Episode 64: Ask The Audience (#2): Language for Autism, and Neurodivergent Therapists
Jul 25, 2024
Show Notes
It’s natural to have many questions following neurodivergent discovery, diagnosis, or while embracing a new identity. Additionally, there are individuals who might not identify as neurodivergent but are curious about the very nuanced conversations happening in and around the neurodivergent community.
In this second Ask The Audience episode, Patrick Casale and Dr. Megan Anna Neff, two AuDHD mental health professionals, respond to questions they have received from podcast listeners and their communities.
Top 3 reasons to listen to the entire episode:
- Dive into the controversial topic of whether "everyone is a little bit autistic" and understand why this statement can be harmful and dismissive to the autistic community.
- Gain insight into the nuances of language used to describe neurodivergence, including the pros and cons of terms like ASD, high functioning, and on the spectrum, and why identity-first language can be empowering.
- Explore the unique challenges and potential advantages of being an Autistic or ADHD therapist, and learn practical tips for preventing burnout and finding success in the field.
As you navigate your own neurodivergent journey, remember that you are not alone, and your inquiries are invaluable, not just to you, but to countless others facing similar challenges. We will continue to have episodes like this in the future, so we appreciate your questions to help guide these future episodes.
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Transcript
PATRICK CASALE: Hey, everyone. You are listening to the Divergent Conversations podcast. We are two neurodivergent mental health professionals in a neurotypical world. I'm Patrick Casale.
MEGAN NEFF: And I'm Dr. Neff.
PATRICK CASALE: And during these episodes, we do talk about sensitive subjects, mental health, and there are some conversations that can certainly feel a bit overwhelming. So, we do just want to use that disclosure and disclaimer before jumping in. And thanks for listening.
This brings us to episode two of Ask The Audience. Thanks again for submitting your questions. We are always excited for these. We love the support. We love being able to answer them whenever we can. We're going to try to do this once a month. So, stay tuned for more of those. And now we're going to jump into more questions.
Let's see what else we got. Things that are grabbing me, I mean, I would love to deep dive into identity-first, first person, first language.
MEGAN NEFF: Mm-hmm (affirmative). [CROSSTALK 00:02:19]-
PATRICK CASALE: …affirming language?
MEGAN NEFF: We could do the language, I think.
PATRICK CASALE: Yeah.
MEGAN NEFF: Because we've kind of been talking about like, diagnosis identity, self-disclosure. It feels like it goes with the theme.
PATRICK CASALE: Okay. Yeah. So, one of the questions that we got which is coming up a lot right now is why isn't everybody a little bit autistic? And why do people dislike the term ASD, high functioning, or on the spectrum? Where do you want to start?
MEGAN NEFF: I'll go with the everyone's a little bit autistic. I haven't seen this. Okay, I do you remember our episode with Tiff Hammond? She talked about, like, the autism starter pack, the autism advocacy starter pack. Like, there's a few things if you're entering autism advocacy that, like, you say. And one of them is, like, critiquing this comment, "Everyone's a little autistic."
And I kind of wish that would stop. I do wish people would stop saying it. I think the reason it's harmful is that it's really minimizing. Like, a lot of us have the experience of being, like, sharing an experience of like crowds been hard for us. And then, someone who's not autistic would be like, "Oh, yeah, crowds are hard for me too."
Or it's just like, there's this minimizing of the autistic experience and the challenges we experience. So, I think that's the part people are having a reaction to is how minimizing when this is said it's often said with that kind of minimizing tone.
And I've seen the comparison of like, the analogy that's floating around is like, no one can be a little bit pregnant. And I don't love that metaphor. And here's why. And we unpacked this in our episode with Jack of, it is true that there's a spectrum of autistic traits. Like, we were just talking about that with a heritability. If one child is autistic, the siblings might not be autistic but will have more autistic traits. Or a parent might have more autistic traits.
So, I think, you know, the mind wants to categorize. And I think it would be, like, it helps us, I think, feel more contained and feel like we belong to a group if it's like, either you're autistic or you're not, either you're neurodivergent or you're neurotypical.
The reality is these things are more complex and our brain wants to categorize because that's soothing. But I think the reality is it's actually more complex than this. And like, I look at my siblings, neither of them are autistic, but one definitely has more autistic traits. I wouldn't say she's a little autistic because I just don't like that language. But how do we talk about that? How do we talk about like variants of autistic traits?
That was a long critique. I don't know, like, what are your thoughts about this?
