Neurodivergent therapists are in every practice in Washington. Group practices. Community mental health. Private practice. Grad programs.
Most of us aren’t saying so.
That silence isn’t random. It’s a reasonable response to training systems that were built for one kind of brain and still treat other kinds as a risk.
I’m a neurodivergent clinician and an AAMFT Approved Supervisor. This post is about what changes when supervision stops managing neurodivergence and starts making room for it.
How many therapists are neurodivergent?
We don’t know. That’s part of the problem.
Andrews and Lund (2015) looked at how psychology tracks disabled psychologists and trainees. They found disability is often left out of diversity measurement entirely. Where it is counted, disabled people appear underrepresented. The authors suggested this may be one of the most marginalized groups in the field.
The closest detailed data comes from medicine. Shaw and colleagues (2023) surveyed 225 autistic doctors. Psychiatry was the second most common specialty. Their findings:
29% had not disclosed being autistic to anyone at work
46% had requested workplace adjustments, and only about half of those were implemented
80% had worked with a doctor they suspected was autistic, but only 22% had worked with one they knew was autistic
That last finding stops me every time. We’re there. We’re just not visible to each other.
Why do ND clinicians hide?
Because disclosure is a gamble.
Romualdez and colleagues (2021) studied autistic adults deciding whether to disclose at work. Their biggest concern was how coworkers’ attitudes might change. The researchers concluded that organizations, not autistic employees, need to take more responsibility for making disclosure safe.
In clinical training, the stakes feel higher. Supervisors write evaluations. Evaluations shape licensure. A trainee who discloses and then gets labeled “not a good fit” has a lot to lose.
So many of us mask. We perform the calm, soft-spoken, endlessly flexible therapist we were taught to be. And it costs us.
What does ableism in supervision look like?
Usually it doesn’t look like cruelty. It looks like feedback.
Here’s some I received in training:
Processing out loud got called “too much”
Being direct got read as aggressive
Unmasking in supervision got labeled “unresponsive”
Saying “I’m emotionally heightened today” led my supervisor to tell the group to be extra careful with me
None of those were clinical skill problems. None of them hurt a client. They were style differences, evaluated against a neurotypical template of what a therapist should look and sound like.
This is where antioppressive practice and neurodiversity overlap. Whoever sets the template decides who passes. The same pattern has shaped how clinicians of color, queer clinicians, and working-class clinicians get evaluated for generations.
What changes in neurodivergent affirming supervision?
You don’t need a new model. You need different questions.
Ask how your supervisee takes in feedback. Written or verbal? In the moment or after time to process?
Separate style from competence. Before giving feedback, ask: is this hurting the client, or is it unfamiliar to me?
Make disclosure optional and safe. Never require it. Never share it. If someone tells you they’re ND, that information is theirs.
Never announce accommodations publicly. Adjust quietly. My “be extra careful with Rachel” moment is exactly what not to do.
Name your own neurotype if you’re able to. Visibility from supervisors changes what feels possible for trainees.
Evaluate outcomes, not performance. Is the client getting better? That matters more than whether the therapist looks the part.
Why this matters for clients too
ND clients are better served by ND clinicians who don’t have to hide. A therapist who has been allowed to unmask can model that for clients. A therapist who masks all day has less left to give.
Affirming supervision isn’t a favor to ND clinicians. It’s part of affirming care.
Keep learning
If you supervise in Washington, my Responsive Boundaries CEU covers how traditional professional norms can fail neurodivergent and marginalized clinicians and clients. And grab the free WA CEU tracker to keep your renewal hours in one place.
References
Andrews, E. E., & Lund, E. M. (2015). Disability in psychology training: Where are we? Training and Education in Professional Psychology, 9, 210–216.
Romualdez, A. M., Heasman, B., Walker, Z., Davies, J., & Remington, A. (2021). “People might understand me better”: Diagnostic disclosure experiences of autistic individuals in the workplace. Autism in Adulthood. https://doi.org/10.1089/aut.2020.0063
Shaw, S. C. K., Fossi, A., Carravallah, L. A., Rabenstein, K., Ross, W., & Doherty, M. (2023). The experiences of autistic doctors: A cross-sectional study. Frontiers in Psychiatry, 14, 1160994. https://doi.org/10.3389/fpsyt.2023.1160994