Neurodiversity affirming schema therapy with Emma DiCicco (Ep 71 re-run)

[00:00:00] Bronwyn: Hello, mental workers, and welcome back to the podcast.

[00:00:09] Have you ever wondered how to do schema therapy? You might've heard of it and you might've been like, what is that? Today, we're going to talk about schema therapy and not only that, but how to make it neurodiversity affirming. And today to talk all about it is Emma DeCicco. Hi, Emma.

[00:00:28] Emma: Hello. How are you going Bronwyn?

[00:00:30] Bronwyn: Good, thanks. And listeners, you may know Emma from a previous episode. She was on very early in the podcast. One of my first guests that I had on, and she was talking about what makes a workplace work for early career psychologists. And now she's back on for this episode. So Emma, a huge welcome. And maybe just tell the listeners, remind them who you are.

[00:00:50] Emma: I feel very lucky that I was one of the first people to be on your podcast, because you're very, very, very popular. And it's really exciting when people mention it. I'm like, "Oh, I was on that one"! So you're far more exciting than I am.

[00:01:03] Just briefly, I'm a clinical psychologist and director of the Dash Health Hub. I'm also a mom of three beautiful kids who are currently on school holidays and may pop in. In terms of psych world, I'm a therapist. I do assessments. I do a whole lot of different stuff and supervise as well. So my favorite to work with, I guess, um, in terms of psychs are early career psychs. So this works perfectly to be able to be on your podcast.

[00:01:35] Bronwyn: Yeah. Emma does a lot of stuff. Um, Yeah, mumming and psyching, that's a lot of stuff, but I'm so glad that you have this early career interest as well, because that suits us well on this podcast. So let's dive into it. I reckon today we'll probably cover like, what is schema? What is neurodiversity affirming treatment? Why do we need it? And then go through the model that you've developed. Is that okay with you?

[00:02:00] Emma: Yeah, absolutely, um, we will be here all day, all week, all year, um, if you let me go on for too much, so please interrupt at every given point that you possibly can.

[00:02:11] Bronwyn: Will do. Will do. Okay. So maybe the first thing I'll ask is what drew you to this area? So I assume you've been doing schema therapy for a while, and then what prompted you to be like, okay, we need to adapt it.

[00:02:24] Emma: That's such a good question. Uh, originally schema therapy was, it was kind of one of those things that, um, I was introduced to by a supervisor who are really respected and trusted. When I started reading about it, it really just, it was one of those moments of, "Yes, this makes so much sense" and it makes so much sense for a whole range of clients.

[00:02:47] Um, it was originally developed, uh, by Jeffrey Young specifically around, uh, uh, I think it was borderline, um, type clients who were coming through doing traditional CBT and it just really wasn't hitting the mark for them.

[00:03:01] But it has expanded so much, um, from that point and now it's actually how I formulate. So I formulate everybody, in my head, through a schema model. Uh, so it just makes sense of the world, for me at least, and for lots of my clients and clinicians that I get to supervise as well.

[00:03:20] Bronwyn: Yeah. I think for me, I found it was the next natural step after learning CBT and ACT as well. I felt like with some of my clients, CBT or ACT weren't hitting the mark. And then I was just like, I'm not sure how to make sense of this person's behavior. And then like you, when I discovered schema, I was like. Ah, this makes sense. And then now I formulate everyone through the schema model and then I do like adaptations if they need it.

[00:03:44] Emma: Yes. Yep. And I think that's the beauty of it. You can adapt it. You, you know, it can be so tailored, for each client really easily. And it really helps for us to, uh, have a framework for our own counter transference as well. So it just sits beautifully within almost every modality can, can be, um, integrated into it. And I think that's my favorite.

[00:04:05] I remember going to an ACT and schema workshop by Mitch Hart and I think it was Rob Brockman as well. And just how they would integrate ACT and because I love ACT as well. And, and, um, schema, it just made so much sense. Uh, and it's just such a fabulous way to be able to work with our clients.

[00:04:26] Bronwyn: Yeah, I totally love it from that perspective as well. So I love how it incorporates attachment theory and I love how it can help us make sense of our counter transference. So for example, if I'm noticing that some boredom is coming up for me, it's like, I wonder if the client is bored of this story and I wonder if there's a detached protector mode in the room right now that's stopping them from accessing the feelings of their vulnerable child. And I'm like, "Oh wow, this helps me make sense of everything".

[00:04:50] Emma: Exactly. Yeah, absolutely. And when, you know, we're feeling really activated, understanding our own schemas and what might be happening for us really helps to, you know, set that scene for what's happening in the room, um, and the interactions with our clients and what might be happening for them as well.

[00:05:06] Bronwyn: Yep. Totally. Okay. So we're both like major fangirls of this therapy. Um, yeah, love it. And so, so why, why do we need to have it neurodiversity affirming? Is it not already neurodiversity affirming?

[00:05:19] Emma: Well, I think it depends on, on how you look at it. But one of the things that, that started to happen as I was practicing more and more, there was some times where I start to feel that, you know, internal discomfort around this doesn't quite sit quite right for me, and I'm not sure why, and I'm not sure what's happening. Um, and I think it was, you know, early on, uh, there was a lot of impeaching the, the parent, what used to be called the parent modes and things like that, um, and that really didn't, um, sit well with me for a lot of reasons and the more that I started to dig into this, uh, I, I really got the sense that, this entire model was created and developed, um, by certain people for certain clients, but that may not have been, um, taking into account like innate neurodivergent clients and, you know, people's natural way of being in the world.

