As a kid, I would rarely raise my hand in class because I had such an extreme fear of being wrong. As any of my colleagues will tell you, I have become much more outspoken. But it wasn’t until I was in graduate school in my mid-20s that I finally felt confident that I was right enough to counteract the times I was wrong. This feeling continued to show up, especially group supervision, where I was afraid of asking for support because I wanted my peers and supervisors to see me as a competent therapist. It felt shameful to be learning.
Children with ADHD feel a heightened sense of shame. These experiences of being criticized more often than peers leads to children, adolescents, and adults who struggle with anxiety and depression, among being at risk for other mental health conditions.
According to Metalyc, an AI company that surveyed therapists for its AI documentation tool, 24% of therapists identify as having a neurodivergent condition, which is higher than the estimated 15 – 20% of the global population. We need better supervision to support neurodivergent therapists through their shame responses so that they can get the full benefit of clinical supervision. When we support neurodivergent professionals, others who struggle socially, with organization, and with trauma responses will also benefit.
ADHD and Shame
I will speak for myself here, knowing that some but not all other neurodivergent clinicians will have experienced something similar. I really struggled in clinical supervision for a long time because of my own internalized shame and belief that there’s something wrong with me.
- I do not have a trauma history, but can easily fall into fawning patterns. I’m quick to agree to projects and work before realizing that it doesn’t align.
- I have a visceral feeling of shame when I don’t know the answer to something. It’s like part of my body goes numb, I can feel my face start to flush, and my heart races. Speaking in a group while feeling that seems impossible.
- Someone disagreeing with me feels like criticism. It’s hard not to feel my throat tighten and get defensive. Learning to breathe through that so that I could respond as calmly as possible took time.
- Disagreeing with someone else also feels like a threat to my nervous system. The idea that I could end up in a conflict felt intolerable.
- I didn’t really know what to expect in clinical supervision, which meant that preparing for supervision was difficult. Along with this, my early clinical supervisors did not have training in clinical supervision. They were repeating what they had experienced, but were often newly licensed and not very experienced.
Tips for trauma informed clinical supervision of neurodivergent therapists
Along with being neurodivergent, many of the therapists and social workers I’ve supervised over the years have been neurodivergent. Here’s what I would change to hold neurodivergent therapists accountable while recognizing their need for tailored support.
- Transparency: Clear job expectations and reasonable plans for correcting outstanding tasks.
- Consistency: Feedback and staff accountability are consistent across staff and supervisors.
- Collaboration: Staff having an opportunity to share how they like to receive feedback (both positive and constructive) as well as when feedback will be provided. Supervisors should also seek feedback from their supervisees and accept feedback without defensiveness.
- Learning environment: Clear guidelines for clinical work and clinical professional development. Setting the expectation early on that clinical supervision is a space to learn.
- Support: AI tools have meaningfully supported neurodivergent therapists with completing documentation since then
- Meaning making: Individuals with ADHD in particular need to feel a meaningful connection to their work to improve focus
Collaboration and being transparent are two of the foundational expectations of trauma informed care. Neurodivergent people may struggle with unknowns and are more likely to assume there’s something wrong with them than there’s something lacking in the system in which they work. Having clear expectations eases that anxiety and shame. Creating a learning environment establishes safety for neurodivergent therapists to be safe (enough) to not have all the answers. Even better is a supervisor who can admit they don’t know everything. I like to set the tone for this early on in a supervisory or managerial relationship by sharing my training and clinical background and acknowledging that my supervisees may come from a different theoretical orientation. This acknowledges the limits of my experience and expertise.
Supporting staff generally with finding meaning in their work is important for preventing burnout and compassion fatigue. This is especially important with neurodivergent therapists, whose struggle to focus is more likely to lead to a cycle of burnout and shame.