Therapy for Autistic Adults: What to Expect in Your First Session

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that affects the development of a person’s brain and nervous system. ASD is part of the natural diversity in human brains, traits and behaviors, also called neurodiversity. Autism occurs along a spectrum, and each autistic person may have a very different combination and intensity of autistic characteristics and support needs. In general, when compared to neurotypical peers, autistic individuals typically experience differences in sensory and cognitive processing, social approaches, communication and their relationship to routine and repetition.

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ASD has long been stigmatized and misunderstood, even within the medical community. Often, autism is associated with early childhood, but in reality, it’s a lifelong diagnosis. The CDC estimates that nearly five and a half million US adults are autistic, yet the scarcity of resources for autistic adults is staggering. A 2019 study found that 84% of US counties have no diagnostic resources for autistic individuals of any age, and accessing high-quality mental health services as an autistic adult is notoriously difficult.

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For many autistic adults, this gap in resources can make getting help daunting—but all the more important. Autistic adults are more likely to be diagnosed with a mental illness––between 40 and 50% of autistic individuals have or have had anxiety, and as many as 40% have or have had depression, compared to 18.2% and 21.4% of all US adults, respectively. Even more worrying, 66% of late-diagnosed autistic adults reported experiencing suicidal ideation at some point in their lives. Stigma and a broad social failure to accommodate autistic needs are likely drivers of poorer mental health outcomes among autistic adults.

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Autistic adults can thrive despite adversity, but many of us confront similar challenges and could benefit from support. These can include, but are certainly not limited to:

• Masking and unmasking
• Autistic burnout
• Sensory sensitivity and sensory overload
• Disclosure and accessing support
• For late-diagnosed autistic adults, processing a new diagnosis

So, you’ve found a therapist who works with autistic adults and scheduled your first session. What’s next? 

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Your first session with your therapist will be an opportunity for them to learn about you and what brings you to therapy. It will also be an opportunity for you to get to know your therapist and discuss how they can best support you.

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During your first session, your therapist will work to understand your concerns and get a baseline measure of your mental health and quality of life. They’ll ask questions about your personal and mental health history as well as why you are seeking therapy. They will also discuss your goals for therapy. If you are unsure what goals you want to set, your therapist can help you hone in on them.

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Your therapist may also ask whether you have received a formal autism diagnosis and what support you have received in the past as an autistic person, if any. Prosper Health’s therapists can work with you regardless of whether you have been formally diagnosed. If you want to pursue a diagnosis, a Prosper Health clinician can help you set up a telehealth autism assessment. 

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Your first therapy session is also a chance to learn more about your therapist and their approach. This is a great time to ask any questions about your therapist's experience, style, clinical approaches or beliefs. This can help you confirm whether they’re a good fit for your needs.

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To get the most out of your first session, it’s helpful to think about—and write down—the questions you’d like your therapist to answer. This can help you better understand who your therapist is, their mental healthcare experience and what your work together will look like.

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Identify what you want in a therapist

You may have already considered what’s important to you in a therapist when you were first matched with a provider. However, it can help to come up with questions that help you dive deeper into the things you’d like to know about your therapist. The following are examples of questions you might want to ask in your first session:

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• Can you tell me about your experience working with clients who have had experiences similar to mine?
• What led you to specialize in autism?
• Have you worked with clients of my gender identity/sexual orientation/race/ethnicity/etc before? How have you supported them?
• How would you describe your style as a therapist—gentle, challenging, flexible, agenda-driven, etc.?
• What clinical approaches do you specialize in?
• How long have you been practicing as a therapist?
• What should I expect from a typical session?
• How do you measure progress? How will I know if it’s working?

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Some people may also want to gain a more personal understanding of their therapist based on what is important to them in a therapy relationship. Each therapist may have different boundaries around discussing their personal lives. It’s okay to ask your therapist if they’re comfortable discussing some more personal questions, but know that some therapists may not be willing to answer them. Below are a few examples of questions people sometimes ask about a provider’s personal life and beliefs:

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• Is anyone in your personal life autistic?
• What are your political beliefs?
• Are you religious or spiritual?

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Asking the right questions can help you feel confident about your next steps in therapy. It can also illuminate any immediate misalignment between your needs and your therapist’s approach and experience. However, it can take some time to settle into a therapist-client relationship and get truly comfortable with your therapist. It takes time to build a therapeutic relationship, and it’s normal not to feel 100% all-in right away (for example, I was skeptical of CBT’s efficacy until I found the right therapist). However, you should always feel safe and supported from the beginning.

