Neurodivergence: Having the big conversations and living your values with Dr Naomi Fisher

Welcome to the Business of Psychology podcast. Today we're joined by a guest I recommend often. When I'm talking to clients and other parents, I very frequently find myself recommending her books and accessible webinars on supporting children who are struggling through alternative education and reducing demand. And when I'm talking to other psychologists and therapists, I use her as an excellent example of somebody who's able to combine two specialisms and pull off a psychology based portfolio career beautifully.

Dr Naomi Fisher is a clinical psychologist specialising in autism and trauma. She's an EMDR consultant and trainer, and a prolific author who's cultivated her expertise through research, public sector work, and in her independent practice. Today we're exploring how her experiences doing her PhD in autism and NHS practice has shaped the impactful work that she does today. And we're also going to dive into the politics of neurodiversity and why Naomi is concerned that current social pressures are making it really hard for clinicians to have those nuanced conversations about diagnosis and education, and why she's launched her new podcast, Let's Talk Neurosense alongside Dr Danielle Drinkwater.

Full show notes and a transcript of this episode are available at The Business of Psychology

Links for Naomi:

Website: naomifisher.co.uk

Podcast: Let's Talk Neurosense: The Psychology of Neurodiversity

Sunstack: Think Again: Making Childhood Fit For Children

Links for Rosie:

Substack: substack.com/@drrosie

Rosie on Instagram:

@rosiegilderthorp

@drrosiegilderthorp

The highlights

• Naomi tells us about her unusual route into clinical psychology, doing her PhD first 01:57
• I ask Naomi about the central question of her PhD 06:38
• Naomi talks about what drew her into clinical work 08:45
• We discuss the breadth of experience our clinical training gave us 12:07
• Naomi describes what she typically does in her practice at the moment 15:54
• Naomi talks about her drive get good information out there and the backlash she’s received 20:21
• I ask Naomi how she deals with being recognised 26:48
• Naomi tells us about her podcast, Let’s Talk Neurosense 37:33
• Naomi tells us where we can find her 51:48

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Speakers: Rosie Gilderthorp, Naomi Fisher

Welcome back to the Business of Psychology. Today we're joined by a guest I recommend often. When I'm talking to clients and other parents, I very frequently find myself recommending her books and accessible webinars on supporting children who are struggling through alternative education and reducing demand. And when I'm talking to other psychologists and therapists, I use her as an excellent example of somebody who's able to combine two specialisms and pull off a psychology based portfolio career beautifully. Dr Naomi Fisher is a clinical psychologist specialising in autism and trauma. She's an EMDR consultant and trainer, and a prolific author who's cultivated her expertise through research, public sector work, and in her independent practice. Today we're exploring how her experiences doing her PhD in autism and NHS practice has shaped the impactful work that she does today. And we're also going to dive into the politics of neurodiversity and why Naomi is concerned that current social pressures are making it really hard for clinicians to have those nuanced conversations about diagnosis and education, and why she's launched her new podcast, Let's Talk Neuro Sense alongside Dr Danielle Drinkwater. I'm really excited for the episode today, so let's bring on Naomi Fisher. Welcome to the podcast, Dr Naomi Fisher.

Hello. Thank you for inviting me.

It's so lovely to have you here, and I think there's so much we're gonna cover today, but where I'd like to start is kind of at the beginning. So I know that you took a unusual route into clinical psychology in that you did your PhD first. So can you tell us a little bit about your PhD and what that left you with?

Yeah, I mean, my route was perhaps even more unusual because actually I started out going to university to be a doctor. So I went to medical school and I did the first two years of medical school, and then we had the option where I was to do an intercalated year, and I chose psychology. Not particularly because I was really drawn to psychology, but just because I thought it we, it was an opportunity to do something different and I knew already that I wasn't massively excited about biochemistry and physiology and anatomy and all the things I've been studying. And then I did psychology and I was just like, wow, this is amazing, this is so exciting, I really like this. It's just, it was like sorts of stuff just opened up for me, and so actually the PhD was because I got to the end of my degree and I didn't want, I decided I didn't want to go on and study to be a doctor. So everybody else, my peers all went on to clinical school, and I did have a place and I decided not to go, but it just felt too much. I just, I felt I wanted to go on study in psychology basically. So that's how I ended up doing my PhD. And I think it has influenced everything since that, 'cause I did a PhD at, I went to London and I did this PhD, which was an interdisciplinary PhD at the Social Genetic Developmental Psychiatry Research Center, which is at the IOPPN. Sorry, so many acronyms. Kings College London, but basically in Camberwell, near the Maudsley Hospital. And this PhD was meant to be helping us to think about things from lots of different angles. So even though I did a psychology PhD, I spent time in the lab doing, you know, running gels doing, and some of the other students I was with in my sort of cohort, they were geneticists and there were, there was a real sort of merging of different ways of thinking about psychology and development. And I think that really influenced me actually. Thinking back, I think I learned to think about things from different angles, always to be, not just to think from one perspective, like that was just built into the structure of the PhD that I did. And then I spent quite a lot of time traveling around London visiting autistic children, or children with moderate learning disabilities because the children I visited, it was a cognitive psychology PhD, so it was very much visiting children and doing little games with them, doing little tests with them. And I, yeah, I spent my time traveling all around these schools in Greater London. I have these memories of myself, like trundling off with my suitcase of tests, you know, and I would have to leave at 7:00 AM in the morning to get to the school by nine. And, yeah, so, and I do think that was really influential in what I've ended up doing, but also I think it really gave me an appreciation of the graft and the hard work that goes into research. You know, how they, you have to, each data point is a child or a person and you have to relate to that person and get to know them and yeah, I feel it kind of set me up for thinking about psychology and research, and actually just thinking scientifically, I think I got a really good training in how to think scientifically and what the difference is as, as a scientist practitioner, which I think we should be as clinical psychologists, what that science bit really means.

