Working With Neurodiverse Couples As An Imago Relationship Therapist

In this post, I would like to explore how we might work with a neurodiverse couple, that is, a couple where one of the partners is neurodivergent and the other is neurotypical, or a neurodivergent couple where both partners are neurodivergent. As an Imago Relationship Therapist, I do have Imago in mind, though much of the post applies to any modality of couples therapy.

The post is a bit of a whopper, so I’ve put a contents list under this paragraph just to help you navigate it a bit more easily.

I’m going to be quoting a lot from Nick Walker’s book “Neuroqueer Heresies*,” and I have included the reference at the bottom of this post. I love Nick Walker’s work; he has really helped me challenge my own internalised ableism around my own neurodivergence and is a master at getting the language that we use around neurodivergence correct.

What is Neurodiversity?

So what exactly is neurodiversity? Nick Walker describes it as

“the diversity of human minds, the infinite variation in neurocognitive functioning within our species.”

It’s just a biological fact about humans – like how we come in different ethnicities and genders, we also have different kinds of brains and nervous systems.

The Neurodiversity Paradigm vs. The Pathology Paradigm

Before we jump into the therapy stuff, let’s get clear on two really different ways of looking at brain and nervous system differences:

The Pathology Paradigm is basically the traditional medical model that Nick Walker critiques in his work. It boils down to:

1. There’s one “right” or “normal” way for nervous systems to work.
2. If your nervous system works differently, there’s Something Wrong With You that needs fixing.

This is the mindset that treats autism, ADHD, and other brain and nervous system differences as “disorders” or “deficits” that need treatment or curing. Quite honestly, it’s about time we moved away from this paradigm and realised that it is upsetting and offensive to many neurodivergent people (including me).

The Neurodiversity Paradigm, on the other hand, it’s far more positive:

1. Brain and nervous system diversity is natural, healthy, and valuable – just another form of human variation.
2. There’s no single “right” kind of brain, just like there’s no single “right” ethnicity or gender.
3. The social challenges neurodivergent people face look a lot like what happens with other kinds of human diversity – power imbalances, discrimination, but also creative potential when differences are embraced.

As Walker points out, making this shift from pathology thinking to neurodiversity thinking isn’t just nice – it’s absolutely essential for helping neurodivergent people (and their relationships) thrive!

Let’s Get The Language Right

Here’s a common mix-up I should clear up: a single person isn’t “neurodiverse” – that would be like calling one person “diverse.” Instead, a group with different types of minds would be neurodiverse.

When talking about someone whose brain works differently from society’s typical expectations (neurotypical), we say they’re “neurodivergent.”

Identity-First Language

Whilst we’re on the subject of language, my preference is always for identity-first language when it comes to neurodivergence. This is opposed to person-first language.

I would say “I am autistic” rather than “I have autism”. Autism isn’t something I have caught, and it’s not a disease, it’s is an intrinsic part of me.

I love what Pierre Novellie said about this in his book, “Why can’t I just enjoy things?“*,

“I’m not looking through an autistic lens, I have autistic eyeballs.”

For me, saying “I have autism” would be like someone saying “I have gayness” or “I have blackness.” It really doesn’t fit.

The same goes for ADHD and AuDHD. I would refer to someone as an ADHDer or AuDHDer rather than them “having” ADHD or AuDHD.

Opinions differ on this, including within the autistic community, and I mention this because from a neurodiversity paradigm perspective I want to talk about difference not disorders.

I’m fully aware that before my diagnosis I wasn’t clear on how to use these terms either. I have now become a bit of an evangelist around the language used to address neurodivergence. It’s a little bit like a reformed smoker raging about how terrible smoking is for you. I know this, and I do my best not to be a total bore when it comes to using the correct language (but alas, don’t always succeed).

It matters to me so much because the way in which we use our language says a lot about how we see people. If we’re clumsy, it’s easy to hurt others without intending to, and it reinforces the message that many of us who were neurodivergent received over our lifetime; that somehow there is “Something Wrong With Us“.

Understanding Autism, ADHD and AuDHD as Forms of Neurodivergence

There are many ways in which we can diverge from the neurotypical. I’m going to talk about the three most common ways in which people can be neurodivergent. These are Autism, ADHD, and AuDHD.

Autism, in Walker’s words, is “a genetically-based human neurological variant” with “particularly high levels of synaptic connectivity and responsiveness.”

In everyday terms, this means autistic people often experience the world more intensely and with less automatic filtering than non-autistic people. This affects everything – how they think, move, interact with others, and process sensory information.

