A mental health therapist recently asked autistic people for advice about working with autistic clients. There were many helpful replies, and I added to them. She was already humble and anti-ableist in her engagement, so I could skip those foundational requirements. This post is based on my reply, and I will update it over time and add more detail including relevant links.
Working with nonspeaking clients
If you want to work with nonspeaking autistic people in the field of psychology, you may want to do some of the following things:
Understand that the diagnostic criteria for autism are really messed up.
Watch Damon Kirsebom’s video on reframing severe autism.
Learn about regulation and how to be a good regulation partner — more about this soon.
Watch Noah Seback’s presentation on adapting counselling services to suit nonspeakers.
Now, for working with any autists: Get advice from systems (those with multiple people/parts in one body) about how to recognise and deal with autistic clients who have cPTSD and Dissociative Identity Disorder, including those not yet diagnosed. Trauma is big. Dissociative disorders are common. It may be safe to say that any autistic person who approaches you or is sent to you for therapy has experienced trauma (often repeatedly). Their trauma responses will often have been misunderstood and punished (or at the very least, treated inappropriately). It’s not all just about being ‘wired for anxiety’.
Health issues that affect coping
Learn about the Chronic Constellation associated with EDS.
Learn about craniocervical instability and its downstream effects and how they relate to the Chronic Constellation.
Learn about and the electrolyte dysregulation in sensory overload and why some medications frequently prescribed to autistic people can make this worse.
Learn about PANS and PANDAS (the P is misleading — this can persist in adulthood).
Oh, and learning about some genes like COMT, DAO and MTHFR could be handy too, and about how certain genes affect certain behavioural phenotypes, such as addictive behaviour. In fact, understand that there may be multiple neurodevelopmental factors, ranging from congenital channelopathies to foetal alcohol syndrome and even heritable gastointestinal issues that may play in on a person’s ability to cope. Too much focus is given to these things by people seeking causes and cures for autism, and too little attention is paid to them when autistic people self-report health problems. Learn about all this so that you won’t treat these things as ‘psychological’ when they are physiological.
Learn to recognise absence seizures. People who have them often don’t realise that’s what they are.
Learn all about the various issues surrounding sleep. For many, this is one area which, if optimised, can provide a good thrust towards all-round improvement in quality of life.
Miscellaneous frayed bits
Here are a few things you may already know — or, I hope you already know, because they are some of the more commonly known things, I am just adding them in for good measure…
You know that even speaking autists struggle with telephones and many speaking autists need AAC, or text-based communication, right? So the idea is to accommodate their communication needs rather than to force them to do it your way?
Optimising natural autistic strategies
You know that stimming helps, and dropping eye contact to be able to focus, and that these natural autistic skills can help people cope, and that late-diagnosed people sometimes have to re-learn them… right?
You know that gender dysphoria is a big thing, don’t you? And that transgender advocacy organisations can help?
You know that mention of food can be a trigger, and that ARFID, anorexia and other eating disorders are quite common?
Executive functioning, dyspraxia and practicals of living
You know that your client may be anxious about how much they have to pay you while their personal money management is abysmal, and besides, they may be poor; and in spite of an IQ in the genius range, they can’t cope with ‘normal’ things like laundry, shopping and dealing with the municipality? Executive functioning is a major struggle for many. Dyspraxia is a common reality. You know that already, from your books, I hope?
You now that many (but not all) autists experience hyperempathy, and they may sense your vibes that you’re trying to hide?
Masking (pretending to be normal) adds to suicide risk in autistic people who can speak. You know that, right? Even researchers know that these days. And you know that depression isn’t the only thing that makes people suicidal?
You know Spoon Theory is helpful, right?
This article is a work in progress. Expect it to change over time.