E32 – Neuro-Affirming Therapy + guest Romy Graichen

Julie Legg speaks with Romy Graichen from Therapy Advances; a neurodivergent therapist, trainer, and consultant, about the intersection of ADHD and therapy. Diagnosed later in life with ADHD, autism, dyslexia, and dyspraxia, Romy shares her unique journey and the challenges she faced navigating a world often shaped by neurotypical norms.         

Together, they discuss how therapy can be more inclusive and empowering for neurodivergent individuals, emphasizing the transformative potential of integrating lived experiences into therapeutic practices. Romy shares her work in training therapists to move beyond traditional, neurotypical frameworks, fostering a deeper understanding of the unique needs and strengths of neurodivergent clients. She highlights the importance of adapting communication styles, challenging biases, and creating affirming spaces where clients can feel seen and understood.

KEY TAKEAWAYS

  • Romy’s Personal Journey: How her late diagnoses brought clarity to lifelong challenges, reshaping her perspective on identity and capability.
  • Biases in Therapy: The neurotypical frameworks in traditional therapy often overlook the needs and experiences of neurodivergent individuals.
  • Inclusivity in Practice: Advocating for updated therapist training to prioritize neurodiversity and create affirming spaces.
  • Celebrating Strengths: Highlighting creativity, adaptability, and empathy as key ADHD strengths that flourish in supportive environments.
  • A Call to Action: Encouraging professionals to embrace change and develop tools that better support neurodiverse clients.

LINKS

TRANSCRIPT

JULIE: I’m Julie Legg, author of The Missing Piece and diagnosed with ADHD at 52. Welcome to ADHDifference. In this episode I chat with Romy Graichen from Therapy Advances. Romy is a dedicated advocate for ADHD and neurodivergent inclusion, drawing on her lived experiences as a multiple neurodivergent individual with ADHD, autism, dyslexia, and dyspraxia, to inform her work as a therapist, trainer, and consultant. Late diagnosed, she understands both the challenges and strengths of neurodivergence and focuses on creating affirming inclusive spaces for individuals and professionals. Romy, thank you so much for joining me today. [Hi. You’re welcome.] Look, you were first diagnosed with dyslexia in your 20s, and later with ADHD and autism in your early 40s. There’s a lot to pack in there. Can you share your personal journey with me?

ROMY: Yeah, sure. So yeah, so it started …  I was working in a school, and it was a music school. There were quite a lot of creative kids there and also staff. And my boss kept noticing that when I needed to read out phone numbers that I would often say 38 as 83 and so she just kind of clocked it. And then it was like “Have you ever thought about dyslexia?” and I’m like no, no. Like I was at university at the time, no one’s ever mentioned anything like that to me before. But it also just really hit right in the shame spot, like the things that I got wrong that I was covering up so heavily. And then I remember my third year at uni there was a lecturer who just really openly said “Oh and if I say something wrong, it’s just because I’m dyslexic.” And I was just like, oh you can just own it just like that? Okay. So I ended up going to student services and had an assessment with them and they were like “Yeah you’re dyslexic and you’re probably also dyspraxic but we can’t test for that here.” And all of a sudden, things just kind of was like oh so I mean I am clumsy but it’s not like it wasn’t willful and it wasn’t just a case of you just need to try harder. And I remember just going through a process of needing to settle that and seeing things a little bit differently. Anyway, life kind of goes on.  I met my then husband and I remember the day I met him. I was like oh, I think he’s autistic, but we got on really well. We had three kids and my youngest started displaying some autistic traits and certainly dyspraxia and also some ADHD traits. And my mum said “She is so much like you.” But I was like, really? Okay, well I can see the dyspraxia, and she’s like “Yeah but she also does this, this, and this and you did that all as a kid.” And I was like oh, okay. So then my second child ended up also getting a diagnosis and I was like oh okay, something’s going on here. So I asked for an assessment. And in the UK it I think it took about two years to get an autism and then I think then another year to get ADHD assessment, and that’s where we are.

JULIE: Wow, wow, absolutely. Now you’re a psychotherapist. That’s right. And you work heavily, you’re heavily involved with training therapists yourself, including a specialist diploma. And you’re addressing neurotypical biases in therapy. So could you tell me more about some common neurotypical biases that you encounter in therapy?