[00:06:15] And so, we started I'm packing that a little bit more and I say we, because I was lucky or am lucky enough to be part of a peer group. And so we all practice schema therapy and we've all come together and over the years just formulated and reformulated and started to challenge some of their kind of implicit ideas and notions that are inherent in any therapeutic model, but in particular schema therapy in this case. And so we came up with. this affirming model, this neurodiversity affirming model.

[00:06:50] Bronwyn: I think that's really amazing that you noticed the discomfort, I guess you noticed it through practice, through reading, through interactions with other colleagues, and you're like, look, something just doesn't quite fit here. We need to make sure that. when meeting the needs of neurodivergent clients. And I guess just for the listeners with neurodivergent clients, um, I guess there are forms of neurodivergence such as autism, ADHD, Tourette's, there are all sorts of like neurodevelopmental, I guess, differences that people can have, right?

[00:07:17] Emma: Yes, absolutely. Yeah. So when we're talking about neurodivergent, we're, we're talking about anyone who's wiring, um, is different to what we would consider the typical, the most common or the, the neuronormative, um, version. And we know that neurodiversity, um, in terms of the spectrum, all people are neurodiverse, we, you know, we, we have this very normal neurodiverse spectrum of humans.

[00:07:40] And then within that, there, there is, um, this... neurodivergence, um, and sometimes it's innate. You're born that way, and sometimes it's acquired, whether it's through trauma or, for instance, acquired brain injury, things like that. But it means that the way that your brain and your nervous system operates is a little bit different than, say, what the typical is.

[00:08:02] A lot of our current, uh, ideas and beliefs and, um, models were based on this idea of what wellness or health looks like. And they tended to be very neurotypical ideas of what wellness and health look like. And I know in my own process, um, of going through, through what I call and what I say to my clients, their therapist grandparent, who is my therapist, trying to unpack some of the ways that, you know, when we're working on resting and having, you know, all of these, this sense of balance and not doing too much. And, you know, inside me, I'm like, but that's, That doesn't feel right to me. That's not how I operate.

[00:08:43] And so this whole idea of, okay, well, you know, rest to say, you know, one person doesn't have to look the same as resting to another person and the way that I rest and look after myself is actually really different to the way somebody else rests and looks after themselves. So we started to really challenge some of those implicit notions around, what health and wellbeing and even illness looks like.

[00:09:10] Bronwyn: Did you feel like, schema therapy was perhaps imposing an idea of health and wellness that just really didn't mesh with many neurodiverse clients ideas?

[00:09:21] Emma: Yeah, I think a big part of this did come from You know, when we were looking at those, um, critic modes and sorry, sorry, I should really say I'm distinguishing from the underlying early maladaptive schemas that we talk about. Um, and they are the, you know, the traits that we have, and I'm talking about the modes, which are the states that that we can be in at any given time. And that tends to be related to the activation of the underlying schema.

[00:09:50] Bronwyn: Can I give an example?

[00:09:52] Emma: Yes, please do.

[00:09:55] Bronwyn: So like, if someone cuts you off in traffic and then you flip into a state where then you swear and cuss at them and stick your finger up, you might be said to have gone into an impulsive angry child mode. So that's the example.

[00:10:09] Emma: Maybe, maybe, or an angry protector, depending on who you are.

[00:10:14] Bronwyn: Yes, true. So different functions, different modes. Um, but you might have an underlying, I guess, schema of maybe, what would you say an underlying schema of that would be that would prompt someone to go into that mode?

[00:10:26] Emma: Well, if it's a, um, if it's, uh, an angry protector, it might be a mistrust... trusted. Yeah. Something along those lines could be there. Um, you know, there's even might be something in the impaired limits range, um, as well. But yeah, I think it's, and that's the beauty of it. It's unique to everyone. So, you know, unpacking ourselves and knowing ourselves and the different ways that, um, we present on, on any given day.

[00:10:55] And then, you know, our own backgrounds and those, those core needs and, um, the schemas that we may have developed from that is, it's such a... an amazing way to be able to reference ourselves and track ourselves throughout our experiences.

[00:11:10] Bronwyn: Yeah, I think you were saying something before I cut you off with the example, but now I can't remember what your line of thinking was. I'm sorry. I got excited because I was like, Oh, we're talking about schema again.

[00:11:23] Emma: Yes, we'll have to that. Yes, I was distinguishing between the, the schemas and the modes because I, switch very quickly into, into talking about modes. Um, so what I, what I was referring to was this idea that, you know, when working with, um, some more neurodivergent people who tend to be, uh, the majority population that I work with, there was this really strong sense of, you know, I have like this critic mode that I've got this, this, you know, and we tend to have like a, punitive critic who's really nasty to us, that horrible voice in our heads, or a really, uh, guilt inducing one, you know, you're not good enough, and all of that sort of stuff, and, or a demanding one, you should be doing more, you should be better, you know, that, those are the, the three main kind of critic modes.

[00:12:09] But with our neurodivergent people, we really noticed this really strong attachment to these critic modes, and it was like life or death, so watching, the actual, um, when, when those modes were challenged in any kind of way, um, in a traditional sense of how we would work in schema therapy, it was really, really, um, quite, prominent in, and just this sense of this is life or death. You can't take this away from me.

[00:12:36] And so we really started to understand, um, wow, This is, you know, this is different for neurodivergent people. These, a lot of these, um, internalized ideas, and belief systems and kind of the messaging that the critics would throw at them were very much related to safety in the world.

