Seeds of identity are planted by genes and watered by the environment in which they grow. Although an explosion of identity development unfolds during adolescence, identity formation is an ongoing process across the lifespan. Identity itself is a personal construct unique to each individual, yet highly influenced by social interactions. Personal factors such as neurology, cultural roots, physical characteristics, spiritual beliefs, self-concept, and disability are all important considerations in the identity formation process. External factors such as systems of discrimination or oppression, media trends, research, and other exposures are crucial influences. Whether or not we have access to certain protective factors such as securely attached relationships and a supportive community matters to the process of self-identification. Experiences of neglect, abuse, or other trauma also matters. In short, our personal characteristics combine with life events to inform the narratives we internalize about ourselves and the labels we embrace or reject.
Neurodivergent individuals such as autistics, ADHDers, dyslexics, and others may be especially vulnerable to societal rejection, invalidation in close relationships, and other potential obstacles to the development of positive identifications. By making space in the therapy room for clients to explore any neurodivergent identity narratives that may emerge, learning from the field of Disability Studies, and actively combating ableist practices within our profession, marriage and family therapists can formulate best practices to better serve neurodiverse populations.
Marriage and family therapists are uniquely equipped to offer therapy that not only nurtures the personal identity exploration journey of neurodivergent clients, but also the interpersonal dynamics surrounding the process.
For example, an MFT may invite adult partners in a committed relationship to dialogue about the impact of one party’s recent ADHD diagnosis. Perhaps the clients express relief, stating this new identification serves to validate years of unanswered concerns. For this couple, having new language to speak about their challenges provides an insightful lens through which to view the specific challenges they face together. It is a personal choice for the ADHDer to either integrate their diagnosis within their overall identity framework or not. The system itself also faces an identity choice: Will the relationship integrate the diagnosis and adapt accordingly? What changes to the relationship, if any, are needed to best support both parties going forward?
Of course, a diagnosis of neurodivergence may not always elicit relief and insight. Perhaps a different couple arrives in the therapy office expressing anxiety and relationship tension based on the recent ADHD diagnosis of one member. Perhaps the new label confirms a depressing sense of otherness and isolation the ADHDer has felt since childhood, exacerbated by their partner’s weaponization of disability terms against them.
A skilled MFT can warmly invite clients to examine their positive or negative assumptions about diagnosis, neurodivergence, and other disability concepts. It is important to allow space for clients to self-ascribe whatever labels they choose, and to encourage respect between partners regarding these decisions. The MFT can identify distress-maintaining thoughts, behaviors, and interpersonal interactions to encourage healthier alternatives en route to individual and interpersonal health. In this way, identity exploration at the individual and systemic level can unfold organically over the course of therapy.
Recent years have shown an encouraging shift towards MFTs actively engaging with the social issues of our time. Can MFTs lead the way towards understanding the diversity of human brains?
The position of MFTs at the heart of private practices, behavioral health institutions, and meaningful social settings presents an exciting opportunity to appreciate all forms of human variation, including brain differences. A term first used by autism rights advocate Judy Singer and journalist Harvey Blume in 1998, neurodiversity refers to the fact there is no single type of normal human brain, but rather an infinite variety of brain types. Roughly 86 billion neurons in each human brain can exist in an infinite number of wiring arrangements—all of which are valid. Science affirms this biological reality and points to the astounding complexity inherent to each human brain (Armstrong, 2015; Valizadeh, Liem, Mérillat, Hänggi, & Jäncke, 2018).
The neurodiversity movement invites us to view neural variations as naturally-occurring aspects of personhood. Accordingly, neurodivergent individuals deserve the opportunity to experience identity exploration, societal accommodation, and interpersonal respect. Today’s proponents of this movement often elevate the social model of disability over the medical model of disability, use Identity-First Language, e.g. autistic, and advocate for the elimination of functioning labels, e.g. high-functioning autism or low functioning autism (den Houting, 2019; Baron-Cohen, 2017). While frequently embracing the term disabled, some neurodivergent self-advocates reject labels such as disease or disorder to describe their neurodivergent qualities (Baron-Cohen, 2017).
It is important to note that some neurodivergent persons reject certain tenets of the neurodiversity movement entirely, preferring instead that others see past their differences. The use of Person-First Language, e.g., person with autism, often emphasizes this perspective.
There is no correct or incorrect way to self-identity. However, referring to the self-identifications made by others does require special care. Dunn & Andrews (2015) discuss psychologists’ use of either Identity-First Language or Person-First Language, encouraging authors to listen directly to disabled voices for answers. Similarly, the current Publication Manual of the American Psychological Association (2020) includes specific guidance for authors writing about disability. Bottema-Beutel, Kapp, Lester, Sasson, and Hand (2021) recently created a comprehensive guide to avoiding ableist language. And, finally, the internet provides instant access to official position statements and a multitude of other helpful information by simply going to websites created by self-advocacy groups such as the Autistic Self Advocacy Network (ASAN; autisticadvocacy.org).
