Communicating with Providers
How do you make sure you get what you need from conversations with therapists, psychologists, and other healthcare providers?
Why this is hard
Conversations with healthcare providers are a specific social situation with their own rules. You're expected to be open about difficult topics while also being mindful of limited time. You need to articulate how you feel, while that might be exactly what you struggle with.
For autistic people, masking adds another layer: the automatic tendency to adapt, to come across as "more normal" than you feel, to minimize problems. This makes it harder to get the help you need.
Practical tips
Write down what you want to discuss beforehand
Figure it out on the spot
Why: A list prevents forgetting what's important. Many autistic people find it hard to formulate spontaneously under pressure.
Bring your notes
Trust your memory
Why: After a session you often forget details. Write down what was discussed, or ask if you can record.
Say when you don't understand something
Nod and pretend you get it
Why: Healthcare providers sometimes use jargon or vague language. You have a right to clear explanations.
Share how you're really doing
Automatically answer 'fine' when asked how you are
Why: Masking in therapy undermines the whole process. This is the place to be honest.
Ask for time if you need it
Answer immediately while still processing
Why: 'I don't know' or 'can I think about that?' are valid answers.
Name your sensory needs
Ignore your discomfort to seem 'normal'
Why: If the lights are too bright or there's too much noise, say so. A good provider will adjust.
Session preparation checklist
Go through these questions before your appointment:
- 1How have I been feeling since the last session?
- 2Were there specific situations I want to discuss?
- 3What questions do I have?
- 4Is there something I didn't say last time but wanted to?
- 5How are the things we're working on going?
- 6Is there anything not working in our sessions?
Difficult conversations
You disagree with the diagnosis or conclusion
"I don't recognize myself in this conclusion. Can you explain what you based this on?"
You have a right to explanation. If you still don't recognize yourself, ask for a second opinion.
The approach isn't working for you
"I'm noticing this isn't helping me. Can we try something different?"
Therapy isn't one-size-fits-all. A good therapist adapts.
You don't feel heard
"I feel like we're talking past each other. Can I explain how I experience this?"
Communication problems aren't proof you're difficult. They're normal.
You want to stop with this provider
"I don't think this is the right match for me. I'd like to stop / find a different therapist."
You don't need to provide elaborate justification. You decide about your own care.
You're overstimulated during the session
"I'm overstimulated right now. I need a break / we need to stop."
A good provider respects this immediately. If that doesn't happen, it's a red flag.
On timing and energy
Sessions often last 45-60 minutes. That might be too long if you're overstimulated, or too short to discuss everything. It's okay to mention this.
Don't schedule appointments right after a session. Conversations about difficult topics cost energy. Give yourself time to process.
If you notice sessions exhaust you: discuss it. Maybe shorter sessions are possible, or video sessions from your own safe environment.
Writing instead of talking
Some things are easier to write than to say. You can email your therapist between sessions, or prepare something to read aloud. If talking is difficult due to overstimulation, shutdown, or alexithymia, writing is a valid form of communication.