ROMY: Okay. So if we start right from the beginning, most therapy books were written by neurotypicals for other neurotypical. And in most therapy training and counsellor training there is absolutely no or very, very little mention of any neurodiversity. So people get skilled in how to you know, convey empathy with another neurotypical person but not really how it works when they’re not neurotypical. And so I started off my journey doing Person-Centered counselling and I actually found that doing that taught me how to mask better because I learned how to do conversations with neurotypical people better than I did before. And then I kind of learned about Transactional Analysis and that was much more. Like with Transactional analysis I kind of you know, the person who invented did wrote a book that’s What Do You Say After You Say Hello. You’re not neurotypical if you write a book like that, right? So much more incorporating some different ways of being I think in TA. But anyway, going back to your question, so for a very, very long time there was this belief that if you’re neurodivergent then you’re basically a neurotypical with a broken brain, and we just kind of need to fix what’s broken. Rather than this is a different operating system. You’re on Android and I’m on a Mac or on an Apple device and we need to find different ways to actually operate things across, how we communicate with each other. We do empathy … like I was saying, like empathy is so different. So there’s that. There’s also historically been a real heavy focus on actually on masking in therapy and getting clients to mask and getting clients to comply, which we know doesn’t work. Like people can behave in a particular way in therapy and then walk out of it and go “I feel even worse now. This is supposed to help me.” And I can see that you’re nodding so maybe this is resonating with you?

JULIE: Yeah, yeah. I think to be your authentic self in therapy is essential otherwise you’re not going to get to the bottom of issues, yeah. Masking is a terrible thing and especially such an intimate moment when you’re seeking help to some really big, really big challenges, wow. Now this neuro-affirming supervision … so you’ve written a chapter on that for an upcoming book that’s on autistic therapists?

ROMY: So it’s been written by autistic therapists. So everyone’s written a different chapter in it, yeah.

JULIE: Yeah so can you tell me about neuro-affirming supervision? Can you tell me more about that?

ROMY: So neuro-affirming supervision, just like neuro-affirming therapy, is about making sure that you look at: what does the person in front of you need? What are their sensory needs? What are their regulation needs? What are their communication differences? And not making assumptions around what you see but actually being there with curiosity and actually inquiring. You know, is it that I’m really boring right now because I’m actually boring myself? Or is it that … is there something here that’s actually not captivating enough? Is there something going on for the other person? Actually just inquiring about it without any judgment. So there’s a lot about that. There is a lot of therapists that have said that they felt that they needed to perform in supervision. They needed to comply and mask because they were so fearful that their supervisors were judging them because they were not doing therapy right, or they weren’t behaving in the way that they were expected to be. Reflective in this, on the moment, or in this on the spot, when actually we know their processing differences. Sometimes people take a week to actually go “Oh I get it now.” And it was seen as like “Oh this person’s really resistant.” Or, it’s caused a lot of supervisors to just disengage with supervision. And supervision is supposed to be a space where we can be honest. We can be really honest and go “I am struggling so much right now, and this person is totally like my mother. Or I feel like I’m 5 years old when this person says this and this or that person’s voice is just really grating on me,” or whatever. But in order to be honest, just like you were saying, in therapy in order to be honest we need to be able to feel safe and it’s really about that. It’s about kind of challenging people in our profession to know better and therefore to do better. Because if our therapists can be held appropriately, they’re going to be able to go out there and do the work in a much better way.

JULIE: That’s fabulous. When you were talking about processing, I know my ADHD brain does take a while to process things and at times I just need … I need to think and ponder and let my overthinking work for me and try and extract answers to the question, if you know what I mean. So I’m not particularly good at reactionary on-the-spot you know, kind of processing. Yeah. Especially for important questions and in therapy that’s obviously that magic time to yeah, to have a really good ponder and get the most out of that session, for sure.

