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Think You Have No Autistic Clients?

How many of your therapy clients are autistic? And what about your therapist colleagues? Caroline Hearst, who trained as an art psychotherapist and now works as an autism acceptance educator, suggests the numbers are far higher than we think. To mark World Autism Awareness Day, the founder of Autism Matters talks training gaps, internalised oppression, and the dangers of assuming neurotypicality and pathologising autism.


I’d like have a short chat about something I think is hiding in plain sight, namely the number of autistic therapists and psychologists, as well as the many unidentified autistic therapy clients. In case you think this is going to be irrelevant to you, as you have only one autistic client and not a single autistic colleague, let me give you a couple of reasons why I think this is unlikely.

It is now accepted that many people who train as therapists do so in response to their own issues. What greater issue could there be than constantly feeling like an outsider and struggling to understand why other people behave as they do? This is the experience of most autistic people due to our atypical brain wiring and development. We want to learn about psychology because we desperately wish to understand why we seem to be constantly failing to connect well with other humans, despite being very able in other areas.

Due to the stigma attached to autism and the abundance of myths and misunderstandings about the condition, there is a lot of internalised oppression amongst autistic people. Although autistic people struggle socially and have problems mentalising, many of us are highly attuned to the feelings of others. Being a therapist is a good fit as it enables us to feel socially acceptable and useful while earning a living. Having contact with other humans in a highly structured way enables us to sidestep our inability to connect in unstructured social environments. I have had many therapists confide in me that they are aware they are autistic but they don’t feel able to disclose this to colleagues or clients.

When offering CPD to therapists, I sometimes feel the need to issue a health warning – “if you recognise the traits I’m describing and think you might be autistic, you might right”. I say this as a result of many experiences of people coming up to me in breaks with a horrified look on their faces saying, “I do x, y and z, do you think I’m autistic?” I used to reassure such people saying, “Well you know how doctors when they are learning about new conditions often think they recognise the symptoms in themselves…” But I realised that by doing this I was colluding with a stigmatising and negative view of autism. I have never taught a course without there being at least one person who identified themselves, or who I identified, as likely to be autistic.

I know from experience, having trained as an art psychotherapist and being a client of various therapists, that autism is either not well covered or not covered at all in therapy trainings. This leaves many therapists in the same position as the general public in terms of their knowledge of autism being absorbed from media tropes. Autism is a complex condition and those previously considered experts are now getting used to having their views contested by emerging autistic communities. However, it is something generalist therapists need to know about because they can damage autistic clients if they are unable to recognise autism and therefore make incorrect assumptions about their clients.

Therapists no longer assume heterosexuality and pathologise homosexuality, however it is not unusual for therapists to assume neurotypicality and pathologise autism. At the end of one of my courses, a concerned woman came up to me and said, I have a client who is just as you described, but she’s not autistic". I asked how the therapist knew this, and we both laughed at how deep the assumptions about the visibility and presentation of autism were. Despite having her client’s issues described in detail, it was too difficult for this well-intentioned woman to imagine that someone she knew and liked could be autistic.

In case this has you concerned about labelling, I will finish with my favourite quote on this issue:

“Diagnoses are often thought of as labels but they could also be considered as signposts. Signposts do something more than labels – they help people find their way on a journey” (Ava Ruth Baker, ‘Identifying AS: what does it matter?’, conference presentation, 2008).

Caroline Hearst is the founder of Autism Matters, which offers autism awareness courses and talks, as well as onsite training for therapists and employers.  Caroline is also the founder and a director of AutAngel, a community interest company run by and for autistic adults.


Caroline Hearst

Caroline Hearst trained as an art psychotherapist and self-identified and achieved a diagnosis of autism in adulthood after years of personal therapy. Caroline credits her discovery that she is autistic with enabling her to understand herself and transform her life. Caroline now works at Autism Matters an autism educator offering CPD and consultations to therapists. She is particularly passionate about helping autistic adults and health and social practitioners to identify and understand autism, and received a 2017 Winston Churchill Memorial Trust Fellowship to look at autistic peer support and co-produced research. Caroline is also the founder and a director of AutAngel, a community interest company run by and for autistic adults. In this capacity she edited ‘Being Autistic’ and developed ‘Exploring Being Autistic’, an innovative post identification peer support programme which has been positively evaluated by Dr Laura Crane of CRAE.

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