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.”

I have heard a version of these words many times, spoken quietly across the room in my consulting space in Hove, often by a man who has spent thirty or forty years assuming the problem is simply him. There is the round-and-round of a decision that refuses to settle. There is the reaching for someone else to confirm what you already half-know you want. There is the dread of the task that sits untouched until the last possible hour, the all-night frenzy that somehow delivers, and then the flat, grey crash that follows. And underneath all of it, the conviction that something inside you is faulty in a way it is not in other men.

If you have been drawn to read this because those words landed somewhere familiar, I would like to meet you there first, before offering any frame at all.

What this man is describing is not a character flaw, and it is not weakness. It is, very often, the lived texture of a neurodivergent mind that has gone unrecognised — most commonly, in the experience I have, a form of ADHD that was never named, because it did not look the way we were once taught to expect. There is an assumption that ADHD is something boys are picked up for at school and grow out of. In truth, a great many men were never picked up at all. The ones who reach me in midlife are often those whose difficulty was quieter than the textbook restless boy — more daydreamer than disruptor — or those who found ways to cover it: through overwork, through achievement, through pouring the restlessness into something that looked, from outside, like drive.¹ It is probable that this is a large part of why so many men reach their forties or fifties before anyone names what has been happening, and why a referral for an adult assessment in this country can mean a wait of years rather than weeks.²

Neurodivergence is a broad term. It holds ADHD and autism, and also dyslexia, dyspraxia, dyscalculia and more. The thinking that has done the most good, to my mind, is the shift from treating these as defects to be corrected towards understanding them as genuine differences in how a brain is wired — different operating instructions, not broken ones.³ That reframing matters enormously, because a person who believes they are broken spends a great deal of energy hiding, and a man who understands he is simply built differently can begin, at last, to work with himself rather than against.

The machinery beneath the struggle

I would like to stay with the inner machinery for a moment, because naming it precisely tends to bring relief.

Much of what this man describes belongs to what clinicians call executive function — the brain’s set of management skills: starting a task, holding several things in mind at once, sensing the passage of time, and steering yourself from intention to action.⁴ When these run differently, a deadline does not feel like a date on a calendar; it feels like nothing at all until it is suddenly upon you. This is sometimes called time blindness, and it is the engine of the procrastinate-panic-crash cycle. The task is avoided not out of laziness but because the threshold to begin feels impossibly high. Then panic arrives, and panic, for many ADHD minds, is the only thing that finally generates enough urgency to start — which is why the all-nighter works, and why it is so corrosive. The body pays the bill afterwards in exhaustion, and the spirit pays in disillusionment and low mood.

Sitting alongside this is the way many neurodivergent people feel emotions — quickly, intensely, and with a particular sensitivity to any hint of rejection or criticism. This last quality is significant enough to have its own name, rejection sensitivity, and it helps to explain the obsessive seeking of someone else’s confirmation.⁵ In men this can be especially hard to see, because it is often hidden beneath a surface that has been taught to look unbothered. The man who checks and re-checks a decision, who cannot rest until a colleague or a partner has signed off on what he wants, is not weak and is not lacking confidence in the ordinary sense. He is responding to an inner alarm that is set far too loud — one that reads a small wrong move as evidence of being fundamentally unacceptable. The reassurance-seeking is a sensible response to that alarm, even when it exhausts everyone, himself most of all.

And then there is the shame — the quiet “why am I like this”, the feeling that it is not safe to trust yourself. This is, in some ways, the heaviest part of the load, and it is rarely the neurodivergence itself. It is what gets layered on top across the years: the missed deadlines reframed as a moral failing, the forgotten things taken as proof of not caring, the well-meant “you’re so capable, if only you applied yourself” absorbed as a verdict on your worth. For many men there is an added weight — a sense that they ought to have mastered all this by now, that other men seem to manage it without apparent effort, and that needing help is itself a kind of failure. People do not arrive in therapy broken by their wiring. They arrive worn down by a lifetime of misreading it, and often by a long-held belief that they should have been able to think their way out of it alone.⁶

Reflect for a moment, if you would. When something goes wrong for you, how readily do you reach for the explanation that the fault lies in your character rather than in the way your particular mind is built? And how long have you been carrying that explanation?

When the difficulty lives in a relationship

These difficulties do not stay neatly inside one person; they live in relationships too. I work with many couples where one or both partners is neurodivergent, and the patterns are recognisable. One partner forgets the thing that mattered, and the other reads it as not loving them. One needs a great deal of reassurance, and the other becomes frustrated at not being able to get through. There is often an imbalance in the invisible work of running a shared life, and a steady accumulation of small ruptures that neither person quite understands. Part of what is happening here is what researchers have called the double empathy problem: the idea that misunderstanding between a neurodivergent and a neurotypical person runs in both directions.⁷ It is not that one partner lacks empathy and the other has it. It is that two minds are working from different instruction manuals, each making sense of the other through their own, and missing. Naming this in the room, gently, can lift an extraordinary weight from a couple, because it replaces blame with understanding.

