Supporting Autistic Clients Through the Complex Journey of Disclosure and Identity Integration
Abstract
Autistic adults face multifaceted decisions surrounding whether, when, and how to disclose their autistic identity to others. This complex journey involves stages of self-discovery, evaluating risks and rewards of disclosure, handling others' reactions, and ultimately integrating one's autistic identity. As therapists, we strive to validate clients' realities, provide sensitive guidance around disclosure, bolster self-advocacy skills, and encourage community and environments where autistic people can live openly and authentically. To equip therapists to engage with clients throughout what is a sensitive and deeply personal process of self-discovery and adjustment, this article starts the conversation about best practices for working with autistic clients when they first realise that they are autistic. It focuses on the therapist’s role in supporting clients across the stages of self-realisation, disclosure, identity integration, and consideration of the therapeutic approach.
Introduction
In recent years, a growing number of adults are realising they are autistic later in life (with or without formal clinical assessment via medical routes). Through online resources and personal accounts, they recognise their own lived experiences align with descriptions of autistic traits. This self-discovery often marks the beginning of a complex journey—grappling with the meaning of an autistic identity, deciding if, when, and how to disclose it to others, and integrating this reality into one's self-concept.
Navigating disclosure decisions and identity integration can be deeply nuanced and highly individual for each autistic person. As clinicians, we can strive to validate clients' realities, provide sensitive counsel around risks and benefits of disclosure, empower self-advocacy skills, and foster environments where autistic people can live openly and authentically as their integrated selves.
This article synthesises insights from research and perspectives of autistic individuals to inform best practices for supporting clients across this multifaceted journey. First, we examine the path to self-discovery and self-identification in autistic adults. Next, we explore considerations surrounding disclosure to employers, family, and friends. Guidance for handling negative reactions and integrating identity follows. We consider ways to think through appropriate therapeutic approaches and conclude by highlighting critical areas for future progress in enhancing quality of life and inclusion for autistic people.
The Path to Self-Discovery and Diagnosis
In recent decades, knowledge and visibility of adults as autistic people have expanded substantially. The stereotype of autism as an inherently childhood condition is fading as more evidence demonstrates that autism is something that a person is from birth to death. Many autistic adults recognise aspects of themselves in first-hand accounts shared by their autistic peers online and in literature. They may identify with described experiences like sensory sensitivities, needle-focused interests, difficulties with eye contact, struggles reading social cues as well as being misread by others, and a sense of difference that can elicit judgment from others.
Through exploring resources created by and for autistic people, some adults discover an explanatory framework for longstanding quirks and challenges. Their autistic traits were perhaps less pronounced or misattributed to other causes earlier in life. New learning about autism allows pieces to coalesce into a coherent whole. They conclude they are likely autistic based on extensive self-research and self-reflection.
This pathway of self-diagnosis, or self-identification, often stems from external barriers to formal clinical assessment, most commonly cost and long wait times. Structural factors within the healthcare system make assessments (and a ‘medical diagnosis’) inaccessible or untenable for many. Moreover, clinical diagnostic practices still struggle to identify more subtle manifestations of autism in verbally articulate adults, particularly women and girls. Standard assessment tools were normed on male children and are ill-suited for capturing camouflaged traits in adults. Thus, self-evaluation fills a void where formal channels fall short.
In light of these realities, counsellors and psychotherapists approach self-identified autistic clients with an open, non-judgmental posture, and invalidate neither the assertion of autism nor the individual. We suggest that therapists make space to understand clients' reasoning rather than dismiss conclusions as illegitimate due to being without a specialist's stamp. Ask how realising that they are autistic helps explain previous struggles, decisions, relationships, and identity. It is supportive to discuss options if the client wishes to seek formal assessment, but affirm their self-knowledge as valid regardless.
The Risks and Rewards of Disclosing an Autism Diagnosis
After recognising one is likely autistic, a momentous question arises: should I disclose this to others? Friends, family, employers – who, if anyone, should know? For each relationship, autistic individuals weigh complex considerations around anticipated risks and rewards. Navigating if, when, and how to reveal one's diagnosis is deeply personal.
On the potential upside, disclosing offers relief from masking aspects of oneself to maintain appearances. It opens possibilities for greater acceptance and support from loved ones. Disclosing to an employer unlocks legal protections requiring reasonable accommodations. Joining autistic communities can provide validation, advice, and belonging.
However, stigma and prejudice carry grave risks because it doesn’t always end in happy-ever-after. After disclosure, some friends and family respond with skepticism and even shame, struggling to reconcile negative stereotypes with the person they know and love. Employers may funnel the individual into narrow roles or regard them as less capable or less competent. The misleading ‘spectrum model of autism’ itself, emphasising degrees of deficit and impairment, fuels harmful assumptions that autistic people can be less or more autistic (as if the spectrum means a continuum), rather than recognise that it means that there is a spectrum of differences in an autistic person. People may believe that autistic people are inherently dysfunctional and require “fixing” to assimilate. into society for their own god and that of everyone else. Additionally, internalised stigma often haunts the disclosure process.
Therapists can collaborate with clients to carefully weigh the pros and cons of their specific circumstances, neither pressing for nor against disclosure universally. Counselling can explore the individual client’s life and take account of preferences, desires, risks and benefits to that individual. The process can be one of an alliance, and the content of the exploration can emphasise core values of empowerment and self-determination so the client controls if, when, where, how, and to whom they disclose. For example, some individuals choose to be open about being autistic broadly, while others selectively disclose only to certain trusted confidants or in contexts where accommodations are needed.