I think that's really interesting because I think often we think of different tracks and often you meet professionals who think along their track, you know, maybe with a very deep expertise, but there's the kind of medicalised track and there's the very research focused track, and then there's often the clinical track. And I think it's really helpful to have that perspective of all three ways of looking at the problem and perhaps that is something that, you know, we lose or we don't give enough time to in the way that we do training generally for clinical psychology.

Yeah, and I think there's also the personal track isn't there? So there's the kind of what your life brings and what your life experience brings as well. And I think one of the things that I did when I was doing my PhD was, because I really wanted to get more of an understanding as well. So I befriended an autistic boy for two years while I was doing my PhD, and I also ran a social club for adults with learning disabilities. So every Monday I would go and organize things like trips to the cinema and bowling, and I think actually that was a really essential part of my whole PhD experience as well, I got to know some of the people who I was doing the research for as well.

What was the kind of central question of the PhD?

Well, that's an interesting one. What was it? It's one that now I don't think, I think it's very different now. I don't think people would be asking the same questions now at all. So basically what I was looking at is, can we help autistic children to understand things that they find difficult to understand? So like an understanding of other people's minds and also kind of being flexible, cognitive flexibility. Can we help them do that by using kind of stories and metaphors. So I did this thing where I got them to take a photo, we took photographs of what a doll was looking at, and then we put the photograph into the chart into the doll's head, and then we changed the photographs. So it was the idea of sort of helping them think about people can change their minds. Anyway, I don't, it's, yeah, it was fun to do. They really enjoyed it. And we had another one which was about being able to change your mind and do something differently. So I had these little trucks with front, like, you know, it was like a little Caterpillar truck and it had detachable front things and it was like our minds are like trucks and we could do things in different ways. So I was essentially looking at can we teach children different ways to do some of the things that they are finding hard.

That's really interesting, and I think you're right, that is quite different to how a study might be framed now. But it is, I think, really useful to think about that. I, you know, we're gonna come onto this much later, but I found it really interesting for a project I've been working on to look back and look at what we have studied over the last, you know, 50 years, longer than that. And of course it's changed and evolved dramatically, but from everything we've done, we've learned something and moved somewhere. And I just think that's fascinating in terms of your career and what you've gone on to do, but also the wider picture and how we are thinking about the neurodiversity movement, for example now. So what drew you into clinical work?

I think I had been drawn to clinical work from the start, so I think part of my going to study medicine was actually I wanted to do clinical work. And I realised doing that I was more interested in how people's minds worked than I was interested in how their bodies worked. And so I think when I'd done my PhD, I obviously had a choice. I could have gone on to research, or I could have done, gone into clinical. And I really had this feeling, I want to learn skills so that I can help people directly that I'm working with. I did have, I had quite a hard time in the third year particularly of my PhD, when I would visit, I visited families at home and they would often really want to tell me about the children's difficulties and they would want to ask my advice. And I was just a third year PhD student and I was very aware that I didn't really have valid advice. I didn't have training that would help me give them advice. But they would ask me about their children's schooling, they would ask me what I thought about what they were doing, whether they were getting it right, and it was clear there was a really high level of anxiety around how to help their children, which at the, I just felt, I don't have, I don't have the skills to help you with this. And I thought I would really like to go and acquire the skills actually and do clinical training so that I feel that I'm able to help. And I thought at the time when I did clinical training, I thought that I would perhaps come back to research. And I think lots of us felt that actually on the clinical training that I did, and then it turned out that's quite difficult to do, to find something that kind of brings those two, combines, those two things. But I didn't actually feel, when I went to do clinical training that was necessarily turning my back on research. I just felt like these are skills I really want to acquire, that I want to be someone who has practical skills to help, as well as the skills to do research.

So what did that step over look like? So after you finished training, what kind of roles were you drawn to then?

