Facilitators and barriers in psychotherapy from the perspective of autistic adults: an enhanced critical incident study

ABSTRACT

Purpose

A significant portion of autistic adults experience mental health challenges. Currently, the literature is incomplete when it comes to understanding the needs and preferences of autistic adults who receive therapy. This study elicited the perspectives of autistic adults, focusing on the facilitators, barriers and ways to enhance psychotherapy based on receiving this care for mental health problems.

Methods

Using the qualitative, exploratory approach of the Enhanced Critical Incident Technique, eight autistic adults took part in interviews.

Results

A total of 147 critical incidents were extracted from participant interviews and categories salient to therapeutic practice. The study identified key factors influencing therapy, such as trust and respect, practical approaches, client factors, structure of sessions, knowledge about autism, support for individualized needs, access to mental health services, and involvement of family/advocate. These factors were categorized into eight main areas relevant to therapeutic practice.

Conclusions

Findings from this research reveal that psychotherapy with autistic adults is analogous to performing this work with non-autistic adults, in the sense that this work too entails elements of individually tailored treatment and the reliance on common therapeutic factors. There are also differences in this work that necessitate providers having foundational knowledge about autism. Learning directly from autistic adults’ insights may help to improve upon the delivery of mental health care for autistic adults.

KEYWORDS:

• Autism
• adults
• mental health
• psychotherapy
• enhanced critical incident technique
• qualitative methods

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

A summary data that support the findings of this study are available from the corresponding author, DBN, upon reasonable request.

Notes

1. There is no consensus regarding how to communicate about autism. In this paper, identity-first language is used (i.e., autistic people/adults) rather than person-first language (i.e., person with autism), which aligns with the finding that many autistic people prefer this language (Kenny et al., 2016).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Theresa Jubenville-Wood

Theresa Jubenville-Wood, Ph.D., is a psychologist who specializes in supporting women’s mental health, new mothers and neurodivergent women. She helps clients overcome burnout, perfectionism, and stress/anxiety related to pregnancy, parenting, small-business ownership, and life transitions. She also helps her clients understand and celebrate their neurodivergent identities while working through individual challenges.

David B. Nicholas

David B. Nicholas, Ph.D., has a background in psychosocial outcome and intervention research related to children, youth and families affected by illness and disability. Dr. Nicholas brings expertise in qualitative and mixed method research approaches. He brings an extensive clinical and administrative background in the fields of social work and health and disability. Over the past 20 years he has held over $12 million in research grants, and has been a PI on major grant funding from the federal and provincial sources including grants funded by SSHRC and CIHR. Dr. Nicholas has been a key leader in nurturing capacity building, addressing vocational issues in ASD, and building partnerships in Canada and internationally. Much of his current research focuses on seeking more equitable opportunities for obtaining and retaining employment for persons with ASD

Jonathan Weiss

Jonathan Weiss, Ph.D., is a Clinical Psychologist and Associate Professor in the Department of Psychology. He completed a pre-doctoral internship at Surrey Place Centre (Toronto) and a post-doctoral fellowship in the Dual Diagnosis Program at the Centre for Addiction and Mental Health, and was a research fellow in the Department of Psychiatry at the University of Toronto. Dr. Weiss research is funded by the Canadian Institutes of Health Research and the Social Sciences and Humanities Research Council, as well as from non-Tri-Agency sources, including the Ontario Mental Health Foundation, Kids Brain Health Network, and the Public Health Agency of Canada. He currently holds the York Research Chair in Autism and Neurodevelopmental Disability Mental Health

Sharon Cairns

Sharon Cairns, Ph.D., started her career as a psychiatric nurse but then went on to complete her MA and PhD in Clinical Psychology at the University of Manitoba. After working for a number of years in post-secondary counselling, Sharon joined the Werklund School of Education at the University of Calgary where she teaches graduate courses in counselling psychology and supervises graduate student research. Clinical interests include interpersonal violence, post-traumatic stress, resilience, and eating disorders. In anticipation of retirement in 2019, Sharon is not accepting any new students for supervision. Dr. Cairns’ research focuses on the nature of post-secondary counselling concerns. She has been tracking the trends in counselling concerns since 2005. Another branch of her research is in the area of program evaluation.