Episode 24: Neurodiversity Affirmative Practice [featuring Joel Schwartz]

Show Notes

Neurodiversity,  Neurodivergent, Neurotypical. What do all of these terms mean?

If you're trying to not only ensure competency but create a neurodiversity-affirmative practice, this episode is for you!

Joel Schwartz and I talk about incorporating neurodiversity affirmative practices in your business and discuss why it's not ok to just do the bare minimum.

We talk about our journeys, struggles, and experiences, Joel's as an ADHD therapist and entrepreneur and mine as an Autistic, ADHD therapist and entrepreneur.

Joel owns the only group therapy practice in California staffed completely by neurodivergent therapists, and moderates the Neurodiversity Affirmative Therapists FB group.

This episode is in support and solidarity with Autism Acceptance Month. I love brains that work differently and function outside of a neurotypical world. Let's continue to combat the shame and stigma and celebrate Neurodiversity!

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A Thanks to Our Sponsor!

I would also like to thank CPH & Associates for sponsoring this episode.

This episode of the all things private practice podcast is being brought to you by CPH & Associates. CPH & Associates is a leading provider of malpractice insurance for outpatient mental health practices throughout the United States. With up-to-date legal resources and competitive rates, CPH can ensure your private practice against board complaints and malpractice lawsuits.

CPH has committed to providing exceptional customer service and superior coverage to mental health professionals. Protect your career and find peace of mind with CPH. Get a quote and apply at cphins.com/allthings.

Transcript

PATRICK CASALE: This episode of the All Things Private Practice Podcast is being brought to you by CPH & Associates. CPH & Associates is a leading provider of malpractice insurance for outpatient mental health practices throughout the United States. With up-to-date legal resources and competitive rates, CPH can insure your private practice against board complaints and malpractice lawsuits. CPH offers both individual and business entity coverage which can protect your LLC or corporation.

A business policy with CPH is tailored to meet the needs of your practice providing options to add general liability to your office, business, personal property coverage, and cyber liability for data breach coverage. Policyholders who also have access to our attorney helpline providing two hours of consultation with a malpractice attorney for situations with a client that could result in a claim or lawsuit. CPH is committed to providing exceptional customer service and superior coverage to mental health professionals. Protect your career and find peace of mind with CPH. Get a quote and apply online at cphins.com/all things, cphins.com/all things.

Hey, everyone, you are listening to another episode of the All Things Private Practice Podcast. I'm your host, Patrick Casale joined today by friend and colleague, Joel Schwartz. He is a clinical psychologist out in California. He runs the neurodiversity affirmative therapy group, which is a really wonderful Facebook group, and then owns the group practice, Total Spectrum Counseling. And Joel is going to just really talk a lot about creating a neurodiversity affirmative practice and things you can do to make changes and also provide some awareness and education during what we're calling Autism Acceptance Month. 

Joel, I'm really happy to have you here. I know our schedules have not aligned at all.

JOEL SCHWARTZ: I'm happy to be here, and to finally talk to you, and finally get a chance to… I know that this has been something that has affected your life quite a lot, especially, recently, and I think that's going to open up a really nice avenue of conversation, especially, as both of us are neurodivergent people. I think it's important to start by saying, you know, I am not autistic even though I specialize in working with autistic people. I am a very proud ADHDer or VASTer as some people are trying to push as a new term to take away the disorder. But, you know, I co-run my practice with my wife who is autistic, and all of our clinicians identify as either autistic or ADHD.

PATRICK CASALE: That's really cool. And, you know, you're certainly one of the well-respected names in the community when it comes to neurodiversity affirmative therapy and just advocacy. And it means a lot to have people out there who really are knowledgeable and kind of leading the charge, so to speak. And it's really fantastic that you have only, I think you've mentioned, 100% of your clinicians and the only group practice in California that is all full of neurodivergent therapy? 

JOEL SCHWARTZ: Yes, therapists, yes. 

PATRICK CASALE: Very, very cool. So, you know, I want to hand this over to you, because you're the expert in a lot of this, and you're the one that has all the trainings in the world. I'm still learning, by the way, you know? Like, learning that I'm autistic, I don't know if it was a shock, but language around it, like I was using ASD for a while, and I like that you politely were like, “We need to shy away from that term.” 

And I'm still really trying to embrace it. But I think it's been life-changing in a lot of ways, too. You know, I identify as autistic and ADHD, and I think the ADHD always made a lot of sense. But I don't think I ever recognized that I was autistic. I think there was a lot of shamefulness around the diagnosis too when I got it and went through the testing process. And it's been kind of cool to step into it more so and just be like, “Yeah, this is who the fuck I am, and this is how I identify, and it's really a wonderful experience.”

