Therapist who Gets It about… autism? sensory processing? idk
January 14, 2022 7:18 AM   Subscribe

How do I find a therapist who will take my (42F) sensory and social overwhelm seriously? I don't care if they're an "autism specialist" (the word seems accurate to me, but I'm not diagnosed, I hear getting diagnosed is hard, and I don't need a diagnosis or label). But I do want them to believe me even though I look normal.

I get extremely overwhelmed in social situations, and extremely overwhelmed by sounds, smells, and other sensory details.

I hide it well, but the stress comes out eventually. I snap at my husband or my mom for no good reason. At its worst, it gives me day-long sobbing meltdowns. Avoiding the meltdowns is hard work.

I was raised to hide this shit in public. So I keep it together around strangers, feel terrible, and fall apart once I get home.

Therapists don't really believe me. I've tried a few over the years, and gotten help on other stuff. But on this, I'm a middle-class middle-aged woman who looks and acts normal in their office. They seem to think I'm being too hard on myself. When I talk about this stuff, they seem to hear "She's an introvert who worries too much, and sometimes she gets tired and crabby just like anyone else." When I emphasize the intensity of it, they seem to hear "She's exaggerating now. She's beating herself up for having normal bad days and needing down time." And then after every session I'm humiliated and overwhelmed by trying to prove myself. So then therapy is making things worse!

Where can I find a therapist who will take this stuff seriously? I happen to think I'm autistic, but I don't even care if my therapist agrees. I tried one who listed "autism" as a specialty on Psychology Today, and it turned out he still thought I was a totally normal woman who needed to go easy on herself. Whatever, I don't need a formal diagnosis. I just want someone who believes me about my symptoms and knows how to work with them.

If it matters, I live in Massachusetts.
posted by flexible-footwear figurine to Human Relations (11 answers total) 14 users marked this as a favorite
I know the language is not great, but I have had the most success with therapists who describe themselves as specializing in “high functioning” autism (or “Asperger’s” even though that isn’t a term anymore). These are the ones used to the kind of presentation that gets missed into adulthood. And also make sure that they specify somewhere they work with autistic adults; many therapists may work with adults and kids but their autism specialization is only in kids and they don’t understand what it looks like in adults.
posted by brook horse at 7:48 AM on January 14 [1 favorite]

Also, if sensory issues are one of the major concerns, you may also benefit from seeing an occupational therapist, who is more likely to take those symptoms seriously right off the bat.
posted by brook horse at 7:49 AM on January 14 [6 favorites]

Psychology Today allows you to search on autism as a specialty within your geographic area. Beware of those therapists who seem to have any kind of ABA affiliation, however.

Here's a search for Cambridge, MA. You can modify the location.

If cost is no object, I saw a Buddhist pastoral counselor whom I really liked, and who was comfortable working with autistic people. He's based in Cambridge but will take online appointments. Does not accept insurance, however. Feel free to PM me.
posted by Sheydem-tants at 8:03 AM on January 14 [1 favorite]

I am in a similar boat as you are, although I haven't yet sought a therapist for these specific concerns. A couple of other ideas:
* Look for someone who has treated women, or at least girls, with autism. Females tend to "mask" better. Thus, people are less likely to recognize our concerns.
* Try to get recommendations for specific therapists from other people with autism -- whether those are local or online therapists. I am on a subreddit for women with autism. I have heard many stories about women with autism not being taken seriously.