So during my training I became really interested in trauma and post-traumatic stress disorder. So I, my first jobs in the NHS were in primary care, so in sort of general psychology services with adults. And then I moved into working more specifically in trauma. So I worked in specialist trauma services in London with refugees, with people who'd been sexually abused as children, or with adults. So, and that wasn't, that wasn't necessarily, it was just the jobs that came up, to be honest. It was looking at what jobs are there. You know, you have to be pragmatic. When I was, when I finished my training course, there weren't loads of jobs around. So I, yeah, so what I did was basically I spent some time in a GP surgery in Lewisham, seeing everybody who came through the door, which actually again, I think was really helpful. And I think when I look back now, I am really glad that I got that general experience in the NHS rather than specialising or rather than, yes, rather than just working with autistic people, for example. I feel that one of the things that I bring, which is really valuable, is a kind of wider perspective on general mental health, on trauma in particular. Yeah, so I worked in, on and off, I had my children as well fairly soon after I finished my clinical training, but I worked, within the NHS, I worked in primary care and I worked in specialist trauma services.

That's really interesting and I think people often underestimate the value of breadth in experience. You know, very often, I mean, actually I would say 90% of my coaching clients feel that they're not specialists enough to have value. And they really sort of denigrate the fact that they've done, you know, maybe five years in this kind of work, five years in that kind of work. And I'm always saying to people like, I do believe that being a specialist once you go independent helps you a lot. I think it's very hard out there to get a kind of fulfilling business without a specialism, but all of that general experience that you've accumulated in different areas is so helpful to making you a better clinician, and also kind of, it's one of the special things I think that we bring that kind of path that is unique to us, that has shaped the way that we're gonna view the people that we're working with.

Because our clinical training does that from the start, doesn't it? So if I, if I had done what I thought I was going to do in my clinical training, so in our clinical training for anybody who doesn't know, we have to do six months placements and we have to do adult, we have to do child, we have to do learning disability, you have to do older adults. And then in the end you get choice about what you do. If I had been able to choose when I went in, I probably wouldn't have done older adults, for example. I might even not have done adults. I might have just said, I'm interested in working with children. And actually it was so helpful to do those other things and see things from a different perspective. And I do think that the way that is kind of baked into our training as clinical psychologists is really, really useful. And then you have to do two specialisms. So you can't specialise too early, you are pushed to continue to be a generalist. And I think that perspective has just been invaluable. And I do think that when you specialise too soon and when then you just specialise, you know, people use all sorts of analogies, don't they? Like if you've only got a hammer, then everything looks like a nail, and I think there is an element of that, that you can be very much within your specialism, and you don't look outside it, and so you see everything through the lens of that specialism.

Yeah, I think that's true, and I think it is a real strength of the way that clinical psychology training works that you are forced. I never would've done older adults. I knew that I would find it very emotionally difficult. I was being avoidant and actually I grew so much as a person, I think, from having to face my fears of that particular area of work. And I think it's shaped the kind of empathy that I have for clients who, yeah, I don't work with older adults, but I work with adults who are carers for older adults, and I can understand that part of their life in a way that I definitely wouldn't if I hadn't done that placement. So yeah, I completely agree with you and I think we are so quick to talk down our training, to talk down our expertise, that it's really nice actually to spend a bit of time reflecting on what is special and what is really good about the training that we did.

Yeah, absolutely. I think it was amazingly valuable and I'm so pleased I did do that. Some of the most valuable years I've spent, very difficult years, but valuable as well.

So one of the things I often talk to my coaching clients about is your amazing portfolio that you have in your independent practice. And I use you as an example of somebody who is able to do a lot of things well, because in my mind there's a really clear underpinning set of values that hangs everything that you do together. So, you know, can you just describe a little bit of what you do typically in your practice at the moment? Because there's a lot of it.

There is a lot. And I have to say as well, I wasn't, it's taken a while to build up, like it hasn't just happened. I think that sometimes, yeah, when people are starting out in private practice, perhaps it can be hard to visualize how it's gonna be different, but, so I'll talk about the different elements of what I do. So I still do direct clinical work. I work with children and families mostly, and mostly that's with a parents actually rather than children. And they're almost exclusively autistic children who are having trouble with school. I do also do some adult work. I'm a specialist in EMDR to the point of being a trainer in EMDR. So I run my own training programs on EMDR, and that's the standard training. And then I also do a lot of sort of adjunct things, like with that. So I do EMDR consultants training, which is the training for supervisors. And then I also run days, individual days on EMDR and neurodiversity. So there's a whole kind of element of training, which for me has been mostly around EMDR. Then also supervise, and again, that's mostly EMDR supervision, and I have specialised that really, so I do, I've chosen, I thought, what is it, what is it that I have that other people might not do? And I've tried to focus on that. And that's the same with my clinical work. I try and think about what is it, so I'm very comfortable, for example, doing EMDR with autistic children and demand avoidant children. So I kind of look for the bits of, that I think other people might not be able to do. Then as well as that, I write books. I started writing books in about 2019, I think, and initially when I started writing, I thought that my books would be quite separate to my sort of psychology career because I was writing about education outside the school system, because my children were mostly educated outside the school system. But of course they were still about me and about psychology and how I thought that the psychology, I thought the missing psychology basically when it comes to the school system. So I started writing. I think I maybe have six books that I've written. I'm not sure. I have two more coming out this year. And they are really big, wide combination of things. So I've done a self-help book for teenagers. I've done a parenting book, I've done a textbook and I've got an EMDR textbook coming out this year. I just really enjoy writing, and I think it wouldn't work if I didn't really enjoy it. So I think writing's one of the ways I kind of process and make sense of things. And then is there anything else? Oh, I do webinars for parents, of course. Yes. So I do self-help webinars for parents, and they're often for parents of autistic children, although not exclusively. And I started doing that partly because I became aware of how hard it's for parents to get really good high quality support and how lots of parents when say their child is diagnosed autistic or when their child's behavior just seems really inexplicable, it's very hard for them to find good evidence based information about what might help. And there's quite a lot of people out there putting stuff out there. And a lot of it isn't psychologically informed and isn't evidence based, and so I felt slightly compelled to start putting things out there, which was using the evidence base and was also drawing on my clinical practice because I just felt, when I was in that position as a parent looking for help, I really want to know that the information I'm getting is based on something real, you know, there are things out there you can get, which just aren't very high quality. And actually when I started, when I started, before I did webinars, I actually went to lots of other courses. I went to lots of other people's webinars and things to see what was out there. So I did quite a lot of research and then thought, this is why I want do this. And then I also have prerecorded courses, which are mostly the same content. Is that everything? I do think it might be.

