed your paperwork, and I understand you’re new to therapy and want to discuss…”
Building rapport doesn’t require small talk. Rapport is something you build over time through real conversations.
Explain Therapy and Its “Unspoken Rules”
One of the hardest parts for neurodivergent clients can be understanding the “unspoken” rules of therapy. Spell them out explicitly so clients know what to expect:
What is therapy? Therapy is a safe, confidential space where you talk with a trained professional to explore your thoughts, feelings, and behaviors, with the goal of improving your mental and emotional well-being. It's about working together to help you understand yourself better and find healthier ways to cope with challenges that align with your natural way of being.
Why is authenticity important? Explain that one of the best ways to use therapy is by being your authentic self. Sharing real thoughts and feelings give clients the best opportunity to get at the issues and find the best solutions and supports.
What will therapy look like? Explain how long sessions are and how long a person might continue therapy as well as how your sessions are structured considering your modalities. EMDR looks different than CBT. Explain if you suggest “homework.”
What is trauma-informed care? First, I encourage that all therapists use a TIC framework and explain it to their clients. Such as “TIC is an orientation to our work that I use which recognizes the incredible impact of trauma on our lives and attempts to avoid re-traumatization, emphasizes collaboration, choice, and trust-building. It’s also important to know that you do not need to talk about the details of trauma to heal from it. However, you are welcome to discuss whatever details you need to.”
How is the therapist-client relationship different from other relationships? What if I see you in public? What about social media?
Here is what I tell clients: Therapy is all about building a supportive and trusting relationship as a basis to help you meet your goals. It is a safe space to share your thoughts and feelings openly. We're a team working together to help you achieve your mental wellness goals. Therapy is a unique relationship. You may tell me the most personal details of your life, but if I see you at a grocery store, I can’t say hello first to preserve your privacy. When therapy ends, to protect all clients and the integrity of the profession, we aren’t able to meet socially. You can, however, have a refresher appointment if you need to. While I have a professional social media presence, I can not engage with clients in these spaces. This keeps our relationship professional and effective.
What is mandatory reporting? Make sure they know what’s reportable and what isn’t. We want them to have informed consent, and they may not have read their disclosures.
Ask them about appointment reminders: They may need more than an email two days in advance.
Highlight important policies: Do you charge full price for a missed appointment? This information is important and can help them prioritize making it to appointments.
Discuss Their Reasons for Coming to Therapy
This is often where the first session starts. It’s ok to start here and get into the “housekeeping issues later, but they should be provided in the first or second session.” Knowing what to expect can reduce anxiety. Let the client explain why they’re here and what’s on their mind. This is crucial for understanding how to approach their care.
Set Goals, Make a Plan
Work with your client to set clear goals. Make a plan and stick to it—but also leave room to adjust if needed.
Ask for Feedback—And Mean It
Encourage them to provide feedback, and let them know it’s an ongoing dialogue. This helps foster trust and open communication.
Wrapping Up
When the session’s coming to an end, say so. Summarize what you talked about and give them a supportive statement. Seeing a therapist for the first time or a new therapist, is anxiety-provoking for most neurodivergent clients:
“We’ve had a good session, and we’ve got a solid plan moving forward. I really appreciated your commitment to yourself today.”
The usual niceties are still great ways to end: schedule their next appointment and thank them for coming. Let them know you’re looking forward to seeing them again.
Is there anything you think is important to add in your first session with an Autistic, ADHD, or other neurodivergent client? Share in the comments.
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