ADHD is another way brains can be wired differently. It typically involves differences in executive functioning (the brain’s management system), attention regulation, impulse control, and often comes with unique energy levels and information processing styles. Like autism, ADHD isn’t a defect – it’s just a different way brains can be organized and function.

AuDHD – When Autism and ADHD Co-occur

Many people experience both autism and ADHD together – sometimes called “AuDHD.” This isn’t just having two separate conditions; these neurotypes can interact in complex and unique ways that create distinct experiences. For someone with AuDHD:

• They might hyperfocus intensely (ADHD trait) on special interests (autistic trait).
• They could experience sensory sensitivities (autistic trait) that trigger restlessness or impulsivity (ADHD trait).
• Their social communication might involve both directness and tangential thinking.
• Executive functioning challenges might be more complex than with either neurotype alone.
• They might have seemingly contradictory traits – like being both highly structured in some areas while struggling with time management in others.

In relationships, a person with AuDHD might bring unique dynamics – perhaps diving deep into understanding their partner’s needs while also forgetting important dates or appointments. Their processing of emotional information might involve both intense focus and difficulty maintaining that focus through a lengthy discussion.

Imago Relationship Therapy Through a Neurodiversity Lens

So what does all this mean for Imago Relationship Therapy? If you’re not familiar, Imago is all about turning conflicts into healing opportunities by improving how couples communicate and understand each other.

Imago therapists serve as facilitators rather than experts, focusing on the relationship’s “Space-Between” rather than fixing individual partners. Their main tool is the Imago Dialogue process, which creates safety through structured conversation. The dialogue includes:

• Mirroring: Repeating back what you heard from your partner
• Validating: Acknowledging your partner’s perspective makes sense
• Empathizing: Connecting with their feelings

This process transforms conflicts into connections and shifts couples from talking at each other to sharing with each other. Imago therapy emphasizes HOW couples communicate over WHAT they discuss, supplementing dialogue with practices like Zero Negativity and daily appreciations. The approach focuses on building skills that create lasting change rather than just weekly venting sessions.

What I’ve written above gives a framework for what Imago Relationship Therapy is; it’s the map and not the territory. We may have to tweak the structure of the Imago dialogue process to accommodate the needs of the couple that we are working with at the time.

How might we adapt the strategy for a neurodiverse or neurodivergent couple?

1. Recognise Different Communication Styles

Walker points out something super important: “the communication difficulties between autistics and non-autistics run both ways.”

The Double Empathy Problem

The idea, called the double empathy problem, was put forward by Dr. Damian Milton (who is autistic himself) back in 2012. He basically said, “The communication problems between autistic and non-autistic people aren’t just the autistic person’s fault!”

Instead of seeing it as autistic people failing to understand everyone else, the double empathy problem points out that both sides struggle to get each other. It’s like two people speaking different languages and both getting frustrated when the other doesn’t understand.

Here’s what makes this concept so important:

1. Both autistic and non-autistic people have trouble fully getting each other’s social signals and communication styles.
2. Our brains process information differently, creating totally different experiences of reality.
3. The difficulties aren’t built-in deficits but challenges that pop up when different types of brains try to connect.

The science backs this up. Studies by Crompton and colleagues in 2020 found that autistic people communicate just fine with other autistic people. The problems mainly happen in mixed groups.

Another study by Edey and team (2016) showed that non-autistic people actually struggle to read the emotional expressions of autistic people – proving it’s definitely a two-way street.

Why This Matters

Instead of just expecting neurodivergent people to adapt to everyone else’s way of communicating, it suggests we all need to meet in the middle.

It’s about seeing autism not as a “disorder of empathy” but as a different – and equally valid – way of experiencing and connecting with the world.

How can we take this into account if we were an Imago Relationship therapist?

• Remember that different doesn’t mean deficient – just different ways of communicating.
• Give people more time for the mirroring exercises if they need it.
• Understand that eye contact might be distracting or uncomfortable for autistic clients. This is a big one for an Imago relationship therapist because we emphasise eye contact so much in the training. The reality is that for many autistic people, eye contact is an extremely sensory experience and can feel overwhelming. Instead of eye contact, encourage autistic partners to look around their partner’s face or glance now and again at their eyes when they feel able to.
• Be aware that things like tone of voice and facial expressions might be processed differently.
• Be aware that when you give sentence stems around feelings or body sensations, a neurodivergent individual may not be able to tune into them quickly. Give it time and hold it lightly.
• My friend and colleague Paul McManus talks about being a translator. As we stay with the metaphor of different languages, sometimes you need a translator to help one person understand the other. We can do that really well with validation and empathy as an Imago therapist, especially if you’re a neurodivergent therapist yourself and the client really makes sense.

