Putting all of this into a therapeutic context, it is important to recognise that Autism is Autism, period. And if you have met or worked with one Autistic client, you have certainly not met them all. The spectrum is far wider and deeper than you can imagine, and it is imperative to remain curious as to what your client’s unique experience is like. Figure out what challenges may present themselves in session and collaborate on how you can work around these together. This may look like asking about any sensory issues and how these can be mitigated. As an example, sometimes I use The Feelings Wheel as a simple check in tool with clients (Wilcox, 1982). The original wheel image uses bright, contrasting colours to highlight each emotional state. This can present significant overwhelm for a client with visual processing sensitivities, so I have another wheel that uses analogous colours ranging from soft green to purple hues that can be easier for the eye to take in.
Fostering a client’s freedom to unmask during sessions is another way to provide support that actively works to dismantle harmful stereotypes perpetuated by ‘high vs low functioning’ labels. I often encourage neurodiverse clients to engage in stimming behaviours as often as they like in our sessions. I also make it known that I will sometimes engage with stimming behaviours during sessions too (I can say with great certainty that I would not be able to sit still for very long without my fidget cube nearby, and am no stranger to gleefully flapping my hands when I a client shares an experience of joy with me). Currently I am in the process of cultivating a collection of diverse toys and tools that can be accessed by clients during sessions specifically to encourage stimming.
An empowered, authentic self can be decimated by shame. And there is nothing shameful about being Autistic. The purpose of the ‘high functioning’ myth serves only to protect the comfort of the perspective that if we all go about life in the same way, this way must be normal and correct. But we therapists know that the most profound growth occurs when we sit with discomfort and challenge ‘normal’. So, let’s ditch the functionality labels, step out of the comfort they used to protect, and support our clients in finding their own unique ‘normal’.
Sources & Additional Reading:
Alvares, G. A., Bebbington, K., Cleary, D., Evans, K., Glasson, E. J., Maybery, M. T…Whitehouse, A. J. (2020). The misnomer of ‘high functioning autism’: Intelligence is an imprecise predictor of functional abilities at diagnosis. Autism: the international journal of research and practice, 24(1), 221–232. https://doi.org/10.1177/1362361319852831
Chalwa, D.S. (2019). Large study supports discarding the term ‘high-functioning autism’. Retrieved from https://www.spectrumnews.org/news/large-study-supports-discarding-term-high-functioning-autism/#:~:text=Researchers%20coined%20the%20term%20’high,(an%20IQ%20below%2070).
Williams, K. (2019). The Fallacy of Functioning Labels. Retrieved from https://www.ncmh.info/2019/04/04/fallacy-functioning-labels/
Willcox, G. (1982). The Feeling Wheel: A Tool for Expanding Awareness of Emotions and Increasing Spontaneity and Intimacy. Transactional Analysis Journal, 12(4), 274–276. https://doi.org/10.1177/036215378201200411