How Disability Justice Shapes Our Therapy Practice: A Place to Start

If you have arrived at this post, you are likely wondering how this practice thinks about disability and care. Maybe you are disabled yourself and looking for a therapist who will not add to what you already carry. Maybe you love someone disabled, or you are a fellow practitioner thinking about your own work. Maybe you have come across the phrase "disability justice" and want to understand what it asks of therapy.

We are a psychotherapy practice based in Vancouver, working online across Canada. We are small by design. Our work is shaped by the lived experience of disabled, trans, and queer people, including our own, and by the disability justice movement that has given us a framework for naming what we try to practise.

This post is a starting place. It is not a comprehensive explanation of disability justice, which is a movement with its own authors and long history. It is an orientation to how we work, with links to other posts that go deeper into the specifics. If any section calls you, follow the link. If you would rather read the whole piece first, that works too.

Where our thinking begins

The disability justice framework was articulated in 2005 by Patty Berne and nine other disabled organisers, and it was distilled into ten principles by Berne with Aurora Levins Morales and David Langstaff, on behalf of Sins Invalid. Sins Invalid is a performance project and movement organisation led primarily by disabled people of colour. The framework was built because the existing disability rights model, while important, did not hold what multiply marginalised disabled people were actually living through.

Much of what we know about what these principles ask of care in practice has been shaped by the writing of Leah Lakshmi Piepzna-Samarasinha (they/them), whose books Care Work and The Future Is Disabled are, in our view, the most honest existing writing on what it takes to live these principles out in actual relationship. We credit them openly. Our work has been shaped by theirs.

We are not the authors of this framework. We are practitioners trying to honour it, and we fail at that regularly. What we try to do is describe, as honestly as we can, what following these commitments looks like inside a therapy practice. The principles ask specific things of care: they ask about who leads, about how access gets built, about the pace of the work, about whether intersecting identities can be held together or only one at a time. The sections that follow walk through each of these.

For a closer reading of the principles themselves, we have a separate post on what the disability justice principles ask of care that goes deeper into the framework and what it asks of anyone trying to practise care shaped by it.

How we think about who leads

The principle called leadership of those most impacted reframes who is the expert in a session. In most therapy traditions, the therapist is positioned as the one who knows: trained, credentialed, holding the map. Disability justice turns this around for good reason. When the person in the room is disabled, neurodivergent, chronically ill, or Mad, they have spent their whole life being the expert on their own body. They know their flare patterns. They know which kinds of fluorescent lighting push them toward overwhelm. They know how long they can sustain a conversation before the words start to fuzz.

Our job, as therapists, is not to override this expertise. It is to build a collaboration with it.

This changes a lot. It changes how we conduct intake: we ask what you already know about your pace, your triggers, your nervous system's signals. It changes how we pace sessions: we follow the cues you give us about when to slow down, when you need a break, when something is landing and when it is not. It changes how we handle disagreements: if you tell us something we are doing is not working for you, the assumption is not that you are resisting the work. The assumption is that you are telling us something important about how you need the work to be shaped.

For clients who have been in therapy before and had the experience of being talked over, or dismissed, or told their access needs were "resistance," this can feel unfamiliar at first. It is meant to. Part of our work is making clear, with time, that you are not negotiating for space in this room. You are already the authority on yourself, and we are here to work alongside that authority.

How we think about access

Access, in the disability justice frame, is not an accommodation. There is a real difference between these two words.

Accommodation is what you add on after you have designed the thing for a default body. It is the ramp you install after the building is built. It is the larger-print intake form you make only after someone asks for it. It is the captioning you turn on when a Deaf client joins. The baseline design remains unchanged; the accommodation is a patch.

Access, as the principles describe it, is part of how the work is built from the beginning. It is the assumption that a range of bodies, minds, pacing needs, communication preferences, and sensory tolerances will be entering the room, and it is the decision to shape the room for that range from the start.

