How can stakeholders use principles of self-determination, individuality, and compassion to support individuals with autism and their self-directed mental health care pursuits?
It’s a common phenomenon and instinct to want the best for family members or clients with autism, especially when it comes to their mental health. But, the best-intended approaches to nudge people with autism toward mental health support can at times be ineffective or misdirected.
An alternative approach is based on the seemingly counterintuitive principle of encouraging the individual’s development of agency over their own pursuit and manner of care.11 This can be worked towards by applying principles of person-centered support, individual motivation, awareness of all mental health factors, positive counseling relationships, and of course, self-compassion.
Moreover, it’s imperative to note that neurodivergent communities are not monolithic and effective strategies vary depending on the individual’s culture, level of development, personal goals, and presenting challenges. However, knowing and applying these general principles and concepts can make the difference between “supporting” or “enforcing” the mental health of autistic people.
Prioritizing Person-Centered Support Over Paternalism
Agency, autonomy, and self-determination are basic tenets of existence and something that most people, whether neurotypical or neurodivergent, value. These individual rights are best integrated into care that is person-centered in its emphasis on clients’ control over their own treatment; this is a stark contrast to paternalistic-based care that places the onus of care direction and implementation on someone other than the client themselves.4
Paternalistic approaches towards autistic individuals with the goal of them engaging in mental health support are often well-meaning, but they run the risk of feeling infantilizing or potentially patronizing to the individual. Examples of this approach can include telling an autistic person that they “need help,” as opposed to “deserving support,” or mandating therapy attendance.
Supporting the individual’s autonomy and working towards their self-empowerment has the benefit of not only organically growing motivation for mental health, but also developing long-term self-advocacy skills into adulthood. This principle can be applied using the previously mentioned person-centered approaches to building individual motivation and positive counseling relationships.
Additionally, both person-centered and paternalistic models can be combined as they are not necessarily mutually exclusive, and at times, it may be necessary to implement one theory over the other. Especially in cases where an individual is at risk of harming themselves or others.
Motivating Instead of Mandating Mental Health Care
Further elaborating on the importance of self-determination for autistic people is the idea that mental health care is most effective when entered willingly as opposed to forcibly through enforced or coerced therapy attendance.
Since mandated therapy participation is rarely beneficial, the client-empowering approach is to help autistic individuals identify their own goals using motivational interviewing techniques with synchronous awareness of the stages of change theory.5 This strategy involves identifying the individual’s goals, barriers to change, and reasons for motivation or discouragement; it’s also not uncommon for their mental health or long-term goals to not necessarily match those that are held by family members or teachers.
However, it can be frustrating or disheartening for stakeholders when a loved one is not progressing consistently toward mental health self-advocacy. Especially when challenges with emotion identification and social communication are present, or if the individual’s current development level challenges their ability to understand or communicate self-determination concepts.
As a result, caregivers and support professionals who can, and must understand these concepts need to advocate for and work towards client inclusion and agency over their own mental health. The ultimate goal is that autistic individuals develop the ability to independently choose and engage in mental health support from minor age into autonomous adulthood.
Addressing Autism, Co-occurring Conditions, and the Individual
The goal of any mental health program or psychotherapy is to treat the individual, not their diagnosis or label. While autism can be a huge part of a person’s self-identity, it is far from being the only part. Co-occurring conditions, medication use, environmental factors, family dynamics, physical health, and many more aspects combine together to form the individual’s mental health status.8
Autism can absolutely impact how therapy and supports are approached, but attributing the origin of all of the individual’s needs and challenges to autism is a potential invalidation of their individuality and personhood. Nevertheless, accurate diagnoses can be extremely crucial for determining effective therapy modalities and motivation strategies, calling to attention the chronic misdiagnosis of autism as a personality disorder and vice versa.6
Understanding this overarching principle, family members and support professionals can gain empathy for individuals with autism and work towards supporting them as a person and not a diagnosis.
Customizing the Counseling Experience
Another prominent component of providing compassionate and client-centric mental health support is working with the reality that psychotherapy is not always accessible for people with ASD. From a shortage of relevant experience to an absence of client rapport, finding a therapist as an autistic person, or for someone else on the spectrum, can be a long and arduous process.7
Often, therapy modalities designed for neurotypicals need to be altered in order to work with an individual’s autism instead of against it, especially with the acknowledgment of the common neurological trait of thinking rigidity.2 To counteract this, stakeholders may recommend counselors with a long list of qualifications or years of experience working with neurodivergent clients. But, while experience and professional competency are crucial, the client ultimately needs to like working with the therapist and their treatment style.
Encouraging individuals with autism to research therapists themselves, or observing their reactions to different therapists, is the best way of identifying the most effective provider. Newer treatment modalities such as “Geek Therapy” can also capitalize on their interests to make therapy more engaging for people with autism.1 Combining this with the rise of teletherapy can further help set a course for comfortable and sustainable mental health support.
Practicing and Encouraging Self-Compassion
Self-compassion is the practice of being kind and forgiving to oneself. This practice is not to be confused with “excusing” behaviors, but rather working towards self-awareness and self-acceptance.
