Neurodiversity Affirming Schema Therapy Model (STAND)©

About the STAND Attuned Model – Schema Therapy adapted for Neurodiversity.

Schema therapy, developed by Jeffrey Young (1993), has proven effective for treating complex psychological issues by addressing deeply ingrained maladaptive schemas. However, traditional schema therapy may not fully consider the unique cognitive and emotional profiles of neurodivergent individuals, such as those with autism, ADHD, or other neurodevelopmental conditions. Recognizing this gap, DiCicco, Garett, Smith, Ambrosus and Clarkson (2023) introduced the Schema Therapy Adapted to Neurodiversity (STAND) model, specifically tailored to meet the needs of our own neurodivergent clients.

Understanding Neurodiversity in Therapy

Neurodiversity is a concept that embraces variations in human brain function and behavior as part of natural diversity rather than as deficits or disorders. Neurodivergent individuals often exhibit differences in communication, social interactions, sensory processing, and executive functioning. These differences can significantly impact how they perceive and respond to therapeutic interventions, necessitating a more personalized approach.

The Core Principles of STAND

The STAND model integrates key principles of schema therapy with neurodiversity-affirming practices, ensuring that therapy is both effective and respectful of neurodivergent experiences. The core principles of the STAND model include:

  1. Validation of Neurodivergent Experiences: STAND emphasizes validating the unique experiences and perspectives of neurodivergent individuals. Therapists acknowledge that neurodivergent traits are intrinsic to the individual and not something to be ‘fixed.’ This validation fosters a safe therapeutic environment where clients feel understood and accepted.
  2. Adaptation of Techniques: Traditional schema therapy techniques are adapted to accommodate neurodivergent needs. This might include modifying communication styles, using more visual aids, incorporating special interests, and allowing for flexible session structures to accommodate sensory sensitivities or use of different sensory modalities.
  3. Focus on Strengths and Resilience: While schema therapy typically focuses on identifying and changing maladaptive schemas, STAND also highlights the strengths and resilience of neurodivergent individuals. Therapists work with clients to recognize and build on their inherent capabilities and coping strategies, fostering a sense of empowerment.
  4. Sensory and Emotional Regulation: The STAND model incorporates strategies to address sensory sensitivities and emotional regulation difficulties commonly experienced by neurodivergent individuals. Techniques such as mindfulness, grounding exercises, and the use of sensory tools are integrated into therapy to help clients manage sensory overload and emotional dysregulation.

Practical Applications of STAND

In practice, the STAND model involves several key adaptations to traditional schema therapy to better serve neurodivergent clients. One significant adaptation is the modification of schema modes. In traditional schema therapy, schema modes represent different aspects of the self that manifest in response to life situations. STAND introduces new and modified modes to better capture the experiences of neurodivergent individuals.

Modified and New Schema Modes

  1. Blended Child Modes: Traditional schema therapy identifies various child modes, such as the Vulnerable Child or Happy Child. The STAND model introduces blended child modes that reflect the complex, multifaceted emotional experiences of neurodivergent individuals.
  2. Neurotypical Adviser ©: This mode represents an adaptive voice helping the neurodivergent individual navigate the neurotypical world of societal expectations and norms about how one should behave and think, which reflect neurotypical standards.
  3. Ableist Critic © : Similar to the Critical Parent mode in traditional schema therapy, the Ableist Critic embodies internalized ableist attitudes and beliefs. This mode criticizes and demeans the individual for their neurodivergent traits, often echoing negative messages received from society, peers, or even family members. Therapy involves identifying and challenging this mode to reduce its harmful impact, which is a crucial aspect of therapy.

Challenging Ableist Assumptions

An essential component of the STAND model is challenging ableist assumptions that clients may have internalized or encountered in their environment. This involves:

  • Education and Awareness: Therapists educate clients about ableism and its impact, helping them recognize and question ableist messages. This education empowers clients to develop a more positive and affirming self-view.
  • Validation of Neurodivergent Traits: Therapists emphasize that neurodivergent traits are not deficits but part of the natural diversity of human functioning. This validation helps clients embrace their neurodivergent identity and reduces internalized stigma.
  • Reframing Challenges as Differences: Instead of viewing certain behaviors or traits as problems to be fixed, therapists help clients reframe them as differences that require understanding and accommodation. This perspective shift can reduce feelings of inadequacy and promote self-acceptance.

Integrating Neurodiversity-Affirming Practices

The STAND model incorporates broader neurodiversity-affirming practices to create a supportive therapeutic environment:

  • Flexibility in Communication and Session Structure/Interventions: Therapists adapt their communication style to suit the client’s preferences, such as using more direct language, allowing for non-verbal forms of communication, creative methods to modify standard interventions. Sessions are structured flexibly to accommodate the unique needs of each client.
  • Incorporating Special Interests: Recognizing the importance of special interests in the lives of neurodivergent individuals, therapists integrate these interests into therapy. This can make sessions more engaging and provide a motivational boost, helping clients connect therapeutic concepts to their passions.
  • Sensory and Emotional Regulation Tools: The STAND model includes strategies for managing sensory sensitivities and emotional dysregulation. Techniques are tailored to the client’s sensory profile, aiding in self-regulation and reducing stress.

