What Happens When I Speak: An Autistic Therapist on Unmasking, Silence, and the Cost of Being Seen
Image credit: Shannon Tidwell, Dreamstime.com
It’s been a brutal week. Today, on Mother’s Day, I’m taking time to myself to just process, and rest, and recover (since I can’t be with my mother, and the mother of my children and I are divorced).
Being a therapist in solo private practice, working with 50 clients and doing an average (these days) of 30-35 sessions a week, is both incredibly rewarding, and deeply exhausting. It’s possible that I just put too much into my work – too much heart, too much time, too much extra work sharing resources and materials with people afterward, too much social worky type stuff connecting my clients to other supports in addition to doing therapy. Plus I write, and teach, and coach, and speak, and am building a business. My list of unfinished projects is long and a source of a fair amount of guilt.
I’m also trying to show up more authentically in the world, both in public and with the people I care about, personally. As a neurodivergent person working with neurodivergent people, I feel a responsibility to do so. Because I can, in part, and because I have an unusual and worthwhile perspective on the world from my weird little corner of it, and a lot of privilege – which I try to use for good. And also because the people I love deserve to see more of the real me, not the tightly scripted and masked version that I’ve typically presented to the world.
That said, there’s a cost to unmasking. Which is what I will try to share in this post.
So… Wednesday morning, before my first session of the day, I made a video.
Not the kind I usually make — the polished, educational kind where I’m wearing a good shirt and explaining polyvagal theory. This one was somewhat raw. It was a follow-up to a Facebook post that I had made, describing what I’ve been watching happen in my community as Medicaid cuts start to ripple through Oregon. In that post, I talked about what it feels like to be a therapist watching clients lose coverage in real time — clients who are autistic, traumatized, who have spent years building the capacity to function, who are now being told by the machinery of policy that they don’t matter enough to fund. The Facebook post resulted in being bullied and abused by someone I thought was a friend. In the video on Wednesday, I talked about speaking up publicly about that and getting bullied for it. I talked about the exhaustion of being a person like me in a world like this one.
If you’re curious, here’s the original Facebook post: https://www.facebook.com/share/p/1AvtRNmMeM/
And here’s the video: https://youtu.be/pd09a_nLVJg?si=7XHDuOvJKN7XV_Ah
And then I shared it with the people I love most – my wife and kids.
And waited.
And mostly got silence.
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I want to be clear: this isn’t a story about blame. My family loves me. My partner is a psychologist who thinks deeply about trauma and the nervous system and the human condition. My kids are, in their own ways, trying to show up for me. Nobody failed some external test of goodness.
But here’s what happened inside me: I shut down. The turtle pulled back into the shell. And the shell got a little thicker.
If you’re neurodivergent — if you’re autistic, or have ADHD, or both — you may know exactly what I’m describing. The moment after you’ve said something real and vulnerable and true, and the silence lands. Not hostile silence. Not contemptuous silence. Just… nothing. An acknowledgment of the photo you were in, not of what you said. And your nervous system — which is already hypervigilant, already scanning the environment for rejection cues — registers that silence as data.
You got it wrong again. Too much. Wrong topic. Wrong tone. Put it away.
Today, after several days of processing and discussion with my wife and kids, I’m reaching the conclusion (as I’ve done less consciously thousands of times before, throughout my life), that it just isn’t safe to share my true self, even – maybe especially – with the people I love most. The raw, unfiltered, deeply human part of me that craves connection and support, that is uncertain, that is wounded and struggling, is just too much for most people to handle. Maybe I can share it with a therapist – maybe. Even in therapy, I tend to hide that rawest part of me, for reasons I don’t fully understand. I’m not sure I really share it with anyone. And there are reasons for that.
There are reasons why we mask. There’s an element of the neurodivergent community that sees masking as oppression from an ableist society, that demands that we unmask as completely as possible at all times, that to mask is to give in to ableist oppression. I respect that point of view, and yes, ideally, everyone (neurodivergent or not) should be free to be their true selves at all times, without the fear of being subjected to abuse and shame.
And yet.
And yet.
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My partner asked me, in a long and generous and honest exchange we had about all of this: what is it that you want, regardless of what others think, say, or do?
I had to sit with that for a while.
Here’s what I came up with: I want to be seen. I want to be safe. I want to be able to use my voice. I want to be loved and accepted for who I actually am, not the version of me that’s been carefully edited for palatability. I want to speak my truth. I want to have purpose. I want to work toward a world that’s kinder and safer for everyone.
That’s not a complicated list. But getting there — for someone like me — is one of the hardest things I’ve ever tried to do.
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Difficulties reading social situations are a diagnostic criterion for autism. I’ve known this as a clinician for years; I’ve lived it as a person for decades without having the framework to understand it. Before my diagnosis at 56, I just thought I was bad at people. Awkward. Off. Too much in some moments, not enough in others. The kid who would talk passionately about something he cared about and watch the other kids’ eyes glaze over. The adult who would say the thing that made the room go weird and not understand why.
