Barriers to Mental Health Treatment for Autistic Clients: What Therapists Typically Get Wrong About Autism

Despite increasing awareness of autism spectrum disorder (ASD), significant barriers persist in mental health treatment for autistic clients. Many therapists lack adequate training and knowledge about autism, leading to misinterpretations and ineffective interventions. This post addresss recent research and clinical insights to highlight common pitfalls in therapy for autistic individuals and offers evidence-based recommendations for improvement.

Insufficient Training and Knowledge Among Therapists

Research consistently demonstrates that most mental health professionals receive minimal formal education on autism. For example, Lipinski et al. (2021) surveyed 498 psychotherapists in Germany and found that only 2% reported being highly knowledgeable about autism, while 53% had very little autism-specific psychotherapeutic training. Furthermore, 27% did not know where to seek support when working with autistic clients. Notably, education about ADHD was similarly lacking.

A Canadian study by Gallant et al. (2023) surveyed 577 community mental health clinicians and found that clinicians felt significantly less knowledgeable and confident supporting autistic clients compared to those with ADHD. While some treatment adaptations such as increased structure, predictability, shortened sessions, and the use of special interests were implemented, these often occurred without formal training. Other shortcomings included reduced confidence in listening to autistic concerns, issues with demonstrating empathy towards clients, difficulty in applying mental health knowledge, and struggles with effectively utilizing interventions.

Harmful Misinterpretations in Therapy

Therapists may inadvertently harm autistic clients by applying neurotypical frameworks to interpret autistic behaviors. Jones (2024) outlines several common misinterpretations:

• Labeling needs for consistency or justice sensitivity as manipulative or narcissistic

• Mischaracterizing meltdowns as tantrums

• Interpreting alexithymia and executive functioning challenges as resistance or denial

• Dismissing pattern recognition and anticipatory dread as magical thinking or OCD

• Viewing sensory sensitivities as histrionic or emotionally stunted

• Seeing shutdowns or overwhelm as refusal or sulking

• Labeling stimming as anxiety

• Attributing the realities of neurodivergence to victim mentality or self-pity

• Misdiagnosing black-and-white thinking as borderline personality disorder

• Calling sensitivity to internal bodily experiences hypochondria

• Mistaking autistic burnout for chronic depression

• Writing off irritability due to sensory hyposensitivities as a negative mindset or anger issues

Such misinterpretations can lead to inappropriate interventions and reinforce stigma.

Systemic Issues and the Impact of Masking

Therapeutic approaches that place responsibility solely on the client such as framing the autistic individual as the "problem" fail to address systemic barriers. This can result in autistic clients feeling responsible for others' emotions, which in turn, perpetuates overthinking and isolation. Minimizing or denying the reality of being autistic (e.g., "You're too smart/social/successful to be autistic" or "Everyone is a bit autistic") further invalidates clients' experiences.

Encouraging masking or "pushing through" behaviors can suppress regulatory behaviors like stimming and necessary self-care, leading to burnout, depression, and increased suicidality (Jones, 2024). Therapists must recognize the dangers of masking and support authentic self-expression. 

Recommendations for Practice

To improve outcomes for autistic clients, therapists should:

• Pursue specialized training in autism and neurodiversity

• Adapt sessions for structure, predictability, and sensory needs

• Use concrete language and capitalize on clients' strengths and interests

• Involve family and support systems in therapy

• Avoid neurotypical assumptions and validate autistic experiences

• Recognize and address systemic barriers, not just individual challenges

Conclusion

Addressing barriers to mental health treatment for autistic clients requires systemic change in therapist education, clinical practice, and societal attitudes. By integrating research-based adaptations and fostering genuine understanding, therapists can provide more effective and empathetic care.

References

• Gallant, C., Roudbarani, F., Ibrahim, A., et al. (2023). Clinician Knowledge, Confidence, and Treatment Practices in Their Provision of Psychotherapy to Autistic Youth and Youth with ADHD. Journal of Autism and Developmental Disorders, 53, 4214–4228. https://doi.org/10.1007/s10803-022-05722-9

• Jones, S. (2024). The Autistic Survival Guide to Therapy. Jessica Kingsley Publishers

• Lipinski, S., Boegl, K., Blanke, E. S., Suenkel, U., & Dziobek, I. (2021). A blind spot in mental healthcare? Psychotherapists lack education and expertise for the support of adults on the autism spectrum. Autism, 26(6), 1509-1521. https://doi.org/10.1177/13623613211057973