You were diagnosed as autistic in your thirties. At first it was a relief: finally an explanation for the exhaustion after every meeting, for the noises other people do not seem to hear, for the feeling of always being one step behind in conversations. Then the questions came. What now? Do I need therapy? What for, if autism cannot be cured?

Looking for therapy for autistic adults has nothing to do with wanting to stop being autistic. It has to do with anxiety, exhaustion or relationships that become an uphill struggle in a world designed for a different way of functioning. This guide explains how therapy can help, how it should be adapted according to the leading UK clinical guideline, what to avoid and how to choose a professional who really understands autism.

What is therapy for if autism is not something to cure?

Autism is not an illness, so there is nothing to cure. What does cause suffering, and can be treated, is what often comes with it. A meta-analysis by Hollocks and colleagues, covering 35 studies, estimated that 27% of autistic adults currently have an anxiety disorder and 23% depression, and that over a lifetime these figures rise to 42% and 37%. The authors warn that the studies vary widely and rely mostly on clinical samples, but the message is clear: the mental health of autistic adults deserves attention.

The NICE guideline on autism in adults puts it this way: when an autistic person also has a mental health problem, they should be offered the psychological interventions recommended for that problem, adapted to the way they function, and the professionals delivering them should understand the core features of autism.

How a psychologist can help an autistic adult

Anxiety and depression

These are the most common reasons for seeking help, and adapted cognitive behavioural therapy is the most studied option. A meta-analysis by Weston, Hodgekins and Langdon, covering 48 studies, found medium-sized improvements in anxiety and depression as rated by clinicians and people close to the person, though smaller ones according to the person themselves, and concluded that more robust trials are still needed. Promising results, in short, but not yet definitive.

Autistic burnout

Many autistic people describe an exhaustion that is nothing like ordinary tiredness. A study by Raymaker and colleagues, carried out with the participation of the autistic community, defined autistic burnout as intense, long-lasting exhaustion, typically three months or more, with loss of skills the person used to have and reduced tolerance to stimulus. They link it to a build-up of stress and a lack of support, when for a long time what is expected of the person outweighs what they can give. Participants named acceptance and social support, rest or reduced expectations, and being able to do things their own way without masking as key to recovery. The authors distinguish it from occupational burnout and from depression, even though they can look similar.

Sensory and emotional overload

Noise, light or certain textures can build up to the point of meltdown. Therapy can help you identify what overloads you, plan ahead and have strategies to regulate yourself. The NICE guideline also asks for adjustments to the environment: less fluorescent lighting, less noise, more personal space and, if needed, earplugs or ear defenders.

Woman working with headphones to reduce noise, a common adjustment for sensory overload in autism

Understanding your diagnosis, especially if it comes late

For many people, a diagnosis in adulthood is freeing, because it finally explains difficulties they have lived with for years, such as social exhaustion or the feeling of being different. Even so, rereading your whole story with this new information takes time, and doing it with someone who knows about autism helps you make sense of it and let go of some of the accumulated guilt. If you are still at the questions stage, you may find Asperger's in adults: signs, what it means today and which test to take useful.

Relationships, work and social skills

If you want to, therapy can also work on the social situations you find difficult, communication with your partner or anxiety at work. For people who identify difficulties with social interaction, the NICE guideline suggests social learning programmes, in a group or one to one, with explicit rules and specific strategies for difficult situations, as well as support to find and keep a job.

What therapy adapted for autism looks like

The NICE guideline sets out how to adapt cognitive behavioural therapy for autistic adults with anxiety, depression or other common problems. In practice, this means:

Adjustment How it shows in sessions
More structure and visual support Worksheets, diagrams, images and written material
Starting from behaviour Working on concrete situations before abstract thoughts
Explicit rules Explaining the rules and the reason for each task
Plain language No metaphors, ambiguity or too many hypothetical situations
Breaks and special interests Regular breaks and, where possible, using your interests
Support from someone close Involving a family member or partner to put things into practice, if you agree

The same guideline asks professionals to foster the person's autonomy, involve them actively in decisions about their care and, where possible, maintain continuity with the same professionals. Online therapy can fit well with this, because it lets you have sessions in an environment you already know, with the light and noise set the way you need.

What good therapy should not do

  • Try to make you seem less autistic. The Raymaker study warns of the potential dangers of teaching autistic people to mask their traits, and its participants linked recovery from burnout with being able to stop masking.
  • Promise a cure. For the core features of autism, the NICE guideline specifically advises against exclusion diets (such as gluten-free or casein-free diets), vitamins and supplements, chelation and anticonvulsants.
  • Decide for you. The guideline stresses fostering your autonomy and your involvement in every decision.

How to choose a psychologist for autistic adults

Not every psychologist has training in adult autism, and it shows. These questions can help you choose:

  • Do they have experience with autistic adults, not just children?
  • Does their approach respect neurodivergence? The goal should be your wellbeing, not that you come across as neurotypical.
  • How would they adapt sessions? A good answer mentions structure, written material and plain language.
  • Do they explain things clearly and in the format that suits you? In writing, with diagrams or however you need.
  • If you do not have a diagnosis, can they advise you on an assessment?

If you do not have a diagnosis yet, the MyPsicoTest Autism (ASD) Test can help you sort out what is going on before your appointment. It does not diagnose, but it points you in the right direction. And if you suspect something else is going on as well, such as ADHD, we cover it in Neurodivergence in adults: what it means, signs and where to start.

A psychologist who specialises in autism

At MyPsicoTest we recommend Xènia Capel Salcedo, a licensed clinical psychologist (COPC 14982) who specialises in autism, with a practice in Igualada and sessions online. On her website she explains that her service covers every stage of life and that she supports teenagers and adults who want to understand their diagnosis, improve their social skills or manage anxiety at work and in their personal life. She designs individual plans, uses evidence-based techniques for cognitive flexibility and social skills, and puts real emphasis on emotional and sensory regulation, to reduce anxiety and avoid overload. As she puts it, the aim is not to cure but to build on strengths and provide tools, while respecting neurodivergence.

She also carries out diagnostic assessments, with clinical interviews, standardised tests and, for adults, a review of their life history, and works with families when needed. Online therapy lets you have sessions from home, in English, Spanish or Catalan, and the first contact is a free, no-commitment information session by phone.

If your result worries you or you want a professional assessment, you can talk to Xènia Capel Salcedo, a licensed psychologist (COPC reg. 14982), who offers a free first consultation call and online therapy from anywhere.

MyPsicoTest team · Updated: