How Therapy Fails Women With Autism

Or how I spent hundreds of pounds not solving my biggest problems reaallly slowly.

Jul 23, 2021

None of my therapists looked anything like this but you try drawing from memory when you have aphantasia.

Nice white lady #1, 2015

Trigger: A friend pushed me to go to the doctor after I admitted to having suicidal thoughts. (Apparently, this is alarming. Who knew?)

I cried to the GP and was given a prescription for Citalopram and a number to call the Talking Therapies team. Three months later I sat in front of nice white lady #1, wondering what the hell to talk about.

It was CBT, apparently, but it felt aimless. I was horrified to find that I seemed to be leading the sessions though I had no clue what was going on.

It was strange being listened to. Getting to finish all of my sentences. I discovered that I felt very distant from my family. Talking about my relationship with my brother made me cry. I learned that consistency was important to me, and almost entirely lacking in my life.

Six weeks later, my NHS-funded therapy was over, and I felt… better. I’d learned that it was okay to tell people what you were thinking. That it was okay to ask for what you need. Recommended, even.

I learned that just because my boyfriend drank, it didn’t mean I had to. I felt empowered. Proud of myself for ‘working on myself’. The suicidal patch was over. I was ready to try again. Hurray!

Nice white lady #2, 2016

Trigger: Anxious, paranoid thoughts on a loop. Inability to think straight.

I was still trying to quit drinking but kept getting drunk. I had no willpower, and it was ruining my life.

My boyfriend had persuaded me to let him move into my tiny flat and it was going badly. But how could I ask him to move out?

He didn’t seem to like me or have any interest in making me happy, and yet he said he loved me and wanted us to live together forever. He gave his phone number to a girl who flirted with him on a night out, then criticized me for acting jealous. Relationships were so confusing!

Cue me, sitting opposite nice white lady #2 and wondering WTF is going on.

This time it was psychotherapy, and the therapist was younger than me. She explained how our relationship was part of the process.

“It’s important you feel comfortable with me,” she said, and I wondered how I could feel comfortable in this context. And why was her chair so far away? Was that ‘a therapeutic distance’?

She listened with a pleasant expression while I filled the space with my worries, careful to stay away from anything too real because my actual experience was shameful.

By the third session, I’d had enough of my own stream of consciousness. It was harder to decipher than Orlando, which my boyfriend had lent me, and which I couldn’t read without falling to sleep. Sincere apologies Virginia Woolf and the academy at large.

The nice white lady smiled and nodded, and I wondered for how many years we could sit here doing this. Me paying fifty pounds a pop to ramble insanely because — and there isn’t enough formatting in the world to stress this adequately — I DID NOT KNOW WHAT WAS WRONG WITH ME.

Letting the patient lead the session, in the state of mind I was in, seems like cruelty to animals.

Really, these psychotherapists need to throw their more bewildered clients a bone.

Hearing myself complaining about all the ways in which alcohol was ruining my life, gave me a clue, and I decided to try AA again. If I could just stop drinking that would be something.

Therapy pointed me in the right direction, but only just

Progress, under the watchful eyes of those kind and educated white ladies, was slow. I have no idea how much money I would have spent before anyone suggested autism.

Progress via AA was slow, too, but at least there I acquired the extremely valuable new ability to resist alcohol. Plus I heard amazing shares. And it cost a fiftieth of therapy. AA allowed me to make sense of my experience gradually, by listening to the experience of others. Over time, I pieced together my own story. Except with great chunks of it missing. I couldn’t remember my childhood, for instance. Nor much of my teens. Why was that?

Psychology articles online talked of the importance of processing the past. Would that help me to have a sense of who I was? Because mostly I felt like a feather on the breeze of whichever personality wafted by.

And so, without any better ideas, I returned to therapy. Again. And again. And again.

It always felt insufficient. I never got better at knowing what to talk about.

I spent hours analyzing the nature of therapy itself. Accidentally pushing my therapists to defend their discipline like a demented external examiner simply because I didn’t understand what we were supposed to be doing.

What was the use of feeling my feelings, for instance? Why did it matter if I was emotionally numb? What was the point of dredging up the past? Who cared if I didn’t remember it? Wasn’t it better off that way?

“You’ve told me what you were thinking, but I want to know what you were feeling,” my fourth or fifth or maybe sixth nice white lady therapist said, and I was like:

“Well, don’t we all, babykins?”

Whenever the therapist asked me this, and they all did, eventually, I felt anxious and panicky. Because I had no idea how to answer the question. I wasn’t sure I felt anything. Besides the anxiety, I mean, about having been asked. And the fear around not understanding the question.

“What if we do all this talking, and I spend all this money, and there’s just nothing in there,” I asked, and my therapist laughed, but I was entirely serious. Sometimes it felt like she was searching for something that just wasn’t there.

This bewilderment went on for more years than we have time for, so I’ll summarise, because thankfully now I can. My pattern of becoming so overwhelmed and anxious that I needed to engage with doctors or the mental health team continued years into my sobriety.

Finally, I was referred to a psychiatrist. I’d like to say this is what led to my breakthrough, but alas not.

Life continued, and my habit of intermittent struggle continued. By now, in 2020, I had resolved many of my worst issues (unhealthy relationships, problem drinking, low self-esteem, catastrophizing) and so at last I could see more clearly what I was actually battling.

Something was off within my brain. Scheduling was impossible. Short-term memory was non-existent. Administrative tasks on the computer made my brain hurt. Staff meetings were befuddling. I made the same small domestic mistakes over and over and over. I constantly lost my keys, phone, and items of clothing. Living this way was incredibly stressful. Losing and breaking things so often was very expensive. It made me hate myself. Sometimes it made me wish I was dead.

What was wrong with me?

Was it ADHD? Or dyspraxia? Tests online said maybe.

And then, one day, somebody suggested Autism. Reading about how it manifests in women I discovered I was a textbook case. Well, thank god.

The relief was indescribable.

It was the beginning of a new chapter. One that actually made sense. I didn’t have to work hard to make the label fit or add disclaimers, the way I always had as an ‘alcoholic’ in AA or the way I had with depression and anxiety.

I was autistic. Autism was me.

My lack of awareness of how I was feeling or even my body, more generally, made sense. There wasn’t anything wrong with me, I just hadn’t developed an emotional dimension. Nobody had ever talked to me about feelings and what they were for, so I had no understanding of this realm, but I found that studying helped. I printed off a feelings wheel and practiced describing how I felt in my body.

Within a month I made more progress with feeling like a whole person than in six years of therapy. Those nice white ladies were kind and educated and patient, but their person-centred what-have-you didn’t work for me.

How many people are still making their way through the world feeling faulty because they haven’t found the information they need? If only one of those therapists had thought to give me a feelings wheel. How much time we would have saved.

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