How to Find the Right Therapist for Autistic Adults: A Practical, Affirming Guide

For over a decade, Ana David has had a therapist who truly sees, understands, and cares for her. But even she can attest to the difficulty of finding a therapist for autistic adults. Before she found her current therapist, David had several traumatic experiences in the healthcare system.

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Unfortunately, David’s story is all too common. Many autistic people have had negative experiences in therapy. If this is true for you, you’re not the problem. Typically, the real issue is a mismatch in therapeutic approach.  

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The effectiveness of therapy for autistic adults depends heavily on the therapeutic relationship, says Dr. Kelly Whaling, Research Lead and Licensed Clinical Psychologist at Prosper Health. It also depends on whether therapy is adapted to your personal support needs. These may be quite different from those of people whose cognitive function aligns with social norms (also known as neurotypicals). That’s why autism affirming therapy is so important.  

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In this guide, we’ll explore how to find a therapist who truly supports you on your terms, so that you can be partners on your journey toward better mental health.

Finding mental health services for autistic adults can be challenging. Take Ana David as an example.

As an undiagnosed autistic person, David grew up with anxiety and depression. The first two times David sought mental healthcare, at ages 17 and 25, her providers rebuked her, belittled her traumas, and dismissed her concerns. “You’re too smart and pretty to be depressed," one therapist said, before misdiagnosing her with borderline personality disorder."

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Not everyone has an experience exactly like David’s, but there are many ways autistic people report being negatively impacted by therapy. Like society in general, the healthcare system is also built around non-autistic norms. Many therapists don’t receive training in the treatment of autistic clients specifically.

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When clinicians don’t understand the unique traits and needs of autistic people, they may misinterpret or pathologize autistic traits, communication styles, or sensory needs. Some therapists try to change or eliminate autistic traits, which can reinforce masking, notes Whaling. Research suggests that sustained masking is associated with depression and anxiety.

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Even well-meaning therapists can inadvertently cause harm if they’re not informed about autism, so finding the right therapist for autistic adults is just as crucial to finding a therapist to begin with. 

If negative experiences make you wary of therapy, you’re not alone. David felt the same way, but she emphasizes that finding autism affirming therapy was lifesaving. It just goes to show that the problem isn’t you—it’s a system that isn’t built with autistic people in mind. Suitable therapists are out there. You just have to find them.

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“If you met 20 bad therapists, it does NOT reflect on the entire population,” David reiterates. “Take every failed interaction as an opportunity to learn more about yourself and the healthcare system.”

The most effective types of therapy for autistic adults are different for everyone. They depend on you, your preferences, and any co-occurring conditions or life challenges you have. Here are some common types of therapy that may be useful when adapted for autistic people:

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Cognitive Behavioral Therapy (CBT)

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CBT focuses on changing unhealthy thoughts and behaviors to healthier ones. “By addressing these patterns directly, individuals can create meaningful and lasting changes in how they feel and act,” says Dr. Anna Kroncke, therapist at Prosper Health.

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CBT targets issues such as anxiety, depression and stress by teaching coping strategies and problem-solving skills. Research shows that adapted CBT may help autistic adults reduce anxiety and depression symptoms and develop coping strategies 

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Dialectical Behavior Therapy (DBT) 

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DBT teaches people how to manage emotions and deal with difficult situations in a healthy way. Research on DBT for autistic adults is still emerging, though early findings are promising for emotion regulation and distress tolerance. 

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Acceptance and Commitment Therapy (ACT)

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ACT teaches clients how to accept emotions, detach from negativity, be present, and live by their values. Preliminary research suggests that ACT can reduce distress and experiential avoidance among autistic individuals.

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Mindfulness-based cognitive therapy (MBCT)  

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MBCT is a type of cognitive therapy that teaches mindfulness practices such as breathing exercises, meditation, and awareness of the present moment. These can be useful for supporting grounding, distress tolerance, and awareness of sensory experiences.

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Person-centered and Humanistic Approaches

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In person-centered therapy, clinicians recognize all clients as unique, trust each client’s view of their own world, and allow clients to take the lead in finding their own solutions. Humanistic therapy is similar, focusing on a client's individuality, their entire personhood, their strengths, and their potential for growth.

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These therapies align closely with neurodiversity-affirming principles. According to Whaling, they should be the foundation of therapy for autistic clients, regardless of other modalities included in a client’s plan. Since nondirective formats can cause anxiety for autistic clients who prefer structure, Whaling says that person-centered principles should ideally be layered underneath a more structured technique.

