How Autistic Therapists Experience Empathy for Clients

By the time I discovered I was autistic, I’d already been a therapist for many years.

One of the questions my GP asked me when I first requested a psychiatric referral was what I did for a living. When I replied that I was a therapist, his initial response—which the psychiatrist supported—was that I would lack the emotional and empathic capacity to work effectively with clients if I was in fact autistic.

As someone who, like most therapists, cares about my clients’ well-being over and above my “job” as a therapist, I faced a few shaky months. Did being autistic mean I lacked empathy? And, without empathy, could I be a good therapist?

When I explored empathy and autism, I discovered that the issue is highly complex and an ongoing subject of debate.¹ Current research that focuses on self-reports of autistic peoples’ experiences suggests differences in empathy, as opposed to a lack of it altogether, in some autistic people. These differences might include feelings of excessive empathy and difficulties conveying empathy to others.² It has also been suggested that differences in empathy are attributable to alexithymia, a condition that potentially affects how people process other peoples’ emotions in addition to their own emotions and which is thought to affect up to 50 percent of autistic people.³

Pricilla Du Preez, Unsplash

Therefore, the assumption that an autistic person will lack empathy to the extent that they cannot be a kind, compassionate therapist is likely based on an overly simplistic understanding of autism that isn't supported by current research. However, research does suggest that at least some autistic people, including those who have alexithymia, do experience empathy differently from most people.

These differences may include struggling with “cognitive empathy,” which involves understanding or knowing what another person is thinking or feeling.⁴ Still, they may display average “affective empathy,” which involves feeling what others are feeling.⁵ Can autistic people who fall into these categories make good therapists?

What I’ve experienced myself, and what I’ve seen in autistic therapists I’ve worked with, would suggest that they can.

Conveying Empathy

Personally, I feel that my experience of empathy differs from many people, especially when it comes to displaying empathy toward others. Because of my challenges with social communication, I typically find it hard to express feelings of empathy toward someone. It feels like my feelings are too big or complex to express verbally; on top of that, comforting people (other than my children or partner) through touch is very uncomfortable for me.

This has caused problems socially, and some people have suggested that I am cold or unfeeling. Because of this, I used to worry that this would be an issue with therapy clients—but in fact, many have commented that my tendency to stay quiet and comparatively neutral allows them to focus on their internal experience.

These are skills that many therapists are taught. In my work training other therapists, however, I have noticed that some struggle not to interject too much with clients, particularly if they are moved by what their client has told them. Thus, the calm and quiet exterior that can be problematic for me in other situations turns out to be a kind of natural skill that can be helpful during therapy sessions.

Less Empathic Involvement

I suspect I experience a lower level of empathic involvement with others than is typical. Except with very close others, I generally do not become upset about other peoples’ experiences to the same level that my colleagues and peers do. I often need other people to explicitly point out what a mutual friend or family member is going through.

Other autistic therapists, as well as autistic people in other caring professions, have shared with me that they seem to experience lower, or different, levels of empathy toward their clients, compared to their colleagues. But in general, it doesn't appear to influence their ability to work in a caring, professional, and effective manner.

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It matters deeply to me that I help every one of my clients. By not becoming overly involved or invested in my clients’ experiences, I find it comparatively easy to maintain a cool head. Like some of my autistic clients who work with people in a caring capacity, I find other ways of campaigning for my clients’ needs, such as raising awareness of autism.

Meeting the Needs of Autistic Clients

As an autistic person, I often feel very uncomfortable with how others convey empathy or sympathy. It feels too overwhelming to be on the receiving end.

Therapists, of course, are trained in offering a safe space to their clients, which includes maintaining boundaries and not responding empathically in the same way they would towards a friend or family member. Research suggests that autistic people find it easier to communicate with each other than non-autistic do with autistic people.⁶ Autistic therapists may therefore have particular skills in terms of working with autistic clients.

In my own experience, being the client of autistic therapists has had some benefits. In particular, they have seemed better attuned to when I reach the end of my comfort zone.

If you are an autistic therapist, it's highly possible that you're aware of differences in how you experience empathy compared to your colleagues and peers. But as long as you care about working ethically and supportively with your clients and come to the role from a point of genuineness, being autistic need not have any negative bearing on your work. Indeed, I believe that you will bring some skills to your role that enhance your ability to meet the needs of your clients in a unique way.