For clients with AuDHD, communication can involve additional complexities. They might hyperfocus on certain parts of a conversation while missing others, shift topics based on both autistic associations and ADHD tangents, or struggle to maintain focus during lengthy dialogues despite genuinely wanting to engage. These clients may need both autistic accommodations (like clear, direct language) and ADHD supports (like periodic movement breaks or sentence stems to help them stay on topic).

2. Adapt the Imago Dialogue Process

The classic Imago dialogue with mirroring, validation, and empathy is great, but might need some tweaking. In an Imago relationship therapist, you could:

• Use visual aids to help people follow the dialogue structure. This could be as simple as writing the process on your whiteboard for everyone to be able to follow.
• Give extra time between steps for processing. Bear in mind that neurodivergent people are not processing slower, they’re just processing more. They’re having to deal with their entire environment flooding through their senses when neurotypical people just filter most of this out.
• Take breaks when someone gets overwhelmed. Just stop, have a stretch, go for a walk around the room. Get a brew. Be human about it.
• Be flexible with the format while keeping the core ideas intact. Neurodivergent people are perfectly capable of doing all stages of the dialogue process, they may just need to do them differently. You don’t need to alter the process in its entirety unless one of the people you’re working with is struggling in some area.

For AuDHD clients specifically, consider combining strategies for both neurotypes. They might need written prompts to keep them on track (helpful for ADHD) while also benefiting from longer processing time (helpful for autism).

The standard Imago process of taking turns speaking might be particularly challenging for someone with AuDHD, who might struggle both with waiting for their turn (ADHD) and with formulating their thoughts quickly enough (autism).

Consider allowing brief notes to be jotted down while listening, to help manage both the impulse to interrupt and the need to process. Once more, with a neurotypical couple, this may be considered a real no-no, but having used this with some of the neurodiverse couples I’ve worked with, it doesn’t get in the way, and it just tends to the needs in the room at the time.

3. Reframe “Frustrations” as Brain Differences

Regular Imago therapy connects partner frustrations to childhood wounds. That’s still important, but with neurodivergent couples:

• Help them figure out which behaviours come from brain differences versus childhood wounding. They may not know, and it may not matter, so don’t get hung up on this.
• Don’t treat neurodivergent traits as problems that need fixing. This can’t be over-emphasized. You are not attempting to make your neurodivergent individual neurotypical. If anything, your job is to help them accept themselves just as they are and let go of the idea that there is one acceptable way of being in the world.
• Look for accommodations and adaptations instead of expecting the neurodivergent partner to fundamentally change how their brain works, which, of course, is impossible.

Reframing frustrations is especially important for AuDHD partners, whose behaviors might seem contradictory and confusing. For example, someone with AuDHD might deeply care about their partner while frequently forgetting important dates or details. They might hyperfocus on a project and seem to ignore their partner one day, then be completely unable to focus on anything the next day.

These aren’t character flaws or signs they don’t care – they’re manifestations of how their brain processes information, manages attention, and organizes priorities.

Help couples distinguish between neurocognitive differences and relationship issues, while finding practical workarounds for challenges (like shared digital calendars, reminder systems, or communication protocols).

4. Create Sensory-Friendly Therapy Environments

Walker emphasises that sensory experiences can be way more intense for autistic folks. As a couples therapist:

• Make your office sensory-friendly (adjustable lighting, quiet space).
• Have fidget toys available and let people move around if needed.
• Check in about sensory comfort during sessions.
• Be flexible about session length based on processing and sensory needs.

For AuDHD clients, you’ll want to address both sensory needs and attention/movement needs simultaneously. Your environment should minimize sensory overload while also accommodating a need for movement or stimulation. This might mean having a space where a client can pace while talking, offering both calming and stimulating fidget options, or creating zones in your office with different sensory profiles.

Remember that AuDHD clients may have conflicting needs – needing to move (ADHD) while also being sensitive to certain sounds or textures (autism). Work with them to identify their specific needs, which may change from session to session.

5. Honor Stimming and Self-Regulation

Walker describes stimming (self-stimulatory behaviors like rocking or hand movements) as having “vital functions in autistic consciousness.”

Stimming refers to repetitive movements, sounds, or behaviours that many autistic people engage in to self-regulate, focus, or express emotions. These might include hand-flapping, rocking, humming, or fidgeting with objects, and they often serve as a natural coping mechanism that helps autistic individuals process sensory information or manage stress.

