Total Confusion: AS/Cognitive Behavioral Therapy

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I'm here for advice because I'm totally confused. In fact, I feel like I'm being driven insane by therapists. Here's my background. I've been going to a Cognitive Behavioral Therapy group because my therapist recommended it, and I was trying to explain my social anxiety and disconnect to the mediator who teaches the David Burns CBT techniques. The techniques are based on having negative beliefs and overcoming them enough to go forth and function. In my case, interacting successfully with people. Has anyone had experience with CBT? I honestly don't know if I should be going to these groups.

Anyway, I explained that I didn't have a lot of negative beliefs about myself, so I wasn't sure how CBT could help me. I don't feel like I am worthless after unsuccessful social interactions, but I have a lot of trouble making friends, getting people to respond to me in groups, and having people misinterpret my behaviors. Everyone, including therapists, constantly assigns to me motives that I don't have. I never have any motives when interacting with people. I just want to be able to connect with them with my real thoughts and feelings, but I usually get no response or weird looks, and afterwards, I never know if I should try to connect with them again or if they disliked me and I should stay away from them. I haven't made one new friend in several years of grad school. Basically, all my social interactions are unsuccessful. Everything feels extremely shallow during interactions, and I always want something deeper and more genuine.

In the CBT group, the mediator asked me what I was projecting that was driving people away from me. I didn't know, so I asked him about my body language and tone of voice and facial expressions that were offputting, but he wouldn't tell me, like he expected me to know or go home and figure it out for myself. That's why I asked him. No one's ever told me that information. I said that I often mention odd ideas because I find them interesting to think about and not necessarily do (e.g. shrinking people down and keeping them in jars, like in a terrarium of little people or as a collection), but I don't bring these up right away when I meet someone. But if the person is friendly, this stuff might pop out of my mouth within a few minutes, usually without a lot of conscious control. In social situations, I say stuff like this because I don't know what else to say and I find weather-related topics boring, or I don't say anything at all because I just can't follow the ongoing conversation. All the topics jump from one to another and by the time I think of something to say, it's too late. I never know when I should step out of a group when they're all talking to each other and I'm quiet, or if I should try again and again. But nothing I try seems to work. Everyone pretty much ignores whatever I say. I fake-smile and fake-laugh a lot because I have no clue what's going on during these interactions. A lot of the time, I'm evaluating whether what someone said is valid/true/makes sense. That takes a lot of mental energy because I have to consider all the different factors. Everyone else seems to understand each other and get each other's jokes right away. I'll get a joke ten minutes after everyone else laughed and I'll laugh while everyone else is talking about a school shooting tragedy or something like that. I did that last week in my CBT group. Joke, no get, no laugh. Ten minutes pass. Dead children, get joke, laugh at joke. D'oh!

I've been to two different therapists in my life besides the ones in the CBT groups. I never tried to seek a diagnosis of anything but just tried to cope with social anxiety and get better in social situtations. One thought I had AS. One didn't because I was pretty good in a one on one situation with her talking about my issues. But I did feel like I was faking a lot of stuff there. I think I have a habit of faking my way through all interactions. It's really exhausting but totally ingrained. I have a huge range of facial expressions that I bring out as soon as I leave the house and I feel like I'm contorting my face most of the time. In eighth grade, I walked around with a creepy smile on my face for the whole school year. People asked me what was wrong with me at the end of the year. I ape everyone else's facial expressions, with a small time delay. When someone brings up that someone died, everyone else immediately responds and I have no expression and feel nothing. But if someone tells me how they feel that someone died, I get it and can get really emotional. I can feel what they feel. I have empathy. They just need to share some little bit of feeling to bring it out in me.

Every once in awhile, I'll meet someone who responds well to me, and I feel like these people have some "spark of life" that I can't find in most people. But I may not be able to start/maintain a friendly relationship with them because they could be a total stranger that I talked to for three hours at the beach while I was only there to take photos by myself. What am I supposed to do here? Ask them for their email address so I can keep in touch with them? They never ask me for mine. I always enjoy these interactions a lot. They're like a high to me. The conversations are wide-ranging and neverending and I learn a lot about the other person and vice versa. But what then?

