Autism and Gender Exploration in Therapy: Supporting Autistic Adults with Gender-affirming Care

Two people sit together on a mountain peak

The Intersection of Autism and Gender in Therapy: A Nuanced Exploration

Navigating therapy as an autistic adult is a profoundly personal and often complex experience. For those who are also exploring their gender identity, the journey can be even more nuanced, with additional layers of challenges and triumphs to navigate. Despite increasing awareness, the intersection of autism and gender diversity remains under-discussed in many therapeutic settings, leaving many clients feeling unseen or misunderstood.

Research now shows that there is a significant overlap between autism and gender diversity. According to the largest study to date, individuals who do not identify with the sex they were assigned at birth are three to six times more likely to be autistic than cisgender people (Dattaro, 2020). This study, which analyzed data from over 641,000 participants, revealed that 24% of gender-diverse individuals have autism, compared to just 5% of cisgender individuals (Warrier et al., 2020). These findings are crucial for clinicians to understand, as they reinforce the need for tailored, gender-affirming, and neurodiversity-inclusive care in therapy settings.

For many autistic individuals, exploring gender identity brings unique challenges. The sensory sensitivities, communication differences, and social anxieties commonly associated with autism can make the already complex process of gender exploration even more difficult. It’s not uncommon for clients to struggle with articulating their experiences or to feel overwhelmed by societal pressures and expectations. At the same time, this intersection can also present opportunities for profound self-discovery and self-affirmation, especially when clients are met with the right therapeutic support.

As both a Registered Psychotherapist and a Board Certified Art Therapist, I’ve seen firsthand how essential it is to approach therapy with an understanding of this intersection. Clients who navigate both autism and gender diversity need spaces where their identities are not only acknowledged but celebrated. They need therapeutic environments that can flexibly adapt to their communication styles, sensory needs, and emotional experiences. The role of the therapist becomes one of both guide and ally, helping clients to feel truly seen, heard, and understood.

In this blog, we will explore the unique challenges and triumphs that come with working with autistic adults who are exploring their gender identity. Drawing on both talk therapy and art therapy practices, I’ll share concrete strategies for therapists, reflect on the power of gender-affirming, neurodiversity-inclusive care, and offer insights into how these approaches create empowering therapeutic outcomes. Whether you’re a therapist seeking guidance, a client navigating these experiences, or someone looking for resources, I invite you into this important conversation.

Understanding Gender Diversity in Autistic Adults

Autism and gender identity are two deeply personal and often misunderstood aspects of human experience, each carrying its own set of challenges and unique perspectives. For many autistic individuals, gender identity becomes a space for profound self-exploration, one that doesn’t always align with societal norms or expectations. Recent research continues to reveal a notable overlap between autism and gender diversity, with autistic individuals being more likely than their neurotypical peers to identify as transgender, nonbinary, or gender-expansive (Gratton, 2022). This correlation sheds light on the complexities faced by autistic adults navigating both their neurodivergence and gender identity in a world that often misunderstands both.

A pivotal study examining this intersection found that people who do not identify with the sex they were assigned at birth are three to six times as likely to be autistic as cisgender individuals (Warrier et al., 2020). This research underscores the importance of understanding the dual experience of being both autistic and gender-diverse, which can amplify feelings of isolation, sensory overwhelm, and emotional fatigue. These individuals often grapple with sensory sensitivities and the emotional complexities of gender dysphoria, a condition where there is a deep discomfort between one’s assigned sex at birth and their true gender identity (National Autistic Society, n.d.).

Sensory Sensitivities and Communication Differences

For many autistic adults, sensory sensitivities play a significant role in how they experience their gender. Autistic individuals often experience heightened sensitivity to textures, sounds, or visual stimuli, making gender expression, particularly through clothing, hairstyle, or makeup, a more complex process. What may be a simple act of self-expression for some can feel physically uncomfortable or overwhelming for those with sensory processing differences. For example, wearing clothing typically associated with one’s identified gender can provoke distress, complicating the experience of affirming one’s gender identity through physical appearance.

