Episode 147: Redefining Neurodivergent Assessments and Overcoming Internalized Ableism [featuring Jessica Hogan]

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Transcript

PATRICK CASALE: Hey, everyone. You are listening to another episode of the All Things Private Practice podcast. I'm your host Patrick Casale. I'm joined today with my friend and colleague Dr. Hogan or Jess, (whatever), those are in parentheses in the bio she sent me, is as an autistic ADHD licensed clinical psychologist in Minnesota, in California, where she owns her own practice, Neuron and Rose Psych. She oversees a neuro-affirming assessment training program for doctoral students and postdoc fellows built over 15 years of experience working with autistic individuals. She has been conducting autism and ADHD assessments for over a decade.

Additionally, Dr. Hogan teaches psychodiagnostic assessment in a clinical PsyD program and serves as the principal investigator on a research project examining the experience of autistic therapists. Her special interests include neurodiversity-affirming care, true crime, reading, and circus arts. Welcome to the show.

JESSICA HOGAN: Thanks for having me, Patrick. I am super excited to be here.

PATRICK CASALE: This was super impromptu and spontaneous, which I know is not always an autistic trait that we have where task switching can be hard. So, I appreciate you being willing to come on. And you said this is your first podcast?

JESSICA HOGAN: Yeah, definitely. So, not what I envisioned for my first podcast because I definitely thought I would have time to prepare. And, you know, like, let the autistic side of me really shine through. And, you know, be perfect with everything that I had prepared. But I was, like, trying to channel the ADHD me that loves chaos. I was like, "You know what? Come out today. Come out and play. Like, let's do this. Let's just like get it over with and let's rip the band-aid off. And let's talk about this awesome topic." So, yeah.

PATRICK CASALE: Love it. And I appreciate that. And I think this topic is super important. It's obviously one that is gaining a lot of traction within the mental health spaces, especially, those that are trying to be neurodivergent affirming.

So, we're going to talk about creating neurodivergent affirming assessments and ensuring that they are accessible. I think the accessible pieces the big part of this because I know you know this that, like, when most people are calling around looking for assessments right now, for autism or ADHD, they're being told potentially like 12 months, 18 months, 24 months, where the prices are very, very, very high. Or the worst part of all of it, they're just not neurodivergent affirming.

And I think trying to figure out the balance of all three of those is challenging. And I will give you and your practice a lot of credit because I think you're really trying hard to do that for the community. So, tell us a little bit about why it's important, what you're doing?

JESSICA HOGAN: Yeah, for sure. So, like you said, I mean, this is a huge issue right now in our community where, I mean, with prevalence rates being up to one in 36 kids and one in five people in outpatient treatment, being autistic. I mean, this is huge right now. And waitlists are up the wazoo. I mean, in the UK, I think it's like years long. And so, this is really big right now.

So, I mean, when we say accessible assessments, I mean, this means so many different things, which I mean, we're not going to cover everything today. But I mean, it could mean accessible as in financial, it could mean accessible as in I'm going to accommodate all of the client's needs like, you know, their communication preferences, or needs, or their sensory preferences, their need for different kinds of things and appointments that maybe you wouldn't even think of and it could mean for the assessor being accessible for them.

But our team is mostly neurodivergent. And so, making it accessible for them too. And also, like you said, like without a huge weight, which we have the team to be able to accommodate, generally, at least so far. We haven't had to give anybody a big wait.

So, it encompasses a lot of things. And I don't even know where I want to go first. But I mean, maybe just the fact that, like, virtual assessments are huge now. And I definitely used to be in the camp of, "Oh, you can't do an autism assessment virtually. Like, there's too many things that we would need to observe about the client." You know, with that old school, like, medical model mentality of, "Oh, I'm going to be able to observe if you're autistic." Which was totally not true for a lot of people who might be high maskers.

