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Therapy & Neurodiversity

Updated: May 26

May is Mental Health Awareness Month!


I’ve spent most of my adult life taking advantage of one sort of therapy or another. Growing up undiagnosed, in a family rife with undiagnosed autism, I had a lot to work out in order to be the adult I am today.


I mainly agreed to go to college because an older cousin had told me that colleges offered counseling services and they said I could DJ at the college station. As a young person, and I say this with no malice, I was starved for an emotionally competent adult who didn’t take my choices personally to simply listen to me, to help me translate myself into the language that the world outside my personal head-bubble spoke.


Like, how do people know what to do? What to say? What to want? How to be? Where to hold their arms when chatting with another humanoid?




For years, I ascribed my inability to blend in to having exceptionally old and egg-headed parents. That wasn’t entirely wrong, but it also wasn’t the full story. Over the years, therapy solved a lot of the “antique parent” problems but was never able to bridge the gap between the bubble I lived in and the rest of the world. It’s not that my lovely therapists didn’t care, or try-- they just didn’t recognize the under-lying issue: undiagnosed autism in a female.


Working on my self-confidence was never going to correct my occasional inability to make the mouth words happen out loud. Mindfulness was never going to help my physical coordination. Developing “resilience” was never going to stop me from being an emotional sponge that absorbs all the emotions flying around in the air around me but having no way to distinguish them from my own or manage them. Building up my physical endurance was never going to cure the chronic fatigue I suffered due to sensory assault of the world outside of my quiet, dimly lit apartment. Making better to-do lists was never going to fix the fact that my body has no innate sense of time.


I struggled for years trying to overcome all of these seeming ”symptoms of depression” and sure, I probably was mildly depressed on and off, but what I ultimately was was an undiagnosed autistic woman struggling in a world not organized for her benefit.


Granted, when I was in my 20s and 30s, my therapists were all in their 40s and 50s. These lovely women would now be in their 70s and 80s, even 90s and had no more awareness of autism in girls and women than I did.


My concern is that I’m hearing stories of the same sort of disconnect happening, still!


Our community needs access to well informed, high quality mental health care. Right off the top of my head I can think of four distinct ways that mental health care issues can collide with autism and other types of neurodiversity:


  • The rate of co-occurring mental health conditions is very high for those diagnosed with autism and other types of neurodiversity. It’s of the utmost importance that neurodiverse people can access compassionate, well-informed professionals who know how to work with their unique issues instead of minimizing or misdiagnosing.


  • Without an existing autism or neurodiversity diagnosis, neurodiverse people are often diagnosed with mental health conditions that they don’t have- for instance many women have been incorrectly diagnosed as being bipolar or borderline personality disorders prior to finally being diagnosed with autism.


  • Therapists often have no training in recognizing or working with autism and neurodiversity. This can have a huge impact on effective treatment: for instance, trying to “desensitize” someone to their sensory sensitivities as though they were phobias will never work.


  • Even those with some training in neurodiversity may still have an outdated and overly narrow idea of what autism looks like: “you can make eye contact and have a conversation- you can’t be autistic!”


For neurodiverse people in need of mental health support, it’s urgent that they connect with mental health workers who are prepared to meet their unique needs.


A little bit of googling led me to the page of one therapist who seems to get it: https://rosereif.com/find-a-therapist-for-autistic-adults/


She offers the following advice to those looking for a therapist:


Ask them “What are your Autistic clients’ common treatment goals?”


She follows up by answering for herself: “If someone asked me this question, I would talk about how my Autistic clients desire to:

  • Beat anxiety, or if that’s not possible, at least do better at coping with having anxiety

  • Be in a romantic relationship

  • Advocate for themselves at work

  • Stop drinking or smoking pot

These are the words my clients use to describe what they’re trying to get out of therapy. I use the exact words that they use to build a treatment plan to help them make the changes they want to make.”


Rief cautions that “a therapist who doesn’t understand Autism might rework these client-defined goals to read as:

  • Stop making inappropriate hand gestures when anxious

  • Develop empathy for other people (which current research explains is NOT a correct assumption about people with Autism)

  • Be perceived as a ‘team player’ at work

  • *I don’t have a comparable goal for quitting drinking. In my experience, many healthcare professionals assume that Autistic people don’t drink or use drugs. So, they never ask about use habits. Thus, they never realize if this is a problem for their clients.

Listen to the words the counselor uses and ask yourself, “Is that how I would describe my problem? If counseling was successful for me, is this the outcome that I’d have achieved?”


With therapy, as with the rest of your life, you are allowed to find and use what works specifically for you. Advocating for yourself with your mental health provider is essential.

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