The Mental Health Field is Being Invited to Repair
July 19, 2026
By Dr. Lauren Jessell
There is a particular kind of misattunement that can happen in the therapy room: not the absence of care, but care filtered through incomplete understanding. It is a form of disconnection I have unintentionally participated in at times as a therapist, and one I have also experienced firsthand as a client.
As therapists, we are trained to understand human experience through particular theoretical frameworks. Many of us are trained through psychodynamic and relational lenses, which emphasize the role of early relationships, attachment patterns, family dynamics, and unconscious processes as the central pathway for making meaning of a person’s experience. These frameworks offer profound insight and can illuminate aspects of human behavior that might otherwise remain unseen. The challenge emerges when it or any single framework becomes the dominant lens through which we interpret every aspect of a person’s life.
When we become too attached to a single way of understanding people, including psychodynamic theory, we can unintentionally flatten or misinterpret a person’s reality and narrow the tools we have to work with. We begin to view everything a client shares through the theories we were taught rather than staying curious about what may still be missing or what we and the client still have to learn.
Ironically, recognizing what has been overlooked can create an opening for psychodynamic repair. When we acknowledge what we did not previously understand and make space to explore it, we create an opportunity for deeper attunement and healing.
For many adults who are late identified as Autistic, ADHD, gifted, or otherwise neurodivergent, years of therapy may have taught them to understand themselves primarily through attachment, family dynamics, or the emotional mirroring they did, or often did not, receive from caregivers. Many arrive carrying profound relational trauma. Those experiences matter deeply. But they are not always the whole story.
I do not say this as an outsider. I was trained within both psychodynamic and behavioral frameworks and, for years, understood my clients through those lenses, often feeling confused by therapeutic stuck points I can now recognize as also being (for some) neurodevelopmental in origin.
Recognizing an underlying neurodevelopmental difference is not separate from psychodynamic work; in fact, it may be central to it. Experiences understood as attachment patterns, defenses, or unconscious conflict may not be fully understood without considering the neurodevelopmental identity through which those experiences develop and are experienced. Autism, ADHD, giftedness, and other neurodevelopmental differences are not competing explanations to psychodynamic or any other theoretical understanding; they are essential aspects of identity that shape psychological development. When integrated together, neurodevelopmental and psychodynamic perspectives deepen one another, each providing a more complete understanding.
The Intergenerational Story
One of the strongest predictors of neurodivergence is family history— the presence of neurodivergent traits across generations. Not Tylenol. Not vaccines. Family.
Autism, ADHD, giftedness, learning disabilities, and other neurodevelopmental differences are highly heritable. They emerge through complex genetic and developmental pathways, often reflecting patterns that can be traced throughout families over time.
For generations, many families have struggled without the language, support, or frameworks needed to understand their differences. Parents and other family members have been labeled as “codependent,” “emotionally immature,” or blamed for their children’s struggles when, in many cases, these patterns may reflect the downstream effects of unrecognized and unsupported neurodevelopmental differences within their own lives and within previous generations.
Executive functioning challenges, alexithymia, addiction, depression, burnout, and chronic, internalized shame; these things profoundly shape family systems, particularly when there is no understanding of the underlying mechanisms driving these experiences. Too often, systems like mental healthcare designed to help families focus only on the visible consequences of these struggles rather than exploring the deeper context. Families are left with explanations that assign blame to them without providing a framework for understanding.
When caregivers struggle to identify, understand, and communicate their own internal experiences, emotional attunement, mirroring, and co-regulation with a child may become more difficult. Children develop a sense of themselves through the countless ways caregivers notice, name, and respond to their emotions, needs, and experiences. When those responses are consistently mismatched, children may develop relational wounds, insecure attachment patterns, chronic self-doubt, and difficulty trusting their own perceptions.
These injuries are real and deserve careful attention in therapy. Attachment wounds, family dynamics, and relational trauma matter. But they are not always the whole story. A family can carry both relational pain and neurodevelopmental differences across generations. Understanding the impact of attachment and family relationships does not require overlooking neurodivergence; recognizing neurodivergence does not require dismissing relational harm.
A more complete understanding requires holding both truths at the same time: families can unintentionally contribute to a child’s wounds while also struggling with inherited differences that were never recognized, supported, or understood.
