Autism, Neurodivergence and Psychoanalytic Psychotherapy: Understanding the Individual
Updated: Aug 27
Neurodivergence, including autism, is not a mental health problem. Being autistic is a way of being in the world, just as being neurotypical is. It is not an illness that needs to be cured. Autism forms part of the particular way in which a person experiences themselves, other people and the world around them. It is therefore important to distinguish neurodivergence from mental health difficulties. Neurotypical people can experience depression, anxiety, trauma, eating difficulties or other psychological problems, and neurodivergent people can experience them too. The presence of one does not imply the presence of the other.
An analogy can help to make this distinction. If a person with diabetes were given a treatment that removed their diabetes, we would not expect their personality, character, memories, relationships or sense of who they are to disappear with it. Diabetes is a condition that affects the body but does not constitute the person. Autism raises a different question because it is bound up with how a person thinks, experiences, communicates, relates and makes sense of the world. It forms part of their subjectivity, their particular experience of being themselves.
Autism is also a broad diagnostic category. People who receive an autism diagnosis can have very different ways of experiencing themselves and the world, with very different personalities, strengths, interests, capacities and support needs. For some people, autism may present few difficulties in their everyday lives, while for others it may be associated with significant challenges in particular areas of life and a need for substantial support. The diagnosis therefore cannot, by itself, tell us very much about the psychological life of the individual. It provides information that can be important in understanding someone, but it is not an account of who they are. The same diagnosis can have very different meanings in different people's lives.
At the same time, much of the world around us is organised according to neurotypical expectations. From school and work to shopping, travel and social life, there are assumptions about how people will communicate, relate to others, respond to change and manage their surroundings. These assumptions also shape ideas about friendship, romance and what a successful working or social life should look like. For a neurodivergent person, finding their way through a world organised in this way can require considerable effort.
The difficulties that can arise are therefore not simply a consequence of being autistic, but can emerge from the relationship between a particular person and the world they inhabit. A young person may find that ways of being which make perfect sense to them are repeatedly misunderstood by others, or that considerable effort is required to navigate situations that seem straightforward to those around them. Over time, this can affect how they see themselves and what they expect from other people. What began as a difficulty with the environment, such as struggling with school, can become entangled with anxiety, shame, isolation or a sense of not fitting in. Understanding this process requires more than identifying the behaviour that is causing concern. It requires an interest in what that behaviour means to this person and in the place it has come to occupy in their psychological life.
Psychoanalytic psychotherapy begins from the idea that no two people are the same. It does not start with a fixed idea of what an "autistic person" is supposed to be like, or with a standard psychological programme to be applied to everyone who shares a diagnosis. Autism can be an important part of understanding a person, but it does not tell us who that person is. Two people with the same diagnosis may have entirely different personalities, histories, relationships, anxieties, desires and ways of making sense of themselves. Autism will have a different meaning in each person's life.
From a psychoanalytic perspective, a diagnosis is a name that tells us something about a person, but it does not tell us everything about them. What matters clinically is how the young person themselves relates to that diagnosis and to the meanings attached to it. A diagnosis can bring relief, recognition and a sense of finally having an explanation for experiences that have been difficult to understand. However, it can also be something unwanted, imposed upon a child, shaping how other people see them and, in turn, how they come to see themselves. Psychoanalytic psychotherapy makes space for the young person's own relationship to their diagnosis rather than assuming that its meaning is already established.
The individual is therefore at the centre of the work. Rather than asking, "What do we do with an autistic young person who has this difficulty?", psychoanalytic psychotherapy asks what the particular difficulty means for this particular person. How do they experience it? What does it represent to them? What place does it occupy in their life? How has it developed within their relationships and history? What do they understand about themselves, and what remains difficult to put into words? These questions can help develop an understanding from which useful ways forward can be constructed.
Psychoanalytic listening does not assume behaviour has one fixed meaning waiting to be discovered by the therapist. Meaning develops through the person's own words, associations and relationship with the therapist. This is important when working with autistic young people, whose ways of communicating may not always conform to conventional expectations. The task is not to translate everything into a predetermined psychological language, but to remain curious about how this particular person communicates and what becomes possible when their way of expressing themselves is taken seriously.
Psychoanalytic psychotherapy is also interested in what the young person wants for themselves. The aim is not simply to make someone better able to conform to expectations or to remove behaviours that other people find difficult. It is to create a space in which their own wishes, interests and ways of relating can become clearer. For one person, greater independence may be important; for another, a particular relationship, activity or form of communication may matter much more. The question is not what an autistic person should want, but what this person wants, and what might help them pursue it.
This does not mean ignoring autism or treating it as though it were irrelevant. On the contrary, understanding autism and neurodivergence is an important part of understanding the individual. Psychoanalytic psychotherapy has a substantial body of theory, clinical experience and research relating to autism, and this knowledge forms part of the therapist's understanding. At the same time, theories and generalisations can never fully describe an individual person. The task is to bring this knowledge into the room without allowing a diagnosis or a theory to become a substitute for getting to know the person.
For a child or young person, their experience cannot be separated from the relationships in which they are growing up. Parents are also trying to make sense of what they see, and uncertainty about how best to respond can become part of family life. The question is rarely whether a particular behaviour should be encouraged, discouraged or accommodated. What matters is coming to understand what is happening between this child and the people around them, how each person has come to understand the situation, and what possibilities may have become difficult to see. Psychotherapy offers a space in which these meanings can be explored without assuming in advance what the answer should be, allowing the young person and their family to develop an understanding that belongs to them rather than applying a predetermined model.
My approach to working with autistic and other neurodivergent young people is grounded in the same principle that informs my work more broadly: there is no substitute for getting to know the individual. A diagnosis can provide valuable information, but it is not an explanation of a person's inner life. The work is to understand the particular person, their relationships, their history and the meanings they give to their experiences, and then to work together towards ways of living that feel more manageable and more genuinely their own.
As a child, young person and family psychotherapist, I have many years of experience working with neurodivergent children, young people and their families, including through my previous work in CAMHS and specialist services. My current private practice, Eastbourne Child Therapy, provides psychoanalytic psychotherapy for children, adolescents and young adults, including those who are autistic or otherwise neurodivergent. The aim is not to change who someone is. It is to create a space in which they can be understood, including the things that may currently feel confusing, painful or difficult, and from that understanding find their own way forward.
Written by Ben French BSc, C-Psych, C-Obs, MA Psych.Ben French is a Child and Adolescent Psychotherapist and Psychoanalyst working with children, teenagers and young adults aged 2 to 25. He has over 15 years’ experience supporting young people’s mental health, including senior roles in CAMHS and education.
