This article is written primarily for trainee and qualified therapists, counsellors, psychotherapists, and therapist-coaches who identify as neurodivergent, whether that’s as autistic, ADHD, AuDHD or another form of neurodivergence. You may already have noticed a conspicuous gap in your professional world. While your training may or may not have taught you about working with neurodivergent clients, it most likely said very little about being a neurodivergent practitioner. The supervision literature has even less to say. Yet the challenges are real and specific, and they don’t disappear just because you’re now the one holding clinical responsibility. If anything, they can feel sharper once we start working with clients.
I want to write about those challenges directly, because vague reassurance that my supervision practice is ‘neurodivergent-affirming’ tells you very little. What follows is what I encounter as a supervisor, what I hear in neurodivergent therapist communities, as well as my lived experience of neurodivergence and clinical experience as a psychotherapist. Much of what good supervision offers doesn’t change at all. Everything I’ve written elsewhere about relational supervision applies equally to neurodivergent supervisees. But neurodivergent practitioners often encounter challenges that arise from the way their brains organise experience, and supervision needs to be able to meet those challenges without requiring emotional and mental labour to translate their experience for their supervisor. Neurodivergent-affirming supervision treats the challenges neurodivergent practitioners bring to their work, from executive function to masking, as legitimate professional issues rather than personal failings.
I’ve written this article with therapists and counsellors most directly in mind, since that’s where the majority of my supervision practice sits. But if you work as a therapist-coach or coach, particularly one bringing psychotherapeutic depth into coaching work, you’ll likely recognise most of this too. The frame around the work differs; the underlying difficulty with admin, time, and masking your own struggle rarely does.
Executive function and the admin of private practice
The work is rarely the problem. Everything around it often is.
Again and again, I meet neurodivergent therapists and counsellors who are deeply skilled in the therapy room: present, thoughtful, attuned, often exceptionally so. The difficulties tend to arise elsewhere. They emerge in the administrative demands of practice, in the invisible labour of organisation, and in the constant negotiation between how your brain actually works and how you believe a competent professional ought to function. Over time, those practical struggles may result in something much heavier: shame.
Here’s a familiar pattern. Notes don’t get written or only get written incompletely and in a rush at two o’clock in the morning because you’ve got supervision the next day. Invoices are sent late, or not at all. An email sits unanswered for eleven or thirty days and has now accumulated so much shame that opening it again, let alone replying, feels impossible. Your CPD log remains empty despite the hours you’ve actually invested in learning. You may even have bought several excellent online trainings that you fully intended to complete, only to find yourself forgetting they existed until months later.
By the time difficulties like these arrive in supervision, they are rarely just organisational problems. They have often become evidence in a case your inner critic has been building against you for years.
Most of these struggles are related in some way to executive function. I think that executive function deserves to be named in relational supervision. It needn’t emerge only as a desperate confession after you’ve concluded that you’re defective or failing. Running a private therapy practice means running a small business. Administratively, small businesses can be merciless environments for brains that struggle with task initiation, working memory, planning and self-directed organisation.
Most psychotherapy and counselling trainings don’t prepare you for this. During placement, you may encounter some of these difficulties, but placements usually come with an existing administrative infrastructure and people whose job includes chasing you for paperwork. Once you qualify and begin working as a therapist in private practice, that scaffolding largely disappears. You become responsible not only for your clinical work but also for every aspect of running your business. For many neurodivergent practitioners, it’s this rather than the emotional labour of therapy that proves most exhausting.
What truly neurodivergent-affirming supervision can offer here is not another productivity system. You’ve probably tried several already, and their failure has been added to the evidence collated by your critical parts. Relational supervision can offer something far more useful: a place where administrative struggle is understood as a legitimate professional issue rather than a character flaw. Sometimes that leads to practical conversations about what a genuinely sustainable practice looks like for your particular brain. That might mean fewer clients, different session patterns, body-doubling while writing notes, or externalising what working memory cannot reliably hold. Sometimes the work goes deeper than that, because the shame attached to the admin is often much older than the practice itself. The therapy room may be where it’s showing up now, but it probably didn’t begin there.