When One Theory Becomes the Only Explanation
The problem begins when one theory becomes the only explanatory framework for a universe of human experience.
If every sensory difference is understood as trauma…
If every social misunderstanding is understood as childhood attachment wounds…
If every executive functioning difficulty is interpreted as resistance…
…then something important is lost.
These interpretations narrow our clinical formulations at best and, at worst, create a barrier to true intergenerational healing and identity integration. Without space for neurodevelopmental differences, clients may struggle to understand not only what happened to them, but also who they have always been.
Our Field Is Being Invited to Grow
Mental health has a long history of oversimplifying complex human experiences, sometimes causing great harm. This is not because clinicians lacked compassion, but because our theories inevitably reflected the limits of the knowledge available at the time.
Many healthcare providers were never trained to recognize how autism, ADHD, giftedness, and other neurodevelopmental differences present across the lifespan, particularly in women, intellectually gifted individuals, people of color and gender-diverse individuals. That gap in knowledge has had negative consequences.
It means there are clients whose full experiences we did not see in the therapy room. It means some clients spent years with us searching for answers within frameworks that could explain parts of their experience, but not the whole.
And yet, this moment for our field also offers, ironically, a profound psychodynamic opportunity.
When we recognize what we missed, we have an opportunity to do what therapy has always sought to do: repair ruptures, restore connection, and create a more accurate and compassionate understanding of the self.
Perhaps one of the most healing things we can offer a client is an acknowledgment, a bid for repair.
We didn’t fully understand your nervous system,
We weren’t taught how neurodevelopmental differences could present across the lifespan,
We weren’t fully attuned,
I’m sorry.
That must have been incredibly lonely.
I’m listening now.
This is not an abandonment of psychodynamic work. It is psychodynamic work at its most reparative: recognizing where our understanding was incomplete and creating space for a fuller, more integrated story to emerge. And for many late-identified neurodivergent adults, it may be the first time someone has truly seen them, not only through the lens of what happened to them, but also through the lens of who they have always been.
Effective Trauma Therapy Must Acknowledge Autistic Identity
May 5, 2026
By Dr. Lauren Jessell
You're probably familiar with the maxim (or the pop song) "What doesn't kill you makes you stronger!" But for autistic individuals , trauma may have much more far-reaching effects.
New research reveals a powerful, reciprocal relationship between autism and trauma: Autistic people are more likely to develop PTSD-like responses, and those trauma responses can worsen core autistic coping strategies — social withdrawal, sensory sensitivity, and repetitive behaviors (Al Abed et al, 2024; Haruvi-Lamdan et al, 2020).
This vulnerability reflects fundamental neurological differences. Without support or understanding, autistic brains may process even seemingly small or “everyday” stressors—sometimes called “little traumas”—and store them in the nervous system as overwhelming or unsafe. These cumulative microtraumas, along with larger or more acute traumatic events, combine to deepen distress and complicate autism’s presentation.
A recent study in mice carrying autism-related genes found that mild stressors triggered trauma-like memories in autistic-model mice—memories that non-autistic mice did not form (Al Abed et al, 2024). These PTSD-like responses were not merely emotional reactions; they actively altered brain function, creating a feedback loop that intensified autistic traits. The study identified disruptions in how specific brain cells regulate memory and stress responses, suggesting trauma may “stick” more readily and resolve less naturally in autistic brains without targeted intervention.
Because of this complex interplay, autism assessments must include thorough trauma screening. Similarly, trauma therapies—including Eye Movement Desensitization and Reprocessing (EMDR)—need adaptations to fit autistic people’s neurological and sensory profiles. Unfortunately, trauma symptoms frequently mask autistic traits, and autism remains unidentified and underdiagnosed in many adults especially once trauma and its secondary consequences (e.g. addiction, eating disorders) overshadow it.
Autism and trauma can no longer remain separate in the therapy room. After all, where else in medicine would we ignore a key diagnosis and expect positive outcomes?
When healthcare providers recognize this connection, they can provide more effective care. For example, adapted therapy like EMDR protocols and trauma recontextualization techniques can help reprocess traumatic memories and reduce emotional reactivity. But these techniques must be paced, structured, and delivered with neurodivergent acknowledgement and safety in mind. Predictability, sensory regulation, and a trauma-informed approach are all necessary.
