Acknowledging the Challenges of Seeking Therapy as an Autistic Adult

As a therapist whose clinical work primarily focuses on autistic and neurodivergent adults, I have many clients who come to me sharing that they are questioning if they might be autistic and seeking a diagnosis. Most of these adults began questioning if they were autistic after decades of difficulty functioning at the same level, or in the same way, that everyone else around them seems to be able to. Often, the patterns that they recognize in their younger selves – difficulty with friendships, bullying, meltdowns and shutdowns, fine and gross motor challenges, intense interests, difficulty labeling and expressing emotions – seem so obviously autistic upon reflection. Their parents, even those who received suggestions from providers that their child might be autistic, may have ignored or downplayed the severity of their concerns because they were able to function effectively in some settings or didn’t “seem autistic.” In other words, they didn’t fit the limited understanding of autism that is still pervasive today among therapists and the public.

Adult autistics who are not diagnosed at a young age tend to experience decades of invalidation, dismissal of challenges and needs, and ultimately develop extensive methods of coping that are exhausting and unsustainable. Many also seek therapy when autistic burnout has set in and they are no longer capable of functioning and desperate for answers and support. The emergence of social media hashtags such as #actuallyautisitc and autistic Tiktok creators sharing about their lessor recognized symptoms has been life-changing for many of these adults. A significant number of clients who come to me for assessment and treatment began to recognize their symptoms after learning about autism through social media.

As a community, there has been a push to move away from labels such as “high functioning autism” and find more accurate and less harmful ways to label the subset of individuals who are most often missed diagnostically. Social Psychologist, Dr. Devin Price, coined the term “masked autism” to better reflect this group and capture the many ways that masking serves as a form of coping in an ableist society and is also deeply harmful to one’s wellbeing and identity. For an in-depth exploration of masked autism, its origins, implications, and steps for recognizing and “unmasking”, check out Dr. Price’s newest book Unmasking Autism.

A quick Google search for autism-related resources reveals the fact that the world of psychology and autism is still obsessed with children, harmful conversion therapies such as Applied Behavior Analysis (ABA), and an overall lack of resources for adults. The truth is, a significant portion of psychologists and other mental health providers remain unprepared to identify and treat masked autism. This often makes the process of finding the right provider more difficult. For those who hold multiple marginalized identities, such as being queer/trans, chronically ill or disabled, and/or BIPOC, may increase the difficulty of finding a provider who is a good fit for you.

Suggestions for navigating the process of finding a therapist:

· Trust your intuition. You may have a lifetime of experience doubting or ignoring your intuition. If a therapist doesn’t feel like a good fit for you, you’re allowed to trust that instinct.

· Prepare questions for your therapist before your initial session. When you pick a therapist, you are hiring them to provide their clinical knowledge and perspective, which will differ greatly from therapist to therapist. Consider questions such as, have you worked with other autistic clients? How do you approach therapy with autistic clients? What accommodations or modifications to therapy do you usually make when you work with autistic adults?

· Utilize search engines such as Inclusive Therapists, which prioritize providers who are more likely to meet the needs of multiply marginalized clients.

· Look for keywords in the bios of providers that match aspects of your identity or concerns (ex. Neurodivergent). Similarly, look for keywords that suggest they may not be a fit for you. For example, if a therapist is certified as a Board Certified Behavior Analyst (BCBA), their educational background is focused on training that most autistic people find harmful and traumatic.

Some providers focus heavily on “skills” for supporting autistic adults. This word means something different to every provider and may warrant further questioning. I find that most adults need support identifying internalized ableism, better understanding their needs and limits, and education and practical strategies for managing executive function and sensory processing.

The Goode Practice has several providers with experience working with masked autistic adults, as well as those with multiple marginalized identities.