The One Hour You Don't Have to Translate Yourself: Counselling for Neurodivergent People

Working out how much eye contact is the right amount. Rehearsing a phone call before you make it. Sitting still in a bright, noisy meeting while your body is asking you to do pretty much anything else. Smiling at the right moment, saving the overwhelm for later, then falling apart once the front door is closed.

Many of the neurodivergent people I work with describe this kind of tiredness, and it isn't the sort a good night's sleep fixes. It's the tiredness of spending most of the day translating yourself into a language other people find easier to follow. It even has a name: masking, which means suppressing natural ways of being in order to meet other people's expectations. It's common among autistic people and people with ADHD, and it can contribute to exhaustion, burnout and a quieter sense of who you actually are underneath[1].

I should say plainly that I'm not a specialist in neurodiversity, and I tell anyone who gets in touch the same thing. I've done training and I keep learning, and a good number of the people I see are autistic, have ADHD, or both. This isn't an explainer on what any of that means (there are plenty of those, and the best ones are written by neurodivergent people themselves). It's about what I've learnt from sitting with people, and why I think counselling can be the one hour where translating yourself isn't required.

Plenty of things grow in the cracks. That isn't the same as being given soil.

Why the translating usually falls on one person

There's an idea I find myself coming back to a lot, called the double empathy problem. The researcher Dr Damian Milton put it forward in 2012 [2], and it suggests that when autistic and non-autistic people misunderstand each other, the difficulty sits between them, rather than being a deficit inside the autistic person alone [3]. Put simply, it's a two-way street, and for a very long time we've mostly expected one person to do all the crossing.

The research is mainly about autistic people, so I don't want to stretch it too far. But the principle behind it, that understanding is a shared job, is one I try to carry into the room with everybody I work with. If the gap is between two ways of communicating, then it shouldn't always be the neurodivergent person who has to close it. In a counselling room, a good share of the adapting should be mine.

What person-centred means here

Person-centred counselling is built on a simple but quite radical idea: you're accepted as you are, without having to earn it by meeting anyone's conditions. I'm not trying to fix you, or steer you towards seeming less neurodivergent. You lead, and I follow.

For some people, that can feel genuinely unfamiliar. If you've spent years being told, openly or in more subtle ways, to try harder, be quieter, or be different, a room with no agenda can take a while to trust. Research on neurodivergent clients describes the person-centred approach as offering an authentic space for people with long histories of masking [4], and guidance for counsellors is clear that nobody should be pressured to unmask before they're ready [1]. So if you'd like to keep a bit of the translating going at first, that's fine. You can set it down in your own time, or not at all.

What counselling for neurodivergent people can look like in practice

Here's something that surprises people about person-centred work: it's traditionally wide open. You bring whatever you need to each session, and I don't steer. For many people that's freeing. For others, a blank page is exactly the problem, because where do you even begin when anything is allowed?

Person-centred counselling traditionally steers away from asking lots of questions or leading, but with some neurodivergent clients, more structure and more direct questions can help [5]. This is where I try to remember what person-centred really means, which is following the client. If you tell me you'd find it easier with a bit of shape, then offering shape is following you, not departing from the approach.

So early on we talk about it. Would you like sessions to be open, or with more structure? Sometimes I'll lead a little more, asking more questions, or offering a short summary of things you've mentioned (from our introductory call or earlier sessions) with a few options for where we might go that session. It can change from week to week depending on how you're feeling, and that's allowed too.

The room itself matters as well. I don't want to overstate this, as I'm not reinventing the space for every preference, but small things add up. I've taken the batteries out of a clock before because its low tick was hard for someone to bear. So many everyday places are jarring, bright, loud or busy, and the hour in here shouldn't add to that.

Some people also think better with their hands busy. Fidget toys, drawing materials and Play-Doh are there if you'd like them, and for plenty of people, giving one part of the brain something to do leaves the rest free to reach thoughts and feelings. Nobody has to use any of it, and some people never touch it. Walk & talk sessions come at it from another angle: moving while we talk, side by side, with no sustained eye contact to manage (which some people find hard and others find perfectly fine). You can also choose between meeting in person, online, or out walking.

None of this is clever technique. It's all the same idea, that understanding is a two-way street, and that in this room (or even out of it) I should be doing a good share of the adapting.

What I'm not, and what I am

I'm not an expert in your brain. You are. My job isn't to teach you to seem less neurodivergent. It's to understand how things are for you, as they are, and to help you make sense of whatever feels worth making sense of, whether that's burnout, a late diagnosis, relationships, work, or simply wanting an hour where nobody needs you to explain yourself.

If you're neurodivergent and wondering whether counselling could feel different from the other places you've tried to be understood, you're very welcome to get in touch. It's completely fine to tell me what you need before we even begin.

References

1. NCPS. Neuro-affirming practice: what counsellors and psychotherapists need to know when working with autistic clients and those with attention differences. https://ncps.com/our-voice/neuro-affirming-practice-what-counsellors-and-psychotherapists-need-to-know-when-working-with-autistic-clients-and-those-with-attention-differences

2. Milton, D. E. M. (2012). On the ontological status of autism: the "double empathy problem". Disability & Society, 27(6), 883–887.

3. Brosnan, M; Camilleri, LJ. (2025). Neuro-affirmative support for autism, the Double Empathy Problem and monotropism. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC11966444/

4. Jones, F; Hamilton, J; Kargas, N. (2024). Accessibility and affirmation in counselling: An exploration into neurodivergent clients' experiences. Wiley Online Library. https://onlinelibrary.wiley.com/doi/full/10.1002/capr.12742

5. Counselling Tutor. Understanding the Double Empathy Problem in Neurodivergent Therapy. https://counsellingtutor.com/neurodivergence/the-double-empathy-problem/