When Therapy Misreads Neurodivergent Clients
On the limits of interpretation in therapy.
Updated May 24, 2026 | Reviewed by Tyler Woods
One of the most pointed critiques of psychoanalysis came from Karl Popper, writing in Conjectures and Refutations (1963). When he looked at psychoanalysts' work, he found that he was looking at something resembling "astrology rather than astronomy" (Popper, 1963). Studying these theories, he wrote, had the effect of an "intellectual conversion or revelation": once your eyes were opened, you saw confirming instances everywhere, and the world seemed full of verifications. Anyone who failed to see what you saw was either blinded by class interest or suffering from repressions that had not yet been analysed (Popper, 1963).
His main point is that Freud had built a theory that could not really be tested. A theory is meaningful, Popper argued, only if it tells you what would prove it wrong. Freud's theory, on Popper's account, cannot be falsified, and rules nothing out. For any behaviour a patient might present, and for its opposite just as readily, an interpretation is already waiting, so nothing the patient does could ever count against the theory. A theory that sets out to explain everything ends up, on Popper's view, explaining nothing.
Say you come in and say you feel sad about a friend who has pulled away. The therapist wonders aloud whether the sadness is covering anger , which is a perfectly reasonable thing to wonder. You consider it and say no, you really are sad, you know the difference. A good therapist holds the anger reading as one possibility among others. The difficulty comes only if the reading becomes the only one possible. Then your ‘no’ can be heard as confirmation: of course you cannot feel the anger yet, the anger is what has been pushed away! You say again that you are genuinely not pushing anything down, and that too can be taken as evidence of resistance.
Popper's critique is not perfect, but it points to a potential flaw of traditional therapy , and it may be of particular relevance to the neurodivergent population. Many neurodivergent clients describe going to therapy only to have their reactions read by therapists who are trained, have good hearts, and are working faithfully within a respected tradition, as some kind of defence or resistance.
Most psychological theories were built on data drawn from people who are, broadly speaking, neurotypical, yet in practice, they are applied to everyone as though the fit were guaranteed. Freud's theory of resistance, Adler's framework of compensation for inferiority, Klein's account of splitting and projection were developed in clinical settings that did not include autistic or ADHD adults as a recognised population, and the field has not gone back to revisit them in light of what is now known about neurodevelopmental differences. A small body of research on therapeutic work with neurodivergent adults has begun to emerge, but it has not yet reached most training programmes.
The risk is sharpest when a client's neurodivergence has not yet been identified, because then neither person in the room has the frame that would make accurate sense of what is being said. An autistic client who says they took their partner's words literally and were genuinely confused by what was meant is not being defensive, naive, or defiant. An ADHD client who says they forgot the appointment because they forgot the appointment, with nothing underneath, is offering an equally accurate report, but one that a therapist trained to listen for latent content may reread as avoidance.
Many neurodivergent adults have spent their lives being doubted by people who assumed there must be something else going on, because what they said did not match what was expected of them. When that doubt is met again, this time carrying the authority of expertise that may or may not be justified, it can land harder than ordinary disbelief, even when no one intends harm.
A person's own reading of themselves is not hard fact either. Research on the limits of self-knowledge suggests that people routinely confabulate explanations for their own behaviour, constructing plausible accounts after the fact that may have little to do with the actual causes of what they did (Cassam, 2014). So the lesson is not that the client is always right and the therapist is always overreaching, but that neither side holds a certified truth.
A good therapist must be able to hear past what a client says, because people do not always know themselves, and insight is often what they came for. But that has to be balanced by epistemic humility, by a willingness to hold one's own reading as a guess that might be wrong. Where exactly that line falls, between pressing a useful challenge and overriding someone who knows themselves, is not something any theory can settle in advance, because it depends on the particular person, the particular moment, and the particular thing being said.
Popper himself did not dismiss psychoanalysis; he thought it might contain important anticipations of a testable science (Popper, 1963). But the core of his caution is worth keeping close. An interpretation that cannot be falsified should be treated as what it is: a theory, an unproven idea, a possibility.
In practice, a therapist can offer an interpretation and mean it as an offer. A client can take a challenge seriously and still keep hold of their own sense of what is true, while staying open to the chance that the challenge has caught something they had missed. Perhaps the most useful thing any helping relationship can give a person is the confidence to weigh an interpretation, to keep what fits, and to set down what does not.
Cassam, Q. (2014). Self-knowledge for humans . Oxford University Press (UK).
Chapman, R., & Botha, M. (2023). Neurodivergence‐informed therapy. Developmental Medicine & Child Neurology , 65 (3), 310-317.
Notturno, M. A., & McHUGH, P. R. (1987). Is Freudian psychoanalytic theory really falsifiable?. Metaphilosophy , 18 (3/4), 306-320.
Popper, K. (1963). Conjectures and refutations: The growth of scientific knowledge . Routledge.
Share this post Facebook Bluesky Linkedin Email
There was a problem adding your email address. Please try again.
By submitting your information you agree to the Psychology Today Terms & Conditions and Privacy Policy
Imi Lo is a consultant and the author of three books, including The Gift of Intensity. She holds three master's degrees in Mental Health, Buddhist Studies, and Global Cultures.
Get the help you need from a therapist near you–a FREE service from Psychology Today.
This article is part of the Bringwise Psychology Journal — daily insights on human behavior, mental health, and personal growth.