Moreover, many gender-diverse autistic individuals experience communication differences that shape their engagement with societal gender norms. As Madge Woollard, a nonbinary autistic pianist, described, “A lot of us autistic people don’t really fit in socially, and I think this extends to ideas around gender” (National Autistic Society, n.d.). This detachment from social expectations, while freeing for some, can also lead to further social isolation. Gender-diverse autistic individuals may feel out of place in both neurotypical and gender-diverse spaces, particularly when their unique communication styles or sensory needs are misunderstood or overlooked.

Social Exclusion and the Accumulating Impact of Isolation

One of the most significant challenges faced by gender-diverse autistic adults is social exclusion. This exclusion manifests in both neurotypical and gender-diverse communities, leaving many feeling disconnected from social networks that are vital for emotional support and identity affirmation. Each time an autistic person is excluded—whether from social settings, employment, or healthcare services—the effects accumulate, deepening their sense of isolation within their community (National Autistic Society, n.d.).

Social exclusion for autistic individuals often starts early, with many children being denied access to inclusive education due to the misunderstanding of their needs. This pattern continues into adulthood, where a lack of workplace accommodations can prevent autistic people from maintaining stable employment. The experience of exclusion is compounded for those who are also gender-diverse, who may encounter additional barriers in spaces meant to be affirming. Research shows that these dual experiences of marginalization contribute to higher levels of anxiety, depression, and minority stress in gender-diverse autistic individuals (Warrier et al., 2020).

However, this exclusion is not inevitable. Social inclusion, which involves access to education, employment, and healthcare, along with societal efforts to understand and accommodate differences, is key to addressing this isolation. Social inclusion means more than physical presence; it means being respected, understood, and valued as a full member of society. This is particularly important for gender-diverse autistic individuals, who often find themselves navigating complex identity dynamics in spaces where they are rarely fully understood or accepted.

Creating Inclusion in Therapy: The Therapist’s Role

Given these dynamics, therapists play a critical role in fostering social inclusion for gender-diverse autistic clients. In my practice, I emphasize creating a therapeutic space where both autism and gender diversity are not only acknowledged but actively celebrated. This involves going beyond simply accepting these identities—it requires building an environment that accommodates sensory sensitivities, adjusting communication styles, and recognizing the importance of autonomy in the therapeutic process.

Therapists must also understand the impact of cumulative social exclusion on their clients’ mental health. Studies show that autistic individuals who are also gender-diverse face higher risks of co-occurring mental health challenges such as depression and anxiety, largely due to the intersection of minority stress, social exclusion, and sensory overwhelm (Gratton, 2022). Providing gender-affirming, neurodiversity-inclusive care helps mitigate these risks by offering a space where clients can safely explore their identities without fear of judgment or exclusion.

A key aspect of this work involves embracing an anti-oppressive, intersectional approach to therapy. Intersectionality reminds us that many gender-diverse autistic clients are also navigating other marginalized identities, whether related to race, socioeconomic status, or disability. As therapists, it’s our responsibility to be mindful of these layers and to create spaces where all aspects of a client’s identity are respected and integrated into their therapeutic journey.

Tailoring Talk Therapy for Autistic Clients: A Neurodivergent-Affirming Approach

Talk therapy, when adapted thoughtfully and with sensitivity, can be a profoundly effective tool for autistic adults exploring their gender identity. However, it requires a departure from conventional methods, which often fail to consider the unique ways autistic clients process and express emotions. Neurodivergent individuals, particularly those on the autism spectrum, may approach therapy with distinct communication styles, sensory sensitivities, and emotional processing patterns that necessitate a flexible, client-centred approach.

Research consistently shows that autistic individuals often experience alexithymia, a condition characterized by difficulty identifying and describing emotions (Jones, 2024). This can create barriers to traditional talk therapy, which frequently relies on verbal emotional expression. Asking an autistic client, “How do you feel about that?” may not only be ineffective but also frustrating for the client. Instead, neurodivergent-affirming approaches focus on alternative ways to explore emotions and experiences.

In sessions, I frequently use open-ended prompts that focus on physical sensations, experiences, or cognitive processes rather than directly probing emotional states. For example, questions like “What’s your experience of this situation?” or “How does your body react when you think about this?” offer clients the opportunity to engage with their internal world without the pressure of having to immediately identify their emotions. This shift in language helps clients feel more at ease and understood, creating a therapeutic environment that respects their neurodivergent needs while still fostering deep exploration of their identity.

