Integrative counsellor Tina Kanetis explains how therapy can be adapted to better meet your needs – and what to do if it’s not working

Why doesn’t therapy always feel right for neurodivergent people?

Many of the difficulties neurodivergent people face don’t come from who they are, but from environments that weren’t designed with them in mind – and therapy is no exception.

Therapy works best when you feel safe, understood, respected, and able to reflect in your own way. If those things aren’t in place, it’s not a personal failure. It may simply mean your needs aren’t being fully considered yet.

What kinds of adjustments can make therapy more accessible?

Therapy can be adapted in many practical ways depending on what helps you feel comfortable and able to engage.

For example, session length might not suit everyone – 50 minutes can feel manageable for some, but overwhelming or exhausting for others. You might prefer shorter sessions, a slower pace, or extra time at the beginning or end to settle and reground yourself.

You’re also allowed to take breaks if you lose focus, feel restless, or begin to shut down. Therapy doesn’t have to mean sitting still and talking continuously. Movement can aid concentration, too. Using a fidget item, doodling, or simply moving in your chair can support focus rather than detract from it.

Do things like eye contact or the therapy environment matter?

Yes, your sensory experience matters. Overstimulation can make it more difficult to think, reflect, or feel safe.

Small details in the room can have a big impact, such as lighting, noise, temperature, smells, or visual clutter. So if something feels ‘off’, it may be sensory, and you’re allowed to raise it.

Eye contact and seating are important, too. Many neurodivergent people find direct eye contact uncomfortable or overwhelming. Therapy doesn’t require constant eye contact to be effective. You may prefer sitting side-by-side, at an angle, or looking elsewhere while talking.

What if I struggle with communication or organisation in therapy?

Therapy can sometimes use metaphor, symbolism, or tone – but not everyone finds these helpful. If you prefer literal language, find metaphors confusing, or communicate in a more direct or analytical way, you can say so. It’s not your job to decode your therapist.

Practical aspects matter, too. Executive functioning challenges can make organising sessions stressful, so you might benefit from reminders, clear instructions, written summaries or a consistent time slot. These are reasonable adjustments, not signs that you’re uncommitted.

How do I know if therapy isn’t working – and what can I do?

If something feels ‘off’, it’s worth reflecting on your experience.
You might ask yourself:

  • Do I feel understood as a neurodivergent person?
  • Are my sensory and communication needs considered?
  • Do I feel safe enough to be unmasked?
  • Do I leave sessions feeling supported – or exhausted?
  • Am I adapting to the therapist, rather than the other way around?
  • Sometimes therapy doesn’t work because the fit isn’t right – not because you are ‘too much’ or ‘too difficult’.
  • You are allowed to ask for adjustments, give feedback, review how sessions are structured, or change therapists if needed. You deserve therapy that works for you.