Improving Therapy for Autistic Adults: Literature Analysis and Adaptations to Neurotypical Therapeutic Practices
Disclaimers:
Land Acknowledgment: We live and work on the unseated territories of the Wahpekute and Chumash peoples, we pay respects to their elders past and present. We encourage folks to explore the ancestral lands they live and work on, and to learn about the Native communities that live there, the treaties that have been broken. If folks feel called, we encourage them to consider taking actions to support Native communities, reparations, and land back movements (see other resources at the end for more info).
A note on language: The language in the DSM, including the use of the word disorder (D in acronym), some find this harmful, while others prefer the language “disorder.” When this language is used, it is because, as mental health professionals, we need to use this same language when referring to “diagnoses” in the DSM. In addition some Autistics find the use of the level system helpful in identifying the level of support needed, while others view it as an overly simplistic way of defining something that’s fluid, and may feel it’s harmful and minimizing. The beauty is that each individual gets to choose what language feels validating and affirming to them. Inspired by Dr. Jennifer Mullan, we use the term, “therapy participant” rather than “client” or “patient,” as we work toward decolonizing therapy.
Educational Purposes: The information presented here is for educational purposes, and not meant to diagnose, treat or cure medical conditions or challenges, including neurodivergence (including mental health challenges), or physical health.
Have You Been Wondering: Is CBT bad for Autistic People?
Are you an Autistic adult who has faced barriers to accessing mental health care? Have you struggled to find a therapist who truly understands you? Or perhaps you've felt that therapy often seems rigid or doesn't fit your needs, leaving you feeling anxious or overwhelmed? Maybe you've even questioned whether therapy is the right fit for you at all?
In today's discussion, we'll explore the unique challenges Autistic folks face when it comes to therapy. We'll look at the barriers to care, co-occurring mental health (MH) conditions, and suggest ways to adapt therapy to better meet the needs of neurodivergent (ND) clients. In doing so, we'll highlight the insights of recent studies examining Autistic adults' perspectives on therapy and adaptations that can improve the therapeutic process.
Co-Occurring MH Conditions, Barriers to Care, and Poor Past MH Care Experiences—
Autistic individuals are at an increased risk for co-occurring mental health conditions, such as depression and anxiety (Pappagianopoulos et al., 2024; Paynter et al., 2025). This heightened risk can significantly impact their quality of life and daily functioning, which may be further exacerbated by the substantial barriers they face in accessing mental health care (Pappagianopoulos et al., 2024; Paynter et al., 2025). These barriers include services being designed around neurotypical norms, clinicians’ lack of awareness, stereotyping, and resistance to adapting services to meet the needs of Autistic folks (Paynter et al., 2025). There are also distinct differences in the therapeutic environment for Autists, including communication styles, emotional expression and identification, thinking patterns, and sensory processing (Paynter et al., 2025). These differences may place Autistic people at a higher risk for developing mental health conditions, as factors like emotional regulation difficulties, intolerance of uncertainty, and sensory processing challenges have been linked to vulnerabilities in mood and anxiety disorders (Conner et al., 2022; Glod et al., 2015; Jenkinson et al., 2020; Paynter et al., 2025).
Beyond co-occurring mental health conditions and barriers to care, Autistic folks often experience negative interactions with healthcare professionals (Marco et al., 2025). For instance, participants in Marco et al.'s (2025) study reported that clinicians were often inadequately trained in neurodivergence and in understanding the individual needs of their neurodivergent clients. Autistic adults also highlighted challenges like stigma, social isolation, and anxiety as issues frequently overlooked by healthcare providers (Marco et al., 2024). Autistic adults experience significant unmet mental health needs, underscoring the need for both increased access to services and improved quality of care (Pappagianopoulos et al., 2024).
This highlights a gap in the literature regarding Autistic adults’ perspectives on how therapy could be improved, as well as how helpful they find different therapeutic approaches (Paynter et al., 2025). While research has explored potential therapy adaptations, much of this has been from the clinicians’ perspective (Cooper et al., 2018). In response, researchers (Marco et al., 2025; Pappagianopoulos et al., 2024; Paynter et al., 2025) sought to examine Autistic adults’ perspectives on their past mental health experiences and the adaptations to therapy previously suggested by clinicians (Cooper et al., 2018).
