Out On The Couch
As you may know, April is Autism Acceptance Month. As knowledge of autism continues to grow and change with every year—and there are a greater number of adults who know that they are autistic—we wanted to highlight a few things that can help affirmative therapists work with their autistic clients.
Avoid Using Functioning Labels
“High functioning” and “low functioning” (or “support needs”) are commonly used within the medical community and in education for practical purposes, but many autistics dislike these classifications because they can minimize or oversimplify lived experience. People who are identified as “low functioning” or having “high support needs” are routinely dehumanized or infantilized. People who are labeled as “high functioning” or “low support needs” have their experiences erased and have to fight for any support at all. In addition, many autistics who were initially diagnosed with Aspergers reject the use of that term, as it is named after a Nazi scientist who did research on autistic individuals (Czech, 2018). At the same time, some autistic people do use these terms to describe themselves—not all autistic people have the same experiences.
Another note: when polled, the vast majority of autistic adults prefer identity-first language (“autistic person”) rather than person-first language (person with autism)—this is contrary to the language generally used in classes about autism (Brown, 2011; Taboas, et al, 2023).
Sensory Experiences Can Vary—But Are Often Very Important
Therapy often involves discomfort—but physical discomfort can make communication much more difficult. You may expect lots of clients to be shifting around in their chair during an appointment, but an autistic person may react much more strongly to sensory stimuli than an allistic (non-autistic) person. In addition, some autistic people may seek out sensory stimuli in a stressful situation, while others may avoid it.
If you want to make your space more welcoming to autistic clients, consider adding sensory toys, a variety of lighting, and if you have space, multiple seating options. Most important, actively encourage your autistic clients to tell you what their sensory needs are, and if they aren’t sure, to experiment with different options.
And at the very least, remember that ear defenders, noise canceling headphones, sunglasses, fidgeting, and avoiding eye contact can all be very useful tools for self-regulation among autistic people, and allowing them to use the tools they need will help them to be able to more effectively do therapeutic work with you.
Autism Isn’t the Only Impact on Social Issues
Autistic people may be inclined to “blame” struggles, especially social/interpersonal ones, on autism. (This seems to be particularly common soon after diagnosis or discovery, when an autistic adult may be spending a lot of time thinking “oh so THAT’S why I react this way!”) On the other hand, autistic clients can also be frustrated when medical professionals or therapists constantly turn to their autism as the explanation for any problem. In addition, autism (or more specifically, being autistic in an ableist world) can be a cause of trauma, but can also interact with other sources of trauma, like generational trauma and family systems conflicts.
Sometimes you may need to push your client to consider other sources of conflict or discomfort, and sometimes you may need to give yourself a gut-check to make sure you aren’t pointing the finger at autism a little too eagerly.
A Lot of Queer and Trans Individuals are Also Autistic
The reason for this is open to argument, but there appears to be a high correlation between queerness and autism. In many cases, young trans or queer adults are only diagnosed as autistic in adulthood, which can mean that untangling the different threads of their identity can be a struggle.
As always, it is important to remember that autistic experience—like queer or trans identity—is not a monolith, and autistic queer individuals have a wide range of experiences.
Autism Is Underdiagnosed In Many Populations
In the 1990s there was a spike in autism diagnoses which led to concerns that rates of autism were increasing. However, autism was often treated as a disorder affecting young white cis boys—it was and remains often diagnosed in cis girls and BIPOC, as well as in adults who were diagnosed (or were misdiagnosed) as children.
Some adults self-diagnose, and may or may not pursue a formal diagnosis. However, it is common for self-diagnosed adults to experience dismissal by medical professionals of their lived experience as invalid. Whether an affirmative therapist agrees with a self-diagnosis or not (and whether or not they are qualified to make or interpret a formal autism diagnosis), respecting rather than dismissing that experience is important in order to maintain a trusting relationship with the client.
As the population of adults with autism diagnoses increases, the number of autistic adults in therapy is also going to increase. Working to be more aware of and embracing of autistic identities is a great way to celebrate Autism Acceptance Month, and also a great way to be a more affirmative therapist!
Learn More From Our Courses:
Brown, L. (2011). The Significance of Semantics: Person-First Language: Why It Matters. Autistic Hoya. Retrieved from: https://www.autistichoya.com/2011/08/significance-of-semantics-person-first.html
Czech H. (2018). Hans Asperger, National Socialism, and “race hygiene” in Nazi-era Vienna. Molecular autism, 9, 29. Retrieved from: https://doi.org/10.1186/s13229-018-0208-6
Taboas, A., Doepke, K., & Zimmerman, C. (2023). Preferences for identity-first versus person-first language in a US sample of autism stakeholders. Autism : the international journal of research and practice, 27(2), 565–570. https://doi.org/10.1177/13623613221130845