Have you recently discovered that the way others (or yourself) have conceptualized you did not include potential Autism or ADHD? Have you felt that you’ve been misdiagnosed or misunderstood?

Many folks (particularly those with marginalized identities) have their struggles conceptualized (by others and the medical system) as explicit pathologies. Often clients coming to me have been diagnosed with Bipolar, Generalized Anxiety Disorder, OCD, Borderline Personality Disorder, PTSD, or Major Depressive Disorder. Diagnoses can come with major stigma and internalized shame, as well as other people in your life treating you as though you are broken and helpless.

Part of the neurodiversity movement has been opening up the potential of Autism Spectrum Disorder (ASD) and ADHD as ways to conceptualized folks who have otherwise been shamed. Although ASD and ADHD are still DSMV diagnoses, they typically (particularly ADHD) come with less shame and stigma. Often folks with marginalized identities (including femme presenting folks) can get what I might called over-pathologized. Their presenting behavior (or what are called symptoms by the medical system) often gets put in the bucket of “crazy.”

Part of what the neurodiversity movement has done is to offer a new paradigm for folks who have been over-pathologized, to look at who they are as a natural part of human diversity. Their presenting behavior, their feeling patterns, their sensory sensitivities, their unique take on the world, are somewhere on the spectrum of human diversity. Their pain and struggles are real, and they can be addressed (including in therapy). However, they are not sick and broken. They are whole and neurodiverse.

I explore the intricacies of ADHD, autism, or AuDHD with clients, including:

• Translating over-pathologized parts of clients into tangible goals. What is happening? What would you like to be better? How can we get you there?

• How has communicating with people closest to you been impacted by your neurodiversity? Let’s find ways to communicate more effectively to help improve relationships.

• Discovering and/or accommodating sensory sensitivities that could be impacting mood, focus, anxiety, sadness, and stress.

• Processing sadness and/or grief associated with being over-pathologized.

In tandem with exploring client’s neurodiversity, I work with clients on looking at the intricacies of themselves beyond any pathological paradigm. I have found that moving from more stigmatized diagnoses to identifying as being neurodivergent can be a liberating step on the path to healing, self-love, self-acceptance, and, inevitably, a more joyful, sustainable life.

Feeling like you are battling with your body constantly can be enraging and all-consuming. Let’s find a path forward.

As someone who is diagnosed with fibromyalgia, and has worked with many clients with EDS, hypermobility, fibromyalgia, auto-immune disorders, long covid, and chronic fatigue, I understand how hard finding a path to better health can be. I often approach clients that the first step is managing symptoms you are experiencing. Instead of pain being a 9-10/10, we try to get it down to a 7/10. I am happy to help coordinate developing a care team, as well as a regimen of what therapies, habits, appointments, joyful activities, eating, and body movements might help you have a more prolonged period of better health.

It is also important to address different forms of grief associated with chronic illness. You may be grieving illness you had in your younger self that was mistreated due to not knowing more intricacies of what was going on that you are now becoming more aware of. You also may be grieving a younger version of yourself that could do a lot in your body, and as your body has increasingly dealt with more and more pain, parts of your identity that you associated with (such as being a gymnast for many hypermobile folks) now feels like you can never access that part of yourself again. You also may be grieving what you worry you will not have in your future with your changing body.

I am passionate about working both with clients on processing the emotional implications of chronic health conditions as well as doing my best to explore practical steps to reduce suffering in the short term. I embrace for myself and my clients that this can be a long and windy road. I also hold hope for them that things will get better.

Have you felt like the transition from childhood to adulthood after being considered “gifted” or “talented” has been challenging in particular ways that there is no roadmap for?

Working with folks who have been identified as highly intelligent, talented, and/or exceptional has been a deeply rewarding part of my clinical practice. There are unique pressures and struggles, often what I conceptualize as having some delays in certain parts of your development along with rapid acceleration in other parts, that can leave the adult version of yourself stuck and distressed.

My essential goals with clients who are on this path are as follows:

1. Learn and practice that just because you are extraordinary at something does not mean you are required to do that thing.