[00:12:55] And we started to really, really recognize that a lot of the messaging was. ableism. And so, and it was a lot of, um, this, you know, ableist type critic stuff and the whole, that's kind of the beginning really of when we started to look at, wow, we need to really change this because, uh, a lot of the messages that have been internalized along the way, they're trying to keep them safe in this neurotypical world, this neurodivergent person, um, in this neurotypical world.

[00:13:27] And so if we're really trying to challenge that, that's... That's going to be, um, a catastrophic threat to their, to how they, how they are in the world and their sense of safety in the world.

[00:13:40] Bronwyn: So it just wasn't working.

[00:13:42] Emma: Not at all.

[00:13:43] Bronwyn: Yeah. So I can think of, yeah, I mean, I can think of an example. It's like of the ableism. It's like, let's say we've got an autistic client who, um, masks so that they essentially do not cause the ire of their colleagues at work and do not risk getting fired. Let's say they're on probation. Maybe any slip ups, um, any mistakes will be noticed more by colleagues and that could put them at risk of losing their job. They need this job.

[00:14:07] I think previously in schema therapy, I think this has changed a bit, but we were very much like, banish the critic. So there was a line of thinking like, you just got to get rid of it. I think with internal family systems that has come back to like, no parts are bad. And I think we're a little bit more kind to the critics now. And we're like, okay, work with it.

[00:14:23] Yeah. Um, but guess I could say that... I could see an autistic person becoming really upset if I was like, look, the critic's not working for you, this one that's telling you to mask at work, just get rid of it and be more yourself. And so on the outside, it's kind of like, looks like a good intervention, but for that person I could totally imagine that they would be like, no, this is life or death for me.

[00:14:48] Emma: And, and, you know, the way that it would trigger such distress, we really, you know, if we really pushed that idea and that agenda because that is the way that it needed to be done. And yes, you're absolutely right. It's, it's moved on since then, which is fantastic. Um, but it really points to the implicit biases, uh, biases around what is, you know, health and what, what should this look like, um, in, and air quotes a normally, you know, functioning person.

[00:15:15] And so we really started to challenge that and that started all the way back then. Um, and your example is a perfect one in that, um, we realized that a lot of the messaging in there was safety messaging. And so we started to tease out what we call this, um, neurotypical advisor or this neurotypical healthy adult who kind of is a mode that contains all these, all this knowledge and awareness around, okay, the neurotypical world functions like this, uh, without the, you know, that then feeding into necessarily the criticisms of, but you're weird because cause you don't, if that makes sense.

[00:15:56] And we, we really redirect that to this neurodivergent healthy adult who's able to go... this is who I am, these are my needs. Um, and you know, these are some of the ways that I can advocate for myself and stay safe.

[00:16:10] Bronwyn: I think this points to the harm that could be produced by not being neurodiversity affirming, which is that we might be recommending a client act in a particular way, not realizing that this might put them or place them in a, in a risky, unsafe position. So that could be one of the harms potentially, right?

[00:16:32] Emma: Yeah, absolutely. You know, we, I look at, um, you know, some autistic people that I've worked with both professionally and, um, in my own, uh, life and for instance, some of the stimming behaviors that, that they engage and we know that, you know, so important and we really need to encourage that and it's, you know, it's regulation and it's wonderful, um, but for some people that, you know, doing, you know... their particular brand or, um, what they need in terms of stimming out in a public setting might actually put them at risk of, you know, someone coming along who doesn't understand or whatever.

[00:17:10] Um, and so really being able to navigate through that in a, in an affirming way around, there is nothing wrong at all with stimming. In fact, we want you to, to feel regulated and to be able to engage in whatever you need to, to be able to regulate and feel safe. But also, um, we need to factor in, you know, the threats that you may be presented with, um, out in that world, uh, without, you know, engaging in any shaming or masking. It's, it's really, really tricky.

[00:17:44] Bronwyn: Yeah. And I really love it because the way you're describing that to me sounds like you're saying, look, you aren't the problem. And which I think is a fundamental shift. Um, so it's like, Neurodivergent people aren't the problem. The problem is that we live in a neurotypical world and that creates difficulty for neurodiverse people to thrive and function the way that they wish to live their life.

[00:18:06] Emma: One hundred percent. Yeah. And that's, that's the idea behind all of this. I think it's, um, you know, we look at neuro minorities. Um, so we'd look at the neuro spiciness that you were born with, basically. Yeah. And then if we look at that through the lens of the power threat meaning framework, um, we start to really understand that idea that you are not the problem at all, but the distress and the suffering that you are experiencing is because your particular blend of neuro spiciness, interacts with the, you know, the world interacts with that in such a way that it's created so much, you know, so many threats. There's such a power imbalance.

[00:18:46] Um, and of course, then our autonomic nervous system, our entire system is reacting to those threats and it creates this cycle of, um, you know, distress and for some, you know, they may go on to, to develop depression, anxiety, all those things, which makes sense considering what they're experiencing in the world.

[00:19:06] Bronwyn: Yeah. So it really says, I guess, like the critics is developing as part of this minority stress.

[00:19:12] Emma: Yeah. Yeah. And that's, that's a big part of it. The minority stress modeling, um, and really integrating that, that power threat meaning framework to, to start to shift the idea that, it's a problem within the individual as opposed to it is very much like cultural society, environmental and yes, we, we want to go out there and shift all of those things as well. But, you know, when we're sitting in the room with that individual and supporting them, really helping them to unpack that and, um, experience that in a different way can be deeply, deeply affirming for them.