ROMY: Absolutely and I think also in with therapy sometimes it’s so overwhelming like if you’re being asked a question and like with some of our ADHD processes it’s like “Oh my God. I can see like 110 different angles to this.” And because we have such a history of being gas-lit, or of being told that we’re not paying attention when we should be paying attention, there’s like so much fear also that kind of feeds into this which just kind of stuck. I was like I don’t know, which one of the 11-ty things are actually relevant right now. And that kind of leads me on get to, or kind of closing back to empathy. If we’re looking at ADHD, particularly ADHD, empathy is just as attention driven as everything else is in our lives. So if your attention just isn’t there for whatever reason and that’s not something  that should be any judgment on. If the attention just isn’t there then the empathy can’t be there either. If you’re completely done and spent, there can’t be any empathy, right. And if you’re a person that just has so much somatic empathy, like if you’re with somebody and you’re just having all the feels, you can exhaust yourself much more, right. And so in therapy there should be space to learn to regulate some of this. It’s almost like you can turn down the empathy dial and in theory that sounds really lovely, and in practice that might take a really long time. Like I think that’s the other thing, we often … like the six sessions and you get some work done is maybe something you can do with a neurotypical person. With neurodivergent folk you … time, I mean we have time blindness. Like time in itself is such a weird construct! So six sessions, what can you do? I mean in some ways you can do a lot, and in some ways you need so much more, and it really is okay.

JULIE: And this is part of your training? You’re training therapists to think this way and to look at it all at that angle. I think it’s marvellous. It’s really shaking up, shaking up the system I think, which is brilliant. And there’s more of … there’s more of us, you know. We’ve always been there but at least recognized now and diagnosed certainly helps us, yeah, process some challenges that we’ve had along the way. Which leads me to some questions about approaches and techniques that you use for your neurodivergent clients. Now, can you tell me about brainspotting and other sort of cutting-edge techniques that you use?

ROMY: Yeah of course I can. So, have you heard of EMDR? [No.] Okay. Well, brainspotting was developed out of EMDR. But, just as a side note, so what we do in brainspotting is we use a pointer and we find an eye position that actually correlates with either an emotional experience or with a calming experience in your body. And then we start to process, whatever we’re processing on, from that point. So we might be finding is it here, or is it stronger here, or does it feel stronger over here? Wow. And then what we actually find is we can go into trauma from a calmer place. So we might go, okay, where in your body do you feel calm, or grounded, or neutral whilst you’re still thinking of this? And I might go okay, so I’m feeling really activated in my arms and my legs and I just kind of feel like I want to run, but actually if I’m thinking about a calm place, and even just looking for that calm place in itself is calming and grounding. I’m noticing that actually my nose feels calm, or my earlobe feels calm, or my cheek or whatever. And then we go okay, just let’s focus on that cheek and let’s just hold that eye position. Like maybe this one was the right eye position. Let’s just hold that eye position whilst you’re focused on that calm place and it’s absolutely fascinating. So I’ve had people who have said after one session of this, they’ve never felt safety in their body and all of a sudden they can actually tune into safety by looking at a particular spot. And they’re just absolutely amazed. So I’m a huge fan of brainspotting which I’m a consultant, and I’m currently co-writing some training on helping other brainspotters working with neurodivergent folks.

JULIE: That’s so fascinating. But how wonderful that the results are huge. That’s wow! The things I didn’t know. Thank you for filling me in on that, that’s great. Oh, you’re very welcome. Now you practice your neurodivergence affirming therapy, what does that look like in practice? And you know, and I could put it another way, if someone was to yeah use your services, or use yeah, what would it look like?

ROMY: So at the moment I only work online. So I meet them in a Zoom room, we chat for a bit just to kind of get to know each other a little, and we find out what they’re struggling with, what they might want to work on. I might talk about some of the different tools that I’ve got available. Specifically around ADHD I find that common topics that bring people to therapy are, for women, it often is that loss of a sense of self because, because they’ve been masking their entire lives. It might be that they’re in complete burnout. It might be people sometimes come because they’re struggling with work and feeling like they’re really not being productive enough and then they do like an hours of focused work but can’t actually get started. So there’s a lot of motivational challenges that they might be experiencing. I work with couples so there often is, especially in the mixed neurotype couples, the understanding of how each of the people in the couple need to communicate, how they do communicate, what the communication is about and how it’s being received, so the people can actually step into each other’s shoes again and start hearing each other again. Trauma is a big one as well because neurodivergent folks have a much higher risk of being traumatized based on, based on experiences in life but also based on our nervous system. So we are much more prone to actually experiencing trauma and rejection sensitivity is a big one. I’m thinking of specifically in relationships rejection sensitivity is the thing that people carry so much shame about as well. It’s like a process that happens that often is probably a trauma response. I think Dodson said by the time a kid with ADHD is 10 he will have had like, was it 20,000 negative comments? [20,000.] That’s just incredible. Like each one of those will have been felt in the body and will be held. And that shame spiral that kind of kicks in. And then there’s that kind of that full force, yeah.

