How Clinicians can Embrace The Neurodiversity Paradigm in Practice: A Conversation with The Dorm’s Sam Jaffe, LMSW

Clinicians who have adopted the Neurodiversity Paradigm as a framework are prepared to support clients in embracing their neurodivergence.  This is an important first step for effective & neurodiversity-affirming treatment.

This blog was developed in collaboration with The Dorm

I recently visited The Dorm for an in-service training to collaborate with their clinical team and share my latest insights into how therapists can best support young adults who have been diagnosed with Autism, ADHD, or other forms of neurodivergence.

To kick off this conversation, I started with the concept of the Neurodiversity Paradigm, a framework of embracing the natural differences in human brains with more nuance, value, and acceptance. This framework, most importantly, shifts our mindset away from thinking of ‘normal’ or ‘typical’ brains and accepts that neurodiversity is a natural and beneficial part of human variation. Coming from this perspective, we can support our clients in embracing their neurodivergence and navigating mental health challenges more effectively.

What follows is a conversation I had with The Dorm Senior Therapist, Sam Jaffe, LMSW, MSEd, who leads several skills and process groups designed specifically for neurodivergent individuals.  We had the chance to dive deeper into the key considerations that the Neurodiversity Paradigm guides clinicians to address, including internalized ableism and the role of family and community in treatment.

Sam Jaffe: Caron, thanks for taking the time to speak with me on the Neurodiversity Paradigm to bring this framework to a wider audience. To start, as research progresses on neurodiversity and autism, many clinicians today are evolving their practices to be more affirming of neurodivergent clients. From your perspective, how does the Neurodiversity Paradigm provide a framework for identifying goals for treatment?

Caron Starobin: For clinicians, the Neurodiversity Paradigm involves looking at the entire ecosystem surrounding a client, so the overarching goal of treatment will be to both understand what the client can change (without masking) and also to understand what about the environment can be changed to improve their outcomes.

This can involve examining the school system, workplace, family dynamics, and any other systems surrounding the client. For example:

• Understanding if accommodations can be made in the school or workplace: If you're working with a client who's in a school system that is not very accommodating, a clinician may help provide guidance or advocacy tools to approach the school in the most effective way.

• Examining family roles and dynamics: There may be some behaviors or parts of the family system that are inadvertently ableist. Your role as a clinician might be to provide some psychoeducation for the family to help them understand their child better.

• Building relationship skills: Self-determination and the desire to connect with others are big themes within the neurodiversity paradigm, and understanding that everybody—each autistic person, just like each client—has their own pace and process. If they desire to connect with other people, just helping them gain access to those resources and people who are socially accepting of who they are is another goal of treatment.

• Assessing for co-occurring conditions: A really important goal of treatment is addressing what co-occurs with an autism diagnosis. Autism is not a mental health disability—it is a neurodevelopmental difference. However, mental health co-occurrences often include anxiety, depression, social anxiety, OCD, and sometimes bipolar disorder. A clinician may also want to explore any trauma, including family of origin trauma, relational trauma, and multigenerational trauma, and how these intersect with neurodivergence.

• Reframing negative self-perceptions and ableism: Internalized ableism might look like a client saying, “I don’t want to be friends or associate with anyone else who has autism because I’m not like them.” This perspective often develops from experiencing rejection and wanting to avoid being treated in the same way. Helping clients recognize and explore internalized ableism, when they are ready, is a major treatment goal and also comes with a lot of self-education for the therapist. 

• Sensory interventions can also be a key part of treatment, as they support self-regulation, which is foundational for overall well-being.

Sam Jaffe: Can you speak more about ableism and internalized ableism? At The Dorm, I work with many autistic clients who want romantic partnerships and meaningful connections, but some will say, “I don’t want to be around anyone with autism.” As a clinician, it’s surprising and heartbreaking because I see this amazing, interesting, funny person in front of me but they’ve obviously absorbed negative messaging around their neurodivergence. 

So how can we, as clinicians, address ableism—not only in society but also within our clients, especially when it’s self-directed?

Caron Starobin: As clinicians, we first need to educate ourselves about ableism. How does it show up in our own lives, relationships, and encounters? Once we’ve done our own work, we observe and ask:

• Is there internalized ableism in our clients?

• Is there systemic ableism in their environments, such as schools or workplaces?

If we notice our clients distancing themselves from others who share similar experiences, we can name it. Gently and gradually, we can use psychoeducation to discuss what ableism is and what it looks like. Many clients feel relief when they understand this concept—they’ve never thought of it that way before. Others might show resistance, and that’s okay. It’s about pacing ourselves with where the client is in their journey.