2. Embrace, be at peace, and be in a more playful relationship with the part of yourself that is extraordinary.

3. Separate your worth as a human being with how often others observe you as being extraordinary.

4. Separate your worth as a human being with how often YOU observe YOURSELF as being extraordinary.

5. Work on tapping into the joy and energizing quality of what is extraordinary about you.

6. Accept and embrace the power of the part of you that is extraordinary.

7. Utilize this part of you to change the world in ways that you feel genuinely called to do, regardless of the degree of impact on the world.

8. Teach and encourage others to do the same. To build a world where we are in joyful, balanced relationship to our talents.

If you are in the earlier parts of this journey, the last few points may seem a bit daunting. I conceptualize these steps in order for a reason. If we do not have a solid relationship, in our core, to this part of ourselves, skipping to (for example) step 6 can come too fast.

I have found it to be much more powerful to develop that healthy foundation to then build what is often a beautiful and exciting life on top of. Feel free to reach out or ask any questions.

Do you feel lost in your identity as an artist? Are you wrestling with sustainably, consistently creating art that moves you?

I enjoy working with creatives, including folks who identify as artists as well as people who find joy in creating and would like help to consistently engage in creating.

I have worked with actors, comedians, classical and rock musicians, painters, writers (of many sorts), and folks who run organizations dedicated to creativity.

For many of my clients who don’t explicitly identify as artists, they have engaged in creative activities as children and feel disconnected from the part of themselves that once created.

In either case, I have two general distinctions in my work to help sustain creative practice that I often do work in both with the same client.

Identity:

One important aspect of creative practice is identity. Finding your identity as a creative person can be extremely helpful in directing your energy, resources, and time to practicing in that art. It can help with creative prompts to engage with art.

Often it helps in the process of sharing your art, whether that be in small, intimate circles of friends, family, or partners, all the way to public or global sharing with the hopes of having as much reach as possible.

There are many questions and prompts that I utilize to explore creative identity. The goal is for the client to obtain a sense of creative identity that feels stable enough to them in the moment to direct their energy and also flexible enough to allow time and experiences to shift and change their creative identity.

Directing Energy to Sustainable Creative Practice:

This aspect of exploring creativity typically is separated into two facets. One is exploring creative practice from an executive functioning lens, which is essentially linking whatever you intend to do in your mind with what you actually do in observable reality.

Society teaches us to increase the perceived value of the thing we intend to do. Essentially the message is, “if you cared more about creating the art you want to create, you will do it.” Themes of laziness, questioning if you really want it, and beating yourself up typically follow from inner or outer (other people) sources.

I do my best to shift from focusing on “caring” more, or what is typically defined as “motivation” to lowering the cost of engaging in the task.

Lowering the cost essentially means making it easier (with time, resources, energy, and more) to engage in the task.

This could look like having a dedicated space in your home with all of your art supplies in view to engage in creative practice, for someone who has had no dedicated space and no visual cues to create art.

This could look like creating a sensory environment that eases you into the type of focus needed for art making. Paying attention to sound (noise cancelling headphones, or background sound that helps with focus), smells (aromatherapy), touch (soft and comfortable clothing and furniture), taste (water infused with lemon, a hearty snack), see (engaging visual prompts to stimulate your mind, or little visual distraction to ease into focus), and more.

There is a risk in naming specific examples because everyone is different, and often we have tried many things before we get to therapy. And the internet is filled with hacks around ADHD, executive functioning, and creativity. But I am hoping that in listing some of the premises of interventions with brief examples that you might be able to apply this to yourself in whatever way is UNIQUE to you.

Another aspect of consistent creative practice is priotizing your energy to be directed towards it. There is often a myth that we can just add tasks (including creative practice) to our life without taking anything away. These other tasks often fall in the domains of non-creative work to make money, relationships (friendships, romantic partners, family), parenting, household tasks, health-related tasks, sleeping, eating, and pleasurable tasks.

Cutting out things from your life can have serious consequences, including relational conflict, losing a job, a dip in health, feeling disconnected from friendships, worrying about not being a good parent, and many more. I cite these examples because it is important to note that giving up part or all of the energy you are directing to other domains is typically not easy. There’s a reason you’re allocating your resources there. And there can sometimes be grief in the things you take energy away from.

But being humble, and finding grounding in our limited, finite nature as human beings can also be liberating. Liberating yourself from the myth of infinite growth (wink, GDP and capitalism), and the myth of limitless personal optimization (wink, productivity hacks), can really help ground you and regulate your nervous system.

