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There is a dearth of research on autistic people’s self-esteem levels and therapeutic alliances. However, pre-existing research suggests that mental health practitioners, especially those who work in schools, often express implicit or explicit anti-autistic bias. This study investigated autistic adult’s perceptions of bias in their relationship with their mental health practitioners, and the correlation to their self-esteem. A mixed methods design was used to quantitatively establish self-esteem levels among autistic adults and thematically analyze interviews about their experiences with bias in their therapeutic alliances. The results indicated that autistic adults have overwhelmingly low self-esteem and often conceive of experiencing bias from mental health practitioners as self-esteem injuring events. Indications for mental health practitioner education and practice are provided.