A Qualitative Study Investigating the Positive Experiences of Therapy and Therapeutic Relationships of Late-Diagnosed Autistic Females

Background:Autistic adults face a paradox: they have a greater risk of developing mental health difficulties, while also experiencing increased barriers to accessing mental health care. Research on reducing these barriers has previously focused on physical adjustments such as providing quiet waiting rooms, and cognitive adaptations such as using unambiguous language. Approaches to building the therapeutic relationship have been under-researched. Methods:The researchers interviewed 12 UK-based late-diagnosed White autistic females about experiences of therapy that they identified as being particularly positive. The study adopted a critical realist and neuro-affirmative stance, with an insider researcher position. The researchers developed common themes and subthemes through reflexive thematic analysis. Findings:Three themes were developed from the interviews and incorporated eight subthemes. Theme 1: “Providing and delivering beneficial therapy for autistic clients” included “sourcing therapy” and “autistic expectations of positive therapy.” Theme 2: “Features of a positive therapeutic relationship from an autistic perspective” included “building trust and rapport,” “equitable power dynamics,” and “reciprocity and a collaborative approach.” Theme 3: “Understanding autism and using adaptation strategies” included “adaptation strategies,” “understanding autism,” and “positive autism.” Conclusions:While physical and cognitive adaptations improve the accessibility of therapeutic interventions, therapists must also focus on adapting the therapeutic relationship with autistic clients, particularly with an enhanced focus on power dynamics and collaborative approaches. All participants described positive experiences of connection when their therapists shared relevant insights and experiences to build common ground. Recognizing less stereotypical presentations of autism and exploring internalized ableism in both the therapist and client improved the positive experience of therapy.