This quote from Dr William Mandy made me question what effective help looked like for autistic people, so I interviewed 12 autistic adults to research what makes therapy feel positive. What they shared was enlightening – barriers that were so easily addressed, I wondered how we had missed them for so long.

The words we use matter more than we think

Let’s start with language. Most of us have been taught to use person-first language – ‘person with…’ – to avoid defining someone by their condition. But most autistic adults prefer identity-first language, ‘autistic person’, not ‘person with autism’.

Why? Because autism isn't an add-on or affliction, it's a fundamental part of how autistic people experience the world. Ask your clients what language they prefer and use it. Having that choice can be massively empowering.

The same principle of asking and adapting extends to how we communicate in sessions. ‘I cannot infer well and become very anxious at the demand that I manage subtext or social expectations’, one participant explained. Another described what builds rapport: ‘Honesty, transparency, detailed explanation and patience while I question as much as I need to’. What she appreciated most was her therapist's ‘transparency of thinking’. ‘There are no hidden agendas; I'm not having to second-guess what she is thinking’.

No hidden agendas, no second-guessing; being explicit about the therapeutic process, boundaries, and expectations means that clients can engage with the therapy, instead of spending their energy decoding it.

When the therapy room itself becomes a barrier

Multiple participants described sensory challenges that overshadowed the therapy. ‘A sensory issue for me is wearing shoes’, one person shared, ’and I didn't feel I could take them off/ask to take them off as she would think it was weird’.

Uncomfortable shoes; that's all it was. However, the inability to address this basic need meant that sessions were spent managing distractions rather than engaging in therapy.

Others mentioned needing to fidget, hold cushions, or pace – normal autistic self-regulation strategies which can be easily misunderstood as having an ‘unconscious meaning’, which one person described as making her feel ‘othered and faulty’.

The therapists who got it right did simple things. They provided fidgets. They explicitly gave permission to move furniture, take shoes off, or bring comfort items from home. They remembered the sensory preferences session by session. As one participant put it, ’I think a bigger factor is the willingness to understand what I need’.

That willingness to understand, to ask, to listen and to adapt isn't complex clinical training. It's the foundation of person-centred practice, applied with awareness that 'person-centred' means centring the autistic person's actual experience, not our assumptions about what they should need.

Sometimes the most powerful therapeutic intervention is simply making the room safe enough to take your shoes off.

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