I mean, it's enough, but I feel like it, people often ask me, you know, how do you have the energy or the courage to go and do all of these things? But what comes across so clearly whenever I talk to you is it's this like passion, like I almost can't help. I need to put this out there, because people need to know this.

Yes, maybe. I think you might be right. I definitely feel like I have a drive to do things well and to try to fill the gaps for people. But also I feel like I have a drive, when I think that something isn't right or when I think that people aren't able to get good information. Like for example, when I started out with schools and thinking about difficult problems with schools from a psychological perspective and all that kind of thing, I felt like there was no real voice out there saying, you know, it is a valid choice not to send your child to school. And actually, you could do that and disaster will not ensue because I felt like all the voices that I heard were very much on the line of, you know, you must push your child into school, you must make sure they go, if not, you know, I know what happens when you don't send your child to school, because I didn't send mine to school. People do say, what about the future? Aren't you worried about this? Aren't you worried about this? And I just wanted to be the person who said, okay, take a breath. You know, it's okay. You've got this thing. To be that kind of voice behind parents thinking, I'm not the only one. I'm not the only one seeing these problems. That's where I see myself kind of giving parents permission to follow the thing, their intuition, listen to themselves, because that's sort of what I wish I'd had.

Yeah, and I guess it is that kind of scientific perspective, which is so lacking, not just, not just in education, but you see it really strongly there, sort of ironically actually the evidence that is used to say that attendance is everything. I've heard that phrase. I've been told that over and over again. Attendance is everything, get them here, it's always better. And the people saying that, they really believe it because there is this really low quality evidence that they're using that they get given and they regurgitate to parents. And I think it takes a lot to counterbalance that. It's such a strong narrative.

It's very, very strong and you get a lot of backlash. So when I first started talking about this on Twitter, yeah, I got a huge backlash. People were very, very angry. Teachers, people told me that I was undermining the education system. In fact, people took, someone told me that I was single handedly responsible for the attendance crisis.

Oh my God. That's a lot!

People felt there should kind of be a professional front where we all were on, had to be on message. You know, we all had to say, school is the best place for you always, and you must attend. And that somehow, if you didn't say that, you were letting the side down. And that you were, you know, I mean, I remember when I worked, 'cause I have, although I'd say I've worked mostly in the NHS with adults, I have also worked in various different services as locums with children. And I took some work in a neurodevelopmental clinic in southwest London. And I remember how totally transgressive it would've felt to say to a parent, have you considered not taking them out of school? You know, it just would've felt completely impossible to say that. And also, I remember we had a couple of children come through, so this was a diagnostic clinic who weren't at school, who were home educated, and the response of the team was immediately that the home education was likely to be a problem. But you know, it was like, well, you know, maybe their behavior is because they're home educated. Maybe they're not, they're not getting the right socialization, all that kind of thing. Yeah. It just made me think about all these things that we are expected to sort of, toe the line with, the beliefs that we've expected to just do. And I think it's only when you step out of those beliefs that you, it becomes obvious to you. You know, like I think back to when I was a trainee, I worked with, obviously I worked with children in my training as well, and I remember one girl who wasn't going to school. And I wrote a very strongly worded letter about how she must return school and how that that was basically if she didn't, you know, we didn't think that things would improve and that kind of thing. And I look back now and I'm like, wow, how far I've come. But at the time I thought that I was right. I thought that was helpful. You know, I thought that her parents should be pushing her into school. And it's only now with retrospect that I, yeah, I didn't know how much I didn't know. And I do think that's one of the amazing things about being a clinical psychologist is that you hear so many stories all the time. You hear from so many very, very different people. And if you are able to remain open and curious about that, then you, you change as a person, you know, your mind changes. And I sometimes wonder what I would be like if I hadn't become a clinical psychologist, because I think it gave me this insight into all these worlds that I'm not part of. Because people come and they tell you, don't they? And people come and tell you things that they might not have told anybody else how they feel. And that's just such a amazingly privileged place to be, I think.