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Other therapies

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Other modalities may be used if an autistic client has comorbid conditions. For example, an autistic adult with OCD may pursue Exposure and Response Prevention (ERP) therapy. Meanwhile, an autistic adult with trauma may benefit from Cognitive Processing Therapy, Prolonged Exposure Therapy, or Trauma-Focused CBT.

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“Finding a therapist who has expertise in areas you seek to address is really important,” says Kroncke. “For example, Prosper Health has some therapists who have expertise in both autism and PTSD, but not every therapist would share that expertise.”

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It’s important to note that no type of therapy is effective for every autistic person. It’s all a matter of finding the therapy that works best for you. In addition, these types of therapy are only effective when they are adapted specifically for the autistic client. 

Autistic people often have different needs in therapy. This is due to factors like masking, burnout, and differences in communication, sensory needs, and emotional processing styles. 

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Why adaptation matters more than modality

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Most therapies were developed with neurotypicals in mind, so even evidence-based therapies need to be modified for autistic cognitive and sensory processing styles. “Evidence-based does not mean effective as delivered off the shelf,” says Whaling. “The research supports these approaches when adapted, not when applied as standard.”

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Without adaptations, therapy can be futile or even harmful. For example, typical mindfulness practices can be dysregulating for some autistic people.

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In addition, some autistic clients may experience standard, unmodified CBT approaches as invalidating if emotional experiences are overly reframed or minimized. Moreover, some autistic clients may find traditional cognitive restructuring approaches less intuitive unless they are adapted to fit literal, detail-oriented, or bottom-up processing styles. 

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In the case of unmodified DBT

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Likewise, DBT may not be effective if it relies on neurotypical social metaphors, roleplay formats, or group formats that don't account for sensory sensitivities or demand avoidance. Moreover, DBT often involves diary cards in which you monitor your emotional states. This can be difficult for those who have difficulty naming, recognizing or expressing emotions—also known as alexithymia.

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When unadapted, DBT and other approaches may inadvertently reinforce masking. They may train autistic clients to adjust their social behaviors and emotional expression to meet neurotypical norms, without mentioning the costs of doing so.

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Pacing can also be a problem, as many autistic people need more processing time. When that’s not provided, it can make them feel less engaged and “reinforce the sense of inadequacy that many autistic adults bring to treatment,” says Whaling.

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Not only can therapies for co-occurring conditions run into similar issues as above, but co-occurring conditions themselves may bring additional challenges. None of this means that these therapies should be avoided, but they will require adaptation to be helpful, as we will explore shortly.

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What is neurodiversity-affirming therapy?

Neurodiversity-affirming therapy is therapy tailored for a neurodivergent person’s individual needs, perspectives, and strengths. It recognizes autism (and other neurological differences) as a unique way of “being” in the world, as valid as any other, notes a 2023 article in the Journal of Consulting and Clinical Psychology.  

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This type of therapy appreciates the fact that, instead of being inherent to autism, mental health struggles are often a result of environmental factors. For instance, a neurodiversity-affirming therapist acknowledges the double empathy framework. This perspective suggests that social difficulties are often due to differences in neurotype—not deficits on the part of autistic people.

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What’s more, autism affirming therapy views meltdowns and shutdowns as nervous system responses to overwhelm or stress, not behavioral failures. It also addresses alexithymia directly instead of ignoring it.

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The goal of autism affirming therapy is never to cure autism or make a client appear more neurotypical, but to reduce distress and increase well-being, “as defined by the autistic client,” says Whaling. This can involve developing strategies to navigate overwhelming environments, as well as addressing trauma, anxiety, and depression. This is especially important as nearly 75% of autistic individuals have at least one co-occurring condition. In any case, clients are allowed to be their authentic selves.

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Autism affirming therapy must be individualized for each client. Here are some common modifications:

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• Using literal, concrete language and explicit psychoeducation
• Supporting information processing with visual supports, structured worksheets, and written summaries
• Honoring preferred communication styles (e.g. differences in eye contact, response timing, and verbal processing) 
• Supporting pacing and repetitive behaviors
• Sharing session agendas in advance and keeping sessions structured and predictable
• Giving explicit rationale for all skills and interventions, and keeping them aligned with meaningful goals
• Using sensory-anchored strategies to identify emotions

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Specific therapies may also need their own adaptations. For example, ACT often involves metaphorical language to clarify concepts, which can be enlightening for some autistic people, but confusing for others who process information more literally. A therapist should always check to see if a metaphor resonates with the client, and offer plain-language alternatives if not. 