JOEL SCHWARTZ: Yeah, you bring up a really important point. You know, one of the things that we do is testing. And when we get into what does neurodiversity affirmative practice look like in a little bit, I can expand more, but one of the fundamentals is that there's such a stigma around autism. It's such prejudice. And, you know, I don't know if there's a word for it or just a phobia. You know, the same way that there's transphobia or homophobia, that is so embedded in how Allistic, which is a term the neurodiversity folks have come up to mean not autistic, how Allistic clinicians have such an anti-autistic bias that they will do anything to not give that diagnosis. 

I have received so many reports where it will let you know, sensory processing, executive functioning issues, OCD traits, social anxiety, not autistic because they were able to make eye contact for five minutes, you know? And then the whole idea of ruling out everything else before you say somebody is autistic is also kind of an endemic problem because it should be the opposite, it should be autistic, is the umbrella under which everything else develops. 

And so, because of prejudice, because of bias, because of just really poor awareness of what autistic experiences actually are, there is an epidemic of people not getting their diagnosis until they come into contact with a practice like ours, which really understands the subjective experience of autism, what masking is, what's, you know, a stereotype versus what is the reality. 

And so, in our practice, there’s just almost a year-long waiting list of people who've been denied diagnoses, who really know in their heart of hearts that this matches their experience, and they can't find a clinician who really understands it or is willing to take their perspective instead of just a more rigid DSM-based one.

PATRICK CASALE: That's really well said, and it's wonderful that you're offering those service because I know so many people need it. And I myself, you know, I'll own my shit. Like, there's definitely stereotype around it, right? Like, without knowledge, and with just this misconception that this is what someone who is autistic looks, and acts like, and functionality, and all the pathologizing shit behind it, right? That a lot of us maybe if we're not as aware, or not putting in the work to become affirmative, and really have the understanding, I think that is the misconception, because when I got, “the diagnosis”  I was like, “Wait, like, I just really struggled socially, like, what is this? This is this doesn't make any sense to me.” 

But then looking through a lot of my life and childhood, I was like, “Oh, yeah, this is spot on”. And, you know, I had a psychologist in testing years ago, like I had talked to her for about 10 minutes, and she's like, “You're autistic, aren't you?” And I was like, “No, I'm here for an ADHD diagnosis.” And I was like- 

JOEL SCHWARTZ: Right.

PATRICK CASALE: It just really put me off. And the more I've learned about myself and just autistic people in general, I just think that it's such a beautiful part of the community, and such an overlooked one, and such a stigmatized one, too, because I think there's just a lot of misconception. 

Like, I've had family members reach out recently, and they're like, “That's not the case, I never saw it. You know, like, and you shouldn't be talking about it out loud.” I’m like, “Oh, God, this perpetuates the inability to normalize experience and to really affirm experience too.”

JOEL SCHWARTZ: That's right, and I will say to you, congratulations on finding this out on yourself. This isn't something to be ashamed about or sad about. Though, I mean, obviously, when you look back at one's life, with new understanding, there's a lot of mourning that has to happen and there's definitely internalized stigma. So, it's not to deny the emotional complexity of this, but really being able to accurately identify something about yourself, which is intrinsic to who you are and own it is a beautiful thing, and it's something that I congratulate people who are not this narrative of, “Oh, you're autistic, oh, you're screwed. Your life is over here. There's …” No, this is something different, and interesting, and new to be embraced and celebrated. And if you can do that, there's no reason why you can't live a kick-ass life in whatever way that you decide kick-ass means.

PATRICK CASALE: Yeah, and I so much appreciate that, because that feels really validating. And it's so interesting, because the person I did testing with is a, “expert” in ADHD and autistic diagnosis in the area, and that's exactly what he told me at the end of the testing process was, “Life is going to be really challenging now that you know, and you know, it's going to be a lot of adaptation, and you're going to have to do A, B, and C.” And I was just kind of like, “Oh.”

JOEL SCHWARTZ: Like you haven't being doing that already?

PATRICK CASALE: Right, right. Like, that hasn't been my experience. Like, all of a sudden it's going to change. And I do think there is that mourning process. But now, like you said, just the beauty of it and the congratulatory statement. I think that's so validating. And I imagine people who come in contact with you and your practice, it's just a life-changing experience to have people who really get it, and that's a really beautiful thing.

JOEL SCHWARTZ: If anything, it's the opposite. It's now that I know this, I can stop masking, I could stop putting so much effort into changing things that I know are just inherently who I am, and just kind of have to accept. There's a relief and an ability to relax and finally be like, “Oh, I don't have to put all this fucking effort into things all the time.” And so no, it's the opposite. It’s like, I don't have to do all this adaptation now. I can actually kind of let my freak flag fly a little bit and enjoy life as me. So, yeah.

PATRICK CASALE: That's exactly how I've started to move into the mindset because now I can name it, and I can tell people in meetings I'm not going to make eye contact with you. It's not something I'm doing to be disrespectful, but that's how I need to process information, and that's how I need to feel comfortable and grounded. And I'm in a divergent group with people, and I’m like, “I may not be looking at the screen, I may be doing other things, but I really promise you that I'm paying attention.” 

