Here it is, my first blog post at the grand old age of 52!!!! Huge thing for me to put my work out here. It's a long one, hope it helps someone. I haven't included all my references here, but happy to provide them.

In pcc,(person-centred counselling) you will not always know if a person is autistic, some clients might not want a diagnosis, some might self-identify, so a counselling service embedded in good practice principles, detailed below, may just be of more benefit to all.

It is necessary to critique good practice, because evidence points to autistic people not feeling able to access counselling (Hallet & Kerr, 2020), which suggests not all counsellors are neuro-affirming. It is necessary to critique concepts around good autism practice to clarify further understanding and promote learning. Neuro-affirming practice facilitates meaningful connections and it is posited that many autistic people struggle to find this with professional services (Noble et al, 2024). The widely held view that this is a problem  with the client, rather than recognition of it as a required societal shift in perception, is challenged by a study by (Robinson et al, 2020) Robinson also challenges increasingly common ideas of the  autism expert and  I feel this is another reason why it’s important that good practice  is critiqued. What exactly does autism expert mean for the counsellor and the client?

To establish shared trust and understanding and grow a therapeutic relationship where autistic clients can thrive, certain practice standards need to be in place. I have therefore, developed a set of gold standards, which I feel can support counsellors to develop good practice with autistic clients. Developing a private counselling practice following the guide below may help move towards more neuro-affirming good practice :

GOOD PRACTICE GOLD STANDARDS:

1.    COUNSELLOR UNDERSTANDING OF AUTISM THEORY

Counselling is largely an unregulated profession in general, despite there being professional organisations who are moving to ensure more standardisation and accountability. There are many workshops and courses being offered to counsellors about autism, with no standard for accrediting content or approach, meaning there is huge potential for harmful language, damaging and outdated beliefs (Chapman & Botha, 2022). My own counselling training, 10 years ago, did not include any awareness of neurodivergence. I have continuously been learning since. I fully agree with Jones in that neurodivergent – informed training should be included in core counsellor training (Jones et al, 2024).

Neuro-affirming good counselling practice begins with counsellor understanding of autism theory. According to the research, we can determine that a basic understanding of autism theory is critical, to develop autism affirming good counselling practice (Jones et al, 2024). Education and training on autism created with autistic communities, along with continual learning, is necessary (Flower et al 2025) But what does this actually mean? Useful guidance from Aucademy website highlights that training that focuses on autistic experience, ie, thought processes, emotions etc, not just observable autistic behaviours , can be a useful  way of determining whether it is autistic led or not (Aucademy,2025) Evidence suggests viewing autistic communities as the autism experts, (Gillespie-Lynch et al, 2017), which surely naturally should occur!

The current situation for autistic client, is that there are many counsellors who claim to be specialists in autism. The study by (Chapman & Botha, 2022,) stipulates that the meaning of ‘specialist’ is vague and so can lead to harm and there is no one standard way to assess autism understanding of the counsellor. While there will be some counsellors genuinely invested in the neurodiversity movement, others may rely on outdated beliefs and misinformation, (Hallet & Kerr, 2020) This leaves autistic clients unsure who has sufficient understanding, unsure of counsellor’s true beliefs, meaning the potential for harm is huge. Entering a counselling room in itself can be massively anxiety provoking for anyone.  

Research reports that many autistic communities experience well-meaning professionals who lack autism knowledge, which has led to negative experiences for autistic clients (Camm-Crosbie et al 2019) .This is how I know good practice needs to include neuro-affirming training for the counsellor. This is important for good practice because literature shows that there is a lack of appropriate accommodations and a sense of not being taken seriously, (Hallet, 2020) and having  symptoms discarded (Camm-Crosbie et al,2019) If the counsellor lacks understanding, anxiety will increase for the autistic client and there may be implications for self-esteem and self-worth levels, resulting in not feeling believed and acknowledged.

The overarching theme amongst research is the importance of access to a clinician who understands autism, ( Brice et al, 2021 ;Chapman & Botha, 2022) and this  also supports my gold standard of autism theory knowledge. Most important, adjustments overall in the findings of their study all relate to clinician knowledge and communication. Feeling understood, may increase feelings of safety and acceptance in the counselling space, which literature shows as above, is not the case for many autistic people in society, (Shaw et al, 2024)

Conversely, autism theory is only able to explain some lived autistic experiences, some of the time, for some autistic people (Beardon, 2022), This highlights the importance of working with the human being you have in the room, at that moment in time. Counsellors not acquiring appropriate and relevant knowledge, means continuing poor mental health for many autistic communities, when the statistics already depict a devastating picture. The most critical elements of autism knowledge, relating to good practice in pcc relationship, to be understood by counsellors are:

