Working with Autistic Folks

What Therapists Need to Know

There’s been a boom in understanding about neurodiversity and therapy in the past decade. And yet, I still have clients coming to me sharing experiences with therapists that should not be happening. I’ve also had my own experiences in therapy that have been harmful. Since working with autistic folks for the past several years, and being autistic myself, I’ve learned a lot. Here’s what you need to know to avoid harm, and maybe be a good fit for your autistic clients. 

What Un-Affirming Therapy Can Look Like

Right at the beginning of my career as a therapist, I was the client of someone who immediately did not believe me about what I was experiencing. I would say something about how difficult something was for me, and that was immediately dismissed as “I’m sure it’s not that bad.” When I gave feedback about that, it was taken as an attack. I questioned the validity of this at the time, but I still inappropriately took it to heart. This was not a one time thing. There were other iffy interactions as well, and I fairly quickly ended our work together. To be clear, you really want your clients to give you feedback. It’s our job to handle it well, and explore that with them. It’s an opportunity to skyrocket the therapeutic process, actually. Now that it’s been several years since I ended that horrible therapeutic relationship, you’d think I’d have a more generous view of the experience. I don’t. Now that I’ve been actively working with clients for years, I’m actually more upset that it happened. It was harmful and unnecessary. So how can this be avoided? 

Believe Us

You don’t have to give us a particular diagnosis or agree with everything we say to be validating. Trust that we can understand our experience as individuals and know our own lives best. Invalidation is common toward autistic people no matter how well we mask or what our support needs are. In folks who have been diagnosed later in life, they probably have said something to someone or have had a limitation come up that was dismissed. It is reinforcing past harms to have another person (you, the therapist) doubt us when done flippantly. Giving alternative explanations and solutions is of course welcome, but be aware it may be activating and requires appropriate gentleness. 

Sensory Stuff is Forever

Sensory habituation is reduced in autism. This means that autistic people don’t get used to, or “habituate” to repetitive sensory input, like sounds, lights, or smells. Something that I’ve found to be useful is helping people through the process of figuring out for themselves when they are overstimulated by their environment. I’ll use myself as an example, sometimes I would get irritable when I’m waiting for a bus. I used to think “Wow, my mood is all over the place.” Then I realized I was wincing at every passing car, and it was likely the noise that was making me irritated. I now bring ear plugs everywhere I go and no longer experience any problems waiting for the bus. I could have wasted so much time trying to work on that irritability in therapy when ear buds are an easy fix! 

Fidgeting is Good

In every “mental status exam” I’ve ever seen, fidgeting is mentioned as something notable. I’m not saying it’s not, however, fidgeting and other repetitive motor movements (pacing, touching hair, rocking, etc) are not always signs of distress in autistic people. Repetitive movements are a tool for regulation, but it don’t mean we’re having a tough time. Seeing fidgeting as a natural state for your autistic clients is a great way to start. Offering tools (like having fidget toy options in your office,) modeling fidgeting as a healthy thing, and definitely not assuming that your clients should stop, will go a long way. 

Sometimes People Don’t Like Us

A challenge I hear a lot from clients is that other people misread their intentions or add subtext to their words. For example, if an autistic person asks a clarifying question, but doesn’t add fluff or make the “right” facial expression while doing so, this can sometimes be misread as “talking back.” There is evidence to suggest that autistic people are read as unempathetic or awkward by neurotypical people, and have lower overall social favorability. This is a misreading of our character, however it is a real phenomenon. So what do we do about this as therapists? Don’t discredit us when we say we feel like people are judging us harshly. Even if we are feeling this beyond what is factually true in a moment, there’s a reason we make this assumption, and it’s likely because this has actually happened before. Help us cope with that, advocate for our own communication style, and find the people who will think we’re great! 

We Can Make Our Own Decisions

Sometimes when someone gets diagnosed as autistic or someone finds out we are autistic, a shift happens. We lose credibility in our words and experiences. Because autism is a neurodevelopmental disorder with a lot of stigma still attached, sometimes professionals will assume that our ability to make our own decisions about medical care, relationships, or lifestyle is questioned. Folks with higher support needs face this in the most extreme ways. It may take more creativity in those cases, but preserving autonomy (not independence) should be a top priority. I want therapists to know that this happens so we can check in on our unconscious biases. It’s also helpful to know this to help our clients if this is happening to them in their families or professional settings like a doctor’s office. 

Get training and consultation

The good news is that the neurodivergent-affirming therapy world is growing! This means there are so many opportunities for you to learn and grow in your practice helping autistic and otherwise neurodivergent folks. Look up trainings available, listen to podcasts about the topic, read blogs (hey-o!) or other articles about it. It’s also possible that somewhere in your therapist network there might be someone you can consult with. Side note: Please pay as you can for your colleagues’ time or make it a mutual support system (like a consultation group where everyone can contribute.) 

The fact of the matter is, there aren’t enough therapists to go around for neurodivergent folks to find someone who identifies in exactly the same way as them. I think it’s our jobs as therapists to grow our competency so that we can adequately support those who may be a good fit, but would be a better fit if we did some learning ourselves.