Unpopular opinions: rethinking the work we do as therapists

As therapists, we often carry a quiet reverence for the frameworks and traditions we've inherited. We trust in the process. In the talking, the insight, the container. And much of that trust is well-placed. Therapy can be life-changing.

But what happens when the process itself becomes limiting? When the "frame" excludes rather than includes? When we mistake neutrality for safety, and evidence for truth?

This post is an invitation – not to discard the craft – but to question it with care. To make space for unpopular opinions. To ask: who is this model serving, and at what cost?

Here are a few of mine.

Talking isn’t always therapeutic

One of therapy’s most sacred assumptions is that talking helps. That language bridges the internal and external worlds. That insight emerges through articulation.

But for many – particularly neurodivergent clients – verbal processing is not the most accessible route to healing.

In psychodynamic work, we explore the symbolic, the unsaid, the unconscious made conscious. But even that can become overly verbal. Interpretations, questions, reflections, all assuming that the right words will unlock the door.

In reality, some clients experience talking as dysregulating or performative. For them, healing may happen in silence, in shared gaze, in metaphor, or in a moment of co-regulation that defies language.

Non-verbal communication, creative tools, somatic noticing, even quiet companionship, can hold as much depth as dialogue. We shouldn’t pathologise quiet, or confuse speech with process.

Masking is often rewarded in therapy

We often pride ourselves on creating space for authenticity. But how often do we unconsciously reward clients for performing "insight" or "progress"?

Neurodivergent clients, especially those skilled in masking, may quickly learn the rhythms of therapy. The reflective tone. The self-awareness. The regulated affect. They may say what we expect to hear, or present as "doing well" to avoid shame or judgment.

The danger here is subtle but profound. We may collude with the mask, reinforcing social camouflage rather than supporting the uncovering of the true self.

From a psychodynamic lens, we might see this as a version of the false self, in Winnicott’s terms, a socially adapted persona developed in response to early relational demands. For many neurodivergent clients, this persona has been necessary for survival. But in therapy, if we’re not careful, we risk reinforcing it.

A neuroaffirmative approach invites us to move at the pace of the client’s nervous system, not their intellect. To gently notice performance without shaming it. To model curiosity over correctness.

Therapy isn’t always the right container

Not every struggle needs therapy. Not every moment calls for deep introspection.

Sometimes coaching, mentoring, peer support, or simply a pause from self-analysis offers more relief and restoration than another hour spent digging through the psyche.

Yet there's often an unspoken hierarchy. Therapy is seen as the pinnacle of healing, and other forms of support are viewed as less legitimate or “surface level”.

But the reality is more complex. For some, therapy may feel too slow, too destabilising, or too focused on insight over action. Others may need scaffolding in executive function, self-trust, or community, not interpretation.

From a trauma-informed and neurodivergent-affirming stance, we can recognise that different people need different containers at different times. No shame. No superiority. Just fit.

“Evidence-based” doesn’t mean it works for everyone

There’s a reverence in our field for manualised, measurable, and replicable interventions. CBT, DBT, ACT, they're often seen as the gold standard, especially in public health systems. And yes, they have their place.

But we must remember that what’s evidence-based isn’t always experience-based.

Much of the research excludes or misrepresents neurodivergent people. The measures of “improvement” are often tied to masking, compliance, or reduction of distress – not integration, agency, or authentic living.

CBT, for instance, can be profoundly helpful for some. But it also presumes that thoughts lead behaviour, and that logic leads emotion. For many neurodivergent clients, this cognitive-first model doesn’t resonate with how they feel, process, or relate to the world.

Psychodynamic models have long honoured the unconscious, the irrational, the associative. And yet, even these can fall short when they’re overly pathologising or rigid. A neuroaffirmative psychodynamic approach might ask how we honour symbolic meaning without imposing a neurotypical narrative arc.

Professional boundaries can be dehumanising without nuance

Boundaries are essential. But when enforced without cultural, relational, or neurodivergent awareness, they can become cold, clinical, or even retraumatising.

Some of our boundary practices – strict neutrality, emotional flatness, distance, were designed to protect the therapist from projection. But in doing so, they can deprive the client of real human connection.

Neurodivergent relational norms often include intensity, vulnerability, and a need for co-regulation. For these clients, formality can feel unsafe, confusing, or shame-inducing.

Winnicott spoke of the “holding environment”, a space where the therapist provides a reliable, attuned presence. Sometimes that presence includes warmth, transparency, humanity. Not friendship, but realness.

A boundary is not a wall. It’s a membrane. Permeable enough to allow relationship, strong enough to hold rupture and repair.

Final thoughts: interrogate the frame, not just the client

Therapists are trained to look inward, to attune, to reflect, to stay curious about our countertransference. But we must also learn to look outward. At the models we inherited. At the assumptions we carry. At the systems we uphold.

It’s not a betrayal of the craft to question it. It’s a deepening of it.

We can honour the therapeutic tradition while also evolving it, toward something more inclusive, more nuanced, and more human.

If something in you bristles at these ideas, pause with that. Not to reject it, but to ask: whose values does this protect, and whose does it exclude?