So, you know, with an affirming assessment, to make it accessible for a high masker not only, like, virtual assessments, but also, like, asking about, like, the internal lived experience of what's going on, and being able to explore that adequately. And not just be like, "Oh, like, how's eye contact for you?" And if they say, "Fine." You know, great. But like, going a level deeper. And really exploring what that means for somebody versus just taking the map, like their surface level [INDISCERNIBLE 00:06:02]. So, that's what comes to mind, first of all.

Also, feel free to jump in wherever, Patrick. Otherwise, I might just go and talk your ear off for all day.

PATRICK CASALE: Well, considering it's a special interest of yours I encourage it. But yeah, I think you're right. So, you know, there's different layers of accessibility, right? And we could talk about that all day. And the online component is super important because I think that is accessibility at its finest, in a lot of ways. Like, the ability to do an assessment, like, from here to your screen, and to go through these processes without having to go into an office, without having to show up in a pretty sterile environment a lot of the time, kind of with the acknowledgement of like, I'm going there for a purpose, right?

I remember doing my assessment, I'm 37, I'm I 38? I don't know. I'm 37, I turned 38 in August. I was assessed when I was 35. And I just remember, like, going in pretty apprehensive, pretty nervous, pretty anxious. Also, I know I'm going there for a purpose, right? Like, I'm going there for this assessment.

And I just remember some of the questions where I was just like, "I don't know how to answer this. Like, I don't want to answer this." Or, "I'm feeling really uncomfortable."

So, I know that had an impact on the assessment, in general. And I think, like, when we're talking deeper than just like, do you make eye contact? Or is eye contact comfortable for you? What about, like, just starting off with interests? Like, interest-based assessment, interest-based questions, too? Because how fricking important is it to get into that inner world through the world of special interest?

JESSICA HOGAN: Yeah, and that's another big thing that we kind of train our students and supervisees in is, you know, like that autistic culture piece where like, you know, we are not going to build rapport and connect by doing the small talk thing, by talking about the weather. It's going to be talking about and connecting over probably shared interests, or it could be a little bit of info dumping on both sides, you know, in an appropriate manner like when it comes to like self-disclosure.

But definitely, you know, it's usually like we hear from our students that it is a little bit more than maybe they've been trained to disclose or that they've been comfortable disclosing. And I think that's a big part of just cultural competence, is being willing to look at that and being willing to step out of your comfort zone in that way.

Because, yeah, like, if they ask you like, "Oh, like, do you like X, Y, and Z, too?" It's okay to say yes. And it's okay to, like, connect over that. It's highly, highly encouraged. And we want clients to feel comfortable. And that's how they're going to is if you show up authentically. If you're not showing up authentically, they're not going to feel comfortable, you're not going to get good data and good results. And it's not going to be a great experience.

And we also encourage, like you had said, like, maybe not even knowing what some of those questions are asking. Like, we also really encourage people to ask questions and to ask what does that actually mean? Or when you ask me about masking, or synesthesia, or whatever. Like, it's okay to ask, like, "I actually don't know what that means."

A lot of people do because they've done their own research, but a lot of people don't. And it's okay to ask. And it's okay to be like, "Wait, like, is that an autistic thing? Or is that, you know, something that you're seeing in me, is like a tree?" Like, that's totally fine to ask about.

And we want to be collaborative with the client because it's not just like we're the expert on everything and you know, we come in with our own expertise. Like, you're the expert of you or kind of the expert here, and like, let's work together to figure this out. Not just like me telling you what's going on and me keeping what I'm thinking secret the whole time. I think that's a really old-school way of doing things.

PATRICK CASALE: And I think that just goes to speak to, like, how important this ability to be human, to be authentic, to build rapport through disclosure, through not being buttoned up. And I know for myself as an autistic ADHDer, like you just see through that shit. And it's like, almost impossible to drop into a vulnerable space when the therapist, or the provider, or the assessor is just unwilling to go there, or unable to go there because of so many factors like, "Oh, it's not professional to disclose." Or, "You know, as the expert I'm supposed to stay very stoic and unresponsive."

