What Psychoanalysis Gets Right—and Still Misses—About Autism: A Plain-Language Reflection from the Margins
A reflection and translation of the academic paper, “Sitting with Invisible Difference,” this piece explores why traditional therapy fails many autistic people—and what affirming, neurodivergent-led care could look like instead.
Introduction
I’ve spent much of my life being told that therapy was the key to healing, to self-understanding, to becoming whole. Yet traditional talk therapy never worked for me. Not because I didn’t try, or because I resisted help, but because it was never designed for someone like me. As an autistic gestalt language processor (aka, ‘non-verbal autistic’), I don’t communicate in neat, linear sentences. I speak in echoes, scripts, and fragments—whole constellations of meaning that don’t always translate into the tidy dialogues therapists expect. The kind of therapy I was offered always seemed to presume that if I could just name my feelings in real time, I could learn to manage them. But I didn’t have the words. Often I still don’t—not in the way they want them.
So when I came across the article Sitting with Invisible Difference: Psychoanalytics and Autism, I felt a flicker of recognition. Here, finally, were psychoanalytic clinicians acknowledging that the field has historically failed us—not because we are unknowable, but because the frameworks used to understand us have been too narrow. The article explores what might change if psychoanalysis truly took autistic experience seriously. It’s a welcome effort, and in some places, a deeply thoughtful one. But the language is dense, wrapped in academic phrasing and technical terminology, as if it was written for a room full of psychoanalysts rather than the people most affected by its insights.
This reflection, then, is my attempt to translate and respond—not just to make the article more accessible, but to push it further. Because for those of us on the far edges of communication norms, whose ways of processing language, identity, and experience sit well outside the neurotypical frame, it still doesn’t quite reach. And it’s time we were not just spoken about, but heard.
Talking Without Scripts: Why Talk Therapy Often Fails Gestalt Language Processors
For those of us who are gestalt language processors, the entire premise of talk therapy is already skewed against us. We don’t process language analytically, bit by bit, building from single words into neat sentences. Our language comes in chunks—scripts, echoes, remembered phrases that hold emotion and meaning, even if they don’t always line up with what’s being asked in the room. These fragments often carry more truth than our attempts to explain things directly. But in a traditional therapeutic setting, this way of speaking is frequently misunderstood. Our scripting is seen as avoidance. Our silence is interpreted as resistance. Our metaphor, when we do manage it, is mistaken for confusion.
Therapy sessions tend to hinge on the ability to reflect aloud in the moment—to articulate feelings, trace patterns, narrate one’s life with clarity and insight. But for those of us who can’t access our inner world in that linear, verbal way—at least not on command—it’s like being expected to write poetry in a language we don’t speak fluently. What emerges instead is delay. We might walk away from a session and only hours or days later realise what we meant, or what we felt, or what we wish we’d said. Sometimes the words don’t come at all. Not because the feelings aren’t there—but because the route to them doesn’t travel through the usual linguistic pathways.
If therapy is meant to help us understand ourselves, what happens when the very format of it assumes a kind of knowing we don’t possess—or possess only differently? What happens when the doorway in is barred by the therapist’s own expectations of how insight should sound? It isn’t that we can’t benefit from therapy. It’s that therapy, as it is usually practiced, was never built with us in mind.
What the Article Tries to Do: a Plain Language Summary
The article itself begins with a clear and necessary admission: psychoanalysis has long failed autistic people. Not through lack of interest, but through a refusal to see how neurological difference fundamentally shapes what it means to be a person—and how that difference affects what support we need. For decades, psychoanalysts have tried to understand autism using theories built around neurotypical development, often interpreting our differences as deficits, or worse, as signs of psychological damage. This paper pushes back against that tradition, calling for a rethinking of what psychoanalytic ideas look like when applied to autistic experience.
