Help - how to engage with therapy

Post Reply New Topic

Right, and CBT is not necessarily against that. If a course in CBT can help you manage your anxiety around other other people or whatever, that responsibility becomes much easier. Goals such as the furtherance of human positivity can be more fully realised without the monkeys of anxiety/depression/trauma etc. on your back.

It's not about programming poor aspies to behave more like NTs, or anything like that. CBT practitioners are geared to work with NTs moreso than the neurodiverse, but that's not a failing of the concepts that shape the therapy. It's just a fact of life on this earth; everything is geared to people who are not like us. The thing to do is get real and deal with what is here and now, not wait for the world to catch up and appreciate us, and make therapy that is 100% tailored for us.

Ultimately I don't disagree with the major thrust of your post. I would prefer a world where we are more accepted and integrated. But this thread has little to do with that. It's about a disconnection between a person and some therapy that could help.

It sounds like you need to bridge the gap. Was your therapist familiar with conditions like alexythimia? Did you make them aware that you have trouble labelling emotional states?

Fear can be habitual, ingrained, characteristic... but it does not have to be so. There is choice involved in how you react to fear, and that's one thing that you could work with.

The tone of your posts does suggest that there is resistance to the therapy, and that could be coming over. If I can detect it, your therapist certainly will. One of the problems seems to be this idea that you feel like you are told you are the one 'at fault'. This problem can perhaps be cured by a conversation; perhaps you could talk about using a lexicon that agrees better with you. How I see it; it's not so much you are 'at fault', than you have some ways of relating to your thoughts that could use a different perspective. You have more power than you know to respond differently, and that you need to be empowered to do this. If that's a fault, then there are billions of faulty people at large on this earth.

I admire your desire to try and make it work. I'm not sure how much help I can give, if my words have been of any use at all.

It's strange, because I thought CBT was about not placing blame, and just concentrating on practical approaches to dealing with day-to-day problems, but now it seems that any therapy is labelled CBT, regardless of the approach used, because that is the current buzz-word which gets funding.

It's worth remembering that some (usually 18-25s in transition) people on the spectrum do get practical training to deal with "fear of going to a cafe or bar, getting on the bus, meeting people or talking to a group" which is not CBT, therapy-based or focused on anxiety, but is considered as social/advocacy/work-support training, solely focused on accompanied learning and the opportunity to express concerns at the time they happen, in order to get practical feedback. In those situations the anxiety is treated as 'normal, fear of the unknown' but expected to diminish in response to experience. It is a distinction between 'the social model' and the 'medical model', human being or patient.

I think you have to accept that what passes as CBT in one location may be quite different in a different location, and therapists are only human, so whatever approach they take has been filtered through their own perceptions. Some aspies report benefits from CBT, others find it obstructive and useless, but there's no way of telling whether they are referring to the same process.

Your past experiences seem common to people on the spectrum - until there is some recognition that the phrase 'how do you feel about that' can be quite meaningless for some people, and indicates a need for a different approach, that situation is unlikely to change. Emotional-based therapies are probably back-to-front for us - but unfortunately the responsibility to recognise whether or not it is inappropriate for you is down to you, since awareness of your status doesn't give the course-givers awareness of what it is like to be you. In all these situations we end up having to be our own therapists - yet another spectrum irony.

If you experience resistance to the vocabulary or techniques, do not assume it is you at fault - you do have the knowledge that you have reasons which may be very different to a significant proportion of people who undertake therapy, therefore it is possible that what is being offered is not suitable for you. The best you can do is accept it as a learning experience, and hope that there are some useful ideas. You do not have to make yourself 'fit' the requirements of the course; if it is suitable, it should fit you, at least enough to be of benefit. If you cannot accept (and consequently reject) that which does not fit, rather than become irritated or angry with it, it is the therapy which does not suit you - not the other way around!

Another thing, if you find you are 'blamed', don't end up having to justify the impact of autistic differences, just make statements if you need to - if the therapists do not understand your condition, it is their responsibility to find out (although they might not). And it is your responsibility to be aware (even if you do this at a later date) whether you are 'letting yourself off the hook too easily', or whether you have identified something which really does need a different approach. For example, CBT is unlikely to be designed to incorporate sensory difficulties, but these are physical experiences relating to external causes, not mental/emotional constructs; even though the severity, or coping option, may relate to stress and anxiety.

