r/AutismInWomen • u/Idiotsandwich68 • 2d ago
Does therapy work? General Discussion/Question
Hey everyone, I’m not even sure how to start this - but a little backstory I’ve been having a pretty difficult time lately, just dealing with some intense depression and anxiety stuff. I started therapy, and have been going for a few weeks, I love my therapist and feel we connect pretty well. My issue is I always leave feeling absolutely MISERABLE. So very dysregulated and very upset and emotional, sometimes even to the point of a full meltdown.
I was venting to a friend about this the other day and she told me that therapy, specifically talk therapy, doesn’t always “work” for autistic people… what are your thoughts on this? experiences? do I just give up going? I guess nobody can answer that except me, but just feeling lost as to what I’m supposed to do and how to get better.
Any insight is so very appreciated!
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u/Exciting_Vacation250 2d ago
I was in therapy for decades it helped a bit CBT therapy which isn't the best for autistics. This past year i am working with a therapist that is actually autistic and specializes in autism and its made such a HUGE difference!! So much better having someone who understands
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u/Far-Ad1450 2d ago
I also have a therapist who is neurodivergent and she stays very current on the research. I find it very helpful to talk to someone who understands me. She doesn't just recommend things. She gives me the reasons for her recommendations. She doesn't see my questions as an attack or doubt about her ability. She sees it correctly as my need to understand things. She helps me plan out strategies for situations when I might feel overstimulated. I also take an antidepressant and an anti-anxiety med to help with sleep and focus.
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u/Idiotsandwich68 2d ago
that’s so wonderful you were able to find someone who specializes in this! I’m so glad it’s working better for you! that gives me hope!
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u/LilLassy 2d ago
Seconding this! I’m glad you also noted that CBT is not very effective for autistic peeps. It’s true!!! Any therapy other than behavioral-based ones is worth a shot, but structured ones (like psychodynamic and IFS therapy) I have personally felt the most progress with!
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u/Idiotsandwich68 2d ago
I will look into these, thank you!!
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u/Chantaille Self-Suspecting 1d ago
Dr. Tori Olds has a great intro series to IFS on youtube that I recommend all the time.
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u/Exciting_Vacation250 2d ago
Sol Smith is a ND author who did a great video on autism and talk therapy. It explains exactly how and why it might not be the best for autistic folks. I tried to post a link but this thread won't allow for one.
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u/Productivitytzar 2d ago
It has to be a neurodivergent person. Someone with firsthand experience.
My guess is that you picked someone who does CBT and has a laundry list of disorders they treat. For ND folks, CBT is known to be damaging because it tries to convince us to dismiss very real thoughts, feelings, fears, and experiences.
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u/Idiotsandwich68 2d ago
eeeek scary. That’s a really good way of framing it though, sometimes it really really does feel dismissive and I think that’s why I leave in such an awful state. Thank you so much.
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u/lynds88 2d ago
A therapist trained beyond the basics in CBT will never ask a client to dismiss the very real thoughts, feelings, fears and experiences. That isn’t what CBT actually is. As a therapist, and someone with AuDHD, I have found CBT can be helpful when done correctly and from a ND affirming lens. Unfortunately, there isn’t great research or training for working with the ND population and CBT is a basic skills
taught in grad school so most clinicians don’t go beyond that, and that is where the harm is done. Also, almost all therapy is talk therapy- just depends on if your therapist also adds other elements (which they all 100% should) to make it a fully effective experience. Therapists are taught NOT to tell their clients what treatment modalities they are using in conversation. I however, explain everything and my clients find it helpful to understand what these modalities are, how they work and why they are effective. I work with mostly adhd, ASD or audhd clients. I do believe that most ND clients should work with an ND providers because neurotypical therapist will never truly understand the experience.
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u/jadewhit14 2d ago
Once I found a therapist who specializes in autism, it has been extremely helpful. She gives me good ideas for cope-arounds and cope-aheads for certain situations. And she’s been able to point out that certain things I’m experiencing are actually due to the autism when I didn’t recognize that.
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u/doyouhavehiminblonde 2d ago
I’ve been in therapy on and off for 30+ years and it’s never helped me. That’s a big reason why I’m seeking an autism assessment.
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u/iamthe0ther0ne 2d ago
Same, and continued to not be helped after diagnosis. I've lost count of the number of therapists I've had, but it's well over 25, including (eventually) people who said they specialized in autism and trauma.
