When Talking Therapies Don’t Quite Fit: Rethinking Support for Autistic Adults

Talking therapies are often presented as universally beneficial: a space to explore emotions, process experiences, and make sense of distress through relationship and reflection. For many people, this can be deeply helpful. However, a growing body of research suggests that for autistic adults, mainstream talking therapies are not seen as effective.

This is not because autistic people are unwilling or unable to engage in therapy, but because many therapeutic models are built on assumptions about communication, emotional processing, and relational styles that do not always align with the autistic experience. As awareness of neurodiversity grows, it is becoming increasingly important to ask not whether autistic people need therapy, but whether therapy needs to adapt.

What autistic adults say about therapy

Research consistently highlights a gap between what autistic adults want from therapy and what they often receive. A striking example comes from a qualitative study exploring autistic adults’ experiences of psychotherapy, which notes that a common criticism is that sessions tend to focus heavily on emotional expression and processing rather than offering practical support. As the authors summarise:

“A common criticism of psychotherapy made by autistic adults is that sessions tend to focus on processing emotions and experiences rather than practical recommendations.”(Maddox et al., 2020, as cited in Pappagianopoulos et al., 2025)

This finding is echoed across multiple studies. Autistic clients often report wanting clearer structure, explicit goals, concrete strategies, and collaborative problem-solving. When therapy remains abstract, emotionally led, or reliant on implicit communication, it can feel inaccessible or even frustrating.

Importantly, this is not a rejection of emotional work. Rather, it reflects a difference in how emotions are accessed, understood, expressed and integrated. For many autistic people, insight emerges through thinking, pattern recognition, and practical experimentation, not solely through verbal emotional exploration.

The problem is not empathy — it’s alignment

One useful way of understanding these difficulties is through Damian Milton’s concept of the double empathy problem. Milton argues that breakdowns in understanding between autistic and non-autistic people are reciprocal, arising from differences in experience and communication rather than from a deficit within autistic individuals alone (Milton, 2012).

Applied to therapy, this suggests that when an autistic client feels misunderstood, the issue may not be a lack of engagement or insight, but a mismatch between therapeutic expectations and the client’s way of making meaning. If a therapist expects emotional articulation in a particular form, and the client processes differently, empathy can fail on both sides.

This has significant implications for talking therapies, where mutual understanding and attunement are central. Without adaptation, even well-intentioned therapists may inadvertently prioritise their own model of insight over the client’s lived reality.

When therapy works better

Research and lived experience both indicate that autistic adults report more positive therapeutic experiences when therapists demonstrate:

• explicit understanding of autism and neurodivergent communication styles

• flexibility in how insight, progress, and engagement are defined

• willingness to use structure, scaffolding, and collaborative goal-setting

• clarity of language and avoidance of vague or implied meanings

These elements are not incompatible with relational or humanistic practice. In fact, they often enhance it. Frameworks such as Egan’s Skilled Helper Model, which emphasise exploration, preferred scenarios, and action planning, show how therapy and coaching can retain empathy while offering clarity and containment.

Similarly, coaching approaches that integrate reflective listening with practical focus often align well with autistic processing styles. This may explain why many autistic adults report more positive experiences with autism-informed coaches or therapists who adapt their approach.

Why this matters

Autistic adults experience significantly higher rates of anxiety, depression, burnout, and trauma than the general population. Access to effective psychological support is therefore not optional — it is essential. When therapies are not adapted, autistic people may disengage, be labelled “resistant,” or internalise the belief that therapy simply “isn’t for them.”

This is a systemic issue, not an individual one. Improving talking therapies for autistic people requires changes at multiple levels: training, supervision, assessment criteria, and theoretical flexibility. It also requires listening seriously to autistic voices, not as anecdotal exceptions, but as sources of legitimate knowledge about what helps and what harms.

What this means for neurodivergent-affirming coaching

While coaching is not a substitute for therapy, neurodivergent-affirming coaching can offer a complementary form of support for autistic adults, particularly where traditional talking therapies feel inaccessible. Coaching frameworks often place greater emphasis on clarity, structure, collaborative goal-setting, and practical exploration, which can align well with autistic processing styles. When coaching integrates counselling skills such as empathic listening, careful use of language, and responsiveness to individual needs, it can provide a relational space that feels both supportive and purposeful.

Importantly, effective neurodivergent-affirming coaching does not assume deficits to be corrected, nor does it rely on emotional expression as the primary route to insight. Instead, it values different ways of making meaning, including thinking through patterns, exploring preferred futures, and identifying workable strategies. Used ethically and within appropriate boundaries, coaching can offer autistic adults an additional avenue for reflection and growth, particularly when delivered by practitioners who are informed about neurodiversity and attentive to the double empathy problem.

Laying groundwork for change

As future practitioners, supervisors, educators, and service designers, we have an opportunity to do better. That begins with recognising that no single therapeutic model fits everyone, and that inclusivity in therapy means more than access — it means adaptation.

Better talking therapies for autistic people will not abandon empathy or relational depth. Instead, they will broaden how empathy is expressed, how insight is recognised, and how change is supported. They will value practical understanding alongside emotional exploration, and shared meaning over assumed understanding.

This is not about lowering standards or diluting therapy. It is about making therapy fit for the people it aims to serve.

References

Milton, D. (2012) ‘On the ontological status of autism: the “double empathy problem”’, Disability & Society, 27(6), pp. 883–887.

Maddox, B.B., Crabbe, S., Beidas, R.S., Brookman-Frazee, L., Cannuscio, C.C., Miller, J.S. and Mandell, D.S. (2020) ‘“I wouldn’t know where to start”: perspectives from clinicians, agency leaders, and autistic adults on improving community mental health services for autistic adults’, Autism, 24(4), pp. 919–930.

Pappagianopoulos, J. et al. (2025) ‘Therapy through the lens of autism: autistic adults’ experiences of psychotherapy’, Counselling and Psychotherapy Research.