This post was origially published as an article in Group Circle, the newsletter of the American Group Psychotherapy Association, Fall 2025.
I am a queer, trans, and autistic group therapist in Portland, OR. I had the pleasure of presenting a queer, trans, and neurodivergent special institute, and a trans-affirming group therapy workshop, at AGPA Connect 2025 in San Francisco. I was gratified to feel well-received by the AGPA community, and I am thankful to my institute and workshop attendees for the opportunity to learn with them. I am writing this article to explain the importance of neuroaffirming therapy, to provide some suggestions for making groups more neuroaffirming, and to connect with other neuroqueer group therapists. Where relevant, I discuss my lived experience.
Introduction and Definitions
In recent years, clinicians and the public have increasingly been recognizing that some people have brains that do not conform to cultural expectations. Autistic people, ADHDers, and folks with dyslexia, dyspraxia, dyscalculia, and Tourette’s, are examples of people with different brains. Neurodivergence means that some nervous systems differ from this cultural ‘normal.’ It is debatable whether neurological norms are statistical, inborn, learned, or imposed; probably it is a combination of these. Brains that can conform to these cultural norms are neurotypical (Walker, 2021).
Cultural institutions and practices such as education, work, psychology, and psychotherapy cater to and cultivate ‘normal’ brains. These fields have mostly sought to marginalize, pathologize, and control neurodivergent people (Price, 2022; Chapman, 2023). Institutions and practices that punish the neurodivergent and reward the neurotypical are neuronormative. In sum, neuronormative culture creates and rewards neurotypical people, and punishes and pathologizes neurodivergent people (Walker, 2021). Happily, in recent years, neurodivergence is becoming more accepted, and people increasingly accommodate the needs of diverse neurotypes. A neurotype is akin to a distinct style of brain.
Neuroqueer is where neurodivergence meets queer theory (Walker, 2021). This could mean queer, trans, and neurodivergent brains; or people whose practices make their brains neurodivergent; or neurodivergent people whose queer theory and practices subvert and resist neuronormativity’s hegemonic grip (Walker, 2021). Personally, my autistic, trans, and queer experience and life practices are an interwoven and inseparable whole cloth of joy, strength, pain, difference, and resistance.
Neuronormativity creates enormous pressure and friction for neurodivergent people. Minority stress theory is one way to conceptualize this process. It was first developed and applied to LGBT populations (Brooks, 1981; Meyer, 1995) and later extended to autistic people (Botha and Frost, 2020). Minority stress is the result of living in a society that is not built for you and which constantly creates obstacles, shame, and confusion about who you are and whether or not you belong. Minority stress leads to adverse life outcomes, and it can express as mental health symptoms. Therapists who treat the symptoms—rather than minority stress, internalized oppression, and the person-environment mismatch—miss the root causes of distress and risk recapitulating these harms.
Ideas have power, and I’m a fan of theory you can use. These definitions and their associated ideas around neuroqueer liberation have made a difference for me (Strong, 2024). They are theoretical tools for creating neuroaffirming groups, cultivating cultural humility, and accepting and accommodating neurodivergence. To make them useful, you have to use them.
Neuroaffirming Therapy
I think of neuroaffirming therapy as having three main components: 1) Understanding, accepting, and accommodating neurodivergence; 2) Reprocessing, deconstruction/reconstruction, and identity transformation; 3) Dealing with neuronormative hassles. These are interwoven processes, and they apply just as well to a neuroaffirming self-help journey. I’ll briefly explain each with personal examples.
Understanding, Accepting, and Accommodating Neurodivergence
Some people have known that they are neurodivergent for a long time; others have only recently learned about it. People are in different places in their different journeys. Neurodivergent people often suffer from shame, self-judgment, and internalized ableism. When neurodivergent people understand and accept their differences, they can acknowledge and work with their strengths and limitations.
Since self-identifying as an autistic person, I have relinquished years of misplaced shame and striving (i.e. holding myself to neurotypical standards) and reoriented to the things I actually enjoy and want to do in my life. I have learned more about what my needs actually are and how to accommodate them. For example, I am quite sound- and light-sensitive. I have started using supports, such as sunglasses and earplugs, and I have learned about which environments I can tolerate. I continue to work to understand, accept, and accommodate my needs in different life situations.
Reprocessing, Deconstruction/Reconstruction, and Identity Transformation
Neurodivergent people often need to reconceptualize the past, reprocess their feelings and needs, and come to a new self-understanding. They may need to relinquish long-held habits of body and mind, find new ways to be themselves, and gain more flexibility around masking that used to seem automatic and compulsory. (Neurodivergent people use masking behaviors to camouflage and compensate for their differences, Pearson & Rose, 2021). People may feel grief about the past, relief at recognition, and longing for neuroaffirming community. Neurodivergent people may need to modify their self-concept to include their specific strengths and vulnerabilities. This can make it much easier to accommodate their needs and request accommodations from others.