So I told all this to the mediator tonight, and he basically dismissed everything I explained. He seemed to think that I wasn't trying hard enough. I've been trying my whole life. I always try to be as friendly and helpful as possible when people ask me anything, like if a student asks me a question during office hours. I always give everyone else the benefit of the doubt. Actually, I never doubt them in the first place. I have no motives, so I assume that they have no motives either. Wrong! He identified one of my negative beliefs as "I feel disconnected from people in social interactions". Is that a negative belief? I feel like that's a fact. Is it invalid? Is it distorted? Am I really totally connected but don't realize it? That makes no sense! Everyone else in the CBT group has negative beliefs like "I am worthless/incompetent/unlovable". I don't have those. I'm so confused right now. I don't know if I should start pursuing a diagnosis or if it's all in my head. I really feel like I'm being driven insane.

As for the rest of the AS traits, I have many of them. I have obsessive interests that I can do all day long without seeing anyone. I don't need to see anyone at all, but I enjoy spending time with people I like if I know that they like me. I have numerological obsessions. I really like the numbers 3 and 7. I have many of the speech patterns. I'm always repeating what people say to me and I say things over and over again the exact same way because if I change the words I change the meaning so I can't change the words. I drill points into people until they run away from me. These patterns show up in my writing too. People have noticed them. I feel like people need to be shielded from my intensity. I can't ever sit still. I rock back and forth while eating at the kitchen table or sitting on the couch. At my desk, I constantly fidget my legs and feet. As a child, I was so clumsy that my parents told me I had Parkinson's Disease. I still have the clutziness triad of dropping things, falling over, and bumping into things. I can't stand it when people eat or drink things next to me or even the specific way they push food around on their plates. The exception is when I'm conversing intensely with them and I don't notice their eating behaviors. My mother calls me to remind me to eat food. When I go shopping, I develop something I call "Mad Human Disease". I start getting even more clumsy, then bored out of my mind/being tortured by boredom, then my brain shuts down and I need to recover for several hours in peace and quiet afterwards. In the outside world, I'm very observant and always the first to notice anything. I'm intelligent and creative and have an excellent memory and learn things easily and can figure things out easily except for social interactions. I talk to myself all the time. I rehearse conversations. Every little thing that I see or hear gets incorporated into one of the complex realities in my head. I can associate anything with anything else. These are things I can't really mention in the CBT group, because I feel like I've already been dismissed several times and expected to just say that I feel horrible about myself and I should use the CBT techniques like everyone else does. They're supposed to make you feel better about yourself, but I feel worse after I get back from using and abusing them.

Sooooooo sorry for the lonnnnnnng rant. I'm very confused. I need help. Do I sound like it's all in my head like the mediator seemed to be saying? I don't even know for sure what he was saying. He's always psychoanalyzing me and never says anything directly!! ! Why is there no "I am going insane" emoticon? Let's try both of these.

I'm really only familiar with CBT with respect to OCD, and I'm not familiar with any of the particular methods. I can see how it can apply to those with social anxiety, but AS isn't necessarily social anxiety.




The problem is, the therapist is likely NT. They tend to have different responses to social situations than those on the spectrum and this really gives them an inability to empathize with those on the spectrum. For example, most NT's tend to relate social abilities to self worth, and so social rejection tends to lower their self esteem. I think a person on the spectrum is far more likely to just be puzzled about what they are doing wrong. Most therapists I've encountered have mis-judged my feelings, intentions or reactions to various situations. Honestly I really don't see how NT's get on sometimes because it seems to me they are frequently devastated by or worry about completely silly things.



Yes, well that is the $10,000 question isn't it. Obviously if any of us knew, we wouldn't have that problem.



The problem is, he thinks you have NT social problems rather than some type of processing disorder.



I would generally avoid bringing up topics that involve doing unorthodox things to people.




I would even avoid it with friendly people.



How are tornadoes boring?



Honestly, I think talking about shrinking people and collecting them in jars is far more socially appropriate than jokes about dead children.



