Q&A

ACT with Autistic Adults: Neuroaffirming Insights on Burnout, Identity, and Values

For an increasing number of autistic adults, a formal diagnosis arrives not in childhood, but in midlife. When these clients reach the consulting room, they often bring with them not only the struggles of symptoms themselves, but years of adversity and alienation that have left the additional burden of internalised narratives about being difficult, broken, or lazy. Therapists, too, are navigating the changing landscape of autism diagnosis, and may be anxious to ensure they can establish neuro-affirming

What makes Acceptance and Commitment Therapy particularly well suited to working with autistic clients?

It’s easily individualized: We can readily adapt and tailor ACT to suit each client’s unique needs and communication style.
It’s infused with compassion and validation: We take the time to understand and acknowledge and validate the unique concerns and desires of autistic clients, while helping them foster self-compassion and prioritising emotional safety.
It’s strengths-based and values-guided: We help clients utilise their strengths and values, to build positive self-identity, look after themselves, and take effective action to improve quality of life.
It’s safe and supportive: We emphasise safety and wellbeing, especially when working on challenging new behaviours such as self-advocacy and unmasking.

Your course ACT for Autism emphasises a neuroaffirming approach. What does that mean in practice when you’re using ACT with autistic adults?

Neuroaffirming is short for ‘neurodiversity-affirming’. It’s an approach to delivering therapy that affirms and supports neurodivergent differences, instead of regarding them as ‘deficits’ or ‘symptoms’ or evidence of a ‘disorder’. It involves actively supporting clients in areas of difficulty, while acknowledging that their wants, needs, strengths, and resources may be very different to those of neurotypical people.

Almost any model of therapy can be delivered in a neuroaffirming way, adapting the model to suit the specific needs of each unique client. However, because of its non-pathologising stance, its compassionate yet action-oriented approach, and the flexibility in how it can be adapted and delivered, ACT is especially well suited to this way of working.

Autistic burnout is increasingly recognised, but still often misunderstood. How does ACT help clinicians work effectively with burnout without reinforcing pressure to “push through” or mask?

‘Autistic burnout’ is a debilitating state of chronic exhaustion, heightened anxiety, reduced stress tolerance, emotional reactivity, sensory overload, and loss of skills. It’s a response to chronic stress without adequate support, and it negatively impacts every area of life. Unfortunately, it’s frequently misdiagnosed as depression or occupational burnout - and as a result, mistreated.

ACT helps clinicians to make the correct diagnosis and respond from a compassionate, neuroaffirming stance. ACT helps clients to defuse from harsh self-judgment (e.g. I’m weak) and self-defeating beliefs (e.g. ‘I just need to try harder, make more of an effort’), and instead foster an attitude of self-acceptance and self-compassion. Here, values-guided committed action does not mean doing more but doing less: pacing and resting, reducing demands and responsibilities, conserving energy, building rest and relaxation into daily routines, seeking support, reducing sensory overload, and self-soothing.

Trying to ‘push through’ or ‘tough it out’ or 'mask better' or 'do more' will only worsen the burnout – so ACT encourages a gentle, slow, restorative approach: small steps over time can have big effects.

Many autistic clients struggle with self-identity, particularly those who receive a diagnosis later in life. How does ACT support the development of a more compassionate and workable sense of self?

ACT fosters positive self-identity through multiple overlapping methods, including:

defusion from harsh, self-judgmental narratives
recognising and drawing on strengths and values
self-acceptance and self-compassion
self-appreciation: actively acknowledging and appreciating your own actions and qualities
supporting clients wherever they are in terms of autistic identity, and allowing them to make their own choices about person first or identity first language (e.g. ‘autistic person’ or ‘person with autism’)

ACT is well known for its metaphors and experiential exercises. How do you adapt ACT language and processes so that they remain accessible and respectful to neurodivergent ways of thinking and experiencing?

Both neurodivergent and neurotypical clients may struggle with metaphors or complex, jargonistic or ‘flowery’ language. The good news is, every concept and exercise in ACT can easily be modified into simple, everyday language that’s easy to grasp. But hey - it’s important to be wary of overgeneralisations, such as ‘autistic clients struggle with metaphors’. Yes, some do; but others are poets, writers, musicians, artists, linguists, and they’re truly brilliant with metaphors.

As it happens, we don’t need to use metaphors in ACT; every concept or idea can be expressed in plain, non-metaphorical language. However, there are many ways to modify metaphors to help clients ‘get them’ - such as acting them out with props or using drawings and animations to illustrate them.

Many autistic clients have spent years living according to external expectations. How do you help clients reconnect with values that genuinely feel like their own?

There are many different ways to get to authentic values with autistic clients, but often a good place to start is simply by asking questions about what matters to them. For example, it’s often good to start by asking about their ‘spins: intense, deeply-focused, passionate interests in particular topics, subjects and activities. (‘Spin’ is short for ‘special interest’).

Another rich area to explore is relationships: Who do they care about? What’s most meaningful or pleasurable, in that relationship? What kind of relationship do they want to build, and how do they like to connect?

And a third option is to explore what they’re like when they ‘unmask’ – for example, when they’re alone, or with people who accept them as they are (so masking isn’t necessary). When they take the mask off, how do they behave? What do they like to do? How do they treat themselves - or others?

It's also important to defuse from all those externally-imposed expectations: all those neurotypical ideas about how they should (or shouldn’t) think or feel or behave. They’ve often unconsciously internalised these ideas, leading to harsh self-critical narratives because they're not living up to these expectations ( an example of 'internalised ableism'). So it’s important to raise awareness of such narratives, and explore how they function, and repeatedly practice defusing from them.

What ACT strategies do you find most helpful when working with sensory sensitivities?

Generally, we start with awareness. We help people notice what kind of sensory stimuli are most challenging, in which environments; how their thoughts, feelings and behaviours are affected; and what factors increase or decrease tolerance (e.g. stress, fatigue).

Then, in line with a value of self-caring, we help clients create action plans to reduce stimuli where possible – e.g. wearing sunglasses or noise-cancelling headphones, or working in a low-stimuli environment such as a quiet office with dimmed lights.

And we help clients develop acceptance and self-compassion skills to better handle difficult sensory stimuli, especially in situations where it’s not possible or practical to significantly reduce them. They can learn how to open up and make room for those stimuli, without being overwhelmed by them.

For clinicians already trained in ACT, what mindset shifts or practical adjustments support effective, neuroaffirming work with autistic clients?

The most important aspect of a neuroaffirming mindset is to genuinely value neurodivergence; to foster an attitude of genuine respect and appreciation; and actively embrace the qualities of openness, curiosity, empathy, and humility. It’s important to learn about the unique strengths and challenges of autistic clients, and actively draw upon their lived experience to guide therapy; to be sensitive to the prejudice, discrimination and disadvantages they have to contend with in a world built for neurotypicals; and to help them defuse from beliefs that they need to be more neurotypical, or that neurodivergence means inferiority.