What the authors attempt is both ambitious and overdue. They take familiar concepts from psychoanalytic practice—things like transference (how we relate to others based on past experiences), the therapeutic frame (the structure and ritual of therapy sessions), narcissism, intellectualisation, and obsession—and ask what happens when these are filtered through the lens of neurodivergence. Can a behaviour that once looked pathological be re-understood as adaptive? Can the therapist's own confusion or discomfort be a clue, rather than a judgement?
Throughout, the paper encourages therapists to slow down and reconsider their expectations—especially those rooted in assumptions about how communication, emotion, or connection should look. It’s a call to meet autistic clients not as puzzles to be solved or problems to be fixed, but as people whose subjectivity may be shaped by difference, yet is no less worthy of respect and understanding.
Breaking Down the Big Concepts: Translations and Reframings
To make sense of the article’s core arguments, it helps to translate some of the psychoanalytic concepts it engages with into language and ideas that actually feel usable. These are terms that carry specific technical meaning in psychoanalysis, but also risk being misunderstood—or misapplied—when working with autistic people. Here’s how we might reframe them, with a focus on how they show up in practice.
Countertransference
In therapy, countertransference refers to the therapist’s own emotional responses to the client—feelings that can arise consciously or unconsciously during sessions. Traditionally, these reactions are seen as valuable tools: if a therapist suddenly feels frustrated, lost, or unusually protective, those feelings may reflect something the client is expressing emotionally, even if not in words. In theory, this can deepen understanding.
But when the client is autistic, those feelings are often misread. A therapist might experience a sense of confusion, or even emptiness, in the room—and assume it means the autistic person is shut down or emotionally unavailable. In reality, it may be that we’re communicating in ways they don’t recognise. Or worse, they may be experiencing a kind of projected discomfort: feelings of inadequacy or uncertainty that they’re unconsciously placing back onto us, because our way of being triggers something unresolved in them. The article wisely reminds therapists to be cautious with these reactions—to sit with their own discomfort before assuming it belongs to the client.
I’ve experienced this directly, though I didn’t understand what was happening at the time. I was hospitalised after my first autistic shutdown—before I knew I was autistic, before I had any language for gestalt processing, before I understood that I had alexithymia. I was in panic, not because I was a danger to anyone, but because I couldn’t function in the world as it was and no one around me could explain why. The hospital felt like a kind of essential imprisonment, and I quickly realised I didn’t have the scripts—the right scripts—that would unlock the door so I could go home. I knew I wasn’t saying the things they needed to hear, but I didn’t know what those things were. I wasn’t resisting help; I was trapped in a system that demanded verbal clarity from someone who couldn't access it on command.
The therapist assigned to me—psychoanalytically trained—grew more and more frustrated. I could sense it, even if I couldn’t name it. Her anger vibrated in the air between us, and it compounded my panic. But because I couldn’t explain that panic in the ways she expected, it only escalated things further. I didn’t have the words, and I didn’t know I was supposed to have them. I was expected to reflect on my feelings, to speak insightfully about my inner world. But all I had were fragments, and a growing sense that I was failing some test I didn’t even know I was taking.
Looking back, I wonder what she saw when she looked at me. I suspect she thought I was “hard to reach.” But what if it wasn’t me who was unreachable? What if her frustration said more about her training than about my capacity? Psychoanalysis doesn’t quite know what to do with alexithymia—even now, I think that’s still true. The absence of easily expressed emotion is treated as a defence, a refusal. But for me, it wasn’t that I wouldn’t talk. It’s that I couldn’t—not like that, not in that moment, not in that place. And no one could hear that silence for what it really was: a cry.
The Frame
The therapeutic frame refers to the set structure and expectations of therapy: sessions begin and end at the same time, in the same space, with consistent boundaries. This predictability is meant to create a sense of safety and containment.
For many autistic people, structure and ritual are also deeply important—but we may not participate in these rituals in the expected ways. For example, some therapists expect that over time, the beginning and end of sessions will become more fluid—that greetings will be warmer, partings more casual. But for an autistic person, those transitions might always feel abrupt or difficult. We might always need to say goodbye in a particular way. We might need to ask about the same object in the room each week as a kind of grounding. That’s not resistance or lack of progress—it’s just rhythm. Our rhythm.