So I learned to be quiet.
Not quiet as a spiritual practice — I’ve done that too, and that’s something else entirely. Quiet as armor. Quiet as self-protection. I got very good at being a container for my own inner world, which had the unfortunate effect of making my inner world invisible, sometimes even to me.
And here’s the thing nobody tells you about that kind of silence: it doesn’t protect you. It just means you’re invisible and in pain, instead of visible and in pain. The RSD — rejection sensitivity dysphoria, for those unfamiliar — is still there. You haven’t escaped the rejection. You’ve pre-rejected yourself, which feels marginally safer but is genuinely terrible.
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In training to become a therapist, there’s a concept we are taught that comes straight from Freud: “judicious self-disclosure.” In traditional Freudian psychoanalysis, this is taken to an extreme: the therapist is told to become a blank mirror, with virtually no presence as a complicated human being in the room at all. You sit behind the client taking notes. They don’t look at you. You rarely speak. There are no pictures of your partner or kids in the room. The client knows virtually nothing about your personal life.
Jungian tradition is different; Jung believed in the concept of the “wounded healer,” and that your own healing journey is part of your toolkit for helping others. Jung and Freud apparently had arguments about this – and Jung famously got into trouble, and had an affair with a patient. So there are reasons why this debate about how much you show up as a human being as well as a therapist actually matters. We walk this edge all the time in our profession.
I’m more Jungian than Freudian, by the way. And yes, I am aware there are risks to this.
I probably disclose more about my personal life in the therapy room than the average person. This is mostly intentional – I have found over the years that my clients, who are mostly neurodivergent and often carry a lot of shame, find it very validating and supportive to know that they aren’t alone, that the things they struggle with might seem weird but are very normal for the population I work with and am part of. Normalizing things that the rest of society shames and judges is healing, in itself. Plus, “relating” is just how autistic people communicate.
And, I try as best I can not to overshare. Clients don’t need or want to know their therapist is having a hard time himself. That’s not helpful. Role reversal, where the caregiver needs to be cared for, is dangerous, whether you’re talking about a helping professional with a client/patient, or a parent with a child. The whole purpose of therapy is to help another human – not to receive help, or encouragement, or positive regard yourself. That warps the relationship in ways that are rarely helpful and potentially dangerous.
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There’s a metaphor I used in that exchange with my partner that I mentioned previously that keeps coming back to me. Unmasking — showing up authentically as your neurodivergent self, especially in front of people you love — is like being a turtle whose shell has been removed.
The turtle will die, by the way. That’s not a rhetorical flourish. Without the shell, the turtle is done. The shell is the turtle’s protection, its exoskeleton, its literal structural integrity. When I unmask in front of the people who matter most to me, I’m not just being brave or vulnerable in the Instagram-inspirational sense. I’m removing something that has kept me alive. And I’m doing it on faith that what’s underneath is worth protecting — and that the people I’m doing it in front of will take that seriously.
Silence is not nothing when someone does that. Silence is enormous.
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I don’t want to pretend I’m perfect at any of this. I spent most of my adult life not communicating with the people I love — getting so consumed by survival mode that I’d forget to reach out, sending funny videos as a substitute for connection, doing the bare minimum and then wondering why I felt unseen. I’m as guilty of avoidance as anyone. This is not a one-directional failure.
But I’m trying to change that. And what I’ve learned, in trying, is that the change is harder than I expected — not because of the effort required, but because the old patterns have such a long memory.
Every time I speak up and get met with silence or confusion or the “wrong” response, it takes me a little longer to try again. The nervous system is an excellent record-keeper of danger. And social rejection, for someone with significant RSD, registers as danger.
I knew perfectly well, in the moment I shared that video, that I wanted acknowledgment. Not applause. Not therapy. Not a detailed critique. Just: I watched it. I heard you. That matters. Something that engaged with what I actually said, rather than how I looked while saying it.
The silence said: the content doesn’t matter. The silence said: your inner world is not what we’re here for. The silence said, as silence has said to me a thousand times over the course of my life: put it away.
And then I have to make a choice about whether to listen to that.
After a lot of processing, including conversations with my wife and oldest son, I’m reaching the sad but necessary conclusion that I should probably not share as much with them. It’s ironic to me that I can receive better support (as well as potential bullying and abuse) from relative strangers on social media, people I don’t really know at all in a personal sense, than I can from the people closest to me.
And, that’s just what people are showing me, based on behavior. As Maya Angelou said, “When people show you who they are — believe them.”
It’s complicated, and it’s reality. And as the Buddha would tell us, the root of suffering is in not accepting reality as it is, and expecting something different.
I will probably go back to masking a lot and largely give up on the idea of sharing more of my authentic self with my closest people. That goes against all my values. And it’s also necessary for my survival.
