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A common misconception about people who are neurodivergent is that they cannot or do not want to form friendships. Although some neurodivergent individuals may choose not to form many (or any) friendships, research now shows that neurodivergent people generally want friends; they just have trouble making them. “People who are neurodivergent [are] forced to live in a world that is not set up for them and is largely just not accepting of any of their differences,” says Kelly Beck, a licensed professional counselor (LPC) who is an assistant professor of psychiatry at the University of Pittsburgh. This can lead to relationship challenges not only with friends but also with family, medical professionals and colleagues. In addition, neurodivergent adults are often expected to conform to neurotypical behaviors in social interactions, Beck says. For example, neurodivergent people may have difficulty interpreting neurotypical social cues, which can lead to discrimination if their responses don’t match what society considers to be the “correct” reaction. Kylie Pilot, a clinical therapist and cognitive rehabilitation specialist at the University of Pittsburgh, has also noticed differences between how neurotypical and neurodivergent people sometimes perceive and experience social interactions. A person who is neurotypical may have developed ways to make up for or buffer socially awkward moments or missed social cues, she says. For example, if a neurotypical person forgets someone’s name, they may be more likely to use context clues to indirectly learn the person’s name or find an appropriate way to ask. A person who is neurodivergent, however, may not be able to notice those social clues as easily (or at all) and may feel uncomfortable asking for the person’s name again. Pilot is a certified provider for the Program for the Education and Enrichment of Relational Skills (PEERS), an evidence-based social skills treatment for youth with socioemotional struggles developed by UCLA’s Semel Institute for Neuroscience and Human Behavior. The PEERS program works to help neurodivergent people interested in friendships learn skills to navigate social interactions, she explains. The social skills people need assistance with varies, depending on the resources (or lack of) they had while growing up, she adds. Children often have access to social skill programs through their schools, which can help them navigate friendships, but adults don’t necessarily have the same options. “When you’re young, you think everyone is your friend, [but] … as you move into adulthood people aren’t as kind,” Pilot says. “[Neurotypical adults] have a more solid expectation of what ‘good’ … or neurotypical social skills are. And they have an expectation that other people will also adhere to them.” PEERS is one of the few intervention services that has a program for young adults (i.e., people between 18 and 35 years old), Pilot notes. This program for young adults teaches age-appropriate social behaviors and responses and offers optional lessons on romantic interactions.

Redefining social relationships

Jamie Kulzer, an LPC in Pennsylvania, recommends counselors, especially those working with neurodivergent people, embrace the social model of disability. This model acknowledges that disability itself is not the problem. Instead, it is society’s unwillingness to provide more flexibility and offer appropriate accommodations that prevents people with disabilities from fully participating in society. “Ideally, society will change and be more accepting and understanding [of neurodivergence],” Kulzer says. But societal change can be a slow process, and until that happens, she says counselors need to provide their clients with the tools they can use to navigate a world set up by and for neurotypical people. Kulzer, an associate professor of clinical mental health counseling at the University of Pittsburgh, says that the social model of disability is in stark contrast to the more traditional medical model of disability, which focuses on “fixing” perceived deficits. Many counseling interventions are based on this medical model, she notes. For example, some interventions might ask clients who are neurodivergent to make eye contact when talking to others even though many neurodivergent people find eye contact to be difficult or even painful. This goal of making eye contact was designed with neurotypical people and values in mind, she stresses. It assumes that eye contact is necessary to conversation and ignores the discomfort of neurodivergent people. She advises counselors to use techniques and tools that are designed with neurodiverse people in mind when working with this population. Unfortunately, many well-intentioned neurotypical individuals believe they are helping people who are neurodivergent by asking them to conform to neurotypical behavior, and they often don’t realize they are causing harm or that their advice is unhelpful because they’re approaching it from their own perspective and experience. Kenneth Smith, a licensed professional clinical counselor in Ohio, compares teaching social skills to people who are neurodivergent to having someone who easily picks up math concepts explain it to a student who is struggling in this area. “Some people just naturally get math, but most people need to be taught from a bottom-up approach, deductive way,” he says. “The problem is the people who get math … [tend] to be terrible teachers because they don’t get how to teach [it].” He says this concept applies to social skills as well. “Most people get it intuitively, but that’s the problem — they don’t know how to teach it,” he explains. “If somebody struggles with social skills, they need to be taught a more direct, broken-down version of how to make friends.” Smith, the founder and clinical director at the Center for Autism, Assertiveness and Social Skills in Columbus, Ohio, advises counselors take a direct approach when teaching neurodivergent clients to make friends by breaking down the steps involved in making friends. He also cautions counselors to avoid giving vague advice such as “just talk to people” or advice that isn’t socially appropriate, such as telling a client to approach a group of people and introduce themselves. Pilot and Kulzer, who is also a PEERS educator, agree that role-playing is a great technique to use with this population. Kulzer, Pilot and Beck presented on counseling neurodiverse adults who have social skills challenges at ACA’s 2022 Virtual Conference Experience. Practicing different situations in group sessions or one-on-one sessions helps clients get a better understanding of what to expect when they go out into the real world, Pilot says. For example, if a client is prone to walking away in the middle of a conversation, they could practice this in session with a counselor, who would be able to give them feedback as to why the behavior might not have been appropriate and ask them how they would feel if they were on the other end of the situation. “Role-playing is helpful because even though every interaction is different, it gives our clients an idea of what to expect or what might happen,” she notes. Practicing social interactions is especially important for autistic clients because people on the autism spectrum often struggle with relating to others, says David Meer, an LPC at Neurodiverse Counseling Services in Scottsdale, Arizona. Autistic people may be more inclined to make friends with people online through online gaming or apps such as Discord, where they can find people with common interests without having to adhere to the social conventions typically used in in-person settings. For example, people who meet others online do not have to worry about facial expressions like they would if they met someone in person. “A lot of parents will get upset with them [their kids] and say those aren’t real relationships,” he says. “[But] they are real relationships. Online relationships are genuine connections that sometimes feel safer than in real life.” In addition, some autistic people get overstimulated when trying to process everything that is going on around them, Meer adds. When autistic people are in a more controlled environment, such as at home playing a video game, then they’re more likely to be comfortable and able to talk to others, he says.