Identity formation should be self-ascribed and self-paced.
Emerging in the U.S. during the 1980s, alongside a social movement to reclaim the word “disabled” as a positive self-identification, Disability Studies is a field of psychology that elevates disabled voices. Research in this area can provide valuable insight to any MFT seeking to increase knowledge and compassion.
For many people today, describing themselves as disabled is the result of an introspective identity formation journey marked by radical self-acceptance. For others, a similar commitment to self-reflection leads to a rejection of this term entirely. This is a personal choice.
No population is homogenous. Allowing clients to define their brain and body qualities using their own terms and identifications maintains an important ethical standard. This conveys respect for client autonomy and avoids stereotyping (Murugami, 2009).
A literature review conducted by Johnstone (2004) noted six categories of self-identification that disabled individuals within the examined studies used most often:
- Externally ascribed, disempowering identities—This is characterized by adopting an identity label assigned by the media, professionals, or by anyone other than the disabled person themselves.
- Overcompensating identities—This may occur when a disabled person, for various reasons, feels pressured to outperform nondisabled persons.
- Identities that shift the focus away from disability—This category assigns a negative connotation to the term disability and certain diagnostic labels, rejecting these in favor of alternatives. Examples are those who prefer Person-First Language as well as certain individuals in the Deaf community who argue for sign language to be elevated to the status of a linguistic minority.
- Empowering identities—This category coincides with a social shift in the 1990s away from medial models and towards social models of disability. Persons using this form of self-identification recognize the significance of their neurotype, mental health diagnosis, chronic illness, or physical condition to their overall identity framework. Identity-First Language is most often used here.
- Complex identities – Persons in this group may use multiple descriptors for themselves, partly because of their acknowledgment that their self-identifications are fluid in various contexts and partly due to internal tensions.
- Common identity or disability culture—This is characterized by a sense of kinship to a non-homogenous community of disabled persons united by a similar set of life experiences. There is a tendency here to advocate for greater recognition of disabled experiences and the inherent value of all disabled persons.
Awareness of these categories may increase therapist competence. When appropriate, MFTs may invite discussion about the categories without passing judgment, imposing a hierarchical order of categories, or implying that client health depends on the achievement of any particular category or categories.
Identity formation is always complex and deeply personal.
Kreider, Luna, Lan, and Wu (2020) compared three specific models of disability identity formation: Stages of Acceptance of a Learning Disability (Higgins, Raskind, Goldberg, & Herman, 2002), Gibson’s (2006) Disability Identity Model, and Forber-Pratt & Zape’s (2017) Model of Social and Psychosocial Disability Identity Development. Interestingly, the oldest two models begin with an individual becoming aware of their differences and end in either identity transformation or identity acceptance. The most recent model, however, begins with acceptance of differences and ends in social engagement. This distinction is subtle, but intriguing.
As an ADHDer myself, I often wonder what would happen if a worldwide paradigm shift placed acceptance of neurocognitive disabilities as a collective starting point instead of a personal destination. Would this result in more individuals experiencing mental health benefits due to the opportunity to form positive self-identifications in the context of a more accepting society? I also wonder how MFTs can support such a shift. Perhaps it starts by simply making space, eventually going beyond this to design best practices en route to allyship and advocacy.
Making space for neurodivergent identity formation means ending ableism.
Ableism can be overt or implied. It occurs when disabled people and their associated self-identifications, communication preferences, and support needs are presumed inferior (Bottema-Beutel et al., 2021). MFTs should reflect on any personal beliefs or behaviors that may unknowingly discriminate against disabled clients. The following is a list intended to inform best practices:
- In couples therapy, don’t promote eye contact as a necessary component to interpersonal validation. Maintaining eye contact may be physiologically overwhelming or highly distracting to some neurodivergent clients. Instead, encourage partners to physically turn their bodies towards one another at whatever proximity feels most comfortable. Clearly state each party’s right to direct their own gaze wherever allows them to feel present and connected within the conversation. This may mean a client looks at their partner’s nose, mouth, or forehead. It could even mean a client looks down or away while gently rocking their body back and forth during the conversation. Clients can convey validation to each other in numerous ways other than eye contact.
No population is homogenous. Allowing clients to define their brain and body qualities using their own terms and identifications maintains an important ethical standard.
- Treat all modes of communication between partners as equal and valid. While some couples greatly benefit from learning ways to better verbally communicate using face-to-face interactions, this format should not be regarded as the gold standard for meaningful couple communication. Disabled and nondisabled clients alike may benefit from the use of so-called impersonal electronic communication options en route to improving their overall communication and conflict resolution skills. Discouraging electronic communication between partners promotes neurotypical norms as superior, ignoring that neurodiverse populations often find great connectedness through the use of e-mail, text, and Augmentative and Alternative Communication (AAC).
