Mental Health

Make Therapy Autism-Friendly

…and it needs to start with increasing therapists’ awareness.

This blog was supposed to come out sooner, but I was having mental health challenges at the beginning of this month. Combine that with doing the end-of-semester tasks and this meant no blog post.

So this kind of was inspired by a sentence made in my DBT blog post in which I mention that therapy needs to be autism-friendly. I was critiquing the DBT skills program and DBT as a whole in an autistic lens. This is also a good excuse for me to reflect on why most therapists never suspected me to be autistic. Honestly, the main issues with autism and therapy come down to two core issues: 1) therapists’ lack of awareness and 2) people’s desires to fix the person who is different instead of changing the environment.

Issue #1: Lack of Awareness

Cara, therapists are taught about autism. Right? Yes, but they are only taught the basics of autism which mainly deals with the traits and possibly how to get rid of those traits. They’re not taught about how traits can present in some people who are assigned female at birth or how social conditioning in AFAB people causes them to mask traits. They are only shown studies involving boys or aren’t taught how anyone who doesn’t show the typical male autistic traits can still be autistic. They aren’t taught the strengths that come with autism, but only the challenges. Their professors may cite Autism Speaks as a credible source. Due to this lack of awareness, they might not be taught about the autism SPECTRUM and just only think autistic people are all just “groaning hand flappers”. Parents of autistic children are told “Your child will never do this or can never do that”. Some therapists may not continue their education to learn new therapy techniques or update their knowledge on a particular therapy issue.

My solution: Continuing education about autism, with a strong preference for using autistic sources. Many therapists are required to get continuing education points based on their certification, but how many of them go for the source of easy points or go to the same topic over and over again? How many of the workshops that give continuing education points are about autism? Do those workshops feature autistic people, who are the “true experts” in autism? Are therapists taking the time to read and learn about autism without doing it for the sake of getting continuing education points? Finally, are those sources contributing to harm in autistic people?

Issue #2: Fixing the Problem Person Instead of Changing the Environment or Teaching Coping Strategies

We teach kids to be nice to or include people who are different from us, yet parents and professionals want children to be normal. People cite the medical model in a similar way: this is what’s wrong with the person and it MUST be fixed. While I see some issues with the social model of disability and the neurodiversity movement, it mainly cites that we need to change the environment to be welcoming and to focus on their strength. I DO believe in focusing more on the strengths instead of challenges to decrease stigma.

When I was seeing my second therapist in 2014, she noticed I had issues with eye contact and she made me make eye contact with her whenever I was talking. This is why I’m pretty good at eye contact on a good day. She saw a problem that needed to be fixed, so she did.

So why do I have both “change the environment” AND “teach coping skills”? Realistically, changing the environment may not be possible. In the US, less than 2% of children are DIAGNOSED as autistic. If the numbers are similar with people diagnosed as adults, we make a very small percentage of the population. People don’t seem to want to work to accommodate a very small population so we’re expected to deal with it.

My solutions: Instead of thinking “Why do we have to accommodate such a small percentage?”, think “What can I do to ensure that everyone can be successful?” Figure out what environmental changes will help the autistic person and see if that’s possible as realistically, some venues may not allow a host to reduce sensory input. In the event the environment can’t be changed, the autistic person will need to learn some coping strategies. These can include finding a place designated for the autistic person to go to so they won’t experience sensory overload, having something to wear to reduce visual or auditory sensory input, or fidget toys to help with self-regulation. For example, I have an infinity cube to help me cope in social environments. A person on a Discord server I’m a part of wore sunglasses at their grandmother’s house because of very bright lights. Autistic YouTuber Purple Ella has a room she goes into to relax her in social situations and a secret phrase that cues her husband that it’s time to go. Do not force eye contact, but instead make sure we’re attentive. Don’t discourage stims that don’t cause harm to oneself or others. When I stim at home, I use my hands. I may have my arms to the sides and flap my hands with my fingers pointing downwards or I may flap one or both hands while having my fists partially clenched. Stimming helps with self-regulation and taking away the ability to self-regulate causes mental health issues and meltdowns.

What other solutions do you have to these issues of why therapy isn’t autism-friendly?


Hold On a Little Longer: Graduation Update

I was supposed to graduate this month. However, due to project delays that are not my fault, I will need to continue next semester and will now be graduating in May 2022.

I am coping okay with this as this was something that I was suspecting would happen. I had made peace with this possibility. I feel okay about this because my walk across the stage date was going to be May 2022 anyways. What bothers me is that it’s taking me four years to get a Master’s degree which is supposed to be 2 years (or 3 years for part-time schooling), so it took me just as long to get a Master’s degree as it takes to get a Bachelor’s degree.

I know I have a disability and that it can take me longer to do things than a typical person. I finished my Bachelor’s degree in 4 years despite challenges with academics in university so my then-undiagnosed disability wasn’t a significant enough challenge to have to stay in school longer.

It’s really starting to affect my mental health and I worry that I’ll be slipping into old negative behaviors and dangerous thoughts. I have therapy on Monday so I can process it with my therapist then. I feel a depression coming on, which makes no sense as I expected this to happen.

I know I’m not supposed to care what other people think, but some autistic people (especially autistic women) do care what other people think. I’ve gotten so much judgment for being in grad school for more than two years and having to stay another semester longer is going to cause more judgment and having me question if I should have gone through with this.

I’m scared that my thoughts are about to turn dangerous and I know I can’t call for help because I know what emergency service workers do to black people with mental health crises.