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People often seek out therapy when they are having issues functioning in their daily lives or when they have mental health issues. Women with autism are no exception. We know that women with autism are more likely than other people to have mental health issues such as anxiety and depression1 and that many high functioning autistic women face difficulties in their day-to-day lives.
While therapy can be incredibly useful in helping women to lead fulfilled lives, some traditional forms of therapy can be more difficult for autistic women to engage in.
Some of the problems women may face when accessing non-specialised forms of therapy include:
1. Difficulties with the social aspects of therapy.
Because many women with autism have become so skilled at masking—including masking emotions such as distress and discomfort—they may find it very difficult to reveal what is happening during therapy and it can be difficult for a therapist to “read” their client. Clients may also find it hard to pick up on the social and communication cues their therapists are giving out, including non-verbal communication. This can cause issues with the therapeutic relationship, which is at the core of many approaches underlying psychotherapy.
2. Difficulty understanding and expressing emotions.
Some people believe that people with autism have difficulty experiencing emotions; however, autistic people tend to experience deep and often very intense emotions. They are more likely to have a problem expressing their emotions, though—and there is an overlap between autism and a condition called alexithymia, which refers to an inability to describe emotions felt by oneself and others.2
In addition to this, people with autism often experience a feeling of being so overwhelmed by their emotions that they try to keep a lid on them so that they don’t experience a full-blown meltdown. These problems with being able to get in touch with emotions in a safe way and express them during therapy can present a barrier within the therapeutic context.
3. Looking for a problem in the wrong place.
Psychotherapeutic approaches may attempt to find the root cause of a current problem by looking into your past. It may address problems such as: Do you have social anxiety because you were bullied at school? In fact, if you have autism spectrum disorder, the root cause of your problems may be the way your brain works—as opposed to traumatic experiences in your past.
4. Non-compliance with at-home tasks.
Some of the “homework” which therapists assign to people with autism may prove very difficult for them to complete and there is a high degree of non-compliance from clients. This may be partly because the homework has been set in terms that fail to recognise the needs of autistic people. It may also be because it is simply too difficult for them to complete (partly because distress or confusion from the client were not picked up on during the session).
On the other hand, some therapists and psychologists specialise in therapy for people with autism. The benefits of this include:
1. An understanding of the communication difficulties.
A therapist who specialises in working with adults with autism will be aware of the social and communication difficulties the patient may be facing, which will help overcome some of the barriers present with non-specialist therapists.
2. Focus on strategies.
Therapists who specialise in working with autistic people will utilise the strengths that autistic people have, including focusing on strategies that can be utilised in a variety of situations. Many people with autism respond well to having formulas that they can apply in a variety of situations and CBT-based approaches can be helpful here.
3. Enlist the help of family members.
Your therapist may be more likely to engage your spouse or other family members in your treatment. Neurotypical people may find it very hard to understand what is going on in the mind of someone with autism; thus, incorporating an educational element into the therapeutic process can be useful. It’s essential for women with autism to have the right type of support. Therapy can be considered a partnership between the client, their spouse and/or family member, and the therapist.
4. Visual aids.
People with autism may respond well to a range of visual tools that help them explore and make sense of their issues and potential solutions. Drawing, computer programmes, flow charts, and other means may be employed during sessions.
5. Educational.
Therapeutic approaches that are adapted for people with autism may focus on educating the client about the impact of autism, including how the brain works in certain situations and why someone may experience intense meltdowns and how to deal with them.
6. Focus on learning social cues and interactions.
Approaches such as Applied Behaviour Analysis (ABA) can help people with autism recognise social cues and more subtle forms of communication, as well as learn how to cope with day-to-day demands. This can help people, for example, work out when other people might feel it’s time to move on from a conversation subject or how to engage in a group conversation.
One potential problem of therapies that focus on a person’s autism is that they may fail to address the client in all their complexity and can become too reductive, with a tendency to focus on a person’s autism instead of fully exploring other factors which impact their lives. Angela explained this dilemma when she went to a therapist who specialised in working with adult autistic women. “I did learn some good strategies, but I felt like that’s all our sessions were about. They didn’t seem to give me the chance to look into things deeply enough for me.” For instance, is it enough to simply look at social anxiety as a symptom of autism, or do we need to additionally explore someone’s childhood to see how their beliefs about the world were shaped due to their upbringing?
Therapeutic approaches for women with autism need to be encompassing enough to explore all the factors in their lives which have brought them to this point. For me, when I’m working with women with autism, I adapt my usual way of working, as opposed to adopting a whole different approach.
In addition to being aware of the difficulties in working with and expressing emotions, I’ll perhaps suggest that their spouse sits in on a session or develop a clear strategy for them to express their needs to their spouse. I’ll spend more time helping them clearly write, draw, or otherwise express strategies for dealing with difficult situations. Then, I'll help them identify links between different situations where these strategies can be employed in a more direct manner than I may feel the need for with a neurotypical client. I also spend more time educating my clients about autism and the didactic element of our sessions becomes significant. In the first instance, it is advisable to contact your primary healthcare provider in order to see whether they offer any autism-related services.
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References
1. Bargiela, S, Steward, R, Mandy, W (2016) The experiences of late-diagnosed women with autism spectrum conditions: An investigation of the female autism phenotype. Journal of Autism and Developmental Disorders, 46(10), 3281-3294
2. Hill E, Berthoz S, Frith U (2004). Brief report: cognitive processing of own emotions in individuals with autistic spectrum disorder and in their relatives. Journal of Autism and Developmental Disorders. 34 (2): 229–235