And I just think that it feels kind of empowering and kind of freeing. And I've just noticed the shift in energy in terms of embracing, advocating, and also just showing up. I think that it's really been transformational.

JOEL SCHWARTZ: Totally. And I do something similar. One of the pre-eminent autistic scholars, and you know, really one of the people who defined the neurodiversity paradigm as a movement and some of the definitional aspects of it and vocabulary is a autistic scholar named Nick Walker. And she came up with this term called neuroqueer, which is partially about the overlap of queer experiences and neurodivergent experiences. But also, it's understanding that the queer experience that LGBTQI folks have in comparison to cishet folks is similar in feeling, it's not the same. I'm not making an equivalent, but there's a similar feeling and otherness of being neurodivergent. And therefore, just as a part of embodying one's queerness means to daring to do that in a straight cishet space. 

You know, if you're gay holding your boyfriend's hand in public, wearing your hair differently, you know, [INDISCERNIBLE 00:11:34] is a queering straight space is the idea of neuroqueering and neurotypical space. And so, you know, one of the ways that I started doing that once I discovered this idea or learned about this idea from Nick is whenever I go to a classroom or a conference, I have these foam rollers, and I have hand fidget stuff. And I tell people around me, “My body is going to be loud and doing this throughout because I cannot move and pay attention. If you're the type of person that, that bothers, don't sit by me, but I'm not going to, you know, not do this.” And most people think flipping like, “Oh, that's interesting. Tell me about it. Because, you know, we're all therapists who are interested in other people.” Other businesses or other fields may not be so understanding, but that doesn't mean you can't adapt it. 

And I think that that's an important thing, saying, I'm not going to spend an inordinate amount of time stopping myself from being myself because this is how I am best myself.

PATRICK CASALE: That's a powerful statement, and that definitely sinks in, you know, as I have, like, lots of tactile stuff and sensory stuff in my hands right now. But I so agree, because otherwise, I think, for people who don't get it, and don't have any understanding, and a lot of people who are neurotypical, they might be looking at you while you're moving around, like you're not paying attention. You're being disrespectful. How come you can't sit still? 

And even, I was in fucking yoga yesterday, which is painful enough as someone who has the flexibility of a two-by-four. And I have to be like moving constantly and like even in poses where I'm like, “Oh, my God, I can't sit still.” Like, I have to be like moving, I can't like just be with this. But I've realized that is my way of really settling and being more mindful and grounded. And it just feels counterintuitive for a lot of people, I think.

JOEL SCHWARTZ: No, it's absolutely true. I can't stand some of the like mindfulness, and what's the word? Meditation-based techniques that they try to have us do because it's physically painful for me to just sit still and work that way. I mean, I'm already pretty mindful that ADHD folks kind of pathologically live in the presence. I can't think beyond it sometimes. But just having to sit still and focus on your breathing, it's like you might as well be, you know, whipping me. It's so uncomfortable, you know?

So, I mean, when we talk about neurodiversity affirmative practice, these are the things that we have to think about. How do we make it and adapt our tools that are really made for neurotypical people into a way that it's accessible for neurodivergent people?

PATRICK CASALE: You got me laughing over here off the camera because you're so spot on and that's how I was feeling yesterday. And I was almost thinking, like, does anyone in the community do yoga for people who are neurodivergent or autistic? Because this just doesn't feel well-suited for me to be like, be mindful, and focus on your breath, and, you know, be still and I'm like, “My brain is, like, fuck. Now, I can't sit still like this is not comfortable.”

And I think that you start to pay attention more and more to language in general. And I know you're a big advocate on identity-first language. And I've really started to understand why. So, can you tell us a little bit about how important that is and why identity first over person first or person-centered?

JOEL SCHWARTZ: Yeah, yeah, yeah, that's a good question. It all goes back to, if you remember from probably undergrad, the Sapir Whorf hypothesis, which basically says that our language directly influences our thoughts or cognitions the way that we conceptualize things, and, you know, when I talk about this in my training because I'm a big Star Trek nerd, I always have a picture of Lieutenant Worf to cling on, even though it's not spelled the same way. 

But the Sapir Whorf hypothesis, you know, suggests that, I just said it, I'll repeat it, the way that we talk influences the way we think about things. And the idea of using what's called person-first language, a person with autism, a person on the spectrum, comes from really a neurotypical normative standpoint that seeks to see autism primarily as something negative, something almost to be held in front of you, like a stinky sock. It's like, this is me, this is the autism out here, and you're so much more than your autism. We also hear, “Isn't everybody a little autistic?” Is kind of another part of that. 

