Mental Health Awareness Month: Mindfulness and Ableism

As a a part of mental health awareness month, I wanted to share some thoughts on various therapy approaches that may be helpful or harmful specifically to the neurodivergent community.

Unfortunately, I have often had clients come to me with horror stories from previous therapy relationships, feeling dismissed, gaslighted, and misunderstood. This is because many therapy modalities do not account for different neurologies and assume everyone will heal the same way or would have similar goals. And many therapists are not effectively trained in neurodiverse affirmative approaches for working with Autistic clients, clients with cognitive disabilities, or ADHD.

So let’s start with a really common therapeutic approach: mindfulness. Mindfulness can be really great for some, but can actually create more anxiety in others when not done in a person-centered approach. Mindfulness is all about regulating your emotions and feeling grounded, but too often people assume the only way to go about this is by taking some deep breaths, meditating, or doing yoga. I have had multiple clients who have shared that deep breathing only creates more anxiety. And when I’m working with a kid with ADHD, is it really realistic of me to expect them to sit still for even a few minutes to focus on their breathing? I think not, and that would also be a really ableist approach.

Mindfulness also requires a sense of awareness of one’s bodily symptoms. So if you notice your heart is racing, being able to say “Okay, my heart is racing which means I’m feeling anxious. That’s okay, but what can I do to manage/cope right now?”. But what if you struggle with noticing cues from your body, as many neurodivergent people do? This skill is called interoception….the ability to take cues from our bodies and process them to make decisions about what we need. This can be noticing that you’re hungry, thirsty, tired, sore, in pain, or sick. It can also be difficult for many Autistic people to process neuroception, or the ability to process cues from our environment to make safe decisions. When the environment is filled with so many signals and someone struggles to filter them all out, this creates an enormous amount of sensory overload that can be difficult to manage, especially by simply taking some deep breaths.

But that doesn’t mean that mindfulness can’t be useful, it just needs to be adapted to each individual. If mindfulness is all about being in the present moment, therapists should explore with a client what DOES work for them rather than simply throwing ableist suggestions their way because that’s what works for neurotypicals. Here’s an example….when I’m feeling stressed or overwhelmed what I have found most calming is to organize. I take out of my files and completely reorganize them, or I clean out my closet, or I make lists. Many neurotypical people would find this to add on to their stress, but not me! To me, this is mindfulness, because I am giving my brain a break from whatever is causing the stress and anxiety, finding a way to feel in control and grounded, and then I am better able to problem solve. If I tried to just take deep breaths, I know I would continue to think about whatever was causing me stress.

For some clients, going to an “inner world” can be their mindfulness. So imagining not just some calm and peaceful visualization, but imagining themselves in another world, where they feel in control. It could be entirely created by them, or maybe it’s putting themselves in their favorite book or movie, or maybe it’s just having a conversation with someone mentally that would be interesting to them. Inner worlds are incredibly common for many neurodivergent people, and can serve many different purposes including escaping reality, feeling in control, practicing a conversation, building more confidence, or just something to fill the time when bored.

Being mindful of our needs and taking care of ourselves is incredibly important, but it’s even more important to recognize that this is going to look different for different people. Mindfulness and self-care have become buzz words that are often equated to yoga, meditation, and a spa day. If that works for you, great. If not, that’s okay too. Think outside the box, think about times you have felt stressed and focus on what HAS worked and how that can be recreated. There is no need to force yourself to sit still and breathe if you know that’s not your style, but it’s still important to explore your own neurodivergence, needs, triggers, and creative coping skills. Want to imagine yourself in an elven forest while listening to LOTR soundtrack because you feel the most regulated and grounded in that moment? Awesome, you just found your mindfulness hack!

Not all brains work the same, and that’s a good thing!

Ellen Merker, LPC