Finding an Autistic Therapist: How We Work and Why It Matters

It occurs to me that if you are looking for an autistic therapist you might be interested

to know how we work. You could buy our book, On Being an Autistic Therapist,

certainly, but I thought I would give you a window into the therapeutic process of one

autistic person-centred therapist. A bonus episode, so to speak.

In this piece I am talking as a privileged person: I may be autistic, and therefore, in

society as currently constituted, disabled; but I am a white, north-western, middle-

class (or at least, thanks to certain prestigious universities, middle-class-presenting),

ciswoman with no intellectual disability and tolerable physical health. It is enormously

important to make that point and to recognise just how much difference it makes.

The questions I tend to be asked are:

“Do you also work with non-autistic or neurotypical people?”

“How do you adapt your therapy for autistic / non-autistic people?”

“If you say that it’s ideal that an autistic client gets an autistic therapist, how is it that

you work with non-autistic people?” People who are a little more informed might say

“How about the Double Empathy Problem? Isn’t it a fact that autists and non-autists

process, understand, and experience empathy differently?” It would seem so.

I am inclined to say that we, the autists, may be more qualified to work with non-

autists than non-autists are to work with autists. Not due to some innate superiority

but because we are surrounded by them. They are, so to speak, openly non-autistic

and their society, in which we live with some difficulty and confusion, is designed for

them and in their image. We cannot help seeing how they live, how they speak, how

they interact. How they process internally may remain a bit of a mystery, though we

can learn at least the theory of that. But they live, speak, and interact openly,

unmasked, for all to see.

We can observe them in depth, as they, in general, cannot observe us.

Why can they not observe us? For two main reasons.

One, because we mask or camouflage. There is a tendency among autists to say

“high-masking” where the term used to be “high-functioning”. I am not entirely happy

with that but it does express something important. That is, that the more people think

we “don’t look autistic” or “seem to manage just fine”, the more we are masking,

acting, not being ourselves, pretending not to feel the pain and confusion that society

as currently constituted causes us. And we pay a very high price for that. We shut

down, we melt down, we burn out, and, at a rate up to nine times higher than non-

autists, we take our own lives. And the better masked we are the more we struggle,

and the less the non-autistic world understands why.

The second reason is the long history of autism being seen, studied, discussed,

treated, as a disorder or even a disease; categorised together with mental illness or

with intellectual disability. Of course, autists are just as likely to have mental illness

or intellectual disability as non-autists, but autism is neither of those things. Because

the way we are is seen as a disorder, the approach is to try to change or even cure

us rather than to be curious about our experience and ways of being...as we have to

be about the experience and ways of being of the non-autists in whose society we

have to live.

To non-autists we are often a closed book. On the other hand, we have probably

spent much of our lives trying to decipher them. Just as you learn a language and

culture more quickly and more fluently if you are immersed in that language and

culture, we learn the non-autistic experience and ways of being by immersion, while

they do not learn ours unless they make a specific and intentional effort to immerse

themselves in our language and culture. It is perhaps harder for them than for us,

because we are, to such a great extent and so often, hidden.

One of the first things I learned as a child was that I could not assume that I

understood...anything at all. People did not seem to say what they meant, do what

they said, or understand what I said or did. So I learned to ask, to sift, to study in

depth the way these different humans processed, experienced, behaved.

And that has been the most valuable lesson that I have taken into my work as a

therapist. It is why I was immediately drawn towards the person-centred approach.

Carl Rogers said “the best vantage point for understanding behavior is from the

frame of reference of the individual”. In other words, don’t assume. Don’t look at their

lives from your frame of reference.

That is why it can actually be an advantage to find society as currently constituted

baffling. To be constantly brought up against the fact that others don’t seem to

experience, process, and express things in the same way as we do. It is so easy for

a neurotypical person to think “you seem to have had the same experience as I

have; most likely it will have had the same effect on you as it has on me”. Much of

the time, because they belong to the predominant neurotype, they will be right. While

I know it probably hasn’t. I know that the things that were traumatic to me were likely

not traumatic to you, and vice versa. And if they were, our responses are likely not

the same. Because trauma is an effect, not an event. I know that what’s obvious to

me may well not be obvious to you, because I have so often experienced the

converse.

So I will approach what you are saying with what Fritz Perls called “creative

indifference”, which doesn’t mean I am indifferent to you (far from it) but that I try not

to lean towards one conclusion or interpretation or another. I will try to see your life

through your eyes, and I will always be aware of how difficult that is. Irving Yalom

tells therapists to look out of the client’s window, not their own. I like to think of that

as if the client and I are driving along a road, one side of which is a beautiful bank

with wild flowers and singing birds, and the other side just blank tarmac with cars

rushing along, bounded by a high concrete wall. It’s potentially a lovely road, but not

through your window.

So actually, there isn’t any difference in the way I work with autists and non-autists.

Each one is a unique individual, autistic, non-autistic, neurodivergent, neurotypical...

who has invited me into their landscape. I don’t know what their experience has

been. I don’t know how they think, process, express. I don’t know who peoples that

landscape or what their language is. The only way I can discover is to accept the

invitation, and walk on in.