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Modified CBT often involves a deeper focus on behavioral strategies, while mindfulness practices typically require reconceptualization.

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Adaptations may work well for some clients and not others. The right therapist will work with you to design a treatment plan that meets your own individual needs.

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If finding a therapist seems like an overwhelming endeavor, it can help to divide the task into smaller, actionable steps. Here’s an example:

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Step 1: Identify therapy goals

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Consider what’s motivating you to seek therapy. Here are some common goals autistic people might have:

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• Finding care for co-occurring conditions, like anxiety or depression 
• Getting help with social skills and navigating social situations
• Coping with work stress
• Managing burnout or sensory sensitivities
• Regulating overwhelming emotions
• Learning personalized coping skills
• Handling life challenges (e.g. trauma, major life transitions, grief)
• General life support 

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It might be helpful to try journaling about what makes your life more challenging so that you can identify what you’d most like to work on with the help of a therapist. List two or three aspects of your life you’d like to be different in six months, suggests Whaling.

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Step 2: Identify the support you need

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Think about the type of support you'd prefer. Would you like a structured, skill-building approach with measurable goals, or simply a safe space to process your emotions? Do you want a short intervention or long-term support?

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Jot down what you’ve found helpful and unhelpful if you’ve had therapy in the past, as well as any communication or sensory preferences you have. If you want, you can also look into evidence-based modalities (CBT, DBT, ACT, etc) to see if there are any that you feel may be a good fit for you, and think about any adaptations you might prefer. 

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Keep the above information in mind when searching for a therapist, and consider writing all of it down to share with therapists during initial consultations. It may also be useful to bring any psychological assessments you’ve had so that you and your therapist can use the data to help determine your needs.

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Step 3: Find possible therapists

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Whaling suggests looking into directories for neurodiversity-affirming or autism-competent providers, such as the Association for Autism and Neurodiversity (AANE) therapist directory and the Therapist Neurodiversity Collective. Specialty clinics like Prosper Health—a telehealth provider specifically for neurodivergent adults—are another option to consider.

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You may also consider asking your doctor, psychiatrist, or even other autistic people for referrals. “A friend of a friend of a friend recommended a licensed therapist who, anecdotally, had ‘rescued’ their nephew from the depths of suicidal ideation,” says David. “That’s how I met Anca, my therapist of almost 13 years.”

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Step 4: Research potential therapists

Research your potential therapists online by reading online profiles and client reviews. Ideally, a therapist’s profile should express that they’re neurodiversity-affirming. But remember, not every autism therapist for adults is the same. That’s why you should get more information before you start.

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Consider looking into whether they specialize in your areas of concern and have a history of treating autistic clients with your specific struggles, including any co-occurring disorders.

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If you belong to a minority or marginalized group, you might want to confirm they have experience with similar clients. You may also want to see if a potential therapist has lived experience with autism themself. 

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Step 5: Ask the therapist questions before you start 

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Once you’ve identified potential therapists, it’s time to make some calls or emails. This is an opportunity for you to ask questions and clear up whatever you’re unsure about. You can also ask for a phone consultation or trial session for an even more accurate idea of whether a therapist is right for you. Here are some questions to consider asking:

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• What degrees or certifications do you hold? What was your training?
• What is your experience working with autistic adults?
• What’s your understanding of autism or neurodiversity, and how does that shape your work?
• How do you tailor your approach for autistic clients?
• Have you helped others with [insert any specific issue you're facing] in relation to autism?
• How do you assess progress? What will we do if I’m not progressing?
• What kind of treatment plan or therapies do you think will help me?
• Do you have experience in [modality you’re interested in]?
• Do you take my insurance?

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“Trust your gut here,” says Whaling. If they give vague or defensive answers, or they seem uneducated in autism (like suggesting that autistic traits need to be “fixed”), they may not be the right fit.

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Step 6: Evaluate the fit of the therapist

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During your first session, pay attention to whether the therapist adjusts to your needs. For example, do they accommodate processing differences, such as by giving more time to process information and allowing silence and nonverbal responses?

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“While one session might not reveal everything, it can help you assess if they listen well, seem genuinely engaged, and can adapt their approach to fit your needs,” says Whaling. “If the vibe feels off or unhelpful, don’t hesitate to walk away.”

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We’ll explore more green and red flags below.

One of the most crucial considerations is how your therapist views you and your autism—ideally as a legitimate part of your identity, not a symptom to be managed.

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They're curious about your experience and recognize that autistic distress often stems from life challenges, instead of being inherent to autism. They address external factors that contribute to your difficulties. 