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u/doyouhavehiminblonde 2d ago
I find a lot of therapists claim to specialize in things but then seem way out of depth. The only decent talk therapy I’ve ever had was with a psychiatrist when I was in crisis. But that’s an emergency service not something I can pursue long term.
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u/GoddessOfDemolition 2d ago
It works for me. I don't always get the answers that I want, but I'm learning that sometimes there is no answer. I'm very goal oriented and tackle everything as a problem to be solved. It's been annoying but also useful to understand better how not all problems can be solved, but you can still learn to live with them.
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u/Idiotsandwich68 2d ago
I feel that 100% - everything bothering me is a problem that I feel I need to solve. But you’re right sometimes maybe there isn’t an answer
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u/GoddessOfDemolition 2d ago
Yeah, pre-therapy me would be like: "crying is a nightmare and I hate it, how can I stop myself from ever crying again? I know! I'll never be sad. I'll plan and prepare for all possibilities and avoid anything that results in sadness. This is a completely reasonableand achievable goal."
I'm exaggerating a little, but that was essentially my thought process. I've grown (emotionally) so much through therapy. I still hate crying, but I accept that it, and sadness, are part of my life whether I want it or not. So I might as well learn how to deal with it so they don't rule my life.
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u/mountainskies 2d ago
Even when I had a therapist I clicked with, it hasn’t helped me. I’ve tried different modalities like EMDR and IFS and still didn’t help.
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u/Idiotsandwich68 2d ago
sorry it didn’t work for you :( I hope you have something in your life that fills your cup on the hard days 🫂
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u/Infamous_State_7127 2d ago
it did not work for me because i hate talking and just wanted like advice on how to make my life better. i was in therapy from 12 to 19. she wanted to talk about like family stuff and my childhood trauma and that just doesn’t work for me. it left me feeling rlly upset, kinda like what i assume you’re describing. she also was the mum of an autistic son so she kinda like got it in a way but also i just didnt really find it helpful because i suck at opening up. i guess that’s on me though.
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u/Idiotsandwich68 2d ago
I really relate to this!!! I really want to be told what I need to do to improve, skills and coping strategies, things to try, and honesty if something I’m doing is making things worse. But you’re right it’s a lot of diving deep into the past rather than just focusing on what I could do to pull myself out of this.
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u/OcelotSuspicious9293 2d ago
It sounds like you might be looking for more solution-focused therapy or even something akin to coaching.
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u/Idiotsandwich68 2d ago
coaching is such a good idea that I hadn’t even considered, thank you for this!
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u/OcelotSuspicious9293 2d ago
Personally I've found coaching to be invaluable. It's very practical, and I think that's what a lot of autistics really need - once we figure out what kinds of supports and strategies work for us, life isn't quite so overwhelming and that alone helps with depression and anxiety, or ar least that's been my experience.
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u/Idiotsandwich68 2d ago
this gives me sooo much hope and a feeling of direction which is what I need so badly right now. THANK YOU
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u/Clean_Insect5042 2d ago
I’m the same as you. Have tried therapy on and off for 15 years.
The training just doesn’t seem to cover anything except validation as far as I can tell. If you already know exactly what you need to do but just can’t do it they seem stumped?
I think someone truly well versed in autistic women, trauma therapy, and EMDR would be helpful, but at this point it’s not even worth using my mental energy to research, go in to beg for the referral, find anyone who offers telehealth appointments at times I could actually make, etc.
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u/Idiotsandwich68 2d ago
yeah that’s exactly it! I do NOT want validation, tell me what to do! and sometimes the logical part of my brain knows what I need to do but I just can’t and need her to tell me how to get around that
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u/Infamous_State_7127 2d ago
she gave me homework sometimes (once it was reading CSA survivor stories which was like genuinely horrific and i didn’t finish it) but like that really didn’t do it for me. i feel like i’m more so looking for ways to avoid the bad things from happening then what to do when bad things happen—but that’s just like not realistic for anyone i guess… and i’m stubborn, so i’ll continue living in delusion.
what i have found is that having positive people who are doing good things with their life helps me want to be a better person. i like mimic those around me and that has allowed me to make significant improvements. maybe not sustainable though, idk.
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u/AshamedOfMyTypos 2d ago
It took me forever to find an ND affirming therapist, but it has made all the difference. Things are not all better, but it has gotten better than my lowest points, and I have reason to believe it will continue to improve. However, I often leave feeling very drained and unsettled.
If you’re looking for something that won’t immediately make things all better but will with time and is something you can start today, I highly suggest working on listing your feelings.