To function and assimilate within a neurotypical society, people with autism often have to endure constant and conscious work and effort. When these expectations aren’t met, they may feel shame or self-hatred that deters them from pursuing mental health support. Parents and family members may also feel sympathy, as opposed to empathy, for them as a result.
However, teaching self-compassion techniques can help improve the overall mental health of autistic individuals by using acceptance instead of shame as a motivator for mental health care engagement.10 Caregivers, family members, and support professionals can also benefit from self-compassion to emphasize the importance of self-care before caring for others.9
Applying Awareness and Advocating for Mental Health Autonomy
Everyone has mental health, but the motivating approach and treatment strategy may be impacted by a person’s neurotypical or neurodivergent identity.
Although often done with caring intentions, stakeholders cannot force people with autism to seek counseling or to work towards pre-determined mental health goals. Parents and professionals certainly have a duty to encourage what’s best for clients, but it is possible to offer guidance without sacrificing client agency.
These general principles and theories can be applied to empower autistic people to care for their own mental health out of self-determined acceptance, not obligation. People with autism need to determine their own goals and develop their own motivation not only for maximum therapy efficacy but for their innate right to autonomy.
How can you apply these principles to support the mental health of your family member or client with autism? Tell us your ideas and thoughts in the comments section below.
We hope you enjoyed the information in this article. STAGES® Learning also offers free downloadable resources to support teaching and learning with individuals with autism. Start with our free Picture Noun Cards and see our collection of other downloadable resources here!
References
- Bean, A. M. (2020, August 13). Geek therapy for professionals. Psychology Today. https://www.psychologytoday.com/us/blog/geek-therapy-professionals/202008/geek-therapy-professionals
- Cooper K, Loades ME, Russell AJ. Adapting Psychological Therapies for Autism - Therapist Experience, Skills and Confidence. Res Autism Spectr Disord. 2018 Jan 1;45:43-50. doi: 10.1016/j.rasd.2017.11.002. PMID: 30245739; PMCID: PMC6150418. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6150418/
- Enhancing Motivation for Change in Substance Use Disorder Treatment: Updated 2019 [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2019. (Treatment Improvement Protocol (TIP) Series, No. 35.) Chapter 3—Motivational Interviewing as a Counseling Style. Available from: https://www.ncbi.nlm.nih.gov/books/NBK571068/
- Fernández-Ballesteros R, Sánchez-Izquierdo M, Olmos R, Huici C, Ribera Casado JM and Cruz Jentoft A (2019) Paternalism vs. Autonomy: Are They Alternative Types of Formal Care? Front. Psychol. 10:1460. doi: 10.3389/fpsyg.2019.01460 https://www.frontiersin.org/articles/10.3389/fpsyg.2019.01460/full#B27
- Hachtel H, Vogel T, Huber CG. Mandated Treatment and Its Impact on Therapeutic Process and Outcome Factors. Front Psychiatry. 2019 Apr 12;10:219. doi: 10.3389/fpsyt.2019.00219. PMID: 31031658; PMCID: PMC6474319. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6474319/
- Iversen S, Kildahl AN. Case Report: Mechanisms in Misdiagnosis of Autism as Borderline Personality Disorder. Front Psychol. 2022 Feb 4;13:735205. doi: 10.3389/fpsyg.2022.735205. PMID: 35185714; PMCID: PMC8855062. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8855062/
- Lipinski S, Boegl K, Blanke ES, Suenkel U, Dziobek I. A blind spot in mental healthcare? Psychotherapists lack the education and expertise for the support of adults on the autism spectrum. Autism. 2022 Aug;26(6):1509-1521. doi: 10.1177/13623613211057973. Epub 2021 Nov 26. PMID: 34825580; PMCID: PMC9344568. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9344568/
- Mosner MG, Kinard JL, Shah JS, McWeeny S, Greene RK, Lowery SC, Mazefsky CA, Dichter GS. Rates of Co-occurring Psychiatric Disorders in Autism Spectrum Disorder Using the Mini International Neuropsychiatric Interview. J Autism Dev Disord. 2019 Sep;49(9):3819-3832. doi: 10.1007/s10803-019-04090-1. PMID: 31175504; PMCID: PMC6669096. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6669096/
- Pyszkowska A, Wrona K. Self-compassion, ego-resiliency, coping with stress and the quality of life of parents of children with autism spectrum disorder. PeerJ. 2021 May 3;9:e11198. doi: 10.7717/peerj.11198. PMID: 33986986; PMCID: PMC8101449. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8101449/
- Ru Ying Cai and Lydia Brown.Cultivating Self-Compassion to Improve Mental Health in Autistic Adults.Autism in Adulthood.Sep 2021.230-237.http://doi.org/10.1089/aut.2020.0034 https://www.liebertpub.com/doi/abs/10.1089/aut.2020.0034
- Späth, E.M.A., Jongsma, K.R. Autism, autonomy, and authenticity. Med Health Care and Philos 23, 73–80 (2020). https://doi.org/10.1007/s11019-019-09909-3 https://link.springer.com/article/10.1007/s11019-019-09909-3#citeas