JULIE: Actually, hearing that back from you in a big bundle, I’m you know, I’m thinking gosh we have been through a heck of a lot haven’t we. And you’re so right, with the loss of self and you know, trauma comes in different packages doesn’t it. It doesn’t have to be grandiose by other people’s means. If it’s deeply personal, that’s traumatic. You’re right with relationships, and self-doubt, and the loops, and the masking, it is a lot to carry. It is. And, you know, I celebrate myself for getting through my lifetime to be honest and I was diagnosed 3 years ago myself. Yeah. There was a lot of living and a whole bunch of lack of understanding about why I, why my brain did what it did and how my life resulted from that. So no, I can definitely see there’s a lot to unpack and there’s that … it’s all interconnected, isn’t it. it’s not just you’ve lost yourself; we’ll fix that. It’s all bundled into a quite a complex package for ADHD. And you’re working across all neurodivergence too, so you know with dyspraxia, dyslexia, and autism, and that must be difficult too. Because what might be a tool for an ADHD person isn’t necessarily the tool for an autistic person and you’ve got to try and make it work. Wow. You’ve got your work set out for you there Romy. It’s very complex. I’m impressed. I’m impressed that you’re very passionate about it and you’re training therapists to do even greater work than they currently are. I think it’s incredible.

ROMY: I thank you for that but I … if we look at ADHD and the you know, the real common co-occurring conditions, we have dyslexia, dyspraxia, dyscalculia, really common. I think there’s a 50% chance that you have one of those if you’re ADHD. Recent figures suggest that if you’re ADHD you have a 70% chance of also being autistic and that’s something that most clinicians are not getting their heads around. So in the, currently using the DSM5, so the book that clinicians use to diagnose somebody, in the DSM4 it was still you could not be both. You could only either be ADHD or autistic. And people started realizing hang on a minute, we have this wonderful … we have these people with this really wonderful and interesting mix of actually the brain doing ADHD processes and autistic processes and sometimes it looks like this, and sometimes it looks like that. And when we give these people ADHD meds all of a sudden, the autism comes out because the ADHD is kind of taken care of. But it means that people just need to know. People need to know. If you’re working with somebody with ADHD you need to know all this other stuff so that you can support your people better. And you’re absolutely right, something that might work for one ADHDer isn’t going to work for somebody that’s autistic, might also not work for another ADHDer. So it is just about you know, let’s get to know what might work for you and sometimes we have to get it wrong in order to get it right. So for us it’s just data, it’s just information on “Alright, so that didn’t work. Let’s try this one out.” It’s the same with kind of when we’re working on regulation strategies, I give people probably about 50 different regulation strategies that we kind of work through. And I always say practice them between now and next time I see you. Not all 50, like there staggered. But the idea is that you have a whole host of things and your body and brain will be able to respond to some of them and not to others. And that’s absolutely okay. And so your body can work out this one can work for me and if I get really dysregulated I’m going to go and do this. And if that doesn’t work I’ve got 10 others that I can go to. And maybe not have a meltdown, or maybe I do have a meltdown but I can recover much quicker afterwards.

JULIE: Wow. Now Romy, if … I was going to say if any but I think there may be, what changes would you like to see in the therapeutic field to serve the neurodivergent clients better? What more work is there to be done, or do you think you’re on the right track with your work? Is it evolving or is you know ….

