Therapist DOs and DON'Ts

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I think you are infering. That's also a "don't" You offer an idea that is new TO YOU, to a patient who has a habit of overthinking and analyzing everything to the bone. The new solution you're offering is dismissed because it isn't new, it has been though of, modelled, imagined in real time situations, and found to be flawed. The issue is this one: your patient might just say, "no, nope" and not explain why they are refusing this idea. It's sometimes too long and too exhausting to go through the whole thought process again in order to explain the "whys" to you. When that happens, just ask "oh, have you thought about this before?" and I'm pretty sure the answer will be yes.

Well, bear in mind I am diagnosed with ADHD, not autism. Also, I haven't set foot in a counselor's office since I left college, over 14 years ago. So it's been a long time and I'm not sure if I remember well exactly how this played out in counseling. I just have this vague recollection that they always wanted to talk about things in a touchy-feely way that sounded really stupid to me.

The failure was that no one ever considered that I might have ADHD, or any sort of learning disabilities, and they certainly never considered autism. They took the approach that all of my issues were related to emotional/mood upsets or "depression". For instance my sleep issues were always attributed to depression. This might be a whole other topic for discussion, but I think in general many issues are commonly attributed to depression, that shouldn't be.

I used to cry very easily, and once I got started I couldn't stop. A very slight emotional trigger could set me off, or a sensory issue or even just a mild sense of overwhelm or confusion, and I would just cry until I exhausted myself. It was all very straightforward to me, I knew exactly why I was crying, but I couldn't explain it because I couldn't talk while I was crying. Other people got more upset about it than I did, and they would try to "talk me through my feelings" to find some deeper significance to the event, and I got really frustrated because I felt like they were looking for something that wasn't there.

I think this is a very difficult thing for most people to understand, how an expression that seems so obviously emotional, like crying, doesn't necessarily have a complex emotional motivation behind it. There might be some emotional reasoning behind it, but not as much as they think there is.

I burst into tears during my ADHD evaluation, when they gave me a test that taxed my working memory. The mere sensation of "my brain doesn't want to function this way" was enough to set me off. To me that is the same as crying because I am in physical pain. If I cried because someone hit my head with a hammer, there would be no confusion as to why I was crying. I basically feel like my brain is hit by an invisible hammer every time I have to think in a way that isn't natural for me.

I'm rambling, and don't know how to put this into a DO/DON'T format, but hopefully some of this makes sense. As far as situations where people attribute emotional reasoning where there isn't any, I could give a lot more examples from daily life or relationships than I could from a therapeutic context, because those are more recent. It might be another thread topic though.

This is what I'd like from a therapist.

1. Don't make me over. What you see is what you get. So what, if I like The 60s and I look like one of The Kinks? That's the way that I like it.

2. Talk to me like I'm a grown adult. Don't speak to me as though I'm a child, or a teenager. Don't talk down to me and please don't talk like a Valley Girl, just because my birth certificate states that my real gender is Female. Talk to me with the same grammar that you would use if you were talking to a man.

3. Do see me as a person who has a lot of potential. I'd be more motivated to set goals if you were to do that.

4. Do listen to what I have to say and ask questions if you don't understand me, instead of laughing at the things that I have to say. I'm your client and not a comedian.

5. On the days that I'm happy or doing well, a logical approach would be better. On the days that I'm feeling under the weather and I seem tearful, an emotional approach would be better. Different things will work for me on different days.

6. Do not take my special interests away from me. I'll stop seeing you, if you try to do that.

Are you FTK? (Female-to-Kink?)

Actually, I am.

Awesome!

Big don't here: Whilst friends find "ohh look at me I'm crazy" jokes hilarious therapists do not. Especially if you claim the bag you have with you contains your mothers severed head.

do: realize that sometimes we may say everything is ok but it really isn't. I don't always have the words to explain what I'm feeling and it's too exhausting to figure out how to make someone like a therapist to understand.

don't: ask vague questions. Ask specifically about how christmas went with family. Did you feel overwhelmed by anything? What did you do when you felt overwhelmed?

^^THIS^^ so much! Emotions are so greatly varied in ASD. Some people can barely connect to them, others are overwhelmed by them while some of us have inappropriate emotional responses that do not correspond to what an NT would normally associate with the reaction they are witnessing. Many meltdowns look like crying fits - I know mine decline to the point of very low or no verbalization at all. And usually they have nothing at all to do with being sad, or angry or any other associated emotion. It is simply an overload - too much input, not enough processing power = blue screen of death meltdown.

NT's experience the world by how they feel about it. ASD experiences the world by what they think about it. That does not mean that NT's do not think just as it does not mean that ASD does not feel. It's a different perspective. If you want to try and meet someone with ASD on their level, disconnect the emotional filter and try and engage them intellectually. Ask what they think - not what they feel.

I'm no therapist but I would venture a guess that many ASD issues that may require a therapist's assistance are opportunity's to act as an NT translator. Helping someone who doesn't understand NT culture to bridge that gap. It may be more about practical advice than emotional support. And you may have to be able to really understand HOW to break down the NT instinctual social tools to their absolute most basic form. Make sure that your definition of a word matches an ASD definition of a word. Never assume someone with ASD understands all of the implied 'shades of grey' that may exist. Like 'friend'. In ASD that may be as simple as a yes or no answer. The NT version is much more complicated; friend, acquaintance, work related, family, best, etc...

