Epistemic Justice, Safety, and Neurodiversity-Affirming Practice: A Lived Experience-Led Response to Wade and Waller (2025)

This lived experience-led response critically examines Wade and Waller’s (2025) proposed core competences for cognitive behaviour therapy (CBT), identifying omissions that risk perpetuating iatrogenic harm and epistemic injustice. The framework’s neuronormative, clinician-dominated orientation neglects co-production, intersectional factors, and neurodiversity-affirming principles. Drawing on evidence from qualitative research and our collective lived experience as neurodivergent researchers and clinicians, we outline risks embedded in competences such as firm empathy, prioritising early change, routine outcome measurement, high-intensity pacing, and exposure interventions. We propose affirming adaptations that centre safety, consent, flexibility, and client-defined progress and collaborative goal-setting. Our recommendations emphasise identity- and trauma-informed care, flexible session formats, and training co-produced with lived experience experts. Embedding these principles into CBT competence frameworks would promote ethical and inclusive practice, mitigating the risks for harm and fostering genuine therapeutic alliance.