And it's like, well, that's not really how humans interact. So, I think it almost feels like you're putting yourself in an impossible situation to get accurate data when you're just relying on like, test after test and measurement after measuring.

JESSICA HOGAN: Exactly, yeah. And I feel like, you know, with that, like, with, like, the test after test, like, I feel like, you know, yes, like, we might do different kinds of assessments. But I think that what really, like, ultimately, in the kind of affirming world was affirming assessments. Like, it is going to be like that, like, interview base.

And with affirming assessments, we also don't require, you know, somebody outside. Like, it can be helpful to have an observer to talk about, you know, the client's trades, whether that be for autism, or for ADHD, or whatever. But we don't require it because sometimes it's just not helpful.

And a lot of the times it's the parent saying, "Oh, well, like, I did that, too." But, I mean, like, these things are genetic. And so, you know, oftentimes, it might be because, you know, they're neurodivergent themselves, and that was just the family and culture to do things in a certain way, you know?

Like, I thought that I came from a neurotypical family. And no, after discovering my own neurodivergence, I'm like, yeah, all of these things, like, you know, I was playing speed chess at Christmas, and doing, you know, like, all the things that we do as a family I'm like, "That doesn't seem normal. That is definitely like a neurodivergent like, thing."

And so, yeah, like, it's just, yeah. I think that we've got a wow for that as well. And the DSM allows for that as well, even. Like, we don't necessarily need that developmental data to make a diagnosis. So, yeah.

PATRICK CASALE: Wait, you can get the complete opposite reaction for developmental data from a collateral perspective, right? So, like, I know, when I was going through my process, my psychologist called my mom. And my mom was like, "Oh, yeah, he was just a happy kid. He read all the time." That was it.

Like, and whether we call it like someone else's own internalized ableism that they still have yet to unpack, or just because a lot of parents, there's so much stigma here where they're like, "I don't want to openly admit that my child's autistic. Like, I think that's a reflection on me as a parent." In some ways, we hear that a lot, unfortunately. And that's the reaction that was received on that end was like, when I remember telling my mom that I had gotten an autism diagnosis, formally, and she was just like, "Oh, but you were so happy as a kid."

And I was just like, almost, like, this projection of like, this makes me feel invalidated as a parent because I wasn't able to see that, or I didn't understand that that was what was happening, or going on.

So, it can be a very dismissive process if we are only relying on like collateral data. And it certainly doesn't always support the outcome that we're looking for.

JESSICA HOGAN: Or especially if they, you know, have all these stereotypes in their mind about like, what autism is, and like, they're still buying into all these myths about autism. And so, that would make it unhelpful. Like, you know, parents tell my clients all the time, like, "Oh, well, yeah, you were friendly." Or, "Oh, like, you know, you did well in school."

My mom keeps coming… She's very supportive, but she keeps going back to, like, "You were always like, 'I need to be like in the spotlight.' And you were always so social." And I was like, "Yes, mom, but like in certain situations, like in some social situations where I'm comfortable, where I was with my other neurodivergent friends." Like, I'm late for the party, you can't fucking shut me up. But like, in some situations, like I want to go hide in a corner and like, not be seen or heard at all, and just be invisible.

So, it totally depends. And, like, we can just like rely on those stereotypes. And, yeah, allow that to be a thing. It is my favorite thing ever to call out parents if they happen to come into feedback I'll just straight up be like, "Oh, well, it's interesting that you guys share traits and have you thought about that you might be autistic ADHD as well?" It is my favorite thing in the entire world.

PATRICK CASALE: I enjoy that, too. I also, like, a little bit of my own story. Like, I took my dad to Spain last year for his birthday. We were eating, we were walking around San Sebastian, we were kind of drunk, go figure you were just with me in Spain like a week ago. So, you know how it goes.

I just remember being like, talking to him about the way he moves through the world. I started to realize like, very quickly after my diagnosis, like, oh, my father's also autistic, like this makes a lot more sense now. Oh, he collects like bobbleheads and has these movies, and these shows, and this music that he listens to repetitively. And there's so much, like, rigidity in certain ways. And there's so much struggle to regulate sensory systems and all of this stuff.

