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When Therapy Doesn’t Ask You to Fit In
How Art Therapy Can Offer a Neuroaffirming Space to Process Life
by Chloe Sykes, Art Psychotherapist and Yoga Teacher
(Art Therapy in Manchester | Therapy in Manchester)— Hey From Within
Sometimes therapy can feel like another place where you are expected to explain yourself.
Sit still.
Make eye contact.
Answer the question.
Find the right words.
Stay focused.
And if you cannot do those things in the expected way, it can be easy to wonder whether you are the problem.
But what if therapy could begin somewhere different?
What if the space adapted too?
What if you could move while you talked, draw before you spoke, take longer to process a question, look at something you had made instead of directly into another person's eyes, or sometimes say very little at all?
For some neurodivergent people, these differences can make a therapeutic space feel more accessible.
This is part of what I mean when I talk about neuroaffirming art therapy.
It is not about providing therapy because someone is neurodivergent. It is about recognising that a person who is struggling with anxiety, overwhelm, relationships, identity, burnout, grief, trauma, low self-esteem or simply finding life difficult may benefit from a therapeutic environment that does not ask them to constantly work against the way they experience the world.
What Does Neuroaffirming Therapy Mean?
For me, neuroaffirming practice starts with a simple question:
What if we understand the person before we try to change anything?
Neuroaffirming therapy does not mean ignoring difficulties. Someone may be exhausted by sensory experiences, struggling with relationships, overwhelmed by everyday demands or unsure how to communicate what they need.
Someone with ADHD may be struggling with attention, impulsivity, restlessness, organisation or the impact these experiences have had on relationships, education or work. Someone who is autistic may be navigating sensory differences, communication expectations, social exhaustion or the effects of masking. People may also experience more than one form of neurodivergence, alongside anxiety, depression, trauma or other mental health difficulties.
These experiences deserve support.
But the aim does not have to be to make someone appear more neurotypical.
Sometimes a more useful question is:
How can we help this person understand themselves, recognise their needs and find ways of navigating life that feel more sustainable?
This might involve adapting the therapeutic environment, changing the way questions are asked, allowing different forms of communication and recognising strengths alongside difficulties.
The National Autistic Society's SPELL framework similarly emphasises adapting environments and approaches around the individual, with structure, empathy, low arousal and positive approaches forming part of its person-centred framework. NICE guidance for ADHD also highlights individual strengths, environmental modifications and tailoring support to a person's circumstances and needs.
There is no single neurodivergent experience.
So there cannot be one perfect way of making therapy neuroaffirming.
The person in front of me needs to help shape the space.
When Words Are Not the Only Way In
One of the things I notice in art therapy is how much can change when communication does not have to happen through words alone.
A client might arrive wanting to talk while moving their hands constantly.
Another might prefer to look at a piece of artwork while we speak.
Someone else might need to make an image first and only later find the words to explain it.
Sometimes the artwork becomes a third object between us.
For someone who finds eye contact uncomfortable, this can create another way of being in relationship without the pressure of maintaining direct eye contact throughout a conversation.
The art gives us somewhere to look together.
It gives thoughts somewhere to land.
For someone with ADHD, making while talking or having something to do with their hands may also make it easier to stay engaged with a conversation. Movement and changes in position can be part of creating an environment that works with, rather than unnecessarily against, how someone is able to concentrate. NICE specifically includes changes to seating, lighting, noise, distractions and opportunities for movement within examples of environmental modifications for ADHD.
Art does not have to replace talking.
It simply gives us another language.
Processing, Movement and Pace
Sometimes I ask a question and there is silence.
That silence does not necessarily mean the person does not want to answer.
They might still be processing the question.
They might be working out what they think.
They might need to experience the question internally before deciding whether they want to respond.
Art making can naturally create space for this.
A pencil moves across paper.
Clay is pressed between hands.
A collage begins to take shape.
There is no expectation that every thought needs to be immediately translated into language.
For some people with ADHD, movement can also support attention and engagement. For someone who is autistic, reducing unnecessary sensory or social demands may make it easier to stay present. For someone who experiences both, these needs may overlap, change or sometimes conflict.
