Episode 6: Challenging Stigma Around Autistic Therapists

Show Notes:

There can be a lot of stigma around autism and especially being an autistic therapist, which can make it even harder for autistic individuals to step into this career.

They may even be told that they can't be empathetic or relate to others in a way that could help their clients, which is just NOT TRUE.

If you are autistic and have been hesitating to step into the mental health field because of the stigma around autism, then this episode is for you.

Top 3 reasons to listen to the entire episode:

1. Understand how being autistic can make you a better therapist for other neurodivergent clients, often more so than an allistic (not of the autism spectrum) therapist.
2. Identify ways to combat the notion that autistic people can't make good therapists, as well as how to navigate grad school when you are receiving a negative perspective on autism from professors or supervisors. 
3. Learn how to structure a private practice to support your needs and create a stable work environment for more longevity in your career as a therapist.

When Dr. Megan Neff was asked why they became a therapist, the answer was "because I'm autistic." This episode can help you explore in what ways autism can help you succeed as a therapist, as well as in what ways you might struggle and how to face those times.

Check out the resources on Megan's website to learn how you can find a Neurodivergent Affirming Therapist: https://neurodivergentinsights.com/resources 

🎙️Listen to more episodes of the Divergent Conversations Podcast here
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Transcript

PATRICK CASALE: Hey everyone, you're listening to another episode of Divergent Conversations Podcast. I'm your cohost, Patrick Casale.

MEGAN NEFF: And I'm Dr. Neff.

PATRICK CASALE: And today we are going to talk about our journey into becoming therapists and maybe what we would be doing if we weren't masking and if we weren't therapists. So, Megan, you wanted to start this topic up, so take it away.

MEGAN NEFF: Yeah, yeah, I guess I've got kind of two prongs that have informed my interest in this topic. One, I get this in my DMs and my emails a lot from either students who are going through programs, autistic, ADHD students going through programs, who are interacting with the ableism in the system and just being like, "How did you do this? How do you become a therapist? Do I come out as an autistic therapist?"

So, one, just I get a lot of questions around this. And then, the second reason… oh, or people who aren't necessarily in training, but they're thinking about going into training, but they're terrified about the process of becoming an autistic therapist. 

The second reason is I… So, I did something kind of impulsive, but like, also, I've been thinking about it for a few years. But I don't know if you're like this where you're thinking about something and then you just are like, "Yes." And then you're all in. So, I did that where I applied for a psychoanalytic relational institute that would start next year. And whenever you're applying for things like programs or internships, the classic question is, why did you become a therapist? And I typically start with some, like, beautiful Martin Buber quote. Martin Buber is a Jewish philosopher who is definitely a special interest of mine, who talks a lot about, like, authentic human encounter. 

But what I found myself saying instead of some Martin Buber quote, for the first time, I said, "I became a therapist, because I'm autistic." And so much of the messaging is we become therapists despite our autism versus, like, because of our autism. So, that just started a train of thought. This last week, I was really curious about around the intersection of how autism informed me becoming a therapist, how it influences, and then for other people as well, who might be interested in entering this profession. That was a very long-winded way of answering your question, Patrick?

PATRICK CASALE: I think it's a perfectly Megan Anna way of answering my questions.

MEGAN NEFF: It is a very autistic Megan Anna way of answering your question. I like barely remember what your question was at this point. But I think it was something about why the heck are we talking about this today?

PATRICK CASALE: And so, you're talking about the DMs you're getting from people who are experiencing ableism in their program, how the hell did you get to this? When do I start? Like, how do I come out and openly disclose? Right? That's a piece, but you mentioned like, did I become a therapist, because I'm autistic? Instead of despite of-

MEGAN NEFF: Yeah.

PATRICK CASALE: Can you kind of go a little deeper on that. Like, elaborate more on what you mean by that? 

MEGAN NEFF: Yeah.

PATRICK CASALE: Because I'm curious for the audience, like, yeah, so if you're coming to terms of I became a therapist, because I'm autistic, because… I don't know what that means for you?

MEGAN NEFF: Yeah. Gosh, like, there's so many ways that inform that. I think one of the first things that comes to my mind is the hot potato phenomena. So, I'm curious if you relate to this, but ever since I was little, like, I've struggled with social-based questions, which is very common for autistic people. So, even now, like, my sister who I'm fairly close with, when we interact, she will often start with how are you? And now uncomfortable just be like, "I don't know how to answer that, Sarah."

