How therapy can help adults with neurodivergence

“I feel wrong and different and I’m convinced there is something that happens inside me that is not normal. I go round and round inside my head before making a decision and then after I’ve made it nothing ever feels good or right. I am obsessive about getting someone else to confirm what I want to do, and at work it’s so stressful having responsibility that I generally avoid anything I have to do until the very last minute and then I stay up all night in a frenzy of panic. It is usually ok but then I am shattered, exhausted, disillusioned and depressed afterwards. Why am I like this. I don’t feel it’s safe to trust myself.”

Something close to this reaches me fairly often, usually from a woman who has spent most of her life assuming she is the problem. She goes over a decision again and again, settles it, and then finds the settled version brings no relief. She needs someone else to tell her the choice is sound. Work feels worse than it should, so the thing that has to be done gets left until there’s no time left, and then it happens in one long, panicked night. It usually turns out fine. What comes after is the flat exhaustion, and the old question underneath it — why am I like this.

I’m Claire Sainsbury, an accredited member of the BACP. I work with individuals and couples in Hove, and online across Brighton and the rest of Sussex. A good number of the people I see arrive with some version of that account, often after years of putting it down to laziness, anxiety, or a fault in themselves.

What they’re describing usually turns out to be something other than a character weakness. Often it’s a neurodivergent mind that nobody ever recognised — most commonly ADHD, missed in childhood because it didn’t look the way we were once taught to expect. The old picture was a boy who couldn’t sit still. In girls it has tended to be quieter and more inward: worry rather than disruption, and a lot of effort spent looking as though everything is in hand.¹ That’s part of why so many women reach their forties or beyond before anyone names it, and why a referral for an adult assessment in this country can mean a wait measured in years.² None of this is a diagnosis — that needs a proper assessment — but it is often where one begins.

Neurodivergence covers a lot of ground: ADHD and autism, and also dyslexia, dyspraxia and others. The most useful change in how we think about it has been to treat these as real differences in how a brain works, rather than faults to be corrected. That matters, because someone who believes they’re broken puts a great deal of energy into hiding it, while someone who understands they’re wired differently can start working with themselves instead of against.

What tends to be happening

Much of it comes down to what clinicians call executive function — the brain’s managing skills. Getting started. Holding several things in mind at once. Sensing time as it passes. Getting from meaning to do something to actually doing it.³ When these run differently, a deadline doesn’t register as a point on the calendar; it sits at a distance, not quite real, until it is suddenly upon you. The task gets avoided because starting feels strangely impossible, though from outside it looks like idleness. Then panic arrives — and for a lot of ADHD minds, panic is the one thing that reliably makes enough pressure to begin. So the all-nighter works. It also costs a great deal, and the bill comes afterwards, as exhaustion and low mood.

Alongside this, many neurodivergent people feel things quickly and intensely, and are very sensitive to anything that reads as rejection or criticism. This is pronounced enough to have a name of its own, rejection sensitivity.⁴ It helps explain the constant checking, the need to have a decision confirmed by someone else. The checking makes sense when a small mistake can feel like evidence that something is wrong with you.

Then there’s the shame — the quiet “why am I like this”, the feeling that your own judgement can’t be trusted. This is often the heaviest thing in the room, and it is rarely the neurodivergence itself. It’s what has gathered on top over the years: forgotten things read as not caring, missed deadlines treated as a moral failing, “you’re so bright, if only you’d apply yourself” taken to heart as a verdict. People don’t arrive worn out by how they’re wired. They arrive worn out by decades of misreading it.

If any of this is familiar, it’s worth asking how quickly you reach for your own character as the explanation when something goes wrong, and how long you’ve been reaching for it.

In relationships

None of this stays inside one person. It shows up in relationships. In couples work the patterns are recognisable: one partner forgets something that mattered and the other hears it as not being loved; one needs a lot of reassurance and the other grows frustrated at never quite giving enough; the unseen work of running a life together falls unevenly, and small hurts pile up that neither can quite account for. Some of this is what’s been called the double empathy problem — the misunderstanding between a neurodivergent and a neurotypical partner goes both ways.⁵ Neither is short on empathy. They’re working from different manuals and reading each other through their own. Saying that plainly, in the room, can take a surprising amount of weight off a couple.

How therapy helps

Can therapy help with any of this? I think it genuinely can, and it’s worth being clear about how. Talking therapy adapted for ADHD has reasonable evidence behind it for easing the day-to-day disorder and the anxiety and low feeling that often travel with it.⁶ For autistic adults, affirming work can lessen the exhaustion of constant masking and some of the depression that masking costs.⁷ The aim is not to sand someone down until they pass as neurotypical, but to help them understand how their own mind works, build a life and some habits that fit it, and — the part that changes most — treat themselves with a little more kindness.

Some of the work is quite practical. Once you understand executive function, the avoid-panic-crash pattern stops looking like a personal failing and starts looking like something that can be set up differently. Some of it is slower: learning to recognise the rejection-sensitive alarm for what it is, so it loosens its grip and the need for outside approval can settle into something nearer to trusting yourself. And a good deal of it is simply making sense of a life. When someone finally understands why things have gone as they have, the story changes — from being broken to being wired differently and never having had the instructions. I’ve watched that land in people. The relief, when they see it was never about trying harder, stays with me.

Good therapy for a neurodivergent person works with the way your mind runs instead of insisting it behave like someone else’s. It goes at your pace. It doesn’t treat your way of thinking as something to be corrected, and it takes your particular sensitivities seriously. In practice I draw on cognitive and behavioural approaches, on skills for steadying strong emotion, and on a trauma-informed way of working built up over many years of practice — though the technique matters less than the relationship, and being met as you are.

There is a version of ordinary life where you are not braced against your own mind. A decision gets made and left to stand. Work begins without the sleepless night. You stop waiting for someone else to tell you that what you want is allowed. That shift is real, and it usually begins with understanding yourself rather than trying harder.

If you’d like to talk any of this over, you’re welcome to get in touch. You can reach the practice through the contact page at thehovecounsellingpractice.co.uk/contact, or by phone on 07947 073298. Individual sessions are £90 and couples sessions £110. There’s no pressure in making contact — just a conversation, when you’re ready for one.

References

1. Young, S., Adamo, N., Ásgeirsdóttir, B.B., et al. (2020). Females with ADHD: an expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/hyperactivity disorder in girls and women. BMC Psychiatry, 20, 404.
2. National Institute for Health and Care Excellence (2018, updated 2019). Attention deficit hyperactivity disorder: diagnosis and management (NG87). London: NICE. On adult assessment waiting times, see contemporaneous reporting (e.g. BBC News / Nuffield Trust, 2023–2024).
3. Barkley, R.A. (2012). Executive Functions: What They Are, How They Work, and Why They Evolved. New York: Guilford Press.
4. Beaton, D.M., Sirois, F. & Milne, E. (2022). Experiences of criticism in adults with ADHD: a qualitative study. PLOS ONE, 17(10), e0263366.
5. Milton, D.E.M. (2012). On the ontological status of autism: the ‘double empathy problem’. Disability & Society, 27(6), 883–887.
6. Young, Z., Moghaddam, N. & Tickle, A. (2020). The efficacy of cognitive behavioural therapy for adults with ADHD: a systematic review and meta-analysis of randomised controlled trials. Journal of Attention Disorders, 24(6), 875–888.
7. Cage, E. & Troxell-Whitman, Z. (2019). Understanding the reasons, contexts and costs of camouflaging for autistic adults. Journal of Autism and Developmental Disorders, 49, 1899–1911.