[00:19:46] Bronwyn: Totally. So validating, maybe for a person their whole life has been told you're like, you're weird, you're different and that's wrong and that's bad and you're bad. Um, so like a lot of uh, neurodiverse clients who I've seen will have this social isolation, um, schema, which essentially says I'm different. And usually that's coupled with a defectiveness schema. So it's like, and I'm bad. So they'll seek out the differences and then they'll criticize themselves very harshly for having that.

[00:20:11] And then that leads to putting on a mask to try and protect themselves. But sometimes it only further increases their feelings that they're different, um, and unacceptable to others. I reckon saying to clients, like, look like, you know, the world is set up for neurotypical folk, and this is the messaging that you've got it hugely affirming, hugely validating. It's like, I'm not wrong.

[00:20:31] Emma: Yes, that's exactly right. And that's the whole idea behind it is, you know, how, like what has happened to you in this world and what messaging have you been sent your entire life about what is right, what is normal, all of those things. And how have you, then absorbed, absorbed those messages along the way.

[00:20:50] Um, and so if you think about it, it does not take much for, you know, a neuro spicy neuro minority person, to go into the world and have this sense of, I'm different. I don't fit in and be bombarded daily with that messaging. And we've just got these trauma after trauma, after trauma, after trauma, every single day, threats to their system every single day. And that in itself is enough to create huge amounts of distress, but they aren't the problem.

[00:21:22] Bronwyn: Yes. Oh, so beautiful. So maybe just, um, coming off the back of that, I'm having a look at this wonderful poster that you and your colleagues have created for this model. And one of the things I'm noticing here is that the there are pink flags.

[00:21:36] So it says consider screening for neurodiversity when there is a long history of depression and anxiety, um, atypical response to treatment. So I wonder, like, did you and your colleagues notice that perhaps like a lot of neurodiverse folks haven't like they keep on being treated and treated for depression, but maybe this hasn't been picked up?

[00:21:55] Emma: 100%. And that's, I think one of the, one of the most prominent themes that have come through between all of us. Um, and there's, there's a few of us in this group. Most of us work in long term kind of trauma spaces and as people are coming through and, you know, they've been branded, don't respond well to treatment or worse, non compliant to treatment or they've got treatment resistant, whatever.

[00:22:23] As, as we've, you know, really worked with them and gotten to know them, we've realized pretty quickly that there, there's certainly, you know, neurodivergent and when we go back to childhood and history, we can very, very quickly see that they, you know, they might be autistic, they might, um, ADHD, some blend of both, whatever it is, dyslexic, Tourette's, everything that, might have been missed along the way.

[00:22:52] And so, we really started to recognize that there is a very high percentage of these people coming through who've just been missed, and so they are, Um, very distressed, uh, and of course the standard treatments won't work.

[00:23:07] Bronwyn: Mm. So the first thing I see in this poster is saying that, okay, well, if you've got some pink flags, consider screening for neurodivergence and then apply a neurodivergent lens. So that means that looking at their developmental history, their attachment styles through a neurodivergent lens, um, have a look at their viewpoint of their early experiences and consider whether there's heritability in their family of origin, right?

[00:23:32] Emma: Yeah, absolutely. Because we know that there's really strong heritability. So, when we start hearing about parents and how they parented, uh, or some of the difficulties that, that parents may have had, um, diagnoses along the way, you start to think, okay. Maybe there's more to this. Maybe we're looking at, you know, a line of, um, different generations who were autistic or, you know, ADHD is again missed. And so we've got this intergenerational neurodivergent trauma playing out as well as the neurodivergent wiring, in there.

[00:24:09] And so, it's really important that we, we reflect on, on those possibilities, um, and start to build out a broader picture of what interactions might look like, what needs might have, um, either been met or missed or, you know, and how that, how that played out along, the different generations for that client.

[00:24:31] Bronwyn: Yeah. And that's part of schema, like going through that history, but you've really just applying the neurodivergent lens and really considering those hypotheses that like, could neurodivergence be here?

[00:24:40] Emma: Yeah. Yeah, absolutely. And I think, um, you know, it, it, it, This, it's so nuanced because, uh, we know that particularly for autistic and ADHD is the way that autobiographical memories are stored and accessed is different to say a neurotypical. Um, and so you tend to get this reliance on semantic recall and this sharing of what should be really emotive and emotional. It's almost like fact sharing. Um, and it's really easy to just automatically go, "Oh, they're detached, it's a detached protector". So, you know, we, we have to step back and go, Oh, it could be. Yeah, absolutely. But it could also be this.

[00:25:21] So how do we, how do we explore that a little bit more? How do we look at, you know, the memories and the retrieval of memories that would be emotionally salient or not? You know, often, um, you know, these populations are coming through with not many memories of childhood. And so we, we, we put neurodivergence on the, On the table in terms of one of our differential ideas, um, in those populations.

[00:25:45] Bronwyn: Yeah. I love that. It's, it's like, instead of automatically being like, ah, detach protector, like emotional inhibition, emotional constriction, it's like, yeah, just being like, ND question mark and exploring that.

[00:25:56] Emma: Absolutely. Yep. Definitely. Um, so there is, yeah, there's that reliance on the, you know, semantic recall over the episodic memory, um, but there might be really great details in there. So, and, and of course you've met one ADHD. Oh, you've met one ADHD, you've met one autistic person, you've met one autistic person. We need to smash down these, these ideas and these myths around what that looks like, you know, the age old, "Oh, but they make eye contact and they have friends. So they can't be autistic". Um, that needs to go.