Whether, and how, ADHD therapy helps

So — whether, and how, can therapy help? On the question of whether, the honest answer is yes, and meaningfully so. Talking therapies adapted for ADHD have good evidence behind them for easing the practical chaos and the low mood and anxiety that so often travel with it.⁸ For autistic adults, affirming therapy reduces the exhaustion of constant masking and the depression that the masking costs.⁹ Across the board, the most useful work is not the kind that tries to file the edges off a person until they pass as neurotypical. It is work that helps you understand your own wiring, build a life and a set of strategies that fit it, and — this is the part that changes everything — begin to extend yourself some compassion.

On the question of how, I would describe it like this. Some of the work is practical: understanding executive function so that the procrastinate-panic-crash cycle stops feeling like a personal failing and starts looking like a system that can be redesigned. Some of it is emotional: learning to recognise the rejection-sensitive alarm for what it is, so that it loses some of its grip and the constant need for outside confirmation can soften into genuine self-trust. And a great deal of it is what I can only call the reframing of a life story. When a man finally understands why he has been the way he has been, the narrative shifts — from “I am broken” to “I am wired differently, and I was never given the manual”.¹⁰ I have had the privilege of watching that shift happen, and it is one of the most moving things in this work. The relief on a man’s face when he realises it was never a question of trying harder is something I do not forget.

Good therapy for a neurodivergent person looks like therapy that works with your brain rather than insisting it behave like someone else’s. It is paced to you. It does not pathologise the way you think. It is curious about your particular sensitivities and honours them. In my practice I draw on cognitive and behavioural approaches, on skills for steadying intense emotion, and on a trauma-informed understanding built up over sixteen years — but more than any technique, the work rests on a relationship in which you are met as you are. I see clients in person at the practice in Hove, and online across Brighton and the wider Sussex area, whichever suits the way you live.

An open door

I want to leave you with this. There is a version of your days in which you are not braced against your own mind — where a decision can be made and allowed to stand, where the task can be begun without the all-nighter, where you no longer wait for someone else to tell you that what you want is allowed. That version is not a fantasy. It is what becomes possible when you stop fighting how you are built and start understanding it. You are not wrong. You were, perhaps, simply never given the right map.

If you would like to find out more, you are warmly welcome to contact the practice to arrange an initial assessment. You can reach us through the contact page at thehovecounsellingpractice.co.uk/contact, or by calling 07947 073298. Individual sessions are £90, and couples sessions £110. There is no pressure in getting in touch — only an open door, and someone on the other side of it who understands.

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 (NICE) (2018, updated 2019). Attention deficit hyperactivity disorder: diagnosis and management (NG87). London: NICE. See also reporting on adult ADHD assessment waiting times, BBC News / Nuffield Trust (2023–2024).
3. Walker, N. (2021). Neuroqueer Heresies: Notes on the Neurodiversity Paradigm, Autistic Empowerment, and Postnormal Possibilities. Fort Worth, TX: Autonomous Press. (Articulation of the neurodiversity paradigm.)
4. Barkley, R.A. (2012). Executive Functions: What They Are, How They Work, and Why They Evolved. New York: Guilford Press.
5. Dodson, W. (2021). Emotional regulation and rejection sensitive dysphoria in ADHD. ADDitude Magazine / clinical commentary; see also Beaton, D.M., Sirois, F. & Milne, E. (2022). Experiences of criticism in adults with ADHD. PLOS ONE, 17(10).
6. Beaton, D.M., Sirois, F. & Milne, E. (2020). Self-compassion and perceived criticism in adults with ADHD. Mindfulness, 11, 2506–2518.
7. Milton, D.E.M. (2012). On the ontological status of autism: the ‘double empathy problem’. Disability & Society, 27(6), 883–887.
8. Young, Z., Moghaddam, N. & Tickle, A. (2020). The efficacy of cognitive behavioral therapy for adults with ADHD: a systematic review and meta-analysis of randomized controlled trials. Journal of Attention Disorders, 24(6), 875–888.
9. 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.
10. Leedham, A., Thompson, A.R., Smith, R. & Freeth, M. (2020). ‘I was exhausted trying to figure it out’: The experiences of women receiving an autism diagnosis in middle to late adulthood. Autism, 24(1), 135–146.