ALL THINGS How to Identify a Neuroaffirming Therapist

By Laura A. Ryan, OT, OTR, OTD

“Neurodiversity is the natural variation in all of our brains. Just like our fingerprints, no two are alike.”

AN INCREDIBLY IMPORTANT MOVEMENT GAINING TRACTION IN THE THERAPY WORLD IS THE RECOGNITION OF THE MYRIAD OF VARIATIONS IN NEURODIVERSITY AND THE IMPORTANCE OF HAVING ONE’S PERSONAL NEURODIVERSITY PROFILE AS THE CENTER OF THE THERAPY PRACTICE.

In formal language, neurodiversity-affirming practice includes ethics, justice, and equity in supporting autistic and otherwise neurodivergent individuals (OTs for Neurodiversity, 2022) and the recognition of neuroaffirming interactions as a basic human right. In practical language, neurodiversity-affirming practice honors the importance of recognizing, embracing, and respecting the different experiences each individual brings to the therapy table and uses those experiences to form an individualized and collaborative therapeutic relationship. The individual is the primary stakeholder in the therapy process and, as such, should expect their voice and vision to be the central part of the therapy process.

The Therapist Neurodiversity Collective (2023, January 1) posted an informational brochure that listed the eight signs of a respectful therapist who embraces neurodiverse affirming practice, which include:

1. One should presume competence. The assumption that the individual CAN versus CANNOT should, at all times, be utilized. Presuming competence facilitates dignity and leads to greater opportunity for authentic real-world experiences. By presuming competence, you recognize an individual is greater than the sum of their parts, that traditional means of showing competence (such as standardized testing) do not support the many facets of an individual, and that competence may be impacted by environmental and societal barriers rather than individually constructed ones.

2. There should be the provision of barrier-free access to assistive and augmentative communication. Being able to communicate is a basic human right, and the means to communicate should be readily available for all. The means of communication can vary but should always be upheld as valid and impactful.

3. The expression of self-determination should be facilitated. All individuals have the capacity to make their own choices and, ultimately, choose the direction of their life. This capacity should be at the center of the therapy process. Self-determination should begin at a very young age by giving a child choices or asking for their thoughts and respecting their voice. Self-determination progresses toward adulthood by providing an individual an active role in choosing meaningful activities to pursue after high school graduation.

4. Advocating for inclusion and/or least restrictive measures should be embraced. All individuals deserve equitable and unrestricted access to all settings and the support of accommodations to make access to those settings possible.

5. Self-advocacy skills should be facilitated. Through active collaboration, individuals will be given the education, tools, and support needed to make empowering decisions around the direction of their life.

6. A strength-based approach will be utilized. Potential is always seen and embraced. Goals should be built upon the natural and inherent strengths and potentials the individual possesses. Additionally, the creation of such goals should be a collaborative process.

7. Body autonomy is respected at all times. The boundaries of one’s body and the space around such is respected and upheld at all times unless otherwise specified by the individual. Stimming is seen as a necessary bodily response. Practices such as hand-over-hand assistance are done with the individual’s consent.

8. Compliance-based practices are to be avoided. Compliance-based practices aim to conform behavior to a neuro-normative culture and do not support the above principles.

The profession of occupational therapy recognizes the importance of neuroaffirming therapy. Since its inception in the late 1800s, occupational therapy has recognized the healing value of engaging in occupations that are personally meaningful and fulfilling and has used meaningful occupation as the cornerstone of the approach.

More recently, Dallman et al. (2022) speaks to the ethical mandates of occupational therapy including facilitating well-being by recognizing the unique intersection of one’s needs, preferences, and environments; promoting capabilities by providing not only direct intervention but also reducing environmental and cultural barriers; and creating meaning through the myriad of unique interactions between the individual and their surroundings.

The vision of the American Occupational Therapy Association (AOTA) states occupational therapy is an inclusive profession that maximizes health, well-being, and quality of life for all people, populations, and communities through effective solutions that facilitate participation in everyday living (AOTA.org, 2022). In order to fulfill this vision, occupational therapy’s approach when working with an individual should be cost effective, evidence-based, and person centered; collaborative by working with the individual and their family and community to produce effective outcomes; and accessible by providing culturally responsive and individualized services.

Occupational therapy practitioners believe that engaging in meaningful occupations is motivating and relevant. There are many benefits to providing therapy through meaningful occupations. When the therapy includes relevant occupations or pastimes, the skills that are achieved through addressing these occupations create a context that is understood by the individual. This understanding allows the transfer of learning to other areas of life. Additionally, therapy is led by the individual as they fulfill the activities that are inherently important to them.

Engaging in a collaborative therapy process (individual-family/friends/caregivers-therapist) with individualized focus and goals that are intrinsically valid upholds many, if not all, of the eight premises of neurodiverse practices but, more importantly, creates a personalized therapeutic alliance that leads to the ultimate of success.

References

American Occupational Therapy Association (2023, January 3). Mission and Vision. AOTA. https://www.aota.org/about/mission-vision

Dallman, A. R., Williams, K. L., & Villa, L. (2022). Neurodiversity-Affirming Practices are a Moral Imperative for Occupational Therapy. The Open Journal of Occupational Therapy, 10(2), 1-9. https://doi.org/ 10.15453/2168-6408.1937

OTs for Neurodiversity (n.d.). Home [Facebook page]. Facebook. Retrieved January 4, 2023 from https://www.facebook.com/neurodiversity.ot/ https://www.youtube.com/watch?v=WprLOcEyh6M Therapist Neurodiversity Collective (n.d.). Home [Facebook page]. Facebook. Retrieved January 1, 2023 from https://www.facebook.com/ NeurodiversityCollective

OT Spot (2023, January 3). History of Occupational Therapy. OT Spot. https://www.myotspot.com/history-of-occupational-therapy/ TEDxOcala. (2021, December, 15). Neurodiversity: the new normal [video]. Youtube.

Resources Therapist Neurodiversity Collective. https://therapistndc.org/

Least dangerous assumption. (2020, September, 15). In Wikipedia. https://en.wikipedia.org/wiki/Least_dangerous_assumption.

Laura A. Ryan, OT, OTR, OTD, is an occupational therapist who grew up on a large horse farm in Massachusetts. She has been practicing for 30-plus years and has been using hippotherapy as a treatment tool since 2001. She enjoys seeing the happiness and progress each person has achieved through the therapeutic impact of the horse. Laura has also developed a program for breast cancer rehabilitation using therapeutic input from the horse.

Email: hooves4healingot@gmail.com