[00:26:27] Bronwyn: Yeah. I can't tell you the amount of clients who I have seen and they've told me about interactions with health professionals and they are neurodivergent, but they've had interactions which are like, "Oh no, you make eye contact. You can't be neurodivergent" or "you've got a university degree. You can't be neurodivergent". And just the look of hurt. In the client's eyes, it's, it's so painful, um, to just be dismissed.

[00:26:51] Emma: Yeah, absolutely. And again, being dismissed. Becomes the norm in their experience. And so you can see, um, how some of the schemas will have developed along the way. And it just is this deep wounding that is just constantly ripped open again and again and again.

[00:27:11] Bronwyn: Yes.

[00:27:13] Emma: The look on your face is everything. I wish they could see the look on my face too.

[00:27:17] Bron2: Yeah, it's just so painful to see and it's like, yeah, you have to be very valid and empathetic, but there's also this inner rage in me that's like being squished down at the same time so I can give like an appropriate response.

[00:27:30] Emma2: But do you know what? That's, I think the beauty of this model is really humanizing the therapist as well. And so being able to acknowledge in myself with my clients, like my angry, my angry child right now is wanting to tear the entire thing down, like this entire place down and wanting to like, fire off and I'm, I'm just, you know, I'm just going to put her over here for a little while.

[00:27:53] That is really, that can be really affirming to have someone feel angry on somebody else's behalf.

[00:27:59] Bron2: It totally can be. And you're right. Yeah. I love that about the model as well, that it doesn't force us to be like, uh, blank state robots.

[00:28:07] Emma: Yes. Robots. Yes. No robot.

[00:28:09] Bron2: Okay. So we've got apply a neurodivergent lens. I really love this other part of the poster, which is talking about life problems and symptoms. So I really like the questions here because one of the things that says is who sees it as a problem? Why, what is the underlying expectations are the expectations driven by themselves or driven by ableist learnings? What factors external to the person contribute to the problems?

[00:28:32] And I'd love reading these questions. Like they're beautiful.

[00:28:35] Emma: Yeah. And I think that's, that's the biggest part of this. It's qualitative exploration of lived experience. Right. Um, and so we really want to pack if somebody is coming and saying, you know, I don't want to go down the lines of I'm not emotionally available because it really perpetuates this idea around autistic people.

[00:28:53] Bron2: It does. I'll give you an example though.

[00:28:55] Emma: Which is wildly inaccurate. Yeah.

[00:28:57] Bron2: Um, but they keep on getting fired from work.

[00:29:00] Emma: Yeah. Yep. Absolutely. So, um, that, that is a really great example. And, um, I think It's a wonderful way to frame lots of the different life problems that could be showing up. And so, I would immediately start to go, okay, are we looking at burnout here? Are we looking at the expectations in the workplace? Were they overly rigid or not, not defined enough? What was happening in their environment and around them? And what expectations, did they have? And who was that a problem for?

[00:29:33] Bron2: Yes.

[00:29:34] Emma: Um, and how, how can we start to, to challenge some of those things in different ways?

[00:29:39] Bronwyn: Yeah, totally. Yeah. I mean, um, I'll share with listeners like personal, it's like, but I've said this in a lot of neurodivergent people as well, is that for me, I can be very passionate and I think a lot of neurodivergent people are. And what usually that comes in is that we'll see that there's a policy or something in the workplace that isn't working. And we'll be like, Oh, I can fix this. This is great. And then we'll go full steam at it and not realizing that they've got all these other boring processes and consultation that you need to do. And it's like, it's a problem. I'll fix it.

[00:30:09] Um, and then usually it's defined to the neurodivergent person as like, your passion is the problem. But I really like your questions that you have, which is that like, okay. Is this the problem? Who is it a problem for? And is this expectation driven by ableist learning?

[00:30:23] Emma: Yes.

[00:30:23] Bronwyn: And

[00:30:24] Emma: That's exactly right. And I think the, the example that I most often use, um, and I think it's relevant to, to lots of families, um, is one around, um, within, within the home. So we get lots of families, parents coming through saying young person won't do "X". Um, and so I will use the one of, um, you know, won't sit down for dinnertime and dinnertime is a nightmare and, you know, it's just all over the place.

[00:30:51] And so I started to go, okay, so who, whose expectation is this, um, and it might be the parents. And so then, okay. Okay. All right. Why? What's that based on? What's your goal? What are you trying to achieve, um, by having that expectation there? And normally, it's something along the lines of, well, there was some research along the way that families who eat dinner together, like, are more connected and they, you know, children do better.

[00:31:13] Like, okay. Was that based on neurodivergent families with multiple different sensory needs and, you know, food differences and all the rest of it? No? Well then, how's this working for you as a rule? Yeah. It's not? Okay. So, how do we meet the need?

[00:31:31] Because connection, absolutely valid. But dinner, when you've got the different sensory stuff, somebody's not hungry, somebody's upside down in the chair, and you know, is that environment conducive to the connection? No? Right. Well then, perhaps we need to throw the rule out and come up with some different ways of doing this. So, in my own household, we don't have dinner together. It is a disaster to even try. So, we find different ways to connect.

[00:31:58] Bronwyn: Excellent. And so I'm just reading that's reflected in your poster, which is like, so for ND therapy goals, it's validate differences in diversity, integrate accommodations and modifications. It's values based, realistic and achievable. And it says prioritize workability. So that's just what you were describing there.

