What Autistic Kids Have Taught Me About Therapy

I’ve spent years sitting on the floor with autistic kids who believe, long before they ever meet me, that they are the problem. Not because someone told them directly, but because they’re perceptive. They’ve absorbed the tension at home, the tightness in a parent’s voice, the helplessness after another school call, and the weight of adults who are out of options. 

A surprising number of the autistic children I meet can recite their diagnoses the way other kids list their favorite characters: ADHD, ASD, OCD, ODD, generalized anxiety, social anxiety, sensory processing disorder, mood dysregulation…on and on. 

They say these words with the matter-of-fact tone of someone who’s decided the only way to survive being treated like a problem is to name it first. When they sit across from me, small legs pulled up to their chest or folded tightly underneath them, their first question is something like, “Are you going to fix me? My dad says you’re here to fix me.” Kids don’t lie about this stuff. 

They report what they hear, and somewhere along the way, the professionals in their life—in an attempt to help, simplify, or categorize—stacked labels so high the child couldn’t see themselves anymore. That’s what autistic kids have taught me about therapy—the room becomes safer the moment we stop trying to fix them. 

When a Child Arrives Already Carrying Blame 

I’ve had children walk in and immediately seek the farthest corner of the room. I’ve seen kids tuck themselves inside the tent and whisper, “I know I’m the problem.” I’ve had children refuse to take off their backpack because they weren’t sure if they’d be allowed to stay. I don’t coax them out. I don’t insist they talk. I don’t ask for eye contact. I sit. I lower my voice. I match their posture. I wait. 

If all I do in that first session is show the child that I’m safe, that I won’t force vulnerability, and that I see them as a person—not a project—then the session has done its job. Many autistic kids communicate through energy before words; through pacing, breath, doll placement, construction patterns, retreat, play sequencing, and the way they use space. 

When I pay attention, the child is already talking. 

They show you: 

  • what feels overwhelming 
  • what feels grounding 
  • what feels predictable 
  • what feels too close 
  • what feels sensory-safe 
  • and where their nervous system sits on the ladder that day 

If I’m willing to enter their pacing—not impose mine—I get invited into their world. And that invitation is sacred. One child taught me this by accident. She was drawing spirals on the carpet with her finger—not talking, not looking at me. I followed her spiral with my breath, slowing as she slowed. I didn’t realize she was watching until she said quietly, “You breathe like me.” That was the moment I realized that I don’t need eye contact to build connection; I need attunement, as do they. 

Parents Don’t Come to Me Because They’re Cruel—They Come Because They’re Terrified 

I’ve worked with so many families who start with resignation, “We’ve tried everything.” “He’s going to get himself killed someday.” “She ruins every family outing.” “I can’t deal with her anymore.” “I don’t even like being around my own kid.” Years ago, those sentences pierced my chest. Now I listen for what they’re trying to say beneath the frustration. 

Parents aren’t villains in these stories. They’re exhausted humans who’ve been in survival mode for years. They’ve taken time off work for school meetings, fought insurance companies, been given contradictory advice, been judged by strangers, and weathered crises other parents can hardly imagine—elopement, medical trauma, meltdowns in public spaces, property destruction, suicidal ideation from a child too young to tie their own shoes––and the harshest words often hide the most fear. The more hopeless a parent sounds, the more likely they’re experiencing complete desperation. 

Once, after weeks of angry refrains, a father finally said, “I’m terrified. I don’t know how to help her. I don’t want to lose her.” I didn’t confront him. I didn’t correct him. I didn’t lecture him on parenting styles. I just let the truth settle, because that moment—when fear becomes visible—is where the real therapy began. 

Parents need a place to collapse too. They need someone who sees through the panic. They need someone who can interpret the emotional signal behind their words. If I look long enough, “She’s awful” usually means “I’m afraid I can’t protect her.” 

Why Control Matters So Much 

Some autistic kids arrive in therapy having had their choices stripped from them over and over; 
what they eat, what they wear, how they sit, what they focus on, how they talk, what stims they’re allowed to do, how they should “behave,” and what parts of their personality are acceptable. By the time they get to me, they assume adults will tell them who to be. So, I reverse the power dynamic. “You’re in charge here,” I tell them. Not metaphorically. Literally. 