Yeah. I often think about that too, 'cause I worked in learning disabilities in Tower Hamlets. And so, and it was a wonderful job. You know, I hear, I hear people all the time who are working in really limiting roles where they're not allowed to practice in the way that they want to. I had the dream. I was out and about in the community, visiting people at home, getting involved with staff teams in day centers and care homes. Like I really, I got to really flex my psychological muscles, and I enjoyed every second of it. But I often think, what would parenting have been like for me if I hadn't seen that diversity of the way that people live and do things? Because honestly, I think the little voice in my head would've been so much more rigid if I hadn't seen, oh, it can work for people in all of these kind of ways, which look so different to anything that my life has ever been like.

Yeah, it really challenges you, doesn't it? It's amazing. And actually going into people's houses particularly does that, I think because them coming into see you at the clinic is quite different. And I certainly, even back when I did my, I started doing my research and I visited children at home all around South London, it was, yeah, it was, it is amazing. It's just an amazing experience. You just learn so much from it.

Yeah, you really do, and I guess I think this might be a related area, but these days you do a lot of stuff which is really public facing. So you're out there doing webinars, you're doing podcasts, you are very visible and as you've mentioned, sometimes that brings with it people who are not so kind, as well as all the people who are tremendously grateful to you. Like, you know, I do hear in my support groups that I'm in, a lot of people talking about how amazing you are. And I'm like, I know her, which is really nice. But does that stuff come easily to you? Or, you know, has it been something you've had to learn to deal with?

No, I don't think it comes easily and I don't think, it wasn't really something that I anticipated. I guess you can't think these things through necessarily beforehand. Perhaps I should have done that, thought about the implications of doing lots of webinars where people see your face that they're gonna recognise me, and that is, you know, I've had people, had people come up to me in parking lots in car parks to say hello, I just wanted to say I really liked your webinar. And sometimes it's really, the times it's most complicated, I feel, is when I'm with my children. And people will come up and I'm like, oh my goodness, what did you just see? Or what did I just say? And once somebody came up to me when I was on a merry-go-round with my daughter, and she was not happy at all. It's very hard to juggle those different roles and it feels very exposing. I think that's the thing about it, and I think, I think that's something I have struggled with because I think that in the therapy room we say we, we are very much in relation with people, aren't we? We're very much responsive to the person who's right there with us in the room, and we choose what we say or we don't say thinking about them. And yet, if you are more public facing, if you're doing webinars or something, then you have to think about not only all those people who you're talking to, but potentially all the clients who you've ever worked with, and who you might be saying something to now, which they don't like or which they feel is invalidating. You can't validate everybody all the time, it's not possible. So I think I have that tricky, that balance between the individual clinical psychologist and how I am with individuals and then how I am on a bigger scale. And I do, yes, there are certain settings, there are certain places I go and I have this kind of feeling of, oh, here I'm saying this. Like I go to Home Ed camps. If I go to a home ed camp, I can't walk around without people coming up to me. And it's lovely. I really love it, but I'm really glad it's not like that all the time. You know, I'm really glad that my fame is really localised, most of the time I know this setting is gonna be like I'm famous, just in this little bit and then I'll be able to go home. Yeah. But it's not something I would really have said that I wanted to happen and I feel more, yeah, I think I would prefer to be a bit more anonymous.

Yeah, it's challenging. I think I have a similar, on a smaller scale thing, where I'm well known in one very specific area. And, and thankfully it's a bit easier 'cause that doesn't overlap with my children hardly ever. It did once and my daughter wouldn't stop saying that I was famous for like a week, just because I happened to bump into two psychologists that I didn't know, who knew who I was. But that really, yeah, I can imagine that's a balance that if you did anticipate it at the beginning, it might have stopped you from getting started.

Yes, it would've done, it definitely would've done. Yes, there were many things that have happened that if I'd known about them in the beginning, I would've said, no, thanks very much. I wouldn't be doing that. But it's kind of, you just take a step, don't you, go one step further and then you're like, oh, actually this is gonna happen. Oh, actually this is happening, and then you're in, and then, and there's kind of no way back in a sense, yeah, you're right, you're right in it.

Yeah. And I think it's often about like, how, how much do you want to spread that message? Is it, is it going to be worth it? And I think, although it might be something you explicitly thought about, if it wasn't worth it to you, you probably would've started thinking about it and got scared, and after the first webinar, never done another one.

Yes, possibly. I think there's something strange about webinars though, because you do them and you don't actually see most of the people. In fact, online stuff is similar to this. You put it out there, you don't actually know how many people read it, it's not like being in a room at a conference where you give a talk and you see all the faces. So I think it's slightly easier to convince yourself that perhaps all these people are somewhere out there in the ether. You know what I mean? And the fact, the translation to everyday life is quite a shock, the thought of, oh yes, these are real people listening to me, which is great as well because I do want to get out what I say, and I think, I mean, you talked at the beginning, my values, and i sometimes joke that basically my value is if I see everybody kind of going in one direction without necessarily asking why, my main tendency is to go directly the opposite direction. I think I've been like this since I was quite young. You know, it's just kind of, I dunno what you'd call it, being a contrarian or just asking difficult questions, you know, like, why do we all have to go to school? And I might be wrong about those questions. And I wake up in the middle of the night sometimes going, oh, what if I am fully responsible for the attendance crisis? What if it is, because I do get emails from people who say, we read your book and we took our child out of school. And I do gulp when I get emails because I might, you know, I'm only one voice and I'm only, I'm trying to draw on research, trying to draw on people's experiences, but I cannot tell every person.