Recognizing Non-Traditional Forms of Emotional Expression

It is essential to recognize that autistic clients often express emotions in non-traditional ways. Emotional expression might manifest through body language, sensory responses, or patterns of speech that differ from neurotypical expectations. For example, some clients might speak in a monotone voice even when they are experiencing strong emotions, while others might use indirect ways to communicate their feelings, such as through metaphors, art, or referencing special interests. As a therapist, it is important to learn to read these cues and create space for these forms of expression to emerge naturally.

Moreover, sensory sensitivities can significantly influence how emotions are experienced and expressed. Autistic individuals may find that their sensory environment either heightens or dampens their emotional experiences, making it crucial for therapists to provide a sensory-friendly space. In some cases, simply adjusting lighting, reducing noise, or providing sensory tools can facilitate more open and comfortable communication. In this way, therapy not only becomes a place of emotional exploration but also a sanctuary where the client’s sensory and emotional needs are honoured in tandem.

Creating a Collaborative and Autonomous Therapeutic Environment

One of the most critical elements in working with autistic adults, particularly those exploring their gender identity, is the creation of a collaborative and autonomous therapeutic process. Many autistic clients have spent their lives in environments—whether at home, school, or work—where their voices were marginalized, their autonomy limited, and their needs overlooked. As such, therapy can become a place where clients reclaim control over their narratives, and this autonomy is especially important when it comes to exploring something as deeply personal as gender identity.

By inviting clients to set the pace of the conversation and decide which topics to explore, therapists help foster a sense of safety and empowerment. It’s crucial to avoid overwhelming clients with advice or directives, as this can evoke feelings of being controlled or misunderstood. Instead, the therapeutic process should feel co-created, with the client’s voice leading the way. This approach not only honours the client’s autonomy but also aligns with neurodivergent principles of self-determination and respect for individual agency (Jones, 2024).

For many autistic adults, the exploration of gender identity is deeply intertwined with their experience of autonomy. Traditional societal expectations around gender often clash with autistic individuals’ unique ways of understanding the world, making it vital that therapists create space for clients to navigate these norms at their own pace and in their own way. Some clients may wish to explore their gender identity slowly, while others may feel more immediate urgency. Either way, the therapist’s role is to support the client’s journey, providing tools for reflection rather than prescriptive solutions.

Adapting Communication Styles and Strategies

Flexibility in communication is key when working with autistic clients. It is important to remember that communication differences are not deficits but alternative ways of processing and sharing information. For instance, some autistic individuals may prefer written communication, typing responses during or between sessions, or using visual aids like charts or drawings to express themselves. These approaches should be embraced and normalized within the therapeutic space.

Additionally, it is helpful to integrate clients’ special interests into the therapeutic process. Many autistic adults find comfort and joy in engaging with their special interests, which can serve as powerful tools for self-expression. In one case, I worked with a client whose special interest was science fiction, and we used references from their favourite stories to explore complex emotions and scenarios related to their gender identity. This not only made therapy more engaging but also provided the client with a familiar framework for understanding their experience.

Affirming Gender Identity While Respecting Neurodivergence

It’s also essential to balance gender-affirming care with neurodivergence-affirming practices. This dual affirmation requires a deep understanding of how autism and gender intersect. For instance, many autistic individuals report feeling disconnected from societal norms related to gender. As Dr. Wenn Lawson, an autistic advocate and psychologist, explained, “The non-autistic world is governed by social and traditional expectations, but we may not notice these or fail to see them as important” (National Autistic Society, n.d.). This unique relationship to societal expectations around gender can be a source of empowerment, allowing autistic individuals to define their gender in ways that feel authentic to them, unencumbered by external pressures.

However, for some, this disconnection can also create feelings of alienation from gender-diverse communities that may expect a certain level of gender performance or expression. It’s important for therapists to validate these experiences and offer a space where clients can explore their gender identity without feeling pressured to conform to any specific gender norms, whether within neurotypical or gender-diverse frameworks.

