Policing Tactics in Therapy: An Autistic Perspective Through the Power Threat Meaning Framework
In recent years, the concept of policing tactics in therapy has gained attention, revealing how certain therapeutic practices, often presented as ‘standard care,’ can have deeply harmful effects, particularly for autistic individuals. These tactics are not always overt; they are frequently embedded in the everyday practices of mental health professionals who may unknowingly perpetuate them. For autistic people, whose behaviours are too often misunderstood or pathologised, this can lead to experiences of therapy that feel more like control than care.
The medicalised nature of psychiatry has long been criticised for its tendency to pathologise neurodivergent behaviours rather than seek to understand them within the context of the individual’s lived experience. This approach often fails to account for the systemic oppressions and historical traumas that shape these behaviours, instead framing them as issues to be corrected. The result is a form of therapy that can feel disempowering and coercive, particularly for those who are already marginalised.
In today’s article, I will explore specific ways in which therapists may inadvertently uphold policing tactics within their practice, particularly when working with autistic clients. By contrasting these practices with the Power Threat Meaning Framework (PTMF), I aim to highlight a more compassionate and contextually informed approach to therapy. Finally, I will offer practical suggestions for my autistic readers, empowering them to navigate these challenges and advocate for their needs within the therapeutic setting.
Pathologising Normal Responses
One of the most insidious ways in which therapy can inadvertently uphold policing tactics is by pathologising behaviours that are, in reality, normal responses to systemic oppression and historical trauma. For autistic individuals, whose experiences often diverge from neuronormative expectations, this can be particularly damaging. Rather than seeking to understand these behaviours within the broader context of an individual’s life, therapists may label them as symptoms of a disorder, thereby missing the opportunity to provide truly compassionate care.
My own experience in the early 1990s serves as a poignant example of this. During a period of severe meltdowns that lead to my first shutdown, I found myself subjected to a system that had no idea what was happening with me. Rather than exploring the underlying causes of these shutdowns—whether they were linked to sensory overload, trauma, or the immense pressure to conform to societal norms—the response was to prescribe a cocktail of medications aimed at ‘stabilising’ me. This approach did nothing to address the root causes of my distress or the context in which it occurred. Instead, it left me feeling further disconnected from myself, as though my very way of being was something to be corrected rather than understood. I delve deeper into this episode in my book, “No Place for Autism?,” where I explore the episode in great detail.
The PTMF offers a starkly different approach, one that seeks to understand the meaning behind behaviours rather than simply labelling them as pathological. By considering the threats an individual faces and the meanings they ascribe to their experiences, the PTMF allows for a more nuanced and compassionate understanding of autistic behaviours. This approach can lead to more effective and empathetic care, as it recognises the individual’s context rather than forcing them into a one-size-fits-all model of therapy.
For autistic individuals navigating therapy today, it is crucial to advocate for a trauma-informed approach that acknowledges the full context of their experiences. This means seeking out therapists who are willing to explore the underlying causes of distress rather than simply focusing on ‘symptom reduction.’ By doing so, therapy can become a space of healing and empowerment, rather than one of control and correction.
Rigid Treatment Plans and Compliance
The influence of behaviourism on the therapeutic environment has long shaped how treatment plans are developed and implemented. Behaviourism’s focus on observable behaviours and strict compliance to treatment regimens often results in rigid plans that can feel coercive, particularly for autistic clients who may have different needs and responses. This methodology, rooted in a desire to control and modify behaviour, is increasingly recognised as outdated and ill-suited to addressing the complexities of autistic experiences.
For many autistic individuals, rigid treatment plans can exacerbate feelings of being misunderstood and trapped within a system that does not accommodate their unique way of processing the world. The emphasis on compliance, often framed as a measure of progress, fails to consider that autistic clients might not respond well to traditional therapeutic methods. Instead of fostering a collaborative relationship, this approach can create a dynamic where the therapist wields power over the client, expecting adherence to a predefined path without regard for individual circumstances.
In “No Place for Autism?,” I challenge this behaviourist approach by framing behaviours within Glasser’s Choice Theory, which offers a more holistic and respectful understanding of human behaviour. Choice Theory posits that all behaviour is driven by an attempt to meet basic needs, such as the need for autonomy, belonging, and safety. When applied to therapy, this perspective allows for greater flexibility, recognising that each individual’s actions are meaningful attempts to fulfil these needs rather than simply symptoms to be managed or suppressed.
The PTMF similarly emphasises the importance of understanding the threats posed by rigid systems and the meanings individuals ascribe to their experiences. It advocates for flexibility in therapy, where treatment plans are co-created with the client and adapted as needed to respect their autonomy and lived experience.
For autistic clients, it is essential to communicate the need for flexibility and personalised care in therapy. This may involve seeking out therapists who are open to exploring alternative approaches, such as Choice Theory, and who are willing to adjust their methods to better align with the client’s needs. By advocating for a more collaborative and adaptive therapeutic process, clients can transform therapy from a space of compliance and control into one of empowerment and genuine understanding.
