A look at “The SPC model as a heuristic tool to better understand autism spectrum disorder and other structural diagnosis in psychiatry and psychotherapy” by Ludger Tebartz van Elst (2026)
Autistic adults rarely walk into a therapist’s office saying “I’d like help with my autism.” More often they come because of depression, burnout, conflict at work, bullying, or a feeling of not quite understanding themselves or others. So how do you untangle what’s part of who someone is, what’s a problem that can change, and what’s a temporary state that needs treating? This German paper, by a psychiatrist specialising in adult autism, offers a simple three-part map: the SPC model.
What it proposes
S is for Structure. These are stable, fundamental features of a person, a bit like height, eyesight or IQ. In autism, this would include things like sensory sensitivity or a particular way of processing social information. The key message: structures should be accepted, not “fixed”.
P is for Problems. These are patterns that tend to develop in autistic people’s lives because of how their structure interacts with the world, such as bullying, social withdrawal, interpersonal conflicts or unhelpful communication habits. They’re not part of autism itself, and these can and should be changed.
C is for Conditions. These are temporary psychological or physical states, such as tension, agitation, depressive episodes, shutdowns or psychosis. People can’t simply decide to switch them off, but they have a beginning and an end. Conditions should be treated, sometimes with medication.
The author also distinguishes between static structures, such as sensory hypersensitivity, and dynamic ones, such as self-concept, identity and core beliefs. Dynamic structures may feel fixed in the moment but can shift over time.
The practical value is in sorting experiences into the right box. For example, an autistic person at a noisy party may experience sensory overload (structure). That might lead to an angry outburst (problem), or later to a depressive episode (condition). Each part calls for a different response: acceptance and adjustments, skill-building, or treatment.
A grain of glitter ✨
There’s a lot to like here. The idea that core autistic traits should be accepted rather than changed is a welcome, quietly neurodiversity-friendly stance, and the model is simple enough to share with clients. But it’s a theoretical tool drawn from one clinician’s experience, and the author stresses that it hasn’t been tested.
The lines between boxes can blur. Is someone’s anxiety about social situations part of their structure, a learned problem, or a condition? The author admits that even experts can’t always tell. The language also remains clinical (“autism spectrum disorder”, “patients”). And while the paper’s example mentions people feeling discriminated against “even if this were not objectively present”, that phrasing risks dismissing real experiences of exclusion that many autistic people face.
Why this matters
If you’re autistic and feel overwhelmed by everything that’s going on, this model offers a helpful way to sort it. Some things are simply how you’re built and deserve acceptance and accommodation. Some are patterns you might want to change. And some are temporary states that deserve care and treatment. Therapy can help you work out which is which.
A unicorn’s horn is structure; tripping over it in a crowded paddock is a problem; and the sulk afterwards is a condition. Only the last two need sorting.