One therapist grew increasingly frustrated with me for not “settling into the work” quickly enough at the start of sessions. Time is money. But what they didn’t understand was that my difficulty settling in wasn’t avoidance—it was overwhelm. The space they’d carefully curated—with its gentle waterfall sounds, ambient music, oil diffuser, and soft lighting—was meant to be soothing. And perhaps for the neuro-majority, it was. But for me, it was a sensory onslaught. The layered stimuli didn’t calm my system; they disoriented it. My autistic perception is different, and I needed time just to adapt to being in that space before I could even begin to engage. I didn’t have the words to say, “I’m not comfortable here,” or “this isn’t working for me.” So eventually, I changed therapists. I think a lot of us do this—not because we’re resistant to therapy, but because we can’t name what’s wrong in the moment, and no one’s taught us that the space itself might be the problem.
Narcissism vs. Cognitive Style
Autistic people are often misread as narcissistic because of how we communicate—especially when we’re focused on being precise or when we insist on correctness. But this insistence isn’t about thinking we’re better than others. It’s about survival.
For many of us, clarity is safety. The world is full of ambiguity, and when language gets fuzzy or symbolic, we can lose our footing entirely. So we hold on tightly to precision—not to dominate a conversation, but to stay afloat in it. What might look like a narcissistic defence is often a deeply practical strategy for navigating a world that constantly misinterprets us.
And for those of us who are GLPs, the situation is even more delicate. We don’t build language one word at a time—we find and reuse whole scripts, lines, phrases, and verbal patterns that have worked before. We test them out in different contexts, hoping they’ll land. Sometimes they do. But sometimes we get it wrong. I know I have. I’ve used a script I thought was safe, only to watch someone’s face change, suddenly seeing me as rigid or pedantic, or worse, condescending. But I wasn’t trying to correct them—I was trying to connect. I’d pulled the best-fit words from my internal shelf, and they just didn’t fit the way I’d hoped.
There’s a real difference between insisting on your version of reality to elevate yourself, and insisting on it to stay oriented. I once spent ten minutes trying to explain to a therapist why their use of a metaphor was misleading—not because I wanted to win an argument, but because it unmoored me. It left me grasping for footing in a conversation that had suddenly stopped making sense. That wasn’t narcissism. That was me trying to find the floor.
Intellectualisation
In psychoanalysis, intellectualisation is often viewed as a defence mechanism—a way of overthinking to avoid feeling. And it’s true that many people, autistic or not, retreat into their heads when emotions feel overwhelming. But for autistic people, especially those of us who are GLPs with alexithymia, deep thinking isn’t always a way of avoiding emotion. More often, it’s the only way we can get near it.
Emotions, for me, don’t arrive with neat labels. I can feel flooded by something and have no idea what it’s called, where it came from, or what it wants from me. There’s no tidy, accessible internal map. Instead, I build the map as I go—through metaphors, mental models, scripts, and systems of meaning - and more recently, poetry. For GLPs like me, the pathway to understanding is rarely direct. We reach feelings sideways—through imagery, pattern, story, and repetition. We echo ourselves into clarity. We process backwards sometimes, starting with the words that feel close and hoping they’ll unlock something true.
I’ve had therapists ask me to “just sit with the feeling” instead of analysing it. But that’s like asking me to swim in open water without letting me build a raft first. My analysis isn’t a defence—it’s flotation. Without it, I don’t access feelings more fully; I lose them entirely. The scaffolding of thought is what lets me even approach emotion in the first place. Without that structure, I’m left with chaos—not clarity.
This isn’t avoidance. It’s process. And if a therapist isn’t prepared to honour the shape of that process, they’ll miss the very thing they’re trying to reach.
Obsessions
In classical psychoanalysis, obsessions are often seen as symbolic stand-ins for repressed material—repetitive thoughts or behaviours that point toward something buried in the unconscious. But in the context of autism, that framing doesn’t always hold. What looks like obsession from the outside may, in fact, be something else entirely: anchoring, embodiment, familiarity, care.