This is no small topic and there are no one size fits all answers. It will never be as easy as 'DO' or 'DON'T'.

Do: use a cognitive behavioral approach
DONT: even think about getting Freudian on me

Do: help me work through current situations in my life
Dont: drag out every trauma I ever had... thinking regurgitating all that will solve all my problems

DO: have an open mind, I am totally unique
DONT: tell me I cant have autism on our first meeting, because you dont know how far I come, only to be denied my struggle ever existed

Do: embrace my gifts and acknowlege my difficulties
Dont: treat me like I am either mentally challanged or nothing is wrong with me.

LOL that reminds me of a time when a friend of mine had a psych consult at the prison he worked at.
It went kinda like this

Therapist: come in.
my friend...that means you to you rascal (looking at bare space on the floor)
T: who are you talking to
F: Listen you brat...it is my turn to talk to this lady (still looking at the floor)
F: These little green men in pink tutu skirts are driving me nuts...I cant get a word in edgewise
T: what are they saying?
F: they are doing Russian dances while singing in Portuguese
T: ok I think we are done here
Receptionist...what did you tell her?
F: I told her about my green men in tutu skirts
Receptionist: you better get in there and tell her you are joking cuz she called the paddy wagon

F: Ma'am I was kidding, dont send the men in the white coats after me.
T: rolls eyes.
door closes, friend leaves the office
F: come-on you little green freak. you about had me in the funny farm

hope you all enjoyed that.
btw...dont try this at any therapist office

Jojo

DON'T talk to 13-year old kids as kids. I know it sounds like an oxymoron, but when I was 13 my mother took me out of school one day and dropped me off at a therapist's office with no explanation. I felt utterly unprepared and violated. The fact that I wasn't asked permission bothered me a lot, and the fact that the therapist did nothing but ask questions and communicated only with my parents afterward made me feel even more defensive. He stared at me face to face over his desk and I couldn't say a word. All I could do the whole time was cry because I felt like no one actually wanted to hear what I had to say. I'm sure that was not really the case, but there I was being glared at, examined, and I didn't even know what I did wrong to deserve it. That's not to mention what followed, not that I think you would do this, but yes DON'T prescribe ritalin to a child who shows no DSM described signs of ADD and has freaking kidney disease.

DO take time to explain and discuss matters with kids. A grain of respect goes a long way, especially if you want to see who they really are at heart.

Age 13 was quite literally the worst year of my life, all thanks to the snowball effect caused by that one therapist I only saw for 30 minutes, who handed my parents a magic bullet for "fixing" me. I wish I wasn't, but to this day I am too afraid to seek any sort of counseling. Even some days when I really want to have someone to talk to, I can't do it. I just remember how much bleeding kidneys hurt less than people treating me like a defective car.

I second all of this, and I think they are very important points.

This amuses me because my therapist loves that I know so much, she enjoys debating me.

Good point. I will definitely ask "have you thought about this before?" more frequently.
For the record, I've often been accused of overthinking and analyzing everything to the bone too... Sometimes when I analyze something, mull over a possible solution or approach for hours and hours and imagine it in real time situations, I will come to the conclusion that it will not work. But once in a while if I just try it out (usually at the strong encouragement of someone I trust), I am surprised that it went differently than I expected, because my interpretation of the situation may have been totally skewed in the first place. I can get stuck in a defeatist mindset and it takes an outside person to show me a different way of thinking about it.




Well put... it's disconnecting the emotional filter that for me is the difficult part. That and finding out where the individual person with ASD is on the emotional/non-emotional spectrum and where their boundaries are- For example the "too personal" issue I mentioned earlier, or what CockneyRebel wrote:



I guess the best approach to finding out would be to ask directly "do you feel like covering topic XYZ today?"

I wish this forum had a "like" or "thumbs up" button. Thanks all for keeping the feedback coming.

For a kid, 11-18, I would tell him to embrase his differences from the norm and tell her about all the famous makers and shakers of our society that have done great things who also have Asperger's, autism, or bi-polar, that though these "gifts" can be difficult because society can be cruel to those who are different, people like us who have such wonderful, "special interest" are able to excell in the interests seemingly more so sometimes than NTs. We are able to focus on those interests and learn everything about them and become experts. Bill Gates was probably and awkward dorky kid, but no one is picking on him now, are they?

I would tell them about how fast time seems to get away with you and how in seemingly no time at all, they can either endup being a tired, old beat down ex waitress, who once wanted to be a famous chef but now, is disabled w/ 4 grandkids and wonders where the time went, or they can be anything that they want to be if they want it bad enough and are willing to overcome all obsticles to achieve their goals.

I wish I had known long ago, of just how important my special interest actually were for my future.
You know what stopped me dead in mu tracks of feeling like I could become that great chef?
My Mom said that because I was a picky eater, and many things will not get past my gag reflex simply because they do not feel right in my mouth, that I could never be a great chef.

Since then I have found that to not be true. I do not have to take huge gulps of something I do not like, to be able to tell if it is seasoned right and if all else fails, fake it. I was a very good cook. I do not like guakamole dip, but people loved the way I made it. I cannot handle biting on a peice of onion but I cook with it all the time and have learned to slurp them, verses chewing them. There are many ways of getting around problems to achieve goals.

I just wish, I knew that then. After that dream was crushed, (one I had since age 5), I never had a nother goal like that again.

To this day, people flip out over my cooking, but my dream will forever be unrealized. I never even realized before just how much that hurts, till I just started crying.