Autism and CBT

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Gracey: I see other posters here have commented both on what the NHS does and doesn't cover as well as how effective CBT is or isn't, and re: the latter issue, there seems to be mixed responses (some positive, others negative). Not being in the UK, I can't comment on the NHS, except (to bang a dead horse), (flaws aside)we need an NHS in the States too, still waiting for the US to become a normal country and get universal health care.

Re: your question about the effectiveness of CBT for people w/ASD, the community of Aspies I'm around here in NYC says the exact opposite of what you're being told: that CBT is the only proven form of therapy that consistently works for many people on the Spectrum. Our public health care systems (Medicare, for the elderly and Medicaid for the poor, which I'm on), I dunno if they cover therapists who specialize in that or if they cover therapists who specialize in ASD. What I have found here through my previous therapist is a couple private organizations that are tailored to people w/ASD, one of which does offer psychotherapy. Unfortunately they don't even take private health insurance (I hate explaining our f****d up health care system in the US to people from other countries b/c it's so f*****g convoluted and complicated), but I have decided to bite the bullet and pay out of pocket their reduced rate for poor people b/c they do specialize in ASD. And this organization only uses CBT. We have a specific book that we use for it called "Living Well on the Spectrum", which I've just started reading. My new therapist gives me weekly homework to do w/the book, which is fine w/me and so far I'm finding it pretty educational. I am very early in the process, so I can't speak from personal experience as to the effectiveness of CBT (only time will tell). But aside from the Aspies I know in the community who speak for it, I have a good friend in Canada who (as another poster suggested) taught herself CBT and she swears by it! She lives alone and has various physical health issues, besides her ASD, but she says to me that CBT has given her control of her emotions and most other issues so she can at least tolerate and cope with her life situation.

In short, it sounds like some policy changes are necessary at the NHS (though I'm not saying CBT is the only kind of therapy that works for people on the Spectrum), but I am agreeing w/other posters that it certainly CAN work, depending on the person.

What is DBT anyway and how (in a nutshell) does it work?

Thanks for that, I relate to nearly everything you wrote.

I don't necessarily think that a therapist needs to be an autism specialist to be effective, they just need to be more aware of neuro diversity and be prepared to actually listen to their clients instead of using the same methods with everyone. I know that the "one size fits all" approach is a lot easier for them and will help them tick their boxes/meet their targets, but that leaves their clients damaged and feeling that therapists are impervious to their suffering.

DBT involves:
- Mindfulness (learning to be more aware of your thoughts and feelings)
- Emotional Regulation (techniques to deal with intense emotions)
- Distress Tolerance (ways to cope and avoid total meltdowns)
- Interpersonal Effectiveness (assertiveness, communication skills, etc.)

I've found CBT and DBT to be very helpful. My only problem is when it comes to being 'mindful' of physical sensations, which tends to make me feel worse rather than better. (More aware of pain, discomfort, anxiety symptoms, etc.)

For me empathy was nothing than just a word once. I didn't had a clue that it's more than just mercy and an important thing to NTs. But you can't start to feel empathy if you don't feel it just by changing your thoughts. But you have to deal every single day with people who are emotional driven and do feel empathy. I didn't knew that most NTs act nearly always driven by emotions. But once you know the way their brains work and once you are able to read their body language then you are able to get better along with them because you can adapt your behaviour and change their feelings towards you. But the required adaption of behaviour is mostly not to copy the behaviour of other people.

Sample. You are late to a meeting and feel bad about that. NTs see you and their empathy causes them to read your feelings by feeling the same way. If you feel bad you cause them bad feelings to and they are angry on you because you are late.
Once you know this you know that you have to stop to feel bad about being late. It's a fact that you can't even change. Instead you come in with the best mood and enjoy the people that you see. Their empathy causes them a good mood too and enjoying to see you. It's really hard to be angry on somebody who you enjoy to see.

Life becomes easier once you are aware of the way that the brains of other people work especially if your own brain works a little bit different.

Just finished two years of cognitive behavioral therapy with counselor Jeanne Courtney in El Cerrito, ca

The insurance paid

That b***h did not tell me one original statement

Almost no advice. The things she told me to do were not drastic:. Cafe, podcast, walk,

Almost all sympathy. She was melodramatic in her word choice. "Unfortunate", "distressed", "mad", "helping people", "hurt"




But rarely looked surprised


She told me that the insurance usually rejects the application for the third year of counseling, but she was confident it would grant me a third year because you are "neurodiverse"





That stupid b***h Jeanne Courtney did not know


neuroplasticity

" mad" versus " angry"

graceful degradation

to 83

python

major five personality traits



And not only that but she, acted like, every thought and emotion that went through her stupid lil head was the latest greatest scientific invention



And she was, by far, my best counselor

Out of 35

I have had a lot of CBT on the NHS for depression and anxiety prior to being diagnosed with ASC last year.