Sam Jaffe: At The Dorm we know how important family involvement is in treating young adults and promoting long-term outcomes. You also mentioned the importance of integrating family members, partners, and friends as part of working with neurodivergent clients. How can we bring them into our work with individuals to enhance their mental health outcomes?

Caron Starobin: I can share a story to illustrate this. When I was a brand-new clinician, I had a client who I worked with who had what was at the time called Aspergers (currently in the DSM-V the diagnosis would be called Autism). When I started working with these autistic children, teens, and young adult clients, I recognized that the whole family system was often so dysregulated that the clients had difficulty regulating themselves.  Working with the family system on co-regulation became incredibly important. I observed outcomes that included improved emotional connection and communication between child, teen, young adult and parents, decreased conflict, deeper understanding and empathy for the child, teen, young adult, and improved connection and communication between parents.  Essentially, working on identifying shifts that could occur in the family system improved outcomes for the autistic client and for the family as a whole.   

So… how do we engage other members of the family?

First, we have to always check in with our client for permission, and fully gauge whether they’re ready to invite family members into sessions.  Then we engage the family members in therapy by creating an affirming space where family members and the client can learn about everyone’s roles in the patterns of dysregulation, learn about autism, and potentially learn about underlying issues that may be impacting the autistic client. Often, before family therapy gets going, the client is ineffective in communicating their thoughts and feelings in large part because of communication differences between the autistic client and their neurotypical or neurodivergent family members.   Family therapy can help with that.  In addition, family therapy can help the family members and the client engage in a process of gaining awareness, and insight and increasing empathy and understanding..

Sometimes parents—not all parents, but some parents—need space for grieving. Maybe what they expected when having children isn't exactly what they’re experiencing. Or maybe having an autistic child has left them feeling incompetent because they don't know how to effectively connect with their child. So we have to help them look at all that, grieve those losses, and then reframe their understanding of their family dynamic.

Sam Jaffe: I agree. I know a lot of families struggle with their internalized stigma around autism or neurodivergence. There is even, frankly, still a stigma around therapy. One of the things I hear so often from families—and it happens similarly in romantic relationships—is, "I don't feel like I'm able to connect with my partner, my child, whatever, in the way that I want to." For example, "I was brought up as a hugger, and my child doesn't want to be touched."

This reminds me of the idea of the double empathy problem—the struggles that very different individuals can have in empathizing with and connecting with each other. How can we, as clinicians, help clients understand and navigate that problem? Not just the clients, but the families, the important people, the stakeholders in our clients' lives. How do we help these people connect?

Caron Starobin: Yeah, you're absolutely right. It's a great question. The double empathy problem occurs when two people view the world very differently and are not receiving the empathy they expect from one another. What ends up happening is they blame each other, which leads to disconnection—because blaming isn't relational. It doesn’t bring people closer.

How do we help? The first step is naming what's going on. For example, it's very common for the neurotypical partner to perceive the autistic or neurodivergent partner as lacking empathy, which isn’t true. People with autism do not lack empathy, but sometimes they don't express affective empathy effectively. In fact, some studies show that autistic individuals can have strong affective empathy but may struggle with cognitive empathy. There are different types of empathy.

Naming these distinctions and helping partners or family members process them is key. Is it only the autistic person who struggles to express connection, or is something also missing on the other side? Education and open dialogue are crucial.

This is another example of an area where I find that some parents need space for grieving, and they haven’t allowed themselves that space. If you grew up learning in your nervous system that hugs mean connection, and your child or partner never wants to hug you, that’s a real loss. Holding space for that—not judging it, but allowing it—creates the opportunity for deeper conversations and understanding.

Sam Jaffe: I like that response. It honors the fact that these differences can be difficult. But when we bridge those gaps and find new ways to connect, it’s magical. It empowers families to discover meaningful ways to bond.

What excites me about this conversation is that it challenges the status quo. We are learning new ways of connecting as fellow humans. How do we embrace everyone’s uniqueness and differences while fostering a shared sense of existence? How can we be more welcoming to one another?

Caron Starobin: And it starts by not assuming that if someone isn’t looking you in the eye, hugging you, or touching you, they lack empathy or care. That’s the core of the double empathy problem.

I see this often in couples work, when one partner assumes, "They don't care." Instead, we ask: Is that really true? Let’s find out. Let’s check that assumption. They may not express care in the way you need to feel it, but that doesn’t mean they don’t care.

Sam Jaffe: I love that. It’s about cultural relevancy—bringing in different mindsets, experiences, and backgrounds. This is another way we can see the whole person more clearly. Instead of making snap judgments like, "Oh, I didn’t get a hug, so that person doesn’t have empathy," we can explore the many ways connection and care can be expressed.

I really appreciate this conversation, Caron. Thank you so much for your time.

Caron Starobin: Thank you for inviting me. This has been a great conversation.