Autistic in Therapy

I’ve heard many stories about what it's like for autistic people to go to therapy. Experiences range from helpful to horrific. I mainly work with autistic adults in my therapy practice, and I am autistic myself. It's clear that the mental health field still has a long way to go to create consistently helpful care for autistic people. 

Lack of Training

Surprisingly, there’s not much training in how to support autistic clients for most therapy related graduate schools. When I was in graduate school studying social work, autism was not really a part of the curriculum. I was lucky enough to have classmates who were focusing on autism in a lot of their work, and I learned more from them than any of my instructors about this topic. Since finishing school, there have been some opportunities to learn how to work with autistic people as a therapist, but it’s not as common as other specialties. More resources are slowly popping up, but many autistic therapists feel they are figuring things out on their own.

Why it Matters  

Many therapy methods used today can accidentally cause harm to autistic people if we’re not careful. For example, a therapist might not realize someone is autistic and might see their sensory sensitivities as just anxiety. The way to help with sensory issues is often different from how we’d treat anxiety. Anxiety usually gets better with slow, repeated exposure to what triggers it. Sensory sensitivities, on the other hand, are often reduced through specific tools to reduce sensory input or avoiding sensations as much as possible. Avoiding things can make anxiety worse over time. This is just one example of how not considering autism in therapy can sometimes do more harm than good. Many of my autistic clients tell me stories along these lines. Often, autistic clients earnestly try to do what their therapist suggests. When it doesn’t work, it reinforces the criticism they’ve already internalized. “I’m broken. I’m not good enough. Something’s wrong with me.” 

Shifting Paradigms 

The process has already begun to shift the mental health paradigm away from procedural understandings of diagnosing and treatment towards a neurodiversity-affirming model. Being a neurodiversity-affirming therapist means understanding that each person’s mind is unique. Therapy should be tailored to each individual, with less assumptions about the causes of our clients’ pain. I use my knowledge as someone who has studied autism extensively to filter information through that lens, so that we don’t miss important information about someone’s neurotype. 

Autism Is Not the Problem

It’s important to clarify that autism isn’t something that needs to be cured or fixed. It’s a part of who a person is. Autism itself doesn’t require therapy; it’s not a mental illness. Many autistic people also have other mental health conditions, and often this comes from a lifetime of experiencing ableism. A recent study from 2024 found many autistic women and some men also have other mental health issues. The goal should be to support autistic people and treat other conditions when needed, without trying to eradicate autistic traits.

Misdiagnosis and Misunderstandings

That same 2024 study also found that nearly 25% of autistic people felt they had been wrongly diagnosed with another mental health condition at some point. That’s concerning, because treating the wrong issue can be harmful. In my work, I’ve seen how ignoring autism or treating it as something wrong can cause harm and distrust of mental health professionals. 

What we really need

We need more support, more training, and better education for future therapists. This feels futile to write in 2025, but we need more support, more research, and frankly respect. We don’t need databases with our private health information, rigid intervention, or shame.