But when I was younger, whenever someone would ask me a question about my personhood, I'd have kind of that mini-freeze response. So, it felt like I was holding the hot potato in the conversation. And it was like, "Okay, how do I get them holding the hot potato." And I became very strategic with getting the other person talking. 

And here's the thing, people like to talk about themselves. And so, I learned that pretty young. And so, I got really skilled as an adaptation to my social struggles at drawing the other person out. 

And this is what's so interesting, right? If you look closely at my dialogues throughout life, I do struggle with reciprocal communication, but it wasn't obvious, because what I was doing was, I was not the reciprocal person in many of my conversations. I was drawing the other person out, getting them talking. So, people won't leave a conversation being like, "That was weird." They'd usually leave a conversation being like, "Oh, I felt seen, and understood, and that person's really curious about me." And that was a really sophisticated adaptation to my social struggles. So, that's one reason. I'm curious, first, like hot potato phenomena, do you relate to that at all?

PATRICK CASALE: Oh, yeah, absolutely. I think that it's such a great way to turn the conversation around and take the pressure and the focus off of you. I'm just like, oh, I'm uncomfortable, but I know how to make this person comfortable and I can be that mirror for them, I can be that place to reflect, and be really curious, and be really interested. 

And learning that at such a young age is so fascinating when we start thinking back about our childhood experience and how we kind of navigated the world and made it, "safe" for ourselves. And I think that that, obviously, does allow for that person to feel taken care of, it allows them to feel heard, and validated, and seen coming away from the conversation probably like, "Megan is the best friend in the world. They listen so well. Like, they make me feel so much better."

And I think that also, maybe at such a young age does something to our own sense of self when someone's like-

MEGAN NEFF: Oh, my gosh, 

PATRICK CASALE: "Oh, You're really good at this. Like, you are a really good listener, caretaker." Whatever the qualifier is [CROSSTALK 00:06:27].

MEGAN NEFF: And that becomes their sense of self-worth and value, absolutely.

PATRICK CASALE: Exactly, yeah.

MEGAN NEFF: Yeah. Because it's our social currency. And I knew that, like, this is how I develop social currency. And it also, like, yes, it was more comfortable for the other person, but it's also more comfortable for me. Like, those conversations also did feel good to me, because it felt like, for one, I genuinely am curious about people, so that probably helps. But also, it just felt good to be that presence.

I noticed that I was really interested in my doctoral program. What I noticed was I struggled to get close to people in my cohort. And what I did is I took on a role of mentor. Like, I TA'd all the classes and when I looked at my week, I was like, all of my social interactions are mentorships. And so, becoming a mentor is how I figured out a way to socially connect in a way that worked, because of the hot potato. Like, that's your role when you're a mentor, is to create space for the other.

PATRICK CASALE: Yeah, absolutely. And it's fulfilling a lot of different needs by taking on that mentorship role or the helper role. And it's, also, I think, you know, thinking about my own journey into becoming a helper and a therapist is just the fact that it takes so much of the pressure, again, like you're saying, off of ourselves to have to be the center of attention. And I think if you're used to that, and that's been kind of your experience throughout life, it is a really great profession, because, you know, I'm not in there to talk about myself. I do disclose, I think that's necessary for connecting with any sort of neurodivergent client of mine, but like, I also just know and acknowledge that these 60 minutes doesn't have to be about me. And that takes all the pressure off of like, how am I supposed to show up, and act, and engage, and interact?

MEGAN NEFF: Yeah, and it provides such a tight frame, like, these 60 minutes. So, I think we briefly mentioned we're both avoidant attached, like our structure, but I love intense authentic connection, which I also think is an artistic thing, which I think is one reason I became a therapist is my craving for the authentic. 

But I really struggle with maintenance of friendships. Like, I don't have friends, Patrick. Like, you are probably the closest thing to a friend in my life right now. And it's because we have a frame around work that we interact. Like, I don't really do friendship, partly because of the maintenance. 

And for longtime friends, when I have had them, they've felt like a thing to maintain. I realize that sounds terrible. But I think it has to do with how limited my social resources are, the fact that when I do have friends I struggle to bring myself versus kind of foster conversation. So, there's a lot of things that go into that. 