Personally, accepting autism has opened the door to meeting my authentic needs and enjoying their satisfaction. For decades, I used striving, perfectionism, and intellect to compensate for my differences. This was a constant and dissatisfying struggle. In my early twenties, I experienced a period of intense emotional and existential turbulence, which was diagnosed as bipolar (II) disorder. Looking back, this is better explained as autistic burnout due to minority stress, unmet needs, and masking (Strong, 2024). Since retelling my life story, I am more compassionate towards myself, more realistic about my needs, and more forgiving about the ways I have tried to survive neuronormative culture. These change processes take place on somatic, social, emotional, conceptual, imaginal, and spiritual levels.
Dealing with Neuronormative Hassles
Most neurodivergent people will need to relate to neuronormative society in some fashion for the rest of their lives. Each contact with neuronormativity and ableism occasions minority stress. Thus, there is an ongoing need for neuroqueer resilience when dealing with ableist culture. Anticipating needs and challenges, having a deep well of self-compassion and inner resources to draw on, and building neuroaffirming community can all help buffer against such insults and injuries.
I’ll use my experience of AGPA Connect 2025 as an example, not because it was terrible, but because it is illustrative. Initially, the presenter application process, which I began in May 2024, demanded a great deal of executive function. The forms were confusing and the online platform was finicky. Even my strong executive function skills were taxed. I suspect the process is insurmountable for many folks with executive function challenges.
I have sensory sensitivities and significant dietary restrictions (two common autistic traits.) Thus, travel is stressful and exhausting. The airport lighting, the din of traffic and plane engines, the insufferable reading lights in the plane, the tinny speakers and the captain’s blaring announcements, all impinged on my sensitivity and eroded my ability to self-regulate. Finding food I can actually eat in an airport is always a struggle, so I brought my own. This added weight to my baggage, which stressed my injury-prone shoulders.
The built environment of the hotel was mostly tolerable, both because I wore sunglasses and a hat constantly, and because I had been there before and knew what to expect. Still, I switched rooms twice, for fear the street noise would keep me up at night. Workshops with many simultaneous conversations were extremely challenging due to my sensory processing issues. My high-quality earplugs and noise-cancelling headphones were often not enough. I felt overstimulated, overwhelmed, and exhausted every night. Finally, although I made my dietary restrictions clear when I registered, I could eat almost none of the food served at the institute faculty tables or the Foundation banquet. (I believe this is the hotel’s shortcoming.) I subsisted on roasted almonds and ricecakes, and by day five, my stomach was quite irritated.
I give these examples not to complain about Connect 2025, but to explain the kinds of hassles I face as an autistic person, and what participating in neurotypical society costs me. Certainly, travel and conferences are stressful for many people, we all make sacrifices to participate in activities we enjoy, and we all deal with challenges and discomforts in doing so. But for neurodivergent people (as for folks in other marginalized identity positions), the costs are higher and seemingly at every turn.
I’m glad to report that my social differences were well-accommodated at Connect. I generally felt accepted and comfortable as a visibly queer and trans person, which was delightful, and I was able to connect with other queer, trans, and neurodivergent community members. I have high needs for interpersonal contact and intellectual stimulation, and these were well met.
I was also able to use a tool to self-accommodate. Over the past several months, I have been developing an autism accommodation card sort. About a week before Connect, awash in anxiety, I used it to analyze my needs. This instance of using the card sort helped me realize that 1) I would need to work hard to accommodate some of my needs, which normalized and eased my anxiety; and 2) my needs for social connection and stimulation would be very well met at Connect. This helped me stay motivated for the experience, anticipate my needs, and plan my accommodations in advance. By helping me take care of myself, it also helped me show up for the folks in my institute and workshop. I feel proud to have offered AGPA’s first queer, trans, and neuroqueer special institute.
Neuroaffirming Group Therapy
My connection to my own neuroqueer identities allowed me to hold an emancipatory space in my institute and workshop. Neuroaffirming groups are perhaps best offered by neuroqueer therapists who are engaged in their own journeys of neuroqueer liberation (see Strong, 2024). Something special happens when group leaders share (some of) the marginalized identity positions of their group members. Leticia Nieto and colleagues (2014) articulated a developmental model of social justice skills. For people in an oppressed identity position, a turning point occurs with regular access to social space composed only of folks who share that identity position, and in which they discuss the reality of their shared oppression (Nieto et al., 2014). That said, it is meaningful and important for neurotypical group leaders to adopt neuroaffirming practices. Moreover, in any group, there may be a mix of neurotypes. Here are five suggestions for neuroaffirming group therapy for all group leaders.