And all of it is based in this bias that there's something negative about being autistic, or that it can be meaningfully separated from somebody, and it can't be because autism is the way that you sense. It's the way you perceive. It's the way that you make meaning out of stimuli. It's the way that you relate to other people. And it's your values. If you take all that away, you don't really have a human being left, do you? These are the things that inherently make us who we are. 

And it's not to say that, you know, you're going to have a homogenized group of people based on the neurotype, but these things drastically mediate all experience. And therefore, it's almost silly to think about saying, “Oh, you're so much more than your autism.” It's like, “No, I am, and I'm not, but it's always part of who I am just like my gender is always part of who I am, as my race is always part of who I am, as my, you know, philosophical creed, or religion is, you know.” So, this becomes part of one's identity instead of a stinky sock that could, you know, be turned away from, if the non-autistic people in your life choose to do it, you know? We who have different neurotypes can't turn away from it, we can't, you know, hold it out as if it's something and we might try when we have internalized ableism and we've been, you know, told this all the time. 

So, one of the big switches we can do is go to identity-first language saying you're an autistic person, I'm an ADHD person, ADHDer or a VASTer. VAST stands for variable attention stimulus trait, which is a non-pathologizing way that certain people have begun to talk about ADHD. I don't know if it's going to catch on but at least it takes the last D out, the disorder part out. 

Yeah, and so one of the things that I do in my training is because so many people have internalized that, you know, you have to do a person-first language, that it's bad to not do person-first language is I have them spend, you know, a minute doing kind of a behavioral exercise where they have them just look around the room and go autistic microphone, autistic cat, autistic dog, autistic computer screen, autistic light bulb, autistic window, autistic elephant statue, autistic ceiling fan, autistic exercise equipment, autistic stool, just to kind of get them used to being okay with using this language. 

And, you know, they've done polls with the autistic community and you know, 60 to 90% of autistic people want to be referred to this way. If somebody says they don't want to, I will always allow their self-definition and just like anybody or any identifier, you know, it's their way to identify. So, I will do that. But otherwise, I trailed off and forgotten my point. But, yeah.

PATRICK CASALE: That's okay. I love it. And I think what I also hear you saying is, a lot of times when we don't use identity-first language we're doing it for somebody else's comfortability?

JOEL SCHWARTZ: Yeah.

PATRICK CASALE: And almost this like protective factor of like belonging, or fitting in as if like, I'm just managing these symptoms over here, and you know, this isn't truly a part of who I am, and maybe it'll get better one day or maybe it will become more manageable. And I think that like everything you just said, just identifying in that way and recognizing it's a part of your makeup and just how you experience the world really de-stigmatizes it, because then you can just say, this is how I process information, this is how I connect with people. Like, this is who I am and that feels a hell of a lot more empowering than saying like, this is just something I deal with.

JOEL SCHWARTZ: Yeah.

PATRICK CASALE: And I like that exercise too. I’m now like looking around my room like you were just doing and thinking about that in that way. So, identity-first language-

JOEL SCHWARTZ: That was what I was going to say, is that even the D… not the DSMB, APA Publication guide has changed itself to officially allow autistic person and identity-first language in formal research writing. So, that was a pretty cool thing that happened recently.

PATRICK CASALE: That is pretty cool. And it's nice to see the shifts that are happening and there seems to be a pretty big movement right now, and I think that feels really powerful too, because I think people feel more empowered to just be like, “Yeah, this is who I am.” And I think the generation of younger people helps lead that charge too. Now, as for creating neurodiversity affirmative practices, what else can we be doing or should we be paying attention to in order to really make sure that we're working towards having safe spaces and really affirmative spaces?

JOEL SCHWARTZ: Yeah, and I want to start out by asking you an earnest question. And no offense if you're in therapy or current therapist, but have you because I have not, ever had the experience in psychotherapy of really feeling like you could unmask, that you were fully understood, having these experiences where, you know, my clients will say to me, “You know, I feel so heard, and seen, and understood, and thank you. And, you know, I think about you at, you know, my wedding, and you know, I want to consult with you, I just…” I've never had that therapeutic experience with any therapists that I've seen, even the ADHD therapists, and I want to ask you, have you?

PATRICK CASALE: It’s a great question. And before I turn it back around to say what has your experience been like, especially with ADHD specific like expert therapist, so to speak. So, I get my diagnosis maybe six months ago, I believe, I lost track of time in the last two or three years, and I'm feeling a lot of grief. And I had stopped therapy with a different therapist, and I was doing a lot of attachment-focused work with and we just hit a wall, and I was kind of done with it. And I found an IFS therapist, and I didn't have any intention of going into that relationship and talking about ADHD or autism. It wasn't even on my radar, really. 

And I remember getting the diagnosis and then being like, “Oh, shit, I'm going to tell this new therapist, and she's going tell me like, ‘Oh, I can't help you. I have to refer you to someone who is more so the expert.’” And I told her in our first meeting, and she was like, “Oh, that's so wonderful. I have two autistic children.” And like, all these-

JOEL SCHWARTZ: That’s lucky.

