Autism: The Case for Inclusive Group Therapy
Gail Schrimmer, Ph.D
· Group Psychotherapy: overall merits!
Many autistic young adults, fairing competently with activities and academics during their primary school years, experience a wall of difficulty during college, vocational training, adult relationships, moving out, and career progress. When queried, those with autism report that loneliness, depression, and social anxiety are their barriers to success (Wilson et al., 2025). The argument for needing better treatment programs for those with autism is a compelling one.
Group psychotherapy has a sturdy history of helping individuals cope with prolonged social isolation, distress, bereavement, trauma, addiction, and social inequities. Emotions such as anger and sadness, shared in a group setting, are associated with later positive psychological effects (Brans et al., 2014). Medical improvement and longevity are also linked to socialization: the more social roles and social connections experienced by an individual, the better the lung function and telomere length (Stein et al., 2018; Crittenden et al., 2018). The association between social ties and mortality was found to be independent of self-reported physical health status, with a longitudinal survey studying 6929 adults. The analysis indicated that those who lacked social and community ties were more likely to die in the follow-up period than those with more extensive contacts. Having supportive interpersonal connections is more predictive of overall health than socioeconomic status and health practices such as smoking, alcoholic beverage consumption, obesity, physical activity, and utilization of preventive health services (Berkman, 2017).
Conversely, a meta-analysis indicated that social ostracism triggers suicidal thoughts, as the lack of social affirmation identity is associated with lower self-worth (Chen et al., 2020). In August of 2020, the CDC reported results of a national survey: more than 40 percent reports symptoms of anxiety, depression, and/or increased substance use. Compared to a similar 2018 survey, the 2020 existence of suicidal thoughts in the population had more than doubled – from 4% to 10% reporting suicidal ideation (Czeisler et al., 2020).
One could argue that social support by a lone therapeutic partner is as important as mere companionship with a group of disparate others. Five studies explored this difference, and delineated that while social support can serve as a buffering effect on life’s stressors, companionship and a concrete social role within a community are the stronger predictors of psychological well-being (Rook, 1987).
There is a dearth in the research related to efficacy comparing individual and group therapy, for those with autism. There are sturdy analyses for a host of other diagnoses. In 2021 a series of meta-analyses utilizing over 300 studies comparing group and individual therapy and found that group therapy was equally effective for mood disorders, schizophrenia, most anxiety disorders, eating disorders, borderline personality disorder, substance abuse, and chronic pain (Rosendale, 2021). As compared to individual therapy, group therapy is superior to individual therapy for alleviating social anxiety disorder – a pervasive anxiety symptom reported by those with autism (Barkowski, S. et al, 2016). Additionally, groups are particularly helpful for those who self-identify as being traumatized by bias, isolation, shame, and stigma (Rafieifar, 2021; Craig, 2021). Group therapy is the recommended choice to effectively reduce depression, anxiety, and complicated grief (Marmarosh et al., 2020).
Group therapy is often perceived by patients – and many psychologists – as a secondary treatment option. When asked about running a new group, psychologists report that prior group therapy attempts may have been intimidating, frustrating, inconsistent, and stressful. It took until 2018 for “group therapy” to be recognized by APA as a unique specialty; yet structured group therapy training during graduate school continues to be limited or non-existent. When querying private practices nationwide, these practices report that 95% of their resources are going toward individual therapy, with group therapy accounting for only 5% of private practice resources (Pappas, 2023).
APA’s survey assessing changes in private practice post-pandemic revealed that over 3 million more American patients could be given treatment if only 10% of one’s private practice patients engaged in group rather than solely individual therapy (APA, 2022).
· What is the Case for Inclusion?
For decades “social skills groups” have held a prominent position in the autism treatment toolbox. These types of structured groups are often essential for many with significant social, communication, and behavioral struggles. Largely social skills groups are populated with youth and adults who may, even within the autism diagnostic parameters, have quite variable strengths and challenges. The frequency of an intentionally mixed psychotherapy group of those with and without an autism diagnosis appears to be fairly rare.
Despite autism being associated with unique and interesting strengths such as authenticity, original thinking, an often-unwavering moral compass, and a detailed knowledge of favorite topics, many do not think of the advantages of sharing these traits with neurotypicals. In public schools, children and adults tend to be educated, treated, and socialized in their own vacuum, such as the corner and highly inaccessible classroom within their school. Broader, systemic changes involving inclusion can enhance skill-building and motivation, with a priceless result: the feeling of belonging. (Brandsen et al., 2025).
· Gender Differences
It is not uncommon to hear group therapists report a preference for members with autism, who are specifically female. In the distant past, autism studies rarely had enough subjects to offer powerful conclusions regarding the impact of gender on treatment outcomes. More recently, there is evidence that overall, females with autism manifest lower restricted interests and repetitive behaviors. Females with autism tend to have higher social attention, stronger pragmatic conversational skills, more consistent cognitive development across skill areas, higher motivation for friendships, an enhanced ability to “camouflage” and mask, and greater reductions of observable symptoms following treatment (Meng-Chuan et al., 2020). These differences are significant and easily replicated outside the lab. However, it is arguable that while more pronounced in the autism population, gender differences are ubiquitous in the general population. It can be an important function of group therapy to question and confront gender stereotypes and socialization, rather than offer no resistance.
