Sun. Jun 26th, 2022
Mental health

Therapists, psychologists and nurses who are autistic say it has made them better at their jobs, but that misconceptions about the condition are forcing them to keep their diagnosis a secret

Steph Jones jokes that she used to think she was psychic. The psychotherapist says she can often tell instinctively what a client’s issue is before they’ve even sat down. “I can say to them: ‘All of a sudden my throat is tightening,’ or: ‘I feel dizzy,’ or: ‘I can see a particular image – does this mean anything to you?” she says. This is because Jones has the ability, she explains, to experience not just other people’s emotions but their physical sensations in her own body. And it is a skill that has been invaluable for her work.

It was only after she was diagnosed with autism that she realised this was simply part of her neurodiverse profile. “It’s called mirror-emotion or mirror-touch synaesthesia and is part of what being autistic means for me, as well as having hyperawareness, hyperperception, hyperempathy and hypermemory – all of which come in very handy as a therapist,” she says.

People with mirror-touch synaesthesia vicariously experience other people’s emotional and physical sensations in their own bodies. The condition, which is believed to affect 2% of the general population, varies from person to person: it can mean individuals feel the same sensation – like touch – in the same part of the body that another person feels the sensation. Others describe it as an “echo” of the touch.

Some clients, understandably, are disconcerted by Jones’s reading of their issues. “But once I explain what it is and it makes rational sense to them – rather than it seeming frightening or paranormal – they usually feel completely elated that someone gets them on that kind of deep level.”

It is, she says, “fast-track rapport-building …Being able to tune into someone so quickly means it can feel like we’re skipping the starter and getting right into business, whereas other therapists may need to spend much longer building relationships. I can only describe it as some kind of instant resonance. Clients will often describe how it feels like we’ve always known each other – and it’s just as intense for me as it is for them.”

There are more ways, Jones believes, that having autism can turbocharge a mental health specialist: autistic people often excel at problem-solving, enabling them to pick up cues that neurotypical therapists might filter out. They’re unlikely to judge people, enabling clients to feel genuinely accepted, and often have intense interests, which can lead to an obsession with research, training and further education.

Jacqueline also feels her autistic traits have helped in her job as an advanced nurse practitioner in a 24-hour crisis assessment team – especially being open-minded. “I am very good at remaining neutral when doing urgent crisis assessments of highly distressed people and their families, which often involve the police and emergency services,” she says.

“I am fairly direct and to the point. Again, when you need to assess a difficult situation quickly this is a good skill to have,” she adds. “I also see patterns and themes because my mind likes to find solutions to problems.”

Zoë, a specialist neurodevelopmental clinician, credits her autism with allowing her to qualify in several psychotherapy specialisms with ease. “My autism does actually feel like a superpower: I have focused and studied so hard that I have a wealth of experience that clients often reference, saying how it makes their therapeutic process so much easier,” she says.

Yet while the mental health experts I speak to say their autism has benefited their work, sadly, it is something they have felt they need to keep from colleagues. Jones, for instance, says – until now – her diagnosis has been a closely guarded secret. “Admitting openly that I am autistic could be professional suicide,” she says. “I’m terrified that, in ‘coming out’, I may fall foul of a misconception: the now widely debunked myth that autistic people are not capable of empathy or feelings.”

A keen blogger (under the handle of autistic therapist), Jones was recently thinking about the fact that only 22% of autistic adults are in paid employment. Autistic people can have strengths that may be beneficial to employers, such as tenacity and the ability to see things in a different light, which can be great for problem solving. But getting and keeping a job can be difficult: autism affects communication skills, so people may struggle during job interviews, misunderstanding questions and being judged for not making eye contact. Once in a workplace, the noise of open-plan offices and anxieties over unwritten social rules can be overwhelming.

Jones asked her online network of professional autistic people what they did – and was surprised to wake up the next morning to 450 responses, a number that kept growing. They came from people in every walk of life, but Jones was struck by how many worked in mental health, and how many said their greatest fear was colleagues and employers finding out that they were autistic.

“I was receiving hundreds of messages from other autistic therapists, psychologists, practitioners, social workers and clinicians, most of whom have chosen not to disclose their diagnosis in work because they were too afraid of stigma, prejudice, unhelpful myths about autism – and discrimination,” she says.

In response, she formed an Instagram group, the Autistic Professional Network. Within days, it had 586 followers. “I felt it was important to set up a group where we can safely network, find others who ‘get it’ and remain anonymous if we wish,” says Jones. “Sadly, the common theme we all share is autistic burnout due to hiding who we truly are.”

Masking and camouflaging – terms used to describe neurodiverse individuals who seek to hide or minimise their autism traits to fit in with the neurotypical world – are an uncomfortable and exhausting experience, often linked to mental health issues ranging from stress and anxiety to depression, burnout and an increased risk of suicidal thoughts.

‘We’ve spent a lifetime trying to figure ourselves out’ … Psychotherapist Steph Jones, who set up the Autistic Professional Network. Photograph: Christopher Thomond/The Guardian

It might seem counterintuitive to neurotypical people that neurodiverse people who find social interaction complex should choose a career with empathy and connection at its heart. But, says Jones, it makes perfect sense. “Around 1% to 2% of the UK population is autistic, but in my postgraduate year of around 80 students at least five were neurodiverse: over 6%. We’ve spent a lifetime trying to figure ourselves out, often misdiagnosed with mental health issues and desperate for answers. We’ve become accidental experts in that respect.”