We cannot afford to treat autism and trauma as two disconnected experiences. For many autistic individuals, the experience of trauma—both big and little—shapes how autism is expressed, and the autistic experience shapes how trauma is experienced. Until care attunes to both, it misses half the story. Recognizingautism is essential for effective mental healthcare— it guides treatment adaptation, affirms identity, and stands for far more than a passing social media trend.
Dr. Jessell is a psychotherapist and founder of Paritywell.
The Presentation of Self in Everyday Life
April 10, 2026
By Dr. Lauren Jessell
Erving Goffman, the sociologist whose 1959 book The Presentation of Self in Everyday Life I may have clung to like a life raft during freshman year rush week, famously argued that life is a stage. We adapt our expressions, gestures, and behaviors depending on the audience, carefully managing the version of ourselves we present. There’s a front stage—polished, public, rehearsed—and a backstage, where we can supposedly exhale and exist without performance.
But the problem—the one we see again and again as therapists—is what happens when the backstage never materializes.
Goffman’s premise is simple: social life is theater. Every interaction requires a performance, tailored to meet the expectations of an audience. If we're lucky, we retreat backstage to rest and reconnect with the parts of ourselves not meant for public view. But for many people, especially those navigating chronic marginalization or trauma, the performance never ends. The backstage never arrives and survival becomes bound to the act itself.
Masking, often discussed in autistic communities, refers to the invisible labor of suppressing natural behaviors in order to be accepted by others. Eye contact, tone, posture, speech—everything is monitored and adjusted. Masking isn’t about fitting in; it’s about protection from exclusion.
Across cultures, masking has long been a survival strategy. In Japanese culture, tatemae (public face) and honne (true feelings) describe the split between the self presented to society and the private self kept hidden. In Black American culture, masking often takes the form of constant code-switching—carefully moderating language, tone, and expression to protect both oneself and one’s community from surveillance and violence.
Queer people, people in nonmonogamous relationships, and anyone whose ways of loving or expressing desire fall outside cultural norms often mask not only for their own safety but to protect those they love from misunderstanding and harm. This is why people who mask often feel most at ease in between spaces—at the edges of cultures, relationships, and identities, where expectations blur and no single audience demands full allegiance. These thresholds offer brief relief from constant performance—a place where the self doesn’t have to be fully carved up or concealed. Over time the possibility for meaningful relationships begins to flatten under the weight of the performance, as the backstage—a space where connection might finally be unguarded—never materializes.
For many, the performance started in childhood. Alice Miller’s The Drama of the Gifted Child describes how children in unsafe environments become experts at reading the room, suppressing their needs to maintain attachment. They become helpers, achievers, peacekeepers—whatever the moment requires. Over time, the performance and the self become indistinguishable.
When masking is lifelong and high-stakes, something else happens too: compulsions and addictions become the substitute backstage. These are often misunderstood as pathology, but in reality, they are what hold the mask— and safety— in place. Compulsions—rituals of checking, reassurance, replaying—try to control the fear that the act might slip. Addictions—work, people-pleasing, substances, food, doom-scrolling—numb the weight of constant self-monitoring.
Together, they create a false backstage, a place to retreat—at least internally—from the strain of performance. But it’s not real rest. And when even these supports collapse, dissociation becomes the final strategy. The body keeps performing, but the self exits. You smile. You nod. But you're no longer there. This is why “unmasking” can feel impossible. It’s not just discomfort. The body remembers what happened the last time it showed up authentically: rejection, violence, abandonment. The nervous system holds that history and resists the idea that it could ever be safe to stop performing.
Goffman showed us how performance shapes public life, but its deeper cost is how it erodes private life. Chronic masking doesn’t just create exhaustion—it severs connection. When you're always performing, intimacy becomes impossible. How can you feel close to others when no one is meeting the real you? Over time, the distance grows inward. You lose touch with what you feel, what you want, who you are—flattened in service of the role.
This is why the goal of therapy is never to rip away the mask. It’s there for good reason. It is the scaffolding of safety. Therapy doesn’t begin by tearing down our protections but by asking:
What’s true now?
Is it still dangerous?
And slowly, carefully, we begin to build a life where the answer might one day be no.
Dr. Jessell is a psychotherapist and founder of Paritywell.