For varying reasons, people with autism have the increased likelihood of experiencing mental health conditions such as depression, OCD, and social anxiety, and are likely to be referred to, or seek support from a counsellor or therapist. More and more adults are being recognised as autistic, but if an individual has yet to be diagnosed with autism, or the counsellor does not have a good understanding of autism, traditional talking therapies may be destined to fail, potentially leaving both client and counsellor frustrated.
Some of my clients have reported feeling patronised, frustrated and confused by previous counsellors they have worked with. Many clients have spent a lifetime ‘masking’ their true selves, aware of some difference, but recognising the need to fit in. When the counselling experience for these clients is unsuccessful, it may only add another layer to the challenge they may have faced all their lives, to be understood.
Whilst I acknowledge the difficulty for counsellors working with clients who may be masking their true difficulties, and the well-meaning intentions to offer support, we need to be aware that not all counselling theories are suitable for clients with autism, or these may need to be adapted, and if we approach all of our clients with the assumption of their neurological functioning being the same as our own, we may well make the challenges they are facing more difficult.
Some examples of this in practice:
CBT is a well used, and often successful technique for those with social anxiety. Clients with autism may have difficulty with verbal conversation to varying degrees. (See blog Autism in adults – verbal communication) One client reported to me that CBT for social anxiety was not successful for him because he struggled to verbalise clearly to the counsellor what his difficulties in social situations were. His explanation of the difficulties led the counsellor to understand he had low self esteem, and was worried about being ‘judged’ by others, leading the whole treatment path to changing his thought process about what others might be thinking.
The reality was that the client had difficulty in formulating his responses clearly in social situations, and his fear was more about saying the wrong thing, or not being able to respond at all. Without correctly understanding and identifying this, the counsellor formulated an unsuitable treatment path. Whilst part of the client’s difficulty included fearing being judged by others, (if he said the wrong thing or could not speak) the client was left frustrated when the treatment did nothing to address what was the more significant issue for him. Furthermore, the very difficulty he went for support with was replayed in the therapy, how frustrating!
Another common story I hear is counsellors or therapists being insistent in linking current difficulties to past life experiences. Whilst we are invariably affected by our previous experiences, this approach may be less helpful for someone with autism. Clients have reported to me feeling completely confused by a counsellor inviting them to reflect on situations or feelings, which can often be an abstract concept to them, particularly if they are affected by alexithymia, which simply described means it may be difficult for an individual to either recognise or put a name to feelings. Counselling is a relational activity, the message we regularly receive is that talking things through helps, and for many (autistic and non-autistic) this is true, and important. For others however, it may be less useful, and perhaps an incredibly difficult and uncomfortable activity to engage in.
It is imperative in couples work where one or both partners have or may have autism, that the counsellor has a good understanding of how this is likely to affect the relationship, and how to support each partner with their different needs and ways of communicating. I have seen situations where counsellors have recommended individual counselling rather than seeing the couple together, and where this has only made a bad situation worse as their own way of communicating becomes reinforced, rather than the couple engaging in the process of learning to understand the ways in which their communication differs.
If the counsellor does see the couple together, but does not fully understand how to work with clients with autism, the danger is that expectations will be placed on the clients that cannot be met, leading to further frustration and challenges for the couple. An example of this is the counsellor looking to either client to demonstrate empathic responses in ways that do not match with the way they show empathy. Another is setting tasks to do at home where an individual has difficulties with planning and organisation. If this is not recognised, and one partner fails to complete their homework because of difficulties with planning and organisation, the end result may be their partner feeling further let down, and perhaps questioning their commitment to the therapy, and ultimately the relationship.
Clients with autism may be black and white thinkers. A negative experience in counselling or therapy could lead them to believe all experiences of counselling and therapy will be this way, meaning further attempts to access much needed support may be resisted. Added to this may be a difficulty in meeting new people and visiting new places. All of which highlights the need for counsellors working with these clients to have a thorough understanding of autism, and the challenges that those on the autism spectrum may be facing in order to support them in the best ways possible.
It may come as a surprise to some to learn that certainly here in the UK, qualifying counselling courses generally do not include training to work with clients with autism. If you are looking for a suitable counsellor or therapist, be sure to ask how much additional training in autism they have undertaken, and the ways in which they adapt their practice to ensure it is accessible for individuals on the autism spectrum.