Does Your Therapist Know Enough about Autism to Help You?

I struggled for years in therapy because I did not know I was autistic. My therapists were not informed enough about autism to recognize that I was autistic either. I received diagnoses that were inaccurate. I received treatment approaches that were ineffective for a neurodivergent mind.

The reality is that most therapists know very little about autism. I went to graduate school for mental health counseling and expressive art therapy. The little I learned about autism was what is stated in the DSM-5. I’ve shared in previous essays how the DSM-5 symptoms focus on external behaviors and do not accurately reflect how autism feels internally or how it presents in women.

The majority of general therapists (meaning therapists who received a broad education in mental health, such as mental health counselors, marriage and family therapists, and social workers) do not get to learn about autism beyond the surface level of the DSM-5. It is usually up to the therapist to seek additional classes or training in autism.

As a result, many autistic individuals fly under the radar and go undiagnosed, even when they seek therapy.

Many autistic people, both diagnosed and undiagnosed, find therapy to be challenging and ineffective when they’re paired with a therapist who knows very little about autism or neurodivergence.

Why is that?

Autism shapes how the brain senses, learns, and processes. This has cascading impacts on how an autistic person feels, thinks, senses, socializes, and more.

It means the approaches we use as therapists to help neurodivergent individuals need to be tailored to those differences.

"Incorrect Identification" Illustration by Jackie Schuld

Instead, most neurodivergents get stuffed into therapeutic systems designed for neurotypicals.

For example, if a neurotypical person goes to a therapist for help with social anxiety, the therapist will help them examine their irrational fears and limiting beliefs. They will help them learn how to stay calm in social situations. They will encourage them to practice in social settings and slowly build up their social strength.

If an autistic person goes to the same therapist for help with social anxiety, this approach would be difficult and ultimately ineffective.

Many of the fears that autistics hold about social situations are valid. Trying to socialize as a neurodivergent in a neurotypical conversation can be extremely challenging. Many autistics have a litany of experiences to prove just that.

A therapist who understands autism will help an autistic person to identify and understand these differences. They will explore what aspects to accept about their autistic identity, and what behaviors can be improved. They will look at when the cost of masking is too high, and when masking can be used as a tool. They will explore what kinds of social groups and social situations are worth pursuing.

For example, if sensory difficulties are present in an environment (such as a crowded bar or a place with chemical smells), no amount of “exposure therapy” or “practice” is going to habituate an autistic person to that environment. They will feel uncomfortable.

This would all be missed by a therapist with a neurotypical lens.

The same applies to other mental health conditions that bring an autistic person to therapy. When I sought help for depression and anxiety, I thought there was something broken about me. After years of therapy to help reduce my “anxious” mind, I didn’t understand why I wasn’t getting better.

When I learned I am autistic, it all made sense. Due to how my brain intakes information and processes, I have A LOT of thoughts. I call it constellation thinking - where I have multiple thoughts at once like an explosion in my head. It’s a wonderful thing for my creativity (like writing this essay), and can be challenging when I’m thinking about difficult topics.

Learning I was autistic freed me from constrictive labels like “anxiety” and the endless pursuit to “fix” my brain. I will always think a lot. It’s just how my brain functions. It brought me to a place of acceptance. I could then focus on how to work with what existed.

I don’t believe autism is a “disorder” that needs to be cured or fixed. However, autism is a difference that needs to be understood and tailored to. The more I learn about autism, the more strategies I learn to work with my brain. The more shame I release about differences. The more I seek people and environments that enrich me, and avoid ones that don’t. The more ways I learn to enrich my life and manage difficulties. It’s an entirely different approach than what neurotypical therapy taught me.

It’s also why I encourage any autistic person, regardless of the reason that they seek therapy, to find a therapist who is fully informed about neurodivergence and autism.

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Thank you for reading. If you would like to explore your autistic identity in therapy or become an art therapy client, you can learn more here.