Art Therapy: A Creative Space for Self-Exploration

While talk therapy offers many benefits, some clients—particularly those on the autism spectrum—may find it challenging to articulate their thoughts and feelings verbally. This is where art therapy becomes a powerful therapeutic tool, providing a creative and non-verbal medium through which clients can explore complex emotions, identities, and personal experiences. Autistic clients, who often communicate and process information differently, may find that traditional talk therapy doesn’t fully capture their internal world. In these instances, art offers an expansive, alternative language.

Art therapy has long been recognized as an effective modality for those who struggle with verbal communication, providing a unique avenue for self-expression. Aithal and Karkou (2021) highlight how art therapy fosters a sense of freedom, allowing clients to bypass the limitations of language and engage more deeply with their emotional and psychological landscapes. This is particularly important for autistic adults exploring their gender identity, as the creative process enables them to express feelings and experiences that may be difficult to verbalize or even consciously understand.

The Role of Art in Exploring Gender Identity

For many autistic clients, gender identity is not only a personal experience but a complex, sensory one. The ways in which gender is felt, expressed, and understood can be deeply intertwined with sensory experiences—how clothes feel, how certain colours resonate, or how specific shapes and textures evoke a sense of self. Art therapy offers an ideal space to explore these sensory connections to gender.

In my practice, I’ve seen firsthand how art can become a transformative tool for gender exploration. One client, a nonbinary individual, found it difficult to articulate their emotions around their gender identity through words alone. They were unsure how to navigate societal expectations of gender, feeling overwhelmed by external pressures to “perform” gender in ways that didn’t align with their authentic self. Through art therapy, this client was able to create abstract, colourful representations of their inner world. Each session, they used the canvas to explore both the fluidity and stability of their identity, often expressing feelings of euphoria through bursts of bright colours. As we worked together, art became their primary language for processing identity-related emotions, allowing us to delve into their experiences without forcing verbal explanations they weren’t yet ready to find.

This visual exploration not only fostered a deeper understanding of their gender identity but also empowered them to connect more confidently with their sense of self. The process became one of discovery and affirmation, where the creative medium allowed for safe experimentation with different aspects of their gender, free from societal judgement. This is one of the many strengths of art therapy—it creates a space where clients can explore without the constraints of rigid definitions or expectations.

Special Interests as Pathways to Personal Growth

Another key element of art therapy, particularly for autistic clients, is the integration of special interests into the therapeutic process. Stallings (2022) discusses how connecting art therapy with a client’s special interests can enhance engagement, motivation, and personal growth. For many autistic individuals, special interests are not simply hobbies but are deeply meaningful passions that provide comfort, focus, and a sense of identity. These interests can serve as powerful entry points for therapeutic work, offering clients a familiar and joyful framework through which they can explore more challenging emotional or identity-related topics.

Incorporating special interests into art therapy is not only an engagement tool but a way of honouring the client’s neurodivergence. By respecting and integrating their interests into the therapeutic process, therapists can create a space where clients feel seen and valued for who they are. This also helps to build trust and rapport, as the client recognizes that their therapist respects and acknowledges the importance of their interests.

For example, I worked with a transmasculine autistic client whose special interest was comic books. We used this interest as a foundation for our art therapy sessions, creating a personalized comic book that allowed them to explore their journey of gender transition. Through this process, the client could frame their experience in a narrative structure they found familiar and comforting, transforming the therapeutic space into a creative exploration of both their gender identity and personal growth. The visual storytelling format helped them engage with their emotions, strengths, and challenges in a way that felt deeply meaningful and accessible.

Sensory Regulation and Emotional Processing in Art Therapy

In addition to providing a medium for self-exploration, art therapy can also support sensory regulation for autistic clients. Many individuals on the autism spectrum experience heightened sensory sensitivities, which can affect how they process emotions and engage with their surroundings. Art therapy offers a tactile, multi-sensory experience that can help clients regulate these sensitivities while simultaneously processing emotions. The act of painting, drawing, or working with clay can provide soothing, repetitive motions that calm the nervous system and create a space for emotional expression.

Furthermore, the sensory aspect of art therapy can allow clients to externalize and process emotions in a more manageable way. For clients who may feel overwhelmed by intense emotions, creating art offers a way to project those feelings onto an external medium, making them less overwhelming and easier to reflect upon. This is especially beneficial for gender-diverse autistic clients, who may be dealing with a range of complex emotions related to their gender identity, such as dysphoria, euphoria, or confusion. Art becomes a safe container for these emotions, providing clients with the tools to explore them at their own pace.

