After spending most of my career working in general mental health and treating a huge variety of mental health challenges, I opened Stillwaters Counselling with the goal of providing a mental health resource that specifically meets the needs of queer, trans, and neurodivergent people, and especially those who identify with more than one of those identities. Since 2022 Stillwaters Counselling has been providing neurodivergent and LGBTQ+ affirming therapy in Vancouver and online. This post specifically explores the need for queer and trans ADHD therapy, and I plan to provide more information in the future about the need for queer and trans therapy that addresses the needs of people with autism and other neurodivergent conditions.
The LGBTQ ADHD Experience
Queer and trans people and people with ADHD share common experiences, including experiences of social exclusion, certain mental health symptoms, and difficulties with self-esteem and self-concept. LGBTQ2S people are more likely to live with the trauma of growing up in an environment that invalidated their identity, leading to a set of coping mechanisms called “complex trauma.” LGBTQ2S kids often grow up without role models of adults who look like them or think like them, which can contribute to a sense of feeling adrift or disconnected, particularly if their families are not supportive of their identities.
Kids with ADHD also experience invalidating environments. Research estimates that, by the age of 10, kids with ADHD receive 20,000 more negative messages, critiques, and redirections than their neurotypical peers (think “no, stop, don’t do that” and so on). 20,000 more negative comments. Over the course of 10 years, that's more than 5 negative comments PER DAY MORE than their peers. Imagine the impact on a child’s growing sense of self concept.
Finding Community and a Sense of Belonging
The experience of complex trauma shares a lot of similarities with ADHD, including difficulties with executive function, emotion regulation, impulsivity, a vulnerability to coping with substances, and difficulty with relationships. Both may struggle longer than their peers to figure out who they really are and where they fit. Another interesting parallel between LGBT2QS people and those with ADHD is that they’re likely to rate higher on a personality trait called “openness to experience” which is correlated with acceptance of difference in others, enjoying trying new experiences, and flexibility in some parts of thinking - all arguably strengths!
Neurodivergent people and LGBTQ+ folks face different types of social exclusion. While neurodivergent people get messages that they’re not competent, LGBTQ+ people get messages that their gender presentations and sexualities don’t fit and need to be changed to conform to heterosexist norms. Both may struggle to thrive at school or work where their whole identities or unique strengths are not appreciated. It is really hard to excel in an environment where you feel like there is a pane of glass between you and everyone else, which is a common experience that my clients describe.
Our Intersectional, Anti-Oppressive Approach
LGBTQ2S ADHD therapy has a greater focus on intersectionality and an anti-oppression perspective. For LGBTQ2S people with ADHD, other neurodivergent resources might not feel inclusive if they do not specifically address queer and trans issues. For example, mainstream ADHD resources may not be equipped to provide help with coming out, or may not feel like a safe place to discuss LGBTQ+ relationship issues. Mainstream neurodivergent services may not have the same emphasis on understanding your experience of intersecting identities.
Similarly, mainstream queer and trans resources may not feel inclusive to neurodivergent people. Many of my neurodivergent clients who have previous experiences of social exclusion or rejection feel very overwhelmed at the idea of navigating queer spaces - knowing what to do, what to say, where to stand, how to be. Queer spaces may feel challenging because they don’t meet your sensory needs or otherwise do not feel accessible. One of the roles of of a queer-affirming, neurodivergent-affirming therapist is to help you find community and belonging where who you are (however you talk, stand, or identify) is accepted and welcome, and to support you through situations where this may not be the case. Your therapist’s job is to remind you that you are good and worthy even when you are feeling like you don’t fit.
One of the purposes of an LGBTQ+ affirming, neurodivergent affirming therapist is to help you unlearn negative messages that you may have picked up moving through the world as someone who is different. Your therapist will help you examine how your core beliefs about your own worth, worthiness, and competence may contribute to difficulties in the present - at work, in relationships, in your inner monologue, with your family. Then, you can explore what it would be like to move through the world with new beliefs. Replacing old beliefs informed by ableist, transphobic, or queerphobic society certainly does not happen instantly, but over time change can come from the process of working with a therapist who consistently holds the belief that you are worthy, competent, and deserving of good things.
Accessing Care: HRT Assessments and ADHD Assessments
Both ADHD treatment and trans-affirming care currently require assessments by a qualified professional in order to begin certain medications, including HRT, and to access surgery. An LGBTQ+ affirming therapist specializing in ADHD is able to conduct assessments in both. Currently at Stillwaters Counselling, we offer ADHD assessments, hormone readiness assessments, and surgical recommendations for upper surgeries and gonadectomies (for adults only at this time). One of the WPATH criteria for accessing both HRT and gender-confirming surgeries is that if you struggle with mental health, it is currently “well-managed.” Having a supportive therapist can be a good place to start.
A Therapist Who Shares Your Lived Experience
Another good reason to seek out queer or trans ADHD therapy is that you may want your therapist to have lived experience with both neurodivergence and LGBTQ+ communities, so that you have the comfort and security of common experiences and you don’t have to do the extra work of educating your therapist. Several of our therapists at Stillwaters identify as both neurodivergent and queer or trans. Many clients come to us from a place of feeling frustrated that they have had to explain their identities to their more mainstream therapists in the past, and feel like they can really relax in therapy for the first time knowing there is an implicit understanding of certain things. Of course we all have had different life histories, and there are some things you will have to explain to your therapist about your life, your experiences, and your identities, but it can really help to know that your therapist has lived and felt some of the things that you’re talking about.
If LGBTQ+ ADHD therapy sounds like it would meet your unique needs, please don't hesitate to reach out today and schedule a consultation.