15 Therapist Red Flags Autistic Adults Should Never Ignore!
+ How to Choose a Therapist or Evaluator: 15 Green Flags & The Right Questions To Ask
Autistic adults come to me after years, sometimes decades, of therapy.
Some have seen five therapists. Some have seen ten. Some have spent thousands of dollars trying to understand why they still feel anxious, overwhelmed, exhausted, lonely, misunderstood, or stuck.
What they often assume is that therapy “didn’t work” but I see something different.
Autistic adults that are frustrated with therapy were never working with a therapist who truly understood autism in the first place.
The therapist may have been warm.
Kind.
Empathetic.
Well-intentioned.
However, competence and kindness are not the same thing and when it comes to autism, that difference matters a lot.
The real issue is that there is no guide on how to evaluate therapist or evaluator competence
When searching for a clinician, most people ask questions like:
Are they nice?
Do they take my insurance?
Do they have good reviews?
Do I feel comfortable talking to them?
Those things are important but they are not enough if you are Autistic or AudDHD.
Imagine hiring a surgeon because they were compassionate but never asking whether they had experience performing your procedure. Or choosing an accountant because they seemed friendly but never asking whether they understood tax law.
Yet many autistic adults evaluate therapists or evaluators almost entirely on the fact that they say that they are neuroaffirming or they have a nice personality.
The result can be not feeling heard in an evaluation or years spent trying to fit into approaches that were not actually designed for them.
The question I get asked the most in office and on socials is for a referral for a therapist or an evaluator who can truly help. The problem is that even if I have worked with clinicians before, I can never be 100% sure. So I composed this guide to help Autistic individuals evaluate their current or prospective therapists for fit.
Why Is This Such An Important Decision for Autistic Adults?
Many autistic adults enter therapy or an evaluation carrying a lifetime of messages:
You’re too sensitive.
You’re overreacting.
You’re lazy.
You’re difficult.
You’re negative.
You just need to try harder.
When autism goes unrecognized or misunderstood, therapy can accidentally reinforce those messages. The point of therapy should not be to teach you how to become less autistic. Therapy should aim to help you better understand yourself, reduce suffering if any, build skills, and create a life that works with your neurology rather than against it. An evaluation should accurately rule in or out Autism using updated understanding.
They both definitely require competence, specialized training, and experience working with Autistic adults.
So how do you know if a clinician is or is not?
Here are 10 red flags, 15 green flags & questions to ask before you sign up. Just as important as recognizing competence is recognizing when something feels off.
1. They treat your passions as “pathological obsessions”
If they view your deep interests solely as “restricted, repetitive behaviors” to be limited, rather than sources of genuine joy and regulation, they miss a crucial piece of who you are.
2. They Attribute Every Problem to Anxiety