But what I love about therapy is it's a tight frame, I am present to that person for 60 minutes, and I'm very present, and that's the frame. There's not an expectation. I mean, obviously, there's charting and if there's like email correspondence that needs to happen, but there's no expectations outside of that frame around how you're going to maintain this relationship, whereas, in other relationships, it's like, "Well, you haven't texted me for six weeks or you haven't…" Like, there's all that maintenance that goes into it that's really, really hard for me.

PATRICK CASALE: Yeah, yeah, that's such a good point. And I just want to circle back. I feel honored to be…

MEGAN NEFF: My only friend. 

PATRICK CASALE: Yeah, your only friend right now.

MEGAN NEFF: Do you have friends?

PATRICK CASALE: I do. Yeah. I mean, I find it challenging. Like, it's a weird… I'm trying to put cohesive thoughts together right now. 

MEGAN NEFF: It's hard.

PATRICK CASALE: It is hard. I think that my experience is that people often are more attracted to me socially or in terms of friendship than I am to them, and-

MEGAN NEFF: Yeah, yeah, I get that.

PATRICK CASALE: I have a lot of people who consider me to be, like, one of their closer friends, when in reality, like, I don't really know that much about them nor do they know much about me. So, that's always a strange dynamic. But I mean, I've always been a part of soccer teams and just, I think, that having that type of like, cohesive camaraderie has been really helpful for me, because you don't really have to show up to a team sport with the intention of making friendships or developing relationships. It's like, you're there for a common goal, right? Like, our goal-

MEGAN NEFF: It's kind of all play, yeah.

PATRICK CASALE: Exactly. And you're there to just perform as a unit. And like-

MEGAN NEFF: Sounds so nice, yeah.

PATRICK CASALE: …that's my solace. Like, I'm not a religious human being, but when I get to the soccer field is like my teammates, still, to this day will make fun of me, because I show up, like, an hour early, and they'll show up like 12 minutes before kickoff, and I'm like, "How are you fucking doing this? Like, I need to stretch? But I just find that that is the one place in my life where I have, like, just complete relief, where you and I have talked about that constant buzz, and that discomfort, and that anxiety, and that everything that is our experience, but like that is the place where that is gone, it's just vacancy, it's just like, complete silence. And I think that, for me, is the most peaceful place on Earth. I've realized diverging way over here now. 

But yeah, so I do have some friends. I would say that even if I have people who I like a lot, and I spend time with, and I consistently communicate with, I still feel disconnected from them. I don't feel like we're, like, always attuned or in sync, because I think I also keep myself at a distance. And if we socialize, it's got to be at my house, it's got to be at the places I'd be comfortable going. And I imagine that's challenging for some of them who are like, "I don't want to fucking go to this place, like, for the 100th time. Like, I don't want to come to your house. How come you never come to my house?" But that is the nature of a lot of my relationships, for sure.

MEGAN NEFF: Yeah, yeah. Well, I mean [CROSSTALK 00:13:12] we're on a rabbit trail, but maybe not. I also wonder… So, one of the things I learned early in the, like, autism research discovery phase was how autistic people do better in kind of structured social interactions where they have a frame. So, like, it could be as simple as if you're at a party, you become the person that washes the dishes. Like, you have a role and that's so helpful. And I so resonate with that.

But I wonder if part of becoming a therapist is it gives a role to the really deep way of interacting with other humans. And so, it is a more tolerable way of socially connecting, and a way of connecting really deeply, and really meaningfully. So, I wonder if the struggle around social connection and the desire for social connection is one of the reasons that we became therapists or the other autistic people might become therapists.

PATRICK CASALE: Yeah, I think that's spot on. I also want to give you credit for looping me back in. You know, it's usually the other way around, so…

MEGAN NEFF: Are you more in your ADHD brain today?

PATRICK CASALE: Majorly. I've got Ireland coming up next week. My brain is so scattered. But I think you're right. I think it's that deep desire to have connection. And having that regimented, structured, almost like this is what to expect in this environment, this is what's allowable, this is what's not, this is what we talk about, this is what we don't, then we have these clear boundaries for the most part of like, okay, after that 60 minutes, not that you don't think about your feelings after that 60 minutes, but like you don't have the pressure and responsibility is no longer on you. And I do think that it allows you to have that human connection, that empathy that so many people misconstrue and misunderstand like, the mythology of like, "Autistic people can't be empathetic, and they can't like connect with other people." And that's fucking bullshit. But [CROSSTALK 00:15:16].

