When Therapy Doesn’t Work: An Autistic Search for a “Good Fit” Therapist.
- Hannah Cheriford
- Aug 3
- 9 min read
For a lot of my adult life, I struggled to build relationships with therapists. Really struggled. I’d leave sessions feeling collapsed, angry and confused. Sometimes it would stay that way for days. I’d have literal replays or flashes of the exchanges in my head. I’d feel much worse.
After so many therapeutic ruptures, what felt like common sense kept telling me “it must be me”. But no amount of sitting with, journaling or reflecting could locate the source of such therapist aversion. Meanwhile, the issues showing up in my life continued to logically suggest that I might benefit from working with someone. After weeks of recovering from one therapy break-down I would dive right into another and come out reeling again after a couple of sessions.
This was particularly difficult after I had trained and qualified myself: I could see that the therapists I was working with were compassionate, kind and making sincere efforts. So why did it all feel so terrible?
My late diagnosis of autism put a lot into perspective for me. Though I still struggle to find a good match, I have a lot more tools and insight about myself when searching for one. Looking back now, there are some clear themes that shine out from my journeys with bad-fit therapists. And some harmful beliefs I formed about myself as a result.
Theme 1: They didn’t understand me
What I believed: “I am too sensitive. My fear or being misunderstood makes me too hard to work with. Even therapists who try cannot meet my unreasonable expectations.”
What was actually happening: they literally did not understand me. We were speaking different languages and didn’t know it. I remember a particularly difficult breakdown with a therapist I had liked a lot. She would interpret me giving a lot of context to the issue I wanted to talk about as unconscious depth. While this may be true for a thousand clients, it wasn’t true for me. The more I told her she was finding something in my words that was not there, the more she seemed affirmed in her belief that something meaningful was being hidden. By the time she suggested we move on, I was overwhelmed in a way that could not be addressed between us. I was too scared that by naming the issue, the cycle would just start again.
Why autism matters: For many autistic people, providing a lot of context is a learned response to compensate for regular misunderstandings. For others, detail and clear information are important elements of communication. Autistic people are also more likely to speak in monologic speech (at length). For me, I think a combination of all of the above was true. If the therapist and I had a shared understanding of my communication style, we may have been able to better navigate this moment without the relationship breaking down.
Theme 2: I don’t understand them
What I believed: “No-one can hear me. I can’t find the right words to use. I am a contradiction. This is my fault”.
What was actually happening: I did not share a clear language pool with the therapist, so their efforts to reflect or paraphrase what I was saying rarely landed. The lack of awareness of my autistic traits made it impossible to identify the need for literal language, leaving me feeling frustrated and unseen. Some moments I look back and can tell that the therapist may not have been too far off in their understanding of what I was feeling, but the language barrier between us meant that I could not receive their empathy in a way that mattered.
Why autism matters: Some autistic people can experience semantic rigidity in how they use specific words and phrases, so therapist feedback that does not match this can seem misaligned, even when it’s not far from the truth. For autistics who value literal thinking and language choices, the same challenges can occur when therapists offer symbolic language that does not capture the heart of what they are feeling. Had my therapist and I known and understood this, we may have been able to collaborate on a shared language that could have better met my needs.
Theme 3: They cannot feel me
What I believed: “I am speaking as clearly as I can, I am telling people in exact words what is happening. I must be going mad. It must not matter.”
What was really happening: It took me a long time to realise that the way I express emotions is a-typical. A long time. Even now I have to remind my neurotypical husband “imagine I’m saying this with a sad face” when I’m trying to communicate my internal state. In therapy I would be speaking to professionals directly about my distress, clear voice, open posture and they would not identify or respond to anything I’d said. The conversation would go on and I’d move further and further from the point that had felt important to me, unsure of why. I can see now that they were probably trained to look for more typical distress cues to reflect back, but in the moment I received the message that what I was saying was not important. Frustratingly by the time I visibly emote in a way that is more legible to others, my feelings have become too overwhelming to talk about. Therapists would often take these moments as a sign that there was something to explore and I would end up shut down and dissociated.
Why autism matters: Autistic people emote in diverse and different ways. This can create a barrier to therapist empathy if they are unable to detect and respond to emotions as they show up. Non-autistic people can often struggle to identify autistic happiness or sadness and are more likely to misread autistic fear and anger. This combination can create a lot of difficulty for an autistic person trying to tell their story. For me, I rely heavily on language and words to express my experiences and less on tone, tears or movement. Had I been able to make this clear to my therapists ahead of time, perhaps they’d have found me more easily.
Theme 4: I don’t understand the process
What I believed: “They have noticed something that I have not. I am stupid. I am missing something. I don’t know what’s going on.”
What actually happened: Therapy involves asking open ended, curious questions to help a person explore themselves and increase their awareness.
For a long time I believed that therapists would only be asking questions to ‘progress’ me. I imagined there was a goal in their mind that they were slowly facilitating me towards. They could not tell me directly, so all questions must be a blurred signage to where I was supposed to go. This could leave me spinning out whenever I was asked about something that genuinely did not feel relevant to me- like I’d missed something big but couldn’t figure out how or why. There were moments where I would protest, leaving my therapists seeming genuinely confused that I had been so activated by their curiosity.