The ripple effects of my effort to do otherwise this week have taken me down, to the point where I can barely function. Not sleeping, not eating, hurt and confused and angry and sad. There are 50 clients who depend on me – and I depend on me. I have to be able to function. If the cost of showing up authentically in the world is so high, I simply can’t afford to pay that cost.
This is the world we live in today. It just is. It’s reality.
And I’m also choosing to write about it, and speak about it. Because my experience does matter. And I deserve to use my voice.
It’s a paradox. Sit with me in the uncomfortable tension – please. I’m aware that it’s painful. Oh, believe me, I’m aware.
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I recorded that video on Wednesday because Medicaid cuts are real and they’re happening now, and autistic people and trauma survivors are among the most vulnerable people in any population when the floor drops out of the mental health system.
I recorded it because I got attacked for saying so publicly, and something in me refused to go quiet about it just because someone wanted me to.
I recorded it because I believe, in some stubborn and tired and still-kicking way, that my experience and perspective — as a clinician, as a late-diagnosed autistic adult, as someone who has lived inside the systems I’m talking about — is worth something. Worth saying. Worth hearing.
I believe that even on the days when the evidence suggests otherwise.
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My partner, after our long exchange, said something that has stayed with me: find your true self.
I told her, honestly: my true self would not be accepted. Not by her, not by anyone.
She didn’t argue. Instead she asked me to keep sharing, keep posting, keep walking. And I found myself confused by that — because she’d also just told me my sharing was painful to receive, was already too much, was causing her physical distress.
Which signal do I listen to? The one that says stop, or the one that says keep going?
When I try to share my actual lived experience, much of the feedback I get (in one way or another) says that I’m mentally unstable, and should not speak. That’s too much. You’re wrong. Are you on drugs? Are you drunk? Are you crazy?
Well, yes, I guess by society’s standards, I’m crazy. I’m autistic. I have complex PTSD. I’ve struggled with depression and anxiety off and on all my life. Adulting is hard for me, and always has been. I try to manage that as best I can – and the world, from my perspective, is insane, and brutal, and toxic, and hard to survive. Is it any wonder that I have a hard time, much of the time? Is that really my fault?
I remember being in a DBT program 10 or 15 years ago – I forget when. A therapist I was working with at the time said he wouldn’t necessarily diagnose me with Borderline Personality Disorder, but that I had a lot of elements of it – that I was on that spectrum somewhere, with a lot of holes in my personality, like Swiss cheese. Overly reactive, unstable in how I approached relationships. (Misdiagnosis with BPD is very common for autistic people, by the way, and complex trauma is really what underlies BPD; the symptoms that BPD pathologizes are natural adaptations to relational trauma and abuse.) So I went to DBT, which is the “gold standard” of treatment for BPD.
Like many people, I found the DBT program both helpful in some ways, and extremely rigid and pathologizing in others. I remember having a conversation with the therapist in charge of my treatment at the end – she was young and naïve – in which I finally confronted her about her viewpoint about what was going on in my life.
What if I’m not crazy and overreacting to things? What if the way I’m responding to my environment is actually logical and rational, given the situation, which is unbearable? What if the problem isn’t me?
She was stuck. Her DBT training had nothing to offer, either to her or to me. You could tell she wasn’t prepared to think about this. I left the program that day, and never went back.
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There’s an irreconcilable dilemma at the center of my life right now. I want to be seen. But being seen costs something — sometimes it costs me, sometimes it costs the people I love, often both. And I don’t have a clean answer for how to manage that. I’m a therapist who specializes in exactly this territory and I genuinely don’t know.
What I do know is that silence is not safe. Hiding isn’t survival — it’s a slow disappearance. And at 58, having spent most of my life learning to be invisible, I’m not willing to keep disappearing.
So I’ll keep talking. Even when it lands wrong. Even when the room goes quiet. Even when the turtle is absolutely terrified.
The shell is off. I’m keeping it off. And somehow, I hope, I’ll find a way to create structure — an exoskeleton — that will allow me to not just survive, but to thrive. That’s the name of my practice, after all. I should probably find a way to live and embody that. Even if the tension, and the desire to retreat back into my shell, my invisibility, my aloneness and silence, is very real, every single moment, every single day.
There’s a reason why we mask. There’s a reason why we don’t speak (the common refrain and complaint in my immediate family). It isn’t random. It’s learned behavior, and it’s protective. If you would like to hear more from us in ways that are real and authentic… create a safe space for this to happen. Even if it’s uncomfortable and painful at times.
I guarantee that the exchange will be worthwhile. For both of us.
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K. David Smith is a licensed clinical social worker, late-diagnosed autistic adult, and founder of Thriving Family Therapy, a telehealth practice specializing in complex trauma and neurodiversity-affirming care. He works with adults and families across Oregon, California, Idaho, Florida, Vermont, and Michigan. He believes healing extends seven generations forward and back — and that your story, including the hard parts, is worth telling.
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