MEGAN NEFF: Right, right so many of us are hyper empathetic, yeah.

PATRICK CASALE: Right, like, it has to be deep. You mentioned depth connection and I think therapy allows you to have consistent depth connection. 

MEGAN NEFF: Like, it's so… the word oxygen is coming to my mind. It's oxygenating to have deep human connections. The small talk is not oxygenating for us. I saw a study once, so like small talk releases dopamine for non-autistic people's brain. I was like, "Wow, that must be nice, no wonder they do this nonsensical thing."

But one thing I told my therapist awhile back was, and forgive me if I've said this on this podcast before, but I was like, "I feel like I don't have social ligaments." Like, so ligaments what make our body move. But I'm really good when we get into the muscle. So, like, once I'm in a deep conversation I'm good. But like the transition, the small talk, getting into that conversation, getting out of it. And therapy, it's mostly all muscle, especially, now that I work primarily with autistic clients, we just jump right in. Like, I love it. My clients, we don't do the, like, small talk five minutes. 

When I was working with non-autistic clients there would still be like, typically, a five-minute small talk before you get into the session. And with autistic clients is more like they're just like, "Okay, this is what's on my mind. Let's go." So, I love that it's okay I don't have social ligaments as a therapist.

PATRICK CASALE: Yeah, I think that takes a lot of that unnecessary energy, emotional labor, and energy for us out of the equation, you know? And I've been trying to be mindful, not just for our sake in the dynamic, but like my own sake of like, when we get into the Zoom Room not being like, "Megan, how are you doing?" And then you're looking at me and be like, "Stop fucking asking me that."

MEGAN NEFF: I literally was just thinking about how I was like, "Patrick, can we just hit record when we get into the Zoom Room?" I wonder if that was my way of saying like, can we just get to the muscle and not try and do the social ligament thing because I don't like that.

PATRICK CASALE: I think that's it. And it helps me too, because I don't like it either. And I think that it's just allowing for that state where you feel the most at home, or natural, or at peace in terms of however we can do those things. And I just think that as a therapist, you know, having that empathetic reflection process going deep, being curious, asking questions, like, it's really a lovely experience, and one that we don't often have in our day-to-day. 

And it makes me think of clients who I had starting off like in private practice where I didn't know I was autistic. I also didn't know who I was, as a therapist. I was just, like, trying to figure out how to be in private practice. And the artificiality, the small talk, the clients who weren't ready to go deeper, the clients who weren't a great fit or who probably, you know, it just felt like pulling teeth a lot of the time, and I just noticed how irritated I would get, and how, like, bored I would get too where I was just like, "Okay, do we really talk about this thing over and over and over again?"

MEGAN NEFF: Yeah, yeah, yeah,

PATRICK CASALE: You know, I want to think about one thing too. Like, we are so good at absorbing other people's energy and picking up on how people are experiencing the world, especially, people who are struggling. Like, we have that fucking radar where we're like, "I can tell this person's really having a hard time." And you and I talked about this last week, where we were talking about, like, talking to just folks who maybe were homeless, and people who are struggling, people who were just like, really obviously, having a hard time to us, and just really picking up on that and wanting to be curious, wanting to talk, wanting to support. 

And I think that helps with being a good therapist, because that intuition, that ability to read body language so quickly, because we've gotten so accustomed to having to do that, and facial expressions, and eye movement, everything that goes into tracking, because we're tracking all the time anyway.

MEGAN NEFF: So, okay, here's a provocative question. We're talking about the traumatized parts of being autistic, right? The adaptations we made to socially blend in, the hyper vigilance we have needed to have around other people to decode their body language, and how that has made us therapists. So, essentially, I think we're saying we became therapists out of our trauma. So, what do we do with that when we're both therapists? 

Well, actually, let's pretend you're still seeing clients. We're both in this profession. And we now are looking back being like, "Oh, my trauma brought me here." Like, does that take the meaning away for you? Like, how does that shape how you think about this profession if our trauma's what brought us here? 

And I think that's too reductionistic of a narrative. I realize it's also our empathy. But it's a both and, it's a mixed narrative. But it does seem like our artistic trauma around masking is a big piece for both of us that brought us to this profession. So, does that shape how you experience it for you?