Maria, a mental health nurse in her mid-50s, agrees that a career in mental health might seem a curious choice to those who know her. She once found talking to people so difficult it was hard for her to speak at all. “It may seem very strange that someone like me, who had so little confidence, was so very shy to the point of mutism, and who had such difficulties with people, interaction and social functioning, was drawn to a career that requires all of those skills, but I was filled with compassion, empathy and a desperate desire to help people, especially those that were also misunderstood,” she says.

“I don’t think I actually realised that everyone else didn’t have this extreme anxiety, constant nervousness and incredibly strong sense of justice and fairness,” she adds. “I think what was really driving me was to stop anyone else having to feel the way I always had, to help people where I had been left to my own devices.”

Nadia also became interested in psychology after struggling with her own undiagnosed autism. “I often felt that I didn’t understand myself or others,” she says. “I’ve spent most of my life trying to be ‘normal’ and fit in, which has involved huge amounts of time trying to understand people, and I wonder whether this process of understanding others is continued in my work.”

Like Jones, Nadia feels her autism has meant she is better at her job. “Despite the common myth that autistic individuals don’t have empathy, I find the opposite, in that I can really connect with the people I work with, and can feel what they feel,” she says. “My brain is quite analytical and notices patterns, which can be helpful in various phases of therapy (assessment, formulation, treatment). I also find clinical conversations a lot easier to have compared with generic, informal small talk.”

But Nadia is also worried that divulging her neurodiversity to colleagues could wreck her career. “There can be a lot of misconceptions about autism, and I worry others will assume I am not competent or capable, that I cannot communicate with others,” she says.

Abdullah Shahjan, an autistic therapist who works with the National Autistic Society, agrees that disclosing can be dangerous. “Autistic mental health practitioners who want to be open about their condition are all too likely to experience intolerance and negativity, which could seriously damage their careers. The risk is far greater than in other professions.

“Neurotypical mental health practitioners aren’t any different from the general public when it comes to understanding autism: that is, they have a negative perception,” he says. “This is exacerbated by the fact that as mental health specialists, the only openly autistic people they are likely to see are patients in crisis. This will inevitably lead them to link autism with an inability to function.

“An added problem is that mental health services are still in their infancy,” he adds. “As a specialism, it’s still struggling to be taken seriously as a science and to define best practice. That means that when an autistic practitioner comes along who doesn’t conform, there’s a risk-adverse defensiveness that kicks in.”

Jess Hendrickx is director of Hendrickx Associates, a UK-based specialist in autism spectrum conditions, which provides training sessions to employers within the mental health sector. “We need to get rid of the stigma of being autistic in general but especially in the mental health sector,” she says. “One way to do this is for there to be a wider understanding that autistic people are not flawed or broken, but instead process environments and information differently from non-autistic people. These differences can provide clients with a diverse but equally effective approach.

“Giving the wider public more positive information on autism should help to challenge any biases people may have about being treated by an autistic mental health professional,” she says. “This, in line with education and training for all staff and managers in mental health settings, will hopefully encourage more autistic people in the field to speak up, and more people to consider this as a career path.”

Of course, not all autistic people experience disadvantage in their workplace, but the fear among autistic people working in mental health about “being out” is widely felt.

Oxana is an assistant psychologist. “Being autistic for me means that I am on high alert most of the time,” she says. “I tend to overthink social interactions, notice patterns of behaviour, have an excessive urge to understand systems and organisations. This makes me a good therapist because I ask a lot of questions and facilitate patients to find their own truth. I do not have any preconceived notions of one ‘right’ way to solve their problems.”

But she wouldn’t dream of disclosing her autism. “I have witnessed how professionals would discuss someone autistic and doubt their abilities,” she says. “I feel that instead of gaining credibility for going through any mental health or neurodiverse difference, I might actually lose some.”

Among autistic professionals who have disclosed their autism to colleagues and employers, however, there have been positive outcomes. Karen is a PhD student studying the support of marginalised groups. “My autism helps me in my work because I am a very empathetic and at times an emotionally sensitive person,” she says. “I’ve been told that makes me very relatable and approachable.

“I opened up to my employers about my autism recently because in a meeting I couldn’t string a sentence together and was so ashamed. I blurted it out in tears but it was such a relief. Now I know that they have an understanding of why I am the way I am at times. It helps tremendously.”

Jones, who has decided to start being more open about her autism, is hoping for a similarly positive experience. “I recently told a long-term client of mine. It was the first time I’d ever disclosed in a professional sphere and I was understandably worried what she might say. But her response was brilliant: surprised, kind of excited and definitely curious.”

Jones is now determined to be completely open about her neurodiversity. “I work with hundreds of autistic professionals who are afraid to disclose in work for fear of judgment, so they mask all day, go home and have meltdowns, and it’s the same again the next day,” she says. “I’m taking a huge risk in putting myself out there but I hope that in the long run it will be worth it, not just for me, but for others like me, so they feel brave in owning who they are too.”

Some names have been changed.

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