‘They Say We're the Rigid Ones’: A Reflexive Thematic Analysis of Autistic Adults' Experiences of Psychological Therapies

Abstract

Introduction: Autistic people experience mental health difficulties in higher numbers compared to neurotypical people. Within the United Kingdom, many will access psychological therapies through the National Health Service (NHS), but many autistic people report negative experiences (All Party Parliamentary Group on Autism [APPGA] 2019). This study qualitatively examines the lived experiences of autistic people in their psychological therapies. Method: This research adopts a qualitative approach by using Reflexive Thematic Analysis (RTA) to guide the research process and analysis of data. Eight autistic adults who had received treatment via the NHS were interviewed regarding their experiences of adult psychological therapies and what facilitated or hindered a positive experience. Findings: Four themes were constructed: ‘doing therapy “right”’, ‘the therapeutic relationship’, ‘what's the point?’ and ‘lack of choice’. The processes between the therapist and client underpinned experiences, with a reciprocal relationship between factors impacting and being impacted by the relationship. Psychological therapies were found to foster feelings of imposition of treatment with little ability to choose one's own pathway to recovery. All participants reported a lack of psychological safety regarding their identities as autistic people and named lack of therapist knowledge of neurodiversity as a barrier. Implications: Recommendations include therapeutic boundaries and explicit communication of expectations, allowing the client to be themselves and feel able to engage in practical strategies. Tracking progress is also important, alongside attending relevant training delivered by autistic individuals. Implications for policy include offering more sessions to autistic individuals to allow time for rapport building to reduce re-referrals.