Cultivating wellbeing and positive identity in ‘the garden’

The neurodiversity movement is the catalyst for an emerging paradigm shift within psychological research and clinical practice. It challenges the notion of neurological differences as disorders and highlights the inequalities experienced by neurodivergent people who are navigating a society built around neuronormative ideas and structures.

Central to this movement is having a positive neurodivergent identity in resistance to the medicalised, deficit-based narratives which are used to describe neurodivergent people. Research suggests that this is crucial for neurodivergent wellbeing as it acts as a stabilising force that fosters good mental health in the face of adversity (Atherton et al., 2021; Bogart et al., 2018; Kreider et al., 2020). With this, neurodivergent people can be well positioned to disrupt neuronormative expectations and advocate for systems change.

As neurodivergent therapists working with autistic young people who are struggling with emotional regulation, burn-out, low self-esteem and shame in being autistic, we noticed a gap in formalised therapeutic approaches which both address these challenges and align with the neurodiversity-paradigm. Traditionally, therapy may have contributed to perpetuating the pathologisation of autistic ways of being and overlooking the influence of external factors which influence autistic young people's mental health such as unsuitable school provisions, parenting style and stigma.

Therapists have an opportunity to guide young people and their families towards creating and advocating for nurturing environments while supporting the development of a positive autistic identity. Therapists also have the potential to cause harm to a young person's sense of self, through pathologising valid and appropriate responses to an unfriendly world: such as treating 'school refusal' or more recently termed 'emotionally based school avoidance' with exposure, when this is an understandable response to unmet needs or unmatched environments.

Or alternatively, consider the neuronormativity of therapeutic goals and outcome measures. Do they seek to 'fix' autistic ways of being and perpetuate masking? As therapists, we have a responsibility to navigate carefully and collaboratively with neurodivergent young people, equipped with a truly neurodiversity-affirming approach.

Through an iterative process of therapeutic practice and reflection, we have begun to sculpt a neurodiversity-affirming therapeutic model. It echoes the call from leading neurodivergent scholars for a 'Neurodiversity-Informed Therapy' (Botha & Chapman, 2023) while addressing the needs of the young people we work with.

This model has emerged from a culmination of our professional and personal journeys; reflexively working with young autistic people and their families, while expanding our knowledge of the neurodiversity paradigm and reflecting on how our own neurodivergent identities intersect with our practice.

Our approach has been child-led, allowing us to reflect on neuronormative therapeutic goals, therapist values, qualities and the therapeutic environment. The driving force of this model is to facilitate young people and their families on their journey towards a neurodiversity-affirming mindset while recognising the emotional impact of navigating a neuronormative society.

We are presenting a visual representation of this therapeutic model, using the metaphor of a garden. As with a garden, holistic approaches to mental health require thinking about the ideal environment and tools needed for growth.

Firstly, the 'soil' is an accessible environment. Therapy must be a safe place: this takes time and effort. We have found that creating an atmosphere of collaboration and radical autistic acceptance supports young people to feel safe, seen and to feel a sense of agency over their therapeutic journey.

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This involves modelling neurodivergent acceptance by accommodating our own sensory needs, being flexible with timings, prioritising the relationship, gaining continuous consent, bringing and abandoning agendas as needed and sitting with the discomfort of not always being prepared.

Secondly, the 'sun' as therapist values and qualities. Our values align with Carl Rogers' core conditions of unconditional positive regard, congruence (authenticity – which neurodivergent people excel in detecting a lack of!) and empathy.

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These values lend themselves to a neurodiversity-affirming approach. We believe that appreciating the inherent value of autistic ways of being is essential to unconditional positive regard and authentically working with autistic people.

In considering empathy, awareness of your own neurotype as a therapist is vital to take the double-empathy problem (Milton, 2012) into account when building the therapeutic relationship. Therapist qualities uphold these values and allow a safe therapeutic environment to form. So far we've noticed creativity, curiosity, spontaneity and conscientiousness are key qualities.

Next, 'seeds' as goals. To move away from neuronormative goals, we gently and collaboratively set goals with young people with safety and positive autistic identity in mind.

