Being an autistic therapist
It is a strange thing to describe yourself as an autistic psychotherapist. For so many people, autism is associated with deficits in communication, in understanding, and in empathy. If you look at the psychiatric diagnosis laid out in the DSM-5, it characterises autism as involving a “persistent deficits in social communication and social interactions” (American Psychiatric Association, 2013, p. 31). This locates any difficulties firmly within the autistic person. It’s the autistic person who can’t empathise, can’t put themselves in the others’ shoes, can’t understand the minds of others. This is called Theory of Mind (ToM) in psychology, and the idea that autistic people have deficits in ToM persists in the current understandings.
As a person-centred psychotherapist, empathy is my bread-and-butter. It is key to my belief in what it is that makes therapy work. My main aim, when I’m with clients, is to work hard to understand their world through their unique perspective, with an accepting and non-judgemental attitude. It’s one of Carl Rogers’ therapeutic conditions, the founder of the person-centred approach. He described therapist empathy as “to sense the client’s private world as if it were your own” (Rogers, 1967, p. 284). Contemporary research (such as that described in Browne et al, 2021), has shown that empathy has a significant relationship with client outcomes, and that the therapist’s empathic understanding is one of the key predictors of client outcomes, no matter what type of therapy the counsellor is offering.
So how can I reconcile my beliefs in the importance of empathy, with my autism? I thought autistic people couldn’t empathise? These were the questions I was asking myself a few years ago when I started to realise I might be autistic.
Like many late-diagnosed autistic people, the first step on my journey of realisation was to voraciously consume anything and everything I could about what autism was, trying to work out if it felt like a fit for me. This included both ideas from traditional psychiatric diagnosis, as well as ideas from autistic people themselves – ideas which I would now make sense of as being ‘neurodiversity-affirming’.
I read academic research papers, such as Gernsbacher & Yergeau (2019), who reviewed a large amount of evidence, and found that it failed to support the claim that autistic people lack ToM, or even that all autistic people have a similar universal impairment. Brett et al (2024) found that some autistic individuals had reduced empathy, but there was a greater heterogeneity of empathy in the autism sample, so these differences are not generalisable. Kimber et al (2023) also found heterogeneity in the abilities of autistic people to empathise.
I also watched countless TikToks, as the algorithm realised I was interested in grassroots takes from autistic people describing their experiences. I now understand that there is a huge variety in autistic experiences of empathy – ranging from a lack of empathy, through empathy as an effortful possibility, all the way to hyper-empathy.
Gradually I began to see that my own previous understanding of what exactly autism is, had been wrong. I started to become able to shake off my internalised ableism and develop a more nuanced picture of the relationship between autism and empathy, and now I am confident and sure in my identity as an autistic person with a good capacity for empathy and ToM. As my self-understanding grew, so too did my self-acceptance.
But translating that into feeling safe to disclose my identity to my professional peers and colleagues is an ongoing process. I have felt worried about the stigma of ‘outing myself’ as autistic. The first step was to write a short article in the New Psychotherapist – a professional magazine for members of the UKCP (UK Council for Psychotherapy). That felt risky, exposing my autism within a culture that may judge me based on preconceptions. However, I find I feel empowered about my autistic identity, and proud. I can’t control what happens in the minds of others when they hear I’m autistic, and inevitably for some people they will believe that I am unable to empathise, and may question my suitability in this profession. But I know that I’m a good, empathic therapist; and if you ask my clients they would say the same thing.
It feels to me that the conversation is widening around neurodivergence, as awareness grows around what autism is and how it affects a wider range of people than the stereotypes. Marnau (2021) encouraged other autistic counsellors and psychotherapists to come out and be proud of their identity. As that process continues, perhaps people will be able to expand their ideas about what autism is to be more in line with the reality that many autistic people know is true. I believe there are many autistic therapists out there, quietly doing effective work with clients, just like me.
References
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th Ed) (DSM-5). USA: American Psychiatric Publishing.
Brett, J. D., Preece, D. A., Becerra, R., Whitehouse, A., & Maybery, M. T. (2024). Empathy and Autism: Establishing the Structure and Different Manifestations of Empathy in Autistic Individuals Using the Perth Empathy Scale. Journal of Autism and Developmental Disorders, 1-12 https://doi.org/10.1007/s10803-024-06491-3
Browne, J., Cather, C., & Mueser, K. (2021, February 23). Common Factors in Psychotherapy. Oxford Research Encyclopedia of Psychology. Retrieved 10 Oct. 2024, from https://oxfordre.com/psychology/view/10.1093/acrefore/9780190236557.001.0001/acrefore-9780190236557-e-79
Gernsbacher, M. A., & Yergeau, M. (2019). Empirical failures of the claim that autistic people lack a theory of mind. Archives of Scientific Psychology, 7(1), 102–118. https://doi.org/10.1037/arc0000067
Kimber, L., Verrier, D., & Connolly, S. (2023). Autistic people's experience of empathy and the autistic empathy deficit narrative. Autism in Adulthood, 6(3). https://doi.org/10.1089/aut.2023.0001
Marnau, M. (2021). Coming out as an autistic therapist. Therapy Today, 32(1), 26-29, https://www.bacp.co.uk/bacp-journals/therapy-today/2021/february-2021/articles/coming-out-as-an-autistic-therapist/
Rogers, C. (1967). On Becoming a Person, (1st ed.). Constable.