Autism in Therapy: How to Be Autism-Affirming

April is Autism Awareness and Acceptance Month, a time to celebrate the culture and diversity of the Autistic community while promoting acceptance and inclusion. As an Autistic person, words like "autism acceptance" and "autism awareness" don't mean much until we break them down into actionable, concrete steps. That's why this month, I am breaking down what autism acceptance looks like in practice for various contexts. This post is part of my series on autism acceptance, focusing on concrete ways to practice it in different contexts. Today’s post will take a closer look at autism in therapy and how therapists can be autism-affirming.

Autism in Therapy

Many Autistic people seek therapy to help them cope with the challenges of being Autistic in a non-Autistic world. Additionally, Autistic individuals may seek therapy to address co-occurring conditions such as anxiety, depression, or PTSD. Unfortunately, many therapists are not trained to work with Autistic clients in a way that respects our differences. They may see autism as a problem that needs to be fixed or cured rather than a neurodivergent identity that is valuable in its own right.

Additionally, therapy sessions can sometimes be overwhelming or stressful for Autistic individuals due to sensory overload or difficulty navigating the allistic social-emotional communication methods often used in therapy.

Ideas for Autism Acceptance in Therapy

Autism Acceptance in therapy means recognizing that Autistic people have unique strengths and challenges and tailoring therapy to be more Autistic friendly. It means understanding that the goal of therapy is not to "cure" Autistic people but to support us in achieving our goals and living fulfilling lives.

Embracing autism acceptance in therapy means adapting our therapeutic approach by accommodating autistic needs. Here are some practices that can bring autism acceptance into action in the clinician's office:

Consider Autism as an Identity

The first step towards autism acceptance in therapy is to consider autism as an identity, not a disorder. This may involve things such as using identity-first language (or the preferred language of your client) and ensuring you're taking the client's lead in establishing goals of treatment. Be mindful of treatment goals that are trying to make the person more allistic. It may also involve addressing internalized ableism and helping your client integrate their neurodivergent identity.

Use Identity-First Language

Using identity-first language is a crucial aspect of autism acceptance in therapy. Identity-first language, such as "Autistic person" instead of "person with autism," acknowledges autism as an integral part of an individual's identity rather than a separate condition or disorder. Identity-first language recognizes and values the experiences and perspectives of Autistic individuals and helps promote self-acceptance and self-advocacy. While identity-first language is preferred by the majority of Autistic people, some may prefer language such as “on the spectrum.” It's important to use the language that your client prefers, so it's essential to ask them what language they prefer and honor their preference.

Be Mindful of Allistic Treatment Goals

Allistic treatment goals are goals that are designed to make the client more allistic, or in other words, more like a non-Autistic person. These goals may include reducing or eliminating Autistic traits, such as stimming, or developing allistic social communication skills, such as making eye contact. However, these goals are often based on the assumption that being Autistic is inherently problematic, which goes against autism acceptance.

Instead of focusing on allistic treatment goals, therapists should focus on supporting their clients in achieving their goals and living fulfilling lives as Autistic individuals. This may involve developing coping strategies for sensory overload or interoception differences, improving emotional regulation skills, or building self-advocacy skills. It's essential to remember that Autistic individuals have unique strengths and challenges, and the goal of therapy should be to support us in achieving our goals in a way that values and celebrates our neurodivergent identity.

Encourage Sensory Regulation

Many Autistic individuals experience sensory overload or underload, which can be overwhelming or distressing. To support sensory regulation, therapists should provide a calm and sensory-regulating therapy environment, encourage stimming and sensory exploration in sessions, and help clients explore sensory preferences and triggers, and develop a sensory safety plan.

Reduce Demands for Allistic Social Norms

Therapists should also reduce demands for social-based conversations and allistic social-communication norms (eye contact, "how are you," "tell me about yourself"). Autistic individuals may find these demands overwhelming or challenging, so it's important to be aware of and accommodate their communication needs. Instead, focus on object-based conversation and get to know the person by asking about their areas of interest. Special interests can also be used to co-create metaphors and shared therapeutic language.

Accommodate Interoception Differences

Interoception refers to the ability to perceive and understand internal bodily sensations, such as hunger, thirst, and pain. Many Autistic individuals have interoception differences, which can impact emotional regulation skills. Therapists should consider the impact of interoception awareness on emotional regulation skills and support interoception-building exercises, especially if the client is struggling with anxiety and emotion regulation issues.

Consider Alternative Communication Methods

Autistic individuals may find it challenging to communicate verbally, so therapists should consider alternative communication methods such as chat, writing, use of AAC, and other devices when speaking becomes difficult for clients. Therapists can also use music, art, and photos to discuss the client's emotional words (vs. relying solely on emotion-based vocabulary and words).

Educate Yourself on Non-Stereotypical Autism Presentations

Autistic individuals come from diverse backgrounds and have unique experiences. It's important to educate yourself on non-stereotypical presentations and accurately diagnose women, BIPOC, genderqueer, and other non-stereotypical presenters to provide effective and affirming therapy.

Be An Autism Advocate

Autistic-centered therapy often involves a level of advocacy outside of the therapy hour. Writing accommodation letters, educating parents, and supporting the client in developing self-advocacy skills are all important aspects of Autism advocacy in therapy. For teaching Autistic self-advocacy, this is my favorite curriculum which can be used in a group format or individually.

Embrace Neurodivergent Communication Styles

Autistic individuals often have unique communication styles, such as connecting over special interests and embracing divergent and non-linear conversations. Therapists should embrace this communication style and encourage their clients to communicate in the way that feels most comfortable and effective for them. This may also involve embracing a context-heavy communication style where the client describes the context rather than providing a top-down synthesized answer.

Consider Neurodivergent Trauma

Autistic people are vulnerable to traumas that are not classically thought of as "trauma" within the mental health world—for example, sensory trauma, social trauma, and more. The impact of trauma also impacts our nervous systems more intensely. So supporting nervous system regulation and healing from neurodivergent trauma is often a key part of Autistic therapy.

Summary: Autism in Therapy

To summarize, Autism acceptance in therapy means recognizing and respecting Autistic individuals' strengths, challenges, and needs. It means considering autism as an identity, not a disorder, and accommodating sensory, communication, and emotional regulation needs. Therapists should also educate themselves on non-stereotypical presentations, be an advocate for their Autistic clients, and embrace neurodivergent communication styles. By taking these steps, therapists can provide Autism-affirming therapy that supports their clients in achieving their goals and living fulfilling lives.

Resource

Several of these concepts were influenced by the work of Dr. Joel Schwartz. For a great podcast on how to be a neurodivergent-affirming therapist, check out his interview with Patrick on the All Things Private Practice Podcast.

Additionally, I recommend checking out books like The Adult Autism Assessment Handbook and Is This Autism? A Companion Guide for Diagnosing offers valuable information on autism assessment and diagnosis from an affirmative framework. If you're looking for more resources, my clinician membership area offers a range of helpful workbooks and access to a private community where you can ask questions and connect with other clinicians.