Empowering Clients Through Creative Autonomy

One of the most empowering aspects of art therapy is the sense of creative autonomy it offers clients. Unlike talk therapy, where the flow of conversation may feel guided or influenced by the therapist, art therapy allows clients to take control of their creative process. This autonomy is particularly important for autistic clients, who may have experienced environments where their choices were limited, or their preferences overlooked. In art therapy, clients are free to choose the materials, colours, and techniques that resonate most with them, creating a space where their personal agency is fully honoured.

For gender-diverse autistic clients, this creative autonomy mirrors the larger process of exploring and affirming their gender identity. Just as they can choose how to express themselves through art, they are encouraged to explore and define their gender on their own terms, free from societal expectations or pressures. The art therapy space becomes not only a place for emotional expression but also a microcosm of the broader journey of self-discovery and identity formation.

A Holistic Approach: Integrating Talk Therapy and Art Therapy

By blending talk therapy and art therapy, I am able to offer a flexible, holistic approach that caters to the unique needs of each client. This integration is particularly valuable when working with autistic adults exploring their gender identity, as it acknowledges the varied ways in which these clients process emotions, make sense of their experiences, and express themselves. Autistic individuals often engage with therapy differently than neurotypical clients, and offering multiple modalities allows for a more personalized, inclusive approach.

In many cases, each session might begin with a verbal check-in to discuss immediate thoughts, emotions, or challenges that the client is facing. This structured start allows for the client to ground themselves in the session and provides an opportunity to express themselves through words, a method that may work for some aspects of their experience. However, for clients who find verbal communication limiting—especially when discussing complex emotional or identity-based topics—transitioning into a period of creative exploration through art therapy provides an alternative channel for self-expression.

This dual modality offers clients the freedom to move between verbal and non-verbal forms of communication based on their comfort level. For some, being able to talk about their emotions in a structured manner might feel empowering; for others, it might be easier to express those same emotions through art, using colour, shape, and texture to convey what words cannot capture. The fluidity of switching between these methods in a single session allows for a deeper and more comprehensive exploration of the client’s emotional world.

Personalizing the Therapeutic Approach

As Henderson, Wayland, and White (2023) emphasize, it is essential to understand the full spectrum of autism’s presentation when working with autistic clients. Autism affects each individual differently, and a one-size-fits-all approach to therapy is unlikely to meet the needs of a neurodiverse client base. Some autistic clients thrive in structured, step-by-step discussions that provide clear guidance and logical progression. These clients may feel more comfortable with talk therapy, where verbal communication and reflection are key components of the process. For these individuals, a structured dialogue may feel safe and predictable, offering a sense of control over their therapeutic journey.

On the other hand, some clients benefit from a more fluid, creative approach, where there is less emphasis on structure and more on sensory experience and free expression. For these clients, art therapy becomes a powerful tool for navigating complex emotions related to gender identity, sensory sensitivities, or social expectations. By providing this creative outlet, I can help clients explore their identity in a way that feels less constrained by the demands of verbal interaction.

By being attuned to each client’s specific needs and preferences, I am able to tailor the therapeutic experience accordingly. This flexibility honours the individual’s neurodivergent processing style, allowing the client to explore not only their gender identity but also their place in the world as an autistic person.

Deepening Emotional Processing through Dual Modalities

One of the key advantages of integrating talk therapy with art therapy is the way it allows for deeper emotional processing. Emotional exploration, particularly in the context of gender identity, can feel overwhelming for many autistic clients. For some, this overwhelm is exacerbated by alexithymia, which makes identifying and articulating emotions difficult (Jones, 2024). For others, sensory sensitivities can heighten emotional experiences to the point of distress. In these cases, relying solely on verbal methods of therapy might not allow for a full expression or understanding of their internal world.

Art therapy provides a unique avenue for these clients to externalize their emotions in a tangible, manageable way. For instance, a client might begin by discussing their feelings of gender dysphoria in talk therapy, but when those feelings become too difficult to articulate, they can transition into creating art. The act of painting, drawing, or sculpting allows the client to express emotions in an indirect manner, reducing the cognitive load of putting complex feelings into words. Art serves as an emotional bridge, helping clients process at their own pace while minimizing the pressure of immediate verbal expression.

