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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
The first point of contact is never neutral. It carries the full weight of our assumptions about whose communication style counts as legible. The very first questions we ask shape whether a neurodivergent client feels seen, pathologized, or quietly misread before therapy even begins.
Neurotypicality Quietly Wrote the Rules
Most intake forms ask about some mix of feelings, thoughts, and memories: What did you feel? What did you think? What do you remember happening next? The very structure of therapy as we’ve inherited it assumes that there is a coherent story inside the client, that this story is stored in words, images, and linear memory, and that therapy succeeds when the client produces that story—chock full of feeling words, insight, and a clear narrative arc. That template does not span all neurotypes.
For many neurodivergent people, there is absolutely a stored narrative, but it may not be organized in the shape of verbal language, visual images, or anything that fits neatly into a “tell me about that” question. And yet, our entire frame—training, supervision, progress notes, insurance reviews—still presupposes that it does. So when a neurodivergent client struggles to translate their inner experience into this narrow narrative form, we often misread that as avoidance, resistance, lack of insight, or “not ready for the work,” instead of what it actually is: a mismatch between how the neurodivergent population encodes experience and what our profession has decided counts as acceptable therapeutic communication.
Why Therapy Is Triggering for Neurodivergent People
Let’s start with the most obvious and least talked about: the power of who asks and who answers. Therapy, as traditionally practiced, is structured around one person holding the clipboard, one person renting the room, one person asking the questions, and one person expected to answer them. This seems neutral if you’re trained within it. But for many neurodivergent clients, this is already familiar territory: someone with perceived authority deciding what counts as relevant, valid, or true about them.
Add to that an expected style of communication—coherent, emotionally articulate, socially smooth; unspoken social rules about how much to share, how quickly, and in what order; a clock they’re not allowed to acknowledge; an intake they didn’t consent to design. The result is that therapy often feels like another environment in which they must mask—code-switching into “therapist-friendly” language, editing their questions, streamlining their tangents, making sure they look like a good patient.
Rewriting the Intake: From Non-Consensual to Co-Constructed
The traditional intake is one of the most medicalized moments in therapy. A stranger sits down. We ask deeply personal questions in a set order. The client answers, or feels bad for not answering. We decide what’s “important.” For neurodivergent clients, this can feel like a non-consensual evaluation cloaked in warmth.
We can begin by asking: What is the actual purpose here? Instead of “extracting enough information to diagnose and treat,” we might say that the purpose of intake is to build enough safety and clarity that the client can begin to unmask. The purpose is to co-design a space they can inhabit without bracing for impact. That means higher levels of transparency than we are used to, much more choice, and a willingness to put aside our sense of expert entitlement to people’s stories.
In practice, you might send your intake questions in advance with an invitation, like, “Here are the questions I often ask. Please tell me which you’d like to skip or delete.” You can name the medical model explicitly: “A lot of these questions were created inside a medical system that hasn’t always treated neurodivergent people fairly. We can change them.” You might minimize open-ended demands, knowing that many neurodivergent clients experience open-ended questions as a test with a hidden correct answer that the neurotypical person knows and they don’t. Short, concrete questions with an explicit “does not apply” option can be profoundly regulating.
You can shift from a need-to-know stance to a need-to-share stance. Instead of “I have to get your full history today,” try, “What do you feel you need to share with me so we can start?” You can offer scaffolding: “Here’s how the first session usually goes. Here’s how long we’ll talk. Here’s what’s optional. Here’s when we’ll check in.” Just naming these things out loud begins to return power to the client. It lets them know the goal is not to expose them; it is to build something tolerable together.
Sensory-Friendly Therapy: Ethics of the Environment
Your office is not neutral. It is a sensory event. You are responsible for what is seen, what is heard, what is smelled, what is touched, and how time is experienced. This is both concrete and symbolic. When we take responsibility for the environment, we signal: your nervous system matters here.
You might incorporate questions into intake or early sessions such as: “What should I know about lighting for you—bright, dim, lamps instead of overhead lights?” “Are there sounds that are especially hard—air conditioner hum, street noise, music in the waiting room?” “Any smells that are tough—candles, food, cleaning products, perfumes?” “Do you tend to be more comfortable in a firm chair, a softer couch, or on the floor?” “Would seeing photos of the room before you come in be helpful?”
You can explicitly offer different blankets (soft, textured, heavier, lighter), different pillows (firm, squishy, smooth, nubby), and a selection of fidgets and stim tools, with a direct statement: “These are here for you. There is zero judgment about how much or how little you use them.” And then there’s the clock.
Who Owns the Clock?
The clock is one of the most powerful objects in the room. Traditionally, it belongs silently to the therapist. With neurodivergent clients, you can ask: “How do you want to relate to time in here?” “Would you like a clock facing you?” “Do you want me to give a 10-minute warning before the end, or is that overwhelming?” “Do you prefer not to see the clock and just trust me to hold it?”
There is no one right answer. The point is that you’re not pretending time doesn’t exist while secretly controlling it. You’re inviting collaboration around something that dramatically affects nervous systems and the overall somatic experience of the interaction.
Dress Codes and Bodies in Space
There is, of course, a dress code in therapy—at minimum: be dressed. But when we never name it, we imply a whole host of other norms about what “appropriate” looks like. We can instead explicitly say: “I want you to dress in whatever feels most comfortable and familiar to your body—soft textures, loose clothes, whatever helps you settle. There’s no expectation to ‘dress up’ for therapy.”
We can also normalize different ways of inhabiting the room: “If you ever need to stand, pace, sit on the floor, or curl up with a blanket, that’s welcome. We can talk together about how to make that feel safe for both of us.” The goal is not to engineer the perfect sensory environment for everyone—that’s impossible. The goal is to build an office that offers many possible ways to be, and to explicitly invite the client to curate what works for them.
Constructing Questions as Harm Reduction
Who gets to ask the questions and who is expected to answer them reflects the power dynamic in the room. For neurodivergent clients, this dynamic has often wreaked havoc—clinically, educationally, medically. So when we think about how we ask questions, we’re not doing a stylistic tweak. We are doing harm reduction.
We might name it plainly: “I know that being asked lots of questions by a person with power has not always gone well for neurodivergent people. Part of our work here is to make questioning itself safer.” We can start by asking, “How does it feel to be on the receiving end of questions? Do you want me to be more active, more quiet, or to adjust as we go?” We can ask directly about open versus closed questions: “Are broad ‘tell me anything’ questions helpful or stressful? Do you prefer more concrete, specific prompts?”
We can explicitly empower the client to give feedback: “If the way I’m asking something isn’t working, can you tell me? ‘That question doesn’t work for my brain’ is a totally valid response.” We can increase check-ins: “Are we going too fast?” “Is this making sense?” “Are you starting to tune out?”
We shift from “I need to know everything so I can treat you” to “You need to feel safe enough to share what is actually helpful to share.” Our questions fall in line with that shift.
Intake is already an intervention—let’s make sure it’s a liberating one.
Dr. Danna Bodenheimer
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, which will be out in March 2026.