Finding an autism-affirming therapist

As a new therapist, and someone who has had many bad therapy experiences, I have been reflecting on how difficult it is to find a therapist who is autism-affirming. In this article, I explore some of my thoughts and experiences and offer practical tips for vetting your therapist.

Why are autism-affirming therapists so hard to find?

In most therapy training programs, autism and the concept of neurodiversity are not typically covered.^[1]A blind spot in mental healthcare? Psychotherapists lack education and expertise for the support of adults on the autism spectrum (Lipinski et al., 2021) During my own training, there wasn’t a single class dedicated to autism or neurodivergence more generally!

If autism and other neurodivergences are discussed in trainings, it is often framed through a pathologizing lens. For example, in my research, we found that most Psychology textbooks portray autistic individuals as “deficient” or “impaired”. They imply that the goal of therapy/treatment is to make an autistic person conform to neurotypical norms. These texts also commonly teach outdated stereotypes. For instance, that autistic people lack theory of mind.

As a result, most therapists lack the skills and knowledge needed to support autistic individuals and may not even be familiar with the concept of neurodiversity. In fact, one study found that clinicians were less informed about autism compared to other neurodivergences.^[2]A blind spot in mental healthcare? Psychotherapists lack education and expertise for the support of adults on the autism spectrum (Lipinski et al., 2021) Many clinicians were also found to have held misconceptions and harmful beliefs about autism, increasing the risk of harmful ableist interactions with clients.

Why don’t traditional forms of therapy work for many autistic people?

Traditional therapeutic approaches often overlook the specific needs of autistic individuals because they are based on neurotypical norms. Therefore, when autistic people go to therapy, traits that differ from those of non-autistic individuals are often viewed as problems needing treatment.

For instance, I’ve heard from many autistic people that their therapists dismiss or minimize their experiences of sensory overwhelm, suggesting that they need to “endure” it because their reactions—fear, avoidance, and pain—are “exaggerated.” However, just because most non-autistic people don’t experience sensory overwhelm doesn’t mean that autistic individuals are exaggerating.

Many years ago, I had a negative experience with cognitive behavioral therapy (CBT). When I shared my habits of rehearsing social interactions or wanting to debrief after socializing, my therapist claimed that these behaviours were the cause of my “social anxiety.” They didn’t consider how important it is for me to use these strategies to navigate social situations. These behaviours help with anxiety, not cause it!

Instead of learning how to unmask, my therapy experience led me to mask even more. I was made to believe that there was something wrong with me that needed to be fixed because I didn’t do what “healthy” neurotypical people do. This therapist never acknowledged that my “social anxiety” may have actually been caused by a mismatch between my communication style and the neurotypical world I live in.

I’m not alone in my experiences. A study published last month interviewed autistic individuals who received CBT for social anxiety.^[3]“Resist, Reframe, Redo the Bullying, the Lying, the Harassment”: A Qualitative Investigation of Social Anxiety and Therapy as an Autistic Person (Wilson, 2024) Participants noted that CBT often failed to address how autistic individuals experience social anxiety differently from non-autistic individuals. They highlighted the need for CBT to better account for autistic traits that impact social interactions, such as different processing speeds, the higher likelihood of trauma from bullying and discrimination, and the added challenge of navigating social situations while managing sensory environments, meltdowns, and shutdowns.

CBT is just one example of how traditional forms of therapy tend to prioritize neurotypical norms and may not work for many autistic individuals. In order for therapy to be effective at supporting us, therapists need to make adaptations based on our lived experiences and needs.

Is neurodiversity a new “buzzword” in therapy?

Anecdotally, I’ve also noticed an increase in therapists using the terms “neurodiversity”, “neurodivergence”, “neurodivergent”, and “neurodiverse” in their advertising. I get the impression that most of these clinicians don’t intend to cause harm and are using these terms as a way to try and reduce the stigma around autism and ADHD. However, it’s easy to adopt these terms without fully understanding their meanings.

Notably, “neurodiversity” isn’t a new buzzword for referring to autism and ADHD; it’s a social movement and ideology that recognizes how neurodiversity is part of biodiversity. Additionally, “neurodiverse” refers to a group of people with a variety of brains—both neurodivergent and neurotypical. And finally, “neurodivergence” encompasses all brains that diverge from typical norms, not just autistic or ADHD brains.

Sonny Jane Wise (@livedexperiencecounsellor) is a neurodivergent advocate and educator who has created a lot of content discussing the definitions and implications of these terms. We recommend that you check them out!

With this in mind, just because a therapist uses these terms doesn’t necessarily mean that they understand their implications or that they have the training to work with autistic individuals. For example, I’ve seen therapists claim to be “neurodiversity-affirming” while still labeling autism as a “disorder” with “treatable symptoms.” I’ve also come across “neurodiversity-affirming” therapists who fail to adapt traditional therapy for autistic clients, continuing to promote conformity and masking rather than fostering autonomy and autistic pride.

What is autism-affirming therapy?

Now that you have some idea of what the current landscape of therapists looks like, how do you go about finding an autism-affirming therapist? Personally, I think it comes down to finding a therapist who embodies certain values and actions. Chapman and Botha published a paper on neurodivergence-informed therapy.^[4]Neurodivergence-informed therapy (Chapman & Both, 2023) In the paper, they outlined some of these important values and actions. Below, I’ve mixed their perspectives with my own thoughts and opinions:

1. They view autism as an identity, not a disorder

An autism-affirming therapist recognizes that neurodiversity is a part of biodiversity. This means that autistic traits are simply a form of natural variation. Everyone, neurotypicals included, has behavioural traits that are advantageous in some situations and disadvantageous in others.