[00:32:16] Emma: That's exactly right. So, um, the neurodivergent healthy adult is roughly modeled on, um, our hexaflex or our act hexaflex. Yeah, cool. Yeah. Um, Yeah. Uh, and so we went for workable. So workability over flexibility because flexibility in and of itself, um, has those connotations of ableism.

[00:32:37] You should be able to adapt and respond to all this sort of stuff, which is actually not always workable for every person. So we go for workability.

[00:32:44] Bronwyn: Yeah, no, I love that. And I love that, you know, obviously that goes hand in hand with the value space and it really, offers an exploration of what's important to that person. What kind of person do they want to be? How do they act, want to act towards themselves, other people in the world around them, and then it's prioritizing that workability to have them in mind with their own values rather than the expectations of a neurotypical society.

[00:33:05] Emma: That's exactly right. And, uh, you know, I love your example of the passion, being really passionate about things. Uh, and I'll never forget, um, a conversation with a colleague around, you know, you can't always go for the shiny object in my head. I was like, but shiny objects make me happy. And I can't not and you know, a new project. Yes, absolutely.

[00:33:31] Um, and so I, and I had to look at that and I was like, okay, that's, that's the neurotypical way, right? Yep. How do I adapt it? So my rule is now I must have buffer room for shiny things. So I inbuilt buffer room so that I can go after the shiny things that are really interesting to me. And I can do the info stimming that, you know, really brings out that, that interest in that passion and really aligns with sense of self. Um, and when I say me, it's, it's not just me. It's also like my neurodivergent, family, friends and clients and colleagues as well.

[00:34:07] Bronwyn: Yeah, no, I think that's great. I mean, ND goals right there, Emma, because I'm trying to do something similar where I'm trying to be like, okay, Bronwyn you need to be 90%, so then you have that 10 percent buffer for the shiny things, but it's a work in progress.

[00:34:21] Emma: Yeah. It's one of those, isn't it? Yeah. Um, it's great to get a group together and whoever's got spoons, you can just chip in your spoons when you've got them. And that's kind of how this has come about, really. We've, we've chipped in spoons when we've had them. Um, and, um, decided this needs to get out there. Um, we need to be able to, support clinicians in working with their neurodivergent clients, but also understanding, um, themselves and a lot of clinicians are neurodivergent. We have a much higher percentage than in most, most professions.

[00:34:55] Bronwyn: Yeah, I found that really interesting. Like I didn't realize how common neurodivergence was because me myself being neurodivergent, I totally had like the social isolation schema come up and I was like, "Oh, it must be different". And then I was like, "Oh, wonderful. Everybody's a weirdo". And I mean that in the most affectionate way possible.

[00:35:15] Emma: Absolutely. Yeah. Yeah. I mean, it makes a lot of sense. Um, you, Uh, most neurodivergent people have, you know, highly sensitized to other people. We've got these really advanced empathy skills. Uh, then you've also got the, the need for, for social connection and it being met in an interest based way, because we're all interested in psychology, um, and there's also lots and lots of rules and definitions around the interactions as well. So, it just makes sense. Uh, we're literally designed for these kinds of roles.

[00:35:47] Um, but this also draws me back, I guess, to how we've designed our workplace, knowing that the majority of people coming through who want to work with me would be neurodivergent. We just, yeah, um, and so being able to design, uh, where it places and things like that with those core, those neurodivergent core needs, um, in mind. So that's, I think a really, really core part of this.

[00:36:15] Bronwyn: Yeah. And can I go to another aspect of the model here? So we've got therapy barriers. So we've got goal attainment may be impeded by therapist misattunement, imperfect formulation, non affirming goals, uh, sensory or executive functioning demands, which is like mediated by the client's current nervous system capacity.

[00:36:36] So I really like these therapy barriers because yeah, they're just unique to neurodivergent clients. Can you just comment a bit on those?

[00:36:43] Emma: Yeah, I mean, there's so many different aspects in there, aren't there? Yeah. Um, the, the model that we've generated, which nobody has been able to, um, see yet, uh, we've actually mapped it against, um, polyvagal theory. So I actually mapped the internal external coping modes and how they've developed in conjunction with, um, the fight flights. You know, all, all the polyvagal type stuff. And so you start to learn to be able to track your client and where they're at in terms of their nervous system response.

[00:37:15] We know, you know, things such as the boom bust cycle that we tend to see in autistic, uh, sorry, in ADHDers, also applies to autistic, um, populations, but really starting to understand that, the neurodivergent way isn't necessarily linear. It's, it's definitely not linear, actually, you know, um, and so how do we integrate that into their goals and, and their lives? And I think the simplest example is the one I started with, with my, you know, the grand therapist, um, around the goal to rest won't work for me because resting is, you know, it's, It's not a comfortable state in its traditional form of kind of lying down and not doing much, but organizing things and labeling things, that's restful, that's fun, that's a whole different, that's a whole different kettle of fish.

[00:38:05] Bronwyn: It's one of my favorite ways to like blow neurodivergent clients minds when I told them like they don't have to sit there and try and meditate and I'm like flow activities is where it's at, mate. It's like you organize, you label, you, you do puzzles, you, you play that like farming simulator game, you go for it.

