Using Functional Analytic Psychotherapy to Address Interpersonal Difficulties With a Neurodiverse, Non-Binary Client

Abstract

This case study examines the use of Functional Analytic Psychotherapy (FAP), an interpersonal contextual behavior therapy, to address relational difficulties in a 33-year-old non-binary individual with autism and interpersonal challenges. Neurodiverse individuals, especially those diagnosed later in life, often face compounded social prejudice and elevated mental health risks. Similarly, gender-diverse individuals are subject to stigma, and when gender diversity intersects with neurodiversity, mental health vulnerabilities may intensify. The client presented (a) identity concealment that hindered authentic self-expression, (b) difficulty expressing vulnerability in relationships, including with the therapist, and (c) avoidance of neurocognitive assessment due to efforts to mask symptoms. FAP’s focus on in-session interpersonal dynamics guided the therapist to evoke and reinforce behaviors related to openness and intimacy, while blocking avoidance and minimization. Therapeutic goals included (a) increasing interpersonal effectiveness and social communication, (b) promoting willingness to seek neurodevelopmental assessment, and (c) reducing identity concealment to support meaningful relational engagement. Over time, the client demonstrated greater emotional expression, improved social connection, and reduced experiential avoidance. This case highlights FAP’s potential as an affirming and effective approach for individuals navigating intersecting identities. By targeting moment-to-moment relational patterns and contextualizing behavior within systemic experiences of rejection and late diagnosis, FAP can provide a supportive space for growth. The findings emphasize the need for interventions that are both behaviorally precise and attuned to the lived experiences of neurodiverse and gender-diverse individuals.