‘They've Almost Got, Like, a Checklist to Work Down’: On the Lived Experiences of Autistic Adults Who Have Received a Structured Therapy Service for Depression and/or Anxiety Disorders

This publication is included in the Autistic Autism Scholarship Project. The publication reports two autistic authors, without identifying them by name.

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Miller, P. K., Dewison, N., Bowden, S. L., Ingham, B., Thwaites, R., & Dagnan, D. (2025). ‘They've Almost Got, Like, a Checklist to Work Down’: On the Lived Experiences of Autistic Adults Who Have Received a Structured Therapy Service for Depression and/or Anxiety Disorders. Neurodiversity, 3, Article 27546330251350037. https://doi.org/10.1177/27546330251350037

Publication date: 1 May 2025 Added to AutiHub: 16 Oct 2026 Type: Article Article language: English
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Authors

Publication authors
6
Autistic authors reported by the publication
2
  1. Paul K Miller
  2. Natalie Dewison
  3. Samantha LJ Bowden
  1. Barry Ingham
  2. Richard Thwaites
  3. Dave Dagnan

Abstract

Autistic adults experience higher rates of common mental health conditions than non-autistic adults and report greater difficulties accessing mental health services. In England, psychological therapy for anxiety and depression is primarily delivered through NHS Talking Therapies for Anxiety and Depression (TTad), but little is yet known about autistic adults’ experiences of these services. Using Interpretative Phenomenological Analysis, we conducted in-depth online interviews with five formally diagnosed autistic adults, all in their twenties at time of interview, who had received TTad therapy for depression and/or anxiety conditions. Four superordinate themes emerged: Pre-Therapeutic Context, highlighting how participants’ autism diagnoses had been transformative, and how diagnosis had shaped their therapy experiences; Therapeutic Relationship, emphasising the importance of a therapist's flexibility and understanding of autism, and the damage that could be done by them minimising the relevance of participants’ autism itself; Rigidity and Quantification, addressing challenges with standardised approaches and outcome measures; and Training and Adaptation, identifying how therapists often developed more effective approaches over time, to demonstrably positive therapeutic ends. Findings suggest that TTad services (and analogous international programmes) may require greater flexibility in delivery, enhanced autism awareness among practitioners, and potentially extended treatment timeframes for autistic clients. Lay Abstract The experiences of autistic adults who received talking therapy for depression and anxiety disorders We are a group of academic researchers, psychological therapists, and autistic individuals, with some of us being more than one of these things. We investigated how autistic adults experience talking therapy services in England, specifically focusing on their experiences with depression and anxiety treatment. We interviewed five autistic adults in their twenties who had received therapy through the NHS Talking Therapies for Anxiety and Depression (TTad) service. Our findings revealed that participants’ journeys to autism diagnosis significantly shaped how they engaged with therapy, and that therapists should not underestimate the difficulties of this journey. Participants reported that their therapists sometimes seemed unprepared to understand how autism impacts mental health. They also found the rigid structure of therapy and progress measurement methods challenging. However, therapy became more helpful when therapists demonstrated flexibility and willingness to adapt their approach. The participants emphasised the importance of autistic people continuing to access these services, as few alternatives were available to them when experiencing depression or anxiety. We recommend training for psychological therapists to better understand the specific needs of autistic people and how to adapt therapy approaches to make them more effective.

Bibliography cited by this reference

Cited references are imported from external metadata sources when they are available. The list may be partial.

Cited bibliography overview

These indicators describe the bibliography cited by this publication. An author name is counted each time it appears in one cited reference, so the same person can be counted more than once. Names not yet linked to an author already present in AutiHub are treated as unknown, not as non-autistic. Last computed: 18 Oct 2026 01:33.

Cited references
42
With a DOI
42
Without a DOI, from raw bibliography text
0
10 / 42 (23.8%) cited references include at least one author identified as autistic.
References with data to complete
0 / 42 (0.0%)
References with detected author names
42 / 42 (100.0%)
Without detected author names
0
Without a structured title
0
Without a stable identifier
0
References with raw author names still to review
0
References with external metadata lookup issues
0
These indicators apply to cited references displayed on this page, after technical duplicates have been merged. A reference without a DOI can still support author statistics when a title and author names are available.
Author names detected in the cited bibliography
242
From DOI or external metadata
242
From validated raw bibliography text
0
Raw names already validated
0
Raw names still to review
0
127 / 242 (52.5%) names are linked to an author already present in AutiHub. 115 / 242 (47.5%) names are not yet linked.
Names linked to a person identified as autistic
15 / 242 (6.2%)
Calculated across all author names detected in the cited bibliography. Among names linked to an author already present in AutiHub: 15 / 127 (11.8%). Distinct people identified as autistic: 13 / 200 (6.5%).
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