Labeling Clients as Non-Compliant or Resistant
The labels of “non-compliant” or “resistant” are often used in therapy to describe clients who do not conform to expected treatment outcomes or who challenge the prescribed methods. For autistic individuals, these labels can be particularly harmful as they fail to recognise the valid reasons one might struggle with or reject certain therapeutic practices. Instead of exploring these reasons, such labels pathologise the behaviour, reducing complex responses to mere obstinacy or defiance. This reductive approach overlooks the genuine difficulties that autistic clients may face in therapy, such as sensory overload, communication barriers, or a deep-seated mistrust of the medicalised system.
The dangers of being labelled as “non-compliant” extend beyond the therapeutic setting, particularly in the context of the US judicial system, which is notorious for its massive prison population. Such labels can become a form of ‘evidence’ that might be used against an individual in court, painting them as uncooperative or difficult. This risk is even more pronounced for people of colour, who are disproportionately targeted by these labels, often at a far greater rate than those from the dominant culture. The intersection of ableism and racism in this context can have devastating consequences, further marginalising individuals who are already vulnerable.
The PTMF offers an alternative perspective by encouraging therapists to understand the threats that might be leading to these so-called “non-compliant” behaviours, rather than simply pathologising them. By exploring the underlying fears, anxieties, and past traumas that may be influencing a client’s response to therapy, therapists can provide more empathetic and effective care.
For autistic individuals, it is crucial to reframe these labels and advocate for themselves in therapy. Open communication with therapists about what is and isn’t working can help dismantle the power dynamics that these labels reinforce. By addressing the root causes of their struggles in therapy, clients can foster a more collaborative and supportive therapeutic environment, one that respects their autonomy and unique needs.
Power Imbalance in Therapeutic Relationships
The therapeutic relationship is inherently imbalanced, with therapists holding significant power over the direction and outcome of a client’s care. This power imbalance can be deeply problematic, especially when therapists exert control in ways that undermine the client's autonomy. For autistic individuals, who may already feel vulnerable within the medical system, this dynamic can exacerbate feelings of powerlessness and further entrench the sense that their experiences are not fully understood or respected.
This issue is particularly acute for many impoverished individuals who are placed into therapy by the system, often against their will, and are given little to no choice in selecting their therapist. In these cases, therapy can feel less like a collaborative process and more like an imposed regimen, where the client’s voice is marginalised. Similarly, autistic youth frequently receive therapy or counselling as part of their Individualised Education Programs (IEPs). Here too, they are often assigned a therapist without any say in the matter, which can lead to a disconnect between the therapist’s approach and the client’s needs.
The PTMF provides a valuable lens through which to address these power imbalances. By focusing on the threats that individuals perceive in their interactions with therapists, and the meanings they attach to their experiences, PTMF encourages therapists to be more mindful of how they wield their power. This approach promotes a more egalitarian therapeutic relationship, where clients are empowered to have greater control over their care.
For autistic clients, asserting autonomy in therapy can be challenging, especially within such constrained circumstances. However, it is crucial to establish clear boundaries and communicate openly about what feels comfortable and what does not. If a therapist is overstepping, clients should feel empowered to voice their concerns or seek a second opinion if possible. While this may not always be feasible, especially for those with limited options, even small acts of self-advocacy can help shift the dynamic towards a more balanced and respectful therapeutic relationship.
Overemphasising Symptom Reduction and Neuronormativity
In many therapeutic settings, there is an overemphasis on symptom reduction and adherence to societal standards of “functionality.” This focus often undermines the client’s own goals and values, particularly for autistic individuals who may not conform to neuronormative expectations. Therapy, when driven by the need to ‘fix’ or ‘normalise’ autistic behaviours, can feel more like ‘conversion therapy’ than a genuine attempt to help the individual thrive as their authentic self. Such approaches fail to support autistic clients in learning how to operate their systems as they are designed, instead pushing them to camouflage or mask their true selves in order to fit in with the neuro-majority. This masking not only fails to address the root causes of distress but can also exacerbate it, adding layers of trauma rather than alleviating it.
The PTMF offers a stark contrast to this one-size-fits-all mentality. PTMF prioritises the individual’s narrative and personal goals over societal norms, advocating for a more person-centered approach to therapy. Instead of focusing on symptom reduction, PTMF encourages therapists to understand the meanings behind the client’s experiences and to work with them to define what progress looks like on their own terms. This approach respects the diversity of human experience and recognises that what may be considered ‘functional’ or ‘normal’ in a neurotypical context may not be relevant or even desirable for an autistic individual.
