Obligatory “I’m not a licensed professional” at the beginning of this one because, obviously, everyone should consult someone knowledgeable and trained to find the best solution for you, but I’m not a fan of exposure therapy.

A lot of why I feel this way has to do with the fact that exposure as a concept has been used against me a lot throughout my life as an undiagnosed autistic person. As a child, when I was afraid of or didn’t like the things that all the other kids had no problem with, I was often forced to do it anyway. Either because the other kids could only do it if we all did it (majority rule has been used against me frequently) or because adults in my life thought I needed to “stop being so sensitive.”

Many (maybe even all) of them meant well. After all, we’ve been conditioned to believe so many issues are “all in our heads.” We’re told that the key to getting over such unfounded fears or reluctance is to just get over it. Especially women and children.

If kids don’t like something, we should make them try it anyway (like when a kid refuses to eat certain foods). We believe they’re just testing boundaries, and they should be forced to do “what’s best for them” because we, as adults and caregivers, know better.

For women, if you’re upset about something that most people don’t get upset about, then it’s just hormones. Our pain isn’t taken seriously and our needs are put behind those of the men and children in our lives.

But how often does this “get over it” advice actually work? Has it ever worked? Or do the people who get this advice simply learn to stop reaching out for help? Learn to better mask their unmet needs?

I started therapy for the first time at 17 because my social anxiety and feelings of depression had gotten so extreme. I barely left the house except for school, and even just getting to my therapy appointments caused extreme panic and discomfort.

It was only a couple of months into my treatment when my therapist started talking about exposure therapy, telling me stories about how she took one client to a grocery store, made them get a full cart of groceries and go to the checkout, and let the cashier scan all their items, then made them admit they didn’t have their wallet and leave. She said it helped her client see that their fear of something like this happening was unfounded and that it would make it easier for them to go out the next time alone. It sounded cruel and embarrassing to me, and if someone made me do something like that, I would never show my face in that grocery store again. When that therapist started talking about doing something similar with me to expose away my fears of social situations, I stopped telling her things about my fears of social situations. I started telling her what she wanted to hear so that she would stop talking about putting me through such horrible situations.

Later in life, when I restarted therapy in my late twenties because I was so overwhelmed by feelings of depression and couldn’t see a future for myself, I had a therapist who pressured me to go out more and try new things with people I didn’t know. She was convinced my problem was isolation and that I would get over all of my social anxiety if only I forced myself to go out and do things enough. She ignored everything I said about being exhausted and having no social battery to do these things. She pushed me to commit to attending different social events, a writing group that met every weekend, for example, and I agreed because she wouldn’t stop pressuring me until I did. Then, when I inevitably felt too overwhelmed and didn’t go, she grew frustrated with me and accused me of not trying.

What she didn’t see was the days of dread leading up to the social event, where all I could think of was how much I didn’t want to go, the lost sleep, the panic that rushed through my veins every time I would tell myself to just get over it and go anyway. She didn’t understand how much I went through trying to get myself to go to the outing. She didn’t see how I would panic about not knowing the place or the people, not knowing what to expect, not knowing how much energy it would require or if there would be a safe place for me to go if it got overwhelming. All she saw was that I said I would go, and then I didn’t. In her eyes, I wasn’t trying.

Eventually, she, too, started talking about doing some sort of exposure therapy. Giving me assignments to go out and do things in public that she knew would upset me. Because she thought that if I did them, I would see how ridiculous I was and “get over” my fear. So, as with my last therapist, I started telling her what she wanted to hear. I disengaged until, eventually, she decided we had nothing more to talk about, and I didn’t need therapy anymore.

Not one of my therapists in the first 28 years of my life saw that what I was suffering from wasn’t just social anxiety and depression, that my struggles to fit in, to make friends, to endure situations that no one else struggled with, was a neurological difference rather than a learned one. And, when I failed to “get over” what was really autistic traits, they assumed it was because I wasn’t trying.

Weirdly, these methods of therapy didn’t help me function better in my day-to-day life, nor did they help the feelings of depression that drove me to seek treatment in the first place. They only further traumatized me while reinforcing the ideas that it was not only normal but expected for me to do harm to myself mentally and physically for the sake of fitting in and that the way I naturally am is wrong and needs fixing.

When I finally got diagnosed, first with ADHD and then with ASD, it was because I did the research myself. I identified these things in myself (thanks to the stories and experiences shared in online communities), then sought diagnosis, usually by demanding it. I was still seeing that second therapist when I asked for a referral for ADHD testing. She told me flat out that she didn’t think I had it and only referred me because I insisted. And even after I got diagnosed, she acted like she didn’t believe it and was just placating me.

By the time I got diagnosed with ASD, I had stopped seeing that therapist and gotten a new doctor (because my previous primary care provider acted the same about my ADHD). Thankfully, the psychiatrist who diagnosed me with ASD recognized not only that I was indeed autistic but that I was dealing with a lot of unresolved trauma. She recommended a therapist who specialized in trauma and was knowledgeable about neurodivergence. I started seeing that therapist and the experience has been night and day compared to what I had previously. She has also assured me that she would never recommend exposure therapy in a case like mine and is horrified by some of the things I was told by previous caregivers.

I don’t believe that exposure therapy will ever help in cases where a patient is on the spectrum. And honestly, the more research I’ve done in this area, the more I’ve worked through my own trauma, the more I doubt that there are legitimate use cases at all. Exposure therapy operates from a place of believing that whatever the patient is afraid of is unfounded. But how many people who suffer so severely from social anxiety have no foundation for their fear. It operates from a place of, “These people are just crazy.” It’s dismissive and delegitimizing.

Whether the person is autistic or traumatized or something else, forcing them into a situation where they don’t feel safe is not going to make them feel safer in that situation in the future. If the fear is trauma-based, then the trauma needs to be unpacked and dealt with. Only then can the person feel safe in their own bodies again, let alone in the outside world.

And, in the case of autistic individuals, sometimes those situations are just never going to be tolerable. Once I was diagnosed, I switched my focus from trying to force myself through things that caused me anxiety or overwhelm to instead finding ways to accommodate myself. I stopped going to grocery stores and started ordering them for pick up instead. I began organizing errands so I didn’t have to go to more than 2 or 3 places max in one outing. I learned to be more patient with myself, leave situations if they became overwhelming, and stop caring so much about how it might look to different people.

And you know what? Making these accommodations, giving myself this grace in situations that would never become tolerable, gave me more energy to do things I actually want to do.

It’s still not perfect by any means. I still deal with chronic pain and exhaustion (much of which is the result of pushing myself so hard for so many years), and sometimes, I’m not able to do things that I really want to do. But, on the whole, I get to do things I want to do a lot more, and I spend a lot less time feeling like I’m a failure for not being able to achieve things that are out of my reach.