I’m not obsessed with my spoon. Like many autistic people, I simply have a favourite one. I’ve had it for as long as I can remember. It’s travelled the world with me. It’s been with me through upheaval, grief, change, joy, panic, and stillness. It’s not about control or compulsion—it’s about continuity. That spoon lives in what William Glasser would call my Quality World Picture: it meets my need for comfort, belonging, and self-regulation. It’s not a symptom. It’s a companion.
The same goes for my plushies, or my absolute need for a specific fabric on bedding and pillows. It’s not about preference in the neurotypical sense—it’s about safety. It’s about knowing that my body won’t be assaulted by scratchiness or unexpected texture when I’m trying to rest. These aren’t quirks to be trained away, or distractions from the “real work” of therapy. They are the work. They are the threads that hold together the fabric of my world.
And these so-called “obsessions” are relational, too. They help me connect. A soft toy held in a meeting might be a bridge, not a barrier. My spoon might be part of how I’m present. These things signal who I am, not because I perform them for others, but because they structure my sense of self.
To pathologise that is to miss the point entirely. The object isn’t in the way—it is the way.
Each of these concepts—when reframed thoughtfully—offers a way into deeper therapeutic work with autistic clients. But only if the therapist is willing to let go of assumptions, slow down, and let us show them how we make meaning. The article makes a strong case for doing exactly that. It’s not about discarding psychoanalysis—it’s about stretching it until it can hold us, too.
What the Article Gets Right
What the article gets right, and it’s no small thing, is the recognition that autism isn’t a collection of deficits to be corrected, but a fundamentally different structure of selfhood. It’s not that we are missing parts—it’s that we are built differently. The authors don’t try to collapse autism into pathology or frame it purely in terms of brokenness. Instead, they start to shift the frame toward understanding and supporting autistic ways of being, rather than treating us as problems to be solved. That move—from intervention to interpretation, from normalisation to curiosity—is essential.
There’s also a clear call to revise old theories rather than retrofitting autistic people into frameworks never designed with us in mind. That, too, feels like progress. Psychoanalysis has spent too long asking how autism develops, and not enough time asking what it is like. This paper begins, at least, to sit with that question—to listen. It doesn’t always land, but it gestures in the right direction: toward a therapy that adapts to the client, not one that demands the client adapt to the therapy.
What the Article Still Misses
For all that the article does well, there are still notable gaps—places where it doesn’t quite reach the people it most needs to. The language, for one, is dense and deeply academic. It assumes not just fluency in psychoanalytic concepts, but a kind of educational privilege that many autistic people don’t have access to, especially those who’ve been failed by school systems or traumatised by therapeutic institutions. Most of the autistic people I know—myself included—would find it a difficult read, not because we lack intellect, but because the language creates unnecessary barriers.
It also centres professional voices. Autistic subjectivity is analysed, discussed, theorised—but not spoken from. We appear in the text as objects of interpretation, not as co-creators of meaning. That may be slowly changing in therapeutic spaces more broadly, but the article still leans heavily on clinical authority, even as it tries to question some of its assumptions.
Most glaringly, it doesn’t fully grasp the communicative realities of those of us who are GLPs, non-speakers, or who live with alexithymia. The authors begin to touch the edges of those experiences, but they don’t quite enter them. There’s still an underlying assumption that language—verbal, linear, insight-driven language—is the ideal vehicle for therapeutic connection. But for many of us, language works differently. Our truths arrive in scripts, metaphors, images, sensations. If therapy can’t hold space for those forms of communication, it will keep misreading us.
And whilst I do understand that psychoanalysis operates with different aims and tools than something like the Power Threat Meaning Framework, I still find myself wishing that more of the PTMF’s spirit had found its way into this piece. That framework starts not with pathology, but with the question: What’s happened to you? Not what’s wrong with you. It centres the meaning we make of our experience, including how power and oppression shape our inner lives. That kind of perspective could enrich psychoanalytic work immensely—bringing it closer to liberation, and further from correction.