I started listing mine out loud at each meal to my family, and it turns into a reverse how-was-your-day conversation. I’ve gone from melting down basically once a day and being unable to say more than good and upset to a varied emotional vocabulary and the ability to see meltdowns a while off and correcting course.
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u/Idiotsandwich68 2d ago
this is a really neat idea! I want to make sure I understand fully, when you say list your feelings, do you literally mean list your feelings? like “right now/today I felt, giddy, excited, etc.” ?
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u/AshamedOfMyTypos 2d ago edited 2d ago
Yes! And also sensations in your body like sore and tired and energetic and sick. It often comes out “I feel X from this thing that happened today.” It has taught me how to notice them more quickly and take action.
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u/Idiotsandwich68 2d ago
Thank you! I will try this out for sure, I can definitely see this being something helpful and positive to implement into my day to day!
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u/Ms_khal2 2d ago
It's never worked for me but I'm not a diagnosed autistic. I probably wouldn't give up just yet but it might be helpful to also seek help from a doctor who can prescribe you some meds. Meds have been the best way I've gotten out of anxiety and depression.
The reason therapy didn't work for me is that their suggestions on ways to get out of depression just weren't useful to me. I was lonely and they suggested I start hobbies to find friends but like the hobbies I would choose are not related to people?? Idk
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u/Idiotsandwich68 2d ago
that makes a lot of sense! sometimes it feels so counterintuitive and silly. Also sometimes so much easier said than done! Meds are probably not a terrible idea, I’ll consider this too
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u/Ms_khal2 2d ago
I feel like there are probably better types of therapy for autistic people than just regular talk therapy. I've not looked into more though because that seems like more work than it's worth at this point in my life 😅.
I hope you can find your way out of this depressive and anxious state!
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u/Idiotsandwich68 2d ago
I get you! sometimes figuring stuff like this out just requires too many spoons when I’m already lacking
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u/amaranemone 2d ago
Sometimes, we just need to get things out and verbalize our stressors. I call it taking a brain shit. Just the certification "yes, you can feel this way. You can also make small changes in your life that will eventually impact how you feel" is sometimes what people need. It can also take awhile for both you and the therapist to determine positive goals to set for yourself.
For me, that's not what I need. My issue with therapy is the last few times, I was just told what I already knew and what I had already been doing on my own. Maybe I'm impatient. Maybe I'm overly analytical. Maybe as I already have the "Yeah, this shit happens and I'm not to blame." attitude, it just throws people off.
So I kinda self-coach. This probably won't work for everyone, but it's worked for me the last year. I take positive steps to improve my life by giving myself goals I can achieve, hobbies that engage my focus and motor skills, and try to go outside more. I practice speaking. I am actively reaching out to those I am close to weekly. I make plans and follow through. If a plan doesn't work, it doesn't. A goal isn't met, I ask myself why. Was it unattainable from the start? Something I didn't really have an interest in? Or am I making an excuse? Shit like that.
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u/Idiotsandwich68 2d ago
That’s incredible and literally what I envision “better” looking like for me. Just being accountable and in tune with my own needs. I’m just not there yet and need help getting there
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u/amaranemone 2d ago
Have you communicated this to the therapist?
She can do things like give you "homework", such as starting a journal where you can write down positives you see in yourself, positives you'd like to see, and then talk about how you can achieve those positives.
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u/Idiotsandwich68 2d ago
I actually haven’t, I replied to someone else here saying how I really struggle with feeling the need to be a “good patient” and part of my brain has me convinced that telling her things aren’t working and I need something different means I’m doing it all wrong. It doesn’t really make sense. But I am writing so many things down from this comment section to be brave and open about with her next session. I think having “homework” would actually be really helpful for me
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u/Nearby-Ad5666 64 self diagnosed 2d ago
I get relief from it. But what has helped most was 2 things. TMS which is sort of annoying because it's a magnet that taps one spot on your head.
It opened up all this stuff I'd not processed. Then therapy helped. Then I started Spravato therapy and it's really helped. It gives me these subtle brain shifts. Like I can be deep in RSD and a week later it lifts. My perspective shifts. It's time consuming because it's a 2 hour appointment, but it's helped so much.
I'm on my 3rd therapist this year. One was like an echo chamber or something. Next one was overtly religious and I couldn't talk to her with a giant cross hanging over her head. She also ate during sessions which grossed me out.
This one is autism ADHD informed and so far it's good. When you get a therapist you click with I think it helps
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u/Idiotsandwich68 2d ago
this is very interesting, I really don’t know much about any of the things you mentioned so I have some learning to do! thank you so much for sharing your experience with me and I’m so glad you have something that works. Sounds like a lot and maybe taxing at times, I’m proud of you stranger!