- Recognize that some clients, or their children, have experienced trauma at the hands of therapy professionals or organizations who claimed to want to help them. For example, listening to adult autistic voices reveals some upsetting realities surrounding the origin and application of therapy modalities such as Applied Behavioral Analysis (ABA). Clients may also reference the negative impact of certain propaganda campaigns executed by the group Autism Speaks. Therapists should recognize the important connotation of symbols associated with disability and their usage. For example, many autistics reject the puzzle piece identifier and Light it Up Blue campaign due to their association with Autism Speaks. The rainbow, red, or gold infinity symbol is a frequently used alternative.
- Be willing and flexible to make accommodations in therapy. ADHDers and autistics, for example, tend to experience emotional dysregulation and sensory challenges. Access your creativity as an MFT to find collaborative solutions that best support client needs in the therapy room. This could mean dimming lights to support a client experiencing sensory overload, or encouraging a client in need of greater sensory stimulation to tap their feet or hop while you talk. Accepting a client’s preferred stims (non-sexual, self-stimulatory behavior such as hand flapping) can strengthen the therapeutic alliance. This allows a client to self-regulate and express emotions in their preferred style; Clients should not feel the need to mask certain neurodivergent characteristics.
MFTs should strive to provide high-quality care to all disabled populations, including neurodiverse populations. The field can maintain an empathetic, complex view of identity while making space for neurodivergent clients to explore the struggles as well as the strengths of their uniqueness. In an atmosphere of non-bias and inclusion, clients are free to explore the positive, neutral, and negative aspects of brain variations and other human characteristics and self-ascribe labels as they see fit. MFTs can listen rather than dictate, offering corrective emotional experiences to heal past invalidation.
Ableism can be overt or implied. It occurs when disabled people and their associated self-identifications, communication preferences, and support needs are presumed inferior.

Kelli D. Willard, MA, LMFT, is an AAMFT Clinical Fellow. She is an ADHDer with 10 years of experience working with individuals and couples at Building Intimate Marriages, Inc. She is currently writing a therapeutic workbook meant to guide neurodivergent clients along their personal identity formation journey. email: kwillard@loveallthebrains.com
REFERENCES
American Psychological Association. (2020) Publication manual of the American Psychological Association (7th ed.). American Psychological Association. https://apastyle.apa.org/style-grammar-guidelines/bias-free-language/disability
Armstrong, T. (2015). The myth of the normal brain: Embracing neurodiversity. AMA Journal of Ethics, 17(4), 348-352.
Baron-Cohen, S. (2017). Editorial perspective: Neurodiversity – a revolutionary concept for autism and psychiatry. The Journal of Child Psychology & Psychiatry, 58(6), 744-747.
Blume, H. (1998, September). Neurodiversity. The Atlantic. Retrieved from https://www.theatlantic.com/magazine/archive/1998/09/neurodiversity/305909
Bottema-Beutel, K., Kapp, S. K., Lester, J. N., Sasson, N. J., & Hand, B. N. (2021). Avoiding ableist language: Suggestions for autism researchers. Autism in Adulthood, 3(1), 18-29.
den Houting, J. (2019). Neurodiversity: An insider’s perspective. Autism, 23(2), 271-273.
Dunn, D. S., & Andrews, E. E. (2015). Person-first and identity-first language: Developing psychologists’ cultural competence using disability language. The American Psychologist, 70(3), 255–264.
Forber-Pratt, A. J., & Zape, M. P. (2017). Disability identity development model: Voices from the ADA-generation. Disability and Health Journal, 10(2), 350-355.
Gibson, J. (2006). Disability and clinical competency: An introduction. The California Psychologist, 39, 6-10.
Higgins, E. L., Raskind, M. H., Goldberg, R. J., & Herman, K. L. (2002). Stages of acceptance of a learning disability: The impact of labeling. Learning Disability Quarterly, 25(1), 3-18.
Johnstone, C. J. (2004). Disability and identity: Personal constructions and formalized supports. Disability Studies Quarterly, 24(4).
Kreider, C. M., Luna, C., Lan, M. F., & Wu, C. Y. (2020). Disability advocacy messaging and conceptual links to underlying disability identity development among college students with learning disabilities and attention disorders. Disability and Health Journal, 13(1), 100827.
Murugami, M. W. (2009) Disability and identity. Disability Studies Quarterly, 29(4).
Valizadeh, S. A., Liem, F., Mérillat, S., Hänggi, J., & Jäncke, L. (2018). Identification of individual subjects on the basis of their brain anatomical features. Scientific Reports, 8(1)
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