Empathy

Knowledge and understanding of this, is important for counsellors, as some autistic people experience empathy differently (Chown, 2017), Chown points to the empathising-systemising model, which details different cognitive styles. He explores the extra element of the cognitive process around empathy for some autistic people, in that it not only requires understanding other’s thoughts and feelings, but it demands an ‘appropriate’ emotional reaction. Counsellors need to know that research shows empathy as having a cognitive and an affective element, because the person-centred relationship evolves around the experiencing of empathy. Awareness of any mismatch in understanding and experiencing, is critical to the developing therapeutic relationship.  Awareness of the extra processing time some may experience in figuring out a response, for example, needs to be acknowledged. It is important for good practice as this is how it may impact autistic clients.

Empathy is complex and different types of empathy have been identified. Cognitive empathy, which is described as  the understanding around what others are thinking and feeling and affective empathy which is an’ emotional response triggered by the perception of another,’ (Kimber et al, 2023), Research states that ‘more recent studies have indicated that deficits might be found in relation to cognitive empathy, (Kimber et al, 2023) not affective empathy emphasising the importance of not believing outdated views around autistic people lacking empathy. The well documented breakdown in interaction between autistic and non-autistic people, known as the double empathy problem (Milton,2012), posits that this is due to differing perspectives and perhaps this is due to a tendency to different cognitive styles.

Linked with this, is research around the commonality of alexithymia in autistic communities (Kinnaird et al, 2019), which can pose challenges around emotional processing difficulties for some, perhaps an inability to recognise feelings, perhaps more on this cognitive level. Interoception mismatch, (Jones et al, 2024), struggles interpreting bodily signals and psychological states, is important to know for good practice, as pcc is based on exploring feelings. This study recommends tailored interventions to help support and this is another reason why counsellors need to be aware of this as good practice in beginning to build client relationships. I know this needs to happen, due to research showing that autistic clients feel so misunderstood by counsellors, (Hallet,2020)

Hill points out an interesting concept, around Roger’s idea of empathy being based on a more cognitive style, rather than affective and highlighting how a compassionate approach, so more of a deep atunement, supports good counselling practice. This takes into account, research on increased tendency towards affective empathy, in autistic communities. Perhaps this is an area of pcc that does not support the pcc relationship.

Literature also points to many autistic people experiencing hyper empathy (Kimber et al 2023).  Surely there is no harm in all clients receiving a more compassionate approach.(Hill, 2007) This constitutes another research project and I acknowledge that I have only touched the surface for the purposes of this essay.

Masking and camouflaging

Masking, the suppression of autistic traits, (Price, 2022) and camouflaging, the mimicking of neurotypical behaviours, to fit in with neurotypical society, is widely documented to cause huge mental health struggles for autistic people (Price, 2022: Di Marco, 2025). Counsellors need to know that this can be a barrier to taking part in counselling and can be part responsible for the constant underlying levels of high anxiety, that many autistic communities experience (Beardon, 2022)

 An understanding of this high toll is necessary and the knowledge that some may never feel safe enough to unmask. When building the therapeutic relationship, allowing space for the autistic person to feel prized for who they authentically are, without judgement, may help to reduce their need to mask in other parts of their life. Holding a space that is safe for autistic communities to build a strong sense of self and understanding how this is to work for them, and self-advocacy is critical, (Bertilsdotter Rosqvist et al, 2022) The psychological and physical toll of this and fear of being viewed negatively,  cannot be emphasised enough. This is huge in good practice, to help reduce autistic burn out and to conserve energy (Field et al,2024;Lei&Russell,2020) This is how I know that counsellors need to have this understanding of what the impact of masking is.

As mentioned earlier, experiencing of hyper empathy is common for many in the autistic community, so on both a physical and emotional level, a safe barrier is needed particularly perhaps in new situations and environments. It is so central for counsellors to understand that this means it may take a long while to settle into the counselling space on many levels, for an autistic person. A keen attunement to offering long term work, if this fits for the autistic client is critical, as for example, some services can only offer short term work of 6 to 12 sessions. For an autistic person who has been masking all their life so far, this time may only serve to begin to acclimatise to the environment, prior to commencing any therapeutic work. This emphasises the importance of knowledge of masking  and  I recognise again here, that there is so much scope for further research.

