Seeking therapy: Options and considerations for autistic adults

Prioritizing your mental health

Research shows that over 70% of autistic people are diagnosed with at least one mental health condition. Anxiety and depression lead the list with nearly a quarter of autistic adults diagnosed with one of the conditions – a higher percentage than adults without autism. The good news is society has become better at recognizing and understanding these conditions. Even better, gone are the days where seeking help has a stigma attached to it. Today, therapy is widely accepted and has proven to not only be lifesaving in some situations but worthwhile for almost any autistic adult who is open to it.

When or why might I consider going to therapy?

Some people go to therapy after being diagnosed with a mental health condition. Others have a specific behavior or need support through a challenging short-term period. For others, therapy is a safe space to talk and get support in solving the problems that come up throughout their lives. Even if your only reason for going is because you want to go, that is reason enough.

Here are some situations that might prompt you to check in with a therapist:

You or those around you have noticed signs and symptoms of a mental health condition, like depression or anxiety.
You feel overwhelmed, stressed out or unable to keep up with daily life.
You have sought advice from family or friends about your well-being, relationships or coping strategies, but it hasn’t been enough.
You are using substances or other unhealthy coping mechanisms.
Your relationships are strained, or you feel like you are not able to communicate your wants, needs or feelings to your family and friends.
You feel alone.
You have recently experienced or will soon experience a major change in your life.
You have lost a loved one.
You are experiencing chronic pain or another health condition that impacts your daily life.
You are struggling with sleeping or eating patterns.
You feel like your emotions are out of control.

If you’re thinking about harming yourself, have thoughts of suicide or would like emotional support, the 988 Suicide & Crisis Lifeline network is available 24/7 across the United States. It is free and confidential. Call or text 988 on your phone. Línea de Prevención del Suicidio y Crisis: 1-888-628-9454.

How do I choose the right type of therapy?

Many people think therapy means laying on a couch, talking about their earliest memories. That does exist but it is one of many different therapy options. Certain types of therapy are used for specific conditions, like exposure therapy for anxiety disorders. Other types can help with a wide range of concerns. There are several types of therapy to explore including some common forms:

Cognitive Behavioral Therapy (CBT) is a common type of talk psychotherapy. Working with a therapist you work to identify negative thinking so you can view situations differently and respond to them more effectively. While CBT is not adapted for autism, many autistic people find it useful.
Dialectical behavior therapy (DBT) is similar to CBT. However, DBT focuses more on regulating emotions, being mindful, and accepting uncomfortable thoughts and feelings.
Group Therapy is a form of psychotherapy involving one or more psychologists leading a group of roughly five to 15 patients. Many groups are designed to target a specific problem such as depression, social anxiety, and panic disorders, among others. Some focus more on improving social skills.
Art Therapy is an alternative form of therapy facilitated by a professional art therapist. It is based on the belief that the creative process involved in artistic self-expression helps people to resolve conflicts and problems, develop interpersonal skills, manage behavior and reduce stress, among other benefits. Different mediums are used such as art, dance, music and poetry. It can be done in one-on-one sessions or as part of group therapy.

Many therapists are experienced with more than one approach, and will adapt their approach to each person. Talk to your therapist to figure out what works best for you. Some considerations: Do you prefer a highly structured or more flexible approach? Do you prefer materials, visuals or simply talking? Do you like to set specific goals right away or simply need someone to talk to?

How do I find the right therapist?

Therapy is a personal experience, and it can be a process to find the right person. Before you begin your search, consider some basics. What are your needs and preferences around things like gender, office location or online/telehealth and payment?

If your doctor has recommended you for a certain type of therapy, ask them for referrals. Otherwise, a good place to start searching for someone who meets your key criteria is with your insurance company. You can call member services or use the website to find a list of in-network providers in your area.

You can also search Autism Speaks Resource Guide for therapists by your zip code or use Psychology Today’s Find a Therapist tool, where you can search by location and then refine the search based on issues, insurance, type of therapy, and cost per session, among others.

While these search methods give you a starting point, they don’t usually give you enough information to decide if a therapist is right for you. Many therapists provide their bios on their group practice or personal website. You can get a lot more information this way. One thing to always check: make sure any therapist you consider is trained or certified in the type of therapy you seek.

Keep a list of therapists who seem like they might be a good fit. Then contact each to ask additional questions you have. For example, you might want to ask about the days or times they are available, if they are an LGBTQ ally, for instance, or what experience they have working with autistic people.

Because there are many therapists and types of therapy, it may take time to find your perfect match. But it is worth it. If you don't connect with a therapist, it is okay to let them know. Good therapists will not be offended. They know they cannot help you if you are not comfortable. They may even be able to recommend you to someone else. It is worth asking. And it is worth it to keep searching for a fit.

What about telehealth or online therapy?

Virtual appointments, through telehealth and online therapy, like BetterHelp, have become much more popular and made therapy available to more people. Opting for this could help you avoid long wait lists, transportation issues or scheduling conflicts. Choosing a therapist who will conduct virtual visits could make it easier to find a therapist whose background is a good fit for your needs.

One important consideration in choosing a virtual therapy route is that most therapists who see patients solely this way do not accept insurance. The upside is that their fee per session is typically less than therapists with in-person visits. Additionally, if you do find a therapist conducting virtual visits who does accept insurance, state laws and/or your insurance provider may limit you to seeing one who is licensed or located within your state.

What if I can’t afford therapy?

If you don’t have insurance, look for an outpatient mental health clinic at a local hospital or university where therapists in training see clients under supervision from a qualified, licensed therapist.

Some practices or individual therapists may offer reduced rates for clients who self-pay or a sliding scale based on how much you can afford. Online platforms are usually less expensive per session. Finally, group therapy is usually less expensive than individual sessions.

How do I prepare for my first session?

However you feel going into your first session, it’s okay! "Come as you are" is what therapy is all about. But if you’re feeling nervous, as is common, there are some things you can do before your appointment. You can reach out to your therapist and ask about what you should expect. You can disclose any current diagnosis you feel would be beneficial for the therapist to know, such as autism, if you haven’t done so already. If you are going to an in-person session, you can also ask about accommodations like turning down lights or mention any communication preferences.

At your first session, you may want to ask a support person to come along and sit in the waiting room or even to meet the therapist with you. Your therapist will spend your initial sessions getting to know you. Once you both have an idea of the issues you are dealing with and what you are looking to get out of therapy, you will talk about the right kind of support or treatment path for you.