Countless women have been incorrectly diagnosed with personality disorders and treated for them — via psychotherapy and medication — when what’s really going on is Autism. Or Asperger’s.
Part of the issue is that so little is known about how autistic spectrum conditions actually manifest in women, and how women work with them. It’s a big, big problem, in my opinion. And it’s one that can be addressed.
Therapists working with women on the spectrum can do certain things to help:
1. Please, please, please STOP pathologizing our differences.
STOP treating our differences like problems to be solved, and accept us and our quirks for what they are — just differences that scare other people, but can work really well for us, if they’re properly managed.
Instead of trying to normalize us and get us in line with the neurotypical program, allow us to develop the strengths in our differences and capitalize on them. No, don’t just allow us — encourage us. We have been beaten down for so long, both internally and externally, that we often need help just seeing that improvement is even possible.
2. And help us deal with the things that really ARE problems.
Because we’ve got plenty of those. We’ve got a lifetime of conflict and irregularity and disconnects to deal with, and we have a lot of old habits that may or may not work. We may at times be our worst enemies, between the negative self-talk, the self-defeating rumination, the constant attempts to figure things out, when we’re using incorrect criteria to understand our world.
It’s like we’ve been trying to read a French newspaper while using a Finnish dictionary. Close… but no cigar. And sometimes not even close. But the rest of the world will never know because we’re so adept at covering up our issues and passing as NT.
Indeed, the first step for many of us is getting to a place where we feel comfortable and safe enough to even admit to our difficulties. I still won’t do that in most situations. Even with the people closest to me. Especially not with them.
3. Be logical with us. Use reason.
Get over your infatuation with emotion, and recognize that “right brain thinking” is NOT a bad thing — plus, it doesn’t even exist — it’s just a concept that’s been propagated through junk-food-grade p,op-psychology.
4. STOP assuming that we are the versions of women we appear to be.
As I said above, we’re masters of disguise, and we are so conditioned to blend and mask our AS traits, that you’d never know who and what we are, just from looking with an untrained eye. We have survived this long by blending in, by imitating, by always staying two steps ahead of unsuspecting neurotypicals who just assume that if you behave like them, you are like them. That makes it extremely easy to pass, and extremely hard to genuinely step out of the shadows and show yourself for the person you truly are.
We know your assumptions. We sense them. We adapt to them unconsciously. And believe me, you are much easier to fool, than you can ever imagine.
5. Educate yourselves about the women’s viewpoint from women who are smack-dab in the middle of the autistic spectrum.
Read the blogs of women on the spectrum. Read the words of women and men who are actually living this. Watch the videos. Find out from us what it’s like to be us.
6. STOP treating us like we’re objects for you to fix or repair. And don’t assume that you know what needs to be fixed, to begin with.
Women, especially, need particular care. We are extremely vulnerable, and we’ve often been through a lot of trauma, just from living in our own skins. Don’t treat everything as standard-issue psychotherapy — don’t treat anything with us like that. You have to understand the full spectrum of our experiences, the complicated contexts of our lives. It takes a long, long time to do that — for us, as well as for you.
Anyway, the things we experience can sometimes be managed with different approaches. Sensory diets. Different modes of self-talk. Different focuses. Not to mention having a place to interact with another person who doesn’t treat you like you’re weird or defective or a failed version of a woman, because you have intense special interests or tics and stims that help us manage our sensory overload.
Some say autistic challenges are largely a result of society’s intolerance and almost pathological lack of imagination and acceptance. In my case, that’s often true. Don’t add to the burden of women who struggle, because of your own ignorance and intolerance.
7. Ask us what we want, what we need, and help us where we say we need help.
We spend our lives studying and examining everything, including ourselves. Many of us have voluminous internal (and possibly external) inventories of our deficits, flaws, defects, and a host of things we’d like to change about ourselves. We can probably give you a pretty good idea of where we need help, if you have our trust, and if you don’t put too much pressure on us. Precious few people can offer us the chance to articulate our exact needs. But if you can, you’re golden.
8. Don’t pressure us to show certain results from therapy. Even slightly.
We are so conditioned to comply, to imitate, to fake our way through, and also to perform to expectation, that you’ll likely get a credible imitation of someone making progress, but inside, the woman sitting across from you will still be an anxiety-ridden shell of a person, wondering if she’s done something wrong … again. Don’t pressure us to “get in touch with repressed …” anything. Don’t even suggest that we “should” be feeling or thinking such-and-such as a result of therapy. Don’t reward us for doing what you want us to say, think, do. And don’t even hint at criticizing us for not “getting it”. We’re more sensitive than you can ever guess, and even the slightest hint of pressure to “come to terms” with what you think is going on with us, can derail us and send us on a therapeutic boondoggle that can have serious consequences down the road. Be aware that iatrogenic harm is a very real possibility with us. In fact, with an untrained, insensitive therapist, it’s practically guaranteed.
9. Listen. Watch. Read. Think critically. Try to imagine what it’s like to be us for a while, and see what it’s like to be in our shoes.
Listen. To what we have to say. Not to what you’re thinking or how you’re going to respond to us. Listen to US, not the voice in your head.
Watch. Observe how we are… without jumping to conclusions. Try using a scientific approach as you observe us. And remember that what you’ve been trained to look for is quite often not what you’re actually seeing right in front of you.
Read. Learn about sensory issues, executive function issues. Read the accounts of autistic and Aspie women and really take it in. Dive into our world. See what it’s like. Feel what it’s like. Books will give you a rare inner view of our world that we can never share in spoken words.
Think critically. Take the standard-issue “expert guidance” with a grain of salt, and consider that the vast majority of autism spectrum research and criteria have been developed for 7-year-old white boys from middle-class families. That’s a very small subset of the general population, and a singular one at that. Those boys have issues a lot of us women never will. And they may never face the kinds of difficulties we deal with on a daily basis.
Assume nothing. End of story. Open your mind and check your assumptions at the door.
10. Simply strive to understand — really understand.
We are so alone, and often so lost — both within and without. That’s largely because nobody understands who we are or what they/we are dealing with. A small measure of understanding — of genuine feeling, visceral empathy, not just the neurotypical version of it — will go a long way towards helping us.
In the end, every ounce of effort that a therapist puts into better understanding women on the autism spectrum, can pay off in very big ways.
Conversely, every instance of being blind, deaf, and numb to our situation, has the potential to really screw us up.
So, tread carefully.