2. GOLD STANDARD – Communication

Differences in communication styles are widely documented in research. (Milton,2012:Crompton et al, 2020). Good practice would look like sharing information  about what can be expected from counselling sessions, prior to meeting. The reason I know this is the lower tolerance for uncertainty (Chown, 2017) and anxiety for many autistic communities. (Hallet & Kerr, 2019)

Good practice would be a strengths-based understanding, with sensitivity to language needs and a flexible approach (Jones et al,2024) and is critical for counsellors in adapting to the needs of the person in front of you. How much is the counsellor genuinely willing and able to do this though, may pose a concern for the autistic client.

I feel good practice consists of the following stages in the counselling process:

Pre counselling

Website and advertising – what needs to happen:

• I am aware that my own marketing is always in process ! I feel that good practice should begin, with clear advertising on any websites or given as a leaflet in the initial chat, such as :
• Detailed list of CPD/Qualifications gained by counsellor
• Clarity on beliefs of counsellor around neuro-affirming practice, volunteered by counsellor in initial chat or given on website
• What options are available for what you might need and how it is ok if this changes, such as session time reminders via text or email.
• Up to date picture of counsellor, room if possible and its entrance, for clarity
• Brief video of counsellor introducing their practice, so can hear how you sound, accounting for sensory sensitivities, for example.
• Initial chat prior to any
• counselling sessions -
• Directions and steps on what to do on arrival at counselling. This will include:
• Where to wait
• What happens at first meeting
• What and who can a client bring with them, eg a trusted family member
• Explicit description of what your counselling mode is, what it is not and some basic rules of your practice (Hallet&Kerr,2020)

I know that this needs to happen, as according to research (National Autistic Society, n.d.) the evidence base suggests a clear, detailed, concise knowledge of what to expect, supports reduction of anxiety for autistic communities. I know this to be important for good practice as literature continuously highlights the negative experience of autistic communities around accessing therapy (Hallet&Crompton,2018). By providing clear information on what to expect, this provides clarity and reduces unknowns, hopefully alleviating some anxiety.

Recommendations for good practice for counselling sessions:

• Flexibility on session lengths and number – this can also be changed last minute – understanding around anxiety levels/build ups during day if needed, eg if having session after school. Research shows it may take longer for autistic clients to feel safe enough to build trust, (Hallet&Kerr,2020)
• No expectations on eye contact – side by side work
• Knowledge that sessions will be at client’s pace, with extra processing time if needed. What self- care might be needed after sessions
• Questions are always allowed – specific knowledge on when this can happen
• Processing time – before, after or during sessions. This may look like writing up key points/insights for clients, allowing time in sessions for this to happen, recording sessions, etc Gather this information about client needs at initial stages.
• Finding out if receiving paperwork, contracts, etc prior to meeting would be helpful.

Putting the understanding into practice may allow for a slight reduction in anxiety, with the knowledge there is time to recognise what works for you. This requires the following to happen before any counselling sessions take place  -

Initial chat stage

Why it needs to happen and how I know why it needs to happen

1. Importance of initial 30 minute chat online or face to face

prior to starting counselling, needs to happen to make time and space for introductions for autistic client. For many autistic people who are already experiencing huge levels of anxiety daily, (Wood et al, 2021), expecting to open up to new people in unfamiliar spaces add to this. Adjusting to new environments takes time and therefore processing new information may take longer (Beardon, 2020) This is also a chance for autistic clients to find out about their counsellor relational approach and their knowledge and understanding and how it fits or not, for the autistic client.

2. Should the client want to begin sessions, counsellors need to discuss the next stages with the client. The finding out questionnaire (details in points to action section) to be handed out, or discussed briefly together at first session, alongside sessions agreements and any other paperwork such as assessment forms, with an awareness of not contributing to overwhelm.  Respecting clients pace is good practice to be adhered to and ensures collaboration, also knowing this can be adapted over time.
3. I know this needs to happen as literature points to the balancing of any perceived power dynamics. Personal autonomy and fitting the process to the autistic individual as much as possible, fits with good practice (Jones et al,2024)

4. Form design requires attention to detail, in collaboration with autistic clients and again, the design of such forms could warrant further research. Perhaps forms could be made easier with logical formatting to help reduce cognitive load (Jones et al , 2024) I know this needs to happen as literature states the strength of visual learning for some, in one of their studies ( Roser et al, 2015) This may be particularly helpful for some with alexithymia. Examples to include on the finding -out form, could be, what does my distress look like, what does my anxiety look like and what happens in my body when that happens, eliciting visual or written responses. Knowing that your counsellor values the knowledge of what to do in sessions if certain situations occur, may reduce uncertainties and worries for the autistic client. By fostering this approach, counsellors can support self-awareness perhaps reducing risk of further burn out. I know this needs to happen as so many autistic people live in or on the edge of burn-out daily, in my professional experience.

