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By Elizabeth Stamatelatos
CBT is one of the most widely used and evidence-based psychological therapies. Yet for many neurodivergent people, it does not feel safe or helpful. This tension is increasingly visible. As one social media quote puts it: “CBT is not affirming at all at its core and most autistic leaders and agencies worldwide openly oppose any behavioural therapies for us.”
Views like this are not isolated, and they cannot be ignored.
Much of CBT’s evidence base and many of its core protocols were not developed with neurodivergent experiences in mind. As a result, some people experience it as an approach that tries to ‘normalise’ difference—that is, to encourage individuals to mask, suppress or change their natural ways of thinking, feeling, or behaving to appear more typical—rather than understand distress.
Techniques such as thought balancing and the concept of cognitive distortion can feel invalidating—sometimes described within the autistic community as a form of ‘self-gaslighting,’ particularly when experiences of rejection or discrimination are very real.
At times, CBT can cause harm. But CBT is not a static model. It has always evolved, and it can continue to do so.
Why standard CBT training falls short for neurodivergent clients
There is a lack of specialist training available in neurodiversity-affirming CBT. While diversity is part of the core CBT curriculum, therapists are increasingly working with neurodivergent clients without the depth of training this requires. In short-term standardised therapies, there can be an over-reliance on protocols, increasing the risk of misunderstanding different communication styles, misinterpreting distress, or setting goals that do not reflect the client’s needs.
The skills gap means many therapists may feel underprepared, unsure how to adapt their work, and worried about getting it wrong. Some clients report spending years in therapy before their neurodivergence was recognised, often only when they worked with a neurodivergence-informed practitioner. Without meaningful, specialist training, standard CBT can fall short—and at times repeat the very harms already described.
Why CBT needs new research, not just adaptations, for neurodivergent people
While some research into new models for neurodivergent clients, much of what is described as CBT for autism involves adapting existing models or modifying protocols using deficit-based or neuro-normative approaches. This assumes the original model is universally applicable. However, neurodivergent experiences may involve differences in cognitive processing, sensory sensitivity, and emotional awareness that are not fully catered for in those models.
We need to move from adaptation to co-creation, developing approaches grounded in neurodivergent lived experience, exploring different processing styles, and rethinking assumptions about how people engage with therapy. This is not about rejecting CBT but evolving it. In doing so, we can develop new skills and insights that benefit all clients.
If the evidence base doesn’t reflect the people CBT is working with, it isn’t truly evidence-based.
How neurodivergent lived experience is redefining effective CBT
The rise of social media has allowed neurodivergent individuals—once often isolated—to connect, share experiences, and build communities globally. People are openly discussing masking, sensory overwhelm, and burnout. They are also reflecting critically on therapy, including the harms they have experienced from approaches such as applied behaviour analysis and standardised CBT, as well as what has helped.
At the same time, therapists are actively seeking guidance on how to work more effectively with neurodivergent clients. This represents a powerful form of collective knowledge-building that the profession can learn from. Of course, not all information online is accurate. But dismissing it entirely risks repeating past mistakes. For many clients, social media is where the language of neurodivergent experience is being shaped and where they first feel understood.
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What neurodiversity‑affirming CBT training should include
Better training needs to go beyond surface-level awareness. It should include a deeper understanding of neurodivergent processing and the impact of environments on well-being. This includes areas such as sensory processing, alexithymia, monotropic attention, interoception, physical differences, and the cumulative stress of being part of a minority group. It should also challenge neuro-normative assumptions about behaviour, communication, and social norms.
Crucially, this training must be co-produced with neurodivergent professionals and people with lived experience. The benefits are both practical and ethical. It will increase therapist confidence, develop stronger therapeutic relationships, and create more meaningful outcomes.
Raising CBT to deliver equitable, effective therapy
We can ensure equity by raising the standard of care. Better training leads to better understanding, which leads to better therapy. The skills needed to work well with neurodivergent clients—flexibility, curiosity, collaboration, competence, humility—are the same skills that underpin good therapy for everyone.
Elizabeth Stamatelatos is a lead cognitive behaviour therapist with a specialty in neurodiversity, a supervisor and advocate for neurodivergent voices and lived experience in mental health. She is also co-chair of the British Association for Behavioural and Cognitive Psychotherapies’ Neurodiversity Special Interest Group.