Cultivating intragroup friendships

The theory of the “double empathy problem,” a term coined by Damian Milton (a sociologist who specializes in autism research), suggests that people with different world experiences may have trouble empathizing with one another. This concept applies not only to neurodivergent groups but also to other identifiers such as race, gender and religion. Meer, who is autistic, finds the term “neurodiverse” to be broad and all-encompassing; instead, he prefers to refer to autistic people as belonging to a “neurominority group.” These groups are formed through shared life experiences and a shared identifier such as attention-deficit/hyperactivity disorder or autism. Like other marginalized identity groups, people who are a member of a neurominority group will generally have an easier time relating to someone within the group than somebody outside of it, he says. People within a neurominority group are going to better understand the struggle to communicate and will be more accepting of alternative methods of communication, Meer continues. A neurotypical person, on the other hand, may also struggle with communication if they are in an environment where the majority of people are neurodivergent or from a neurominority group. The double empathy problem highlights that social interactions between people are never one-sided, Beck notes. Because society typically deems neurotypical behavior to be “correct,” she says counselors need to fight these ingrained biases and avoid forcing the idea that the only way for a neurodivergent person to make friends is to act as a neurotypical person by forcing them to perform behaviors they aren’t comfortable with. Instead, counselors can help neurodivergent people find and form friendships within their already-existing social circles.

Finding the right tools

Meer encourages counselors to think outside the box when working with neurodivergent clients, while keeping in mind the importance of identity groups. He shares some ideas about what this type of thinking could look like in counseling:

• Unmasking: Neurodivergent adults may try to hide or “mask” who they are to fit in. Meer encourages his clients to “unmask” and lean into their neurodivergent identities. He says unmasking is similar to the concept of “radical visibility” in queer theory, which encourages people to embrace and be proud of their identity. For example, he says he “might teach people to lean into their autistic characteristics — what’s natural [to them] ... and engage more with [their special interests].”
• Neurodiverse friend groups: Because it may be easier for neurodivergent people to make friends within their identity group, counselors can encourage clients to form these types of friendships and perhaps even prioritize them over friendships with neurotypical people, Meer says. “[Intra-identity friendships] will show you’re not this ‘weird,’ awkward person and that [who you are] is not necessarily a bad thing. ... It’s accepted,” he explains.
• Group therapy: Meer says that group therapy works well for neurodivergent clients who are struggling with social situations. “Group therapy is good because it’s going to be easier to communicate with people who are of the same identity group, and there’s this baseline of what [neurodivergent people] already understand,” he says.
• Digital tools: Technology, such as texts, video chats and online multiplayer, can be a useful tool to help neurodivergent clients work on communication and develop friendships, Meer says. Even the new AI tool ChatGPT can help neurodivergent adults with communication. Some of Meer’s clients, for example, struggle with what is appropriate to write in a work email and how to clearly communicate what they want or need, but using digital tools such as ChatGPT can help them write an email or provide them with a template to follow, he says.

Strengthening support

Neurotypical counselors working with neurodivergent clients should learn more about neurodiversity as well as their own biases around social skills and neurodivergence. “You need to listen to clients and really look at your biases if you are neurotypical,” Beck says. “If you are going … to teach neurotypical social skills, you need to think about if that is going to exhaust someone to the point where they have burnout or is [the advice] going to be helpful.” One way that counselors can challenge their biases is by shifting their thinking around how they communicate with clients. Instead of assuming a client wants to use verbal communication, they can let their clients choose how they want to communicate, Beck suggests. For example, a client may prefer to write out their responses, or they might feel more comfortable talking while walking outside. Allowing clients to choose the form of communication can help them feel more comfortable and more willing to open up, Beck says. It also might make them more comfortable using these communication methods outside of therapy, she adds. The other important thing to keep in mind is that the goal of clinical work with neurodivergent clients is almost never to simply “make friends,” Beck says. It’s to build stronger relationships and support networks. “It might sound obvious, but it is critical to help [neurodivergent] people find networks of people that … accept them for who they are, [that] they enjoy being around and … that they find restorative and not depleting,” she says. Social relationships should bring clients joy and happiness and not be exhausting for them. Some adults might also want to develop and maintain romantic relationships, learn the social skills necessary to succeed in the workplace or just learn to regulate their emotions in social situations that might otherwise be overwhelming, Kulzer notes. And some neurodivergent adults don’t want friendships at all, and that’s OK. It isn’t the counselor’s position to decide if a friendship is what the client needs to be happy. But if a client does want to improve their social skills and friendships, then it’s the counselor’s job to give them the tools they need to achieve their goals without the counselor imposing their own ideas of what a relationship should look like, she says. “Everyone wants friends for a number of reasons,” Smith says. “We’re social animals. We want to be with people. ... It doesn’t matter if you’re neurotypical or neurodiverse. ... Love and friendships are where we find purpose and meaning in our life.”  

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Samantha Cooper is a staff writer for Counseling Today. Contact her at scooper@counseling.org.

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