At this practice, working online has turned out to be one of the most concrete ways we build access in. Not everyone can easily travel to an office, and the cost of a bad commute before a session is real. Online sessions can be conducted from bed, from a familiar room with the lighting adjusted, with a service animal nearby, without the cognitive load of getting somewhere. This is one piece of what accessible, affirming care looks like in our work, and there is a separate post with more specifics on how our sessions are shaped for this.

Access also means pacing communication differently, welcoming written or asynchronous summaries between sessions, working with different session lengths when the default fifty minutes does not serve, and taking as given that the body comes first, not the schedule.

How we think about pacing and the body

Disabled writers have given language to something that mainstream therapy often does not have a word for: crip time. Crip time names the reality that a disabled body moves through time differently. Tasks take longer. Recovery takes longer. Some days are for doing and many are for resting. More than that, crip time refuses the ableist timeline that says you are behind, you are slow, you are not keeping up. Crip time says you are on your own clock, and that is the clock we work with.

This matters in therapy for specific reasons. Most therapy models are built around linear progress: you come in with a problem, you and the therapist do work on it, the problem resolves, you move on. For disabled people, especially those living with chronic illness, chronic pain, or variable capacity, that shape does not fit. Progress is often non-linear. A breakthrough one month may be followed by a flare the next that sends the body back into survival mode. This is not regression. This is how a body with variable capacity lives.

We shape the therapy around this reality. That means pacing the work to what your body can do today, not to a programme's expected arc. It means being willing to slow down, pause, or space sessions differently when that is what the body needs. It means treating rest as part of the work, not as a break from it. And it means that when a flare or a hard patch arrives, the therapy does not disappear. It adjusts.

This shows up most concretely in how we work with chronic pain and the nervous system, and with the particular pacing needs of neurodivergent-affirming therapy. Both posts go deeper into the specifics of how the body leads in these areas of our work. The underlying commitment is the same. Your body is not a problem we are trying to override. It is the guide we are trying to learn.

How we hold intersecting identities

One of the quietest harms in most care settings is the pressure to present one identity at a time. A person walks into a therapy room and, depending on which provider they are in front of, has to decide whether to foreground their disability, their trans identity, their race, their class, their neurotype, or their chronic illness. Pick the one that will be heard best. Pick the one that will not derail the conversation. Pick the one that the provider has the language for.

This is exhausting in a specific way. It asks a person to split themselves into pieces so that a room can metabolise them. The disability justice principle of intersectionality refuses this split. It names that people have multiple identities, that each identity can be a site of privilege or oppression, and that the interplay between them is often the texture of a person's life. A disabled trans person does not experience disability in the morning and transness in the afternoon. They experience both, together, all the time.

In our practice, this means we try to hold all of who you are in the room, not just the identity that is most clinically "relevant" to what brought you in. It means we work from the assumption that your disability shapes your gender experience, that your race shapes your disability experience, that your neurotype shapes your relational life, and that all of these are texture rather than separate topics.

We have written separately about being trans and disabled, a post on the specific weight of navigating two identities the world is not built to hold at once. That post is for people living at that intersection. The principle applies more broadly to anyone carrying multiple identities that mainstream care tries to hold separately.

What this means for working with us

If any of this has spoken to something in you, a few practical things to say.

Beginning with us means a consultation that is free and a first session that is focused on building safety, comfort, and trust. You do not need to have your reasons organised, your identity language sorted, or a clear statement of what is wrong. You can come in with a vague sense that something is off, or a specific need, or simply wanting to see whether we are someone you can be in the room with. We treat the consultation as part of the work, not as an audition.

We are not the right fit for everyone, and we will say so if that becomes clear. Disability-informed care is a practice, not a brand, and if someone's needs would be better served by a different kind of provider, we would rather say that honestly than hold the relationship for its own sake.

If you would like to read more before you decide, the posts linked throughout this page go deeper into the specifics. The blog itself holds our slower thinking. You can take as long as you need. We will meet you there, when you are ready.

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