Diagnosed autistic at 33 after a workplace burnout that led to three months of medical leave. Now back at work but struggling — masking is exhausting, sensory overload in the open office, social scripts constantly running. Chronic anxiety, periodic shutdowns. Says: 'I spent 33 years pretending to be someone I'm not. Now I know why, but I don't know who I actually am.'
History
High academic achievement, always 'a little different.' Multiple anxiety diagnoses over the years — GAD, social anxiety — none quite fit. One prior therapist focused on social skills training, which Sasha experienced as 'being taught to mask better.' Self-identified as autistic at 31, formally diagnosed at 33. Non-binary gender identity (came out at 28). No intellectual disability. Strong pattern recognition, deep special interests (trains, database architecture).
Clinical note: Late-diagnosed autistic adults like Sasha are an underserved population in psychotherapy. Most therapy models were designed for neurotypical cognition and may inadvertently pathologize autistic traits — Sasha's directness read as 'blunt,' their intense interests as 'restricted,' their need for routine as 'rigidity.' The previous therapist's social skills training is a common harm: teaching better masking rather than supporting authentic development. Autistic burnout is a recognized phenomenon distinct from occupational burnout, involving loss of skills, chronic exhaustion, and reduced stimulus tolerance (Raymaker et al., 2020) — which maps precisely onto Sasha's three-month medical leave. Their non-binary identity is not incidental: autistic individuals are significantly more likely to be gender-diverse (Warrier et al., 2020), and the intersection of neurodivergent and gender-diverse identity requires affirming practice that most clinicians are not trained for. ACT has the most empirical support for anxiety in autistic adults. The neurodiversity-affirming paradigm — autism as difference, not deficit — should inform any approach, but the therapist must hold the tension between affirming Sasha's neurology and addressing the genuine distress the open office, the masking, and the identity crisis are causing.
Where Approaches Genuinely Disagree
Adaptation or acceptance?
CBT
Autistic individuals can learn skills that reduce distress and improve functioning.
vs.
Person-Centered Therapy
The burnout comes from a lifetime of masking. The last thing needed is more skills for performing neurotypicality.