Autistic people can benefit from therapy.
There is a common belief that autistic people are not able to benefit from therapy. There may be a decision not to offer a person therapy “because they are autistic”. Autistic people can and do succeed in therapy, if the therapist makes reasonable adjustments that take into account the way autism affects the person they are working with.
Accessibility and information
Make your service as accessible as possible. Offer email contact or letters as an alternative to telephone calls. Some autistic people can find telephone calls difficult. Always ask what the person prefers.
Provide photos of the building and room in advance.
If it is helpful, speak to the person before the appointment.
Some autistic people find it very difficult coming to a new place and meeting unfamiliar people. A little bit of preparation beforehand can help avoid a person being so anxious they cannot attend.
Give as much information as possible in advance – how long the appointment will last, who will be there, what to do on arrival, what will happen, and so on.
Environment
Be aware of lighting, noise (such as a ticking clock), cluttered walls, temperature, etc. All these may be uncomfortable or distracting for someone who is autistic. Always ask the person if there is anything you can do to make the room more comfortable e.g. turn off lights, open or close windows.
Patterns can be quite distracting for autistic people. Be aware of carpets, curtains, and what you are wearing!
Waiting rooms can be busy places. Give the person the option of waiting somewhere quiet or even outside. A staggered start time e.g 10:15 instead of 10am may mean the waiting room is less busy.
Be on time
Stick to the appointment start and finish time.
If things are running late be sure to tell the person exactly how long they can expect to be kept waiting. Do not say five minutes if it is going to be ten. This will increase the person’s anxiety.
Shaking hands with others may feel uncomfortable to someone with autism so do not assume this is expected or wanted.
Explicitly give the person permission to not make eye contact. This can be very uncomfortable for some people with autism. Sitting side by side rather than facing each other may be easier.
Use direct questions. Autistic people may find open questions and small talk difficult. Give options. Be clear and concise. Do not use or expect the person to be able to pick up on implied meanings or questions. The person may not be able to fill in the gaps, so make sure you say what it is you are asking. For example, if you ask if something is an issue there may be an implication that the person may say “No, that is not an issue but this is…”. Autistic people are more likely to only say “No, that is not an issue” without realising there is an expectation to expand on the answer.
Autistic people may find it very difficult to answer questions about feelings. It may be necessary to ask directly about a particular feeling and give an example of someone being in a situation and the feelings associated with that (social stories). For example, “a lot of people tell me that they feel very anxious before they see me. Are you feeling anxious today?” or “Do you feel more sad than usual”?
It may be necessary to educate the person on recognising emotions before anything else.
Let the person know that they can do whatever helps them to feel calm – fiddle toys, movements, objects of comfort. Be creative and patient. For example, some people prefer to sit on the floor whereas others find an activity such as drawing or crafting helps them to process information.
Let the person know when the appointment has finished and what will happen next.
Work in a systemic way – with family and other services.
Use any special interests, if possible, to help when learning new ideas. Special interests can be animals, games, TV programmes or films, a particular topic such as a period in history or place, crafting, etc.
Use choice rather than asking the person to generate ideas for example, provide an emotion wheel for a person to refer to when asking about feelings, or for example saying “what would you like to work on – a, b, or c?” (as opposed to “what would you like to work on?”).
Use lists, structure (such as an agenda), technology (iPads, apps), drawing, or whatever else may provide the perfect individualised approach.
Write down a summary of the appointment for the person to take away with them. Quite often people can forget what has been said and this will increase their anxiety. Autistic people tend to over analyse what has happened and can replay interactions to check how they went. If things are written down, it will minimise the chance to misinterpret what has been discussed.
Allow more time for the person to process and respond to the questions.
State clearly that there are no right or wrong answers. Tell the person to express what is in their thoughts and that you will work out together what that means if it is not already clear.
