There is a particular kind of exhaustion that comes from being both inside and outside the room at the same time. Many autistic therapists know it well. You are enrolled, accredited, progressing. You can theorise, reflect accurately, and sit with complexity. And yet, again and again, the field positions you as if you are adjacent to the profession rather than constitutive of it.
This isn’t usually overt hostility. It’s quieter, more deniable. It’s the cumulative force of microaggressions—those small, repetitive acts that communicate you are not quite who you say you are. Not autistic enough. Not the right kind of autistic. Not what we mean when we say “people like you.”
Training spaces often rely on an unexamined template of the “therapist self”: verbally fluid, affectively legible, relationally intuitive in ways that are culturally coded as neurotypical. When autistic trainees don’t match this template, the response is rarely to interrogate the template. Instead, the person is read as lacking. Your affect becomes a deficit in empathy. Your need for processing time becomes resistance. Your clarity becomes rigidity. The framework holds; you are asked to bend.
And then there is the paradox of masking. If you are not immediately “read” as autistic, your disclosures are treated with suspicion or surprise. You are asked—implicitly or explicitly—to prove your neurotype, while simultaneously being told that your needs are exceptional, inconvenient, or excessive. You find yourself repeatedly requesting accommodations that should be unremarkable—clear instructions, predictable structures, time to think—and each request risks being received as special pleading. The figure you become is faintly archaic: the delicate, demanding relative who requires the room to rearrange itself. Not a colleague. Not quite an equal.
Alongside this runs a more diffuse but equally corrosive discourse: that autism is overdiagnosed, that neurodivergence is fashionable, that difference is being exaggerated. This is what neurophobia looks like in contemporary clinical language. It doesn’t always declare itself openly; it circulates as a tone, a raised eyebrow, a “both/and” that lands as dismissal. Your existence becomes a site of debate rather than a given. You are asked to hold yourself together while the legitimacy of your way of being is treated as provisional.
The othering intensifies in how autistic clients are spoken about. You sit in rooms where “working with autism” is framed as a specialised skill, requiring translation into simpler, more concrete, more managed forms of relating. The client is positioned as fundamentally different—less reciprocal, less complex, less available. You recognise the violence of this immediately. Not because you have read about it, but because you are its object. The language used about autistic people is the language that could, at any moment, be used about you. Even a desire to “help” hits wrong: it so often feels like a missionary zeal, it so often feels diminishing.
There is a substantial body of work on othering in contexts such as racism and migration, which names how dominant groups consolidate themselves by constructing an “outside.” What is often less acknowledged is how this process operates within psychotherapy training itself. The profession that speaks fluently about power, projection, and exclusion can reproduce them with remarkable precision when difference is in the room.
The impact is not abstract. It is felt in the body as vigilance, in the mind as over-preparation, in supervision as a careful calibration of what can be said without consequence. It is tiring in a way that is difficult to explain without sounding either fragile or angry—both readings that are then used to confirm the original misattunement.
And yet, autistic therapists are not marginal to this field. They are reshaping it. They bring forms of attention that are sustained rather than performative, ethics that are less invested in social smoothing and more in accuracy, relational styles that do not rely on implicit norms. They expose, simply by being present, how narrow the existing template is.
The task is not for autistic therapists to become more palatable to training cultures. It is for those cultures to recognise the limits of their own imagination. To understand that what they have been calling neutrality is often just familiarity. That what they have been calling professionalism is often just conformity.
Until then, many autistic therapists will continue doing two jobs at once: the visible work of becoming a therapist, and the largely invisible work of surviving the room.
Dr Stephanie Aspin 