‘They've Almost Got, Like, a Checklist to Work Down’: On the Lived Experiences of Autistic Adults Who Have Received a Structured Therapy Service for Depression and/or Anxiety Disorders

Autistic adults experience higher rates of common mental health conditions than non-autistic adults and report greater difficulties accessing mental health services. In England, psychological therapy for anxiety and depression is primarily delivered through NHS Talking Therapies for Anxiety and Depression (TTad), but little is yet known about autistic adults’ experiences of these services. Using Interpretative Phenomenological Analysis, we conducted in-depth online interviews with five formally diagnosed autistic adults, all in their twenties at time of interview, who had received TTad therapy for depression and/or anxiety conditions. Four superordinate themes emerged: Pre-Therapeutic Context , highlighting how participants’ autism diagnoses had been transformative, and how diagnosis had shaped their therapy experiences; Therapeutic Relationship , emphasising the importance of a therapist's flexibility and understanding of autism, and the damage that could be done by them minimising the relevance of participants’ autism itself; Rigidity and Quantification , addressing challenges with standardised approaches and outcome measures; and Training and Adaptation , identifying how therapists often developed more effective approaches over time, to demonstrably positive therapeutic ends. Findings suggest that TTad services (and analogous international programmes) may require greater flexibility in delivery, enhanced autism awareness among practitioners, and potentially extended treatment timeframes for autistic clients. Lay Abstract The experiences of autistic adults who received talking therapy for depression and anxiety disorders We are a group of academic researchers, psychological therapists, and autistic individuals, with some of us being more than one of these things. We investigated how autistic adults experience talking therapy services in England, specifically focusing on their experiences with depression and anxiety treatment. We interviewed five autistic adults in their twenties who had received therapy through the NHS Talking Therapies for Anxiety and Depression (TTad) service. Our findings revealed that participants’ journeys to autism diagnosis significantly shaped how they engaged with therapy, and that therapists should not underestimate the difficulties of this journey. Participants reported that their therapists sometimes seemed unprepared to understand how autism impacts mental health. They also found the rigid structure of therapy and progress measurement methods challenging. However, therapy became more helpful when therapists demonstrated flexibility and willingness to adapt their approach. The participants emphasised the importance of autistic people continuing to access these services, as few alternatives were available to them when experiencing depression or anxiety. We recommend training for psychological therapists to better understand the specific needs of autistic people and how to adapt therapy approaches to make them more effective.