This combination of modalities allows for a layered approach to therapy. Clients can begin to explore an emotion verbally, then deepen that exploration through art, and return to verbal reflection once the emotions have been externalized in a less abstract form. This cyclical process of verbal and non-verbal engagement often leads to more profound insights and emotional breakthroughs, as clients are able to access emotions that might otherwise remain locked beneath the surface.

Strengthening Therapeutic Rapport

The integration of talk therapy and art therapy also strengthens the therapeutic relationship by giving clients a sense of choice and autonomy in how they engage with the process. Many autistic clients come to therapy having experienced environments where their voices were not fully heard or where their unique needs were not accommodated. In offering multiple pathways for communication and self-exploration, I create a therapeutic space that honours each client’s autonomy and affirms their individual ways of being.

For instance, a client might feel more empowered knowing that they can switch between talk therapy and art therapy as needed, rather than feeling confined to one method of engagement. This flexibility is particularly important for clients who are exploring their gender identity, as the process of gender exploration can be fluid and nonlinear. Just as clients may feel their gender identity shift or evolve over time, so too might their preferred methods of self-expression and reflection. Offering a holistic, integrated approach allows therapy to mirror this fluidity, providing a safe and adaptable space for continuous exploration.

Practical Tips for Therapists Working with Autistic Gender-Diverse Clients

For therapists committed to creating a gender-affirming and autism-inclusive practice, it’s essential to consider the unique needs of autistic clients who are navigating their gender identity. These clients often require specific accommodations to feel safe, understood, and empowered in therapy. By integrating thoughtful, practical strategies, therapists can create an environment that respects both the client’s neurodivergence and their gender journey. Here are some detailed, actionable tips to help therapists support autistic gender-diverse clients in a compassionate and effective manner.

1. Sensory-Friendly Spaces

Many autistic clients experience heightened sensory sensitivities that can impact their ability to focus and engage in therapy. For gender-diverse clients, who may already be processing significant emotional and identity-based challenges, a sensory-friendly environment is crucial to creating a safe therapeutic space. Small adjustments in the physical setting can make a big difference in how comfortable a client feels.

Lighting: Opt for soft, natural lighting whenever possible, or use adjustable lamps rather than harsh overhead lights. Offering dimmable lighting options can help clients regulate their sensory input.

Sound: Minimize background noise to avoid distractions. Consider using white noise machines or soundproofing therapy rooms to reduce sensory overwhelm.

Sensory Tools: Provide sensory aids such as fidget objects, stress balls, or weighted blankets. These tools can help clients regulate their sensory input during sessions, especially when they are feeling anxious or overstimulated.

By creating an environment that reduces sensory stress, therapists allow autistic clients to focus more fully on their emotional and psychological work. This is particularly important for gender-diverse autistic clients who may already feel vulnerable in exploring their identity within a therapeutic setting.

2. Clear and Direct Communication

Communication is key in any therapeutic relationship, but autistic clients may need adjustments to ensure that they feel understood and heard. Neurodivergent individuals often process language and information differently than neurotypical individuals. For gender-diverse autistic clients, who may already struggle with articulating complex identity-related emotions, clear and direct communication is essential.

Avoid Abstract Concepts: When discussing emotions or identity, avoid abstract questions like “How do you feel?” Instead, use more concrete and specific prompts, such as “What thoughts come to mind when you think about this?” or “How does your body respond in these situations?” These types of questions help clients engage without the pressure of decoding abstract emotional language (Jones, 2024).

Offer Alternatives to Verbal Processing: Some autistic clients may find it difficult to engage in verbal processing, especially during emotionally charged conversations. Offer alternatives such as journaling, typing responses, or using visual aids. For example, some clients may feel more comfortable writing out their thoughts during or between sessions and then discussing them with the therapist afterward.

Check for Understanding: Regularly check in with clients to ensure that they understand what is being discussed. For example, you can ask, “Does this make sense?” or “Would it help if I explained this in a different way?” This helps prevent misunderstandings and ensures that the client feels engaged in the conversation.

Tailoring communication in these ways not only respects the client’s neurodivergent processing style but also fosters a sense of safety and empowerment in the therapeutic space.