PATRICK CASALE: No, my thoughts are exactly… I would mirror yours. I think it's a dismissive statement when someone can say, "Oh, everyone's a little autistic." Because for autistic people who understand how much of a struggle most of life can be, and whether you worked really freaking hard to figure out the answer, you invested a lot of resources into the answer, you've identified a certain way because you meet criteria A, B, C, et cetera, et cetera, like, these are lifelong conditions that we are…
MEGAN NEFF: That really impact our lives.
PATRICK CASALE: Yeah, that's, sorry, thank you.
MEGAN NEFF: Yeah.
PATRICK CASALE: And so, if we're talking about neurotypes, it's really challenging to say like, "Everyone shares the same neurotype." Well, of course not. And that just kind of is the way I would look at it. But then you bring up the nuanced, the gray area of like, the traits, right? And that is where a lot more conversation needs to take place, I think, because there's not a lot of room for that conversation in a lot of spaces, so…
MEGAN NEFF: Mm-hmm (affirmative). And I think part of what I think can happen, so in-group, out-group. Like, social psychology studies in-group, out-group. And this happens a lot where, you know, we value those in our in-group. And we can have prejudices and stigma, and be more negative towards those in our out-group.
And this feels racism, this feels sexism, this feels all kinds of things. It also is really powerful to feel like part of an in-group. And I think for a lot of autistic people, when we come to learn this about ourselves, it's often the first time we feel like we're part of an in-group. And so, I think there is a temptation to want to make these things a little bit more rigid than they are and a little bit more categorical than they are.
Do I believe a true neurotypical exists? I think it's more complex than that. I think, if for language use, it's helpful to talk about, like, neurotypicals or neurotypical culture. But I think what we will find in the coming years is all brain neurology is incredibly diverse, and that these categories we've created are a little bit too simplistic. I think they're helpful, but I think they can also create this in-group, out-group dynamic that ends up not being very helpful.
PATRICK CASALE: Agreed, 100%. Well said. Let's see what else we got. We've got the why do people dislike the terminology ASD, high functioning, or on the spectrum?
MEGAN NEFF: Yeah, I mean, this is all part of that kind of older medical model really at the heart of the neurodiversity framework is shifting this from, like, a medical diagnosis to an identity. And so, the word disorder partly, the idea that, like, our brains are disordered would not be a neurodivergent affirming framework. And rather than seeing it as like a difference, a different neurology. So, that's why ASD is not liked.
Like, it is used and there's times where, like, you need to use that language to get the accommodations or whatnot. It's that like currency of the system that's in place for some folks. But that's why a lot of autistic people are moving away from that language.
Similarly, with on the spectrum, it's another way of kind of distancing from our identity. Some people do prefer that but there's been a few studies that have come out in the last few years and most autistic adults do prefer that identity first, like I'm autistic. It's a way of celebrating our identity, a way of instead of distancing from it, it's like, "No, I'm integrating this, I'm proud of this, and I'm owning it."
Yeah. I know you this is something you've talked about before as well.
PATRICK CASALE: Yeah, I mean, I think about when we're thinking about identity-first language verse person-first language, so, if I was to say like, because I use identity-first language, so I'm an autistic person, I'm an autistic therapist, I'm autistic entrepreneur, et cetera, et cetera, et cetera.
If I was to use person-first language, I am a person with autism. I'm a person who has autism. I'm a therapist with autism. It sounds as if you're talking about anxiety. It sounds as if you're talking about a medical diagnosis that you kind of want to create some distance from. And my thought process is like, I don't get to pick and choose when I'm autistic. Like I'm autistic from the moment I wake up to the moment I don't fall asleep. And you don't get to just, like, hang it up at the door when you walk into a social setting, or professional setting, or a medical setting. It encompasses and impacts everything.
So, if we really look at the true definition of identity, and we start to, like, really look at it from that perspective, opposed to saying, like, "I'm trying to remove this condition from myself, my sense of self." That's kind of the way I view it.
And I, you know, with any marginalized group, I'm always going to defer to what the person would like to use in terms of language, but providing some, like, gentle education or curiosity and trying to, you know, just move in a different direction.
And it can be done because I know that when I was first diagnosed I was using language like ASD, and on the spectrum, or I have autism. And I had a lot of unlearning to do as we all do because if a society isn't inherently ableist, then we all have grown up in situations where this kind of messaging has just been conditioned in terms of how we believe, in how we view, and how we move through the world. So, there's a lot of unpacking to do.
MEGAN NEFF: Were people gentle with you when you were doing your unlearning? Because you already had a platform. So, you probably did it publicly, or was it like, because I know I… Yeah, no, let me just ask the question before I…
PATRICK CASALE: Or I'll answer.
MEGAN NEFF: Yeah, were people gentle or were they kind of mean?