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Identify your goals and priorities

In addition to identifying what you want to know about your therapist, it’s helpful to spend some time thinking about what you’d like to share with them in your first session. Sometimes, it’s difficult to remember everything you want to discuss in the moment, so it can help to write down a few notes before your session. Some topics you may want to consider are your reasons for seeking therapy, current challenges or any significant events in your personal history.

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In your first therapy session, your therapist will also ask you about your goals for therapy. It’s not always easy to get specific about what you’d like from therapy, and it’s okay if you’re not sure yet. Below are a few questions to get you thinking about your goals, and your therapist can help you continue to think it through. For some people, journaling before your first session can help generate some ideas and narrow your focus. 

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• What are some things in my life right now that I find challenging?
• What are some things in my life right now that I really enjoy?
• When I imagine thriving, what about my life do I imagine being different?
• What do I want to be able to achieve in my life?
• What do I feel is holding me back?
• If you have been to therapy before—how did it go? What would you like to be different this time?

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Your goals and priorities may also change over time. This is a normal part of the therapeutic process, and you can always let your therapist know if you feel your needs are shifting. Your therapist will also periodically check in to assess your progress toward your goals. This is a good opportunity to reflect on whether your treatment goals are serving you.

Neurodiversity-affirming therapy for autistic adults aims to help them develop coping and self-advocacy skills rather than align their behaviors and traits with those of neurotypical people. It prioritizes a strengths-based, flexible and empowering approach.

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Therapists specializing in work with autistic adults are familiar with the challenges common among this group. They are well-prepared to support these individuals through their own unique experiences as well. Neurodiversity-affirming therapy can also treat mental health symptoms that commonly co-occur with autism, like depression, anxiety and social anxiety.

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Therapists who work with autistic adults may employ several clinical approaches, including:

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• Cognitive behavioral therapy (CBT)
• Dialectical behavior therapy (DBT)
• Mindfulness

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Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) is a leading evidence-based approach in psychotherapy, and it is often helpful for autistic individuals. CBT works by helping an individual identify unhelpful patterns of thinking and behaviors. For instance, a person who consistently is hard on themselves and believes they’re a failure can learn to challenge these thoughts and gradually replace them with more supportive alternatives, like “I do the best I can, and that’s enough” or “The things I have accomplished are meaningful.”

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Dialectical behavior therapy

DBT is a form of CBT that focuses on emotional regulation and distress tolerance. Although it was first developed to help individuals with borderline personality disorder, the strategies and tools it incorporates have shown great success in treating individuals with other diagnoses, like  post-traumatic stress disorder, eating disorders or substance use disorders. Many autistic individuals find DBT helpful, particularly if they also experience one of these conditions.

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Mindfulness

Mindfulness approaches can also support autistic adults, especially when integrated with other clinical approaches. Some autistic individuals find mindfulness practices like meditation challenging or stressful, but therapists specializing in autism can adapt these approaches and suggest alternatives that may work better for neurodivergent individuals.

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Sometimes, autistic adults find additional interventions like social skills therapy and sensory integration therapy helpful. However, not all psychotherapists specialize in these methodologies, and some may need to refer patients to a specialist if they are interested in pursuing them.

Ready to get started? Prosper Health can connect you quickly to a therapist who specializes in working with autistic adults, regardless of whether you have received a formal autism diagnosis. After completing the form below, you can self-schedule your first session within days.

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Prosper Health therapists are highly experienced in supporting autistic adults and offer a wide range of approaches and specialties. 80% of Prosper Health’s clinicians either identify as neurodivergent or have someone close to them who is neurodivergent. Therapy with Prosper Health is also conducted completely over telehealth. Prosper accepts most major insurance plans, and 90% of visits are covered by insurance.

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Throughout my therapeutic journey, working with a Prosper Health therapist is the most impactful therapy relationship I’ve had. Over our year together, I’ve made meaningful, measurable progress toward my therapy goals. Plus, I’m not alone—Prosper Health clients report seeing an improvement in their quality of life in as few as four sessions.

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Starting with a new therapist can be intimidating, but Prosper Health’s team is ready to support you every step of the way. Click the link below or give us a call to start today!