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Heroic experiences

Therapy is not for everyone, some might think! For example, those who have had personal experience of psychotherapy have a real sense of how much personal and emotional involvement is needed throughout the process. And some even say that at certain times in psychotherapy addressing certain issues is "painful". Not that shocks are administered during the process. However, to tackle certain issues when the person him/herself is more vulnerable, the emotional experience is more intense.


But what is the lived experience of the psychotherapeutic process by the adult autistic person?


The scientific articles which have been published on the psychological aspects to be taken into account in the process of psychological intervention with adult autistic people still seem to focus on the methodological aspects and the techniques to be taken into account. And we agree that it is a very important and necessary issue and that we are still very far from an adequate answer. In many cases, we continue to use intervention models and protocols validated and adapted for other diagnoses but not for autism.


Over the last ten years we have seen an increasing number of autism diagnoses made in adults. And no, it has already been made clear that we are not talking about an epidemic of autism in adults. We are more and more able and also more sensitised to detect, diagnose and also intervene in autistic adults. But also here we are still very far from having an adequate answer. And how can we know this? All we need to do is to ask the adult autistic people themselves!


Right now we have about 78 million people worldwide who are autistic. And about 1 in 100 adults is diagnosed with an Autism Spectrum Disorder. And if you think things are going to stagnate, think that every year about 50,000 autistic teenagers come of age.


And we need to think that the very thinking about autism and more specifically autism in adults has undergone a lot of changes over the last few years. Whether in issues related to the aspects of diagnostic criteria, but also in relation to how health professionals and adult autistic people themselves think about their condition.


Adult autistic people feel less willing for the psychotherapeutic process to focus solely and exclusively on the empowerment of social skills. Not that these cannot be important, because they are. But even in relation to these, adult autistic people themselves feel that the work on these competencies needs to reflect more and better the reality as lived by autistic people, in this case, adults. Moreover, adult autistic people feel that they do not have the same availability to be seen as those who need to change their behaviour. In the sense of being those who have something wrong and dysfunctional about themselves and as such need to change at the request of others, whether parents or other third parties.


For example, some adult autistic people, diagnosed in childhood, may feel that when they reach adulthood they still have a whole set of difficulties in integrating into various areas of their lives. Does this mean that the therapeutic work done previously was not important and well done? Not at all! The intervention carried out was certainly well conducted. However, there may have been a negligence of several parts in relation to important aspects for the life of the autistic person and who, from a certain moment on, is in his/her adult life.


The research and clinical practice, in this specific case, in autism and even more precisely in the adult person, needs to have a new balance. That is, if it is important to think about how psychiatric comorbidities impact on the course of a diagnosis of Autism Spectrum Disorder. It is also true that we need and think about the Quality of Life aspects of the adult autistic person. Not to mention how the adult autistic person themselves think their life should be lived in an autonomous and independent way. Of course, we need to keep thinking about how the very assessment tools for diagnosis should reflect the different realities observed in women versus men on the autism spectrum. But the psychotherapeutic process itself and how it can and should be adapted to the lived reality of the adult autistic person. As well as the aspects of the therapeutic relationship which are established throughout this process. There is a whole set of aspects which are fundamental, but which are relegated to a second plan as far as the adult autistic person is concerned.


Psychotherapeutic intervention processes are complex and include a whole set of specific and non-specific, implicit and explicit aspects, but which in certain situations need to be decoded and adapted to the adult autistic person. It is not that the person does not have the capacity to understand, because they do. But the different way in which the autistic person himself thinks necessarily leads to think in a different way. And here, it is the psychotherapist's responsibility to make this same path of reflection.


From the more pragmatic aspects of the intervention, for instance, the length of a session, or the fact that it can be divided in the course of the session. But also other aspects which are more concerned with the therapeutic relationship, a variable considered fundamental in the psychotherapeutic process, and seen as being responsible for a significant part of the positive outcome of the process itself. There are many aspects which some health professionals in the mental health area feel they are not sufficiently trained to have to deal with. Namely, in what concerns establishing a therapeutic relationship with an adult autistic person. I even think that part of this difficulty may come from the fact that the therapist thinks that the autistic person needs to adapt to the process. That is, that the autistic person himself needs to acquire other empathy competencies so that he can be more available for the psychotherapeutic process. When, in fact, it should be precisely the process itself that should adapt to the person. And this implies that the therapist himself also does this work.


However, when we look for information regarding the psychotherapeutic process for the adult autistic person, we find that the scarcity of articles reflects what I mentioned in the previous paragraphs. But also the few articles that exist in this field continue to focus on using standardised intervention protocols for Anxiety, Depression and other diagnoses, without having thought of and adapted them for adult autistic people.


I feel that none of this is by chance or lack of time. I think that it is due to the fact that for many years autism was not thought about in adults. And even today we still think of autism in adults as an extension of what is thought of in children and adolescents. And clearly, adult people, namely autistic people, feel specific needs at this time of their lives and, in some cases, they do not feel a resonance in the psychotherapeutic process.


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