PATRICK CASALE: For the most part people were gentle, but I did receive quite a few DMs from people who were not. And they were like, "You're damaging the movement." More or less, "You're using harmful language. You don't know enough about what you're talking about to talk about." That was really impactful.
And I mean, I had to step back and think like, "Maybe there's some validity here." Right? Also, damn, talk about like we were talking about like this impostor syndrome-esque feeling of like disclosure, to then be told like, "But you're not really autistic enough because you don't know enough to talk about what you're experiencing." Really weird mindfuck. Had to do a lot of learning and unlearning, though. And do some ownership, too.
But yeah, I think that, you know, for anyone who is going to publicly disclose and publicly like, come out in any scenario, you are at risk for feedback and criticism.
MEGAN NEFF: Yeah, I think people often don't realize what they're walking into. Like, I've seen The Truth Doctor who has a large account and historically talks a lot about, borderline personality disorder, and just mental health, in general, has in the last year come out as autistic and ADHD. And I noticed that, like, she's using older language, which in my first part, I did too. I still find like really old blog posts that I have ASD and I'm like, "Oh my gosh, I need to edit that."
And I am seeing people, like, work to educate her. But I think people, when you have a large following, especially, if you already are in the mental health world, I don't think you realize what conversation you're jumping into and like the history of it. And so, I think yeah, that is an interesting experience.
I've seen a couple large accounts lately where they're large for other reasons, and then, discovering they're autistic and it's like, a part of me wants to like message them and be like, "Do you want someone to kind of guide you through that? Like, do you know what you're jumping into? Do you know the conversation? Do you want a guide?"
PATRICK CASALE: Yeah, I mean, hell, that mentorship would be greatly appreciated, you know? But I agree with you 100%. So, for those folks who are diagnosed later in life and coming to terms, and processing out loud, and have platforms, and followings, like it can get dicey because you're also stepping into an advocacy space. And you haven't always done the work yourself, especially, if you didn't know enough about it in the first place. So, I think there's validity for sure, yeah.
Which brings me to a thought that I'm thinking about now because several questions about being an autistic ADHD or AuDHD therapist, people saying I struggle with eye contact, I want to be a therapist, or how am I ever going to be a therapist if I'm autistic ADHD with struggling in terms of my sensory struggles or how I move through the world? I mean, both of us are sitting here as autistic ADHD mental health professionals.
MEGAN NEFF: But we've also both quit clinical work.
PATRICK CASALE: We have both quit clinical work, what's the use of that asterisk [INDISCERNIBLE 00:16:24]?
MEGAN NEFF: Which I don't like. Like, honestly, I would like to hide that because I have some impostor syndrome around like, I'm a psychologist who no longer sees clients. But I do feel like that's important disclaimer. And we've talked about it of like, a lot of our burnout has been getting out of clinical work.
PATRICK CASALE: For sure.
MEGAN NEFF: This is probably sounding very discouraging.
PATRICK CASALE: It can sound discouraging. I think you can absolutely be a competent, confident mental health practitioner as someone who's autistic ADHD. I just think that we live in a world where we have systems in place that aren't really designed for us. So, it's hard to be in a 40, 50-hour work setting and environment if you're in like a hospital system, or community mental health, that's hard on anybody, let alone someone with a system like ourselves.
Also, if you own your own business, there are stressors that come along with that, too. But I do think that for a lot of neurodivergent folks, that is a better fit in a lot of ways to have some autonomy and control over your schedule, and how you see people, where you see people, et cetera. I'm surprised the double empathy question gets asked, but nevertheless, like, autistic people make great therapists-
MEGAN NEFF: Absolutely.
PATRICK CASALE: …regardless of your comfort level around eye contact. Like a really, really good therapist because of how fucking intuitive we are and how much energy we pick up on and absorb.
MEGAN NEFF: Yeah, there's a lot of neurodivergent therapists out there. So, for people wondering like, "Can I do this?" There's a lot. And then, a lot of us specialize working with autistic ADHD clients. And frankly, there's not enough neurodivergent therapists to go around. So, like, if you're worried about will you get clients? Like, absolutely you will because neurodivergent people, spoiler alert, we end up in therapy a lot disproportionally. And we're often looking for people who understand us. And so, it's the getting through training, and then the kind of building the structure that works for you.
I will say of the neurodivergent therapists I know a lot of us can't carry as big of a caseload. Like, for a lot of us 15 or 20 is a full load.
And this comes up a lot in the conversations I'm a part of, of, a lot of us also very justice oriented. So, we want to have like a sliding scale, or we want to offer lower fees, but then we don't have capacity to see 30 people. So, there's this tension that a lot of us feel around to be able to have a livable wage I need to charge this much. It doesn't feel good for my ethics. But there are spaces where there's neurodivergent therapists having these conversations. So, I do think it's about… And teletherapy is a lot more accessible now. And I think that takes some of the sensory element and eye contact. Like, yeah, you can't really tell if you're making eye contact on teletherapy as much.