3. Affirm Autonomy

Autonomy is crucial for autistic clients, particularly when it comes to exploring something as deeply personal as gender identity. Many autistic individuals have experienced environments where their autonomy was limited, often due to misunderstandings of their neurodivergence. Therapy should be a space where clients feel in control of their process and empowered to make decisions about how they engage with their gender identity and therapeutic journey.

Client-Led Conversations: Invite clients to lead the direction of the conversation and the structure of each session. This allows them to set the pace and explore what feels most important to them at any given time. For instance, you might ask, “What would you like to focus on today?” or “Is there anything specific you want to talk about before we begin?”

Respect Client Expertise: It’s essential to acknowledge that autistic clients are the experts on their own experience. Rather than positioning yourself as the authority, offer support and guidance in ways that allow the client to maintain their autonomy. This could mean collaborating on session goals or offering multiple options for how to proceed in the session, allowing the client to choose what feels right for them.

Flexible Boundaries: Flexibility in session structure and expectations can also enhance the client’s sense of autonomy. If a client prefers shorter, more frequent sessions or needs breaks during sessions to regulate sensory input, be open to these adjustments.

Affirming autonomy not only empowers clients but also fosters a sense of trust and safety within the therapeutic relationship. When clients feel they have control over their therapeutic process, they are more likely to engage deeply and meaningfully with their gender exploration.

4. Inclusive and Affirming Language

Language plays a powerful role in affirming both gender identity and neurodivergence. Therapists must use inclusive, gender-affirming language that reflects the client’s self-identified gender while also respecting their neurodivergent communication preferences.

Pronouns and Identity: Always use the client’s preferred name and pronouns. This may seem basic, but it is one of the most important ways to show respect for the client’s identity. If the client is still exploring their gender identity, make space for that exploration without forcing a label. For instance, you might say, “It’s okay if you’re not sure about pronouns right now. We can revisit this when you’re ready.”

Language that Validates Both Gender and Autism: Ensure that the language you use affirms both the client’s gender and their neurodivergence. Avoid language that might pathologize autism or invalidate the client’s experiences of gender diversity. For example, steer clear of phrases like “fixing” or “curing” autism or treating gender diversity as a phase or problem (Gratton, 2022).

Update Forms and Documentation: Ensure that your intake forms and client documentation are inclusive of gender-diverse and neurodivergent individuals. This includes providing multiple options for gender identity on forms and avoiding binary categories where possible. Also, make sure that clients feel comfortable discussing their neurodivergence, and offer space for them to explain how it might impact their therapy.

Using inclusive and affirming language helps clients feel respected and understood, setting the foundation for a trusting therapeutic relationship where they can explore both their gender and neurodivergence freely.

5. Incorporate Creative Interventions

For many autistic clients, traditional talk therapy alone may not be sufficient for emotional exploration and self-expression. Creative interventions, such as art, movement, or music therapy, can offer alternative pathways for clients to process their emotions, experiences, and identity-related questions.

Art Therapy: For clients who struggle with verbal communication, art therapy provides a non-verbal outlet for exploring emotions. Clients can use colours, shapes, and textures to express feelings that might be difficult to articulate with words (Aithal & Karkou, 2021). Art therapy also supports sensory regulation, helping clients process emotions through tactile and visual engagement.

Movement or Music Therapy: Some autistic clients may respond well to movement-based or musical interventions, especially if these align with their sensory needs. Movement therapy can provide a physical outlet for processing emotions, while music therapy can help clients connect with their feelings through rhythm, melody, and sound.

Integrating Special Interests: Many autistic clients have deep special interests that provide comfort and joy. Incorporating these interests into therapy—whether through art, storytelling, or other creative methods—can help clients feel more engaged and motivated in their therapeutic work. For instance, a client with a special interest in visual storytelling might benefit from creating a narrative about their gender journey through art or writing.

Incorporating creative interventions not only enriches the therapeutic process but also honours the client’s neurodivergent strengths and preferences, offering them a broader range of tools for self-exploration.