ROMY: Oh it is absolutely evolving because we’re constantly finding out more. I think what I would love to see is that neurodivergence is something that’s actually being accounted for right from the start. That it’s not an add-on diploma that you’re going to do. It’s actually something that you learn properly because you’re learning how to be with people and how to support them when they’re struggling. And at the moment what we have is we have a lot of neurodivergent folks offering services for other neurodivergent folks, but what we really need is for people to recognize okay you can be neurotypical and offer this service but you need to know all of this. And you need to know that actually for a neurotypical person to work with maybe an ADHDer, that might be harder for you, and that’s okay. Like every time we work with somebody that comes from a different background to us we have to work a little bit harder to understand them, and that’s okay. Like we have to put in the work not them. It’s not on them to tell us. It’s on us to do the learning. It’s on us to do that. And for us to learn how we can make the space safe. So I’d love to see that. I would love to see schools being really informed about this, that actually kids can get a positive understanding of who they are without having to hide those parts of themselves. A really good friend of mine said to me the other day, her little one is, he’s only six, and he said “I feel like a part of me has to die whenever I go to school.” I was just like, oh that just stopped me in my tracks. It’s like, that is just heartbreaking. One of my kids, she’s 15 now, but she was 13 when she started asking me if she was ADHD and she did some of these internet quizzes. And she was like “Well I do this, I do this, I do this, I do this.” I’m like okay let’s … Sadly in the UK you kind of have to go through school and then school need to, because you need to have these symptoms in more than one environment, and school were just like “Yeah we’re not seeing any of this.” And I’m like okay, but you’ve already got the things here, and the educational psychologist was in this meeting and she said “Yeah it’s just about how we actually, how we actually assess.” And if schools aren’t seeing it then girls are just not getting a diagnosis. And it’s like, well how about we start teaching schools what this looks like in girls. How about we start showing that the kid that’s sitting really quietly and is actually pinching her legs so that she can pay attention, and is not getting any kind of negative messages, is struggling, is really struggling. But because she’s not a pain to you, you’re not seeing it. Yeah, it’s things like that.

JULIE: That’s really interesting and I think those girls grow to be young women and diagnosed as adults and school is tough. It should be heaps of fun and you know, the best days of your lives and all those things, but it is tough with ADHD. And we have learned very early on to mask and to fit in, and that seems to be the done thing. You know you … I’ve written in my book, I just you know, to be praised for my masked person is … is really really tough because it means I have to pretend, and that meets approval. But when I’m myself I don’t seem to get that praise, if you know what I mean. Unmasked. Yeah so you’re almost pushed into this ‘Well masking is required. You must mask and that conforms and therefore that’s when you know, you get the big tick. You’ll make friends that way.’ Now, this is my thoughts obviously but yeah, I found it very tough and quite confusing at school. Yeah, the friends … were they really my friends? Were they really there when I needed them? Or, yeah yeah it was tricky. Tricky times but it makes sense to me now why of course.  Yeah, yeah lots of work to do in schools and I think that’s worldwide too. In New Zealand there’s a bit of work to do in the schools as well to try and identify those, particularly girls again because you know more introverted or covert in some of their traits, making it not so obvious.

ROMY: And I hear that and also, one of my other kids, this was still in primary school, like I started to see all the things because of Covid. So Covid meant homeschooling. It meant I got to see things where I was like “What’s going on?” Like, and I took her to have an assessment with an ADHD specialist counsellor who wrote a report for school with all of the things that she was struggling with. So all of the things were in there and the school still turned around and said “We do not see any of them.” I took her to the ADHD Foundation where she had like a Qb test which is the, you know, they strap like a reflective surface on the forehead. And they have a camera that then kind of checks how much movement there is, and gives the kid something to play with where they need to press a button every time an X shows up on the screen but not if something else shows up on the screen. And that’s how they check for movement. Whether there is any kind of movement around but also they check for the attention and the impulsivity. And then afterwards they shared this report with me and they said “She’s on the 998th percentile for hyperactivity.” There is no way school could not have seen that especially with ‘here’s a report and here’s everything that you need to look out for.’ Like it was spoon fed to them and they still were like “We are not seeing this.” It’s like, I don’t know what else needs to happen. And I am … I understand all these things, which is why I’ve been pushing and I’ve been helping or trying to help teachers to see it, but there’s been a lot of “You’re the parent. You’re …” I think if nobody’s ever actually said to me, “You’re just too anxious,” or whatever but I can kind of see it on their faces. Like, this is your problem. This kid is fine in school, until they’re no longer fine in school and then it’s like “But I’ve been talking for years.” And so there so many other parents out there, and often is women, that end up being traumatized by schools not listening. Trying to do right by their kids and often also having ADHD or some other neurodivergence themselves and just feeling completely lost in the system. So these are some of the challenges if I were president of the world, that’s what I would do! 