But I think what I can see really clearly running through is this desire to get people asking questions so that it's almost like what you want to pass on is this like ability to interrogate the evidence and make your own decision, like empowering people really to make a proper choice based on real evidence, which is actually kind of what you do in EMDR and trauma therapy as well. Like it really does run through everything. Like don't just blindly accept what you're told or what you believe.

Yes. That's a nice way of putting it. I like it. Yes, but you are right, it's, I'm not hoping to, I'm not trying to tell parents what to do. I'm saying these are the other things you might want to think about before you decide what to do, because you are the person who's gonna decide what to do. And for that we need to interrogate everything. We need to ask questions that other people aren't asking. And you know, I think of it as like shining a light in the dark corners, the things that people don't want you to talk about or are trying to distract you from talking about, that's where I love to say, so why, why can't we talk about this? And that absolutely relates to trauma work because of course with trauma work, a lot of what you're doing is you're looking for, what does this person not, what are they not able to think about? What are they not able to talk about? They're gonna have to think and talk about those things. You know, and that's hard because they don't necessarily, they don't come wanting to talk about it. Usually with trauma therapy, people often come wanting you to make all their difficult experiences go away. They don't want these horrible flashbacks and intrusive thoughts and everything. They just want to make it go away. And particularly with the EMDR, sometimes people have the impression that that's what EMDR will do. You know, it's like a magic bullet, it'll all go away. They say, I came I came to EMDR because I don't want to talk about one. And like I was saying, I'm really sorry, but we're going to have to start by talking about one because we, that's what we do. And that's, and the way that we enable these things to be resolved is by thinking about, you know, one of the therapists I work with talks about PTSD being a phobia of our feelings. And I really like that idea that we can be phobic of feelings or phobic of talking about things. And I think as psychologists, we have an obligation to say, what are we phobic about here? And could we talk about it? You know, because actually we know that avoiding the thing that you're phobic about is only gonna make you more phobic.

Yeah. And it's, I'm just thinking about an episode I recorded recently with Dr Erin Carroll about smartphones, and she was talking about how smartphones kind of enable this phobia to continue, because we can just look away and I noticed, you know. I do that all the time with intense stuff on the telly. If it's getting to a bit where there's a bit of gore or something, I'll just be looking at my phone all of a sudden. It's like, oh, okay, I would've sat with that. Before I had a smartphone, I would've had to sit with that, or I might have done something a bit more extreme and gotten up and like gotten a drink or something like that, but actually probably I wouldn't have been bothered and I would've sat with it. So I think there is really something in there.

Yes, yes. That we're setting up a society to facilitate avoidance, I think in lots of ways. I was reading an interesting book by a neuroscientist who was saying that we have set up a lot of our society to facilitate avoiding real conversations with people. That we do it, you know, because now we can have asynchronous conversations, we can send text messages, we can send emails, and we do that a lot of the time when previously we would've rung somebody or met them. And in the moment that feels easier. It's always easier to send a text, isn't it, than to actually ring. But his argument is that our brain, we really lose something if we do that because we need that kind of social connection. But we also need all the input that we get from a social connection. And that involves taking risks, perhaps feeling uncomfortable, perhaps moments of anxiety. It involves all of that. Whereas a text much less, much less like that.

It is. Yeah, no, I think that's a really interesting point and I guess it kind of brings us onto another conversation, which I feel is avoided and it, you know, we avoid it as professionals, we avoid it as parents, it's generally avoided, and that is about the kind of neurodiversity movement, the terms that we're using within that and the potential pros and cons of the, the way that we talk and think about neurodiversity and neurodivergence now. So you have a new podcast with Dr danielle Drinkwater. So do you wanna say a little bit about what the kind of Neurosense mission is?