Conclusion: Empowering Autistic Adults Through Thoughtful Therapy

Supporting autistic adults in therapy, particularly those exploring their gender identity, requires a nuanced and compassionate approach that honours both their neurodiversity and their gender experiences. Each client brings a unique combination of sensory sensitivities, communication styles, and emotional processes, and it is the therapist’s role to meet them where they are with flexibility, understanding, and respect. By offering personalized interventions—whether through talk therapy, art therapy, or a combination of both—therapists can create a therapeutic space that feels truly safe and affirming.

The journey of gender exploration for autistic clients can be intricate, involving layers of self-discovery that are influenced by sensory experiences, social dynamics, and internal emotional processing. Therapists must be mindful of these complexities, providing both the structure and the freedom that clients need to navigate their gender identity on their own terms. This often means letting go of traditional therapeutic methods and embracing more adaptive, client-centred approaches that prioritize autonomy and creativity.

Incorporating gender-affirming care into a neurodiversity-inclusive framework is not simply a matter of adding accommodations—it is about fundamentally shifting how we view the therapeutic process. We must acknowledge the interplay of identities and experiences, understanding that autism and gender diversity are not isolated aspects of a person’s life, but interconnected elements that shape their world. By doing so, we create a more holistic and empowering therapy experience, where clients feel truly seen for all that they are.

As therapists, we bear the responsibility of fostering an environment where clients can explore their identities without fear of judgment or constraint. This involves actively dismantling oppressive systems that may have marginalized these clients and offering them a space where their neurodivergence and gender are both celebrated. When clients feel that their full selves are honoured—when their sensory needs, communication styles, and gender expressions are all respected—they can engage in therapy with greater confidence and authenticity.

Ultimately, empowering autistic adults through responsive therapy is about providing them with the tools and support to thrive in a world that often misunderstands or underestimates them. It is about creating a space where they can not only explore their identities but also embrace them fully, with a sense of pride and self-compassion. As we continue to refine our practices and deepen our understanding of neurodiversity and gender diversity, we contribute to a more inclusive and compassionate world, one therapy session at a time.

Continue the Convo

If the ideas in this blog resonate with you, I warmly invite you to connect with me. Whether you’re a therapist seeking guidance on neurodiversity-affirmative care, or someone navigating the intersection of autism and gender and looking for support, I’m here to help. You may book individual therapy sessions or peer consultations online. Be sure to bookmark this blog for future insights, reflections, and updates.

References

Aithal, S., & Karkou, V. (2021). Arts therapies research and practice with persons on the autism spectrum. Routledge.

Dattaro, L. (2020, September 14). Largest study to date confirms overlap between autism and gender diversity. The Transmitter. https://doi.org/10.53053/WNHC6713

Gratton, F. V. (2022). Supporting transgender autistic youth and adults: A guide for mental health professionals. Jessica Kingsley Publishers.

Henderson, D., Wayland, S., & White, J. (2023). Is this autism? A guide for clinicians and everyone else. Routledge.

Jones, S. (2024). The autistic survival guide to therapy. Jessica Kingsley Publishers.

Stallings, J. W. (2022). Special interests in art therapy with autistic people. Jessica Kingsley Publishers.

Warrier, V., et al. (2020). The connection between autism and gender diversity. Nature Communications, 11, 3959. https://doi.org/10.1038/s41467-020-17794-1

Disclaimer: This blog offers general educational information and does not constitute professional advice or establish a therapist-client relationship. Please consult a healthcare provider for personalized guidance. Any decisions based on the content are the reader’s responsibility, and Clayre Sessoms Psychotherapy assumes no liability. All case studies are hypothetical with fictional names and do not reflect actual people. We prioritize your privacy and the confidentiality of all of our clients. We are committed to maintaining a safe, supportive space for 2SLGBTQIA+ community care.

Clayre Sessoms is a trans, queer, and neurodivergent Registered Psychotherapist (RP), Certified Sensorimotor Psychotherapist, and Board Certified Art Therapist (ATR-BC), offering online therapy for trans*, nonbinary, queer, and 2SLGBTQIA+ allied adults and teens across Canada. With a deep commitment to trauma-attuned gender-affirming care, Clayre integrates talk therapy, experiential collaboration, and creative expression to support clients to grow, heal, or navigate change. When not working with clients or supervising newly-licensed therapists, Clayre finds solace in nature, where she recharges her creativity and compassion.

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