Good luck!
posted by NotLost at 9:20 AM on January 14 [3 favorites]

I came to recommend an OT as well - they WILL believe you, can teach you coping/mitigation/management strategies, and might also be the best way to get a personal reference to a regular talk-therapist in the area who gets it.
posted by Lyn Never at 9:21 AM on January 14 [2 favorites]

I just wanted to say I can completely relate. I get similar overwhelm / overstimulation and can barely speak and then I snap. And with two young kids and a chatty husband oh man have I just gone under sometimes. One small piece that has helped me is to simply say “I’m overwhelmed right now and can’t respond.” Because then the time pressure / pressure to be “normal” is relieved. But sometimes I’m so overwhelmed I can’t even speak. In which case I have a hand signal for my husband. It’s also helped to see the signs of it building (I get this weird kind of tunnel vision when it’s building). Also I’ve found when it is building I’m actually like building this internal resistance / trying to hold on to a sense of self amidst all the whirl of sensory stimulation beyond my control. But contra intuitively instead of trying to hang on to my self, it helps to instead let go and submit to the sensory chaos. “I” am not separate from the chaos, I am a part of the chaos, a particle of it. When I submit like that then I get this sudden rush of peace because I’m not fighting anything anymore and not trying to make anything be other than what it is. This might not be your experience at all but I just wanted to share and I totally get you, the overwhelm is real.
posted by St. Peepsburg at 11:15 AM on January 14 [2 favorites]

It's not the same thing, but asking therapists about their familiarity and experience with Highly Sensitive Persons (HSP) might also turn up some providers with enough transferable skills/knowledge to be helpful. There's some overlap in the dynamics of those two ways of being.
posted by dancing leaves at 1:43 PM on January 14 [1 favorite]

My therapist has been extremely good with that even though we never identified autism as an issue. She is a mindfulness and DBT specialist, and there is a huge focus on practice there - what is the problem and what are ways we can mitigate those issues. I've gone from weekly/monthly sobbing meltdowns to maybe yearly? I have had the strength and clarity to organise my life to avoid the build up to those, for the most part. A lot of it has been working on accepting and acknowledging that I am this way - whatever that might mean. Introverted, auditory processing, occasionally mute/alogia, difficulty identifying emotions, highly disassociative. Then working out what triggers the difficult moments, and what can/should be worked through, and what should be mitigated or avoided

And belatedly, this is the first Christmas least a decade? Longer? Where I have not had a meltdown.

Acceptance and Commitment Therapy (ACT), DBT, and trauma are her main specialties. She works closely with therapists who specialise in autism and ADHD in adults as well - it's not her focus but they are part of the same practice. Which may help broaden the search.
posted by geek anachronism at 2:28 PM on January 14 [4 favorites]

Oh, this is still quite rare to see, but if a therapist uses the word "neurodivergent" or "neurodiversity" there is a much higher chance they will believe you about your symptoms. Here is one in Boston.
posted by brook horse at 2:32 PM on January 14 [2 favorites]

Okay, they're rare birds, but try to find a therapist who's autistic or adhd themselves! In my experience there is a world of difference working with someone who shares your neurotype, the general ignorance of neurotypical people is thickly regressive. And don't be afraid to try someone in their 20s or 30s! I've found that the younger gen is more likely to be out and have up-to-date tools. Look for someone who knows what "high-masking" means and has seen adult women before. Agree that "neurodivergent" are "neurodiversity" are good search terms.

Here's someone I found on Psychology Today.

You could try searching AANE, they have offices in Watertown, MA.

I would post in these Facebook groups and ask for referrals:
Neurodiversity Affirmative Therapists
Autism Late Diagnosis Support and Education

You can also try a "lived experience" educator like this person, who will offer peer support and pragmatic advice for surviving day to day.

Last, I suggest finding a trauma-informed therapist. Every autistic person I know has a lifetime of stories about feeling overwhelmed, out of place and disbelieved. That's a recipe for complex trauma. Look for someone who offers DBT, Internal Family Systems, EMDR, somatic grounding work, mindfulness, something like that. Stay away from CBT, it doesn't tend to work well with us.
posted by lloquat at 12:22 AM on January 15 [4 favorites]

You describe your problems here very clearly. If you are as clear and direct with a therapist and they discount what you say, then it’s a them problem. The only thing I can think of in how you communicate with them would be to mention explicitly how the problems affect your daily life in several areas where applicable, work, school, family, relationships, your own well-being, and what price you pay for holding it together so much. The more concrete examples, the better.
posted by meijusa at 9:32 AM on January 16

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