This is why I try not to make assumptions based on a diagnosis.
One person may need movement.
Another may need quiet.
Someone may want lots of conversation.
Someone else may need long pauses.
And the same person may need something different next week.
Tolerance can change depending on sleep, stress, sensory load, masking, relationships and what has already happened that day.
Therapy needs to be responsive to that.
Creating Predictability Without Making Therapy Rigid
For some clients, knowing what will happen in a session is important.
So we might create rituals together.
Perhaps there is a familiar way of beginning.
Perhaps we check in using an image.
Perhaps the art materials are laid out in a particular way.
Perhaps we finish by returning to something familiar.
These rituals are not rigid rules. They can create a sense of predictability, which may make it easier to approach something unfamiliar.
The National Autistic Society's SPELL framework identifies structure and preparation as ways of supporting autonomy and reducing uncertainty. NICE guidance also recognises the importance of structure and individualised environmental modifications when supporting people with ADHD.
Sometimes knowing what is going to happen next gives someone enough safety to become curious about what is happening inside.
Sensory Needs Are Individual
There is no single sensory environment that works for every neurodivergent person.
One person might find a particular texture regulating.
Another might find it unbearable.
Someone might need movement.
Another might need stillness.
One person might find a visually busy room distracting.
Someone else might barely notice it.
Sensory experiences can also change depending on what else is happening.
This is why I invite clients to notice the therapy space itself.
What does the lighting feel like?
What sounds are present?
Which art materials feel inviting?
Which feel uncomfortable?
Does the room feel containing?
Is there too much happening?
Would movement help?
Would less stimulation help?
NICE recommends considering environmental modifications for people with ADHD, including changes to seating, lighting, noise, distractions and opportunities for movement. The National Autistic Society similarly emphasises adapting environments to the specific needs of each autistic person rather than assuming one approach will work for everyone.
There is no checklist that can tell me exactly what someone needs.
The person needs to help me understand.
Looking Beneath the What Can be Seen
Sometimes what we see on the surface is only a small part of what someone is experiencing.
A young person may appear to be avoiding something.
An adult may seem withdrawn.
Someone might become angry, shut down, become perfectionistic or suddenly need to leave.
Someone with ADHD might appear distracted or restless when they are actually overwhelmed, bored, anxious or struggling to organise what they are experiencing.
Someone who is autistic might withdraw after spending a long time managing social or sensory demands.
And sometimes there is no obvious explanation at all.
It can be tempting to focus only on the behaviour.
But beneath the surface there may be sensory overload.
Masking.
Anxiety.
Shame.
Unmet needs.
Fear of being misunderstood.
Communication difficulties.
Identity questions.
Social exhaustion.
Previous experiences of rejection.
Or simply the accumulated effort of trying to function in environments that do not always make sense to them.
This is where I find the iceberg metaphor useful.
The behaviour we can see is not necessarily the whole story.
It is an invitation to become curious.
Not:
"How do we stop this?"
But:
"What might this be communicating?"
Exploring Masking and Identity
Projects such as Sonia Boué’s Neurophototherapy, shared by Autograph, explore how photography and collage can create space for neurodivergent people to revisit childhood, identity and the different ways they may have learnt to present themselves to the world. The project offers a powerful reminder that creativity can sometimes help us notice the parts of ourselves that have been hidden, adapted or changed in order to fit in.
Masking can be part of the therapeutic conversation for some neurodivergent clients.
For autistic people, masking can involve consciously or unconsciously adapting behaviour to fit social expectations. It may include hiding sensory responses, rehearsing conversations, suppressing interests or copying other people's behaviour.
For someone with ADHD, there can also be experiences of working hard to hide difficulties, overcompensating for challenges with organisation or attention, or developing strategies to avoid being seen as lazy, disorganised or "too much".
These experiences are individual, and masking is not something I would automatically assume needs to be removed.
It is something we can become curious about if it is relevant to the person's needs.
What does it feel like to constantly monitor yourself?
Which parts of yourself feel acceptable to show?