Why autism matters: An increased experience of social rejection can heighten the pressure and expectation to ‘get things right’ in relationship with others. For many autistic people with detail-orientated thinking processes (clearly myself included), all small parts of a wider piece may seem relevant, making it hard to understand more interpretive work without prior agreement to it. Preparing for social ambiguity may have been helpful here for me, as well as psychoeducation into the process of therapy and why it works.
Theme 5: They’re offended
What I believed: “I cannot trust my sense of things. I am too much. I am getting it all wrong”.
What actually happened: Often in therapy I’d want to ask questions to help me navigate and understand the work better. These moments were usually points of confusion and defensiveness for both myself and the therapist. I would notice a movement, facial expression or change of tone in the therapist and ask what had happened for them. They would reassure me as if I was feeling insecure and I would be left confused and suspicious. The more I would try to highlight that something specific had happened that did not align with what they were saying, the more they would deny it or explain it in terms that I did not understand (reassurance, affirmation, they’re not judging me). None of this made sense to me – ‘fine you may not be judging me but then why did your face move in a way you are now denying?’
Why autism matters: A heightened attention to detail combined with literal thinking means that my autistic self was sitting with a very different truth than my non-autistic therapist. To me they had clearly made a face that did not match with the statement ‘I’m reassuring’, to them I was likely resisting their presence and reassurance (they maybe didn’t even notice making ‘a face’ at all’). I think of the Double Empathy Problem here. The notion that there may be an empathy deficit cross neurotypes, making it difficult for empathy to exist in a bi-directional way between autistic and non-autistic people. My need for clarity was experienced as critical or exaggerated. With a good neuro-affirming therapist, it’s likely that the face, tone or word choice that I was asking about would have been acknowledged and directly explained.
Theme 6: I’m offended.
What I believed: “They are unprofessional and breaking the rules, they can’t help me”
What actually happened: They took their shoes off without telling me before-hand.
This therapist may have been the perfect one. I will never know. I was so caught off guard by them taking their shoes off, I was unable to be fully present in the moment. Having qualified I now hold more space for therapy looking differently to the picture I had held in my head, but at the time therapists were professionals and I held the belief that being a professional meant wearing shoes. Had I known what to expect, I likely would have managed fine, but the surprise of bare feet being so different to what I had imagined made it difficult for me to return.
Why autism mattered: Autistic people can often depend on predictability to help them feel secure, particularly when heading into unknown places or relationships. Partnered with my rigid belief system around what a professional is ‘supposed’ to look like, I was particularly challenged. There was also a sensory element of the unexpected sight of feet that made it difficult for me to switch my attention away from what had upset me.
Since diagnosis
Though getting my diagnosis has helped me to reflect and gain a new understanding of these interactions, things haven’t always been easier since being diagnosed. Decades of deficit-based language have skewed perceptions and formed minds. Sometimes some people hold harmful views.
Theme 7: They hold discriminatory views
It can be difficult to process this, especially if you need to separate it from your own self-esteem, self-doubt or if you’re someone vulnerable to fawning. I have had therapists let me know what autism ‘really’ means – by listing a number of people they personally dislike: exes, colleagues and trouble makers. In full knowledge of my diagnosis. Of course, they were always quick to highlight the ways I am not like that. These comments are sinister. Both perpetuating harmful and misinformed judgements and inviting me to come alongside them as they do.
Theme 8: They do not understand autism
Even well intending therapists can sometimes miss the mark. When first approaching therapists to explore my autism journey, I was met with “I don’t work with diagnosis, I work with you”. This classic and important therapy line felt more like an invite for me to explain the role of neurotypes: how we are wired can shape interactions, communication and the way we relate, meaning a neuro-affirming approach is fundamental.
Autistic clients deserve to have safe and accessible support that understands and accommodates them – and doesn’t ask them to educate their therapists on neurodivergence. With a rise in late diagnosis, social media attention and public discourse there is a just pressure on therapists to be well educated. Despite this, some trainings continue to promote harmful beliefs based in a deficit model. It is important that therapists seek out training that is approved and contributed to by autistic people themselves. Whether intentional or not, judgemental approaches from therapists can create lasting harm. No person should be stigmatised for who they are, especially when seeking support.
Take aways
What have I learned from all of these troubles? The therapeutic community are first and foremost a community of people. They bring with them the messiness, mistakes and judgements that come along with the human experience. Finding a therapist who feels connected, honest and safe to speak to about when something doesn’t feel right is integral to meaningful relating.
Many neurodivergent people believe autistic clients should always work with autistic therapists. I can see how seeking out a neurodivergent therapist may have worked for me. At the same time, the scope of diversity within the autistic community means that there’s still a chance I would have ended up working with someone I just could not click with. I hold many important connections I hold with neurotypical people in my personal life, who leave me feeling accepted, understood and celebrated. So perhaps there’s scope for a non-autistic therapist to reach me yet.
But I do think that if you’re someone particularly worried about being misunderstood, if you feel likely to mask in therapy or if you’re hoping to really get into what a neurodivergent diagnosis means to you – seeking out an autistic therapist is a good place to start.
Whoever you are, whatever your neurotype and however alone you have felt in this world – there will be people who understand.
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