Many people, especially adults, or children talking to adults, are very good in one on one situations within a certain scope. I would not try to get an evaluation from someone who is not familiar with, and significantly experienced in dealing with adults with AS because they will almost always have misconceptions concerning the manifestation of it in adults.

AS is very similar to NVLD, and a right brain processing disorder is implemented in NVLD. The right brain does pre-filtering of raw data, and the left brain resolves more and interprets. If your right brain does no do this filtering effectively, the left brain gets fuzzy data and has to work harder to resolve it, so many people with NVLD or AS have slow processing speed.

It really doesn't sound like you feel the CBT group is helping you. Honestly, I really can't stand the type of psychoanalyst who thinks there is some deep, hidden meaning to everything and like to reject all reasons that seem too simple to them.

I am, and always was, a very straight forward person. If I say I'm happy, I'm happy.If I say I'm sad, I'm sad. If I say I'm frustrated, I'm frustrated, and in all instances, I'd be able to tell you why.

I think perhaps you should be going to a social group geared more towards people with AS or similar social issues.

Sounds like stupid therapists. I'd quit at once.

Why not try asking the e-mail of one of those people you get along with? You've got nothing to lose.

Yes, he seemed to be misinterpreting everything I described. Except I'm not entirely sure how he misinterpreted them, what he thought I was saying. I asked him exactly what his interpretation was, but he wouldn't tell me except to say that "I feel disconnected" is my negative distorted belief that I need to brainwash myself out of. He also said that I shouldn't ask people things directly. I know it makes people uncomfortable, but I thought he'd give me some leeway and answer because he's a therapist presumably trying to understand and help me. This is a naive delusion of mine, isn't it? I am like a 5-year-old when it comes to people's motivations and intentions. He kept asking me questions about my relationships with the people I already know and love, like my parents and childhood friends, without explaining how they were relevant to my main problems.



He said there were something like 300 non-verbal signs that people project/identify. I asked what my face was projecting to him. He wouldn't tell me. I don't know why.



I'm beginning to think that this guy is so invested in CBT that he's blind to all other possibilities, AS or whatever, and even other types of therapy.



That's a great idea, thank you. I think there's one social anxiety group run by the therapist who brought up that I might have AS in the initial screening appointment that we all have to do before we can get a real session. But her schedule was so full that I could never get an appointment with her. Maybe the reason her schedule is so full is because she's a good and perceptive therapist who can see AS in people with many traits of AS?

I have no experience with CBT, just with a good deal of NTs - including various mental health professionals - who completely misunderstand what I'm trying to say and have accused me of being difficult when I'm being precise. It does sound like this group isn't really working out for you as it is for the other people there. I can't say I'm surprised. I'll try to explain how he probably sees things, but generally speaking if someone starts dismissing that you are able to think the way you say you think there's just nothing you can do to make that person see your point of view. They are too locked into what they know to be true for everyone everywhere at all times.

Yes, this is very frustrating. If you stay with him you must make him see somehow that if he doesn't explain what you're doing wrong you can't begin to fix it because you are blind to it and will just keep doing it. Not out of lack of desire to improve, but because you don't have the ability to identify the root cause on your own. He needs to help you develop those abilities and a part of that may mean giving an honest frank assessment and using that as a basis for some examples and then helping you get better at extrapolating from there. NTs tend to believe that if we just 'really work on' intuiting what's wrong it will happen. It doesn't really seem to work that way for most of us, we have to actively learn what comes naturally to them. Unfortunately changing someone's mind is one of the hardest things to do, and I say that about about convincing him, not about you learning how to read body language and tone of voice better.


If I had a dollar for every time I'd been told I wasn't trying hard enough I'd be a frigging millionaire. The problem isn't trying, the problem is the NT method doesn't really work for us. We can get better than we are at this stuff on our own once we have a good solid basic ground covered, basic tools and examples to extrapolate from. But just telling people they need to try harder is not helpful. It's like telling a drowning man "well stop drowning and swim" rather than throwing him a life jacket, asking him if he can swim or not and then teaching him some basic swim strokes when you find out he can't.


See, as someone with AS my first instinct isn't to say that's a negative belief on it's own. What I would ask is "When you think about that disconnect what feelings if any do you feel?". The belief is valid to me as being able to be a neutral factual thing - some people have little need for companionship and are more bothered at being asked to play the social game than by wanting to but feeling unable to. Similarly many people with AS are quite bothered by it.

