What you must know about counselling if you are autistic

You are autistic, and you think you might benefit from some counselling. Would you know to check if a therapist has specific training and experience to work with autism? Or would you assume, quite reasonably that all therapists would have this?

The reality is that very few counsellors and therapists have adequate training and experience to meet the needs of their autistic clients. I have no doubt that therapists mean well when they agree to see autistic clients, I think the issue is more that they do not know what they do not know about autism. I know this because I was once one of those therapists.

The unfortunate consequence of this however is the stream of autistic clients that come through my doors, week in, week out telling their stories of how therapists have unknowingly made situations worse, and this makes our work together much more challenging too. This feedback rarely reaches the therapist, and together with conflicting views within the counselling profession about how to work with autistic clients, means the cycle continues.

As a counsellor specialising in working with autistic clients and listening to their experiences of counselling, I recognise that the shift in how we work with autistic clients has to be quite significant, it is in many ways about throwing away the counselling textbooks and being prepared to really open our eyes to difference. Differences in ways of experiencing the world, through our senses, through the many different ways we communicate, and the ways we process verbal and other information.

When this doesn’t happen, autistic clients are often completely misunderstood by the therapist, or expected to fit the only way of working that the therapist knows, which is rarely helpful, but neither therapist nor client may have any awareness of this mis-match whatsoever. Clients may dutifully go along with this way of working, trusting in the professionalism of the therapist. Therapists may see a compliant client, but there can be many other reasons for this including ‘masking,’ a concept that needs to be fully understood by anyone working with autistic clients.

Another difficult situation can arise when an autistic adult has previously seen a counsellor prior to this diagnosis or awareness. Mental health issues that are a result of the lack of understanding of autism by others since childhood are often ‘pinned’ to other causes such as relationships with parents or a difficult life event or experience. Not only is this misleading, it is potentially very oppressive. If a client believes their difficulties to be caused by one of these, they are less likely to consider that they may be autistic, and look for more appropriate support. Clients may jump from one therapist to the next trying to resolve what they believe to be the issue, all the while struggling with difficulties that have never fully been understood or acknowledged.

It is my hope that one day all counsellors and therapists will have the level of understanding required to work with autistic clients, both diagnosed and undiagnosed. Until that day comes, if you are autistic, or think you might be, be sure to choose a therapist that has significant training and understanding of autism, and don’t be afraid to ask how they adapt their work to suit you as the autistic client, rather than the other way round.

See also The importance of autism awareness for counsellors and therapists