And I'll just like, "So, I haven't formally told you this. Like, we've never had this discussion. But I feel like it's important for you to know that, you know, I found out that I'm autistic. And I kind of think that you are too based on A, B, C." I had all this stuff lined up, all this data. And he was like, "Oh, that makes sense." And that was just it.

And I was just like, it was very affirming, but it was also just like, "Huh? all of that build-up for that reaction, you know?" And it was just very interesting and fascinating to, like, move through that experience in that way together. So, it was like, unbelievably affirming.

And I think that's the whole point of these assessments so often is like, so many of us, especially, who are adults who are seeking assessments and diagnosis out, we kind of already have probably an understanding that we are neurodivergent. We just want affirmation a lot of the time. I think a lot of us want that, like, aha moment of like, "Oh, everything is much more clear to me now. Now I see the world through a completely different lens." Do you see that a lot too on your end as the assessor?

JESSICA HOGAN: Oh, yeah. [INDISCERNIBLE 00:16:46] yeah. Like, even people who are, like, self-diagnosed already, or like they're at like the 99% like loading piece. Like, I mean, they still, even though I encourage them, I'm not somebody who's like trying to convert them in consults. I will, you know, point blank say like, "You don't have to come for an assessment. Like, you can self-diagnose. Like, you can join the community. Like, I give you permission right now."

But people want these assessments, like, especially, assessments like that are going to be thorough, like our process, and very upfront that it takes a hot minute to get through it because we don't leave any stones unturned. Like, we will look at all those, like, past, like, diagnoses or misdiagnoses. And we'll be like, "Okay, yeah." Or, "I don't know about that one." Then we try to give, like, a clear understanding of what the neurotype or like overlapping neurotypes are because it's often not just one, it's usually multiple overlapping things together. And like really providing that, like, deep understanding of themselves.

And so, we've gotten feedback that just, like, that whole process of being able to tell their story and being able to explore that with someone who gets it, who's probably also neurodivergent, like, and who's been through it, like it can be so deeply healing, especially, if there has been misdiagnosis in the past. Like, and then, being able to go through feedback in a way that's not just, "Here's the diagnosis, goodbye." Like, we really try to go over a variety of topics, and feedback, like looking at internalized ableism. And starting to plant seeds to unpack that or unmasking, or burnout prevention, or disclosure, or self-accommodations, or accommodations at work or at school. There's so much to talk about. And so, we don't try to just, you know, cram it all into an hour.

We're like, "You know, like, it might take four hours, like and that's fucking fine. Like, and we're going to be here for you through it." And I think that, like, you know, some people might argue like a longer assessment process isn't accessible. I think that, you know, requiring a shorter assessment process isn't going to be accessible for a lot of people, especially, people who need that thoroughness, or who need that level of sifting through those past things, or people who are in burnout and they can't figure it out by themselves.

We see so many people who get to that wall and they're like, "Something is up. I think it's, you know, this. Is it true?" And they might not have the spoons to deep dive all this. Like, they need us to help them through it. And so, like, I think that, like, accessibility might just be whatever is the best fit for the client's needs.

PATRICK CASALE: Absolutely. I agree wholeheartedly. And I think that feels like so unbelievably validating for that person on the receiving end. And I imagine you get a lot of those comments at the end of this process of like, "This was so validating, I feel so seen, I finally feel understood."

And for so many of us as autistic people, I think that lack of understanding is what we've been searching for, for almost our entire existence of like, I don't feel like I've arrived. I don't feel like I got the life manual on how to do this thing. I don't know where I fit in. I just feel like on the outside looking in so often. And I hear this time and time again.

And then, it's like, does that formal assessment diagnosis change anything? No, right? Like, aside from the knowledge, and the acknowledgement, and the affirmation, it's like, I am who I am regardless of whether that assessment was completed. But it does give you that lens, and that understanding, and that validation, and that just ability to look at the world differently.