Toward Something Better: What Neurodivergent-Affirming Therapy Could Look Like
So what could therapy look like if it were truly neurodivergent-affirming—not just in name, but in practice, structure, and intent? For starters, it would meet us where we are. It would honour our metaphors, our silences, our rhythms. It would understand that scripting isn’t avoidance—it’s survival. That repetition isn’t disorder—it’s orientation. That our language, our ways of knowing, are patterned, embodied, and sometimes nonlinear. It would listen not just for insight, but for presence.
An affirming therapist would not be obsessed with our ‘progress’ or our ability to articulate feelings in real time. They’d be attuned to the way we show up—the way our bodies brace, the scripts we pull for safety, the sensory environment we’re navigating. They would care less about whether we’ve reached an insight and more about whether we feel less alone in the room. Healing would not be a return to functionality—it would be a restoration of dignity, agency, and mutual understanding.
But this can’t happen within systems built on compliance. The current model of mental health care—standardised, medicalised, productivity-driven—was never designed to support neurodivergent flourishing. It was designed to manage us. It rewards those who mask well, who reflect back familiar patterns, who agree to be made more palatable. It punishes refusal, or even slowness. It pathologises difference, commodifies distress, and turns our pain into profit.
So we need more than just a new kind of therapy—we need a new purpose for therapy. One rooted not in regulation, but in relational care. One informed by the PTMF, which starts by asking not what’s wrong with you, but what happened to you? What does it mean? How are you responding? These are questions that honour our histories, our ways of coping, our rightful rage. They make space for structural violence to be named, and for our responses to be recognised not as dysfunctions, but as resistance.
This vision also requires neurodivergent therapists—not as tokens, but as revolutionaries within a field that has historically excluded them. Therapists who do not just know our experience, but share it. Therapists who refuse to replicate systems of power, who create spaces not of surveillance but of solidarity. But even that vision risks co-optation if we try to force it into the frameworks of capitalism. The kind of care we’re talking about—slow, relational, collective—cannot be scaled or monetised. It cannot be standardised or turned into a billing code. It is incompatible with a system that values people only when they produce.
So perhaps what we’re really dreaming of isn’t reform at all. It’s a different world. One where care is not conditional on compliance. One where our ways of being aren’t just tolerated, but treasured. Where therapy is no longer about fixing us, but about witnessing us—truthfully, tenderly, and without trying to make us someone else.
That’s not just therapeutic. That’s liberation.
Final thoughts …
Psychoanalysis isn’t dead—but it does need to change. It needs to unlearn the urge to make everyone legible through the same lens. It needs to stop mistaking difference for dysfunction. And most of all, it needs to learn to listen in new ways—to pattern, to rhythm, to silence, to metaphor. None of that means abandoning theory. It means making theory spacious enough to hold those of us who were never its intended subjects.
That’s part of why I write pieces like this. Because translation is care. Making complex ideas accessible, especially for those of us whose processing styles are so often overlooked, is a kind of liberation. Theory should not be a locked room; it should be a language of shared meaning, a way to say, “You’re not alone.”
I’ll admit, I sometimes think I could never be a therapist. Not with the way my GLP system works. Not with my alexithymia, or my slow emotional latency, or the way it sometimes takes me days to know what I feel. I read these papers and I can critique them, deconstruct them, translate them—but the idea of being the one in the chair across from someone else? That still feels impossible.
But then again—eighteen-year-old me never imagined I’d be a poet. Never thought I’d write books. Never thought anyone would want to read my words, let alone be moved by them. And yet, here I am. So maybe this is just another unfolding. Another possibility I can’t see clearly yet, but that’s already quietly taking shape. Maybe there’s a future where therapy does work—for us too—not because we learned to fit the model, but because someone finally built a model with us in mind.
That future starts with respect. With listening. With honouring how we are built. And maybe, just maybe, it starts with words like these.