Written by: Ruth Szpanka, MA, LPC
Written from the perspective of an autistic therapist — and an autistic client
In relational therapy, there is an understanding that trauma happens in the context of relationships and therefore is best healed relationally. From a trauma-informed perspective, we strive to understand the client’s individual experience in all its nuance. This is vitally important when working with autistic individuals, as autistic trauma can be particularly misunderstood. Living with PTSD on the Autism Spectrum is one of the few resources that captures how trauma unfolds in autistic lives — not only through major events, but through years of mis-attunement, misunderstanding, and relational rupture. For practices committed to trauma‑informed, neurodiversity‑affirming care, its insights are essential.
Reading this book from the dual vantage point of both an autistic therapist and autistic client provided a unique clarity. It shed light on the frustrations as a client while giving insight to the needs of autistic clients in the therapy room.
Autism and trauma: a misunderstood intersection
The book addresses the fact that autistic trauma is frequently overlooked or misinterpreted. Many autistic clients experience trauma through chronic social invalidation, sensory overwhelm, relational confusion, or repeated misinterpretation by authority figures. These difficulties occur across personal and professional settings. The experiences accumulate over time, often resulting in complex trauma rather than single‑incident PTSD. They are often co-occurring with other “capital T” trauma experiences. Autism may be missed when the clinician approaches the client’s experiences only from a “trauma lens”. Trauma may be undetected in the misunderstood communication styles of autistics.
From a clinical standpoint, the book highlights how autistic trauma responses differ from those of individuals without an ASD diagnosis. When the autistic piece is not considered, shutdowns may be labeled as resistance. Meltdowns may be seen as emotional dysregulation rather than sensory overwhelm. Autistic clients may be labeled as emotionally distant or lacking insight. Their presentation may be considered “off” as they relay the details of the traumatic events. These differences may hinder rather than foster connection. We know that the biggest factor in positive outcomes is the therapeutic relationship. Therefore, the disconnect can lead to frustration for both the client and the therapist.
A dual‑voice structure that bridges lived experience and clinical practice
The book looks at this dilemma from a very enlightening perspective. The two authors share their personal experiences of collaboration and clinical work. Mary P. Donahue Ph.D. is a psychologist and neurotypical. Lisa Morgan M. ED is an advocate and an autistic adult. Through the pages of the book, they illuminate their journey to better understand the language of the other.
As a therapist, I recognized many of the patterns described. I could easily recall times where my words landed differently than I intended. I vividly remember sessions where clients “lost words” in a shutdown or became activated in a meltdown triggered by trauma memories. As much as I would like to say that I navigated these situations with ease, the reality is that even as a fellow autistic, I still fall short. After all, no two autistic people are the same or have the same lived experience.
As an autistic client, I recognized the pain of being misunderstood when understanding was what I needed most. I spent many sessions trying to explain my way of being. I was met by my therapist with a sincere desire to understand, which made the disconnect feel even worse somehow. It was in my diagnosis that I gained clarity. My therapist understood the trauma, but the autism was a key factor as well. It was only when we came together in our own therapeutic collaboration that we were able to better understand the other’s language. When we started to address sensory overload, the toll of chronic masking, and the trauma that comes from being an autistic individual in a neurotypical world, we found ease in the connection. I felt seen when the book gave language to experiences that are often difficult to articulate in therapy.
Implications for trauma‑informed therapy
The book not only illustrates the problem but it offers considerations for therapy with autistic individuals. These are the foundational starting points
- Predictability and structure
- Sensory‑aware environments
- Collaborative pacing
- Flexible communication methods
- Clear differentiation between autistic traits and trauma responses
The greater lesson is these factors could easily apply to individuals from varying populations. From a relational therapy perspective these offer the safety and coregulation benefits that are essential to healing.
If you are interested in a collaborative therapy experience focused on neurodiversity, please contact us at Elements Counseling and Wellness Spa to schedule an intake session.
References
Morgan, L., & Donahue, M. P. (2020). Living with PTSD on the autism spectrum: Insightful analysis with practical applications. Jessica Kingsley Publishers.
Reach out to schedule an appointment on telehealth or at our office in Pittsburgh, PA. Contact us here or email info@elementspgh.com or call 412-587-6020.
The information contained in this blog does not replace professional treatment or diagnosis and is for educational purposes only.
