For a long time, therapy wasn't designed with autistic people in mind.

This isn't surprising given the history. Autism was misunderstood for decades—framed as a childhood disorder, treated primarily through behavioural interventions aimed at making autistic people appear more neurotypical, and rarely considered in the context of adult mental health.

The result: many autistic adults who sought therapy either found it unhelpful, actively harmful, or simply not designed for how their mind works. The model of therapy—sitting opposite someone, maintaining eye contact, navigating subtle social cues, speaking about feelings in linear, verbal ways—can itself feel uncomfortable or inaccessible for some autistic people.

But this is changing. A growing number of therapists now work with an explicitly autism-affirming approach. And for autistic adults dealing with anxiety, depression, burnout, relationship difficulties, or the particular aftermath of late diagnosis, therapy can be genuinely transformative when it's done right.

This guide is for autistic adults—or those recently diagnosed, or those wondering—who want to understand what good autism therapy looks like and how to find it.

TL;DR: Key Takeaways

Autistic adults have high rates of anxiety, depression, and burnout—often shaped by decades of masking and misunderstanding
Autism-affirming therapy accepts autism as a natural human variation, not a problem to fix
Not all therapists have autism-specific training or a genuinely neurodivergent-friendly approach—it's worth asking
Humanistic and person-centred approaches tend to be particularly well-suited to autistic clients due to their non-directive, client-led nature
Late diagnosis brings its own therapeutic territory: grief, relief, identity reconstruction, and renegotiating your history

Mental Health and Autism: Understanding the Landscape

Research consistently shows that autistic adults experience significantly higher rates of mental health difficulties than the general population. Anxiety affects an estimated 40–50% of autistic people; depression is similarly elevated. Burnout—a state of profound exhaustion resulting from sustained masking and adaptation to neurotypical environments—is increasingly recognised as distinct from general burnout and common among autistic adults.

These difficulties are largely understandable in context. Most autistic people have spent years—often decades—in environments that weren't designed for them, using enormous amounts of cognitive and emotional energy to navigate social norms, suppress natural behaviours, and perform neurotypicality. The cumulative cost of this is substantial.

A 2021 study published in Autism found that the majority of autistic adults who had accessed therapy rated it as at least somewhat helpful—but a significant minority found it unhelpful or harmful, particularly when the therapist lacked autism-specific knowledge or when the therapeutic approach was rigid and not adapted to their needs.

This makes the quality of the therapeutic fit especially important.

What Autism-Affirming Therapy Actually Means

The term "autism-affirming" (sometimes also "neurodiversity-affirming") describes an approach that:

Accepts autism as a natural human variation. Not a disorder to be cured, a deficiency to be overcome, or a collection of symptoms to be reduced. The difficulties autistic people face are understood as largely arising from the mismatch between autistic neurology and a predominantly neurotypical world—not from autism itself.

Does not aim to make autistic clients more neurotypical. This sounds obvious, but it has significant clinical implications. A therapist who, consciously or not, frames better eye contact, more conventional social behaviour, or reduced stimming as therapeutic goals is not working affirmingly.

Adapts the therapeutic environment and approach to the client's needs. This might mean: being more explicit and direct in communication, providing more structure or predictability to sessions, accepting non-traditional ways of expressing emotion (talking while pacing, drawing, not making eye contact), or being willing to give clearer psychoeducation rather than only reflective listening.

Takes seriously the role of masking and its cost. Many autistic adults have masked so thoroughly for so long that they've lost contact with their own preferences, needs, and identity. Therapy can offer a space where this performance isn't required—and where the question "who am I without the mask?" can be explored with support.

Expert Perspective: "The greatest service many therapists can offer an autistic client is simple: to be a room where they don't have to perform. For some autistic adults, this is the first such room they've ever had access to. That itself is therapeutic." — Dr Damian Milton, autistic researcher and social theorist, University of Kent

Common Therapeutic Issues for Autistic Adults

Anxiety

Anxiety is the most common presenting issue for autistic adults seeking therapy, and it frequently looks different to anxiety in neurotypical people.

For many autistic clients, anxiety is connected to: uncertainty and unpredictability (difficulty managing unexpected change); sensory overwhelm; fear of social failure or getting things "wrong"; and the constant vigilance required by masking. Some autistic people experience meltdowns or shutdowns in response to high-anxiety situations—and these responses are often deeply shaming, particularly for those who haven't received a diagnosis.

Therapy that's too structured or directive can inadvertently increase anxiety. A more gentle, exploratory approach—where the client leads and the therapist follows rather than imposing an agenda—tends to work better.

Depression and Autistic Burnout

Autistic burnout describes a state of profound exhaustion—physical, emotional, and cognitive—that follows prolonged masking and overextension in neurotypical environments. It's often misdiagnosed as depression, ME/CFS, or burnout in the general sense, because autistic people themselves don't always have the language or self-awareness to identify what's happening.

Recovery from autistic burnout typically involves: reducing masking, reducing demands where possible, increasing rest and recovery, and building environments that are more conducive to autistic flourishing. Therapy can support this by helping clients identify what's depleting them and experiment with more sustainable ways of living.

Late Diagnosis: Renegotiating Your History

Late diagnosis (in adulthood, sometimes in the 30s, 40s, or beyond) is a distinctive therapeutic territory.

The initial response often involves relief—a framework that finally makes sense of decades of experience—followed by something more complex. Grief for the child who struggled without support. Anger at the systems that missed it. A reconstruction of personal history through a different lens: all those situations I found overwhelming, all those relationships that felt confusing, all the masking that exhausted me—now recontextualised.