Addressing Early Maladaptive Schemas

A central goal of schema therapy is to identify and modify early maladaptive schemas (EMS) that develop in response to unmet emotional needs during childhood. For neurodivergent individuals, these schemas often arise due to a mismatch between the expectations of a neurotypical society and their own unique needs and experiences. The STAND model adapts schema therapy techniques to address these specific EMS, fostering healing and growth.

Identifying EMS in Neurodivergent Individuals

Neurodivergent clients may develop EMS related to feelings of defectiveness, social isolation, or inadequacy due to constant pressure to conform to neurotypical standards. For example:

  • Defectiveness/Shame: A client might internalize the belief that they are fundamentally flawed because they struggle to meet neurotypical expectations, leading to pervasive feelings of shame.
  • Social Isolation/Alienation: Neurodivergent individuals often feel misunderstood or ostracized in social settings, fostering a deep sense of loneliness and alienation.
  • Failure: Repeated difficulties in meeting academic or occupational expectations can result in a schema centered around the belief that they are destined to fail.

Modified Schema Therapy Techniques

To effectively address these EMS, the STAND model employs modified schema therapy techniques that are sensitive to the experiences of neurodivergent individuals:

  1. Empathic Attunement: Therapists practice heightened empathic attunement, deeply understanding and validating the client’s experiences of mismatch and exclusion. This involves actively listening, acknowledging the client’s struggles, and expressing empathy for their unique challenges.
  2. Cognitive Restructuring: Therapists work with clients to challenge and reframe maladaptive beliefs. For instance, in addressing the Defectiveness/Shame schema, therapists help clients recognize that their differences are not flaws but variations of human diversity. Cognitive restructuring might involve examining and disputing societal messages that contribute to these negative self-beliefs.
  3. Imagery Rescripting: This technique is adapted to revisit and transform painful memories where the client felt rejected or misunderstood. In an imagery rescripting session, the therapist guides the client to imagine scenarios where their needs are met with understanding and support, replacing the negative emotions and beliefs associated with those memories.
  4. Behavioral Pattern-Breaking: Neurodivergent individuals may develop maladaptive coping behaviors, such as avoiding social interactions to prevent rejection. Therapists support clients in identifying and gradually changing these behaviors by creating safe and manageable exposure experiences. This helps clients build confidence and new, adaptive coping strategies.
  5. Interventions to heal Early Maladaptive Schemas: Therapists engage in direct schema healing work by affirming the client’s neurodivergent identity and addressing the emotional needs that were unmet in their past. This might include practicing self-compassion exercises, developing self-advocacy skills, and finding supportive communities that validate their experiences.

By directly addressing the early maladaptive schemas that have developed due to the mismatch between neurotypical societal expectations and the neurodivergent client’s needs, the STAND model promotes deeper healing and fosters a more positive self-concept. This tailored approach not only alleviates the emotional burden of these schemas but also empowers clients to navigate their world with greater self-acceptance and resilience.

By incorporating these modifications and affirming practices, the STAND model offers a nuanced and compassionate approach to schema therapy that honors the unique experiences of neurodivergent individuals. This adaptation is designed to not only enhances therapeutic effectiveness but also promotes a more inclusive and respectful understanding of neurodiversity.

The STAND model represents a series of significant adjustments to schema therapy, offering a neurodiversity-affirming approach that respects and validates the unique experiences of neurodivergent individuals. By adapting traditional techniques and incorporating strategies to address sensory and emotional regulation, STAND aims to provide a more effective and compassionate framework for supporting neurodivergent clients in their therapeutic journeys.

The STAND model (DiCicco, et al., 2023) was developed by a group of clinical psychologists and psychologists from Perth, Western Australia;

  • Dr Emma DiCicco – Clinical Psychologist, Director of The Dash Health Hub, Carine WA
  • Alyssa Garrett – Clinical Psychologist, Neurodiversity Haven Psychology, Scarborough WA
  • Sherry-Lee Smith – Psychologist/EMDR Consultant, Director of the Phoenix Holistic Health Centre, Wembley WA
  • Rikki Ambrosius – Clinical Psychologist, Nedlands WA
  • Kate Clarkson -Clinical Psychologist, Perth WA (currently on sabbatical)

DiCicco, E., Garett, A., Smith, S., Clarkson, K., & Ambrosius, R. (2023, May). Neurodiversity Affirming Schema Therapy: Assessment, Formulation and Treatment Implications of an Adapted Model [Poster presentation]. Australian Psychological Society and New Zealand Psychology Society’s Member’s Symposium: Exploring Trauma and Neurodiversity. Wellington, New Zealand.

Young, J.E. & Klosko, J.S. (1993, 1994). Reinventing your life. New York: Plume Books.

If you are a therapist and would like to learn more about the STAND model, please visit the website for the training hub for STAND where you can access training run by Emma and Alyssa. Or you can learn more about the model from one of the podcast episodes below. Or contact Emma, Alyssa, Sherry or Rikki if you are looking for peer consultation on the model.

Stand Attuned Training

Mental Work: Neurodiversity affirming schema therapy (with Dr Emma DeCicco) (mentalworkpodcast.com)

What’s the Schemata: Episode 44: Neuro Diversity Affirming Approaches in Schema Therapy Practice — Schema Therapy Training Australia