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Instead of assuming their way is the best way, an autism affirming therapist asks about your preferences, makes accommodations, asks for feedback, and uses it to improve therapy. 

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Red flags

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Some signs that a therapist isn’t a good fit are that they express skepticism about your autism, don't adapt therapy to your needs, or treat you less compassionately due to your communication style. 

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A major red flag? They encourage masking without engaging with its costs. This can include relying on social skills training as a primary intervention—or using behavioral approaches focused primarily on suppressing autistic traits or increasing neurotypical presentation—when you're trying to manage depression and anxiety. Assuming your goals should be the same as neurotypicals’ is another red flag.

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Is this therapist right for me?

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If your therapist has plenty of green flags and no red flags, then that’s a sign they’re a good fit, especially if you feel comfortable with them. If there are red flags, feel free to raise your concerns and see if your therapist improves—if not, then that confirms they’re not the right therapist for you.

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Note that your own feelings are equally as important as the considerations above. Whether a therapist has red flags or not, don’t be afraid to move on and pursue another therapist if the fit doesn’t feel right. Having a good relationship with your therapist is key to making progress in therapy, and this chemistry requires more than an affirming outlook.

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“A therapist can be well-intentioned and broadly affirmative but still not be a useful fit for a specific person's specific needs,” says Whaling. 

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Keep in mind, though, that it’s common to feel a little uncomfortable during your first few sessions. So if there are no glaring red flags, you may want to give it a few sessions before cutting ties with a therapist. 

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Your experience in your first therapy session will depend on your therapist and your dynamic. Generally, though, your intake session will focus on discussing your experiences, diagnoses, and goals. Beyond that, your first few sessions should establish trust. “A client needs to feel comfortable sharing their experience and what they hope to work on in therapy,” says Kroncke. It’s normal not to click immediately with a new therapist, but if it’s a good fit the initial discomfort should fade.

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Improvement from therapy can take some time, but in the meantime, something to keep in mind is how you feel during and after therapy. Do you feel heard, validated, and like you’re developing tools to approach challenging situations? Effective therapy should help you feel capable and empowered as you take meaningful steps toward your goals, even if not everything always goes perfectly. 

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Other great signs of progress are when communication feels natural instead of forced, you can identify and articulate your own needs, you feel less pressure to mask, and you experience less cognitive fatigue.  

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On the other hand, if you find that after a few sessions a therapist just isn’t the right fit, then it’s okay to pursue care from someone else.

Cost can be a significant barrier, so it’s important to find therapists who are upfront about their pricing policies. Some therapists publish their rates on their websites, while others reveal their rates during an initial consultation. 

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Luckily, many practitioners accept insurance. They should share this during your consultation session. Alternatively, many insurance providers offer search tools where you can locate in-network therapists near you. 

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If a therapist doesn’t take insurance, they may offer a sliding scale. Or, you can ask your insurance if they offer any out-of-network benefits. 

Here at Prosper Health, we’re proud to work with most major insurance providers, and we’re always looking to expand our network. 

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Explore online therapy options

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In person therapy has its benefits, but online therapy opens up a world of possibilities for autistic adults. It saves you a potentially overstimulating commute, offers a wider range of therapists than you can find locally, and allows you to receive therapy in a comfortable environment.

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“A client can choose to join from their own cozy couch with blankets they love and their favorite tea, for example,” says Kroncke. “Data also shows that telehealth results in fewer missed sessions so more consistent care.”

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How Prosper Health can help

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Therapy can be life-changing for autistic adults, and finding the right therapist is crucial. At Prosper Health, we offer 100% virtual neurodiversity-affirming therapy, covered by most insurances.

Our clinicians—many of whom are autistic themselves!—are experts in providing personalized care to autistic adults. We’d love to help you find the right therapist.

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Frequently asked questions (FAQs) 

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‍What therapy is best for autistic adults?

While the best therapy for an individual autistic person depends on their co-occurring conditions and treatment goals, CBT and its third-wave offshoots (such as DBT, ACT, and MBCT) are backed by the most scientific support. However, therapy is only effective if it’s adapted specially for the autistic client in question.

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How do I find a therapist who understands autism?

Search online or ask an autistic friend if they have any suggestions. Be sure to do your research and ensure that the therapist is truly autism affirming.

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Is online therapy a good option for autistic adults?

Yes! Online therapy is effective for autistic adults. Many people prefer it for the convenience, and some people find it comforting to attend therapy from a familiar environment.