Right to Choose: Finding the Missing Pieces of the Puzzle

trustinglisteningc

1 day ago

7 min read

For many people, understanding themselves begins with a question they have carried for years:

“Why have I always felt this way?”

Over recent years, more and more people have been exploring the NHS Right to Choose pathway to access an ADHD or autism assessment. For many, it represents an opportunity to finally explore something they may have questioned, struggled with or quietly wondered about for much of their lives.

And behind every assessment is a person, with their own story, experiences, questions and emotions.

For some, it is about finally finding the missing pieces of a puzzle that has never quite made sense. For others, it can open up a whole new set of questions, feelings and challenges that they weren't necessarily expecting.

So, what is Right to Choose, how does it work, and what happens emotionally when you finally begin to understand more about yourself?

First, what is Right to Choose?

Right to Choose is an NHS pathway in England that allows eligible patients to choose an alternative provider for certain NHS funded services, including ADHD and autism assessments, where the relevant criteria are met.

Rather than simply joining the waiting list for your local NHS service, you may be able to ask your GP for a referral to an eligible provider of your choice.

The process generally involves:

Speaking with your GP about your concerns and asking about a referral.
Choosing an eligible provider offering the assessment you need.
Having your referral sent to that provider.
Completing questionnaires and assessment appointments.
Receiving an outcome and, where appropriate, recommendations for next steps.

The process, waiting times and support available can vary between providers, and it is worth checking what happens after an assessment before choosing where to be referred.

For many people, taking this first step can feel significant. It might be the first time they have openly acknowledged that perhaps there is something they have been struggling with that deserves to be understood.

“Suddenly, so much of my life makes sense.”

One of the things that comes up time and time again in conversations with clients is the sense of relief that can follow a diagnosis.

Imagine spending years feeling as though you are trying to complete a puzzle, but nobody has given you the picture on the box.

You might have always found certain things harder than other people seem to. Perhaps you struggle with organisation, emotional regulation, concentration, sensory overwhelm, relationships, remembering everyday things or managing the demands of daily life.

You may have been told that you are:

Too sensitive.
Disorganised or forgetful.
Lazy or unmotivated.
Not reaching your potential.
Overthinking everything.
Difficult, emotional or easily distracted.
Perhaps you have spent years trying harder, pushing yourself further and wondering why things that seem relatively straightforward for others can feel so exhausting for you.

For some people, receiving an ADHD or autism diagnosis can bring an enormous sense of relief.

It can offer a different way of understanding experiences that have previously been interpreted as personal failings.

Instead of thinking, “Why can't I just get it together?”, there may be an opportunity to ask, “What has been making this so difficult for me, and what might I need instead?”

That shift can be incredibly powerful.

It doesn't change what has happened in the past, but it can change how you understand it.

But what if you don't meet the threshold?

This is another side of the Right to Choose journey that deserves to be talked about.

Not everyone who seeks an assessment will receive a diagnosis.

For some people, the outcome may be that they do not meet the diagnostic threshold for ADHD or autism.

And this can be incredibly difficult to process.

You may have spent years questioning yourself. You may have researched, reflected, completed questionnaires and finally found the courage to ask for help.

Perhaps you recognised yourself in other people's experiences and felt that, for the first time, there was an explanation for things you had struggled with.

Then the assessment comes back and says you do not meet the criteria.

What happens to all those questions?

Where does that leave the experiences that prompted you to seek an assessment in the first place?

Some people feel disappointed, confused, frustrated or even dismissed. Others begin questioning themselves all over again.

It is important to remember that not meeting the diagnostic threshold does not mean your difficulties aren't real.

A diagnosis is based on specific clinical criteria. It is not a measure of how much someone struggles, how hard they have tried or how deserving they are of support.

You can still need understanding, adjustments, strategies and emotional support without having a particular diagnosis.

And perhaps one of the most important questions to ask is not simply, “Why don't I meet the criteria?” but also, “What support can I access for the difficulties I am experiencing?”

You still deserve that conversation.

“I've finally got my diagnosis, but what am I meant to do with it now?”

Something else that can come as a surprise is what happens after receiving a diagnosis.

For some people, there is an expectation that the diagnosis will bring answers, support, guidance and perhaps a clearer path forward.

But the reality can sometimes feel very different.