PATRICK CASALE: Yeah.
MEGAN NEFF: So, I think we're living in one of the best times from an accessibility standpoint just because of how easy it is to start your own practice, how easy it is to do telehealth, how easy it is, oh, I already said that, to start your own practice. And go to Patrick for tips on that because it was your original jam.
PATRICK CASALE: It was my original jam. I agree, 100%. My group practice is comprised of about 20 humans. And I would say 18 of them are neurodivergent either autistic, or autistic ADHD, or ADHD. So, it's doable. There are challenges. I mean, we can't lie about that. Preventing burnout is paramount. Soothing your sensory system is crucial. But there are ways to do it in a way that works for you.
Another question was how to find a neurodivergent affirming therapist? We did a whole episode on that. I'm not going to deep dive that right now. But like, there are neurodivergent affirming resources. I would really pay attention to language on people's websites. I would pay attention to how they're talking about neurodivergence, in general.
I often do website edits and audits for people. And if they say I want to specialize in ASD and Asperger's I'm like, "Okay, I think we have some work to do here before we get ready to maybe share stuff publicly." So, I think you have to look at your therapist's websites, I think you have to like look at neurodivergent affirming resources. There are neurodivergent-affirming therapy listservs and directories out there. So, there are resources.
And I would ask your clinicians that you want to work with or your therapists you want to work with some questions when you call them for your 15-minute phone consultation, or you email them like, what is your understanding of autism ADHD? What is your understanding about neurodivergence? Like, really ask those questions. You're entitled to advocate for yourselves because what you don't want to be in is the situation we talked about before where you disclose and the therapist says, "I'm not going to be able to help you." It feels like shit.
MEGAN NEFF: Yeah, absolutely. And I think we're living in a time where more and more people are, like, both disclosing their identities on their like Psychology Today profile or like saying explicitly if they are neurodivergent affirming.
On my resource page, if you go to neurodivergentinsights/resources, I've linked to like 10 of the most common directories.
The other thing I'll say is, if you're having a hard time finding a neurodivergent therapist, and if it's not a mental health issue like PTSD, depression and anxiety, OCD, that's driving you to want support, look into neurodivergent coaching. There's a lot of great autistic ADHD coaches out there who… So, if it's more of the kind of identity exploration, sensory regulation, wellness, there's a lot of great coaches out there as well. And that really expands, especially, because they often will work across state lines, across country lines. So, that's, I think, an untapped resource or an underutilized resource.
PATRICK CASALE: It's a great point, actually, because, you know, the therapeutic model is so colonialized. And the way we practice is so regimented. So, there are a lot of therapists who are going into coaching, too. So, you may actually find a lot more success going in that direction, if you are looking explicitly for someone who really gets it. So, be creative in your search process, for sure.
I don't think we have time for anything else. We got through a lot of these unless you see anything that just jumps out to you.
MEGAN NEFF: Oh, we did a high-functioning [CROSSTALK 00:23:26] language. I don't like that term. But I do think we do need some kind of language to describe different experiences of autism.
But partly functioning ebbs and flows so much. Like, you could look at me giving a presentation and be like, "Oh, she's so high functioning. But then, like, you don't see like the after fall, and you don't see me on the couch, and you don't see me, like, struggling to put words into a sentence afterwards. So, functioning ebbs and flows.
One of the things that the functioning [INDISCERNIBLE 00:24:01] also does is it tends to like underestimate the needs of those deemed high functioning. And it tends to underestimate the ability of those deemed low-functioning.
And it's also just like, can you imagine walking up to like a neurotypical or anyone be like, "Hi, oh, you must be high functioning." Or, "You must be low functioning." Like, what's your functioning level? Like, it's just a kind of gross and very capitalistic way of describing a human.
PATRICK CASALE: For sure.
MEGAN NEFF: So, yeah.
PATRICK CASALE: I see a lot of hosts in like therapy groups looking for a therapist who can support high-functioning autism or low-functioning autism. And then, that's where I always have to pick and choose do I want to go into this right now? Or do I just look at it and just shake my head and move on? But like, you're absolutely right. What do you think about, like, just, I think a lot of people move towards using support needs opposed to functioning labels?
I don't know which one of us froze, but one of us froze.
Okay, well for everyone listening to Divergent Conversations, new episodes are out on every single Friday on all major podcast platforms and YouTube. You can like, download, subscribe, and share. And you can see us next week.