And I think that is so important because then you start to learn strategies to unmask, you start to learn strategies to work through autistic burnout, or to try to prevent it, to start to reevaluate friend groups, to start to reevaluate workplace accommodations. Like, I just think it makes so much of a fucking difference.

And I'm going to bring up some controversial points in a second, but I think you're going to be here for them. So, like, you know, there's this big debate going on within the mental health spaces about, like, can mental health clinicians do some of these assessments?

I know, there was one in my Facebook group that, you know, got kind of heated because a lot of clinicians were like, "Yes, absolutely. You can do these things." Maybe you can't use all of the different tests and assessments that psychologists have access to, but you can certainly assess based on criteria A, B, C, D, E.

Also, aren't we saying we want to create accessibility to people receiving these diagnoses? If we are kind of like gatekeeping saying only these specific professionals can do this specific thing in this specific way, that just feel so ableist and it feels so biased in terms of like, people may wait years. I think getting a formal diagnosis is life-saving and life-changing.

JESSICA HOGAN: Yeah, absolutely. And as somebody who is so passionate about providing access in whatever way that is, whether that be, you know, doing reduced costs, or pro bono evals, or, you know, kind of switching up our process to accommodate the client, I think that, like, this is an amazing thing that's happening. I know that that is controversial. And I think that, you know, like people are going to do it anyway.

And in my opinion, as a psychologist, like if they're going to do it anyway, let's help them, and let's support them, and teach them how to do it competently, which is why I'm working with a couple other providers to make a training about this for master's level clinicians so that they know what, basically, I want to put everything I know into this little course. And then, they can kind of make it their own.

And I think that it is so important right now, especially, in states where like, they don't have cheap options, they don't have affirming options. Like, let's give people the access.

And I know that psychologists can be a little bit territorial over those for whatever reason, whether that be for our jobs, we will always have a job, whether it's a scarcity mindset, we will always have clients. Whether it's, you know, like, fear of competence, let's teach them, you know? Like, I think there's an answer for all of these things. And yeah, so I am all for it.

And I know that, like a big concern is also kind of, like, ongoing support. And like, I know, a lot of psychologists have voiced being what about, like, differential diagnosis? And like, if it ends up being a complex case, you know? Maybe if they don't choose to refer that out to a psychologist? Like, what do they do then?

I'm like, "Well, you know, well, like, what if, you know, I made like a consultation group?" So, you know, I feel like that's going to be like an option, potentially.

So, like, just this week, I've been gauging some interest, like, hey, like, would anybody be interested in doing, like, ongoing group consultation with me for like a very affordable, you know, rate? And I've been getting, like, lots of interest that people really, really want this right now. And they want that ongoing support.

And the service level clinicians aren't just going, "Oh, hey, I'm just going to start doing this. And you know, I'm just going to be doing it, you know, willy-nilly with no knowledge." People want that knowledge, they want ongoing support, and they want to do it well for the clients. So, like, let's do that. Let's make it happen.

So, I'm really hoping that this, like, takes off because I would love to, you know, like, you know, help grow the competence of, you know, masters level clinicians and help support them when those complexities do come up that maybe they're like, "Oh, shit, like, I actually haven't had to, you know, try to suss out like complex trauma from autism before." Or, "I haven't had to suss out like a personality disorder from autism before." So, yeah.

PATRICK CASALE: What about bipolar disorder, right? Like, and thinking about, one, I love everything you just said. And your approach to that, right. Okay, here's a concern, let's figure out a way to alleviate that concern. And I think that is a major component here.

But like, if you think about misdiagnosis, and how frequently it occurs, right? From a clinician, from any provider because you might go in with some impulsivity or some mood dysregulation, all of a sudden you've got a bipolar diagnosis. Now, all of a sudden, you're on mood stabilization medication, which can have major, major impact.