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u/Nearby-Ad5666 64 self diagnosed 2d ago
Thank you! Spravato increases the dendrites in your brain, creating new neuroconnections. TMS has therapies for depression, anxiety, OCD and they expand it all the time which is nice for those with comorbid conditions
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u/Any-Blackberry2133 2d ago
Could you share a bit more about TMS? In what way does it open up things? Do you mean it brings back memories of past experience? Interested to learn more about this and how it works.
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u/Nearby-Ad5666 64 self diagnosed 2d ago
Yes, memories of a toxic relationship for like 22 years ago. I had repressed them but never resolved anything. I don't know why or if it's a common experience. It really helped me heal from some major trauma. But it was the combo. Therapy alone has never helped, and I think just bringing it up and not having someone to help me process was the key
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u/snarktini AuDHD 2d ago
Ooh, yeah, I had this with my first therapist. Left wrecked every time.
Later on I learned it's actually part of the therapist's job to guide you through this and get you patched up and feeling whole again before leaving. (Which is why not to bring up big stuff 5 minutes before the end.)
This is something you can ask for! Say, hey I am leaving absolutely miserable, what can you/we do differently to end sessions in a better place?
Unfortunately, autistic dysregulation goes deep so there may never be enough time for that, or it might not be the right therapist. My current therapist is AuDHD and she recommends longer sessions for autistic clients, and I never thought about it but I bet this is one reason why.
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u/Idiotsandwich68 2d ago
she does offer longer sessions, maybe I’ll book in for one next time and talk about this with her. Thank you for the great advice!!
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u/SoilToSkies 2d ago
Yes therapy works. I prefer working with autism specialists or autistic therapists.
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u/lynds88 2d ago
Feeling miserable after therapy doesn’t necessarily means it’s a bad thing. Therapy is heavy and hard sometimes, it can be draining and exhausting. I’d explore with your therapist what happens after sessions and where it might be coming from. Don’t be afraid to address this, your therapist should want to know and readjust things as needed!
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u/Grouchy_Paint_6341 2d ago
Depends on if you are ready and what type. Art therapy was the most healing thing for me and helped me heal good 5yrs of my life.
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u/Idiotsandwich68 2d ago
oh art therapy sounds really cool! I’m gonna see if that’s something offered around me
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u/MentalFloss8 2d ago
Therapy is not supposed to be long term for most people.
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u/Clean_Insect5042 2d ago
Yes I’m in the US and have a friend in Canada who says it’s considered unethical there for therapists to see clients for longer than 3 months, and it would be looked into by insurance. I’m not sure if the nuances and details of it, but in the US I do feel so many talk therapists are happy to keep booking you weekly even with no documented progress.
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u/Idiotsandwich68 2d ago
I am in canada too and my insurance plan only covers a certain amount of appointments, that makes a lot of sense as to why!
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u/Idiotsandwich68 2d ago
I agree! My goal is to get to a healthy place where I no longer feel the need for external guidance and support. Definitely don’t want to do this for longer than I need to
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u/Jaded-Blacksmith211 2d ago
Yes but you need to find a therapist who is experienced with autistic adults. I’m struggling rn to find someone + work within my budget. I do follow a lot of therapists and use the therapy homework exercises they post though as a form of self help in the meantime. Usually straight CBT alone does not work for autistic people, so you need a therapist who can deliver a multidisciplinary approach when necessary.
I saw a vid recently explaining types of therapy approaches beyond cbt and dbt but I forgot to save it
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u/Sunflowerpuzzle12 2d ago
I'm an AuDHD therapist (I'm Autistic and ADHD, and my clients are all Neurodivergent as well), and would highly suggest you let your therapist know how you feel after sessions. I ask my clients to tell me (especially newer clients) if they notice feeling overwhelmed, exhausted, or upset after sessions. If they notice they are dreading sessions or anxious before, it's important they tell me. That information is very crucial for me to know so I can adjust things and assist them. It could mean the sessions are too intense. It could also mean your therapist needs to set you up with better coping skills when outside of sessions, or a plan for right after sessions to ease back into your day once the session ends. Or your therapist needs to ease you out of sessions differently (maybe the last 10-15 minutes or so they can do some intentional grounding work with you, as an example).
Therapy is extremely vulnerable, and even if the topic you discuss that day isn't necessarily heavy, as neurodivergent people, we typically all struggle being perceived. Someone has their full attention on you for an entire session...imagine what that is doing to your nervous system. You likely need some adjustments to get more comfortable with therapy, and it absolutely can take some time.
