Autism and social justice in therapy: Power, Threat and Meaning

You might have heard something about Autistic people having a “strong sense of justice” – you might even have one yourself. I often wonder about why so many Autistic people feel attached to this phrase, and why autism and social justice are so linked. Sure, it’s not true for everyone, and justice means different things to different people. But it makes sense to me that if we often have a strong sense of the unfair, the inequitable, and the inefficient in smaller systems (why can’t I just let my partner load the dishwasher ‘their way’ without it feeling like my skin is going to crawl off??) no wonder we are often so in tune to noticing it in bigger systems too (class injustice, politics, gender etc.)

The Power Threat Meaning Framework (PTMF) is a project started in 2018 that proposes an alternative to diagnoses by providing alternative explanations to the expression and persistence of mental distress.[1] It’s a way of looking at mental health that acknowledges how social, cultural, political, and environmental powers threaten individual power – causing mental distress (anxiety, depression symptoms). Autism isn’t a mental health diagnosis – it’s a way of being, a neurological difference – but it does often coincide with and cause mental distress, and this is what many of my neurodivergent clients come to therapy with.[2]

In my research as part of my psychotherapy training, I became interested in the potential use of the Power Threat Meaning framework with neurodivergent clients and found it promising. It felt sort of contradictory at first, based on what my clients were telling me and what research backed up – that the medical model of diagnosis is affirming and desired by people who suspect neurodivergence.[3] So what’s the problem? The problem was that while this is true, some found that it can also bring up feelings of loss, confusion and anger. The label, subsequent stigma and misunderstanding or even denial of Autistic difference can often be a source of intense distress, lowering self-esteem, and contributing to depression and anxiety.[4] Even if diagnosis can make accommodations more likely, there are limited resources for Autistic adults, which leads many of my clients to access therapy with me in the first place.

So - was it possible to see the diagnosis as necessary for some Autistic people, and apply the framework in some way to help acknowledge the difficulty and challenges that threaten Autistic people’s sense of wellbeing? This is what I tried to find out. The PTMF isn’t a form of therapy, but it does offer a guideline of questions to challenge the pathologisation of mental distress.

Didn't have a relatable picture so here is one of two terrapins that I saw whilst on a walk in the park the other day. Enjoy!

Here is what the power threat meaning framework looks like in action:

It replaces the idea of what is wrong with you? the framework begins instead with what happened to you? 

This is then followed up by the following questions:

·      How did it affect you, or what kind of threats does this pose to you?

·      What sense did you make of it, or what is the meaning of these situations to you?

·      What did you have to do to survive? What kind of threat responses are you using/did you use?

·      What are your strengths, or what access to power resources do you have?

·      What is your story? How does this all fit together?[5]

Of course, Autism doesn’t “happen” to people; it is part of us, how our brains are wired and how we see the world. In this context, the threat is often the stigma, exclusion, and disabling aspects of being Autistic in a neurotypical world. The PMTF acknowledges power dynamics and injustice outside of the therapy room, which to me is a big part of how I work with clients. It isn’t about blaming external influences and not taking responsibility for change, it’s about separating out the narrative of deficit, of sensitivity and lack of resilience (being told ‘that’s just how it is, you need to get used to it’) that we internalise and making sure that clients are empowered to make their own meaning from them. The more I work with Autistic clients the more it seems to me that the PTMF does have the potential to bridge the gap between diagnosis and mental health provision for Autistic people. For me as an Autistic therapist, it also taps into that strong “sense of justice” that so many of us resonate with.

I’ve got more on how to further adapt the Power Threat Meaning framework in therapy for neurodivergent people, so watch this space!

[1]Johnstone, L., & Boyle, M. (2018). The Power Threat Meaning Framework: An alternative nondiagnostic conceptual system. Journal of Humanistic Psychology.

[2]Gillott, A., & Standen, P. J. (2007). Levels of anxiety and sources of stress in adults with autism. Journal of Intellectual Disabilities, 11(4), 359-370.

[3] Burstow, B. (2019). The Revolt Against Psychiatry: A Counterhegemonic Dialogue (1st ed.). Springer International Publishing.

[4]Ghanouni, P., & Seaker, L. (2023). What does receiving autism diagnosis in adulthood look like? Stakeholders’ experiences and inputs. International Journal of Mental Health Systems, 17(1).

[5]Cromby, J. (2020). Meaning in the Power Threat Meaning Framework. Journal of Constructivist Psychology, 35(1), 41–53.