Counselling and Autism Spectrum Disorder

Promoting the mental health of those on the autism spectrum is something I feel very strongly about. Traditional mental health services like CAMHS and the NHS have been known to discharge this vulnerable group and they are then left unsupported. So I’ve put together some brief information below about the condition and its links to mental health and how to support someone on the autism spectrum. 

What is Autism?

Autism Spectrum Disorder (ASD) is a life-long developmental disability that was first discovered by Leo Kanner (1943).  They noticed that some children showed an unusual interest in objects and a lack of interest in other people and communicating. These children also had difficulty understanding non-verbal cues, and sometimes appeared ungainly and clumsy in their movements compared to their normally developing peers. ASD, as its name suggests, is a spectrum disorder and those diagnosed display a wide range of abilities. We now understand it involves deficits to social imagination, social communication, sensory difficulties and repetitive and restrictive behaviour. At one end of the spectrum will be individuals who are likely to be non-verbal with intelligence quotient (IQ) scores below 70 (low functioning). At the other end of the scale are the higher functioning individuals who have normal or above average IQ’s (scores of 70 and over), though with significant social and communication deficits. However, it’s important to acknowledge that every individual with autism is different and experiences the world in their own unique way. Famous people with ASD include Lewis Carroll, Charles Darwin, Dan Ackroyd and Albert Einstein. 

How common is it?

ASD affects around 700,000 people in the UK (National Autistic Society, 2017a), or around 1% of the population (2014 NHS Adult Psychiatric Morbidity Survey; McManus, Bebbington, Jenkins & Brugha, 2016). The rates are increasing all the time, likely due to increased awareness and improved diagnostic practises. When factoring in the number of parents, siblings, carers and partners for these individuals, ASD clearly has an impact on many lives in the UK as well as posing a significant burden on health and care services. ASD is mostly diagnosed in males, with four times as many males as females receiving a diagnosis (National Autistic Society, 2017a). However, it is widely believed that we are missing females on the Autism Spectrum and there are many girls and women with ASD without a diagnosis or appropriate support. 

Autism and mental health

There are higher rates of mental health conditions like anxiety and depression in individuals with ASD than the general population. For example, around 40% of diagnosed individuals have an accompanying anxiety disorder, with the most common being Obsessive-Compulsive Disorder (OCD), Generalised Anxiety Disorder (GAD) and phobias (van Steensel, Bogels & Perrin, 2011; Lugnegård, Hallerbäck & Gillberg, 2011). In addition, individuals with ASD are up to nine times more likely to die by suicide than those without the condition (Hirvikoski et al., 2016). Therefore, there is a great need for appropriate mental health support for adults and children with ASD.

Counselling individuals on the Autism Spectrum

Several studies have suggested the most effective therapy for higher functioning individuals with ASD is thought to be Adapted CBT. Pacing the sessions appropriately and working with rigid thinking styles are key to the success of the therapy (Cooper, Loades and Russell, 2018). 

It’s easy to see how accessing talking therapy would be more challenging for people with ASD. Difficulties with communication can make creating a meaningful and rich relationship with their counsellor more difficult. This means counsellors need to really understand the unique difficulties and strengths their client experiences. There is no one size fits all counselling approach – every individual with autism is unique with their own strengths and challenges. However, practioners should be aware of any specific sensory difficulties that their clients to make sure their counselling rooms are as comfortable and safe as possible. 

For example, I worked with a young male client with autism who found talking about his thoughts and feelings very hard. We used his intense interest in Doctor Who to discuss what the characters in this TV could be thinking and feeling and that helped us to build our therapeutic relationship and opened new ways of discussing his problems. We dimmed the lights in the counselling room because he found bright light difficult and I wanted him to be as relaxed as possible. 

It’s important to reiterate that these suggestions are generalisations and every individual on the autism spectrum is unique and experiences their condition in their own way. It’s best to work out what the client needs from you to be able to access counselling in a safe and effective way, using their strengths and taking time to build strong relationships. 

“Everyone has a mountain to climb and autism has not been my mountain, it has been my opportunity for victory.”

Rachel Barcellona

Photo by Kat Jayne on

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