PATRICK CASALE: That's such a good question. I think that my conceptualization of being a therapist, because you know, for those of you who don't know, I also am a therapist in private practice and entrepreneur coach. So, like, a lot of my time is spent with therapists now not clients in therapy, but therapists who are working on the emotional and psychological side of business ownership. And this is just my take on therapists in general, not just autistic therapists, that so many therapists have become therapists because of their trauma histories, because of their healing journey.

MEGAN NEFF: That's true. 

PATRICK CASALE: But here's the thing that I think happens, a lot of therapists get into this work to heal their trauma through the work that they do.

MEGAN NEFF: Yep, which is fine if you have awareness that that's what's happening. It's really dangerous if that's happening and you're unaware. That's where therapists can do a lot of harm, I think.

PATRICK CASALE: Absolutely, 100%. Like, everyone who's a therapist has their own story, has their own struggles. We're humans. I mean, we've all experienced it. It probably was a catalyst and a positive factor in terms of what do I want to be when I grow up which I [INDISCERNIBLE 00:22:16], but anyway, but I still don't know at 36 what the fuck do I want to be when I grow up. But I do think, like, without that awareness, yes, very damaging. 

But everyone has gotten into this field for a reason. But the difference, I think, is what I see with autistic therapists, is that you're not necessarily trying to heal yourself through the work that you're doing, you were brought to the work because of the masking trauma, and trauma that you've endured throughout life. But that's your only way of acknowledging how to be. So, I don't know if that necessarily changes, because you're helping other people understand this and process their own emotions and feelings. 

Like, I just think that when I'm in the therapy room, this is the only way I know how to be and the therapy room is the only place that I'm actually allowed to do this in a way where it's actually professionally helpful in that lens, because that's the only way I know how to show up. But you have to mask so often in so many other arenas. You don't always get to show up like this. And as a therapist, especially, like yourself, Megan, like working specifically with autistic clients, I imagine that feels so fucking freeing for you [CROSSTALK 00:23:36].

MEGAN NEFF: Yeah, it's amazing, yeah.

PATRICK CASALE: Yeah, like, you already know going into these relationships, "I get to just show up and be real." And I think that feels really liberating. And a lot of people don't get to experience that.

MEGAN NEFF: Yeah, yeah, it does feel really different and it's been a while, but you know, even last year, I had some people I was working with who weren't neurodivergent and I don't do that anymore and it's for a reason. It's because it does feel a lot more like masking. Yeah, it feels so freeing. It's the biggest kind of privilege and gift to come out of the last few years, is the ability to pivot to work with autistic clients. And I really feel for therapists who A aren't out, and B aren't able to curate their client load in that way, because it's really hard.

PATRICK CASALE: Yeah, it is. I mean, and it's really hard. And that's where the misfiring happens, you know, that's when you start to doubt your ability as a therapist too, because the outcomes aren't there, the relationships aren't being established and, you know, that goes further than autistic therapists in general. I mean, that's just rapport 101, but I do think for us it's an even deeper, more important, even, like, absolutely necessary component of the work that we do. 

MEGAN NEFF: Yeah, yeah. And it's so interesting, if you saw me work as a therapist a couple of years to how I am now it's just so different. Like, before I would rarely self-disclose. Like, if someone's, you know, "Do you have children?" I'd maybe say yes, but then I'd like think through the pros and cons of self-disclosing that and maybe ask them like, why they needed to know that? You know, all that, like, turn-around of like, "Well, what would that mean to you if I had children?" 

I self-disclose so much now and I still am very reflective of why am I self-disclosing? Who is this for? Like, I've got my kind of filter I run through. But I think it was actually on a podcast you did with Joel Schwartz where you talked about how like, autistic people need, like, we need autistic mentors in the sense of we need, like, we don't have stories. And so, sharing from our lived experience in the context of therapy can be really appropriate. 

And I come from a more like psychodynamic lens where self-disclosure is very restrictive. So, that's been a really interesting shift in my therapy to think about self-disclosure so differently. But yeah, I'm just so different in the therapy room as a therapist than I was two years ago.

PATRICK CASALE: You know, that's interesting to see the transition and evolution. And I'm thinking about my own journey too. Like, I haven't seen therapy clients in about six months now. But the ones that I was seeing before my throat surgery were all neurodivergent clients. And most of them were coming to terms of being autistic. And I just realized that you start to really attract the right clients when you're able to unmask and disclose yourself, like, as a professional. It really does empower the client to say like, "Fuck, finally, a therapist who's going to get it." Instead of like having to guess if you're going to understand or be affirmative.

