Trying to Find a Therapist for Autistic Adults? Ask these 3 Questions to be Sure They Won’t Shame You for Being on the Spectrum.

If you’re Autistic and are considering meeting with a therapist, you might have some worries.

And I understand why.

I’m a mental health counselor who works with adults on the spectrum. I have heard horror stories from some of my clients who have tried therapy in the past.

In some cases, my clients describe that the therapist had good intentions. But, they say, there wasn’t a strong connection. My clients tell me that they felt ill at ease and misunderstood by their counselor.

Sometimes, the features in the counselor’s office were too intense and over-stimulating. The Autistic client couldn’t even pay attention to what was being said. The most common offenders are:

• Trickling water gardens
• Burning incense or scented candles
• Noisy clocks
• Lingering food smells
• Scratchy chair fabrics

Other times though, the disconnect has been much more troubling.

Therapists who demanded eye-contact from an Autistic client during their initial meeting. Or those who asked clients to stop stimming behaviors because they “weren’t conducive to good therapy.”

Or therapists who had clearly talked with the client’s parents before the session. These therapists pushed the parents’ goals without listening to the person sitting on their couch.

These therapists missed the point.

They wrongly believed that lack of eye contact or stimming were the problem. The counselors thought those things were getting in the way of good therapy.

They never considered that those behaviors might make effective therapy possible for their Autistic clients.

This TEDx talk by Dr. Amy Laurent, featuring many adult Autistic voices, crystallizes the problems with behavior and compliance-oriented therapy.

Amy Laurent: Compliance is not the goal: Letting go of control and rethinking support for autistic individuals

I know that my Autistic clients are more prone to certain mental health challenges, especially anxiety.

Because, you know, when everyone is telling you “Be more this. No, not like that, you’re doing it wrong. Oh no, that’s even worse!”…it’s easy to get nervous.

My role is to help them overcome those mental health challenges. It is not my want or goal to make my Autistic clients ‘pass for normal’.

So, how can you, an Autistic adult, find a therapist who will celebrate your Autism? One who will not just be aware of it, but who will recognize the strengths that it gives you?

How can you weed out the professionals who view your Autism as the problem, and not as an inherent part of what makes you feel comfortable being you?

Here are 3 questions that you can ask potential therapists to be sure they won’t shame you for being Autistic

What are your Autistic clients’ common treatment goals?

If someone asked me this question, I would talk about how my Autistic clients desire to:

• Beat anxiety, or if that’s not possible, at least do better at coping with having anxiety
• Be in a romantic relationship
• Advocate for themselves at work
• Stop drinking or smoking pot

These are the words my clients use to describe what they’re trying to get out of therapy. I use the exact words that they use to build a treatment plan to help them make the changes they want to make.

A therapist who doesn’t understand Autism might rework these client-defined goals to read as:

• Stop making inappropriate hand gestures when anxious
• Develop empathy for other people (which current research explains is NOT a correct assumption about people with Autism)
• Be perceived as a ‘team player’ at work
• *I don’t have a comparable goal for quitting drinking. In my experience, many healthcare professionals assume that Autistic people don’t drink or use drugs. So, they never ask about use habits. Thus, they never realize if this is a problem for their clients.

Listen to the words the counselor uses and ask yourself, “Is that how I would describe my problem? If counseling was successful for me, is this the outcome that I’d have achieved?”

Tell me about your office space.

Not technically a question, I know. But, try making this statement and inviting a counselor to talk about their office space. You will likely get tons of insight into how well they really understand Autistic clients.

I know that the environment that I create must be serene and non-abrasive for my Autistic clients if I ever hope for them to benefit from counseling.

Recently, an Autistic client was in my office and she seemed very physically bothered. I didn’t get the sense that it was because of what we were talking about. I asked if there was something in the room that was making it difficult for her to be there, and if I could change anything.

She answered “I’m just really noticing your new garbage can.”

Which was news to me, because I hadn’t gotten a new garbage can.