They choose the: 

  • activity 
  • pace 
  • distance 
  • sensory input 
  • theme 
  • transition 
  • silence 
  • disclosure 
  • exit 

Some kids don’t test the boundary at all. Some test it immediately. Some test me for months. Autistic children who’ve been controlled harshly will often push against me to see if I’m just another adult who’s going to tighten the lid. But when they realize I’m not—when they learn I won’t force engagement, shame them for retreating, or push a conversation they didn’t choose—their nervous system relaxes. The rigidity softens. The play becomes exploratory. Autistic kids respond to empowerment the same way plants respond to sunlight: slowly, and then all at once. 

The One Rule: No More Self-Insults 

Kids (and adults) absorb the words they repeat about themselves. So, in my playroom, we say feelings, not identities. “I felt stupid” instead of “I am stupid.” “I felt annoying to others” instead of “I am annoying.” “I felt overwhelmed” instead of “I am too much.”  

Parents often mirror this pattern without noticing. “He’s impossible.” “She’s manipulative.”  “He’s just dramatic.” “She doesn’t care.” I gently redirect both because identity words shape how kids understand their place in the world. Autistic kids, who often face a lifetime of criticism for simply existing, need a place where their sense of self can remain intact. Correcting identity language is one of the simplest and most transformative interventions I practice. 

The “Safety Parent” 

Every autistic family I’ve worked with has a parent who feels like the “problem parent”—the one who yells, withdraws, threatens consequences, avoids conflict, or gets labeled as harsh. What I learned is that the parent who struggles most is usually the one who needs the deepest invitation into the child’s world. I bring that parent into sessions—not to supervise, but to observe attunement in action. I let them see how: 

  • slowly I talk 
  • I match the child’s breath 
  • I phrase questions with permission 
  • I wait in silence 
  • I interpret behavior as communication 
  • I anchor the room with predictability 

This is my favorite part of my work because the safety parent becomes powerful, gentle, and connected once they see their child accurately. Not through shame but through understanding. Over time, the parent becomes a co-regulator instead of a correction officer, and the child, seeing this consistently, begins to reach for them again. I’ve watched relationships that seemed broken transform into genuine companionship, not because I fixed the child, but because the parent finally had a map. 

When We Stop Treating Autism Like Defiance 

In my work with these children and their families, I’ve come to understand that therapists must know autism—not pop-psych autism, not social-media autism, not outdated autism—actual autism, and actual autism is: 

  • sensory processing differences 
  • a different communication rhythm 
  • a unique relational style 
  • a distinct way of understanding fairness and truth 
  • a predictable stress/recovery cycle 
  • and often, a trauma history from being misunderstood 

Autism is not a behavioral issue, manipulation, noncompliance, or defiance. Too many autistic kids have been placed in settings that only worsened their dysregulation. Too many have been punished for sensory overload. Too many have been misdiagnosed as oppositional, disrespectful, or personality-disordered because clinicians didn’t understand autistic communication.  

In my work with autistic clients, I’ve learned, or I should say, they’ve taught me that competence isn’t optional and that I needed to understand that stimming, masking, shutdown, overload, monotropism, sensory profiles, are the way autistic nervous systems respond to relational pressure. I’ve needed to be comfortable with silence, scripting, indirect play, rejection, honesty, rigidity, and shifting connection. And, of course, it’s been crucial for me to step away from the gravitational pull of diagnoses, because each child is unique. Kids aren’t broken. Our lens is. 

Why Parents’ Growth Heals the Child 

People think therapy “works” when the child changes. In my experience, therapy works when the parent: 

  • softens 
  • sees accurately 
  • shifts interpretation 
  • stops fearing their child 
  • recognizes their child is trying 

When the parent experiences a moment of clarity, they come to realize that maybe my child isn’t trying to hurt me. Maybe she’s trying to survive, and the entire trajectory of treatment changes. I once watched a parent who was initially rigid and overwhelmed grow into the most attuned, steady presence in the child’s life. He told me, “I didn’t realize how hard she was trying until I watched you watch her.” That’s the beauty of working with autistic families––when understanding enters the room, hope returns. 

What Autistic Kids Have Taught Me 

Autistic kids have taught me that therapy isn’t about perfect technique—it’s about presence. They’ve taught me to: 

  • move slowly 
  • assume goodness 
  • stop pathologizing difference 
  • treat autonomy as essential 
  • let the child be in charge 
  • listen beneath behavior 
  • respect sensory truth 
  • see parents as co-survivors, not antagonists 
  • hold space for relationships that need repairing, not replacing 

Most of all, autistic kids have taught me that I’m not there to fix them. I’m there to see them. I’m here to understand their internal logic. I’m here to become someone they don’t have to defend themselves against. That alone can change everything. 

