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The complicated question of diagnosis and disclosure
Within my home, there has been frequent debate about whether or not the whole concept of autism – and diagnosis of any kind, whether it be autism, depression, anxiety, or whatever – is relevant or helpful.
My wife, who is a psychotherapist herself with 20 years of experience, was the one who first started calling attention to the possibility that I might be autistic. At the time, I dismissed the idea. I’d been working with autistic children and their families for years and thought I knew what autism looks like. (I did – in children who are heavily impacted, non-verbal or only marginally verbal, mostly boys and mostly under 10 years old.) I was not yet educated on the full range of neurodivergence, like most therapists – indeed, like most people, including all too many professionals who specialize in autism. I wrote off my autistic features as the legacy of complex trauma and chronic toxic stress.
It was only when I went into private practice and started working with a broader range of autistic adults that I started taking the idea more seriously. Especially when my clients started calling me out (gently, and with great kindness and humor) on my “tisms.”
Eventually, as my practice became increasingly focused on neurodivergence-affirming therapy, it started to feel increasingly inauthentic to answer the most common question potential clients would ask – “Are you autistic yourself?” – by saying “I don’t know, my wife thinks so.” How could I truly support people who were newly diagnosed, on the path of discovery, or wrestling with the complex questions around autistic identity when I had avoided walking this path myself?
Relational Neuropsychology: How It Shapes My Therapy Approach
Over the years, both personally and professionally, I have sought to understand the ways in which relationships—both early and ongoing—shape our emotional and nervous system responses. My lived experience, combined with extensive study and clinical practice, has led me to develop a therapy approach grounded, in part, in relational neuropsychology.
Relational neuropsychology has its roots in attachment theory and neuroscience, with key contributions from researchers such as John Bowlby and Mary Ainsworth, who pioneered attachment theory, Allan Schore, who explored the role of early attachment in right-brain development and affect regulation, and Stephen Porges, who developed Polyvagal Theory to explain how the nervous system responds to social engagement and threat. Daniel Siegel and Louis Cozolinoexpanded this work by integrating neuroscience with psychotherapy, emphasizing the importance of interpersonal neurobiology. Jaak Panksepp, a pioneer in affective neuroscience, identified core emotional circuits in the brain that underlie our relational and emotional responses.