Research Findings – Suggested Adaptations to Therapy
The recent study by Paynter et al. (2025) examined 55 adaptations to therapy, with the overarching areas including communication; information; modality; neurodiversity-affirming; sensory; techniques; and visuals. Overall, Paynter et al. (2025) found positive ratings of helpfulness for around half of the adaptations, though there was significant variability in each individual's ratings of the adaptations.
That being said, the most helpful therapy adaptation category was that of neurodiversity-affirming practices.
These practices were rated the highest, particularly among participants with a formal diagnosis (compared to those with self-identified diagnoses; Paynter et al., 2025). The second most helpful category was "information," which involved providing details about the therapy session ahead of time (Paynter et al., 2025). This advance notice helps mitigate uncertainty, a factor that can increase anxiety for Autistic clients (Paynter et al., 2025). It is important to note that Paynter et al. (2025) found that no single adaptation was universally endorsed by Autistic participants. However, this reflects the non-universal nature of mental health care and the differing experiences of individuals, even those with similar diagnoses.
The diversity of responses aligns with previous research from clinicians, which found that a combination of recommended adaptations was most effective (Cooper et al., 2018). These findings underscore the importance of not assuming that any one adaptation will apply to all Autistic clients, highlighting the need for individualized preferences and priorities.
Similarly, Pappagianopoulos et al. (2024) found that Autistic adults preferred a therapeutic approach that is flexible, collaborative, and responsive to individual needs. Participants emphasized the importance of clinicians considering their clients' preferences regarding communication and sensory needs, as this can improve the productivity of the sessions (Pappagianopoulos et al., 2024). Regarding sensory needs, participants highlighted the value of fidget toys or the ability to move or walk around during sessions, particularly for those with co-occurring ADHD (Pappagianopoulos et al., 2024).
Additionally, participants stressed the importance of a non-judgmental and person-centered approach to therapy, which helps individuals who may have previously felt misunderstood by their therapists (Pappagianopoulos et al., 2024). Consistency was also key, with many participants noting that having therapy scheduled at the same time and day each week was beneficial (Pappagianopoulos et al., 2024).
Marco et al. (2025) also identified several themes and subthemes based on participant data regarding previous mental health care experiences, which further emphasizes the aforementioned points discussed by Pappagianopoulos et al. (2024) and Paynter et al. (2025). Broadly, the themes include: the notion of doing therapy “right;” having had a lack of choice and inflexible therapy models (e.g. only doing CBT); the therapeutic relationship (i.e. needing affirming practices and accommodations); and thinking “what’s the point” of therapy (i.e. need for something tangible or feeling it won’t help; Marco et al., 2025).
Present through all these themes is how the therapist was experienced by the individual, with an emphasis on needing a psychologically safe space without feeling added stress (Marco et al., 2025). To this point, findings suggest the importance of clinicians being explicit and clear with expectations and boundaries, as well as ensuring effective communication with the client (Marco et al., 2025).
Finally, both Pappagianopoulos et al. (2024) and Marco et al. (2025) highlight the importance of therapists receiving more education and training on Autism, ideally taught by Autists. Clinicians need to understand both the hallmark features of Autism and its diverse presentations (e.g., gender differences and differences between children and adults; Pappagianopoulos et al., 2024).
Takeaways:
In summary, the findings of these three recent studies (Marco et al., 2025; Pappagianopoulos et al., 2024; Paynter et al., 2025) highlight the importance of individualized, flexible, and neurodiversity-affirming approaches to therapy for Autistic folks. Paynter et al. (2025) and Pappagianopoulos et al. (2024) emphasize that Autistic clients find therapeutic adaptations most helpful when they align with their specific needs, such as providing session information in advance to reduce uncertainty and anxiety.