PATRICK CASALE: …things started falling into place. It was beyond lucky because it was not what I was looking for. And, you know, she sends me like, links to buy like fidget toys, and like [INDISCERNIBLE 00:22:46] stuff that can help with playfulness, and like, checks in on my podcasts. And I'm just like, “Wow, I really do feel that type of connection, and I really do feel seen.” And it all just came out of like, I need to pursue a different type of therapy because this is what I want to work on. It was more for like perfectionism and overachieving, and never feeling good enough, and what it's turned into is not something that I had foreseen by any means.

JOEL SCHWARTZ: Big round of applause for your therapist, that's awesome. And if she hears this, my fist is in the air. But, you know, what she did was pivoted to, if we almost want to use kind of a lens of kind of culturally informed therapy as well, that's what she did, is she adjusted to your, let's say, neurological culture. And she recognized, “Oh, I'm working with somebody whose mind works differently, and here are the things that they need to feel attached.” And she is attending to your sensory needs. That's huge because nobody attends to our sensory needs. 

And that's actually the very first components of neurodiversity affirmative practice is to always start with the sensory. And sometimes this is beyond our scope, and, you know, this is why I really recommend having an occupational therapist who understands sensory differences to consult with or be on staff, or, you know, collaborating on cases. But until sensory safety is attained, and sensory comfort is attained we can't move beyond that. It's almost like, you know, the Maslow's hierarchy and Allistic people, neurotypical people don't understand how much sensory differences affect our day-to-day ability to function. 

And so, one of the things that I will do, this hasn't happened lately because I'm almost fully virtual at this point. But I would bring people to my office and say, “You know, what are the smells like for you? You know, what's the light like in here for you? Is there any adjustments we can make?” I have, you know, jars of… it's like my daughter made this for me, it's homemade playdough mixed with essential oils. 

I can't stand when people have the essential oils in their offices. It's like horrible to me, especially lavender. If you have lavender, I'm going to ransack your office and run away. But you know, having different types of scents that people can access if they need to, have them bring in their scents, their favorite perfumes or you know, scents. You know, when I was a kid, I did this weirdly, intuitively. I look back and go, “Oh my God, you were such a nerd.” But I recognize that it was like something I was doing to help myself sensory, is I love the smell of like fake candy grape. And so, what I did is I had like one of those plastic tins of bubble tape, and I would, like, sneak smells of it when I was alone, nobody was around. Because it was so profoundly, like, yummy and regulating. 

And so allowing people sensory bliss, like, what kind of stim toys? Do we need to go outside and be in nature? So, you know, that's another part of it, is radically leaving the office, if that's not what's going to work. 

So, before I moved to the Central Coast I lived in the South Bay of Los Angeles, and there's a beautiful botanic garden there, and so you know, four or five times a week, I would meet with people in the botanic garden, and we would smell the flowers, and just sit in the sensory bliss of it. And that was profoundly connecting and regulating. So, you know, both in the office and out of the office, the first step is let's work on sensory strategies and sensory regulation in order to access the person's best way of being. 

And oftentimes that can sometimes be enough for a lot of people, is you do that, and suddenly their minds are actually working, and they're like, “Well, I can actually do things for once. All this executive functioning that I was having trouble with, it was really just sensory issues and now the sensory issues are maintained, and I know how to deal with things when I'm feeling a sense of sensory overwhelm. Wow, it's amazing. I can do so much all of a sudden.”

PATRICK CASALE: That's so perfectly said. And I hope people can really take that in, especially, if you don't identify, and you're like, “Oh, my partner does this, or they have weird things about smells.” Like, I have to tell my wife with smells, especially. Like, cooking for me, we have to really limit it in the house, because it will seriously keep me up at night where I can't go to sleep because I'm so uncomfortable. 

And what my therapist did was, it just felt like being seen for the first time, and going into that experience expecting the worst like expecting me to say, “Hey, this diagnosis just came in.” And for her to say, “Nah, I can't do this. Like, it's just out of my scope.” And instead, to feel seen and validated like we start session. She's like, “Look wherever you want, get up and pace, if you want, like do whatever you need to do to kind of settle down.” And you know, if I'm moving a lot [CROSSTALK 00:28:03] the chair gets like… hopefully, if she does listen to this episode, big shout out. And it's been unbelievably powerful, and just really affirming, and it just makes me feel really good to go to therapy. Like, I feel like I got very, very lucky and I know a lot of people don't get to have that experience.

JOEL SCHWARTZ: You have been, but we will lead the revolution. It's shocking to change.

PATRICK CASALE: I think you're doing that too.

JOEL SCHWARTZ: Already is.

PATRICK CASALE: You're doing a lot of this stuff and helping people put this into practice and at least have a better understanding, and experience, and education around it too, which I think is crucial. And what are some other ways that we can do this so that it's not just sensory, it's language, obviously. What else do we have to pay attention to or really kind of hone in on?