This identity reconstruction takes time, and it can be destabilising before it's stabilising. Therapy can provide a supportive space for this process—neither rushing through it nor pathologising the difficulty of it.

Relationship Difficulties

Autistic adults often face specific challenges in relationships—both romantic and social. These may include: difficulties reading implicit social cues, different communication styles that create misunderstanding with neurotypical partners, the weight of maintaining a relationship while also masking, and the particular loneliness of social situations that feel performative rather than genuinely connecting.

Therapy can help explore relationship patterns, communication styles, and what authentic connection might look like for the individual—without assuming neurotypical relationship norms as the benchmark.

What to Look for in a Therapist

Autism-Specific Knowledge

A therapist doesn't need to be autistic themselves to work well with autistic clients, but they do need to have developed genuine knowledge of autism—not just the broad strokes, but the nuances that matter clinically. This includes understanding masking, autistic burnout, sensory sensitivities, and the difference between autistic and neurotypical anxiety presentations.

Ask prospective therapists directly:

What experience do they have working with autistic adults?
What training have they done in autism-specific issues?
What's their position on the neurodiversity paradigm vs. medical model of autism?

Their answers will tell you a great deal about whether they'll be a good fit.

Flexible Communication

The best therapists working with autistic clients are willing to adapt their communication style. This might mean:

Being more direct and explicit, less reliant on implicit cues
Allowing silence without interpreting it as resistance
Being clear about the structure and format of sessions
Not insisting on eye contact
Being comfortable with the client moving, stimming, or not sitting in the conventional therapy position
Offering psychoeducation as part of the work—clear explanation of concepts rather than purely reflective listening

A Genuine Non-Directive Approach

Humanistic and person-centred therapy tends to be particularly well-suited to autistic clients for several reasons: the client sets the agenda; the therapist follows rather than leads; there's no assumed goal or destination; and the relationship itself—rather than technique or homework—is the primary vehicle of change.

This approach respects autistic autonomy and doesn't presume to know what the client should want. It also adapts naturally to the client's way of being in the world.

Practical Considerations for Autistic Adults Seeking Therapy

Session Structure and Predictability

Many autistic people benefit from knowing what to expect. It's entirely reasonable to ask a therapist before starting:

What typically happens in a first session?
How do sessions usually begin and end?
What should I do if I feel overwhelmed during a session?
Is it okay to take breaks?

A therapist who is put off by these questions is probably not the right therapist.

Sensory Environment

The physical environment of the therapy room can matter. If you have sensory sensitivities, it's worth asking about: lighting (some therapy rooms use overhead fluorescent lighting that can be uncomfortable), seating options, whether the room is quiet, and whether the building is easy to navigate without high levels of sensory input.

Online vs. In-Person

Online therapy has particular advantages for some autistic clients: the familiarity and comfort of your own environment, the ability to control sensory input, and the reduced demand of managing a journey and a new physical space. For others, the ambiguity of a video call can be its own challenge.

There's no universal answer. It's worth trying both—or having an honest conversation with a prospective therapist about what tends to work for you.

Finding an Autism-Affirming Therapist in the UK

BACP Directory

Search the BACP's Find a Therapist directory, filtering for therapists who list autism as a specialism. Add a location filter for your area.

Autistica and the National Autistic Society

Both organisations maintain resources for autistic adults, including guidance on accessing mental health support and some therapist directories.

Autism-Specific Organisations

Some organisations specialise specifically in neurodiversity-affirming therapy:

Neurodiversity Hub: Directory of neurodiversity-affirming practitioners
Autism & ADHD: Some providers specialise specifically in combined autistic and ADHD presentations

Initial Consultations

Most therapists offer a brief initial consultation (often free, sometimes 15 minutes). Use this to ask your questions, gauge communication style, and assess whether the person seems genuinely at ease with neurodivergent presentations.

FAQs: Therapy for Autistic Adults

Do I need a formal diagnosis before accessing therapy? No. Many therapists work with clients who self-identify as autistic or who are in the process of seeking diagnosis. The NHS diagnostic pathway has significant waiting times (often two or more years), and a formal diagnosis is not a prerequisite for accessing therapeutic support.

What if I've had bad experiences with therapy before? This is very common among autistic adults, particularly those who encountered therapy before their diagnosis or before they had language for their experience. It's worth being explicit with a new therapist about your previous experiences—including specifically what felt unhelpful or uncomfortable—so they can adapt their approach accordingly.

Can therapy help with autistic burnout specifically? Yes, though it works alongside, not instead of, practical changes. Recovery from autistic burnout typically requires reducing demands on the system; therapy can support the self-understanding and decision-making that makes this possible, and provide a space to explore identity and needs without performance.

Is CBT useful for autistic adults? Standard CBT was not designed with autistic neurology in mind, and some elements (the assumption that thoughts drive emotions in a straightforwardly linear way, the reliance on homework and structured techniques) don't always translate well. Adapted CBT for autism exists and can be useful for specific symptom-focused work. For broader exploration of identity, burnout, and emotional wellbeing, humanistic approaches tend to fit better.

Annabel is a BACP-registered integrative counsellor working with autistic adults and late-diagnosed individuals in Fulham, SW London, and online. She has particular experience with anxiety, autistic burnout, and post-diagnosis identity work. Book a free 15-minute consultation to discuss whether working together might be helpful.

Autism and Therapy: Finding the Right Counselling Support as an Autistic Adult