These findings also underscore the value of a non-judgmental, person-centered approach and the importance of considering sensory and communication preferences, such as allowing movement or the use of fidget tools. Additionally, there is a clear need for therapists to be better trained in understanding the diverse presentations of Autism, with both Pappagianopoulos et al. (2024) and Marco et al. (2025) stressing that education from neurodivergent individuals can help clinicians better serve Autistic clients.
Ultimately, these studies emphasize that therapy should not be one-size-fits-all, as Autistic individuals have diverse experiences and preferences that must be respected to improve mental health outcomes.
If you have faced barriers to mental health care, have been searching for neurodiversity-affirming clinicians, or would like to see if therapy is for you, Neuron & Rose is here to help! We offer a wide range of neuroaffirming services, ranging from psychological assessments to therapy. If you’re neurodivergent and looking for therapy or an assessment from a clinician who truly gets you, follow this link to get started with us and we’ll match you up with the best fit clinician in our practice for you.
Land acknowledgement Resources: Support starts with educating yourself about history, and being willing to sit with uncomfortable truths. It can then include things like: learning about cultural appropriation, and commit to not engaging in and perpetuating cultural appropriation; committing to calling people in to conversations; educating others, honoring Native folks on holidays such as Indigenous People’s Day, considering the implications of celebrating holidays such as Thanksgiving, or the Fourth of July; making land acknowledgements, (to find out whose land you’re on, head here), having conversations with people about what you learn; financial support; uplifting and amplifying Native voices and stories; understanding and supporting Land Back efforts; researching and supporting Native causes, including supporting and advocating Native-led for legislation changes. Some options for financial support of Native communities on Wahpekute land are here, here, here, here, here or here; Chumash land here; National.
References
Conner, C. M., Kim, P. S., White, S. W., & Mazefsky, C. A. (2022). The role of emotion dysregulation and intolerance of uncertainty in autism: Transdiagnostic factors influencing co-occurring conditions. Research in Developmental Disabilities, 130, Article 104332. https://doi.org/10.1016/j.ridd.2022.10433
Cooper, K., Loades, M. E., & Russell, A. (2018). Adapting psychological therapies for autism. Research in Autism Spectrum Disorders, 45, 43–50. https://doi.org/10.1016/j.rasd.2017.11.002
Glod, M., Riby, D. M., Honey, E., & Rodgers, J. (2015). Psychological correlates of sensory processing patterns in individuals with autism spectrum disorder: A systematic review. Review Journal of Autism and Developmental Disorders, 2(2), 199–221. https://doi.org/10.1007/s40489-015-0047-8
Hollocks, M. J., Lerh, J. W., Magiati, I., Meiser- Stedman, R., & Brugha, T.S. (2019). Anxiety and depression in adults with autism spectrum disorder: A systematic review and meta-analysis. Psychological Medicine, 49(4), 559–572.
Jadav, N., & Bal, V. H. (2022). Associations between co- occurring conditions and age of autism diagnosis: Implications for mental health training and adult autism research. Autism Research, 15(11), 2112–2125.
Jenkinson, R., Milne, E., & Thompson, A. (2020). The relationship between intolerance of uncertainty and anxiety in autism: A systematic literature review and meta-analysis. Autism, 24(8), 1933–1944. https://doi.org/10.1177/1362361320932437
Marco, D.D., Wood, P., Troop, N. (2025). They say we’re the rigid ones: A reflexive thematic analysis of autistic adults’ experiences of psychological therapies. Counseling and Psychotherapy Research. https://doi.org/10.1002/capr.12902
Pappagianopoulos, J., Brunt, S., Smith, J.V., Menezes, M., Howard, Mya., Sadikova, E., Burroughs, C., Mazurek, M.O. (2024). ‘Therapy through the lens of autism’: Qualitative exploration of autistic adults' therapy experiences.
Paynter, J., Sommer, K., Cook, A. (2025). How can we make therapy better for autistic adults? Autistic adults’ ratings of helpfulness of adaptations to therapy. Autism. https://journals.sagepub.com/doi/10.1177/13623613251313569