JOEL SCHWARTZ: So okay, the other thing is, this is more so with autistic people than ADHDers. And I should say there are many other forms of being neurodivergent. If you have really any mental health diagnosis, you might be considered neurodivergent in some way. It's kind of an all-encompassing term. But, you know, the two groups, I think, which are the most grossly misunderstood and very overrepresented in therapy are the ADHDers and the autistic people. So, we tend to focus on that. And, you know, from a standpoint of time and resources, there's only so much. We can't be too broad. 

But more so for autistic people but definitely also with ADHDers is leading with passions. You know, one of the criteria for autism is, you know, these intense special interests and special interests for autistic people are part of their identity. It forms a matrix for understanding the rest of the world often. It becomes an inherent part of how they communicate socially. And with ADHDers, our passions will take our attention, whether you want it to or not. So, incorporating special interests and passions into therapy and leading with them, whether you use them in a sort of projective way, or whether you're just using them to form rapport, incorporating them into session as a way to connect and bring emotional regulation that has to be part of it.

And a lot of people are comfortable with this, especially if they're working with managed care, because, you know, how do you justify that I spent 25 minutes of the session watching an anime episode with my clients? How do I, you know, justify to insurance that, you know, we looked up birds on Wikipedia and read random facts to each other? Or, you know, how do I justify that we spent 20 minutes trading AI characters from science fiction that we love and you know, talking about what makes one more human or the other, when really what we're talking about what makes us more human? And we understand that, but the insurance companies don't understand that. 

So, there's a push back, is this really therapy? Yes, this is rapport, this is getting into somebody's world, this is a regulation, it's allowing somebody to unmask in a very profound way that they can't do anywhere else in their life. This is the meat and potatoes or if you're vegetarian, the vegetables and potatoes of what therapy is, and so incorporating this as a normal part of therapy, even putting some time aside every session for engaging with these passions is so important. 

And one of the, you know, strengths I think being an ADHD therapist is and can be is that all this stuff is so fun for me and so interesting for me because every geeky pursuit is fun, is interesting, is novel. So like, it's just amazing. It doesn't feel like work, even though it is work, and I can justify it. But oh my gosh, it's so fun and my clients just love this. And you know the young ones start calling me, “Oh, Uncle Joel, I want to talk to you about this.” And I have to have this moment of like, “Is this like a projective thing, is it's transferring?” No, this is actual rapport. This is having the feeling of being seen, of having somebody fully accept you for the first time. They just don't have that anywhere and it's really beautiful.

PATRICK CASALE: Damn, I'm like thinking about this and how important that is, because it's how people connect and I think if you feel so disconnected from people in everyday life, or even in your social circles, or in your partnerships, at times, this is the way that I think a lot of people feel like they can truly be connected. And the misconception of autistic people don't know how to be connected to other people, or ADHDers really struggling to pay attention or connect in social circles. And I just think that it's about recognizing that connection looks differently-

JOEL SCHWARTZ: I connect with that. 

PATRICK CASALE: …and connection doesn't have to, “Look like eye contact and social like, or surface-level conversation, and like stupid fucking social cues.” that I don't pick up on anyway.  So, I just think that if I'm really interested in something, I'm going to feel really connected to someone who also feels the same, or at least allows me to have that conversation or that experience. And I've talked about this before, and it may feel like it doesn't really add up or make sense. But I think when I travel, I feel the most connected than I ever feel in my entire life. And I think it's because it's like sensory overload, but new, exciting sensory overload. And then I'm really like hyper-focused and like really passionate about meeting people, and learning about their cultures, and their food, and their families. And then I come home, and I'm like, it feels like vacancy in a way, so it's just very interesting to pay attention to the differences and how we move through the world.

JOEL SCHWARTZ: Right, right. What do people do when you ask them about their culture? They deep dive into it. They want to show you everything. It gets to be exciting, in-depth instead of the stupidity of the, you know, “Oh, how are you today?” “I'm fine.” “Oh, it's sunny outside.” I can fucking tell it's sunny outside. You don't need to tell me it’s sunny outside. 

PATRICK CASALE: Exactly.

JOEL SCHWARTZ: Yeah, and that's it. If you can form these connections, even if they're fleeting, but it's on something that's interesting, that’s more depth-oriented, and that is, you know, fuel for ADHD minds, is we have to go depth, yeah.

PATRICK CASALE: Exactly, and that's why like when I travel people are like, “How can you not do the tourist issue? Like, how can you get off the beaten path?” I love doing like-

JOEL SCHWARTZ: Me too, I hate it.

