Doc, You Got Us All Wrong, Pt 2: CBT...? Never Worked for Autistic Me

Cold Open

CBT…? Never worked for autistic me.

So, look, we KNOW masking doesn't work. Or FEAR. Or PAIN. We’re dying from them already.

That's all the words we need.

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Intro

You're listening to AutisticAF Out Loud. One voice. Raw. Real. Fiercely Neurodivergent. Since 1953.

Season 5, Episode 6. “Doc? You Got Us All Wrong, Pt 2: CBT…? Never Worked for Autistic Me.”

Abelist agendas. Bad research subjects. Bad data. Bad therapy.

There’s the whole story.

An experimental multi-part series… around 10 minutes each. Cuz some autistic listeners tell me they like to binge in small bites. Others say they listen in the car… so you can also download the complete series as one file.

Just one autistic elder's truth. I'm Johnny Profane.

Content Note: trauma discussion, medical system critique, institutional discrimination, psychiatric hospitalizations, systemic oppression + experiences & opinions of one autistic voice... in my 70s.

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I've been struggling with an article on CBT & Autism for years.

Sigh. Spoons. A lot of reading. A lot of thinking…

To come to my opinion… my thesis…that any therapy based on purely cognitive techniques… even if pros throw on some Behavioral rubber-band-snapping special sauce on the side…?

It’s inherently ableist… attacking the very way our autistic brains are wired. Demanding abilities many neurodivergents just weren’t born with.

Here’s a snapshot. A quick personal story from when autistic-as-fuck me turned for help…

“I’m sorry… What did you just say?”

“I said…” He looked nervous. “I said… I always recommend aversive therapy for my autistic kids. My clients.”

Me. In a dead-cold voice. “Snapping a rubber band.”

“Y-e-s-s.” He seemed torn. Was I gonna get positive reinforcement… Or that weird, hostile, defensiveness professionals get. When you ask questions.

Into that hesitant silence, I say, “Snap it hard. Hard as they can. Against their wrist.”

“Yes. The sting is important.” Now, he’s eager to share. “When they repeat the aversive stimulus, they…”

Again I interrupt with my ashen, Clint-Eastwood voice. “During a meltdown.”

“Well… actually… just before.” He’s beaming, proud. “They learn to snap the band at the earliest hint they’ll lose control. It’s operant conditioning.”

A kid having a meltdown on Aisle 3. Likely overwhelmed by sensory overload.

Let’s just add a little sharp pain… and see what happens…

As if by giving it some science-y name… it’s not self-inflicted torture.

Brief CBT Background

Cognitive Behavioral Therapy emerged in the 60s. A kind of forced marriage. Between Beck’s cognitive therapy… focused on internal thoughts. And Skinner’s behavioral therapy… focused on observable behavior. Both developed studying neurotypical minds.

Change your thoughts, change your feelings, change your behavior… change your life. Simple, right?

Unless your brain doesn't work that way…

Sometimes…? Research… Ain’t.

How could COGNITIVE Behavioral Therapy not be inappropriate for autistics?

Research Problem #1. It's based on studying neurotypical populations. But we autistics think differently by definition.

Problem #2? For the foundational studies, CBT researchers used white, university student subjects… for the most part. They're easy and cheap to find. But maybe 3% are autistic? Maybe? ALL with decent IQs and functioning student skills… even the few autistic subjects?

And Problem #3 is a doozy. Many autistics survive by people-pleasing. Kids and grownups. We're likely to mask our true experiences to appear "better"... or please therapists. Plus we may have trouble perceiving and communicating our own experience. Self-reported data might not reflect our reality.,

Then there's one that’s rarely discussed. Problem #4… the "waitlist relief effect." Most neurodivergent folks endure months or years waiting for therapy, suffering intensely. When we finally get accepted into therapy? There's overwhelming relief… elevating our mood and behavior. Which distorts everything a therapist will hear.

We may dial up our masking. Cuz we’re scared shitless we’ll lose this lifeline.

Meanwhile, researchers publish, buff their nails…. and attribute any self-reported improvement as proof their technique works.

The Cognitive Part…? A Stopper.

Substitute "executive functioning" for "cognitive." As in the thing they say is largely missing from my autistic forebrain.

The entire technique? One cognitive process after another.. First you must notice. Then you must reflect.Then decide.Then review.Then judge context.The