Playing With Meaning in Therapy for Twice-Exceptional Individuals

In a recent reading group, we were talking about the difference between epistemological and ontological approaches to therapy. Some clinicians spoke about leaning into structure at times—they wanted to get it right, to know how to think and what to say. Other clinicians, myself included, emphasized something else: presence. Yes, we need a frame. But once it’s in place, we have to be able to sit in the room and be with someone.

One member said the two—knowing and being—aren’t opposites but a kind of dance. That stuck with me. Because in my work, especially when doing therapy, what seems to matter most isn’t knowing the “right” thing. It’s creating a space where we can play with meaning, without fear of being misunderstood or prematurely defined.

This blog explores what makes therapy for twice-exceptional individuals unique—and why a playful, relational approach is often more effective than rigid interventions

The Sandbox

I often imagine the therapeutic relationship as a sandbox.

In this sandbox, I might offer a thought, an interpretation, a hypothesis—like placing a shape in the sand. But I’m not looking for the patient to accept it, agree with it, or even respond in a particular way. I’m watching what happens next. Does it spark curiosity? Anger? Sadness? Is it picked up and transformed into something else? Or ignored completely?

That response—whatever it is—is more important to me than the original thought I put out there.

This stance has been deeply freeing for me as a therapist. It means I don’t have to “get it right.” I don’t need to know everything. My job is to stay present, to stay connected, and to stay open to whatever happens next. My real skill isn’t in perfectly interpreting what’s going on—it’s in being able to tolerate and metabolize the response. The disappointment. The mismatch. The moment of discovery. The joy.

This kind of work also reduces defensiveness—for both of us. The patient doesn’t have to worry, “Is this what she thinks of me?” Instead, they might think, “Huh. That’s what she thought of. I wonder if it means anything to me.” That subtle shift changes everything.

Why Therapy for Twice-Exceptional Individuals Needs a Different Approach

I’ve found this approach to be especially important with patients who are gifted, emotionally intense, or twice-exceptional. These individuals have often been chronically misattuned to—seen as “too much,” “too sensitive,” “too complicated,” or not seen at all. They’ve often been told what their experiences mean before they’ve had a chance to name them for themselves.

They may say things like “I don’t feel real” or “It’s like I’m in a fog.” But in my experience, they do have a deep and powerful sense of self—it’s just been flattened, misread, or ignored for so long that it’s gone into hiding. When we can co-create a space where they are not being diagnosed, fixed, or analyzed—but met—something shifts. Play returns. Meaning emerges. Aliveness returns.

Beyond the 2e Patient

Of course, this way of working isn’t limited to the gifted or twice-exceptional. Many people—especially those who grew up in emotionally complex or high-pressure environments—have learned to prioritize performance over presence. They’ve learned to overthink, over-function, and override their own feelings.

For them, too, the sandbox can become a healing space. A place where meaning doesn’t have to be immediate. Where not knowing is okay. Where both of us can be real, curious, and fallible—and where something new can be created together.

Closing

If you or someone you love is looking for therapy that honors the tension between presence and performance, exploration and direction, connection and certainty—I’d be honored to walk alongside you. In my work, I aim to hold space for both the need to feel anchored and the freedom to wonder, to help you find moments that feel true, even when they’re fleeting—and to meet you where you are, again and again.