I know, like, for myself, I was misdiagnosed bipolar 2, when I was in like the thick of my gambling addiction. Do I understand why that diagnosis felt appropriate to that person at the time? Yes, I have no ill will about that. However, that medication made things significantly worse in my life. I went through life for so many years thinking, "Okay, I have bipolar disorder, I have to manage this. This is my like symptomology." And then, it just started to not make sense.

And I wish that I had gotten those years back to have a completely different perspective shift of what I was experiencing because that, like, chronic unknown symptomology struggle I cannot pinpoint is hellacious. So, being able to have an accurate lens to see the world through has made a world of difference.

And that doesn't mean life has gotten easier. Like, I definitely struggle with autistic burnout a lot. But it has allowed me to communicate my needs in a very different way to the people that I care about. And I think that makes a world of difference internally. Sorry, I'm losing my voice for a second. So, that's one thing.

Another thing that goes hand in hand that we're seeing a lot of is like, how come we're seeing so many people being diagnosed autistic right now? So, let's hear your perspective on that.

JESSICA HOGAN: Oh, gosh. I mean, you might need to remind me to go back to the first part of what you were saying, but as far as, you know, like why are there so many people being diagnosed right now? Like, is this just like a TikTok, like, thing? I mean, while I, like, agree that like, you know, is TikTok a part of this? Like, did social media kind of help people see themselves, you know, at all? Like, see any kind of representation? Like, hell, yes.

Is there problematic, you know, content on like TikTok that is like, "Oh, yeah, this is an autistic trait." When really maybe it's like ADHD, or something else entirely, or general, nonspecific, sure.

But I think that, like, it's been so incredibly, like, life-changing and healing for people to be able to see that representation and to discover their neurodivergence. Because I'm in the same camp you are. And I think that whether you self-diagnosed or whether you get an assessment, like, that diagnosis of like autism, ADHD, whatever it is, like that is life-changing. And like, it gives you permission to change everything, if you want to, whether it be your relationships, or how much you're pushing yourself to meet neuronormative expectations, or how much you accommodate yourself, or whatever it is.

So, like, yes, is that contributing this, like, you know, knowledge, and awareness, and acceptance? Is that contributing? Yes, definitely. I don't think that it's necessarily a bad thing. Or that it's, you know, negative overall.

I feel like I, you know, saw some kind of article recently about how, you know, people are self-diagnosing, but they're wrong. Hey, I was like, "Oh, we need a citation for that because so far there's been some preliminary evidence that, you know, people who are formally diagnosed autistic and self-diagnosed. Like, they're kind of starting to score the same on measures." This isn't, like, replicated yet, like in the literature, or fully supported yet. But we've got some preliminary evidence.

And anecdotally, generally, people who come in self-diagnosed, they are correct. And people get shocked by that all the time. They're like, "Wait, like, everybody who comes in self-diagnosed, like, is autistic?" And I'm like, "Yes. Like, nobody's been wrong so far."

People who might not know that's a different story. Or if they just you know, they were coming in maybe for something else. And they were like, "Oh, and can you look at autism too?" That's a different story. But people who are self-diagnosed, they've done the research, they've done the digging, they've done that self-reflection. Absolutely, 100% correct, yeah. And-

PATRICK CASALE: [CROSSTALK 00:31:48]-

JESSICA HOGAN: I was going to go back to your first piece [INDISCERNIBLE 00:31:52]-

PATRICK CASALE: Go for it, yeah.

JESSICA HOGAN: But I was going to ask you what it was because I do not remember.

PATRICK CASALE: You know, I don't know if I remember. I was talking about misdiagnosis, my own diagnosis stuff. And then, yeah, I don't know. This is what happens when you get to neurodivergent humans on any platform.

So, another piece of that, right? Like, yeah, social media can be problematic. We all know that. You don't take it like, it cannot be like all or nothing. You see one 30-second reel and all of a sudden, it's like, "This is me." But it does allow you to say like, "This is really relatable for me. This could be me. Let me do some more like digging into this." Which is what people often do.