Is it group therapy? If it is, then you may find other people's input can give you more insight into the nature of anxiety as they experience it, and if you do no more than use it as an opportunity to try to be comfortable as an observor that might be beneficial, since becoming a conscious observor is one method of limiting anxiety.

Another point is that there is often an expectation to see 'results' - I suspect that people on the spectrum have different timescales to others, so if you find it beneficial, even if others' perceptions of your progress differ, do what is good for you.

The easiest way to sum that up: if you try to get something out of it, you might; if you expect someone else (eg the therapist/the materials) to enable you to get something out of it, you might be disappointed, since as you said, the presumption is that the 'patient' is a failure, but we know the reasons are much more complex. (I hope that is not too cynical.)

Rather than seek therapy myself, I took the aspie approach (despite being unaware of AS) - I did a course for therapists, to get the inside view first (and try to address my own anxieties about group settings at the same time).

Obviously some of the course was interesting, but there were distasteful aspects, reminiscent of brain-washing techniques, which definitely objectified the 'patient', and seemed designed to reduce the therapy role to one of a doctrine-clone. It was not much different to your therapy experiences, just a different viewpoint, and quite horrendous, so I abandoned the course halfway through, with great relief. The most telling point was the fact that most people were doing the course as a requirement of their job, ie unwilling attendees, working in hospitals etc, and many of them also quietly questioned the rationale and doctrine.

I guess I'm 'active-but-odd' and I've tried quite a range of ways to interact with other people in order to 'fix' my social problems. Inventive, but ineffective, because I never found a hint of the answer, and probably made my anxieties worse. But I would say that very few people have any idea what goes on in their own heads, never mind anyone else's.

Sorry this was such a long post!

I am still unclear where the gap is, I just know it is there. My psychiatrist has talked to me about alexithymia, and has prescribed this course, which is offered within a public general psychiatric hospital, where I receive all my care and services. The therapist running the course works with the psychiatrist, in the same unit, but is probably not very knowledgeable about ASDs. The primary focus is people with depression / anxiety (which I was diagnosed with, and no longer diagnosed with depression - still working on establishing what level of anxiety was normal for me before my big crisis).

Can you help me identify how I am resistant to therapy? I have been told this explicitly in the past, by the therapists trying to emotionally challenge me (which was before I was diagnosed with Asperger's). How do I need to change my behaviour or thinking to reduce this resistance?

The quotes I used were directly from the written materials (yes, it is a face-to-face group course). I feel that they have a vocabulary of blame.

I know that a part of autism is a difficulty in accepting criticism, and taking even positive criticism personally (and, of course, in this instance it is intended personally), so I am sure that I am recalling the "blame" sentences to a greater extent than everything else that is said.

Good questions.

http://en.wiktionary.org/wiki/responsibility
Responsibility:
Noun
responsibility (plural responsibilities)
1. The state of being responsible, accountable, or answerable.
Responsibility is a heavy burden.
2. A duty, obligation or liability for which someone is held accountable.
Why didn't you clean the house? That was your responsibility!
(other definitions are given there but they refer to the military)


1. is rather tautological, so we are left with 2. - now, if somebody says "why didn't you do x? That was your responsibility!" then a question arises: how have they come to assign an obligation onto you? Did you give your informed consent to accept this obligation, or have they just dreamed it up and laid it onto you? I suspect that, to some extent, a strong social norm could be justifiably considered to be OK to lay onto a person, e.g. "it was your responsibility to avoid murdering the innocent," because of the strong consensus that this is the case. But I think there are very few things in that category, and mostly we should refuse to glibly accept any obligations laid onto us by others, if we have never signed up to them of our own free will.

So I think that's the way of telling whether the concept is being abused - just ask yourself the questions "how did this come to be seen as my responsibility? Did I agree to it without coercion?" and "Do I agree with their assumption that I'm responsible for this, or not?"

