“I’m a fish!” Deepening receptivity to neurodiversity: a neuroscientifically informed integration of psychoanalytic psychotherapy, reciprocal prediction, and mindfulness

ABSTRACT

Receptivity to our patients’ experience is a vital aspect of the psychoanalytic endeavor. As we receive incoming transmissions, we resonate with what is active in the patient. We hope to then jointly metabolize the experience. When we meet neurodiversity, realms of experience emerge that may elude us. Precipitously formulated ideas in the therapist, based on a neurotypical frame of reference, can impinge upon the discovery of our patients’ authentic world. How do we open ourselves to receive their true experience? This clinical narrative tracks the psychoanalytic travels of an individual who identifies as neurodivergent, who helped the therapist learn to deepen receptivity by dipping into a less differentiated place to follow the here-and-now experience from the bottom up. Throughout the journey, interweaving neuroscientific and psychoanalytic perspectives offered a powerful matrix from which an enriched understanding of our process could emerge. Psychoanalytic concepts including evenly suspended attention, unconscious-to-unconscious communication, alpha function, reverie, and negative capability are explored alongside neuroscientific insights into the stress response, mirror neurons, and the default mode network. A predictive coding lens introduced a view of the therapeutic exchange as a continuous reciprocal prediction, evoking the hypothesis that deepening receptivity required opening awareness to incoming signals and lessening the hold of prior predictions. To bring greater therapist awareness to the present moment and lessen the influence of self-referential evaluation, neuroscientifically-informed reflections also inspired the practice of mindfulness. Subsequent developments suggest that these approaches helped deepen receptivity to the experiences being communicated, leading to new understandings with transformative potential.

KEYWORDS:

• Receptivity
• neurodiversity
• psychoanalytic psychotherapy
• neuroscience
• predictive coding
• mindfulness

Acknowledgments

My deepest gratitude to Lizzie for connecting me with previously un-experienced aspects in myself, and for inspiring me to learn and accept more about my individual wiring. To use a chemistry metaphor: when two elements come together and a reaction occurs, each leaves transformed—thank you. I also wish to thank David Kealy, Ph.D. and Maxine Anderson, M.D. for their insights and comments on earlier versions of this manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Consent for publication

Written informed consent was obtained from all mentioned individuals for the publication of the case descriptions contained in this manuscript. Potentially identifying information has either been disguised or not included and pseudonyms have been used.

Notes

1 The term neurodiversity was coined by sociologist Judy Singer in 1998 (Singer, 2017). Initially applied to describe the autistic spectrum, in particular Asperger syndrome, the neurodiversity framework has expanded to include conditions such as ADHD, dyslexia, dyspraxia, dyscalculia, and synesthesia. The focus within this framework is on considering autism and autistic traits as differences or natural variations rather than as a disorder. The autistic brain is viewed as being differently wired, with the capacity to function well or even superiorly in a well-matched environment (Baron-Cohen, 2017).

2 While the lens of neurodiversity, which includes the consideration of autism spectrum conditions and the broader autism phenotype, has been illuminating in our examination of Lizzie's experience, diagnostic deliberations beyond the presence of autistic traits exceed the scope of the psychoanalytic study presented here.

3 Incoming sensory information includes exteroceptive input from the five senses of sight, hearing, touch, taste and smell, as well as interoceptive input from within the body. Error signals can manifest in a multiplicity of ways; Solms (2021) describes how affective responses, relayed from our basic emotion systems, can serve as powerful signals. For detailed accounts of Panksepp's proposed taxonomy of basic emotion systems and illustrations of their functions, see Panksepp (1998), Solms and Turnbull (2002), and Solms (2021). Regarding the clinical application of Panksepp's basic emotion taxonomy, see Mor-Ofek (2022).

4 An exploration of Bion's extensive writings on Transformations (1965) is beyond the scope of this paper. The understanding I am working with, very briefly: Transformations in K (Knowledge) occur through processes of knowledge (talking about, understanding), whereas Transformations in O (Origin), stemming from ultimate reality, the numinous realm, occur by processes of being (Sandler, 2005).

5 The term Negative Capability was originally coined by John Keats, who described it in 1817 as “capable of being in uncertainties, mysteries, doubts, without any irritable reaching for fact and reason” (Keats, 1817; as cited by Bion, 1970).

6 Equanimity describes a mind state of balance, calmness, and composure in which we feel neither an aversion to unpleasant experiences nor craving for pleasant ones (Cayoun, 2014).