[00:38:21] Emma: That's exactly right. And I mean, we know, and this is, this is, I won't go, um, too deep into it because this is one of my info stim areas and I'll bore the living daylights out of you. But we know in default mode network is, is different in our ADHD brains and therefore things like rest states aren't necessarily experience the same way and so we need more of that kind of positive directed, um, goal, goal focused tasks to be able to rest and so the flow states absolutely and I think that draws me back to another, um, fundamental concept around the schema therapy model is that some of these, um, some of the ideas around the, child modes almost, but the child modes in particular, um, have been, um, Probably what I would call ableist in some ways. So, the impulsive child mode, the way that, that we've conceptualized is, that's actually in and of itself, not something that is inherently negative at all. Certainly not something that needs to be, um, contained at all times. And in fact, particularly for our ADHDers, it is the, you know, it's part of happy child. And so reconceptualizing a lot of that.

[00:39:37] Bronwyn: Cause, um, impulsive child is something that I've been, um, labeled with a lot, but I actually had to come to peace with that myself because I do see my impulsivity as part of my creativity as well. And it's helped me, like, it was part of the reason I started this podcast. It's, it's what enables you to do things.

[00:39:54] Emma: Something that's scribbled on a piece of paper literally in front of me and it's impulsive equals creative. Ah, beautiful child. And so, it's one of the child modes that we've actually connected with, um, in the model as well because we really want to step away from, pathologizing something that is very, very important in, uh, neurodivergent people and integrating sensory components into this as well, which is almost entirely omitted.

[00:40:21] Bronwyn: Wow. I feel so seen thank you. I know this like episode isn't about me, but oh my gosh, it's lovely, isn't it? Yeah, but it's so nice to see that reformulation and really recognizing neurodivergent strengths, because I guess like a lot of neurodivergent folks growing up, they have been told that they're a problem in many, uh, varied and extensive ways. So being able to be like, look, you're impulsive, and sometimes you do need boundaries and limit settings on that. So for example, neurodivergent folks, , and so sometimes you do need limits in certain areas, but when it's part of happy child, and you're going into that impulsive state, it's really quite wonderful.

[00:41:01] Emma: Yeah. And that's exactly right. And I think, um, the idea is that, you know, the coping, the mask, The mask, so what we would traditionally look at as coping modes in and of themselves aren't necessarily, the impulsivity being the issue. It's around what they've had to do to survive. These, these masks and modes have developed for survival. And so it might be, you know, eating and things like that, and that's that detached self soother.

[00:41:28] And so we actually go a few steps and go, okay, what's been happening for that, for that mask or that mode to really really need to step in for your survival and how can we meet those needs earlier and in a different way. so the impulsivity isn't the issue. It's what's happened, you know, three or four steps earlier that we can look at providing supports and changing some things in there for them.

[00:41:53] Bronwyn: Um, okay. So that's, that's really going to the social model disability. So coming back to that and really pointing to what's the environment, what can we do to accommodate, and then the, I guess the central tenet of schema therapy, which is about meeting emotional needs.

[00:42:06] Emma: Yep. Those core emotional needs, um, in which we've also added one.

[00:42:10] Bronwyn: So what's the added one?

[00:42:14] Emma: I know it's a, it's a little bit, it's going to be a little bit controversial, but, um, we, we, we've, we've, oh, that makes me laugh so much. So we've, we've added safety and we've differentiated it from attachment needs because, um, when we think about it, a lot of neurodivergent people, they're born into the world wired to respond differently to the world. Uh, and there is a massive assault of sensory information, uh, and sensations that are just being processed at this phenomenally high level, um, particularly if there are hypersensitivities and things like that.

[00:42:53] And so there can be this, you know, both internal sense of safety, but then also safety within the world that is really, really a core need, um, emotional need, that is often not able to be met or not met for lots of different reasons and I know with my own babies by the third one, I threw the rule book out, um, and then later on realized why the rule books weren't working for my elder ones.

[00:43:20] Bronwyn: So it's safety as distinguished from like your attachment needs to feel safe, I guess, with another person and away from another person so that you can self soothe. And this is safety more in terms of like, uh, feeling safe in, in your place in the world.

[00:43:35] Emma: Yeah. Yeah. And so, it's that, it's part of that idea that, um, you know, neurodivergent babies are much more vulnerable to trauma responses from benign, what we would traditionally think of as benign stimuli. Um, and so, we're really acknowledging that the sense of safety is actually, it's separate, um, and it's a separate core need, and if that isn't met, even if they're, you know, really attuned parents and things like that, um, then that's something that we absolutely need to focus on and, and work out how to meet that need.

[00:44:07] Bronwyn: So that comes back to like polyvagal theory. And I guess this may be this idea that you're overloading people's nervous systems and then, and days are like more sensitive, um, to like neutral stimuli air quotes.

[00:44:18] Emma: Yes. Yeah, that's exactly right. Amazing. Yeah. So it's that kind of the interoceptive extra, you know, septum. The whole neurobiological model type stuff and how we can support those needs, um, in different ways and really highlighting that.

[00:44:32] Bronwyn: Why do you think that's controversial? I think it makes sense.

[00:44:36] Emma: Um, it's for different reasons. I'm not sure that.

[00:44:40] Bronwyn: I'm probably not picking up like, Oh, wow, this sounds good. Yeah. Okay, sure.

[00:44:46] Emma2: Um, I think. It's, it's a challenge to, to the idea that, you know, of that safety as an, an emotion need. Um, and also, but you know, as a neurodivergent person, you hear that and you go, yeah, that makes total sense, but perhaps not to, you know, more neurotypical people might go, but that doesn't make sense. I don't understand. That's not been my experience.

[00:45:07] Bronwyn: Ah, interesting.

[00:45:08] Emma2: Which is completely valid too.

[00:45:09] Bronwyn: Yeah, totally. Okay, cool. Well, oh, I look forward to the controversy that you'll receive in the future.

