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by Dr. Danna Bodenheimer, LCSW, DSW, author of Real World Clinical Social Work: Find Your Voice and Find Your Way and On Clinical Social Work: Meditations and Truths From the Field
For neurodivergent clients with long histories of being misunderstood, consent is not just an ethical requirement. It is often a clinical necessity.
In many training environments, clinicians are taught to listen for what is underneath the story: the hidden meaning, the defense, the avoidance, the transference, the symptom beneath the symptom. That kind of thinking can sometimes be useful. But with neurodivergent clients, an overly interpretive stance can easily become harmful, especially when the client has spent a lifetime being misread by parents, teachers, doctors, and other clinicians.
Neuroaffirming care asks us to shift from assuming meaning to building meaning collaboratively. It asks us to treat consent not only as something obtained at the start of treatment, but as an ongoing part of the clinical relationship.
Why This Matters
Many neurodivergent clients come to therapy with a history of having their inner lives translated by other people. Someone else has often decided what their facial expression meant, what their tone meant, whether they were “really” anxious, whether they were being avoidant, oppositional, rude, rigid, resistant, or manipulative. Over time, this can erode self-trust.
When a clinician moves too quickly into interpretation, the client may not experience that as insight. They may experience it as another version of being overwritten.
That does not mean interpretation is always wrong. It means that for many neurodivergent clients, interpretation should not come before safety, collaboration, and permission.
What Consent Looks Like in Practice
In this context, consent is not just about paperwork or confidentiality. It is a relational practice.
It can sound like:
- “Does that feel accurate to you?”
- “I have a thought about what may be happening. Do you want to hear it?”
- “Would you like me to ask more about that, or leave it there for now?”
- “I want to make sure I’m not imposing a meaning that doesn’t fit.”
These kinds of questions may seem small, but they do important clinical work. They communicate that the client’s perspective matters. They help restore agency. They reduce the risk that therapy will repeat older dynamics of intrusion or correction.
Why Collaboration Is Not “Less Clinical”
Some clinicians worry that if they become too collaborative, they will stop being helpful. But collaboration is not the same thing as passivity.
A collaborative clinician still brings knowledge, training, and curiosity into the room. The difference is that they do not treat their interpretation as inherently more valid than the client’s lived experience. They stay open to being wrong. They make room for the possibility that what looks like avoidance may actually be overload, what looks like flatness may actually be effortful regulation, and what looks like resistance may actually be a boundary.
This is still deep clinical work. In many cases, it is deeper work because it is less organized around therapist authority.
Clinical Risks of an Overly Interpretive Stance
When clinicians rely too heavily on interpretation with neurodivergent clients, several problems can emerge:
- The client may feel scrutinized rather than supported.
- The therapist may confuse difference with defensiveness.
- The client may comply outwardly while becoming less authentic in the room.
- Misattunement can be framed as insight.
- Therapy can begin to reproduce the very relational injuries the client is trying to heal from.
For clients with trauma histories, histories of masking, or histories of chronic invalidation, this matters even more. A therapist who assumes too much can accidentally recreate an environment in which the client’s own knowing is treated as unreliable.
What Neuroaffirming Care Requires
Neuroaffirming care requires humility. It asks clinicians to tolerate uncertainty and to resist the urge to arrive at meaning too quickly. It asks us to ask before we name, to check before we deepen, and to understand that pacing is part of attunement.
It also asks us to remember that consent is stabilizing. For clients who have often had to surrender their own rhythms, preferences, and limits in order to stay connected, the experience of being asked can itself be reparative.
Being collaborative does not reduce the depth of therapy. It creates the conditions that make depth possible.
A Better Question for Clinicians
Instead of asking, “What is this behavior really about?” it may be more helpful to ask: “How can I stay curious without overpowering the client’s authority over their own experience?”
That question leaves room for clinical thinking, but it places dignity and collaboration at the center.
For neurodivergent clients, that shift can make the difference between a therapy that feels extractive and one that feels safe enough to matter.
Consent is not separate from the treatment. For many neurodivergent clients, it is part of what makes treatment work.
Dr. Danna Bodenheimer, Founder and Director of the Walnut Psychotherapy Center, has worked in the field of mental health for more than 15 years. Her expertise is most centered around working with the LGBTQ+ population and neurodivergent population. She takes different, cutting edge approaches to thinking about and treating individual and organizational trauma. She has also long studied the impacts of dual marginalization on the psyches of individuals in treatment and in the workplace.
Dr. Bodenheimer received her bachelor’s and master’s degrees from Smith College, her post-baccalaureate degree from Columbia University, and her Doctor of Social Work from the University of Pennsylvania. She has taught at Temple University, Rutgers University, Bryn Mawr College, and Penn. She can easily discuss complex issues of life along the gender spectrum, neurodivergence, racial dynamics in the workplace and interpersonally, and the lifelong impact that trauma has on overall human functionality. She has also authored two books on how to practice in the field of psychotherapy and has mentored hundreds of developing clinicians as they have grown their own practices.
Dr. Bodenheimer is unusually adept at having difficult dialogues, identifying language to help communicate intricate psychological processes, helping people to say what feels hardest to say, and creating relational environments that allow for lasting connection and safety.
Dr. Bodenheimer has recently developed an expertise around neuro-affirming care derived from multiple avenues of study and clinical work. First, she has long criticized and studied the harmful impacts of ABA (applied behavioral analysis) treatment, while trying to cultivate relational alternatives to this pervasive practice. Dr. Bodenheimer's own caseload is largely made up of neurodivergent clients, immersing her in the world of how different brains work daily. In Dr. Bodenheimer’s own research, her focus has also been on the strong intersection between gender expansion, queerness, and neurodiversity. She offers several trainings on what concrete steps a therapist can use to create a more neuro-affirming space for clients. This often means subverting and deconstructing our dominant understanding of what does and does not actually work, and how to create both relief and the opportunity for unmasking in treatment.
She is working on a book that affirms that self-diagnosis process and will serve as a guide and journal for those exploring their own neurotypes.