JULIE: So, what would that look like Romy? Would … would every teacher ideally be trained on how to pick things up? Or would you have a specialist in the school that would you know, sort of roam the classes and be of assistance? If you were president, what/how would it … how would it look like in schools?

ROMY: Yeah if I were president, what I would say in this utopian life of mine. Oh course. We do so many assessments with kids all the time on reading, or arithmatic. Why wouldn’t we do standard assessments to figure out what their strengths are? What are the things that they’re inherently struggling with?  And then why don’t we just actually put things in place to support the kids that are struggling with certain things and also to enhance the bits where they’re really doing really well on?  Because I mean the neurodivergent kids are the inventors, right. If you think of, was it Thomas Edison with the light bulb, and he got it wrong 2,000 times. Who has that kind of tenacity or hyperfocus to be spending so much time and trying different ways of figuring it out. Like that’s us, right. But allowing kids to actually do the things that they’re naturally good at rather than discouraging them from doing those things. And paying attention in this format and having to sit down and keep your body still rather than running around when that actually absolutely is what you need to do. Like it’s this mass approach that is so oppressive because it’s based on all the schooling stuff. It’s based on neurotypical development and we know the ADHDers, we know that their brain, their prefrontal cortex take much longer to mature than it does for neurotypical peers. There’s so many things that we need to do differently.

JULIE: Well I say Romy for president! Yay. That actually really does sound almost like a simple solution, or a simple start at least. You’re right with the assessment. Just like to see how you’re going with maths, or how your spelling is, yeah. How you approach things. That would be really, really good to implement. I want to see amazing things happening in in your side of the world. 

ROMY: I want to see amazing things happening everywhere for kids and grown-ups too because I mean kids can only do well if their parents are well supported too. Yes, yes. And you know, we need as parents, we need to if we’re in jobs we need to be able to be supported in a way that we’re not completely burned out and then come home and can’t function, and now it’s time to put the kids in the bath. And it’s like oh my God, I can’t string a sentence together anymore because I’m so spent at work. So there’s so many things that I think it’s a whole systems change that we need. Yeah.

JULIE: That’s awesome. Romy, I’ll have all of your website details in the copy of the podcast. So if any of our listeners want to go in and check out more about your counselling, you’re available online which is brilliant so that means you’re available worldwide. And for listeners we’re sort of 11 hours different. Are we 11 or 13 hours, I can’t work it out. But you know, you’re available which is fabulous. Look I have learned so much during this chat. Thank you very much. It’s very fascinating and yeah a greater insight for me and I love it. So Romy, thank you so much for your time. You’re very welcome.

ROMY: Can I, just before I leave, can I tell you something? [Please.] Your book is on the recommended reading for the course that I’m running. [Oh, oh wow.] I am so pleased that you’ve written that book. [Oh thank you so much.] I think it’s really helpful for a whole lot of people to understand some of the challenges that you’ve experienced. And I do think we can, if more people were to pay attention to lived experience we’d be in a much better position. So thank you for writing it and I hope that [oh wow, no that’s brilliant] this podcast goes well. 

JULIE: Thank you so much for sharing that. I think also I just wanted to give a shout out to the other women in the book who shared their experiences. I felt if it was just my story it wouldn’t even touch the sides. I’m one of millions. But yeah, the women I thought the … it was quite an interesting range of experiences. From highly successful, confident to those that have trouble getting out of bed and making a coffee in the morning. And I really thought it was a kind of a ‘warts and all’ story. This is what it looks like. And a lot of the stories there too the women hadn’t told their partners, or their parents, or their children. Very deeply personal. And yeah, I’m just so glad that they allowed me, or trusted me to share it because I yeah, they made the book for me. They made it complete. But that’s very kind and wonderful to hear. Thank you so, so much.

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