Alessio Rizzo: Neurodiversity – adhd, autism and choice



Different ways of experiencing the world such as ADHD or autism are not necessarily a deficit. British psychotherapist Alessio Rizzo who works with neurodiversity tells us more about this idea that has been gaining popularity in recent years, and his work.

What drew me to your approach in psychotherapy was an emphasis on your work with neurodiversity. Can you explain this a bit for us? If I understood this correctly, you try to put this approach of paying special attention to neurodiversity in your meeting with another person in your psychotherapeutic encounters.

How do you think of neurodiversity in your work? What do you think neurodiversity is?

I like the word „neurodiversity“ because it is quite new and it doesn’t carry a heavy label for people like someone called autistic could evoke in people. I like to make a distinction between someone on the autistic spectrum and someone having ADHD experience. All are under the same umbrella (together with dyslexia), probably because of our ignorance right now that we are just starting to make sense of this, but they are different words.

I have been privileged enough to work as a teacher for one year with someone with ADHD and one year with someone with autism. It happened when I was still teaching and I was doing my training in gestalt.

I had to bridge this gap between teaching and therapy. The teaching was coming second; what came first was trying to understand these human beings. My knowledge comes from having spent a lot of time working with people with these experiences. I have gathered knowledge that is not written anywhere.

When I ask other professionals what autism is, noone can tell me exactly what it is, for example. It is really about recognizing that, when it comes to autism, social norms don’t make sense. People with these neurodiverse traits have a huge sense of honesty and integrity. So lying, including white lies, doesn’t make sense. In general, I would say that people with autistic experiences do not understand the “unspoken” part of communication, what we call reading “social cues” or “reading between the lines”.

When I hear that someone dreads small talk, when I hear that someone is very ashamed of social interactions, that is usually a clue that social situations do not make sense to them. That is what I believe is the core of autism, the rest is probably a traumatic experience, because if you don’t understand social interactions, you are likely to get bullied or marginalised. One gets treated differently.

So what you are saying is that there is the kind of core, which is the essence and then what is added up to this essence is further trauma because the person perceives the world differently and this can result in a potential clash with social reality.

What would the emphasis be in this kind of therapy work that you are doing? Other kinds of psychotherapies might try to get this person to accommodate to the world more because there still isn’t sufficient understanding of neurodiversity in our system.

First, things might not be clear at the beginning. You just might be dealing with a lot of traumas to start with. Trauma for me is what is added on top of what you naturally are (an open, energetic and compassionate person, for example) and what stops you from being a healthy human being. You can treat traumas with bodily psychotherapy or with IFS. The whole point is that you let go of whatever stops you from being who you are. So then once the person has enough of an understanding of who they are – maybe they come and say  “I want to date, I want to get into the relationship.” Sometimes they want to do that because they want to be „normal“.

It’s their decision in the end, it’s about honoring them as a human being. Maybe their need to belong to the wider community is so strong that they want to engage with relationships, with these practices and social events. This means that they will have to almost build a muscle, they will have to learn social skills. Or they might say that it’s not important for them to engage with these practices, it is more important for them to be who they are.

It is really about always double-checking where the request for the change is coming from, what the needs are, and giving the person a realistic choice. If you want to do what you have been told to do, you probably have to work extra hard, because it doesn’t come spontaneously to you. If that’s what you want to do, then go for it. And then maybe the person reviews it and  says –  oh no, I don’t actually want to do that.

So the emphasis is on personal choice.  The recognition of one’s need and then the choice that one wants to make in regard to those neurodiverse traits.

Yeah, that choice is deeply therapeutic. Maybe this person was never given that choice. Or was always told, „you need to be that way“.

Here we say, you can be that way because that will give you a sense of community and you might not. What is important that you know is who you are and draw a choice from there.

So this leads me to the question of where you think that the gestalt therapeutic approach is touching this work and where it parts from it.

What I am talking about is deeply relational, which is at the core of gestalt therapy. Coming from the UK gestalt tradition, being relational and paying a lot of attention to the power dynamic in the room. The more I understand my biases, the more I understand my power.

If I am a bit dyslexic – I don’t consider myself being hugely on a neurodiverse spectrum,  I am in a position of power and privilege somehow, because I find it easy to go into a social situation and have a good time because I can understand social clues. So I come from the privileged position as opposed to someone who has been maybe oppressed by this disposition by someone who is non-neurodiverse telling them that they are wrong.

This is where I pay my attention to trying not to replicate this dynamic in the room. Sometimes even as I speak to clients, I might apologize if I said something that has come from my biases. Sometimes when I do interventions I pause and take a moment to realize where my interventions are coming from so that they don’t come from the position that I know what is good for them, and I don’t.

The phenomenological approach that we really have no idea that the other person is going through is really helpful  – I am trained with sitting and not knowing and I am ok with not knowing, let’s discover this together.

You also put a special emphasis on sexual diversity. So if you would be working with LGBT, how would you work with someone who lives within an oppressive social context?

For me, safety comes first. Like, for example, the topic of coming out. I refrain from saying, if you want to come out just come out and face whatever consequences. A few years ago I was running a group of LGBT asylum seekers coming out of the UK, especially from Asian countries, and for them coming out might mean that someone in the family can kill you.

It is really again about respecting the personal choice, so there might be part who wants to come out, who wants to tell the world, one person, or the parents and the family, and another part that tells well you can really expose yourself.

The job there is to really negotiate with all parts and find the way forward, keeping safety in mind. It is really about putting the biases in the bin – what I think should happen – and really listening to what the whole situation here is.