Yes. So our podcast is called Let's Talk Neurosense, the Psychology of Neurodiversity. And the purpose was really to have conversations that we felt were not being had about neurodiversity, particularly aimed really at professionals, psychologists, psychiatrists, doctors, because I think both of us felt frustrated with what happens on social media, which is that you might put something out there, you get an angry response or a hostile response, and things become really, really polarized very quickly. And I had been trying for a while to have some more nuanced discussions about things. And some people responded really well to that, other people didn't. I think I got a sense from some people of why, how, why would you raise this question? You know, to raise these questions is in itself harmful. So I wrote a piece, particularly, I think it was entitled, something like Why I'm Not a Neuro Psychologist, because people often describe me as a neuro affirmative psychologist because I take an evidence based, positive, non pathologizing approach to all the young people and children that I work with. No matter what diagnosis they have, I basically put them at the center of whatever we do. And I became increasingly uncomfortable with being described as neuro affirmative because, for a few reasons, but one of it was the focus on neuro and brain. I felt like we were being pushed away from a focus on children and minds and psychology towards brains and neurology. And I felt that was interesting. And what was that about? You know, why? Why do we feel more comfortable talking about neuro than we do about psychology? And is that actually something about the stigma that's attached to psychology and about minds and you know that somehow they're all more comfortable saying it's in your brain. And the thing about autism and ADHD is that there isn't, well, if you go into it a lot, but there isn't research that shows that having a diagnosis of autism and ADHD means that you have a neurological difference, we've identified that, hasn't been shown, along with every other psychiatric diagnosis, nothing different. But yet saying those kind of things gets a very... and then the nuance goes, just immediately the nuance goes and people immediately start saying things like, oh, you're harmful, or you're, you know, you've betrayed us. And I found that really interesting because I thought, but I'm not doing anything different. Not, you know, I'm not, I'm not suddenly taking a deficit focus approach to children or not suddenly... i'm just not doing that. So what is it that's so challenging to people? So we wanted to have a podcast because we thought we'd like a podcast where people are expressing different views and that we don't necessarily agree with their views, that is not part of the podcast, but we want to hear different perspectives on this. Because quite pressure to have from one perspective and to sort of toe the line. And I felt that, because I feel like when I step out of line, I know I'm stepping out of line, people tell me very quickly that I'm stepping out of line, but, and therefore we blocked the conversation. I've been blocked. People block me because I've raised questions about, I mean, and the other thing I often raise a question about, there are lots of things, but a lot of this kind of, it feels like we are sometimes encouraged to sort of sign up to a neuro affirmative code. If you look online, you'll find literally people have written what they think they think a new affirmative code is, and it includes things like not offering CBT and which isn't evidence-based. Or you know that, yeah, so, I just felt really uncomfortable with the way that I felt we were being pushed towards signing up to a set of values in order to show that we were non pathologizing, person centered, child centered, you know, all of those things. It was like there was this new name for it. I just wasn't sure that that was really a name I wanted to sign up for. But it's can have lots of consequences because people feel very strongly about it. I think they particularly feel very strongly about not platforming some voices, that you should be listening, you should be, that we've kind of got one way that we should be going forwards, a bit like with the school thing, you know, we should all be saying, we know that although it's something different and people see it very differently, but it's a bit like, we've got this belief system, and as a professional, you have a responsibility to back this up rather than just say, I'm not so sure about that, maybe I don't agree. Yeah, I'm sorry. I dunno where I'm going with that.

Well, I just think it's a real, I think I really recognise that. I think, you know, in the communities that I am in, it would be very frightening to put something out. I have kind of gently before been like, Hmm, I'm not sure about neuro types. I don't like that because I don't like typing people. And I really will avoid doing that in most of my work and most of my life, and so I don't feel like I want to do it to myself or to my children. And so I don't, I never really talk about neuro types and sometimes people will kind of call me out for that and be like, oh no, this is because they have a whole different nervous system. And I will kind of gently say, I'm not sure that they do. And I feel like if we don't, because of the way research works, people have to have an inkling that something might be wrong in order to investigate it. And so I'm really interested in listening to the people who might have different inklings to me, because you know, if they go off and they do their investigations, we're gonna learn something useful. We might learn that they're wrong and I'm right. Or we might learn that actually, my theory is not a brilliant one and we need to rethink it. And I just don't imagine that we'll ever get to the end of that process. Why would we? We never have with anything else.

It's being a scientist practitioner, isn't it? It's, it's forming hypotheses and I think that's what I think we should be able to do. We need to be able to form hypotheses and test them, whereas it seems like there's a bit of a tendency to say, no, this is the right way to think about it. Neurotypes is a really good example actually, because I think everybody feels like neurotype is a non-pathologising way to talk so people feel better about saying, oh, this is your child's neurotype. As opposed to saying your child has a diagnosis of autistic spectrum disorder, for example, which has disorder in it, but what is contained within that assumption of neurotype? Okay. That there are different types of brain that we are identifying through our diagnostic process. And that somebody is now gonna be this neurotype for life, really, that's usually what it comes along with, and that it's in their brain. Those are all quite rigid beliefs and I don't think we've got any research to back any of it up. So we've had buying into that because we feel it's less apologizing and I'm not comfortable with that because I feel like we're, in our desire to be non pathologising, which I think is really important, we've kind of rushed towards an alternative which has drawbacks and that we aren't, aren't then thinking enough about those drawbacks. It feels scary to think about those drawbacks. And people will often say, if I do say, for example, say something like, I'm not so sure about Neurotypes, they'll say, so are you saying it's my fault? Well, are you saying I'm a bad parent? No, I've never said that and I would never want to say that, but it's very quickly that people rush between those, either you're with me or you're against me.

Yeah. And what do you think contributes to that? Because I see that as well. I think that's extremely potent at the moment. I feel like it maybe has gotten more so recently.

