Thinking systemically – feeling autistic: Why individual psychotherapy is essential for autism and why group therapy is a valuable complement!

Introduction -Thinking systemically – feeling autisticAutism spectrum disorders (ASD) are among the most misunderstood neurobiological developmental disorders. Whether a child is highly intelligent (so-called high-functioning autism) or lives with additional cognitive impairment, the underlying challenges are similar: sensory overload, lack of social understanding, emotional dysregulation, a lack of everyday transfer, and the experience of constant overwhelm.

In recent decades, the view of autism has shifted from "deficits" to neurodiverse competence. However, the care situation remains problematic: there is a lack of specialized services, multi-professional collaboration, and therapeutic formats that work individually AND in a networked manner .

Individual settings – systemically founded – can provide decisive impulses here.

Autism today: Between overwhelm and isolation

Numerous studies point to alarming trends:

• Autistic people – regardless of IQ – have an increased risk of comorbid disorders such as depression, anxiety, eating disorders or obsessive-compulsive disorders (Lai et al., 2019; Simonoff et al., 2008).

• High-functioning autistic people in particular are often diagnosed late – often only after burnout, dropping out of school or isolation (Happé et al., 2006).

• People with additional intellectual disabilities have little access to sensitive psychotherapeutic services – although behavioral problems are usually an expression of excessive demands or a lack of structure , not “stubbornness” (Matson et al., 2011).

• The life satisfaction of autistic adults depends less on the severity of autism than on social inclusion and reliable support (Mason et al., 2018).

The problem: Neither schools nor many therapists or institutions are adequately trained. There is a lack of individual spaces for reflection, stress reduction, and identity development—and this is precisely where individual therapy comes in.

Individual psychotherapy for autism - the underestimated scope

Systemic individual settings offer more than just “support” – they are often the only place where young autistic people can feel safe:

• Structure & predictability: Regular, consistent sessions help build trust and avoid overwhelm.

• Identity strengthening: Many autistic people experience themselves as "wrong." In individual settings, they can develop a positive self-image and view their peculiarities as resources.

• Emotional regulation & stress management: Openness to stimuli often leads to inner overload. Jointly developed strategies (e.g., sensory boxes, breathing techniques, thought stopping) strengthen self-regulation.

• Systemic understanding of the environment: We consider family, school, peers, and society's perception of "normality." Often, conflicts lie not in the autism itself, but in the environment.

🧠 Scientific background

The effectiveness of individual settings with a systemic focus in ASD is demonstrated by, among other things:

• Cognitive-Behavioral Therapy (CBT) for ASD (Wood et al., 2009): particularly for anxiety.

• Psychoeducation and stress reduction in individual contacts have been shown to increase quality of life (Bishop-Fitzpatrick et al., 2017).

• Promoting mentalization through dialogic settings (Klin et al., 2003): particularly important for empathy problems.

• Systemic approaches within the framework of the TEACCH model show sustainable improvements in everyday family life (Mesibov & Shea, 2010).

Group therapy – but with preparation

Social training or group therapy can be important learning opportunities – but only if the person is ready . Without inner stability, a group setting can have a retraumatizing effect – for example, if social overload is not adequately cushioned.

However, the following can be trained in group settings:

• Perspective taking & compliment exchange

• Reading & interpreting body language

• Communication exercises

• Self-assertion & saying no

• Emotional feedback & impulse control

  
  

Important: Groups must be small , low-stimulus , clearly structured and protected – and based on voluntary participation.

What are autistic people really missing today?

Regardless of whether they have high intelligence or not, many people on the autism spectrum long for:

• Acceptance without expectations

• Belonging without the need to adapt

• Therapy that does not aim to “normalize” but rather to strengthen

• Everyday strategies that are realistic!

• Reliable people outside the family!

• Systems that understand that “outburst of anger” often means “outburst of stress”!

  
  

Individual settings in particular can address these needs by being mindful, individual, open-ended and systemic – with time, space and appreciation.

Conclusion:

Individual and group therapy in interaction: Two paths, one goal

Individual and group therapy are not opposites – they are two different paths with a common goal: self-efficacy, stability and social participation for autistic people .

The individual setting is often the first and most important step. This creates trust, structure, and a place where the person doesn't have to explain themselves or adapt . It's a safe space for genuine encounters – free from sensory overload, peer pressure, or social expectations. Especially for autistic children, adolescents, or adults with additional stressors (such as sleep problems, anxiety, compulsions, or school refusal), the individual session is often the only space where true processing and regulation are possible.

Group therapy, on the other hand, can be beneficial when stability and self-regulation are already established—as a place to practice social skills, experience community, and broaden perspectives. However, group therapy requires preparation, support, and follow-up. It's not a quick fix, but rather a step in a process that begins in the individual setting and should be continually anchored there.

In short:

• The individual setting regulates , strengthens, sorts.

• The group demands , reflects, expands.

• Together they enable differentiated therapeutic growth that includes both the inner world and social experience.

In a world that constantly calls autistic people “different,” we need more spaces that say:

You are exactly right – and we will find your way together!

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Thinking systemically – feeling autistic