How can psychologists meet the needs of autistic adults?

Abstract

In a recent editorial, Mandy declared an autism mental health crisis and proposed six ideas for how this might be addressed, with which we agree. However, we propose that for these ideas (e.g. training for mental health professionals) to be implemented for psychologists, assumptions about best practice need to be assessed considering the evolving conceptualisation of autism. The formation and development of a therapeutic alliance between a psychologist and client has been established as an important ‘common factor’ that impacts the efficacy of therapy. If one considers the double empathy problem and views autism through a neurodiversity lens, the development of a therapeutic alliance between a psychologist and client of different neurotypes might require an alternative approach to standard practice. We propose that psychologists (if they are, for example, non-autistic and working with an autistic client), are at risk of misinterpreting their clients’ communication and needs. As such, we consider the notion of cultural competency, and how the profession of psychology can move forward to help psychologists work effectively with autistic clients, learning from autistic people, including autistic psychologists. Lay abstract In a recent editorial, Mandy described an autism mental health crisis because autistic people are more likely to experience mental health concerns, yet they are less likely to get help. When autistic people do seek support, services tend not to be well matched to their needs. Alongside the six ideas Mandy suggested for addressing the mental health crisis, we think it is essential for psychologists to start changing the way they work to improve the person-environment fit for autistic clients. The relationship between a psychologist and their client influences the gains a client makes from engaging in therapy. The way psychologists are trained to build an effective working relationship with clients is based on neurotypical communication styles. The double empathy problem tells us that autistic clients relate to others differently to non-autistic clients, and so we propose that psychologists, especially when not autistic themselves, need to build the therapeutic relationship in a different way. We feel this is important, as the relationship between a psychologist and client is understood to be an important factor in how much the client can benefit from therapy. In this letter, we draw upon Bulluss’ call for cultural competency when working with autistic clients, and further insights from autistic psychologists, and propose that psychologists rethink some taken-for-granted aspects of practice to be better able to create a sense of interpersonal safety when working with autistic clients.