Working with autistic clients doesn’t necessarily mean working specifically with autism. An autistic person may come to therapy for anxiety, confidence, a phobia or any of the other issues we commonly encounter. And when they do, understanding how autism can affect communication, sensory experience, and a client’s preferences can help us make therapy more accessible and comfortable.
Autism Awareness for Therapists
Autism is defined by the National Autistic Society (NAS) as
‘a lifelong developmental disability that affects how a person communicates with and relates to other people, and how they experience the world around them’ (National Autistic Society, 2025)
Wing and Gould (1979) talked about a ‘triad of impairments’ which formed the primary pattern of the autistic spectrum. These were communication, social interaction, and imagination. A fourth point, limited planning ability, was added later. This made it triad of four since that term was still widely used. Extremely annoying for those with a literal mind!
You will still come across many references to the triad. However, since 2013, the DSM-V uses a ‘dyad of impairments’ instead (Nicholson, 2012). These are:
- social-communication impairments (merging communication and social interaction),
- restricted behaviours (which includes repetitive behaviours, affected imagination and sensory processing issues).
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Temple Grandin (one of the first people to publicly share her experience of having autism) suggested that living with Autism was like living in a world where everyone else speaks Shakespearean English. You get the gist of things, and you pick up enough to get by. But you also know there’s a lot you’re missing that everyone else seems to understand. So just pause, and think for a moment what that would be like.
However, many autistic people don’t like being defined by ‘impairments’ at all. Some have suggested autism could be defined by strengths or neutral traits instead, for example:
- A preference for routine, precision, authenticity, social space, sensory control. (Psychology Network (2018)
- A need for predictability and motivation, the possession of splinter skills. (Abilities disconnected from usual context, sometimes called savant skills). (Bennie, 2016)
Neurodiversity in Therapy
Around 700,000 people in the UK (more than 1% of us) are thought to be autistic. So it’ s very likely that you are working with autistic clients. Whether or not their therapy is related to their autism, the condition is part how they respond to and understand the world. Understanding it can help you work with them more effectively.
Autism-Friendly Therapy Practice
A few small changes can help you welcome autistic clients, and make it easier for them to access your services. Here are just a few ideas:
- Communicate in a way which is comfortable for them. For example, some may prefer to type or write rather than speak during sessions.
- Those who identify as transgender, nonbinary, or gender-nonconforming are more likely to be on the autistic spectrum than those who are cis-gender. Check details like your client’s pronoun preferences.
- If you tend to use a lot of metaphors in therapy, check that your client understands their meaning. Those on the spectrum may need more literal explanations.
- Some on the spectrum are hyper-sensitive to smells, noise, or lights. Create a quiet atmosphere. Ask if removing scented candles, or reducing bright lights and background noises would make things more comfortable.
- As many on the spectrum prefer predictable routines, make things as predictable as you can. Plan sessions well in advance and don’t reschedule unless it’s absolutely unavoidable.
- Some of those on the spectrum don’t use or recognise non-verbal communication. In this case, try to use language that can’t be interpreted in different ways without it.
- Recognise that a diagnosis of autism doesn’t stop your client being an individual. Ask them if they need extra help and what they need.
Autism Training for Therapists
If you want to know more about autism, and get many other ideas about making your practice more accessible to those on the autistic spectrum, we have a FREE course on the subject.
It’s been written by Debbie Waller, an experienced therapist, hypnotherapy author and trainer, and Rae Waller, who is also a published author and on the Autistic spectrum themselves.
Get details and sign up at https://www.cpd.expert/free-cpd/autism
References:
Original article published November 2017, revised and updated September 2026
- Bennie, M. (2016). Autism “Triad of Impairments” Redefined: Lessons From John Simpson. [online] Autism Awareness. Available at: https://autismawarenesscentre.com/lessons-learned-from-john-simpson/ [Accessed 6 Sept. 2026].
- National Autistic Society (2025). What Is Autism? [online] National Autistic Society. Available at: https://www.autism.org.uk/advice-and-guidance/what-is-autism [Accessed 6 Sept. 2026].
- Nicholson, E. (2012). The DSM-5 proposed changes, and what it means to lives affected by autism / Asperger’s Syndrome. [online] Living Autism. Available at: https://livingautism.com/dsm-5-proposed-changes-means-lives-affected-autism-aspergers-syndrome/ [Accessed 6 Sept. 2026].
- Psychology Network (2018). The Triad Of Impairments And Other Autism Myths. [online] Positive Psychology Network. Available at: https://ppnetwork.org/triad-impairments-autism-myths/ [Accessed 6 Sept. 2026].
- Wing & Gould, 1979 cited in National Autistic Society (2022). The history of autism. [online] www.autism.org.uk. Available at: https://www.autism.org.uk/advice-and-guidance/what-is-autism/the-history-of-autism [Accessed 6 Sept. 2026].
About Debbie Waller
Blog Author Debbie Waller is a hypnotherapist, supervisor, and trainer with more than twenty years of experience. As well as having a busy client practice, she runs Yorkshire Hypnotherapy Training and writes books and articles for therapists who want to deepen their knowledge and develop effective practice.
Disclaimer
The information and ideas shared on this blog are based on the author’s professional experience, research, and training. They are intended for educational purposes and to support reflection and professional development. Therapists should always apply their own professional judgment and consider the needs of individual clients when using any techniques or suggestions discussed here.
While every effort is made to ensure the information is accurate and helpful, no responsibility can be accepted for any loss, damage, or difficulties arising from the use or misuse of material contained in these articles.