It certainly helped with challenging unhelpful thoughts in a variety of situations but for me I always knew I was trying to 'trick' my brain but my brain was very good at spotting what I was trying to do and so it never changed or stopped the unhelpful thoughts in the first place.

I also found that when you did not make as much progress as they expected they assumed you were not trying hard enough, but now I can see that trying to tackle social anxiety in this way was never going to work.

Following my diagnosis I was sent for me CBT as I was really struggling to come to terms with ASC, but after a few sessions we abandoned it. Everything the therapist wanted to work on then came up against the 'you are wired differently and this is not going to help' wall.

I am now waiting for DBT and Acceptance Commitment Therapy, which has a 12 month waiting list in my NHS Trust.

I think I read somewhere that CBT is only affective in about 1/3 of autistic patients (probably for reasons others have mentioned). But it is still the most recommended therapy type (probably because 1/3 is better than 0) - until they come up with something else.

DBT is an upgrade to CBT originally designed for people with Borderline Personality Disorder, who suffer from more extreme emotions than most. So if your problem is getting control of extreme emotions, DBT might be worth a shot.

For myself, I don't seem able to get anywhere with CBT, and I've been wondering whether ACT (acceptance and commitment therapy?) might be a good way to go, but I don't know much about it.

I don't mean to put down anybody else's experience with CBT, but what I did with it, that I don't see anybody else mentioning here, is I "made it my own" by taking the parts that worked well for me and incorporating them into my personal philosophy.

Example: you learn to identify and challenge negative self-talk. I use that daily, changing it to positive.

Another example: you learn that what you THINK other people are thinking, may be quite wide of the mark, so you actively ask to clarify.

I was never explicitly given CBT but rather, gifted therapists would introduce one portion of it at a time, as it became applicable with my lived experience. And if I rejected a portion, they did not beat a dead horse.

Later, I used the techniques of CBT with my own clients as a practicing therapist. (Which I no longer am.)

How is it, I wonder, that some people are dismissive of dozens of therapists and therapies, while I found maybe 10% of my therapists, ever, were crappy (and promptly fired) and 90% of them ranged from "acceptable" to "excellent"? Was I that good at picking, or did I come to the experience prepared to learn, experiment and grow?

I feel it was a combination of luck, good choosing and not being adverse to therapies in the first place (Meaning not expecting and looking for the worst and being able to stand up for yourself).

I've mostly kept to the therapist I've had for almost seven years, she's great because she's ND as well. Not sure if she's autistic, but her son is and she has ADHD and sensory issues.

I've had good OTs both times, the hypnotherapists were so-so but the horses were great, my only really bad experience was my middle school school counselor who was a real witch who didn't really believe my diagnoses and would repeatedly insult my therapist me and my mother. I was in special ed one period a day and they all sucked as well, and treated all of us like extra work and tried to get me to give up accommodations. But that school was a hell hole and so I'm not sure I'd count any as true therapists.

None focused on CBT but some CBT was used in bits at a time.

Yes, I think that's a good point. I'd go so far as to say that it's a pretty good definition of therapy that's "working" - you come away with better coping strategies in your toolkit and the confidence to use them. Expecting a silver-bullet for unhappiness is very likely to result in disappointment!



In the context of the OP's original question and home country, these may be rather moot, though. Mental health care with that kind of choice is incredibly expensive here in the UK. Most autistic people are reliant on the NHS, and sadly, that just isn't geared to any kind of flexibility or continuity. If you can get your GP to refer you for therapy, you generally have to wait several months, get no choice in what counsellor you see, and will be very lucky to receive more than a dozen consultations unless acutely harmful behaviours are identified. For Alexithymic people, I think this is particularly pertinent, as a lot of time can be spent trying to develop the patient's emotional vocabulary so that the necessary internal reflection and ability to communicate it is possible, which is also key to "DIY" coping mechanisms. My most recent counsellor told me to my face that she thought the termination of my sessions was "unethical" as I quite obviously still had a need, yet neither her nor I had any power to change that.