And I think we have an idea to do an episode about seeking out neurodivergent affirmative or neurodiversity affirmative therapy. And you know, you're playing this guessing game, a lot of the time, if someone doesn't come out and say, "This is who I specialize in working with and why?" And, you know, I do think that that disclosure piece is so crucial.

And, you know, processing special interests in therapy is unbelievably therapeutic. But then, if you get caught up in the like, "How do I present this to the insurance company? And how do I talk about talk about the fact that you like talked about Lord of the Rings for 16 minutes?" But it's so unbelievably validating for you to be able to support someone who's autistic by diving deep into their special interests.

MEGAN NEFF: I think you call that we engaged in coregulation and self-soothing. But that is what makes it, like, therapy, right? It's at the end of the hour then it's like, where were you during this hour? What was that like for you, for us to connect in this way? And that's that reflection, then at the end of talking about special interests you're connecting in ways that might not typically be thought of as therapeutic. That's, I think, what then makes it therapeutic is, then it's like, oh, yeah, I do feel connected to you. And it's because we're having an object-based conversation, not a social-based conversation or we're connecting around interests not this. 

I had a thought and then it I think it's gone. But I am a little curious, because the other part unless I'm, like, cutting off thoughts that you have around this, but the other part of the conversation was around people who are maybe in training programs or thinking about going through training programs. Like, I've heard some pretty horrendous stuff from people, like, things such as my professor said that you can't be autistic and a therapist. Like, this is the kind of things they're hearing in classes and from their professors, I mean, not even to talk about just the executive functioning and sensory overload of making it through a program but to be hearing from your professor's things such as autistic people can't be therapists.

Like, do you have any words of encouragement, or like what would you say to people who are thinking about entering this profession? Who are in training? I'm giving you the hot potato by saying what are your words of encouragement for this really?

PATRICK CASALE: Well, you know, I think what immediately comes up is kind of like rage, so then I have to center myself to think about how I want to respond appropriately. One, if you're listening to this, and you're in a program, and that's your experience, I think that we both just want to send you our deepest sincerest apologies, because not only can you be a therapist as an autistic person, you can be a fucking wonderful therapist as an autistic person. Your abilities to show up authentically set you apart from those who cannot. And I know so many therapists who went through a program and don't even get me started on the assembly line process of grad school at this point in time, but just have never done their own deep, reflective, oriented work. 

And I believe wholeheartedly that that sets us apart, because if you're willing to go deep and you're willing to have the hard conversations, you're going to be able to hold that space for your clients, you're going to be able to show up the way that they need you to show up when the conversation takes a turn from your connections and associations with the Lord of the Rings to like, "Hey, I'm actively suicidal and struggling with A, B, and C." You can't show up for your clients if you cannot be in that space. Like, if you can't go deep, if you can't sit with that discomfort, if you can't mirror back and forth, if you can't really pick up on what's happening behind the scenes for your clients. Like, these are so important. And we're all so gifted at doing these things. 

We're going to hear this, right? Like, from professors, from agency, community mental health providers, and supervisors like, "You can't have these accommodations, you can't stim in class, you can't move, you can't fidget, you're disruptive." The same shit that we've heard all of our lives, or some professors pushing ABA therapy, or whatever the case may be. But in reality, like, there's such a big movement right now and Megan, I'm proud to say that you're one of the people leading that charge in terms of like, showing up and helping destigmatize, and work on de-pathologizing what it's like to be an autistic human being,

MEGAN NEFF: Yeah, yeah, yeah. Well, thanks for like, taking the hot potato and you have a way with words that I don't. Like, you should be in charge of the encouragement pieces on the podcast. I'm not able to encourage in the same way that you are, which is probably why I'm an analytic therapist, and not like a… no, but thank you. That was moving to hear you say those words.

PATRICK CASALE: Thanks. And, you know, I think we could have a whole episode on this, maybe that informs next week's conversation, but not only how to seek support as a grad school student or a new therapist in the profession, how to find your own ND affirmative therapy. Like, we've got to be talking about this more.

MEGAN NEFF: Yeah, absolutely. I just put up a handful of directories on my website, which we can link to. And thankfully, like, the directories that are out there are, I mean, they're small, but they're growing every week, to where I think it's becoming more of a feasible option even a year ago, because that is the number one DM I get is like help me find a therapist. And in the last year, I've seen a lot of growth, and I think it will continue to. 

