Helping Your Client in Autistic Burnout

By Jennifer Kemp, MPsych, author of The Neurodivergence Skills Workbook for Autism and ADHD and The ACT Workbook for Perfectionism

When autistic clients first present for therapy, it’s because their life has become so unbearable that they desperately need help. Having exhausted all their usual strategies, they are unable to cope, and, despite many feeling some hesitation about meeting a new therapist, they have reached out for your help. These clients are typically in autistic burnout, an experience that can last for years that emerges from the pressures of living in a world that is not designed to meet their needs. Working with a different set of social and communication principles, autistic people experience ongoing stigma, conflict, discrimination and marginalization whether they are formally diagnosed or as yet unidentified (Mantzalas, Richdale, & Dissanayake, 2022).

Autistic burnout is now well-defined in the research (Arnold et al., 2023; Higgins et al., 2021; Mantzalas, Richdale, Adikari, et al., 2022; Raymaker et al., 2020). Being in burnout means feeling chronically overwhelmed and exhausted, finding things difficult that used to be straightforward, having greater difficulty managing emotions, and greater difficulty getting things done. Your client may notice increased sensory sensitivities, a sense of overwhelm in social situations, and notice an increase in unhelpful habits such as skin-picking, nail-biting, and hair-pulling. As a systemic problem, many autistic people also experience worsened mental health and physical health problems, including exacerbation of autoimmune disorders, migraines, gastrointestinal symptoms, and chronic pain. Burnout may look like depression and anxiety, but these systemic problems are a clue that something bigger is also going on.

Working to alleviate anxiety is unlikely to be successful if the person’s sensory stressors remain, or if your client is masking their autistic differences in social situations. A traditional approach to depression is behavioral activation, however, encouraging your client to do more risks worsening their burnout by exposing them to sensory stressors and increasing social pressures. If they can’t follow through on the activation tasks you’ve agreed to, they may feel like they are failing therapy.

The key is to help your client take a step back from demands and expectations for as long as it takes them to recover and make broader changes to the way they have structured their life to relieve these pressures more permanently. This process can take many months or even years to achieve; however, short-term gains are possible by helping your client make self-compassionate choices to look after themselves. These can include any activity that helps your client prioritize their needs, self-soothe and self-regulate after stressful situations, and remove themselves from situations that worsen their burnout. Two particularly helpful strategies are ‘stimming’ and spending time absorbed in their interests. 

Stimming describes activities that are repetitive, soothing, and regulating (Charlton et al., 2021). Encourage your client to explore different stimming options across all their senses, including taste, smell, touch, hearing, vision, proprioception (body awareness), vestibular (balance), and interoception (internal sensations). Stimming might include behaviors they enjoyed when they were younger but were told (or decided) to stop, such as bouncing on their toes, spinning around, or fidgeting with stim toys. It could also include listening to their favorite music on repeat, eating their favorite foods, or gaming with their friends.

Normalize and encourage your client spending time exploring their interests. Whether this involves a deep dive into research, playing games with others, or quiet moments organizing their collections, autistic people find being engaging in their long-term interests and passions particularly soothing and regulating. This simple, self-compassionate choice has the potential to add enormous meaning and pleasure to your client’s life.

Help your client identify the triggers for burnout, such as staying late at work, going to after-work social events, buying groceries at a busy market, or staying up late to support a friend who is constantly in crisis. To identify the early warning signs of burnout and choose to take steps to prevent this, your client will need to tune in to their inner (interoceptive) experiences and take bold steps to look after themselves. After spending many years prioritizing others, this may be difficult at first. Your client may feel like they should do these things, even when they take a toll on their well-being. Work together to evaluate whether these choices are fair, reflect unrealistic neuro-normative expectations, or are people-pleasing habits that undermine their well-being. Identify any deeply held yet unhelpful patterns such as the need to keep everyone happy all the time. They’ll need new skills to set boundaries, advocate for their needs, and give themselves permission to prioritize caring for themselves.

In the long term, your client will greatly benefit from your openness, encouragement, and practical strategies to recognize their needs and unwind unhelpful habits. With support, they can create a more predictable, comfortable, and supportive environment for themselves; build safe, supportive relationships where they are free to be themselves; and finally let go of performing a version of themselves that feels inauthentic and hollow. Feeling a deep sense of belonging and pride in their autistic identity will also form a powerful foundation for improved mental health (Milton & Sims, 2016). Alleviating and preventing burnout may take some time, but it is the only pathway to better mental and physical health, and a more satisfying and enjoyable life.

Jennifer Kemp, MPsych, is a privately practicing clinical psychologist based in Adelaide, South Australia; who works with neurodivergent adults experiencing perfectionism, eating disorders, obsessive-compulsive disorder (OCD), and chronic illness. Using a neurodiversity-affirming approach, Jennifer weaves together acceptance and commitment therapy (ACT), and behavioral and compassion-focused approaches with her own lived experience as a late-diagnosed autistic ADHDer, to help her clients improve their mental health and develop greater self-compassion, self-acceptance, and pride in their neurodivergent identity. Jennifer juggles clinical practice with writing, presenting, and clinical supervision. She is author of The ACT Workbook for Perfectionism.