But ultimately, we're seeing more people diagnose because people have more access to resources. Like, if we didn't have social media around, you would have no fucking idea autistic people still existed. It's just like, we didn't have a way to show up online and share our stories, or share resources, or share our experiences and have other people be like, "Oh, yeah, me too." So, I think that makes total sense that we're seeing this massive neurodiversity-affirming movement. And social media plays a major role in that.

And I don't have any issue with that. And I don't have a single ounce of an issue with self-diagnosis, which I know there's like outcry over that. So, the more affirming we can be means the more we have to look at what is "neuronormative" or traditional, or typical. And say, like, we're going to have to start changing our vantage points about how we assess, about how we show up as clinicians and providers, about how we create accessibility.

And I would guesstimate, and this could be inaccurate, that we don't have enough neurodivergent clinicians and psychologists to provide care for all of the neurodivergent people who need neurodivergent affirming care. So, that does mean that we are going to need neurotypical providers to do some of the work in terms of how do I become more affirming?

I see these things that infuriate me of like PESI is offering a ASD Specialist Certification Course first $63 and has anyone taken it? I was like, "That is not going to help you become autistic affirming." Right? Like, that's not ever going to do it.

And if you're not autistic, it's really hard to ever say that you specialize in supporting autistic people. So, I think it's just about doing as much work as we can to be as inclusive and neuro-inclusive as possible. And that sometimes we're going to get it wrong. But to allow space for learning, and growth, and new ideas, and new vantage points, and new perspectives, and new ways of doing things that don't feel like they are always the evidence-based ways within our profession.

JESSICA HOGAN: Yeah, 100%, and I have a couple points. Let's see if I can keep these in my working memory right now. But yeah, I think that, like, just in general, oh my gosh, which I'm going to lose both points now, which is great. But let's see if I can remember. Oh my God, Patrick, can you remind me literally what you were just saying? I heard…

PATRICK CASALE: So, I was just saying that I think that we're seeing more autistic people because people are sharing…

JESSICA HOGAN: Yes.

PATRICK CASALE: Yep, go for it. And then, also, just talking about how we're going to have to start doing things differently. And that we don't have enough neurodivergent therapists and psychologists in our communities.

JESSICA HOGAN: There we go, okay, my two points they're back. Thank you.

So, all right. So, one thing is that, yes, like, for neurotypical clinicians to be able to do this work, like I am very, very passionate about how I feel like they need to do the work, that it's not just like a one-time PESI course, like, you have a lot of things to unpack, like all the internalized ableism. It's rewriting everything that you've learned, like, basically, like, if you want to be affirming, especially, like, that is a paradigm shift. That is not just like, "Oh, wait." Like, "You know, okay."

But boom, like one little thing, it's done. Like, it took me a very long time to even start, like, sorting out that cognitive dissonance of like, "Oh, shit, like, I have, you know, like, been recommending all these things in the past, and all these things that are, like, harmful for clients. And I don't want to be harmful"

But like, and having to, like, work through that. And like, it takes a lot of actual work. And so, and it takes a long time. Like, I can look at a person based on their website, like exactly where they're at, like in that journey, like it's very predictable. It's like an overcorrect like, "Oh, autism superpower." And then like, slowly, you see the progression from there because it's a balance, right? Like, a superpower. Like, yeah.

PATRICK CASALE: And I was guilty of that, too. You know, like, when I first learned about my own diagnosis, I would definitely use the superpower trope. I definitely talk more from like a person-centered focused point or a person-first perspective. So, yeah, there's an overcorrection. We have to do our own unpacking of our own internalized ableism because we live in an ableist society. So, we ourselves even as neurodivergent humans have to do our own learning and our own unpacking to.

JESSICA HOGAN: Yeah, exactly. And my second point is that Patrick, there are a whole lot more neurodivergent and autistic clinicians than you would think. Like, I just got IRB approval for our autistic therapist study. We need to do eight interviews. I put out like feelers in a few different groups, and we got so much interest, Patrick. Like, we are fucking everywhere, okay? Like, I promise you. Like, we're everywhere.