Time agnosia in therapy: why holding the therapeutic frame can feel so difficult
Therapy is one of the most time-structured professions there is. The fifty-minute hour, the precise start-time, and the held ending are central to the therapeutic frame. Time boundaries matter, clinically, ethically, and relationally. Yet many neurodivergent practitioners, particularly those with ADHD, live with what’s sometimes called time agnosia (my preferred term) or time blindness (a phrase I avoid because of its ableist connotations). Time agnosia describes a genuine difficulty perceiving the passage of time. It isn’t a failure of discipline or commitment. Our brains simply don’t experience time in quite the same way. Difficulties with time perception, and consequently with self-directed organisation, are well established within the ADHD literature (Barkley, 1997).
That creates a genuine tension, and I believe supervision should provide a place where we can acknowledge it honestly rather than pretending it isn’t there. If the therapeutic frame matters, we can’t simply loosen it because it’s difficult to maintain. At the same time, recognising the importance of the frame is very different from telling someone they simply need to become better at managing their time.
Instead, neurodivergent-affirming supervision becomes a place where we think together about what genuinely supports you. That might include visible clocks positioned for your benefit as well as the client’s, buffers between sessions that are treated as clinically necessary rather than spare time to be filled, scheduling that reflects your real transition costs rather than your idealised ones, or practical strategies such as building alarms and timers into your working routine rather than depending on memory. It may involve looking at the boom-and-bust cycle many ADHD practitioners recognise: enthusiastically filling the diary during a period of high energy and then living with the consequences for months afterwards. What rhythm of clinical work, administration and recovery supports your nervous system and allows you to thrive rather than merely cope?
There’s another layer to this as well. If you’ve spent much of your life being told you’re careless with time, unreliable, or always late, then a session running three minutes over may activate something much bigger than three minutes’ worth of feeling. Once again, what appears to be a practical difficulty often carries a historical emotional weight. That history deserves thoughtful attention in supervision, and sometimes in personal therapy too, rather than being borne alone.
Masking, shame and imposter syndrome in neurodivergent therapists
Almost everything I’ve described so far carries a personal cost. Frequently, that cost is shame. Indeed, shame is where I think much of the deepest supervisory work happens. I have more to say about shame than I can include here, so I’ll return to it in a dedicated post.
Many neurodivergent practitioners arrive in this profession with a long history of being highly capable, pushing though, and coping at an exceptional hidden cost. They have frequently become experts at masking: concealing or suppressing neurodivergent traits in order to meet social expectations (Hull et al., 2017).
Masking often intensifies during training and after qualification because there’s now another identity to protect. The therapist mask can be a particularly convincing one: calm, boundaried, emotionally regulated, unfailingly organised. When sustaining that image becomes exhausting, self-doubt and shame are rarely far behind. The gap between how you appear professionally and how you experience your internal world creates another source of chronic, private shame. It’s exactly this kind of shame that feeds the depletion I’ve written about elsewhere in relation to neurodivergent burnout (Raymaker et al., 2020).
Imposter feelings deserve a mention here too. The imposter phenomenon, first described by Clance and Imes (1978), takes on a particular flavour for neurodivergent practitioners. It’s not simply, ‘I’m not as competent as people think’. More often, it’s ‘if they knew how I actually work – how chaotic everything feels behind the scenes – they’d think I shouldn’t be doing this at all’.
Is neurodivergence a fitness-to-practise issue?
Some supervisees fear that their neurodivergence itself is a fitness-to-practise issue. I want to state clearly: Neurodivergence is not a fitness-to-practise concern. Unacknowledged and unexamined struggle, in any practitioner, neurodivergent or not, can become one. That’s precisely why supervision needs to be somewhere to think about what feels difficult. That only happens if the supervisory relationship is safe enough for you to unmask.
This is where the relational part of relational supervision stops being an abstraction. If supervision becomes one more room in which you feel obliged to perform composure, it cannot do its restorative work (Proctor, 1986). The material that most needs supervision never arrives. But the conditions that make unmasking possible are co-created. They depend at least as much on the supervisor as on the supervisee.
