Mental health is a significant issue in higher education with students presenting with depression and anxiety at elevated rates. Whether it be due to the pressure of keeping up, the long hours required to fulfil course/research requirements, the isolation, imposter syndrome or other challenges that creep up while completing a PhD, the outcome on mental health and general well-being cannot be underestimated. Having just finished a PhD in public health, I can attest to the damaging effects that engaging in such rigorous study demands. The hurdles and resultant pressures that had to be overcome were many.

However, as a late diagnosed Autistic woman and unbeknownst to me at the beginning of my PhD journey, there was an added layer of complexity that went beyond the usual academic pressures to succeed. Having access to mental health care that was neuro-affirming and cognisant of the unique struggles that neurodivergent students face in higher education was instrumental in supporting me through my research journey and maintaining my well-being. Here, I will provide some insight into the lived experience of studying while Autistic and the strategies and supports that were personally helpful as a guide to counsellors supporting other neurodivergent students through their own journey.

For me, one of the biggest challenges encountered while studying was consistency. Limitations in executive functioning meant that the initiation and completion of any required task was almost insurmountable and meeting the timelines set by the university was not possible. This not only had an academic impact but also a corrosive effect on my emotional state. The frustration at not being able to meet expectations hurt my self-esteem and was de-stabilising. I assumed the problem was me; that I was just incapable. However, my academic supervisor understood that I needed time to work through the material at my own pace and suggested that I switch from full-time to part-time study. Not having to progress at the same rate as was previously expected and having the additional time to explore the content in a more in-depth manner allowed me the mental space to complete assigned tasks. The counsellor was helpful in allowing me to frame this change in scheduling from one of failure to one of prudence. They helped me see that it was merely a necessary means to achieve a desired end and that this pivot did not reflect badly on me or my abilities.

Another matter that posed an issue for me was the lack of certainty and specificity. In a PhD, everything is up in the air—the research question, research design, data analysis and dissemination. As someone who appreciates clarity and having a well-detailed roadmap for any task at hand, sitting with uncertainty was difficult. The responsibility to make my own choices regarding every aspect of the study was unnerving. Having many options and needing only one led to paralysis and my work stalled for a long time. I went down rabbit holes that—while interesting—added nothing to my work and delayed the attainment of cherished goals. As an antidote, my supervisor recommended regular fortnightly meetings where I presented my work to date, asked the necessary questions and was provided with clear directions and an explicit, written action plan to work through over the forthcoming two weeks. On the other hand, my counsellor was instrumental in helping me confront the fear that arose before attempting any prescribed task and that escalated before each supervisory meeting. Whether it be talking my thoughts and feelings through, journalling, breathing exercises or merely being in her calm presence, I was able to get through my candidature one supervisory meeting and counselling session at a time.

Another hurdle that served as a barrier to timely progress was managing interpersonal relationships. Meeting with supervisors, colleagues, fronting audiences at confirmation seminars or potential collaborators at networking events had me wanting to scramble for the nearest exit, an unhelpful urge when trying to lay down the foundation for a new career. As I became more self-aware and better able to sit with vulnerability—a precious byproduct of the many counselling sessions I had with an empathic therapist—I was able to articulate to my supervisors that I was Autistic, struggled with social anxiety and preferred direct, clear communication. They were understanding, warm and positively receptive, thereby rendering meetings less daunting. However, I never completely overcame my fears and the anxiety did get the better of me sometimes where I cancelled or rescheduled meetings. But this was less than what it would have been if I had not learnt about compassion, radical acceptance and the importance of self-care from my counsellor, a welcome boon to my personal resilience. Again, the strategies learnt and practiced in session were useful in managing painful emotions and unhelpful thoughts.

With supportive supervisors and an understanding therapist, I was able to look back on my life generally and academic path specifically with a less critical eye. I began to reframe the many setbacks not as personal failures and moral defects but as par for the course for any PhD student who also happens to be neurodivergent. I discovered that I had the internal resources to see my candidature through to the end. Moreover, I started to see that as an Autistic individual, I had the strengths that made me particularly suitable to research. Being able to hyperfocus for long periods, spending much attention and time on special interests and preferring solitary work over collective activities made for a dedicated researcher. Moving from a deficit-based lens to a strength-based approach and having access to the right mental healthcare, I was able to get through that elusive finish line with a complete thesis in hand (and my sanity mostly intact).

From the perspective of a budding counsellor, having insight into the specific challenges that confront an Autistic student in higher education may facilitate rapport building. This insider perspective may be invaluable in meeting the client where they are at and walking alongside them with empathy. Additionally, this approach may empower the individual to work through their challenges, thereby affording them a rightful opportunity to flourish. As counsellors, we could assist the client in rising to the task of courageously braving the act of living. And for Autistic individuals, a commitment to thriving rather than simply treading water may produce truly person-centred care and could foster thoughtful and innovative neuro-affirming strategies in the pursuit of this ideal.

However, areas that could warrant improvement in the training of counsellors are their ability to detect Autistic traits in their clients, how best to manage these disclosures ethically and sensitively and when/how to refer the client on to another mental health professional with the required expertise. I had seen many therapists over the years and none had identified what was glaringly obvious. A timely referral to a psychologist or appropriate mental health practitioner for an autism assessment may have saved me years of heartache and brought me to recovery sooner. It was only by coincidence and after having seen myself in an Autistic character in a book that I recognised that I could also be Autistic. Subsequently, I sought a diagnosis and proper care. Whilst it’s not the role of a counsellor to diagnose, they may be well-placed to assist undiagnosed clients get the aid they need. As the demands placed on our mental health care system rise, adequately trained counsellors could help fill the gaps and prevent vulnerable clients from falling through the cracks unnecessarily.

Emna Malas is a recent counselling graduate (University of Canberra), researcher and emerging writer whose work explores neurodiversity, health equity, and the intersections of medicine, religion and bioethics. Emna has recently completed her PhD from La Trobe University (awaiting conferral) in public health, examining the end-of-life care practices of Australian Muslims and the supports needed to ensure cultural safety in healthcare delivery. She is particularly interested in how research methods could be harnessed to challenge stigma and support the inclusion of culturally and linguistically diverse Autistic women across all spheres of society.