You receive the letter. You have the confirmation. You finally have a name for something you have spent years trying to understand.

And then...

What next?

Clients often describe this feeling as being handed a label without necessarily being given the tools to understand what it means for their everyday lives.

They may be left wondering:

How do I actually manage my ADHD or autism?
What does this mean for my relationships?
How do I explain this to my family?
How can I manage work when I find certain demands overwhelming?
Why do I still feel so exhausted?
How do I stop feeling like I am constantly getting things wrong?
Where do I go for support?

A diagnosis can be an important starting point, but it isn't the whole journey.

Understanding what your diagnosis means for you personally can take time. It can involve learning about your needs, recognising your strengths, identifying what you find difficult and exploring ways of making life feel more manageable.

You are still the same person you were before your assessment. You haven't suddenly changed because something has been identified.

But perhaps you now have a new opportunity to understand yourself with a little more compassion.

The emotions nobody always prepares you for

There can be a whole mixture of feelings that come with receiving a diagnosis, and sometimes these feelings can be surprisingly complicated.

Alongside relief, there may be sadness.

Sadness for the child who struggled at school but was told they weren't trying hard enough.

Sadness for the teenager who felt different but didn't understand why.

Sadness for the adult who spent years feeling overwhelmed, exhausted or as though they were somehow getting life wrong.

There may be frustration towards family members, teachers, previous professionals or even workplaces.

You might find yourself looking back and thinking:

“Why didn't anybody notice?”

“Why was I always told I needed to try harder?”

“Why did nobody ask what was making things so difficult?”

“Could things have been different if I had understood this sooner?”

For some, there is a sense of grief for the years spent masking, struggling, overcompensating or trying to fit into environments that never quite felt comfortable.

There may also be feelings of anger, confusion, relief, validation and uncertainty, sometimes all at once.

And that's okay.

You don't have to feel grateful for your diagnosis every day. You don't have to suddenly embrace every aspect of it. You don't have to have everything figured out.

You are allowed to have mixed feelings.

You are allowed to question things.

And you are allowed to take your time.

Understanding yourself is more than receiving a diagnosis

One of the things I feel is so important is that we don't allow the assessment process to become the end of the conversation.

Whether you receive a diagnosis or not, the experiences that led you to seek help still matter.

Perhaps you want to understand why you find certain situations overwhelming.

Perhaps you want to explore the impact of masking and feeling that you have spent much of your life trying to be the person other people expected you to be.

Perhaps you are beginning to recognise patterns in your relationships, your emotional responses or the way you navigate everyday life.

Or perhaps you simply want somewhere you can talk openly, without feeling judged, having to justify your experiences or explain why something that seems small to someone else feels so big to you.

Counselling can provide a space to explore these experiences at your own pace.

It isn't about trying to fix who you are or making you fit into a particular mould.

It is about developing a better understanding of yourself, recognising your needs, exploring the experiences that have shaped you and finding ways to move forward that feel right for you.

Sometimes that means exploring past experiences. Sometimes it means working through feelings of frustration or grief. Sometimes it is about developing practical strategies, building self compassion or learning to communicate your needs more confidently.

And sometimes, it is simply having someone listen and say, “That sounds like it has been really difficult. Let's make sense of it together.”

You don't have to have all the answers right now

Whether you are waiting for an assessment, have recently received a diagnosis, haven't met the diagnostic threshold or are still wondering whether ADHD or autism might explain some of your experiences, you don't have to navigate all of this alone.

Right to Choose may open the door to an assessment, but understanding yourself is a much bigger journey.

A diagnosis doesn't explain everything about you. And not receiving one doesn't take away the validity of what you have experienced.

You are more than a diagnosis, more than a set of symptoms and certainly more than the labels other people may have given you throughout your life.

Perhaps the most important part of this journey is beginning to move away from asking:

“What's wrong with me?”

And starting to ask:

“What do I need to understand about myself, and how can I begin to support myself differently?”

Because you deserve more than just an answer on a piece of paper.

You deserve the opportunity to be heard, understood and supported.

And perhaps, for the first time, to start putting those puzzle pieces together in a way that makes sense to you.

If you are navigating an ADHD or autism assessment, processing a recent diagnosis or simply trying to understand yourself a little better, counselling can offer a safe and supportive space to explore what this means for you. You don't need to have all the answers before reaching out.