What he as an NT is doing is reading strong negative beliefs into you feeling disconnected because that is the general norm. For example an NT saying "I don't feel like I understand anyone here" wouldn't be interpreted in NT talk as saying what to an AS means "I don't know what you people mean by what you say" but as "I feel alienated from all of you and it makes me feel very alone". The former interpretation does not necessarily include any negative emotions, it may be genuinely puzzled. The latter interpretation emphasizes the negative emotions of not feeling like you belong in a group over a lack of understanding what's being communicated.


Yeah, a lot of people in that mental health care industry are like that. I think they're very used to having people who have all the tools to fix their own problems, so they like to be vague and indirect and sort of nudge people towards a direction and see if their natural instincts don't take over. Kind of like introducing a domestic cat to a mouse for the first time, it's assumed that the cat will figure out this is potential food as instincts kick in. Only we're more like one of those weird lab cats that's got a mouse brain so we just lick the mouse to say hi and go back to sleep.

Last edited by KBerg on 15 Feb 2011, 11:02 am, edited 1 time in total.

My psychologist is a specialist in people with AS, and he says that CBT has to be done differently with people on the spectrum than with NTs.

That's one of the reasons I am seeing him - because I didn't want to do CBT with someone who had no idea. In fact, the first thing we did was a diagnostic assessment for AS (and that is how I got my diagnosis), so that he could proceed with CBT in an appropriate way.

Usual CBT is designed by NT's for NT's and run by NT's. With this in mind, the CBT mediator assumes that you know about facial expressions and non-verbal communication. The mediator has been trained to think that it is only your negitive belief that is holding you back thus is not understanding your clear statement that you have absolutely no idea about what you could be doing incorrectly.

I think continuing with this CBT mediator may be damaging in the long run because, even though you know that you don't know about the non-verbal communication there would seem to be a risk you'd feel needless guilt based on the attitude of the CBT mediator. It's not that this person is bad, it's just that they're not trained to even consider that there may be a real and honest to goodness lack of knowledge of communication.

As one-A-N said, it is best for to work with someone who has a knowledge of the differences between NT's and Aspies because they will have a better idea of how to help you as you.

I wish I could give a more thoughtful response but, how can therapists be this awful? Seriously, don't they have to be trained.
Sometimes it seems like they feel their patient is lying to them--why?
Vague, indirect, and unhelpful comments they are all in the post. Pyschoanalyzing--Uggh!

"I don't feel like I understand anyone here" how much clearer could that be, there is a misunderstanding in communication
"So I told all this to the mediator tonight, and he basically dismissed everything I explained." listening to patients is critical, why would a therapist think otherwise
"He seemed to think that I wasn't trying hard enough. I've been trying my whole life." and then you get insulted
"He also said that I shouldn't ask people things directly" very bad advice
"I feel disconnected" that's the therapist conclusion!! seriously 50 min session for that.

I have unfortunately experienced therapy that was a "waste of time" like this.
It is beyond frustrating.
I hope you are someone else. They are not all this bad.
excellent comments from kberg BTW

I can't imagine doing well in such a program. The inconsistency of the whole thing is bizarre. For example, how can I know what I am projecting? For me to know that, I would have to stand outside myself and observe myself. The people around me can tell me what they perceive about what I project. And I can speculate about what they might be thinking about that (Theory of Mind?), but I am on the inside doing the projection.

I would probably be asked to leave such a group because I would eviscerate such inconsistencies and ruin the mediator's process.

Bingo. Everything you wrote in your second post leads me to believe that is the case. His unwillingness to answer questions means he's probably not gonna be of much practical help. He's stuck on what he knows (or rather believes), so he reads into what you say what he knows (again, believes) people are supposed to feel deep down. Because he's cut off deeper communication as an option this isn't going to change.