For autistic clients, it is vital to discuss their own goals and definitions of progress in therapy. They should seek therapists who are open to understanding and respecting these goals, rather than imposing external standards of functionality. By doing so, therapy can become a supportive environment where clients are empowered to embrace their authentic selves and navigate the world in a way that aligns with their own values and needs, rather than being pressured to conform to an ill-fitting norm.
Coercive Use of Safety Contracts
Safety contracts are agreements that clients are often required to sign in therapy, stating that they will not harm themselves or others and will adhere to certain behavioural guidelines. Whilst intended to promote safety, these contracts can be deeply coercive, particularly for autistic individuals. The dynamic created by such contracts places the therapist in a position of control, demanding compliance from the client under the guise of care. For autistic individuals, this can be especially distressing, as it further undermines their autonomy and reinforces the feeling of being managed rather than understood.
Many autistic individuals find themselves subjected to safety contracts after being reported to the police for perceived ‘assaults’ on relatives or caregivers during moments of sensory overwhelm. In these situations, the ‘assault’ may be nothing more than a person scurrying about or flapping their hands in distress, inadvertently striking someone nearby. The underlying issue often stems from a lack of understanding on the part of caregivers or family members, who may be uneducated about autism and unable to create a sensory environment that accommodates the autistic person’s needs. In many cases, poverty exacerbates the situation, making it impossible to create a suitable sensory space that could prevent such incidents from occurring in the first place.
The PTMF offers a more compassionate and effective approach by focusing on understanding the meaning and threat behind behaviours rather than simply exerting control. PTMF encourages therapists to explore the underlying causes of distress, such as sensory overwhelm, and to work collaboratively with clients to address these issues in a way that respects their autonomy and lived experience. This approach recognises that true safety comes from addressing the root causes of distress, not from imposing external restrictions that only serve to alienate and control.
For autistic clients, it is crucial to approach discussions about safety in a way that preserves their autonomy. This might involve clearly communicating what safety means to them and advocating for a more collaborative approach that takes into account their unique sensory needs and experiences. By doing so, clients can work with their therapists to create a therapeutic environment that feels safe and supportive, rather than coercive and controlling. This collaborative approach can help prevent the escalation of misunderstandings that often lead to the imposition of safety contracts in the first place.
Final thoughts …
In today’s article, we’ve explored several ways in which therapy can inadvertently uphold policing tactics, particularly when working with autistic individuals. From pathologising normal responses to systemic oppression, to enforcing rigid treatment plans, labelling clients as non-compliant, exerting control through power imbalances, overemphasising symptom reduction, and using coercive safety contracts, these practices can create a therapeutic environment that feels more like a battleground than a place of healing. Such approaches often fail to recognise the unique experiences and needs of autistic individuals, leading to increased trauma rather than alleviation of distress.
The Power Threat Meaning Framework offers a powerful alternative to these harmful practices by prioritising understanding over control, context over compliance, and collaboration over coercion. PTMF encourages therapists to explore the meanings behind behaviours and the threats clients face, creating a more respectful and compassionate approach to therapy. This framework allows autistic individuals to be seen and understood within the context of their lived experiences, rather than being forced into a one-size-fits-all model that often exacerbates their challenges.
However, the approaches discussed in this article are not yet mainstream in psychiatry and therapy. The majority of therapists may still operate within traditional frameworks that do not fully account for the complexities of autistic experiences. As a result, it is crucial for autistic individuals and their caregivers to be proactive in seeking out therapists who align with the values of the PTMF. Finding the right therapist can make all the difference in ensuring that therapy is a place of empowerment and healing rather than further marginalisation.
To help in this process, here are ten questions that autistic individuals and caregivers can ask prospective therapists to ensure they are making the right match:
1. How do you approach understanding the context behind a client’s behaviours?
2. What is your stance on using safety contracts, and how do you ensure they respect client autonomy?
3. How do you incorporate flexibility into treatment plans to accommodate the unique needs of autistic clients?
4. Can you describe how you address power imbalances in the therapeutic relationship?
5. What is your understanding of the sensory needs of autistic individuals, and how do you accommodate them in therapy?
6. How do you handle situations where a client does not comply with traditional therapeutic methods?
7. How do you ensure that therapy goals are aligned with the client’s personal values rather than societal norms?
8. What training or experience do you have in working with autistic clients, particularly those who have experienced trauma?
9. How do you approach situations where a client’s behaviour is being pathologised by others, such as family members or the judicial system?
10. What frameworks or models do you use to guide your therapeutic practice, and how do they support a trauma-informed approach?
By asking these questions, autistic individuals and caregivers can better assess whether a therapist’s approach aligns with their needs and values. In doing so, they can take an active role in shaping their therapeutic journey, ensuring that it is one that honours their experiences, respects their autonomy, and truly supports their well-being. The road to finding the right therapist may be challenging, but it is an essential step in creating a therapeutic space that is not only safe but also empowering for autistic individuals.