What to Do When Therapy Isn’t Working: A Guide for People on the Autism Spectrum

Note: The following discussion is for consideration only and does not constitute or imply medical or psychiatric advice. When in doubt, seek the opinion of qualified professionals.

If you’re on the autism spectrum and finding that therapy isn’t clicking—whether you’re not connecting with your therapist or just not seeing any benefit—it’s easy to feel stuck. Therapy is supposed to help, right? But when it doesn’t, it can leave you wondering if it’s worth the effort. The good news is you’re not alone, and there are practical steps you can take to turn things around. Here’s how to navigate this as someone on the spectrum, based on what’s worked for others and some common-sense approaches.

Step 1: Figure Out What’s Not Working

The first thing to do is take a moment to think about why it’s not helping. Is your therapist’s style off—like they’re too chatty when you need structure, or they keep pushing emotional stuff when you’re more about solutions? Maybe they don’t seem to get autism-specific challenges, like how sensory overload can derail your day or why social cues feel like a foreign language. You don’t need to overthink this—just note one or two things that feel “wrong.” Writing it down can help if your thoughts get tangled.

For example, if they’re expecting you to pick up on vague hints or unpack feelings in a way that doesn’t click, that’s a clue. Therapists who don’t adapt to how you process the world can leave you spinning your wheels.

Step 2: Speak Up (If You Can)

If you’re up for it, tell your therapist what’s not working. This can be tough—communication might already be a hurdle, and being direct can feel like walking into a wall. But even a simple line like, “I don’t think this is helping me,” can get the ball rolling. A decent therapist will listen and tweak their approach. If talking face-to-face feels too much, try writing it out—email them, text them, or hand them a note. Whatever works for you.

The goal isn’t to confront them; it’s just to give them a heads-up. They’re not in your head, and they might not realize they’re missing the mark. That said, if you’ve already tried this and nothing’s changed—or if the idea of even bringing it up makes you shut down—skip to the next step.

Step 3: Consider a New Therapist

Not every therapist is the right fit, and that’s doubly true when you’re on the spectrum. If yours isn’t getting it, it might be time to find someone who does. Look for a therapist with actual experience in autism—someone who knows about things like literal thinking, executive functioning struggles, or how meltdowns aren’t just “tantrums.” You can ask your current therapist for a referral (if that’s not too awkward) or search online. Sites like Psychology Today let you filter for autism specialists, and some even list if they’re neurodiversity-affirming.

Check reviews or ask around if you’ve got a community—other autistic folks might have recommendations. The key is finding someone who doesn’t just nod along but actually gets how your brain works.

Step 4: Know What You Want

Before you jump into a new therapy setup, think about what you’re after. Do you want practical tools—like how to handle sensory overload at work or navigate small talk without wanting to bolt? Or are you looking for a safe space to process stuff without judgment? Maybe it’s both. Knowing this can steer you toward the right kind of help.

For some on the spectrum, structured approaches like Dialectical Behavioral Therapy (DBT) Cognitive Behavioral Therapy (CBT)—tweaked for autism—work wonders. Others click with therapists who use visuals, like charts or diagrams, to break things down. If you’re not sure, you can experiment—just don’t settle for someone who keeps pushing a one-size-fits-all method that leaves you cold.

Step 5: Trust Yourself, but Safety First!

Here’s the big one: your instincts matter. If therapy feels like a chore with no payoff, don’t force it. You’re not “failing” at therapy—sometimes the mismatch is the problem, not you. It’s okay to try again with someone else, but make sure you communicate with your doctor, wellness team or care givers if you are not sure. Therapy should feel like it’s building something useful, even if it’s slow going.

Never walk away without first discussing your intention with your therapist, unless you feel unsafe. In that instance, If you feel unsafe, you do not have to continue therapy with that therapist. You can choose not to return to future sessions, as emphasized by both Psychology Today and OpenCounseling. However, to avoid being charged a no-show fee, you should cancel any scheduled appointments by contacting the therapist’s office via phone, email, or text. This practical step ensures you’re not financially penalized while prioritizing your safety.

If you believe the therapist has acted unethically, such as violating boundaries or professional standards, you should report them to their professional association or licensing board. This is crucial for preventing harm to others and ensuring accountability. Associations have procedures for managing reports of unethical behaviors, and they will talk with you about your experiences. This step is particularly important if the therapist’s actions, like verbal aggression or confidentiality breaches, are severe. If you have been physically harmed or threatened with harm, contact the police immediately.

Why Consider Another Therapist?

If you feel your current therapy isn't meeting your needs or you're unsure about your diagnosis or treatment plan, it may be helpful to explore other options. This is particularly important for autism, where personalized support can make a big difference.

How to Approach It

Before making a change, consider discussing your concerns with your current therapist. They might address your issues or clarify your treatment plan. If you're still uncertain, seeking a second opinion from another therapist can offer new insights and help you feel more confident in your care.

Unexpected Detail: It's Not About Doubt

Seeking a second opinion doesn't mean you're doubting your current therapist's expertise. Instead, it's a proactive step to ensure you're getting the best support for your mental health, especially given the complexity of autism therapy.

Bonus: Lean on Community

If you’re still stuck, tap into what others on the spectrum are saying. Platforms like X or autism forums are full of people sharing what clicked for them—specific therapists, strategies, or even warnings about red flags to avoid. You don’t have to figure it all out solo.

Therapy can be a lifeline, but only if it fits you. If it’s not working now, that doesn’t mean it never will—it just means you haven’t found your groove yet. Take it at your pace, tweak what you need, and don’t settle for less than what helps you thrive. For those navigating this process, it’s also crucial to remember that therapy is highly individualized. If the therapist’s approach, such as expecting emotional unpacking when you need structure, doesn’t fit, it’s okay to seek someone who adapts to your needs. community support, like talking to trusted individuals, can provide practical insights, but always verify with professionals to ensure accuracy.

What’s your experience been like? Drop a comment—I’d love to hear what’s worked (or hasn’t) for you