I’ve seen families reconnect in ways they didn’t believe were possible. I’ve seen kids reclaim freedom inside their own bodies. I’ve seen parents rediscover the softness they thought they lost, not because anyone was broken, but because the adults finally learned to hear the story beneath the struggle.  

If I could offer one reflection to therapists who work with autistic families, it would be this: When you hear a parent say, “I can’t stand my kid,” don’t judge them. Translate it. What they usually mean is, “I’m afraid for my kid.” If we can hear the fear beneath the frustration, then therapy stops being about correcting behavior—and becomes about connection, compassion, and the possibility of healing. 

How to Be Successful in Child Therapy: Lessons From 5 Decades of Practice

The insights I value the most came from direct work with children, adolescents, and families who taught me what is most important and helpful in the work that we do. I learned from children that what is most essential is that we do not give up on them. Embracing unwavering faith in children as they go through the worst times of their lives may prove to be far more important than any technique or intervention we employ.

The Importance of Therapeutic Presence with Children

Repeatedly, my former child clients tell me this when they come back to visit 10, 20, or even 30 years later as they establish themselves in their adult lives. Surprising to me is the fact that at the time I was seeing these former child or adolescent clients, I did not feel that I was particularly helpful. The crises that brought them to therapy were so intense that I was unable to appreciate the power of therapeutic presence and commitment.

One of the most important insights that emerged from my private supervision with the late Walter Bonime, MD, senior training psychoanalyst, has helped sustain me during the most challenging moments of my 55-year career as a clinical psychologist working with children and families. Dr. Bonime taught me that no matter how frustrated, discouraged, angry, hopeless, or impotent the therapist may feel, it cannot begin to match the depth of the same feelings in the child.

Children taught me that sometimes “more is less.” In certain moments what is most important is that we be a caring presence, a trusted witness. The temptation is for therapists to shower intense moments with words that can diminish the transformative potential of a deep encounter with a child.

I’ve met many a “fawn in gorilla suit” during my career. The analogy suggests that the “fawn” as the core self is highly vulnerable — has been hurt too many times! The aggression (putting on the gorilla suit) is intended to protect that vulnerable fawn by keeping people at a safe distance. Yet, the longing for connection burns deeply within.

Another important understanding gained from the decades of work with children is that whenever a youth says, “I don’t care!” we should assume they once cared a lot, but it simply hurts too much, it is too great a risk to care anymore.

I’ve always told my interns and young clinicians, “when you don’t know what else to do, just treat children and families with profound respect and dignity.” They are surprised how far that goes.

Children carry within them powerful narratives that all too often no one takes the time to elicit or hear. The youth, as much as they might avoid it, long to unburden.

The therapist’s willingness to risk themselves in the therapy encounter, and sometimes be wrong, is a “gift” to children by creating a safer context for the child to express what is difficult to put into words.

An 8-year-old boy asked me to explain the initials after my name. This led the boy to say, “Well, you don’t look that smart!” I told him my family tells me the same thing. It reminded me of how important a sense of humility is in working with children. To connect with children, we must be willing to look like fools sometimes. Otherwise, we are no fun at all. Children will only feel free to talk when they feel free to not talk.

Our goal is to honor strengths without trivializing suffering. This is a delicate operation. The work we do is rewarding. We get paid in the currency of the heart. Some of the moments we share with children and families are precious and priceless. But our work is hard. There is an undeniable emotional toll exacted from caring for children with deeply wounded spirits.

Can we hear the hard stories without the hardening of our heart? To do so requires diligent and disciplined efforts to take adequate care of the instrument of healing — our self. As much attention in our field has been paid to the importance of self-care, each child therapist will need to reflect and honestly assess to what degree it is a priority. If we short-change ourselves, it is likely that we are also stiffing our families, and perhaps the children and families we treat as well.

[Editor’s Note: David and I are colleagues and friends, and we are honored to offer his reflection here, which is not about “what to do” with children and teens in therapy, but, “how to be.”]

Questions for Thought and Discussion 

  • In what ways is the author’s orientation to child therapy Similar to your own?
  • What have you found to be the most effective ways to intervene with children and teens?
  • What have you found to be some of the greatest challenges in working with young clients?