So, yeah, there are some neurodivergent affirming directories or even just knowing, yeah, like what to search for or what to ask, we should definitely do a podcast on that. That'd be really helpful.

PATRICK CASALE: This will help me next week when I message you and I'm like, "What do you want to talk about today?" But now we-

MEGAN NEFF: Yeah, let's talk about how to find a neurodivergent affirming therapist and like, yeah, like what questions you should ask. One of the things that's hard is, it's so hard to find any therapist right now without a waitlist, that like the interview process of interviewing your therapist to become your therapist isn't really happening in the same way, because just getting in with any therapist, for most people is kind of the goal if you're in crisis. If you are wanting to do the deeper reflective work and can wait on a waitlist for six months, then you've got more options.

PATRICK CASALE: Yeah, and we can talk about that next week too. I have a group practice, I have 15 therapists who work at that practice. It's so hard to turn clients away when you know that they can't find that support anywhere else.

MEGAN NEFF: Yeah, when you can't refer them. Yeah, that's so hard.

PATRICK CASALE: It's so hard. And it's so much more than just saying like, we have ND lived experience, right? Autistic group practice owner, autistic clinicians, ADHD clinicians, you got to do the work, too. I mean, it's not as simple as just like saying, I'm an anti-oppressive Black Lives Matter anti-racist therapist, you got to do the fucking work.

MEGAN NEFF: Yeah, these are easy words to say now, but it's like, okay, the language is right. But does it match? Is the person doing the work? I love that, yeah.

PATRICK CASALE: Are the values consistent? And it does mean hiring consultants and trainers to come in with lived experience who are experts in the field to help you continue to grow. Again, I'm diverging. 

I want to talk quickly. You know, I'm just being aware of time too, the double empathy bind to you, too. 

MEGAN NEFF: Oh, yeah. 

PATRICK CASALE: I want to talk about that because what happens, right? Is we mentioned this, alluded to this earlier, and a lot of you who are listening who may become therapists in grad school programs or therapist's, whatever the case may be may have been told by society that autistic people cannot be empathetic, cannot hold space, cannot be attuned. Megan, your thoughts? 

MEGAN NEFF: Oh, yeah, I love the double empathy [CROSSTALK 00:36:20]. Yeah, I love Milton's work. And so, did you know that they, like, did an empirical study to follow up with this theory? Okay, so can I dunk for like five minutes? 

PATRICK CASALE: Sure.

MEGAN NEFF: So, yeah, the theory comes from Damian Milton. I think I've got that name, right. I'll correct it in the notes if not, but believe he's a sociologist in the UK who is autistic. And it's this idea that… And by empathy… So, there's different kinds of empathy and what he's really talking, I think, primarily about cognitive empathy and perspective taking and this whole like theory of mind idea of, yes, autistic people struggle to understand neurotypical people's theory of mind, but also the neurotypical or allistic person struggles to understand the autistic theory of mind. But autistic people understand autistic people. So, it's a cross-neuro-type interaction. It's not that there is a deficit in the autistic person's theory of mind or ability to consider the subjectivity of another person. 

So, there's a follow-up study done by another group of researchers who were like, "Let's test this theory." So, what they did is they had groups of dyads. So, they had three different groups. They had autistic to autistic parents, non–autistic–non–autistic, and then autistic-non-autistic parents. And they had them either do some sort of activity or have a conversation that was structured and then, after the interaction, they each rated the report. And report was just like how easy was it to connect with the other person. 

Now, if we're going with the deficit model of autism, you would think that the autistic to autistic partners would struggle the most, because you'd have two people with social communication deficits trying to interact, right? And so, if that's true, then that would be the worst. And then, the autistic-non-autistic parent, the non-autistic person could like, hold up, you know, the non-autistic person by all of their social awesomeness. But if the double empathy problem was right then you wouldn't see that. 

And that's exactly what they found. The report was the highest among non-autistic-non-autistic, second highest among autistic-autistic, and lowest among autistic-non-autistic, so cross neuro-type. 

They did a follow-up study where people were watching videos and reported them. And the autistic - autistic parents were actually the highest report of observers, which was really interesting. 

So, what this research essentially shows is that it is a cross-neuro type interaction that makes it harder to build rapport, harder to understand what the other person's thinking, not an autistic, like innate deficit that is baked into us. It is a dynamic that happens between two people.

