Square Pegs Don't Fit into Round Holes: What Helps and Hinders in Psychotherapy for Autistic Adults with Co-occurring Mental Health Problems

Abstract

Autistic adults experience disproportionate rates of co-occurring mental health problems. While psychotherapy has been recognized as an appropriate treatment approach for the mental healthproblems experienced by this population, the evidence is still rather limited. Further, the literature is incomplete when it comes to understanding the needs and preferences of autistic adults who receive mental health support in the form of psychotherapy. Given the need to better inform mental health interventions and improve access to mental health services for this population, the current study used qualitative methods to explore critical experiences thatfacilitated or served as barriers to psychotherapy, in the context of receiving this treatment for mental health problems by autistic adults. The Enhanced Critical Incident Technique was used toexplore the subjective experiences of 13 mental health providers who have experience providing psychotherapy to autistic adults with mental health problems, along with the perspectives ofeight autistic adults who have received this type of care. Both groups of participants identified salient experiences that served as barriers to, and facilitators of positive experiences in psychotherapy. Moreover, both mental health providers and autistic adults offered several recommendations, provided through the identification of wish list items, that were believed to enhance experiences in psychotherapy. Together, these perspectives lend towards a more complete understanding of how we can best inform clinical practice when providing psychotherapy for autistic adults with mental health problems. This research highlights challenges to providing psychotherapy to autistic adults whilealso illuminating ways that mental health providers have worked to ameliorate such challenges and create positive experiences in therapy. Additionally, this research sheds light on similaritiesand differences in therapy for autistic adults relative to the general population. The experiences identified by participants in this study demonstrate that positive experiences in therapy are indeed possible when there is a foundation of trust and respect in the therapeutic relationship, providers are knowledgeable about autism spectrum disorder, and treatment is delivered in an individualized fashion. Barriers revealed by participants suggests that there is still substantial room for enhancing mental health care of autistic people. The findings from this research add to the limited literature, while also informing clinical practice for mental health providers, future research, and policy planning.