Neurodiverse-Affirming EMDR Therapy
Neurodivergent people – including those who are autistic or have ADHD – are more likely to experience trauma than their neurotypical peers. Yet their distress is often misunderstood, overlooked, or misdiagnosed. Experiences of exclusion, masking, and trying to meet neurotypical expectations can all leave lasting emotional imprints, often without ever being recognised as trauma. That’s why a neurodiverse-affirming approach to EMDR therapy isn’t just helpful, it’s necessary.
Why neurodivergent clients may need something different
Many neurodivergent clients arrive in therapy with a long history of being misunderstood. They may have been labelled ‘difficult’, ‘too sensitive’, or told they’re not trying hard enough. Over time, this can lead to internalised beliefs like “I’m broken” or “I don’t belong.”
It’s not always the big-T traumas that shape these beliefs. More often, it’s the accumulation of small moments: being told off for stimming, not getting invited to the birthday party, or struggling to meet classroom expectations. When therapy doesn’t recognise these experiences for what they are – real and valid – we miss the opportunity to help clients feel seen.
When working with neurodivergent clients, EMDR therapists are advised to consider not only the impact of significant traumatic events, but also the cumulative effects of stigma, prejudice, and exclusion. These can be just as impactful (if not more so in some cases) than single-incident traumas and are often deeply woven into a client’s sense of self.
EMDR through a neurodiverse-affirming lens
The research on the effectiveness of EMDR therapy with autistic and ADHD clients is still in its early days. While more controlled studies are needed, initial findings from case reports, qualitative research, and clinical experience are promising.
A neurodiverse-affirming approach to EMDR is about adjusting the therapy to fit the client, not forcing the client to fit the therapy. It’s rooted in curiosity, flexibility, and respect for neurocognitive differences. It invites us to slow down, listen more carefully, and remain open to what safety and regulation might look like for each individual.
Adjustments should always be individualised to the client's specific neurodivergent profile. What works for one person may not work for another – and preferences can shift over time. That’s why it’s so important to collaborate with the client regularly, seek their feedback, and remain flexible throughout the process.
Practical ways to adapt EMDR therapy
Here are a few of the adaptations I use in my clinical work:
Visual and concrete aids: Some clients – particularly those with alexithymia or interoception challenges – may find it hard to describe internal sensations. Using diagrams, feeling wheels, or physical objects can help them access and express what’s going on.
Flexible bilateral stimulation: Clients with sensory sensitivities may find traditional eye movements overwhelming. Tactile or auditory methods might be more comfortable, and the pace may need adjusting. These preferences can vary widely, so regular collaboration is key.
Clearer prompts: Open-ended questions like “What do you notice now?” can feel vague or be inadvertently pressuring. Structured prompts such as “Is it better, worse, or the same?” reduce anxiety and support focus without second-guessing.
Returning to the target more frequently: Especially for clients with ADHD, who may become tangential or distracted, checking back in with the target image more often can help keep processing on track.
Redefining safety: Creating a safe space might mean allowing sensory breaks, using the client’s special interest as part of the session, or simply affirming that their way of communicating is valid. Clients should also feel welcome to use sensory supports that help them regulate, whether that’s bringing a fidget, wearing noise-cancelling headphones, or sitting on a different type of chair.
Why this matters
Neurodivergent clients are often navigating a world that wasn’t built with them in mind. When EMDR therapy is adapted to meet the needs of neurodivergent clients, it can support them to feel understood and respected, and to make sense of experiences that may have been missed or misinterpreted in the past.
Being a neurodiverse-affirming therapist means being open to different ways of thinking, feeling, and working. It’s about offering adaptations in a curious and collaborative way, without making assumptions or relying on stereotypes. And it involves adjusting our approach to suit each client, rather than expecting clients to fit into a rigid treatment structure.
I'm Caroline Burrows, an Accredited EMDR Trainer and Consultant. I’m passionate about bridging the gap between EMDR training and clinical practice. If you're looking to learn EMDR therapy for the first time, enhance your EMDR skills, or navigate challenges in your EMDR clinical work, I offer training workshops, on-demand webinars, and consultation. I would love to support your EMDR learning journey.