With this mindset, autism-affirming therapists typically embrace autistic traits without judging them or comparing them against neurotypical norms and standards. In the same way that a therapist shouldn’t judge someone based on their ethnicity or sexuality, they shouldn’t judge someone based on their autism either. Instead, it gives therapists a cultural lens to understand why an autistic individual may behave in a certain way and how their needs may differ from others.

2. They recognize that many problems are systemic, not individual

Autism-affirming therapists are familiar with the social model of disability. They recognize that many of the mental health challenges that autistic people experience are a result of a society that prioritizes neurotypical needs while pathologizing autistic needs.

Not only do they support autistic mental health by helping us access resources, but they also advocate for systemic change. In addition, they acknowledge that the fields of psychiatry, psychology, counselling, and social work all have ableist roots. By working within the system, they recognize that they are part of the system and have the capacity to cause further harm.

3. They promote autonomy, not conformity

Therapists who are autism-affirming support individuals’ needs instead of aiming for “recovery” from autism “symptoms”. This means supporting an autistic client in the ways they want to live, even if it goes against social norms. A lot of the time, this involves supporting autistic clients on their unmasking journey.

4. They use a client-led approach

Therapy for autistic individuals (and everyone else!) should be client-led. This means that the client gets to decide what they are struggling with and what they want to work on. For example, one autistic client may want to use their therapy sessions to learn how to work with neurotypical co-workers, whereas another autistic client may want to quit their job and figure out how to work in a way that allows them to unmask. They respect their client’s choices.

5. They consider how autistic and non-autistic experiences differ

A therapist who is autism-affirming makes adaptations in sessions to fit the needs of autistic clients. This means that they understand how autistic and non-autistic people may present differently, may require different communication styles, and may experience day-to-day life differently. For example, they respect an autistic person’s need for low/no eye contact, stimming, and special interests. They also understand that autistics may display emotions differently.

In addition, they are aware that what is considered “mental health” for an autistic person may not be the same as what they were taught in school. They acknowledge masking/camouflaging behaviours and they are knowledgeable about common experiences that may be distressing or traumatizing for autistic individuals, even if they are not typically distressing or traumatizing for non-autistic people.

6. They consider intersectionality and environmental factors

An autism-affirming therapist considers the whole person, not just their autism. They acknowledge how cultural differences, levels of privilege, and environmental factors differentially influence autistic mental health. This includes factors such as race, ethnicity, gender, sexuality, socioeconomic status, religion, citizenship, location, etc.

As an example, when considering these factors, an autism-affirming therapist who supports unmasking also recognizes that unmasking may not be possible in all situations due to safety concerns. As well, they accept self-diagnosis and recognize that not everyone has the privilege of getting a diagnosis, and that diagnosis in itself may come with a loss of privilege for some.

7. They commit to learning and evolving

The field of therapy is evolving and advancing. Therefore, an autism-affirming therapist is keeping up-to-date with the newest information on how best to support autistic individuals. This isn’t limited to learning about new research. It also includes listening and learning from the autistic community; implementing what we define is important and helpful for supporting our needs. Prioritizing lived experience is crucial.

Last but not least, we are all human and we all make mistakes. The most well-intentioned therapist may still cause unintentional harm to a client. If this happens, it is their responsibility to act with humility, apologize, learn from their mistakes, and commit to doing better next time.

How can I tell if my therapist is autism-affirming?

When choosing a therapist, here are some things to look out for that can help you evaluate whether they are autism-affirming or not. Red flags are indications of views that do not align with the neurodiversity movement and are not autism-affirming. In contrast, green flags are indications of autism-affirming views.

When you are meeting a therapist, you also have the right to ask them directly about any of their views! Here is a list of example questions that may help you gain some insight into where they stand when it comes to autism and neurodiversity:

• What are your views on autism?
• What are your views on eye contact?
• Do you know what neurodiversity is?
• Do you know what double-empathy is?
• Do you know what stimming is?
• Have you worked with autistic adults before?
• Do you use functioning labels?
• What are your views on self-diagnosis?
• Do you offer clients accommodations?
• What are your views on masking/camouflaging?
• Have you worked with autistic clients who are also ___ [insert another aspect of your cultural identity]?

What happens if I discover that my therapist is not autism-affirming?

If a therapist is not meeting your needs, or you don’t feel that your therapist is a good fit for you, you are within your right to find another therapist. This includes the discovery that your therapist is not autism-affirming. If you’d like to stop seeing your therapist, you have several equally valid options:

• You can tell them that you would like to stop seeing them.
  • You do not have to tell them why if you do not want to but most therapists do appreciate feedback!
• You can ask them to refer you to another therapist.
  • Your therapist should try in earnest to give you the names of three different people who may better fit your needs!
• You can “ghost” them (i.e., just stop replying to them and stop booking future appointments).

At the same time, we are also aware that therapy is a privilege and that not everyone has access to affirming therapy. If you do not have the option to find a new therapist, you might benefit from asking yourself the following reflection questions to help guide your decision-making:

Even though this therapist is not autism-affirming,

• Are they still able to help support me?
• Are they open to learning more?
• Can I still trust them?
• Am I able to feel seen and safe?
• Do the pros of having a therapist outweigh the cons of not having a therapist?

In summary, many autistic people prefer to seek out a therapist who is autism-affirming. Such therapists recognize how therapy for autistics differs from therapy for non-autistics and make appropriate adaptations. They also value neurodiversity and other forms of cultural diversity, promote autonomy over conformity, recognize that living in a neurotypical world contributes to mental health outcomes, and commit to learning and evolving to support the autistic community. We hope that more and more therapists receive training about neurodivergence and can offer more affirming care.

In the meantime, we hope that this article can offer some insight on how to navigate finding a therapist. Most importantly, the right therapist for you is the one that meets your specific needs, regardless of what others think!