As an Imago Relationship Therapist you could:

• Make it clear that stimming is totally okay in your sessions. This can be massive for neurodivergent individuals who have been told their whole life that stimming is not acceptable and they have often learned to suppress the behavior.
• Help partners understand each other’s self-regulation needs.
• Include sensory needs in relationship visions.
• Point out when arguments might be coming from sensory overload rather than emotional issues.

For those with AuDHD, stimming behaviors might have both autistic and ADHD components. They might bounce their leg (often seen with ADHD) while also engaging in more typically autistic stims like hand-flapping. These aren’t just “fidgeting” or “nervous habits” – they’re essential self-regulation tools helping them process information, manage emotions, and stay regulated in the session.

AuDHD clients may also experience more complex regulation challenges – they might need both sensory input and sensory reduction simultaneously. Help couples understand that their AuDHD partner might seem inconsistent – needing quiet one moment but noise the next, wanting touch sometimes but finding it overwhelming other times – and that this isn’t manipulation but rather the complex interplay of their neurocognitive needs.

Building on Strengths

A neurodiversity-affirming approach to Imago therapy doesn’t just focus on challenges – it recognizes all the awesome strengths that neurodivergent people often bring to relationships:

• Amazing passion and hyper-focus on interests (which can totally include their relationship!).
• Refreshing authenticity and directness that cuts through communication BS.
• Out-of-the-box problem-solving and unique perspectives.
• Rock-solid sense of justice and fairness.
• Eagle-eye attention to details and patterns others miss.

People with AuDHD often bring particularly unique strengths to relationships. Their combined neurotypes can create remarkable abilities like:

• Intense creativity fueled by both autistic deep thinking and ADHD divergent thinking.
• The ability to notice details others miss while also seeing unexpected connections between ideas
• Passionate engagement with their partner’s interests and experiences.
• A unique blend of hyperfocus and spontaneity that can make life exciting and meaningful.
• The capacity to think outside conventional social scripts while also bringing enthusiasm and energy to interactions.

These strengths don’t just compensate for challenges – they’re valuable relationship assets in their own right. In Imago therapy, highlighting and leveraging these strengths can create powerful healing moments and strengthen the couple’s connection.

As an Imago relationship therapist, you can get your clients to celebrate these strengths in the appreciations part of the session.It’s the differences that can make the relationship feel exciting and stimulating for both partners.

Conclusion

The bottom line? When doing Imago Relationship Therapy with neurodivergent individuals, the core principles still work great, but you’ve got to be flexible with how you apply them.

This is especially relevant for AuDHD clients, who often face double stigma and may have internalized negative messages about both their autism and ADHD traits. They might have been told they’re “too much” or “too intense” while simultaneously being criticized for missing social cues or not conforming to neurotypical expectations. Working through this internalized oppression can be a powerful part of the therapeutic process.

By embracing the neurodiversity paradigm, Imago therapists can ditch the pathologizing garbage that usually dominates conversations about neurodivergence. Instead, they can focus on building mutual understanding, finding accommodations that work, and appreciating differences. This approach doesn’t just help neurodivergent clients—it makes Imago therapy itself richer and more effective by expanding our understanding of the amazing variety of human connection.

Have you worked with neurodivergent couples? What adjustments have you found helpful? Drop your experiences in the comments – I’d love to hear what’s working for you!

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References:

Crompton, C. J., Hallett, S., Ropar, D., Flynn, E., & Fletcher-Watson, S. (2020). ‘I never realized everybody felt as happy as I do when I am around autistic people’: A thematic analysis of autistic adults’ relationships with autistic and neurotypical friends and family. Autism, 24(6), 1438-1448.

Edey, R., Cook, J., Brewer, R., Johnson, M. H., Bird, G., & Press, C. (2016). Interaction takes two: Typical adults exhibit mind-blindness towards those with autism spectrum disorder. Journal of Abnormal Psychology, 125(7), 879-885.

Fletcher-Watson, S., & Bird, G. (2020). Autism and empathy: What are the real links? Autism, 24(1), 3-6.

Heasman, B., & Gillespie, A. (2018). Perspective-taking is two-sided: Misunderstandings between people with Asperger’s syndrome and their family members. Autism, 22(6), 740-750.

Milton, D. E. M. (2012). On the ontological status of autism: The ‘double empathy problem’. Disability & Society, 27(6), 883-887.

Novellie, P. (2024) Why Can’t I Just Enjoy Things? Blink Press.

Walker, N. (2021). Neuroqueer Heresies: Notes on the Neurodiversity Paradigm, Autistic Empowerment, and Postnormal Possibilities. Autonomous Press.

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