Doing Therapy While Drowning: Or Why Autistic Clients Need Autistic Therapists

About the Author: Tasha Chemel is passionate about providing executive functioning coaching from a disability justice and trauma informed lens.  She lives in Washington, DC. When she’s not coaching, you can find her writing songs and annoying her adorable orange cat, Willa.  Visit her website at www.tashachemelcoaching.com.

I am nine years old, and my babysitter is having me  practice swimming in a straight line. I’m blind and am prone to veering. She stands at the other end of the pool, hoping I’d follow her voice.  My auditory processing is as bad as my sense of direction, so it is impossible to tell where the sound is coming from. I find myself in the  deep end, my feet windmilling for purchase. “Where are you?” I’d call. “I’m right here,” she’d answer, her reply growing more exasperated each time I ask.

From kindergarten through high school, I worked with an orientation and mobility specialist so I could learn unfamiliar routes. I had few close friendships, because of blindness or autism or both, and often my teachers and aide were my primary sources of closeness throughout the day. Sometimes my mobility teacher would deliberately spin me around and bring me somewhere in the building. She’d then ask me to find my way to a prearranged place without her help. The rational part of me knew that she was behind me, constantly watching, but the preverbal part felt confused and abandoned. Her absence developed its own shape. She was there but not there.

When I reflect on my therapy experiences  as a self-diagnosed AUDHDer,  I am inevitably  brought back  to those early moments of disorientation and disconnection. How has the largely non-reciprocal nature of therapy itself become a trauma trigger? I’m supposed to be concentrating on conveying the texture of my own inner life through language, and not on the inner life of the person who I’ve hired to help me find clarity and coherence. But like some other autistics, I’m hyperempathic and have mirror-touch synesthesia.  I use my body as a canvas to make sense of a jarring, abstract, and unpredictable world. 

I have a tiny bit of light perception but very few image-forming retinal cells. When I look at a tree, my neck stretches, elongates. I become the tree because it is the only way I can understand what I am seeing.  Similarly, when someone speaks to me, I extract data from their tone of voice about their interoceptive state, which I simulate in my own body. For instance, anger, even when not directed toward me, makes my chest clench. My friend’s tiredness shows up as a sinking sensation. With that friend, If I think I’m picking up a feeling from her, we can talk about it openly and sort through what’s mine and what’s hers with no judgment. However, if there is a power differential between me and the other person, I’m frequently caught in a catch-22. I could share what I’ve picked up on and risk being dismissed or chastised for overstepping. On the other hand, if I ignore  the feelings, they begin to take on more relational weight, to the point that I can’t attend to anything else.

On some level I know that these feelings are not my own precisely because they are so intrusive. But on another, they wash away my own emotional landscape. The colors swirl and blend, until all that’s left is a blankness that I suspect is alexithymia. It sounds like a paradox, but I believe that hyperempathy and alexithymia can co-exist. Some research suggests that alexithymia can result from heightened subjective sensibility to interoceptive cues, but a diminished ability to interpret them. If you add interoceptive inferences from someone else to the mix, it’s not surprising that the resulting overwhelm would feel like a muddy blur. Writing about the co-occurrence of these two conditions is scant, but one Redditor pointed out that it makes us particularly vulnerable to abuse.

In my twenties, I saw an image of my therapist, standing waist deep in freezing water. I shared the image with him, and he told me it resonated: there was some emotional numbness he was working through. I had this glimpse into his life, but for some reason, I never was able to let him into mine. The year before, a father figure, who HAPPENS to be a therapist, told me that I had to kiss older clinicians’ asses if I ever wanted to succeed in the field. Before I cut off contact, he’d call me from his hot tub in Boston. He’d always decide when the conversation was over. He was never my therapist, but he pretended to be.

More recently, I picked up on how another therapist’s frustration masked a profound sadness, some of which had to do with how my trauma distorted our interactions, and some of which was her deeply private pain.  Its ghostly signature stayed with me for days afterwards. It wedged itself into the corners of my eyes and followed me into sessions with my own clients. I felt unequipped to deal with the ever-present shame, knowing  that I had unintentionally violated my therapist’s boundaries in order to feel close to her. Even more  troubling  was my fear that I fancied myself some kind of psychic, when I was actually dealing with garden variety hypervigilance. But I refuse to believe that’s the whole story.

The noted theorist Gregory Bateson claims that every communication has two levels: the report layer is the content of the message, while the command or relationship layer   is about how the message should be taken. In healthy relationships, the command layer recedes into the background. A subtle and unspoken demand of most therapy is that the client should primarily attend to her own emotional cues. If a client is fixated on the therapist’s feelings, reducing that fixation becomes part of the treatment.  The transference is only relevant in as much as it maps onto elements of the client’s other relationships. This is a demand I am never able to fully meet.

For now, I have decided to take a step back, both from being a therapy client and from receiving supervised hours towards social work licensure. I’m not sure what form my healing will take, but I am looking to my community for answers. In the meantime, I have a thriving executive functioning coaching practice, where I use a relational approach to my work with neurodivergent folks. I am open about my autistic pattern recognition, my sometimes uncanny ability to pick up on an errant strand of anger or grief. I drift in and out of attunement with my clients, like we all do, and I aspire to be as transparent as possible. I don’t want my thoughts to be a mystery, even if it means acknowledging that I’ve made a miss-step, or that an exiled part of me is in the room: both signals that I need to do more of my own processing. I’m not always successful, but I try to intuit when a client is afraid they’ve disappointed or upset me. Often when we name that fear, it loses some of its power, and is less likely to lodge in the client’s body between sessions. 

If my feelings become the focus of  the coaching, I sit with that  discomfort. And yes, it is uncomfortable to be so seen. To say otherwise would be disingenuous. But I accept their psychicness, hyperempathy, or however they choose to label it,  as a taken for granted fact that they don’t have to explain. If hypervigilance has gotten entangled with it,  I acknowledge its presence, and refer the client to a therapist, because trauma treatment is beyond my scope of practice. But I tell them that one  does not cancel out the other. Our need to scan our environment for threat is not the same as our longing for connection. To conflate the two is dangerous because it is pathologizing and ignores crucial aspects of autistic cognition.

I hope that one day I will live in  a time when more therapists will feel safe enough to disclose their autism to clients and colleagues. While I recognize that there are some key differences between coaching and therapy, I think that much of what I’ve learned from coaching can be applied to a therapeutic context. I speak from my lived experience as an AuDHDer, not just when they first decide to work with me, but continuously. I’ve found that when done thoughtfully, and especially during conversations about ableism, it’s possible to use moment-to-moment self-disclosure in that “Me too!”  way that is so affirming to many neurodivergent folks.  Most of us have been gaslighted and told our struggles aren’t real. Such disclosures also seek to dismantle what the founders of the Kintsugi Therapist Collective call the well provider unwell patient binary.

Most importantly, I normalize the shame that surfaces when you inadvertently pry into someone else’s private thoughts and  then bump up against their  boundaries. I tell clients that the wound of too-muchness is one that we share.

It’s not just their shame. It’s mine. It’s yours. It’s ours.