No single formula exists, since each individual's priorities differ based on their environment. The therapist’s role is to guide clients to make the most well-informed decisions for themselves given their distinct contexts. Supporting them in articulating their needs to employers and loved ones is also vital. Ultimately disclosure should facilitate self-expression, not trap someone in a box constructed by other’s assumptions or put them at risk of mistreatment or being misunderstood.
Sadly, prejudice means some will react negatively when clients disclose their autism diagnosis. Loved ones may breezily declare something like “You don’t look autistic” or express misguided grief over perceived personal deficits. It can be helpful to illustrate specific autistic traits relevant to their lived experience when disclosing, and not just declaring abstract diagnostic criteria. The benefit of letting others know that one is autistic is that there can be increased understanding and consideration of each other. One person simply saying to another “I am autistic’ likely isn’t enough to bring about deeper understanding - yet explaining and describing more about what that means can start that understanding. Pointing out what it means for the relationship between the two people, including how to understand each other better and meet each other’s needs, is more likely to achieve a deeper understanding and more guidance about how to relate to each other in positive ways.
There may be clients who reveal that their employers are being resistant to making accommodations. Autistic adults have a right to workplace inclusion and non-discriminatory treatment because there are legal protections for the disability status that autistic people have in the eyes of the law. Clients may benefit from exploring the situations and the variables associated with their options. In cases of overt discrimination, clients might want support in deciding whether or how to pursue complaining, including such things as documenting instances and consulting legal resources if needed.
Should friends withdraw or reject them after learning they are autistic, therapists can recognise the deep pain of losing connections, or acknowledge the relief of disconnection from some relationships. Therapists can also support building community with accepting peers - people that they identify with and conditions in which they are understood. There are autistic-run online groups that provide connection and advice without judgment. In-person groups are harder to discover. However, finding external support sustains clients as they establish boundaries against toxicity and forge new relationships based on mutual acceptance.
Integrating an Autistic Identity
Disclosing an autism diagnosis publicly represents a transition. Autism becomes part of one’s identity. “I am autistic”. Ensure clients have space to navigate emotions around this shift, which can be complex and non-linear. Autism has deeply personal implications for self-concept and lived experience. It will permeate their whole being, unlike a transient condition. Integration takes time and care.
Eventually, embracing one’s autistic identity often allows increased authenticity and reduced masking. Therapists can guide clients in authoring their own narratives around being autistic, highlighting both gifts and challenges. And can support them in trying new modes of self-expression. Facilitating a positive autistic identity is important, and discussing examples of autistic advocates modeling pride, talent, and contentment in their identity can be an enriching process.
Therapy can focus on cultivating self-esteem and self-efficacy as a neurodivergent person. Many autistic adults internalise shame around social differences and behaviours that have been judged as odd or abnormal, rather than merely atypical. Having a constant positionality based on asserting that these differences only constitute deficits because society constructs them as such is neuroaffirming. As the neurodiversity paradigm states, the differences simply represent natural, neutral variation in human beings. Helping autistic clients recognise and own their strengths is tremendously empowering. For example, intense special interests can be soothing to be immersed in, can elicit a state of flow, and confer knowledge and meaning to the autistic person. Reframing deficits as “differences” opens new pathways of thought and ways to conceptualise the self. And, together, counsellor and client can craft an empowering narrative of self-acceptance and pride in being autistic.
Ultimately, our most vital role is providing unconditional support while autistic clients recalibrate their self-conceptions and determine how to live as their integrated selves. Their journeys to disclosure and identity integration will be unique. By listening empathetically and responding compassionately, we can nurture the most liberating outcomes from each person.
Future Directions
While understanding of autistic adults' support needs has progressed, critical gaps remain in policies, practices, and societal perceptions. Our models of disability and accommodation must evolve to recognise neurodiversity without judgment. Therapists should continue incorporating perspectives from autistic self-advocates into best practices for understanding autistic people, recognising pain in autistic people, and being aligned with how autistic clients define desired outcomes of therapy and appropriate ways of conducting the therapeutic process.
Unemployment, depression, poor mental health, and suicide disproportionately impact autistic people. Therapists play a vital role in nurturing welcoming environments with therapists who are knowledgeable about neurodiversity and skilled to work therapeutically with neurodivergent people. Integrating the knowledge of autism with a healthy sense of identity and self-efficacy requires a foundation in the therapeutic dyad, of basic safety, inclusion, and respect. Therapy takes plae within the container of a relationship. In terms of what would be attended to, it is interesting to remmeber that autistic people percieve and attend to detail and focus in ways that are different to that expected by people who are not autistic. And autistic people also process emotional material differently, and communicate differently, which may alter the experience of relating. Therapists being competent and confident in interacting with autistic clients, not only with their internal world but also understanding the narratives and getting the point of the reality of external situations, is essential for beneficial support and therapeutic outcomes.
Conclusion
As with all clients, our autistic clients' journeys are nonlinear, messy, and wholly personal. By validating their realities, and empowering authentic expression while managing real risks, we can illuminate pathways to integration and belonging, and to self-understanding that can lead to clients getting their needs met. We can only do that if we accurately know and understand their realities. All therapists having an unwavering commitment to learning about neurodivergent people, specifically autistic adults, best serves their well-being. Moreover, it is in the interests of the therapists themselves to gain confidence in providing an inclusive practice that is truly therapeutic for autistic people.
Vauna Beauvais. Autistic psychotherapist and ADHD-er.
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