"Oh, you couldn't be autistic": Examining anti-autistic bias and self-esteem in the therapeutic alliance.
Even small anti-autistic remarks from therapists damage self-esteem and trust.
01Research in Context
What this study did
Darazsdi et al. (2023) interviewed autistic adults about their therapy experiences.
They asked how therapist attitudes affected self-esteem and the therapeutic bond.
The study used open-ended questions and theme analysis.
What they found
Participants said both obvious and subtle anti-autistic bias hurt their self-worth.
Examples: "You don’t look autistic" or pushing eye contact.
These moments weakened trust and made clients feel flawed.
How this fits with other research
Orm et al. (2023) also gathered autistic adults’ critiques, but about media portrayals. Both papers show practitioners need to listen to autistic voices.
Pollock et al. (2026) extend the theme: late-diagnosed women describe therapists who missed autism because of gender stereotypes. Together the studies reveal layered bias across age and gender.
Mamimoué et al. (2024) review shows poor social relationships raise depression risk in autistic youth. Therapist bias is one more harmful relationship, adding weight to that risk.
Why it matters
If you work with autistic clients, bias can slip out in small comments or goals. Check your language for hidden messages that being autistic is bad. Ask clients what feels respectful and follow their lead. This simple shift can protect self-esteem and keep therapy on track.
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02At a glance
03Original abstract
Many mental health practitioners in the United States are trained to cure or change autistic people. Some of these mental health practitioners may show anti-autistic bias when working with autistic clients. Anti-autistic bias is any kind of bias that degrades, devalues, or others autistic people or autistic traits. Anti-autistic bias is especially problematic when mental health practitioners and clients are engaged in the therapeutic alliance, which is the collaborative relationship between a therapist and client. The therapeutic alliance is one of most important parts of an effective therapeutic relationship. Our interview-based study examined 14 autistic adults' experiences with anti-autistic bias in the therapeutic alliance and the relationship they felt it has on their self-esteem. Results from this research showed that some mental health practitioners expressed hidden and unrealized bias when working with autistic clients, such as making assumptions about what it means to be autistic. Results also showed that some mental health practitioners were intentionally biased and openly harmful to their autistic clients. Both forms of bias negatively affected participant self-esteem. Based on the findings of this study, we offer recommendations to help mental health practitioners and mental health practitioner training programs better serve autistic clients. This study addresses a significant gap in current research on anti-autistic bias in the mental health field and the overall well-being of autistic individuals.
Autism : the international journal of research and practice, 2023 · doi:10.1177/13623613231154622