[00:45:17] Emma: I'm proud of it, right? The, the creative, um, like, no, that doesn't make sense. We are gonna, you know, change it up and, and see what happens there.

[00:45:25] Bronwyn: Yeah. well, Emma, I could, I think I could talk to you about this all day and I think, like, I'm looking at your poster and we got through like barely half of it. I was like trying to like pick out different things, but there's been a lot in here and I just wanted to know, is there anything else that we've missed which you see as essential that listeners should take away?

[00:45:43] Emma: Honestly, um, just I cannot begin to tell you how many things there are in here. And I think that's a big part of it as I've gone to talk about it. I'm like, Oh, goodness, there's so much. I don't even know where to start. Um, because in and of itself, this, um, this is something that I've last year turned into a full day training for my team, uh, and that, you know, they're, they're starting at a really high level, um, of understanding and knowledge. And there's just so much in there.

[00:46:14] So it's there's lots of, lots of nuances, lots of stuff, but the overarching goal of all of these is about supporting attunement. And that, that's, you know, particularly for, for your listeners, you know, not to get too caught up in the modes and the schemas and the, you know, labeling and all of that sort of stuff. At the end of the day, what we're talking about is, that is supported attunement. So attuning to your client, one nervous system communicating with another nervous system and using that to that, that lens to really understand them, their experiences, their needs, um, and developing those clinical instincts around meeting those needs as well.

[00:46:57] Bronwyn: I think that's really lovely. And that was one part of the poster, which is a tuned therapist. Um, but I've seen studies which show that, um, like as humans, we've got pretty much, we've got good like bullshit detectors and, other people, we know when someone's like not being authentic with us, but for neurodivergent people in particular, I think they're just really, really, really good at like, Having like good bullshit detectors. Um, and so if you're not, yeah, if you're not attuned to your neurodivergent clients, they know, um, they know very quickly.

[00:47:25] And I guess one thing that I would say to listeners as well is that I think one of the reasons why I have had many long term neurodivergent clients is because I do not see their requests and preferences as problems.

[00:47:37] So for example, a lot of neurodivergent clients will say to me in some form or another, uh, Um, I like to understand the logic of this and I like to, I like to see where we're starting and where we're going to finish. I feel like I cannot start if I don't know where we're going to finish.

[00:47:51] And I know a lot of other therapists who would be like, I shouldn't have to explain the logic underpinning this. I shouldn't have to provide like a treatment plan for this. Um, but I've been very happy to be flexible and accommodating to what their preferences are. And I noticed immediately their nervous system settles and they feel more trust and better in the process. Um, so I guess like just. really important attunement to our neurodivergent clients rather than seeing them as problems.

[00:48:16] Emma: 100%. And I think that, that speaks to everything that we're talking about is, you know, in that particular case, that the need for predictability, that speaks to that core need of safety, safety in the world.

[00:48:28] Bronwyn: Oh, beautiful.

[00:48:29] Emma: Um, and so that, that's that, you know, I need this predictability because that's how I can regulate because I can't actually project myself forward in that and, and be okay with kind of a general gist of something. I need details and specifics and that's how my brain works. And that, you know, not, not automatically putting that in a, oh, well, that's, you know, a perfectionistic or a compensator or a demanding kind of, you know, mode, but actually looking at that as that might actually be part of their healthy adult advocating for their neurodivergent needs and being able to accommodate those things.

[00:49:04] Okay. It's, it's, it's very, very important as part of that attunement. And so, again, you go back to if you're really sensing that regulation response, then that's telling you everything that you need to know about that client and meeting those needs.

[00:49:23] Bron2: Yeah. Beautiful. I'm so glad that you and your colleagues have really taken the time to formulate this wonderful model that really incorporates all these other models and, and making schema therapy just really, um, more adaptive and inclusive of diversity. It's, it's something to be proud of. Thank you.

[00:49:41] Emma: Thank you so much. Uh, I am, I'm very, very, very blessed to be part of, uh, the group that I am with these amazing, clinicians and general human beings. Uh, so it's definitely a privilege of mine to be able to share it.

[00:49:58] Bronwyn: Lovely. Well, I'm going to give some shout outs for where listeners can find out more about this model. So the model is called Stand Attuned and listeners can contact the group at standattuned@gmail.com. All these links will be in the show notes.

[00:50:13] There is also a Facebook group that you can join. Again, the link will be in the show notes and there's also a mailing list that you can sign up to. Links will be in the show notes. Um, Emma, is there anything else you wanted to give a shout out to, to listeners?

[00:50:26] Emma: Oh, that's so funny. That sounds, um, so promotional for half and I've just come on here and be gone I just want to talk about this because I love talking about this. You have no idea about that. Beyond that, um, you know, uh, The shout, the only other shout out is to my, um, beautiful team at the DASH because they have been so wonderful in supporting this, um, this shiny object that I've, uh, gone after as well. So, um, that would, that would be the other, and my family as well. I can't forget them because they've been wonderfully supportive as well. So, they're my shout out.

[00:51:01] Bronwyn: Oh, that's so beautiful. Thanks, Emma family. And thanks, DASH Health clinicians. You are the best.

[00:51:07] Emma: They are. They definitely are.

[00:51:09] Bronwyn: Well, thank you so much, Emma, for coming on again. It's been a real pleasure to have you, and I'm so glad that we were able to take a sneak peek into this model. Um, I hope it goes well in the future and that we're all applying it very well as schema therapists in the future.

[00:51:22] Thank you listeners for listening. Have a good one and catch you next time. Bye.