Navigating autism and mental health: A qualitative study of therapists' experiences of psychotherapy for comorbidities in autistic adults.

In this study, we explored the psychotherapeutic process for autistic adult clients without intellectual impairment with comorbid psychological disorders, drawing on the perspectives of highly specialized psychotherapists with extensive clinical experience in autism-focused practice. Within the context of the ongoing shift from deficit-based interventions toward neurodiversity-affirming approaches, we investigated how therapists conceptualize comorbidities in autism and how this conceptualization informs their therapeutic work. We employed a qualitative research design and collected data through semistructured interviews with 10 psychotherapists specialized in autism. We analyzed the data using a sequential combination of deductive and inductive thematic analysis. We identified five main themes (comprising a total of 22 subthemes): (a) development of comorbidity as an interactional vulnerability process; (b) change as a reorganization of self-understanding, regulation, and relational engagement; (c) helpful aspects of psychotherapy as needs-adapted, autism-informed relational practice; (d) therapeutic misfit as misattunement, overload, and contextual constraint; and (e) managing therapeutic misfit through adaptation, reattunement, and containment. Therapists viewed comorbid symptoms as arising from an interaction between autistic traits and environmental mismatches, rather than autism itself. Psychotherapy was conceived as prioritizing reducing comorbid symptoms, fostering self-acceptance, and mitigating social camouflaging. Therapists emphasized a flexible, integrative approach tailored to individual needs, supported by a strong therapeutic alliance. The accounts of specialized psychotherapists suggest a shift away from interventions targeting core autistic traits, with greater emphasis on promoting well-being and psychological health. The therapists aligned with neurodiversity principles, advocating for autism-specific expertise, individualized strategies, and systemic efforts to enhance social acceptance. (PsycInfo Database Record (c) 2026 APA, all rights reserved).