· Inclusion Group Therapy in Action
Group psychotherapists, when queried via local listservs and peer supervision groups, offered unanimous support of the inclusion model. Sara Schreiber, LCSW is a certified group psychotherapist and the owner of NJ/NY’s Collaborative Minds Psychotherapy LLC. She runs inclusion groups for teens and adults and is a proponent of this model. She reported that “in my young adult group, one of my autistic member’s special interest is movies and TV. Week after week, he would try to connect with group members by asking ‘so, “Have you seen any good movies or TV shows lately?’ And I would redirect him with ‘what are you wanting with this other group member?’ to which the answer was always ‘I want to connect with them further.’ We would then process how it felt to hear that he wanted to reach them and would explore how to connect in other ways besides asking the rehearsed lines about his special interests. One day, two years into being in group, this member approached another one member with ‘hey, Toni (name changed), I wanted to check in with you about how things have been going with your parents, since I know that’s been hard for you.’ It is moments like these that show me how helpful doing this kind of process work can be with autistic clients in an inclusion group. We learn how beyond just teaching social skills, exploring motivation, desire, and meaningful connection has a more lasting impact. This same member who came in struggling with making friends after high school has now developed a small and meaningful friend group at college.”
Nechama Sorscher, Ph.D. is a Manhattan-based neuropsychologist, group psychotherapist, and author. She reports that “running a mixed group of neuro-typical and neuro-diverse individuals is the clinical highlight of my week. The group is so sympathetic and supportive of its members, and the sessions involve lively conversations and the sharing of significant experiences and emotions. Recently there was a discussion of diagnosis with the group members; for some, it was a new experience to share their diagnoses while discussing the lifelong impact of their attention, learning, and social challenges on their lives.”
Kate Martin, LPC provides group and individual psychotherapy in NJ. She has observed “positive experiences with mixed-neurotype groups…. they challenge assumptions and provide a space for folks with different neurotypes to speak, listen, understand, and connect with each other.”
These positive experiences are not only exhibited in adult psychotherapy groups. Nancy Blanco Melendez, Ed.D. is a Livingston-based psychologist with a group and individual therapy practice. She finds the growing relationships between neuro-typical and neuro-divergent members within her child and adolescent therapy groups clinically and professionally rewarding. “It is extremely fulfilling” she reported, “to be a part of members’ learning processes as they discover how to appreciate each other’s differences while also finding meaningful common ground.” During impasses when misunderstandings or differences are apparent, Dr. Blanco Melendez has observed children “practice asserting themselves, listening, empathizing, and collaborating.” These learning moments, often small, “reflect real growth for the entire group.”
Sometimes an inclusion group is the first-time neuro-typicals and those with autism have ever become socially intimate. One member of Dr. Gail Schrimmer’s young adult group had spent her life being socially isolated or limiting her interactions to those self-identified as neuro divergent. When opportunities to discuss unique interests and obstacles were shared in the group, confidence bloomed and depression waned for the patient with autism. In return, the other members were able to discuss novel topics (e.g., polyamory, kink events) with which they had heretofore received little to no exposure. When asked how they felt about being in a group with someone with autism, one neuro-typical member reported how “refreshing” it is to be with someone who is “so authentic and unafraid to say what we all avoid saying.”
· Inclusion challenges while moving forward
For many who run autism/neuro-typical inclusion groups, the risk and apprehension related to explosive meltdowns is no small matter. These outbursts can occur following a host of sensory, emotional, and cognitive stressors, and are often difficult to anticipate. Without considering how meltdowns can be predicted and treated could result in group members witnessing a range of possibly disturbing behaviors, such as stimming and ticking, verbal perseveration, and physical acting out. (Soden, P. et al., 2025). Proactively exploring and then reframing these meltdowns as stemming from a history of hypervigilance, not belonging, and not being understood, can be quite helpful.
The concept of Universal Design in Learning (UDL) was developed in line with the internationally supported Convention on the Rights of Persons with Disabilities (CRPD). Increasingly, inclusive environments are gaining international traction. However, educational research suggests that in tandem with the move to more inclusive systems, the process breaks down if leaders’ attitudes, training, and skills are insufficient for the task. In addition, having parents, guardians, and other families in parallel treatment or training programs will enhance the experience (Silvio, et al., 2022; Leifler, et al., 2022).
Other factors set the stage for success. Careful intaking and pro-active individual sessions are invaluable for all patients entering into group therapy, as many patients report reluctance or ignorance regarding the therapeutic group process. As with any treatment, pro-active conversations are essential regarding any misconceptions and concerns regarding inclusion groups, personal disclosure, confidentially expectations, cross-professional collaboration, missed sessions, fee arrangements, and termination plans. For optimal experiences for all parties, the inclusion group therapists recommend focused training, collaboration with various providers, consistent supervision, and enthusiasm regarding combining neurotypicals with members with autism. With these components in place, neurodiversity, in all its colors, benefits all the members (Brandsen, et al., 2025). And the clinician as well.
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About the Author: Gail Schrimmer, Ph.D.
is a clinical psychologist specializing in the areas of group therapy, relationship disorders, Autism, trauma, personality testing, and career coaching. She is currently running 5 inclusion groups. In addition to her northern NJ practice, she is a Rutgers’ GSAPP testing and clinical supervisor. drgs@comcast.net.
A reference list is available upon request.