Which parts have been hidden?
Where do you feel most able to be yourself?
What happens when you stop performing?
Art can offer a gentle way into these questions.
Perhaps someone creates two images.
Perhaps they use colour, symbols, collage or characters.
Perhaps they do not want to make an image about masking at all.
The pace belongs to them.
The focus of therapy belongs to them.
Art Therapy Is Not About Being "Good at Art"
You do not need to consider yourself creative.
You do not need to know what your artwork means.
You do not need to make something beautiful.
And you do not have to make art in every session.
Sometimes we might use guided drawing.
Sometimes clay.
Sometimes collage.
Sometimes a large piece of paper.
Sometimes something more structured.
Sometimes something more open-ended.
Sometimes we might talk.
Sometimes we might sit quietly.
The art-making process is selected according to the individual, their needs, interests and sensory preferences.
This flexibility is one reason art therapy can be an appropriate modality for people who find conventional talking therapy difficult, tiring or restrictive.
Research specifically exploring art therapy with autistic children and young people is still developing. A 2025 systematic review of 12 randomised controlled trials found promising results across several outcomes, but the authors also identified limitations including small samples, short intervention periods, high risk of bias and generally low methodological quality. This means the findings are encouraging, but further rigorous research is needed.
For ADHD, the evidence and clinical guidance are different, and I would not suggest that art therapy is an ADHD treatment. NICE recommends that ADHD support should be based around the person's individual needs, circumstances, strengths and goals, with environmental modifications considered as part of care.
For me, this reinforces something important:
The artwork is not the intervention on its own. The relationship, environment and individual needs all matter.
A Space That Can Adapt
For me, neuroaffirming art therapy is not about having the perfect sensory room or knowing exactly what every neurodivergent person needs.
It is about being willing to notice.
To listen.
To adapt.
To ask rather than assume.
To recognise that behaviour can communicate something.
To value strengths alongside difficulties.
To understand that communication does not always look like talking.
And to remember that the person sitting in front of us is more than a diagnosis, a difficulty or a list of behaviours.
Sometimes therapy begins with being allowed to move.
Sometimes it begins with a piece of paper between two people.
Sometimes it begins with not having to make eye contact.
Sometimes it begins with being able to talk about something you love without being made to feel that you are too much.
And sometimes it begins with hearing:
"You are welcome to bring your authentic self here when you feel ready."
Neuroaffirming Art Therapy in Manchester
You might be a neurodivergent adult who has spent years trying to understand why certain things feel harder than they seem to for other people.
You might be exhausted from masking.
You might be navigating anxiety, burnout, grief, relationships, identity or a difficult life transition.
You might have ADHD and feel overwhelmed by the expectations of keeping everything organised, managing relationships or constantly trying to concentrate.
You might be autistic and trying to understand your needs, sensory experiences or the impact of years of adapting yourself for other people.
Or you might simply have reached a point where you know that something is not feeling right and you would like somewhere to explore it.
Parents may also be looking for support for a neurodivergent young person who is struggling.
Perhaps they are overwhelmed at school.
Perhaps they are withdrawing.
Perhaps communication has become harder.
Perhaps emotions feel difficult to manage.
Perhaps they seem to be holding everything together outside the home and falling apart when they finally feel safe.
Art therapy does not need to begin with a diagnosis.
It can begin with the person.
What are they experiencing?
What feels difficult?
What helps?
What makes things harder?
What do they wish other people understood?
And what might they need from therapy?
I offer individual art therapy sessions in Manchester for adults, children and young people. My approach is person-centred, relational, attachment-informed and trauma-informed, with the therapeutic environment adapted around the individual wherever possible.
We can use art, talking, movement, sensory exploration, silence or a combination of these.
You do not need to know exactly what you need before you reach out.
Sometimes the first step is simply having a conversation about what is happening and whether art therapy feels like an appropriate space for you or your young person.
You do not have to arrive with the right words. We can start from where you are.
by Chloe Sykes, Art Psychotherapist and Yoga Teacher
(Art Therapy in Manchester | Therapy in Manchester)— Hey From Within
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