1. Listen to peoples’ access needs and accommodate them.
Different people have different needs. These can include sensory sensitivity, the need to stim, the need for things to be explained differently, physical impairments, the need to use assistive devices, and so on. Group leaders can accommodate neurodivergence by not imposing neurotypical norms on group members.
2. Get curious about your own unmet needs.
As group leaders, we may have needs that are poorly accommodated by our assumptions about how group therapy is ‘supposed’ to work, or what being ‘professional’ means. Growing as a neuroaffirming group therapist includes accommodating your own needs and preferences, rather than policing yourself according to neurotypical standards.
3. Accept neurodivergent communication styles.
Neurodivergent people think, feel, act, and experience the world differently, so it makes sense that they communicate differently. This includes differences in narrative style, eye contact, emotional expression, cognition, and perception. Stay curious and accommodate different styles of communication.
4. Let my people stim.
Many neurodivergent people need to move their bodies in ways that neurotypical people do not. For my special institute at Connect, I brought a bag of stim toys and put them out on the table. Those toys sent the instant message that stimming is acceptable and you’re in good company. Offering stim supports that members can use to modulate their activation is an easy and powerful neuroaffirming practice.
5. Keep learning about neurodivergence and neuroaffirming therapy.
When group leaders accept neurodivergence as a bona fide difference to be accommodated, rather than a clinical problem to be coped with or overcome, neurodivergent members can engage fully with group. Becoming a neuroaffirming group therapist means cultivating curiosity, cultural humility, and respect. This includes ongoing learning from neurodivergent people, as neurotypical ’experts’ have an unfortunate habit of throwing us under the bus (Price, 2021).
Becoming a Neuroqueer Group Leader
The process of neuroqueering my group leadership style has brought me face-to-face with my own vulnerability, tenderness, strengths, foibles, and limits. The work is hardly done, but I would like to offer some initial notes. Pleasure, ease, and curiosity have been watchwords for me in this process.
As a neuroqueer group therapist, I would like to be self-accepting, self-accommodating, and self-aware. I would like to use masking behaviors if I wish, but flexibly and with a light touch. I enjoy and want to continue spending time with my own neuroqueer community, so that my own cup is full. That way I can offer myself to my groups without wanting them to meet too many of my needs. I also want to be able to accept help and nourishment from my groups and group members, in a way that is humane, appropriate, and consensual.
I would like to keep recognizing, enjoying, and expressing my own organicity. I would like to let my aliveness compost the ableism and neuronormativity I have internalized, so that it can make good medicine, good dancing, good stories, and good love for myself and my community. I want to keep coming back to aliveness, and keep learning from my aliveness and others’ aliveness about how to live in and enjoy and heal this world. And I want the strange hillock of expertise, training, and administrative skills I have built be a support for doing this alive work in the world.
I hope these remarks are helpful for group leaders of any neurotype. If these words inspire you, I would be happy to connect. Please feel free to get in touch.
References
Botha, M., & Frost, D. M. (2020). Extending the minority stress model to understand mental health problems experienced by the Autistic population. Society and Mental Health, 10(1), 20–34. https://doi.org/10.1177/2156869318804297
Brooks, V. R. (1981). Minority stress and lesbian women. Lexington Books.
Chapman, R. (2023). Empire of normality: Neurodiversity and capitalism. Pluto Press.
Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior, 36(1), Article 1. https://doi.org/10.2307/2137286
Nieto, L., Boyer, M. F., Goodwin, L., Johnson, G. R., Smith, L. C., & Hopkins, J. P. (2014). Beyond inclusion, beyond empowerment: A developmental strategy to liberate everyone. Cuetzpalin.
Pearson, A., & Rose, K. (2021). A conceptual analysis of Autistic masking: Understanding the narrative of stigma and the illusion of choice. Autism in Adulthood, 3(1), 52–60. https://doi.org/10.1089/aut.2020.0043
Price, D. (2022). Unmasking autism: Discovering the new faces of neurodiversity. Harmony Books.
Strong, S. D. (2024). Learning to be an Autistic therapist: Personal steps towards an Autism-affirming psychotherapy. Ought: The Journal of Autistic Culture, 6(1). https://doi.org/10.9707/2833-1508.1196
Walker, N. (2021). Neuroqueer heresies: Notes on the neurodiversity paradigm, autistic empowerment, and postnormal possibilities. Autonomous Press.