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By framing goals as seeds, we hope to encourage young people to feel a sense of achievement in simply naming the seeds, and to demonstrate that self-development, like a garden, is a lifelong journey of cultivation that requires effort, practice and patience.

With this, we draw a parallel between growing a garden and neuroscientific principles of building neural connections through practice. This connection underscores the idea that the intentional practice of emotional regulation tools aids in building neural connections which reinforce healthy emotional responses. 

Fourth, 'weeds' as internal and external factors which impact mental health. With this, we hope to draw young people's attention to the social model of disability and validate their experiences of navigating a world not always built for neurodivergence.

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This touches on the secondary mental health impacts of being neurodivergent, e.g. stigma and low self-esteem, sensory overwhelm and emotional dysregulation. Using the metaphor of weeds, we aim to show that challenges naturally occur, just like weeds in a garden. We can address and tend to them, but ultimately, just as flowers can grow amongst weeds, there is joy to be found amidst life's challenges.

Finally, 'tools', which can cultivate wellbeing and positive autistic identity. This initially involves a range of psychoeducation, including empowering young people to understand the neurobiology of emotional regulation, which can help with feelings of safety as they navigate the therapeutic environment and relationship.

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We draw on neuroscientific models, such as the Polyvagal Theory and the work of Stephen Porges, as well as the work of Dan Siegel and the Window of Tolerance model.

Overall, we take a narrative approach (as we have with this model), and draw on other evidence-based psychological models, such as Cognitive Behavioural Therapy (CBT) and the work of Tony Attwood (credit to Tony for the tangible construct of the 'Tool Box' that we regularly use), Dialectal Behavioural Therapy (DBT) and the adaptations made by  Sonny Jane Wise, as well as Acceptance and Commitment Therapy (ACT). We invite young people to join us in mindfulness exercises and practices and regularly draw on these in response to physiological and emotional arousal in sessions. This supports young people to notice when they are feeling unsafe and to draw on internal resources to regulate.

When considering autistic identity, we support young people in identifying negative narratives that may have developed over time and help them to map out their autistic or neurodivergent profile. For this we draw on the therapeutic models named above and the work of autistic advocates. 

Finally, we are also guided by systemic models, such as the Family Partnership Model (FPM; Davis & Day, 2010) and engage in indirect work with the systems around the young people, with the parents, family, school, engaging in multi-agency work and building advocacy skills to address societal ableism.

This therapeutic model represents an exciting step forward in supporting the wellbeing and positive identity development of neurodivergent young people. By gently challenging some traditional therapeutic approaches that can pathologise neurodivergence, this model emphasises collaboration, acceptance and empowerment.

It recognises the importance of creating a safe and nurturing environment for young autistic people to thrive, guided by therapist values of authenticity, empathy, and unconditional positive regard. Through the metaphor of a garden, this model encourages a lifelong journey of self-development, while acknowledging the challenges neurodivergent people face in a neuronormative society.

The model offers tools rooted in neuroscience, evidence-based therapies and connection to the autistic community to cultivate positive identity development and advocacy skills. We hope that this framework can continue to develop and support clinical practice to move towards a truly neurodiversity-affirming therapeutic approach.

Aishling Dempsey is a guest editor and an Assistant Psychologist in a Community Paediatrics Service in East Sussex

Anita Marsden is a guest editor and a Lead Clinical Psychologist in a Community Paediatric Service in East Sussex.

Key sources

Atherton, G., Edisbury, E., Piovesan, A. & Cross, L. (2021). Autism through the ages. Journal of Autism and Developmental Disorders, 1-16. 
Bogart, K.R., Lund, E.M. & Rottenstein, A. (2018). Disability pride protects self-esteem through the rejection-identification model. Rehabilitation Psychology, 63(1), 155–159. 
Davis, H. & Day, C. (2010). Working in Partnership: The Family Partnership Model. London: Pearson
Kreider, C.M., Luna, C., Lan, M.F. & Wu, C.Y. (2020). Disability advocacy messaging and conceptual links to underlying disability identity development among college students with learning disabilities and attention disorders. Disability and Health Journal, 13(1), 100827.