Counselling can be anxiety provoking for anyone. Creating opportunity for open dialogue with autistic clients prior to sessions beginning, can help ensure individual needs can be met, reducing anxiety and enabling the best possible chance of engagement for the autistic person. This is how I know this good practice standard is required.

Neuroaffirming language

It is widely posited that many autistic people already face stigma and experience shame from pathologizing language (Bottini et al, 2023). Hearing a counsellor using language based on deficits and disorder can lead to further shame and vulnerability in a supposedly safe space, leading to further vulnerability.  This is how I know that using neuro-affirming language needs to happen. I feel the pcc relationship is ideally placed to allow for clear, unambiguous, language to take place.

What good practice looks like :

Clear, direct communication, (Jones et al, 2024) with a focus on following the client’s pace. Gentle offers of clarification, explanations and checking-in with client around language that may be ambiguous are needed. (Jones et al, 2024) Part of the finding out form would capture all this information throughout the first few sessions, to determine what works best for the client. What matters is that the client can make sense of themselves and has autonomy to do so.

3. GOLD STANDARD - Environment

A counselling environment co-created with autistic clients is good practice (Jones et al, 2024) Sensory sensitivities to light, materials, smells, etc may impact an anxious, autistic person’s feelings of safety in the counselling environment (South & Rogers. 2017). Attention and knowledge to sensory sensitivities and a checking in regularly, may enable the individual to engage in the room and have the psychological space to do the work. (Ward,2018)

Awareness of sensory sensitivities can be captured in the finding out form.  Knowing what physical and sensory adjustments can be made prior to meeting/first sessions, through information via initial chat or website reduces the unknown. My aim is to offer an environment that works for as many of us as possible, with options and flexibility of ‘making adjustments’. This is how I know this is good practice.

A common theme in literature reports uncomfortableness around change, amongst autistic communities, some of the time. This could be due to the unpredictability of society itself and the unwritten ‘rules’ around which neurotypicals dictate how to be. The process of counselling often evolves around change, either of thoughts, self, etc, so ensuring autistic clients feel safe in the counselling environment is key. Stability of the environment may help, so keeping the furniture in the same place each week, or having same structure to sessions, for some people, may help.  A common theme in literature is around reducing anxiety by increasing what is known, so predictability of the environment, can be linked to feelings of safety (Hallet&Kerr, 2020)

4. GOLD STANDARD – Areas of Interest

Recognition of the importance of incorporating client’s areas of interest into counselling work is good practice with all clients I feel. Increase of counsellor knowledge in areas of interest ( Murthi K et al, 2023) and investing time in allowing the client to express any autistic joys, supports good practice. Could we all not benefit from working more with what makes us come alive? Including passions in client work can enhance outcomes and has positive mental health benefits (Bailey, 2023), however it is imperative that the counsellor is aware that sharing information about interests may leave the client feeling more vulnerable, if they believe their passion or joys will be invalidated.

Ruling passions (Bailey, 2025) reframes part of the definition for  autism’s restriction and repetitiveness, hallmarks of autism symptoms (Amercian Psychiatric Association,2013) alluding to how we do not use this language when we speak about neurotypical joys and if this means an autistic person feels fully human when engaging in their passions, how can this be restrictive (Bailey, 2025). This is how I know that viewing practice through the neuro-affirming lens,  is critical for counsellors and can help move towards better counselling experiences for autistic people, (Bailey, 2025). Integrating client’s passions into work, has the potential to develop more meaningful, safer relationships with the counsellor, reducing anxiety and helping the client to thrive during therapeutic work. This is how I know this needs to happen.

Conclusions

What counsellors need to understand:

Counsellors need to understand that original autism research is based on the medical model, with emphasis on cures and treatments for autism, as depicted throughout Chown’s book. Poor practice is not recognising the need to shift to a neuro-affirming approach, so society itself being responsible for disability issues and barriers to accessing what others can do. (Chown,2017)

Evidence shows that the person-centred approach does support autistic people in many ways through the underlying philosophy of non-judgment, congruence and listening. Viewing the client as the expert, provides an essential framework I feel.

What is also neuro-affirming practice in pcc, is the non- directive approach, facilitating the trusting of the client’s own process. I feel this helps to empower the autistic person, supports them in discovering their own sense of self, at their pace, thus shaping identity. This can help to increase positive mental health, for autistic communities.