Unmasking Bias: Autistic Perspectives in Mental Health Training

Abstract

Background:

Due to a combination of thin-slice judgments, ableism, bias, and a focus on allistic (non-autistic) dispositional standards, autistic people may experience admission issues and retention problems in mental health professional fields at higher rates than allistic people.

Method:

To better understand their training and gatekeeping experiences, we interviewed 10 autistic mental health professionals and trainees from a variety of mental health professional programs (e.g., counseling psychology, clinical psychology, counseling, and social work). Utilizing reflexive thematic analysis, we generated three themes across our 11 semi-structured interview questions.

Results:

Our generated themes included ableism (systemic and interpersonal), personal toll (cognitive load and emotional toll), and protective factors (internal and external). Our understanding of our interrelated themes is informed by both double empathy theory and the minority stress model. Participants in our study also regularly discussed a need for better autistic mentorship.

Discussion:

We discuss recommendations for training program advocacy and neurodiversity-affirming practices. Based on our participant answers to strength-based and support-oriented questions, we offer suggestions for autistic mental health graduate trainees.

Community Brief

Why is this issue important?

Research shows that autistic people are judged very harshly on their personal characteristics by non-autistic people in recorded videos and in person. Non-autistic people judge autistic people as less intelligent, less likable, less trustworthy, less attractive, and more awkward than non-autistic peers. The mental health professional fields (counseling, social work, psychology, etc.) heavily factor personal characteristics in their judgment of students’ abilities to be successful in the field. Therefore, the practice of “gatekeeping”—where people are prevented from entering the mental health fields—may impact autistic trainees more than their non-autistic classmates.

What was the purpose of the study?

The purpose of the study was to explore the mental health professional training experiences of autistic students and professionals who had recently graduated, including their experiences with specific training activities (like getting feedback on recorded counseling sessions) and gatekeeping.

What did the researchers do?

We interviewed 10 autistic trainees and professionals about their mental health professional training experiences. We asked specific questions, leaving room for general conversation around these questions. Participants were paid $50 USD for an average interview of 49 minutes. After our interviews were completed, we transcribed the audio into a text form so that we could read and analyze the interviews. We analyzed the data by grouping participant experiences into general themes.

What were the results of the study?

We generated three total themes from our participant interviews, with each theme consisting of two subthemes. These included experiences of ableism from individuals and systems, the emotional and cognitive toll of living as an autistic person in graduate study, and personal and external factors that provided protection. Our participants also discussed how their autistic characteristics positively impacted their work with clients. Factors such as (a) deep, focused interest in clients and psychological science and (b) extreme empathy and c) pattern recognition appeared multiple times, which participants said helped them connect to clients—especially autistic clients.

What do these findings add to what was already known?

Some of our results match results from research focusing on disabled psychologists. Specifically, our participants also discussed barriers to accessing accommodations, expressed similar emotional struggles to the general disabled student community, and discussed a need for improved mentorship. Unique to our study, our participants discussed a desire for their mentors to be more knowledgeable about autism, in general. Our participants also discussed ways in which their autism provided them unique strengths in their fields, which had not yet been explored in the research.

What are the potential weaknesses in the study?

Our study sample was comprised of 10 individuals, which some may consider small. However, our sample was narrow, specific, and purposeful, which allowed for an informative interview and strengthens the conclusions we can draw from our data.

How will these findings help autistic adults now or in the future?

We hope that mental health professional training programs use the results of this study to increase the autistic-affirming practices. This change will both ease the emotional burden on autistic students and act to increase neurodiversity in the mental health fields, which directly benefits autistic clients and supervisees.