Interesting that they called you non-compliant. Naturally there's some kind of assumption of compliance if you sign up to a course, or they'd never get anything done, but I don't see the course leaders have any right to expect total compliance, and I think they're quite inaccurate to call you a non-compliant person just because you can't, or don't wish to, comply with everything they ask of you. And they also seem to be meshing "can't" with "won't."

Freud, a man not reknowned for being open to ideas that clashed with his own, seems to have been guilty of this devolution of responsibility:
I at once took her to one side, as though to answer her letter and to reproach her for not having accepted my 'solution' yet. I said to her: 'If you still get pains, it's really only your fault.'
http://en.wikipedia.org/wiki/Irma%27s_injection
Admittedly this was just a dream he had......I can't find other quotes right now, but his letters do seem to show that he was unable to cope with the notion that he could be wrong about anything. Of course in those days deference to the doctor's authority was more the norm - it's sad that such mistakes are still being made in the 21st century.

I appreciate this position, and there is a strong political need for people with ASDs (especially adults) to resist normalization. I think that most of the therapy that I have experienced or seen is for the benefit of society (rather than the recipient), so that the abnormality of depression / psychosis / anxiety does not interfere with the normality of social engagement.

However, I feel that I need to learn how I can engage with the therapy and services that are on offer, whether that means modifying my behaviour to conform or learning to express my appropriate care needs. My life is limited to some extent by social anxiety, and this is a group of people with expertise on managing it. I will gladly take any suggestions you have for making their general-consumption courses ASD-friendly.

Stuart, I came across a recommendation for a book that might be worth a look. The author, Paul Stallard, is a professor at Bath Uni (UK) with a specific interest in this area.

The book (and its companion volume) is aimed at Children and Young People, but don't let that put you off, since I think it would be true to say that being on the spectrum keeps us young-minded, and when it comes to emotional thinking we probably need a simplified approach anyway. The recommendation was from a parent who found the book much more useful than Tony Attwood's CBT for ASD book. A different point of view on CBT might help you engage with it more easily, and a visual/kinesthetic approach often suits the aspie/autie mind.

Think Good - Feel Good: A Cognitive Behaviour Therapy Workbook for Children and Young People
http://www.amazon.co.uk/Think-Good-Cogn ... 882&sr=1-1

A Clinicians Guide to Think Good, Feel Good: Using CBT with Children and Young People
http://www.amazon.co.uk/Clinicians-Guid ... 882&sr=1-2

This download has some anxiety worksheets from the same author, so you can see if they might be useful to you. (P21 The Cool Cat )
http://www.routledgementalhealth.com/cb ... sheets.pdf

( And this download, by a different author, has some CBT for depression worksheets )
http://www.routledgementalhealth.com/cb ... ession.pdf

I did not know Tony Attwood had a book on CBT - in his big Asperger's book he says that CBT is generally helpful and psychotherapy is generally not helpful. I think this might be a part of the problem - since CBT was declared an effective therapy by NICE, and is the only therapy declared effective, everyone calls their therapy CBT while continuing to do whatever they did before.

Thanks for all the links - the Paul Stallard worksheets are very good.

The course is going okay, but my family think it is hilarious that I am stressed out on my anxiety management day, and have to go and hide when I get back from each session.

I am carrying some of my bigoted baggage from previous therapy, but there is a common theme that I get blamed, or I feel blamed, when therapy is not going as they expect. This is actually going okay now.

Before I was diagnosed with Asperger's syndrome, I guess that some of my lack of emotional engagement, looking away from the therapist, slowly and systematically evaluating questions, ignoring some questions and going off-topic (into my interests) were seen as disruptive and non-compliant. I found this great quote that explains on of the nightmare scenarios for someone with an ASD in psychotherapy: "The absence of crying when it would be expected or appropriate in a particular situation or the absence of the ability or wish to cry as a general life pattern is typically regarded in the clinical literature as defensive or symptomatic, especially in association with psychophysiologic disorders. The most frequently advocated psychotherapeutic technique for dealing with inhibited crying is a combination of interpreting the defence and actively encouraging the patient to cry." Judith K. Nelson, Crying in Psychotherapy: Its Meaning, Assessment, and Management Based on Attachment Theory