03/03/2026
Treatment using the medical model vs neurodiversity affirming therapy
You can help clients by differentiating between unconscious masking and strategic masking and name the risks clearly. Where masking is a survival strategy, you can validate it and reduce the need to use it if the privilege to do so exists. The target is safer internal systems and contexts, not โbetter camouflage.โ Where possible, change the environment first so authenticity becomes possible, and only then consider any personal change.
If unmasking is desired, you might set tiny steps and choose low risk settings first. The pace belongs to the person, not the therapist.
Suggested actions:
1. Build a toolbox of strategies that help with masking & unmasking, such as decompression blocks, sensory regulation, and permission phrases. So you can support clients in coping with masking or help with unmasking through a number of different ways.
2. Create disclosure or "not today" scripts that clients can adapt (e.g. "I'll share this when I'm ready" or "I don't have the spoons today".)
3. Audit where you reinforced masking (e.g. praise for eye contact, tone of voice, using the phone) or even in your note "client refused eye contact". Replace with reinforcement for regulation and the use of descriptive, non-judgmental wording.
4. Prepare ally signals in your therapy room, like visual cues that your space is neurodiversity affirming. For example, naming or welcoming stims, or providing sensory tools.
5. Add in a supervision reflection point: โWhere did my framing or pace implicitly reward masking?โ Bring one instance to supervision and design a plan for change with your supervisor.
6. Create opportunities for client-led (and optional) authenticity markers (like preferred seating, stimming, direct speech)..