And I love that so much that like, we're starting to come out of the woodwork much more. Like, it looks so much different today than even it did two years ago. Like, when I was starting to be like, okay, like, I'm actually pretty certain like I'm actually autistic. And like, I finally got to that point of like I am. But then I was like, very nervous to disclose because, like, not a lot of people were doing that. It was like Megan Anna, it was you, and it was like two other people.

And I was like, okay, like, I don't know how I feel about this, especially, like, you know, like having being questioned. Like, you know, being, like, the thought of that one day, like, being told, like, you can't be a psychologist because you're autistic, I was terrified.

And it took connecting with other neurodivergent and autistic professionals, some of whom were out too, for me, to, like, have that confidence to, like, come out.

But I think as, you know, we've modeled this now more and more people are feeling comfortable coming out as well. And so, I think that we will be seeing more and more neurodivergent clinicians emerge that were just hiding, or didn't feel comfortable disclosing in their workplaces because a lot of us are being, you know, oppressed and discriminated against in workplaces as well.

Sometimes we can. Like, I know people who have been told specifically you will not disclose that you are neurodivergent. And so, there's a whole lot of systemic issues there to work through. But we're here, we're here.

PATRICK CASALE: Yeah, I agree. And I think there's a long way to go. But I like where things are going for sure. And there's so many valuable resources in the community. And what really, I mean, besides actually meeting you in person last week, and like being like, "Jess is really cool." You never know with personalities online, you just never know.

And then, seeing your messaging, your group that you moderate, Therapists Supporting Neurodiversity, is that it?

JESSICA HOGAN: Yeah.

PATRICK CASALE: About offering consultation for clinicians who want to do neurodivergent affirming assessments, I was like, "I've got to get you on here and talk about this." Because I think it's such a cool offer. And the willingness to be like, "I want people to get this right, I want people to do this really well. I'm not trying to, like, prevent people from doing this. I'm not trying to say that you can't do this."

So, that's huge. You just even taking that step and saying, "I want to offer this is huge." So, I commend you for that. And I think that it's a really important place for us to start examining and start moving into. So, I just want to say thank you for that, too.

JESSICA HOGAN: Yeah. And thank you for, you know, seeing that and for inviting me on. Hopefully, you know, something that I said today, like, you know, hit somebody somewhere listening and inspire somebody. So, yeah, thank you.

PATRICK CASALE: And I thank your ADHD parts for convincing your autistic parts to come on a podcast in an hour and a half after I messaged you today, so…

JESSICA HOGAN: Right, yep.

PATRICK CASALE: I know I would have said, "You know, why don't we do tomorrow?" You would have been like, "Let me figure out a way to not do this." So, thank you for that too. I know the internal push/pull and the struggle sometimes as well. So, I just want to thank you for your time.

And just share with the audience where they can find what you're doing because it's super valuable. And we'll link it in the show notes as well for those of you who are listening.

JESSICA HOGAN: Yeah, absolutely. So, I'm on social media. So, @neuronandrosepsych on Instagram and on TikTok. I don't know how much longer we'll have TikTok but we'll see. And then, my website is neuronandrosepsychology.com. So, yes, neuron as in the brain cell. Don't ask me about the name, it's a long story. But N-E-U-R-O-N. So, neuronandrosepsychology.com.

And then, yeah, if you're interested in doing ongoing group consultation with me, affordable membership style, I am going to be working on this over the next several weeks. So, hopefully, by the time this airs, we'll have some like solid details for you. But please feel free to shoot my admins an email at [email protected].

PATRICK CASALE: Good. We'll use this episode as accountability and motivation. So, awesome.

Thanks for coming on. And I will see you on social media in some capacity. And I'll see you in Italy in a few months.

JESSICA HOGAN: [INDISCERNIBLE 00:42:17]. All right. See you then.

PATRICK CASALE: To everyone listening to the All Things Private Practice podcast, new episodes are out every single Saturday on all major platforms and YouTube. You can like, download, subscribe, and share. Doubt yourself, do it anyway. We'll see you next week.