How Can Therapy ACTUALLY Help Adults With Autism?
An Honest Answer To the Question of what therapy has to offer for austic people .
I saw a post on the reddit r/Aspergers the other day posing an excellent question that I am going to attempt to answer. Reddit user JackOfAllInterest asked, “In what ways can therapy ACTUALLY help adults with an Autism Spectrum Disorder?” They went on to say:
I’m writing this post because I often see people suggest therapy as a means for improving the lives of adults on the autism spectrum. While I appreciate the good intentions, I genuinely wonder how it can help past a certain age. (Let’s say 21.)
I write this as an adult with an extremely high functioning case of Asperger’s. At my age, people generally have settled into their social groups and aren’t wishing to expand them. I have a girlfriend, but assuming I didn’t, I’d be ridiculed for my lack of experience and naïveté.
Children have it much different. At their age, they have more than enough time to learn NT social skills and at least try to integrate. They can form their identity and develop as people. But for adults, how can what essentially amounts to platitude spamming be useful for them?
Genuinely looking to challenge my perspective.
I love this post—and not just because “platitude spamming” is an amazing takedown of therapy at its least effective. I believe that this is a question that deserves careful reflection and an honest answer.
What’s the “best therapy for autism”?
If you google “best therapy for autism” you will get answers like Applied Behaviour Analysis (ABA). ABA is an approach that is designed to modify behaviour, normally in children, so that the autistic individual can better align with neurotypical norms. The “problematic” behaviour is punished, and the “desirable” behaviour is rewarded. JackOfAllInterests correctly implies that this type of intervention is not beneficial for an adult who has already formed an identity and lifestyle.
Arguably, neither is ABA designed with social justice in mind. Is it always the responsibility of autistic individuals to reshape themselves for social convention and never the other way around?
So, what is the point of therapy for autistic people?
In my opinion, the other users on this Reddit thread already did an excellent job of answering JackOfAllInterests. I will summarize the top replies:
1. “Curing” autism is not the point of therapy
Autism is not in itself a mental health disorder (or a “disorder” at all, in the opinion of this writer and many others) and should not be the target of therapy. Therapy does not exist to “cure” or otherwise modify an individual’s neurodevelopmentally bestowed style of perceiving the world or processing information.
2. Alleviating the mental health conditions that often go along with autism is the point
Autism is co-morbid (meaning: diagnosed along with) many mental health conditions. The most common ones—at least in children and adolescents—are anxiety, depression, and sleep disorders (Bougeard et al, 2021). These issues should be the target of therapy.
How Therapy Becomes “Platitude Spamming”
So, say you are diagnosed with autism—or you suspect you would be—and you have problems with anxiety, depression, or both? Again, it is not the job of the therapist to alter the way your autistic mind works. But theoretically, a therapist should be able to help you with your anxiety and depression.
Unfortunately, that is just the way it should theoretically work. In practice, many autistic people go to therapy and feel like they were subjected to ideas and a process that was not relevant to them. They end up feeling “platitude spammed”. Why? There are so many reasons, but I will reflect on one major one.
Most therapeutic approaches were created for and by neurotypical/allistic people. Hence, they reflect worldviews with major neurotypical/allistic biases.
For example, imagine that a Cognitive Behavioural therapist suggests that your “irrational thinking” is the reason for your anxiety. After all, your mind tends to race towards worst case scenarios that are unlikely to actually occur, right? The therapist tells you to “catch it, check it, change it”. You are instructed to notice the thought, challenge its truthfulness, and then switch to a more “rational” thought. Over time, your anxiety should relent because you have retrained your mind to be more “rational”.
However, this therapist’s explanation for your anxiety does not account for the differences in your nervous system that may have predisposed it to being in a chronic state of fight or flight (Casanova & Casanova, 2020). Furthermore, your distress at being stuck in incredibly uncomfortable environments predates your habit of imagining worst case scenarios, doesn’t it? Therefore, doesn’t that mean that even if you gain the ability to critique every single one of your “irrational thoughts”, you will still feel stressed? If the focus is kept on your “irrational thinking”, you might miss the opportunity to consider your unique sensory needs and how to meet them. If this happens, you might come to feel that “catch it, check it, change it” is a platitude you could live without.
That is just one example of how therapy could fail you because it was not designed with your experience in mind. But nearly every therapeutic approach could be a bad fit if its allistic biases are not addressed.
Adaptation, as usual, is Essential
To date, there has been little research conducted on what makes therapy effective for autistic people, or which therapeutic approaches best fit this population. My suspicion is that there is no one modality that “works best”. That is because autistic people are people, i.e., individual in their personalities and preferences. For myself, as a person who happens to have major tendencies towards intellectualization, poor interoception, and an exceptionally rich imagination, Emotionally-Focused Therapy works well. It helps me address my vulnerabilities and harness my strengths. But another autistic person might appreciate the systematic nature of Cognitive Behavioural Therapy, and strongly dislike the abstract emotional ideation involved in EFT.
So, is your therapist willing and able to make adaptations to better serve your needs, which may be unlike those of their allistic clientele? Are they aware of the blind spots they have around neurodivergence? Can they work with your communication style instead of implicitly asking you to work with theirs? Here’s the bottom line: therapy should be the place where you are not making all of the accommodations.