PATRICK CASALE: I love the way you laid that out. And that just speaks volumes to how ableism has misconstrued how we kind of perceive autistic people to be able to interact, too. And I think that, you know, we can say that it's… you can all think about your friend groups and your social relationships or anyone that you feel connected to. And I would encourage you to think about that, like, neuro-type interaction, and communication. How easy does it feel to fall into communication and conversation, and socializing? How easy does it feel to be able to build connection and rapport? 

And as therapists, this is a crucial component of our work. Building rapport is the foundation. I think if you don't have it, it doesn't matter how good of a therapist you are, the client's not going to have a great therapeutic experience, and vice versa. And it just speaks volumes to the ability to do so and to really come alongside and easily kind of drop into relationships. So, I do think that's a really important thing to remember. And Megan, again, loved the way you laid that out very, very clearly, too.

MEGAN NEFF: Yeah, I love that study, because I think it gives us empirical grounding to start talking and training therapists of thinking through cross-neuro type interactions through a cross-cultural lens that that is how therapists should be approaching. So much of the training is just kind of gross to hear how you should engage your autistic clients. Like, it is so much more enlivening and expansive to talk about it. Like, this is a cross-neuro type interaction, a cross-cultural interaction that's happening, leading with intellectual humility and curiosity as we would in any cross-cultural therapeutic dyad.

PATRICK CASALE: Yeah, absolutely. I actually interviewed an autistic therapist on my other podcast yesterday and she was just talking about the frustration around grad school programs really not getting this right. And honestly, hardly ever fucking talking about it. So, we need to have more courses popping up in grad school programs on how to work with neurodivergent clients and not just simply a glimpse of like, oh, yeah, these are some disorders in the DSM.

MEGAN NEFF: Well, and when it is talked about it's typically talked about in children. And here's the thing is, like, we're in therapy, right? We know that so many of us have PTSD, substance abuse problems, anxiety disorders, depression. Like, the list goes on and on, we're in therapy. I think programs don't realize that, they don't realize that we're in therapy, we're diagnosed with other things often, and we're being treated for other things, but we're there. And programs will really need to be thinking about this in the next, well, yesterday, but in the next 5, 10 years, I really hope that they start seriously considering how do we work with neurodivergent adults.

PATRICK CASALE: Yeah, absolutely. I mean, you know, those neurodivergent kiddos become neurodivergent adults. It's not like, you know, autistic kiddo, then all of a sudden no more autism. I like to think about it as like the ADHD or autism is the foundation of the house and the PTSD, the substance use, the depression is the furniture.

MEGAN NEFF: Oh, I like that metaphor. That's helpful.

PATRICK CASALE: And I think it all starts to come together when you start to realize like, if this is baseline, right, and then you're experiencing these symptoms of mental health because of neurodevelopmental condition.

MEGAN NEFF: Well, yeah, so then if you're treating the PTSD, so you're getting new furniture, but like the foundation of the house is cracking and breaking, because you're not addressing like sensory needs and all these other things. It doesn't matter how much, like remodeling you do of the furniture if you're not addressing the foundation and the vulnerabilities there.

PATRICK CASALE: Yep. Well, I am going to segue us out of this, because my instinct's [INDISCERNIBLE 00:43:45] like, "So, now let's do this thing." But I'm just being aware of time. And I think that this is a wonderful conversation, one that we could have guests on and talk about their own experiences as autistic therapists and grad school participants, what we would like to have seen differently in school, what we want to see for the future generation. And I think that, you know, if we can continue to all advocate together, then hopefully, we can make some fucking change. 

And, again, to those of you who have experienced what Megan brought up, I'm sorry, and I hope that you can find solace in the fact that there are a lot of autistic therapists out there doing this type of work, openly discussing their livelihoods, and sharing their experiences, because I think it's helpful to validate and to help, hopefully, "normalize" the human condition and experience that we're all having together. 

So, I just want to say thanks for this conversation, Megan, and I'm looking forward to talking about how to find ND affirmative care next week.

MEGAN NEFF: Yeah, thank you. And that sounds good. And I'm awkward with goodbyes.

PATRICK CASALE: I'll take over. So, everyone thanks for listening to the Divergent Conversations Podcast on all major platforms, weekly episodes out. Like, download, subscribe, and share. We'll see you next week, thanks.