What is Autistic-Centered Therapy?

One of the biggest problems facing autistic people, when seeking mental health treatment, is a mismatch between neurology and therapy modalities. Everyone needs whatever therapy works best for their particular brain.

I’m autistic, and I specialize in Autistic-Centered Therapy (AuCT). AuCT is basically equal parts trauma work, advocacy work, autistic interpersonal therapy, and automotive maintenance.

To do effective therapy with autistic people, you must first recognize that most autistic people have some rejection sensitivity and demand avoidance due to a lifetime of feeling othered. Because of this, there's an impediment to forming healthy relationships, there's a lot of self-doubt, and there's a lot of internalized ableism that must be addressed. If an autistic person doesn’t have all this, that's great! But, they're also probably not seeking therapy, so those healthy autistic people aren't a focus here.

Due to the otheredness, there's often complex trauma that must be addressed. There's a lot of processing the trauma, working on healthy AUTISTIC coping skills, finding methods of self-care, and encouraging natural autistic relationship building. This one is tricky. Autistic interpersonal therapy (in my experience) can only be done well if the therapist is also autistic.

There's lots of research to suggest a major difference in cross-neurotype communication vs. same-neurotype communication, and I've found that autistic/autistic communication has an electric vibe to it that autistic/allistic communication just doesn't have. We infodump, we go off on tangents, we get super excited about Special Interests (SPINs), and it's healthy to potentially spend a half hour talking about the your research on trees, or bugs, or your favorite book series, because these are all important to you.

I am restating this here in a separate paragraph. The client's SPINs are IMPORTANT to the client.This cannot be overstated. SPINs are the vehicle by which the client can engage in meditation and healing. Allistics (people who are not autistic) tend to see SPINs as obsessions and think of them as an unhealthy focus, but this is what brings us joy. A lot of autistic trauma comes from allistics telling us that our interests don't matter. But, to an autistic person, our SPINs are an inseparable part of our identity. We ARE what we love. To accept us is to accept our SPINs. An allistic may not understand an autistic’s SPINs, but the allistic MUST accept them and be enthusiastic in learning about them. That enthusiasm helps us bond socially in an autistic way, and that is a big part of autistic interpersonal therapy.

Once you have this bond, you can work on overcoming trauma. You can address past issues where you were hurt due to a lack of bond. You can address betrayals or perception of betrayals. You can work on healthy coping mechanisms.

This is where the automotive maintenance part comes in. Think of driving a car that has a manual transmission and no dashboard. That's the autistic life. Due to our interoceptive difficulties, we often don't know if we're hungry, or full, or thirsty, or sleepy, or have to go to the bathroom, or sad, or depressed, or angry. We just know that the car isn't running. This leads to meltdowns and shutdowns and avoidance of a lot of things. As autistic people, we MUST work on developing a maintenance schedule that works for us. We have to schedule time to eat and drink, we have to schedule bathroom breaks, we have to schedule sleeping (I'm bad about that one). We have to periodically check in with ourselves and do some biofeedback and say "Ah, I'm jittery. Do I need food now? Am I frustrated? Why is this happening?" There are apps that help us do this, but it all takes practice because no one taught us that this is necessary.

That's part of being autistic in an allistic world. We're educated in math and science and reading, but we're not educated in how to work our meat-suits. Allistic kids (figuratively) got a manual at birth of how to maintain and operate their meat bodies, how to interact with others, and how to be successful. Nobody teaches us autistics how to do these things, and we often need to do a LOT of research just to get to the same place that allistic kids reach naturally. It takes effort and energy on our part, and that's a lot of energy that has to be taken from somewhere else. Our world is harder than the world experienced by neurotypical people, and this MUST be acknowledged.

That's where advocacy work comes in. We must educate the world about us. We must fight for autistic rights. We need to abolish Applied Behavior Analysis (ABA) and other harmful practices against our people. We need equity. We need understanding. Fighting for these things (while exhausting) helps us reclaim our power and identity, and validates our life experiences. In doing so, we find other autistic people who may be suffering under the belief that they're just unsuccessfully allistic. In doing so, we promote education and understanding and healthy autistic identities, and by helping to heal others, we heal ourselves.

So, it's a lot, but it's necessary. When working with an autistic client, the therapist MUST avoid therapy cliches like "How does that make you feel?" or "Where are you feeling that?" because we don't know. Work on solution-focused strategies. Work on breaking down impossible tasks to manageable pieces of tasks. Be prepared for the occasional text of horrified self-doubt that's just asking for some reassurance or body-doubling. Recognize that we are incredibly precise in our language, and that things must be communicated as such. Also recognize that we've been hurt by people quite a bit, and ANY pain that is accidentally inflicted by a professional hurts us tenfold.

This is the world of AuCT. If you’d like to know more, send me an email!

Matt Lowry, LPP