I glanced down beside my desk, and realized that the cleaning crew had swapped my garbage can with my office mate’s. The two trash receptacles are nearly identical, except that mine is larger and brown and hers is smaller and dark gray.

This story just highlights how important a therapist’s space is to an Autistic client. A therapist who makes frequent changes to their space might not have the best understanding of what helps Autistic individuals feel at ease.

Sometimes when a potential client asks about my space, I just tell them about my clock.

I’m embarrassed by how many hours I spent scouring the internet for the perfect clock.

• Because some of my clients struggle with Roman numerals, the clock had to have Arabic numerals.
• Many clocks have just the numbers 12, 3, 6, and 9 printed. The perfect clock for my office would have all 12 numerals printed.
• Because some of my clients have vision loss, I wanted the hour and minute hands to be very clearly distinguishable from a distance.
• For the same reason, the clock had to have good contrast between the background and the print.
• All therapists have to be comfortable with silence, but therapists who see Autistic clients have to be really, REALLY comfortable with silence. My clients respond better to therapy when they have ample time to process and develop questions. Many of my clients have been told for years by educators and parents that they need to hurry up, and a ticking clock can be an intrusive reminder of their feeling inept and slow. Rather than have my clients be mindful of the time, I want them to focus freely on the internal experience and their processing of our discussion. For that reason, a completely silent clock was a non-negotiable for me.

Finally, I found one that met all of my criteria:

A few months ago, a client said to me “You could be the worst therapist in the world and I’ll still come to see you just because of that clock. You’re not, by the way, the worst therapist in the world. But you could be, and I’d still be here.”

The client winked, and we had a good laugh.

Mission accomplished.

Lastly, any therapist who uses incense, oil lamps, etc. is out. Even if those things aren’t sensory triggers for you, they are for many Autistic people. Their presence speaks to an unwelcoming environment for Autistic folks.

I’m not sure I can tolerate talking to a new person for 45 minutes. What can you do to help me get comfortable?

A therapist who isn’t familiar with the needs of Autistic adults might say “My office is a safe space, many of my clients tell me they feel at ease here.”

Someone who genuinely gets what’s intimidating about therapy for someone on the spectrum will offer more practical solutions.

Here are some of the things that I offer Autistic clients who worry that a full 45 minutes of 1:1 talk will be too intense.

Walk and talk therapy.

We literally take a walk side by side and do therapy. The down side is that this limits the opportunity for hands on activities. But, many of my clients get so much benefit from walking together as partners, with no chance of eye-contact, and being in nature, that it’s clearly the right choice for them.

Bringing someone along.

Whether it’s a parent, a spouse, or a friend. Sometimes having someone sit with you, or knowing that they’re in the waiting room, can help you to feel more comfortable.

Telling you to do whatever it is you need to do to get comfortable.

Some of my clients ask to take off their shoes, lie down on the couch, turn off the lights, open the windows, play with fidgets, and so many other things. I’m glad that my clients feel at ease to be at ease in my office. I know that this puts them in the best position to get the most out of our time together.

Starting with shorter sessions and working up to longer ones.

Many of my Autistic clients prefer shorter sessions more frequently, and I’m happy to accommodate this, since it works for them.

In-home sessions.

In some cases, it makes sense for me to go to where my client’s problems are happening, whether this is work, home, or school. Then we can create helpful systems and put them in place in their environment. This can really help anxious Autistic clients.

Online therapy.

I offer online therapy to all my clients, and there are many reasons why it can be helpful. When a client is home with a sick kid, or can’t take time away from work to drive to my office, they can just switch their in-office meeting to online.

But many of my Autistic clients prefer to start off by meeting online. It helps them to get comfortable with me and to build a relationship. They get to focus on building trust without having to worry about the stress of getting somewhere new and entering a new environment.

Summary

I hope those are helpful questions to consider asking a potential new therapist to be sure that they’ll appreciate your Autism, and not make you feel wrong for being you.

I would love to hear from you; what other ways might a counselor make you feel welcome? Leave a comment and share your ideas!

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