PATRICK CASALE: [INDISCERNIBLE 00:35:03] cooking classes with people, because I'm like, we get to cook food, which is good, because it elicits like the tactile stuff, right? And the movement, but we also get to communicate about food, and what it means to someone, and what it means to their family. And for me, that's such a beautiful representation of humanity. And I think a lot of people would say, “How can you put yourself in these situations socially where it would be very uncomfortable with a stranger to be in their home and to do this experience?” And like, this for me is the most beautiful experience that I could possibly have.

JOEL SCHWARTZ: Yeah, yeah, I'm with you. I always want to do the non-touristy things off the beaten path. You know, I ask, what's the best hole in the wall restaurant where there's a, you know, chatty, you know, owner, so that I can, you know, experience that from that perspective? Absolutely, I'm with you.

PATRICK CASALE: Yeah, and my wife has always, like, have to mentally prepare for these experiences. And then she ends up loving them. And my wife has ADHD, so like, it's an interesting combination. And I was curious about your own partnership and we don't have to go down that road if you don't want to. But it's interesting to see different perspectives with different types of just experiences and identities in general. And it's been a really cool transformation in our partnership too, to start to better understand how we both move through the world.

Like, her craft room, which is our spare bedroom next door is like a fucking tornado hit it, and I can't go in there. But she's like in there creating all these earrings, and like all these new ideas, and I'm like, “Nah, can't do that, got to stay the hell out of there.” And it's just very, very different in how we move and it's kind of neat though, I really enjoy that.

JOEL SCHWARTZ: Yeah, and you know, you're right, and the biggest issues in cross neurotype relationships, and certainly it's in mine as well are when two people with vastly different sensory needs are occupying the same space, there's going to be conflict. And so one of the things that I kind of tell people is like, expect the conflict. You know, I think a lot of couples think, “Oh, you know, if we just communicate, and you know, if we just get each other, then there's never going to be conflict.” It's like, no, when you have different sensory needs, there is going to be conflict that is going to be built into the relationship. 

Conflict doesn't mean that a relationship is bad, it doesn't mean that it's insurmountable, but when there are vast differences it's going to happen. And it's the same thing with, you know, language differences and processing differences. There's an autistic researcher in England, Damien Milton, who coined the idea, the double empathy problem, which is essentially that, you know, autistic people are always accused of having no empathy for Allistic people, but they seem to be able to hang out with each other fine and understand each other fine, so it's not an empathy deficit. And if you look at the way Allistic people treat autistic people it's piss poor. And so the idea is that it's not a deficit in one or the other, it's that each one has their own way of being and has difficulty understanding the other.

And I'd say the same thing as, you know, the ADHDers as well. And so whenever you have two different neurotypes you're going to have issues that come up from the double empathy problem, which means almost an excruciating amount of having to clarify and talk about what was really meant, and, you know, it can be tiring, it can be times where it's just like, you go fucking do your thing for a while, I'm going to do my fucking thing for a while, and that's all that we can do. 

But again, when you expect that this is something, it doesn't call the whole system into question. It's just understanding that these challenges are part of growing up in a world that doesn't really understand or provide education or ways to bridge gaps between neurotypes.

PATRICK CASALE: Very well said, can't wait for my wife, Arielle to listen to that last statement. But you're so right. I mean, it is like, okay, we both experience the world differently, there's different ways of seeing information and sensing it, and then recognizing it's not foundationally, you know, weakened. It's just more so that we're going to not see eye to eye on things like this, and that's going to cause conflict, and that's going to be okay. And it has nothing to do with a personal vendetta against one or the other or vice versa. So, it's just really important to pay attention to that. 

And she's like, “Yeah, I realize this is how your brain works, and this is what type of information you need right now, and that's okay.” And like vice versa. And I think that's really important. And, you know, I would love to talk about masking, I'd love to talk about a million things. But I do want to honor time, and I really enjoy this. Like, this has been a really wonderful conversation, and I feel like we could do multiple-

JOEL SCHWARTZ: Absolutely.

PATRICK CASALE: …parts of this too. And it's just really exciting and interesting to know that there are so many people out there who really, not only are just educated but really are trying as hard as they can to show up. And I think that makes a big difference. And I definitely respect the hell out of you for doing what you do and it just means a lot that you exist in this space.

JOEL SCHWARTZ: Thank you. I'm going to say just maybe, one more minute on two other things for neurodiversity affirmative practice that I think they're important. 

PATRICK CASALE: Absolutely. 

JOEL SCHWARTZ: And if people want to contact me for consultations, or take one of my trainings, I get into this a little bit deeper. The third thing is the rule for self-disclosure, go out the window, because the lack of self-disclosure is an Allistic convention where they feel if you're disclosing that you're taking over, but self-disclosure is an inherent part of how autistic and ADHD people connect. We get excited. If we just sit back and can't put a part of our experience into it, and we're not interacting, our brains kind of start to shut off, and we're not connected. It's just you rambling about a story. I need to insert something in order to be part of the interesting part of this conversation. And also, because we don't have authentic neurodivergent stories, and elders, and examples to draw from, talking openly about our journeys and our stories is needed for the next generation and for those who are suffering with internalized ableism, to be able to normalize and say, no, this is what we go through, this is normal, and here's what I've done that has helped or hasn't helped. God, I fucked up so much trying to figure this out, I get it. So, the rules for self-disclosure go out the window. 