For me, that means receiving disorganised, associative, hesitant or overflowing accounts of your work as fully legitimate clinical communication rather than as ‘not good enough’ drafts of a better version. It means welcoming the client who feels impossible to understand, the session that went badly, or the weeks when you felt that you’re losing your footing. It also means noticing together, gently, when the mask has found its way back into the room, because it’s bound to, sometimes. When it does, I don’t see that as something to be embarrassed about. I see it as valuable clinical information for us to explore together.
How does Rejection Sensitive Dysphoria (RSD) show up in supervision?
Supervision necessarily involves feedback. For many neurodivergent people, particularly those with ADHD or AuDHD, feedback can feel intensely painful in a way that’s difficult to convey to someone who’s never experienced it. Within ADHD communities, this is often described as rejection sensitive dysphoria, or RSD: a rapid, embodied response to perceived criticism that can feel overwhelming.
I take that seriously in two directions at once. I don’t avoid challenge. Supervision without challenge cannot facilitate growth, and my supervisees deserve better than that. Equally, I think carefully about how challenge is offered and do my best to provide sufficient support for it to be heard. I’d much rather we talk openly about how feedback lands for you than find ourselves in a position where you feel you can bring only the work that demonstrates your strengths. Of course, I enjoy recognising and celebrating what you do well. But I also want to offer you a relationship that’s safe enough for you to explore your growing edges without fearing judgement or rejection. If you’ve experienced previous supervisory relationships in which your brain and nervous system simply weren’t understood, I’d like you to know that another way of working is possible.
Adapting Supervision to Different Neurodivergent Thinking Styles
don’t believe there’s such a thing as generic supervision. Some approaches place greater emphasis on the content of the work than no the therapist’s own process: what intervention to try, what model best explains the client’s presentation, or what the research recommends. There is, of course, a place for that. But interventions can only be made through the person of the therapist. If we pay attention only to technique, we risk overlooking the very person through whom that technique is being applied. That may be one reason why supervision sometimes leaves us with helpful ideas but little sense of having been genuinely understood. My own approach begins somewhere different. I see the supervisee’s way of thinking, feeling and making meaning as an integral part of the supervisory work itself.
Every supervisory relationship develops its own shape, partly in response to how a supervisee’s brain naturally works, whatever their neurotype. For some people, that shape might involve a linear case presentation, a clearly defined supervision question, and a steady pace. That works well for some minds. If yours works differently, it’s not a problem.
If you’re a divergent thinker, for example, you may need to meander around a case before discovering the question hidden inside it. Or perhaps you only discover what you already know at a felt level by talking your way towards it. Some people don’t arrive in supervision with a neatly formulated question because the process of supervision is what allows the question to emerge. If that’s true for you, you’re unlikely to flourish with a supervisor who repeatedly steers you back towards a format that reflects how they think rather than how you do.
Damian Milton’s double empathy problem (2012) is relevant here. Communication difficulties between differently-wired people are not one-way deficits but two-way mismatches. Responsibility for bridging that difference is therefore shared. In supervision, however, acknowledging the power differential means I’d go one step further. I believe the greater share of responsibility belongs with me. It’s my task to discover how supervision works best for you, so that it becomes genuinely transformative rather than merely adequate.
With new supervisees, particularly trainees, I often suggest a loose structure as a starting point. For each client you bring, it’s helpful for me to know the broad reason why they sought therapy, the aspect of that work you’re currently focusing on, what’s happening for you in the therapeutic relationship and internally with regard to your own process, and whether there’s a particular supervision question you’d like us to think about together.
How we arrive there is much less important. I follow your pace rather than expecting you to adapt to mine. Silence is allowed to be part of thinking rather than treated as an absence of thinking. You may need to talk around something before you can talk about it. You may want to bring notes, or no notes. You may think more clearly while looking away from the screen (if we’re online), standing up, pacing the room, or speaking in fragments before the shape becomes clear.
Other supervisees discover that they need considerably more structure rather than less, and that’s equally available. The point is not that one way is better than another. The point is that we can think together about the conditions under which your mind does its best reflective work, instead of leaving you trying to adapt to an unspoken set of rules.
Should you tell clients you’re neurodivergent?
There’s one final issue I want to mention: whether, when and how to disclose your own neurodivergence to clients, colleagues, referrers, or on your website.