Now that you have mentioned these parts, this is I suppose, from the Internal Family System therapy. Can you tell us more about this? What would you say is the special strength of this kind of therapy?

The special strength is that it uses language that is accessible to both the therapist and the client. People read my article about IFS and they make sense. People get them. IFS creates a different relational dynamic, with less power dynamic. The method is clear-  there are different parts of ourselves. Sometimes some parts become burdened with trauma, they lose their original lightness. Sometimes the situation is very complex, different parts of us want different things. You go in there not knowing what you will find. You ask your clients to check with them what parts of them are active at the moment and you start talking to them. This is pretty much an inner form of two-chair work.

IFS uses the idea or “multiplicity of mind”, which states that we have different parts of ourselves, and these parts have their own ideas, opinions, beliefs, memories, and feelings. In IFS there is something we call the “insight” in which you guide the client to notice what parts of them are active inside and we invite the client to establish a dialogue with these parts from a state of consciousness that we call “Self” (with capital S). IFS is, in a nutshell, a way to get into this state called „Self“, from which new dynamics emerge.

The presence of Self is key in IFS because, otherwise, parts tend to disagree and remain in a fight that never ends inside our system. This is almost like a spiritual essence, and it was discovered phenomenologically by Dick Schwartz, the founder of Internal Family Systems therapy. He discovered that, if you detach from all your parts, all of the sudden you enter a state of calm and compassion. If you connect to your parts from that state, the work is very different. You can ask a part to speak directly to the Self, and things spontaneously change.

In my opinion, IFS can treat the trauma better than other modalities that I know of. Since methodology requires that Self is a present as possible, when you speak to the parts that were traumatized, usually the trauma gets released. Any person who can follow this methodology, whether neurodiverse or not, can benefit from this.

Let us return to neurodiversity. When I think about different approaches to neurodiversity one question always comes up; where is the boundary between neurodiversity and what is seen as destructive adaptations to trauma? This is perhaps part of the wider question of where that fine line in general, not only when it comes to neurodiversity.

Thank you for this question, Iva. I think that a fine line exists in anybody who has experienced trauma. I believe that it goes down to our ethical code of conduct as psychotherapists to remember that we don’t know where that line is, but that it exists.

IFS offers a way to shed some light on this. We use the word “burden” to indicate the fact that a part of ourself, at some point in life, has taken on some restrictive and unnatural beliefs or fears that stop that part from functioning spontaneously in a healthy way (we have a protocol called “unburdening” in IFS). This is, somehow, similar to the gestalt therapy ideas of “fixed gestalts” or “creative adjustment”.

Once we have identified a part that is struggling or having difficulties, we simply ask that part whether it has been burdened in the past and if anything has happened that has interfered with the natural state of that part. In this way, we avoid making therapeutic assumption about what is a “natural and healthy way of being” and what is traumatic.

As a therapist having the experience to work with adhd, what would you say, for example, in what way is, for example, an adhd experience different to the „neurotypical“ kind of experience?

From my experience, I would say that people who live with ADHD have the following two patterns:

1. Some difficulties in what they call “executive functioning”. In other words, there are fast and numerous ideas that come to their mind, but there are immense difficulties in “executing” these ideas. It is almost as if their thinking goes 10 times faster than their body, which can only do one task at a time. Any form of planning, time keeping and sticking to a schedule is, therefore, difficult. Ofter people experience fogginess and confusion in their thinking.

2. People with ADHD seem to be strongly affected by their relational field. When working with that student with ADHD, there was no way for his brain to be focussed on learning if there had been any difficulties with his family members. For example, if he had a fight with his brother, he would not be able to focus for days. I believe this point is rarely included in any definition of ADHD. Perhaps more research can be done to discover better ways to support people who suffer from ADHD.

Since most therapeutic approaches deal with the unconscious emotions and healing of past traumas I sometimes find that there is a need for more emphasis on what is valuable in a certain type of experience, what existentialists would call „way of being“.

In line with that, are there any strengths that can be perceived from neurodiverse experiences, as compared to neurotypical ways of being?

If I understand this question correctly, Iva, the answer is that we might have a lot to learn from people who we now call “neurodiverse”. This comes from my Gestalt therapy training and field theory. Every diagnostic label describes a “difference” from the norm, but we have created these norms as a collective. People who we label neurodiverse simply challenge the culture we live in, and, in my opinion, we have a lot to learn. Possibly these differences are the way forward to being a better human species. Here is what we can learn:

1. From people on the autistic spectrum, we can learn honesty and clarity of communication. What would our world be if we did not lie to each other, and if we embraced and accepted our experience without constantly questioning it because society tells us so?

2. From people with ADHD experiences, we can learn that life does not have to run on a time schedule, and that perhaps we are just overstimulated. We can learn that human relationships and simplicity is the key to health.

3. From people with dyslexia we might learn that artistic and non-linear ways of thinking can lead to a better and more creative life.

I know that there are, for example, companies that recruit people on the autistic spectrum for work in the field of IT (information technology). This is because of the precision these jobs require and because the honesty of the workers is an added bonus.

I certainly hope that we, as a collective, start to see diversity of all kinds as a gift and an opportunity to grow rather than something to medicate.

What is it that you as a therapist have learned most in the encounters with different ways of being?

Working with people who think and function differently from me help me remain humble and remind me that I do not know, and that there is wisdom and opportunity to grow when encountering someone who is different.

Interviewed by Iva Paska


Therapy with Alessio, web-page of Alessio Rizzo