And then the last one, is because we're dealing with folks who are systematically marginalized, are consistently denied their experiences, denied doctor’s offices, and psychiatrist’s offices, are ignored by systems and have significant disabilities in executive functioning and communication, you have to step out of your therapist role and be an advocate and a coach. And, you know, I will go to psychiatrist appointments with my clients and help bridge the gap between Allistic and autistic. I will insert myself into IEP meetings and speak strongly for them, because they will stop being able to speak when they feel that ableism is in the room, and I'll call out the ableism. 

So, there's a lot of breaking the therapeutic frame that so many people just are not comfortable with that you have to do if you're going to be working with this population. You have to do it, you have to realize that the therapeutic frame was not meant for the marginalized, it's meant for the comfortable.

PATRICK CASALE: I love all of that so much and I've always really resonated with the power of self-disclosure. You know, I think for people who see me move through life, I talk about that all the time, because I think it's just normalizing the human experience, and the struggles, and the things that we, you know, have to overcome on a daily basis. And I think it builds rapport pretty quickly in connection too, to know that like, we don't have to be blank slates as therapists, we don't have to like only reflect back, we can never show emotion. And it's really nice to know that there seems to be a big shift in the profession, but they're still met with resistance, right? 

JOEL SCHWARTZ: Mm-hmm (affirmative.)

PATRICK CASALE: Of like, that's not ethical, or like, you know, you're doing that to self-serve. And that's really not the purpose of self-disclosure in these relationships. So, I think that's important to really keep that in mind. And I love that you go and advocate in the community. I don't imagine that many people are doing that, especially, from a private practice setting. So, I think that's really, really cool and I think really well needed. 

So, I just want to say thanks, again, for taking a Sunday to do this. And we're going to release this episode pretty quickly because I want to get this information out there for autism acceptance. And I just really appreciate your time. I'm definitely going to be asking you to come do some training for my group practice because I think that is just so powerful, and also will help us really support the communities that exist in western North Carolina too, because a lot of people just aren't doing it.

JOEL SCHWARTZ: Nice, yeah. The trainings that I've done have had a PACE approval from various places. So, sometimes I'll have to fill out an application and whatever your local jurisdiction is, or I do this, you know, a few times a year. But yeah, if anybody wants to set up a practice for their area that can be CE approved, that can definitely be done. 

PATRICK CASALE: Cool.

JOEL SCHWARTZ: Also, join my Facebook group, Neurodiversity Affirmative Therapists. It is a wealth of information.

PATRICK CASALE: It really is and growing all the time. And Joel just does a wonderful job moderating, and just advocating, and showing up. And I know how much effort and energy that takes as a Facebook group moderator as well. It is exhausting at times. But it's nice to be able to set the tone too. 

So, also tell everyone where they can find more of what you're offering because I know you've got some cool stuff in the works as well.

JOEL SCHWARTZ: Yeah, yeah. So, the website is totalspectrumcounseling.com. That's the practice that I co-run with my wife whose name is Brittany Beauvais Schwartz, LCSW. She is autistic and doesn't like to do a lot of the public stuff, and the talking, but she is a brilliant therapist, better than me, in many ways, I will fully say. 

And I'm developing with some of my co-moderators in the group a business that's going to be called Neurodiversity Affirmative Practice, which is going to be all about providing trainings, advocacy, going into institutions, making them neurodiversity affirmative. And also, we're going to have a therapist directory. It will be a paid one. But it's also going to be heavily vetted. You're going to have to take a training to get into it, you're going to have to, you know, sign a ethical form. 

You know, neurodiversity has been appropriated by the culture in a really terrible way where people really don't get it or understand it. They're just using it as a buzzword now, and so many people are being harmed by this appropriation. So, our business is going to really do quality control on this and make sure people are walking the walk instead of just talking the talk. I mean, that's why it's going to be a paid directory because we're going to be actually vetting people, and following up on complaints, and whatnot.

PATRICK CASALE: That's a great, great offering. And for everyone listening, we will have those in the show notes so you can easily access them too. And Joel, again, just thank you for being here and making the time. It's been a pleasure and just really great to connect.

JOEL SCHWARTZ: You're welcome. I'm glad we were able to do this. And I'm so excited to see your journey and I just can't wait to see what more you're bringing to it.

PATRICK CASALE: Thank you. I appreciate that. For everyone listening to the All Things Private Practice Podcast, we have new episodes dropping every Sunday morning, and you can download, like, subscribe and share on all major podcast platforms and we will see you next week.