What do I think is behind that kind of, what that rush, the need to be not at fault. Is that, what do you mean?

Well, I guess that sense of you're either with me or against me. So if you start to say something that isn't a hundred percent aligned with what I already think, then you are betraying me and you know, I don't trust you anymore.

I mean, there is a lot of stuff online that will tell you that people are against you. I mean, I've seen people with, I've seen people come with lists of things that if a professional says, that means they're not near affirmative and you should end the appointment. Like if they say the word's high functioning, for example, or if they use the word autistic spectrum disorder, or if they use, even, I've seen it written, if someone uses person with autism, that means they're autistaphobic and they should never be allowed to work with autistic people. So they are being, people are being told that any kind of different way of thinking about things, means you really shouldn't be doing this at all. But I think also people are under huge pressure. Life is very, very difficult, has been really difficult for a long time, for lots of people. And people, I think people really need to feel that this isn't their fault. So when they found a way that says to them, this isn't your fault. It feels really, really important. And it's hard, it's like a kind of clinging on, it's almost like a sort of life buoy, you know, this is my life buoy, this isn't my fault, it's my neurotype, this is who I am, it's my brain is wired this way, or my child's brain is wired this way. And if you challenge that in any way, it feels like you're pulling the life buoy. You're saying back to square one. I've experienced that clinically, for example, I said that I don't think a child fits criteria for an autism diagnosis. I've had families very, very upset, very angry with me because it feels like we are taking, what are you giving me instead? What's the, where's the alternative life buoy? And we've got lots of systems now, haven't we set up where really there isn't another, there isn't an instead, you know, you're there to get an autism diagnosis and if you don't get one, what d'you do?, Back to square one because CAMHS services are so overstretched. Support in school is so minimal. So I think it's a kind of crisis of people really hanging on to whatever, whatever way might help.

Yeah, and it's so interesting. It's like if the baseline was, we already know it's not your fault, nobody thinks it's your fault from the beginning, regardless of whether this diagnosis is the right one or not. That would change everything, wouldn't it? But in order for that to...

For children as well, we, that's the thing because we also tend to start with the idea of children. It's children's fault, don't we? You know, children must be, get the message. They must learn how to behave. It's a real anti-child thread, I think, in our culture, which is children, yes, children's behavior is on purpose. They're doing that to annoy us rather than behavior is just a way of showing how you feel, it's just another communication. And if we could just have that for the start, and I think you're absolutely right, if we started off with parenting, with the basic underlying thing, we know it's not your fault. It's not your fault if you find things hard, it's not your fault if you're struggling or your child's struggling, that's just our bedrock. We all agree it's not your fault, and then it's that how can we find a way forward?

Yeah. But I think in order for that to feel true, there has to be more support available and, and I think this probably has come about because the only way of getting support is through diagnostic pathways, and the support doesn't even come. That's what is frustrating now, is that even the diagnosis won't actually get you very much support. What it might do is stop some people in the system judging you as harshly. And that's incredibly valuable to people. So we've got these kind of two needs. People need like less judgment and they need more support. And at the moment, the only way they can get even some of that is through these diagnostic routes. Which of course it makes sense that then those labels carry everything for those people, and it is, it does become challenging. But I think as clinicians, it disappoints me that as professionals, we struggle to have these conversations. I really understand it, you know, as a, as a parent with children who are diagnosed, I do understand it, but as a professional, it feels like we have to have these conversations in order to keep the best interests of children and adults who are being diagnosed at the forefront of our minds.

Is it the best we can do? Could we be doing things better? And it's kind of imagining that there might be a different way to do things, even whilst acknowledging that within the constraints of the system there might not be. This might be what you need to do. And that's the kind of difference, isn't it, between the individual level and the bigger where are we going, societal level. And I think we have to try and hold both of those in mind.

But it's a really difficult thing to do. And I think that's why I was really pleased when I saw your podcast launch, because, even though I guess we won't always agree with everything that is said, it's encouraging us to really think, is this the best we can do? I love that question. We should always be asking, is this the best we can do for people? And if we are all coming from that perspective, even if we disagree, surely we can do it compassionately.

Yes. You'd hope so, wouldn't you? And I think that is the case. I think whenever I've, all the people I've talked to, whether they think that, y'know people have such different ideas about what will help, but all the people I've talked to so far really do share this conviction that they want the best that they can get, the best that we can possibly do for children and families really, but adults as well, but particularly for children.

So I think that's a good place for us to finish. I know that people are gonna want to go off and read more of your stuff and listen to your new podcast. So where's the best place for people to go?

My website is naomifisher.co.uk or substack is where my podcast is, and it's called Lets Talk Neurosense, and I actually also have another Substack newsletter called Think Again: Making Childhood fit for Children. And that's just writing. Just subscribe to them, you'll hear about what we're doing.

Amazing. And I have to say, I think you're really good at titles. I think I always thought Think Again was a brilliant title for your substack and I think it's a great title for the podcast as well, really good. So well done. Thank you so much for joining us, Naomi.

Thank you so much. It's been lovely to be here.