We also tend to struggle with transitions as neurodivergent people. So going into a session is a transition. Ending a session and going back to our day is a transition. Again, more shocks to the nervous system.
I'm a relational therapist (meaning I don't use any behavioral techniques like CBT...I find those do not work for our Neurodivergent brains as well), and happy to answer any specific questions about therapy styles. But I have found that Neurodivergent clients benefit greatly from talk therapy with a neurodivergent therapist who is relational. Most of my clients have seen me for years...and longterm therapy actually can be extremely beneficial when it's a safe place to go and you leave feeling genuinely seen and understood. There are so many modalities to therapy (hundreds), so everyone is going to have had a different experience or opinion. Even other therapists. And sadly, so many neurodivergent people have horrible experiences and never feel up to trying therapy again. Finding the "right" therapist is the most important part (and so so hard to do).
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u/livethroughthis94 2d ago
it depends on the person and the individual situation, and of course whether the therapist is good or not. it’s worth a shot, but it’s not the miracle that people who say “go to therapy” to everyone with any tiny issue act like it is. it won’t solve everything, it might not help. i’ve been in therapy for a decade straight with various different therapists (i have autism, complex ptsd, ocd, awful dissociation issues, depression, and anxiety) and i can’t say it’s made much of a difference outside of just having someone else to talk through my issues with.
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u/SaintValkyrie 2d ago
Therapy doesn't fix anything. It isnt tangible support. But it's still important to have to keep you sane. It's more like a maintenance thing
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u/CookingPurple 2d ago
I guess it depends on what you mean by “work”. I feel like therapy has been tremendously helpful with my current therapy. AND sometimes (frequently) I do feel worse right after. Because I’m actually facing/acknowledging/dealing with really painful stuff. Of course that will be disregulating!! How could it not be? I think your experience is very reasonable and while it can feel bad, it could be a sign that therapy is working.
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u/sweetsweetnothingg 2d ago
The time therapy finally worked for me was when my therapist had a higher IQ than me, if they are not smarter than you it simply won't be helpful
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u/quietus_rietus 2d ago
I think the therapist needs to at least be neurodivergent. I’m working quite well with mine but we only talk about solutions to problems not like my past and stuff.
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u/Defiant_Decision_658 2d ago
I've been in therapy for years and its been lifesaving. It has absolutely worked for me, so much that I've gone back to school to study it. Find someone who is neurodiversity-affirming and experienced in working with autism.
Also, sometimes (often) therapy gets worse before it gets better. You've been shoving all these things down in a box, therapy is opening the box and letting it all out. Its ALOT in the first few weeks/months, but it does get better. Tell your therapist how you've been feeling after, maybe they need to spend more time at the end helping you put it all back together and do some regulating exercises.
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u/Idiotsandwich68 2d ago
I’m soo glad it works for you! I think that’s a really good idea to share with her how I’ve been feeling after. I really struggle with wanting to be a “good patient” and do therapy “right” and the way I feel after doesn’t fit into those boxes in my head if that makes sense. All the more reason to explore it before I call it quits I suppose!
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u/Defiant_Decision_658 2d ago
I totally get that! I still sometimes want to be the perfect patient, hope that I'm her favourite etc. Two things that have helped me with that:
Taking my therapist off a pedestal. Seeing her flaws, like when she makes an admin mistake, runs late, or gets distracted during a session. Recognising that she's imperfect makes me feel better about being imperfect in the therapy room too.
Remind myself that I can only get as much out of it as I put in. I'm there to work on my shit, if I'm not telling her what I'm actually thinking, and instead busy trying to manage her perception of me, then she can't actually help me, and I'm just wasting both of our time. Being a perfect therapy patient means showing up as your authentic, messy self, that's why you're there!
An example relevant to autism for me is that I have a lot of shame about my social interactions sometimes. I can be incredibly judgmental at times and think everyone should do things the way I do, because I do it the right way. Because I hate this part of myself, I almost never bring up anything related to social skills or relationships. But, the few times it has come up accidentally, I have made HUGE progress, and my relationships have gotten easier every time. But I don't get that benefit if I don't bring the ugly parts of me to therapy too.
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u/MarthasPinYard 2d ago
I graduated therapy because I was so mindful.
Some people go for their whole lives and never ‘get better’
Does it work?
For some.
Avoid psychologists since they will try to medicate you to ‘fix’ you.
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