Show Me the Real You: Enhanced Expression of Rogerian Conditions in Therapeutic Relationship Building with Autistic Adults

Authors

Abstract

Background: Research in psychotherapy and counseling theory has shown the importance of a strong therapeutic relationship. However, in the context of working with autistic adults, the relationship appears to be de-emphasized, or “different approaches” are recommended without specifying these. Neglect of relationship building may contribute to autistic adults' negative experiences with health care professionals identified in previous studies. Methods: I interviewed 17 autistic adults about their relationship building experiences with a wide range of professionals primarily from mental and medical health backgrounds. I also interviewed two mental health counselors and one psychologist who had experience working with this client group and had been recommended by autistic participants. I elicited best practice recommendations from all participants. I analyzed the data in an interpretive–interactionist framework and present them through creative analytic practice. Findings: I address one major theme in this article: the importance of Rogerian/person-centered relationship conditions. All had to be practiced in an enhanced way: (1) Enhanced congruence could be demonstrated through therapist self-disclosure and refraining from phony relationship building “techniques” such as vocal adjustments. (2) Enhanced empathy could be demonstrated through genuine listening and accurate interpretation; however, interpretation needed to be phrased tentatively. (3) Enhanced unconditional positive regard could be demonstrated through explicit verbal expression, practical demonstration, and remembering. Conclusions: Results largely mirrored research with non-autistic populations: different approaches were not needed for relationship building. Participants emphasized the importance of Rogers' person-centered conditions and described pivotal relationship building moments associated with enhanced expression of these conditions. Community brief Why was this study done? Previous studies have reported that autistic adults often do not experience good relationships with their mental and medical health care professionals, feeling misunderstood or patronized. This is a problem, as strong relationships are essential for good outcomes in many settings. Limited resources exist for professionals to improve their relationship building skills with this client group. The few texts that address this question at all do so only briefly. They either recommend different approaches (but do not specify these) or suggest that relationship building is too hard to be worth the effort with autistic adults. No research has yet engaged autistic adults to ask their recommendations for best practice in this area. What was the purpose of this study? This study sought answers to three main questions: 1. What makes a good working relationship from the point of view of autistic adults? 2. How do successful professionals establish relationships with their autistic clients? 3. What do autistic adults want professionals to do to improve relationships? What did the researcher do? The researcher asked 17 autistic adults and 3 non-autistic mental health professionals with expertise in autism about their experiences and recommendations for improving relationship building. What did the researcher find? Several aspects were important, but this article discusses only one aspect due to a lack of space: using the same relationship building approaches as with non-autistic clients, but in an enhanced way. 1. Professionals had to be authentic in all their interactions with autistic clients. If they were “fake,” many participants became confused, as they could tell something was wrong. They could only trust professionals who genuinely cared about them. 2. Professionals had to show empathy by listening to their clients without trying to advise or “fix” the person. Participants also appreciated if professionals showed understanding of their experience by interpreting it correctly. 3. Participants needed to feel liked by their professionals. Professionals could show this liking best by: expressing it verbally, demonstrating it in a practical way (such as offering a cup of tea, putting clients in touch with support networks in the community, or finding extra resources for them), or remembering client details (such as access needs or interests). How will knowing this help autistic adults? Many of those in the health care workforce want to learn how to engage better with their autistic adult clients. This study aims to lay the groundwork for a future resource for professional development. If professionals are empowered to build better, more trusting relationships with their autistic adult clients, health care outcomes may be improved. What are the weaknesses of this study? This study had a relatively small number of participants. Therefore, the experiences they discussed may not reflect the experiences of the larger autistic community. Professionals should adjust their relationship building approach to each client's preferences.

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