The Missing Link in Therapy

A point of view written by Annika Quinn

If you’ve ever felt frustrated that treatments work in the clinic but fall apart in real life, you’re not imagining things. Therapy is often sold as a cure-all. Got anxiety? There’s a treatment plan. Living with chronic pain? Try pacing, physio, or mindfulness. Struggling with attention? There are coaching, apps, and medication. But for many disabled people, these approaches fall flat because they address only one slice of a much bigger picture. Life isn’t lived in silos, yet too often therapy still is.

Intersectionality, a term introduced by legal scholar Kimberlé Crenshaw, was originally used to explain how race, gender, and power intersect. In disability care, it helps us see how health, identity, and environment collide in ways that single-issue treatments simply can’t address.

When One Size Doesn’t Fit All

The following case is a composite, designed to illustrate how multiple conditions can intersect. It does not represent a single individual.

Take this example: a person living with Autism, ADHD, Pure O (a form of OCD focused on intrusive thoughts rather than visible compulsions), Ehlers–Danlos Syndrome with chronic pain, and ongoing anxiety and depression. On paper, each condition comes with its own treatment manual. In practice, these conditions overlap and feed each other in ways no single manual accounts for.

While each condition is more complex than described here, this summary highlights the way overlapping diagnoses interact in daily life.

How Conditions Intersect in Daily Life

Condition	Impact Alone	How It Intersects with Others
Autism	Social and sensory challenges, need for predictability, executive dysfunction (difficulty with planning, organising, and managing tasks)	Collides with ADHD’s impulsivity, increases overwhelm when pain or depression disrupts routines
ADHD	Inattention, impulsivity, difficulty with time management	Worsens executive dysfunction in autism, fuels shame when tasks are missed, makes pain management routines harder to maintain
Pure O (OCD – intrusive thoughts)	Obsessive intrusive thoughts, compulsive rumination	Triggers anxiety and shame, worsens depression when thoughts feel uncontrollable, disrupted by ADHD’s attention difficulties
Ehlers–Danlos Syndrome (chronic pain)	Pain, fatigue, physical limitations, mobility issues	Increases anxiety and depression, reduces capacity for focus and executive function, worsens sleep, disrupts autism routines
Anxiety	Persistent worry, physical arousal, avoidance	Magnifies intrusive thoughts, increases pain perception, drains executive resources needed for ADHD/autism management
Depression	Low mood, motivation loss, fatigue, hopelessness	Amplified by chronic pain, worsened by shame from missed tasks/social struggles, deepens executive dysfunction

This table highlights what disabled people already know: these conditions don’t live in separate compartments. They collide, tangle, and reinforce one another. Treating them one by one misses the point.

This table highlights what disabled people already know: these conditions don’t live in separate compartments. They collide, tangle, and reinforce one another. Treating them one by one misses the point.

Even if you’re dealing with “just” autism and ADHD, or chronic pain and anxiety, these same intersecting patterns apply. The key insight remains the same: your conditions don’t exist in isolation, and your treatment shouldn’t either.

What Does Better Care Look Like?

What does intersectional therapy look like in practice? It starts with rejecting the idea that conditions can be treated in isolation. Instead of asking, “How do we fix each problem one by one?” the more useful question is, “How do these conditions interact, and what can we do to reduce the friction where they collide?”

A whole-person approach might include:

• Coordinated care between psychologist, physiotherapist, occupational therapist, and GP who actually talk to each other
• Therapy sessions that weave together executive function supports, sensory strategies, and pacing for chronic pain
• A therapeutic relationship that builds safety through consistent validation rather than constant criticism
• Adapted approaches to OCD that avoid triggering unnecessary shame about the thoughts themselves
• Treatment plans built around your actual capacity rather than what “should” be possible; recognising that some days pain or fatigue will win, and the routine has to flex with it

The problem is not that you are too complex; it is that systems are not designed to support complexity.

Beyond Diagnosis: Life Doesn’t Happen in a Vacuum

Your conditions don’t exist in isolation, and neither do you. The world you navigate shapes how your disabilities affect you and how well treatments work.

The Bigger Picture

Factor	Impact on Mental Health/Therapy	What This Means for Treatment
Cultural Background	Stigma around disability or mental illness; language or worldview differences; reliance on community/family norms	Providers should use culturally safe practices, adapt communication styles, validate cultural identity as part of healing
Racial Identity	Experiences of racism increase anxiety, mistrust, and hypervigilance; behaviour may be misinterpreted as “non-compliance”	Providers must acknowledge racism as a trauma source; ensure representation and equity in service delivery
Financial Situation	Reduced earning capacity due to chronic illness/disability; out-of-pocket therapy costs add stress	Providers should offer accessible options; adapt recommendations to be realistic (free tools, public resources)
Gender	Women’s pain often minimised or dismissed; gender norms intensify shame responses	Providers must validate experiences of dismissal; create therapy goals free of gendered expectations
Sexuality/Queer Identity	Bias or invisibility in healthcare; additional stigma layers	Providers should offer affirming therapy; integrate identity as strength rather than side note

How to Advocate for Better Care

You deserve treatment that acknowledges how you actually live. Here’s how to push for it:

Questions to Ask Your Providers

• “How does my [condition A] treatment account for my [condition B]?”
• “What happens to this treatment plan when I’m having a pain flare/depression episode/sensory overload day?”
• “Do you coordinate with my other healthcare providers?”
• “How will we adapt this approach if it’s not working as expected?”

Red Flags That Signal Siloed Thinking

• “Let’s fix your anxiety first, then worry about the ADHD”
• “You need to be more compliant with the treatment plan”
• “That’s not my area; you’ll need to see someone else”
• Dismissing your concerns about how conditions interact
• Refusing to communicate with your other providers

What Good Coordinated Care Looks Like

• Providers who ask about your other conditions and treatments
• Treatment plans that account for your energy levels and capacity
• Flexibility when standard approaches don’t fit your situation
• Validation that your experience of multiple conditions is legitimate
• Communication between your different healthcare providers

When to Seek Second Opinions

• When treatments repeatedly fail without explanation
• When you feel blamed for “non-compliance”
• When providers dismiss the connections between your conditions
• When you’re told you’re “Too complex” for their services

A Real Example of Intersectional Care

Here’s what good intersectional care can look like: Jane (not her real name) has autism, ADHD, and chronic fatigue. Instead of three separate treatment plans, her team developed one integrated approach. Her psychologist incorporates sensory breaks into ADHD coaching sessions. Her occupational therapist helps design daily routines that work with both autism’s need for predictability and fatigue’s unpredictability. Her GP coordinates medication timing to minimize side effects across all conditions. When Jane has a fatigue flare, everyone adjusts expectations rather than labeling her “non-compliant.”

The result? Jane reports feeling understood for the first time and seeing actual progress in managing her daily life.

The Path Forward

Intersectionality is sometimes treated as jargon, but for disabled people it’s survival. Ignoring it leads to fragmented care, endless referrals, and the quiet message that you are “too complex” to be understood. Recognising it creates space for therapy that is humane, effective, and realistic.

A whole-person approach doesn’t require reinventing therapy. It requires shifting perspective: from treating parts to understanding the whole. From silos to integration. From deficit to capacity. From “what’s wrong with you” to “what works for you.”

You are not too complicated. You are not asking for too much. You deserve care that sees you as a whole person living in a complex world. Therapy that acknowledges intersectionality is not just better practice, it’s the only practice that reflects how people actually live.

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This article is intended as commentary and advocacy. It does not replace professional medical advice. Readers should seek qualified professional support for individual care.