While the criteria for a diagnosis of autism is individual, based on difficulties in social relationships, problems in communication, multimodal sensory hypo/hyperreactivity, and restricted/repetitive behaviours, those in the neurodiversity movement adopt a more interactional perspective which locate problems between the person and their family and broader society. They reference a poorness of fit between the inside neurobiology and outside, social relational world. Neurotypical family members and those with autism living in the same family can find life stressful due to dissimilar needs for sensory processing, routines and in communication styles. Relational difficulties are in the heartland of family therapy, and there is clear evidence that systemic approaches are valuable to these families, however many practitioners express uncertainty about their capacity to provide safe and effective services.
What Adaptations Should Be Made?
Authors Christiaens and Carrette note that the other modalities like cognitive behaviour therapy make adaptations when working with people with an autism diagnosis and suggest family therapy should do the same. Drawing on the literature they propose adaptations including ‘a sensitivity to managing uncertainties, difficulties in reciprocal communication and sensory hypo/hyperreactivity.’ Practitioners should avoid too many abstract ideas or idioms although it has been suggested that metaphors can be useful and to aim for shorter sentences and concise wording. Avoidance of eye contact should not be interpreted as a sign of disengagement. Slowing the pace of therapy to support processing of emotions and the meaning of exchanges can be helpful and so is the practitioner making explicit their thinking to model ‘complexities of inner and outer thought.’ Encouraging increased flexibility in both action and thought can be explored by directly addressing a person’s restricted interests and behaviour and the impact this has on others.
What Do ‘Expert’ Family Therapists Say?
While these suggestions seem valid, the authors were eager to address the gap between this anecdotal advice and more reliable research data, to increase understanding of practitioners’ behaviours and experience in working with families when autism is present. A constructivist grounded theory approach was adopted which involved semi structured interviews with 7 family therapists who had expertise working with people with autism from between 6 to 31 years.
What Did These Family Therapists Say?
Therapists expressed an overarching theme of prejudice in the field including the idea that work with families where autism was present, was not possible. They also spoke of the need to treat these families like any other by finding a unique and personalised fit and that adaptations made for families with autism were also helpful with others.
More specific adaptations included attention to sensory stimulation in waiting and therapy rooms and specific enquiry of the client about further changes that may make the process easier. Adapting questioning to locate them in a broader structure and make them explicit was also helpful, as was managing unequal talk time when an autistic person felt compelled to complete a train of thought and in doing so dominated the process.
In Conclusion
While practitioners agreed that adaptations were helpful this was true of work with all families. Processes and protocols, like those practiced at Bower Place, manage inequalities in families be they age, capacity, mental health, or neurodiversity. Allowing each person to fully participate using visual and verbal approaches maximises the possibility of participation and collaboration in the process of change.
Christiaens, J. and Sylvie Carette, S. (2026) What Do Specialised Family Therapists Do Differently When Suspecting the Presence of Autism? A Qualitative Study: Journal of Family Therapy 2026; 48: e70041 https://doi.org/10.1111/1467-6427.70041
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