In a constant reminder and shifting to accepting and practicing our finite nature, we can find pleasure and joy in the mundane. We can also feel more aligned with our values. And in many ways, we can become more productive. The things we do may have more meaning. We may also do them better than we have before, because our focus is not a burned out, scattered mind.

Approaching reducing how much energy we allocate towards tasks can be a process of experimenting. Seeing what types of energy (cognitive, emotional, physical, and more) we spend on different tasks and how much is freed up from letting them go can surprise us at times.

You are a unique individual. Your story, strengths, and confluence of factors is unique to you. A really improtant aspect to what I would consider effective therapy is trying to get to know the client as deeply as possible, and get as specific as possible. One person’s solution may be another person’s Achilles Heel. If there is no “good” or “bad” solutions, and we focus on efficacy and utility, then we can find your unique path.

Solutions may come and go- what works for you this year may not in 5 years. But by practicing flexibility, and developing a system to experiment with the ever-changing nature of life, we become more empowered to engage consistently in creative practices that bring us joy.

Are you searching for ways to recover from pervasive burnout? Have you reached a depth of burnout you haven’t previously experienced?

Burnout, to me, is a state of low energy that is pervasive, and likely includes multiple domains of energy.

Including:

• physical energy (bodily energy, good general health, strong immune system),

• cognitive energy (executive functioning, completing moderate to complex cognitive tasks),

• creative energy (drive for the creative process, fresh ideas),

• emotional energy (space for all emotions, awareness and processing of emotions),

• social energy (interest and energy for interacting with people you typically enjoy, energy to engage in more depleting social situations), and

• spiritual energy (a sense of interconnectedness with the world, an engagement in personal philosophy or faith).

I hope that you can use this list to get an idea of where you are at. If 10 is peak energy and 1 is the lowest possible in each domain, where are you today in each domain? Where have you been in the past three months, in general? And when you have considered yourself NOT in burnout, what was your average level?

This might be alarming, but it can also help you design a path towards recovery.

I get specific with clients and also prioritize maximizing energy in certain domains versus others based on a client’s preferences. Perhaps recovering physically is more important than emotionally for you, in this moment of life, or the other way around.

Getting specific in recovering from each domain is important.

I work with clients on finding low cost (accessible, easy ways to approach changes in behaviors) ways to approach recovering energy. Having lofty goals for energy recovery can be helpful, if they are paired with the reality that we may have a long road ahead of us, and that often recovery is non-linear. There are definitely exciting bursts of recovery that happen for folks, that can feel like unlocking what you’ve been hoping for. But often things take time. I encourage clients to process disappointment, as well as frustration with the process. All the while, continuing to hold hope for recovery and experimenting with ways to get back to better energy. Which inevitably makes you feel more like “yourself.”

Often our memories in life of when we were “ourselves” involve high energy in at least one of these domains, and subsequent behaviors, productivity, or interactions with other people that brought us deep joy.

Are you struggling with catastrophizing, ruminating, and nervousness? Are you looking for tools and ways to manage intrusive thoughts?

My approach to anxiety is that at the core of it is being disproportionately in cognition. Cognition is only observable to us (emotions, feelings, thoughts) and the environment is observable to us and others (our body, other people, anything surrounding us).

Part of what cognition is useful for historically for humans is in solving problems. Something is happening that we don’t like. We utilize cognition to think through solving the problem. Sometimes we can solve them. Then we act upon the solution. Cognition has been put to good use!

Cognition as modern humans in developed societies where our basic needs are mostly met can start to effect us in ways that are stressful. I think that essentially at the root of anxiety (as the cultural phenomenon we are observing) is a use of cognition that results in pain and suffering. The intended benefit of cognition is still there (solving problems and enacting the solutions) without the effect of the benefit.

This may sound harsh, but stick with me. Modern “problems”, often, when we look at the stakes (what are the consequences if this problem isn’t solved) are relatively low. We can get caught in the trap of acknowledging low stakes as, “wait does that mean that what I’m worried about doesn’t matter” and get defensive towards folks pointing it out. Sometimes other people telling us the stakes are low is meant as a jab, and there’s judgement behind it. I try to approach acknowledging the stakes with clients as a morally neutral task. If the stakes are low, they are low. That’s not good or bad. But it is helpful information to prioritize where you are putting your energy.

