Author ORCID Identifier

https://orcid.org/0000-0002-1445-5191

Date of Award

12-31-2025

Document Type

Open Access Thesis

Degree Name

Master of Arts (MA)

Department

Clinical Psychology

First Advisor

Abbey S. Eisenhower

Second Advisor

Alice S. Carter

Third Advisor

Heidi M. Levitt

Abstract

Autistic adults face heightened mental health needs yet encounter significant barriers in psychotherapy. Research on psychotherapy has often emphasized quantitative trials of specific modalities, while little attention has been paid to autistic adults’ own perspectives about in-session therapeutic processes. There is a need for clinical guidance that foregrounds autistic clients’ lived experiences of therapy, with emphasis on identifying what they find helpful or harmful, to inform accessible and affirming practice. In the present study, I conducted a qualitative meta-analysis that investigates autistic adults’ first-person accounts of psychotherapy. Thirty-three studies were included in the analysis. I used critical-constructivist grounded theory to develop a hierarchy of categories representing patterns across studies to clarify processes, harms, and benefits reported by autistic clients. Results included one core category, five thematic clusters, and fifteen categories. Findings indicated that therapy was harmful when rooted in neuronormativity, pathologization, or clinician bias, which placed the burden of adaptation on clients and caused lasting psychological harm. Conversely, therapy was experienced as helpful when providers demonstrated autism knowledge, affirmed autistic identity and experiences, ensured accessibility through structured and practical approaches, and centered client agency through collaborative partnership. These findings culminated in a core category: transforming therapy from a site of pathology to a site of partnership requires affirming, responsive, and flexible care. These findings highlight the necessity of autism-informed, neurodiversity-affirming therapy and underscores implications for clinical training, practice, and future research to enhance mental health care for autistic adults.

Comments

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