Date of Conferral

6-10-2025

Degree

Doctor of Psychology (Psy.D.)

School

Psychology

Advisor

Benita Stiles-Smith

Abstract

Autistic adults face a high risk of co-occurring mental health challenges, yet standard psychotherapy often fails to meet their unique needs, raising concerns about treatment effectiveness. This qualitative study aimed to understand how clinical psychologists decide on therapeutic approaches and adaptations for their autistic adult clients through three research questions: RQ1: How do clinical psychologists decide on the appropriate therapeutic approach they use with their autistic adult clients? RQ2: How do clinical psychologists decide which adaptations are appropriate to implement in psychotherapy with their autistic adult clients? RQ3: Does the therapeutic approach affect how a clinical psychologist chooses appropriate adaptations for their autistic adult clients? Guided by the theory of mind framework, the study utilized a semistructured questionnaire administered to 19 clinical psychologists experienced in working with this population, with thematic analysis of the responses. Findings revealed five themes influencing therapeutic approach selection: cognitive rigidity challenges, social skills deficits, cognitive-behavioral interventions for depression/anxiety, dialectical behavior therapy for emotion dysregulation, and trauma-related symptoms. Six adaptation strategies emerged: using direct language, providing alternative perspectives, incorporating visual aids, checking comprehension, creating sensory-friendly environments, and integrating clients' special interests. Therapeutic approach was not seen to affect adaptations by 63% of the participants. Results of this study may be used to inform and enhance best practice guidelines and potentially improve mental health outcomes, ultimately fostering social change for this population.

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