So, if the stakes are low, and you’d like to not be anxious, how do you do it? Redirect your attention. Sometimes modern society calls this “distraction”, but because often being “distracted” is thought of as “bad”, I encourage clients to approach it as redirecting attention.

Typically the best way to redirect attention is from cognition to environment. The more compelling the environment is, the more likely attention will be easily redirected.

A useful but alarming version of this, is if you are anxious about something that is lower stakes, and you walk across the street and a car isn’t stopping for you, you are significantly likely to naturally redirect your attention to saving your life by avoiding the car.

The result of this is fight or flight and dysregulation.

Ideally the thing that redirects your attention is compelling AND pleasurable. Think about what tends to get you to be in the moment. Typically for my clients this is the relationships they find most compelling, either in the form of physical touch, stimulating conversation, or a pleasurable activity they do with another person. Other compelling attention drawing things often including your favorite hobbies, creative practices, getting yourself in a significantly different physical environment than where you felt anxious, and being stimulating sensorially to pull yourself into the environment.

Often clients come to therapy trying to fight cognition with cognition. If they have an intrusive thought, they think the way to stop thinking it is to fight it. This can sometimes work, but not as often as I’d say the majority of clients would hope.

Typically when folks are experiencing anxious thoughts they are dysregulated, or in some sort of flight or flight state. This is when we are the least capable consciously to counterargue anxiety. We are the most vulnerable in these moments to believe catastrophic thoughts.

I have typically experienced challenging catastrophic thinking to be a thing that is best done when a client is regulated and talking about the thoughts happening in the past, not the present moment.

What jolts you from cognition to environment? I would encourage you to think of ways (low energy cost, moderate energy cost, and high energy cost) to pull yourself from cognition to environment in the typical environments you inhabit (home, work, public spaces you frequent, etc). What are your tools when you’re low energy, moderate energy, and high energy? Typically higher energy interventions are the quickest to get us into the environment (sprinting gets us typically fully into the environment, for example) but are also the highest cost. If you are having a panic attack, it is highly unlikely you can just start sprinting.

I think it is important to develop tools for different situations as well as different baseline energy resources available to you.

I hope that reading a bit about my approach (which is an amalgamation of any person I have heard and have liked their ideas) helps to shed some light and help you experiment with improving how often and how severely you experience anxiety.

I did a 5 part miniseries with The Real Mom Hub on developing and tapping into what I called the Maternal Compass. Check out the five worksheets and episodes. They start coming out 9.23.25 and a new one will release every other week, with accompanying worksheets, finished November 18th.

https://www.therealmomhub.com/maternal-compass

Copy from RMH website:

Welcome to the Maternal compass miniseries.

The Real Mom Hub x Caitlin Ruby Miller, LPC

Motherhood is noisy. Between the endless Google rabbit holes, well-meaning advice from family and friends, and the constant cultural chatter about what it means to be a “good mom”… it can feel impossible to hear your own voice.

But what if you could quiet the noise, tune into your inner maternal compass, and start trusting yourself first again?

What if you already have the wisdom you’re searching for?

That’s the heart of The Inner Wisdom Series—a five-part miniseries from The Real Mom Hub in collaboration with therapist Caitlin Ruby Miller, LPC.

Why this series matters

Every mother carries an instinctive, wise inner voice—a built-in compass that has been guiding women for generations. When we reconnect with it, we:

• Work through the voices of anxiety and shift to operating from the strength of true inner wisdom

• Build an identity as the mother we want to be (not the one we “should” be)

• Learn tools to make clearer, calmer decisions that align with our values

This isn’t about adding another parenting method to your plate. It’s about tapping into the one already inside of you.

What You’ll Get

Each episode comes with a free downloadable worksheet—a companion tool designed to help you take what you heard in the episode and bring it into your real, everyday life.

Think of it like a mini therapy session you can return to again and again (but without the price tag).

How to get the most out of this journey:

• Listen to each episode of the miniseries.

• Download the worksheet for that episode below.

• Work through it at your own pace—journal, reflect, or bring it to your next therapy session.

The more you practice, the louder and clearer your inner compass becomes.

Give yourself the gift of listening to the voice that’s been there all along. Your inner wisdom is ready to guide you.

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