There is no single right answer. Many psychotherapy trainings encourage restraint in self-disclosure and emphasise the importance of keeping our personal experience out of the therapy room. At the same time, many people from non-normative and marginalised communities actively seek psychotherapists, counsellors and coaches with relevant lived experience because they want confidence that certain aspects of their experience won’t require explanation or defence.
Those two realities create a genuine tension. Disclosure can become a powerful marker of recognition for neurodivergent clients looking for someone who understands, even where your own experiences differ significantly from theirs. Equally, disclosure can feel exposing, particularly if shame still surrounds aspects of your own neurodivergence or the years spent masking it. It also raises important questions about what belongs in the therapeutic relationship, what belongs outside it, and how those decisions are best made.
Those questions don’t have universal answers. What I can offer is a supervisory relationship in which they can be explored properly, with someone who themselves has had to navigate them personally as well as professionally.
What doesn’t change
Having spent this article exploring what may be different for neurodivergent practitioners, I want to end by being equally clear about what remains the same.
The ethical foundations of supervision do not change. Supervision must still facilitate your professional development, safeguard your clients, and sustain you as a practitioner (Proctor, 1986). The central importance of the supervisory relationship doesn’t change either. We know that the quality of that relationship is one of the strongest predictors of meaningful outcomes in both therapy and supervision (Beinart and Clohessy, 2017).
Nor does the level of professional rigour change. Neurodivergent-affirming supervision is not a softer or less demanding form of supervision. If anything, it asks for greater precision. It asks both supervisor and supervisee to distinguish between difficulties that arise from the work itself and those that arise from trying to practise through systems, assumptions and expectations that were never designed with every kind of mind in mind.
Ultimately, I hope that neurodivergent-affirming supervision allows your energy to be spent where it belongs: on reflection, learning and clinical development, rather than on trying to perform a neurotypical version of yourself while attempting to do those things at the same time.
If you’ve read this far with a growing sense of recognition, or relief, I’d be very glad to talk.
I supervise qualified and trainee therapists, therapist-coaches and coaches, online across the UK. I offer a free 20 to 30-minute initial conversation so you can get a sense of whether we’d work well together, with no obligation beyond that. Details of my supervision practice and current fees are on my supervision page.
Garthine Walker is a UKCP-registered psychotherapist, clinical supervisor and EMCC-accredited coach based in Cardiff. She holds the Certificate in Clinical Supervision from the Metanoia Institute and offers relational integrative supervision to therapists and coaches online across the UK. Her practice is neurodivergent-affirming and trauma-informed, grounded in both clinical and lived experience of neurodivergence.
REFERENCES
Russell A. Barkley (1997). ‘Behavioral Inhibition, Sustained Attention, and Executive Functions: Constructing a Unifying Theory of ADHD’, Psychological Bulletin, 121:1, 65–94. DOI: 10.1037/0033-2909.121.1.65.
Helen Beinart and Susan Clohessy (2017). Effective Supervisory Relationships: Best Evidence and Practice. John Wiley & Sons.
Pauline Rose Clance and Suzanne A. Imes (1978). ‘The Imposter Phenomenon in High Achieving Women: Dynamics and Therapeutic Intervention’, Psychotherapy: Theory, Research and Practice, 15:3, 241–247. DOI: 10.1037/h0086006.
Laura Hull et al. (2017). ‘”Putting on My Best Normal”: Social Camouflaging in Adults with Autism Spectrum Conditions’, Journal of Autism and Developmental Disorders, 47, 2519–2534. DOI: 10.1007/s10803-017-3166-5.
Damian E.M. Milton (2012). ‘On the Ontological Status of Autism: The “Double Empathy Problem”‘, Disability & Society, 27:6, 883–887. DOI: 10.1080/09687599.2012.710008.
Brigid Proctor (1986). ‘Supervision: A Co-operative Exercise in Accountability’, in A. Marken and M. Payne (eds), Enabling and Ensuring: Supervision in Practice. Leicester: National Youth Bureau/Council for Education and Training in Youth and Community Work.
Dora M. Raymaker et al. (2020). ‘“Having All of Your Internal Resources Exhausted Beyond Measure and Being Left with No Clean-Up Crew”: Defining Autistic Burnout’, Autism in Adulthood, 2:2. DOI: 10.1089/aut.2019.0079.