He may not be a bad guy, he just was never taught people like us think differently. Add to that that he's been trained to be the person who's supposed to know everything about people so he probably quite literally isn't able to understand that what he's been taught can not apply to someone. From his point of view you're either in denial about what you feel or you're just being difficult. There's nothing you can do to change that, if the man is lucky he'll at some point attend a fascinating seminar or lecture where some NT doctor with a fancy degree in CBT and AS will open his eyes. But all you can do is find someone who can actually help you and that person isn't him.

There can b connections between autism and parkinsonlike traits. Some people are born with them, some are not but may or may not get them later, sometimes they are stable, sometimes progressive. Mine I was born with them and they were stable until puberty then became progressive. The following has descriptions of certain movement issues and their connections to autism. If the server is down keep trying back later.

http://www.iidc.indiana.edu/?pageId=468

Some stuff not listed on the page is dyspraxia and apraxia. Dyspraxia is usually clumsiness and ranges from mild to severe. Someone I know with severe dyspraxia is more clumsy than a guy I know who is blind and has severe cerebral palsy. Apraxia is usually a very severe motor planning problem. It can cause inability to speak, if it's apraxia of speech, and it can cause general inability to do just about any voluntary movement. (Apraxia generally if an autistic person has it it will generally cause them to be labeled severely autistic, but not always.)

Note that movement issues in autism can cause trouble in things other than outward movement such as getting stuck on a topic or thought. That page I linked explains a lot of that. Sorry to only reply to one tiny piece of your post but this is one of my areas of knowledge and I can only write what I am triggered to write, not what I try or want to write (another movement related issue).

Your post really makes sense to me and I relate to most of it.

I'm going to therapy right now too and I am definitely getting the same "vibe" as well. Mainly, I'm pretty sure that my therapist believes that my difficulties with social situations are entirely explained by negative thoughts (related to past experiences gone wrong)... or that I'm just not trying hard enough to make new friends.

While it's true that past experiences play a part and that I may experience a negative emotion if a social situation goes wrong, I feel like it doesn't make it to the heart of the issue. It does nothing to answer the why. And I still had these problems even when I was really young. What, then? Still bad experiences? I'm a little doubtful.

Additionally, I'm a very happy person, generally, even despite the fact that I have like... no friends in my program right now. Yes, it hurts me since I sit alone in class and I'm usually the last person to hear about any events. Yes, I often feel extremely disconnected from the people around me too. I'm supposed to be building up a social network in my college years, and all I'm doing instead is just going to class and coming right home. But... all the same, I don't want to dwell on the negativity. Instead, I want to work on improving.

The kind of therapy I'd like to see would be help in building up social skills, help with body language and facial expressions, and, in general, just how to communicate more effectively. I can get by okay, but getting by and thriving aren't the same thing. I know that difficulties never completely go away, but they can be deal with and understood in a way that's helpful.

All this said... I'm not officially diagnosed with AS. Even so, I'm tempted to seek out a support group or something directed at those on the spectrum. I'm sure I'd find it more helpful than simply "talking" about my problems. My only concern is that people will dismiss me simply because I'm good at faking it.

There is a book on CBT for Aspergers. I'm reading it but havent gotten far. You might want to check it out to see what aspects of it they push as helpful and see how it may differ from this group. The author has a lot of experience with AS. Her name is Gaus.

I didn't read ALL of your post but I know exactly what you are saying.

I went to about 2 of these sessions and had the same experience, I also have this experience with therapy in general.

I don't think CB therapy is good for some people, especially people on the spectrum. It's assumed that you are wired just like everyone else are just *malfunctioning*, when you go to these groups. If you aren't wired the way you're *supposed* to be, it's not going to help. You can't work on issues that aren't there and I know that they don't even believe you when you tell them that you aren't struggling with the things they say you are, they think you're playing games.

This has been my experience with almost all psychiatrists and psychologists, they think I'm playing games. It took me awhile to really get it. I usually quietly agree with them, now, and just never come back if I can sense that they are not listening to me and pegging me as someone who's just seeking attention or whatever it is that they think I'm doing.

I think that I would screw that type of therapy up very badly for the therapist and for myself.

I think your therapist failed when recommending you to group therapy. While it is great for people who are NT it is often pretty awful and frustrating for people on the spectrum. The minute a therapist recommends group therapy for me is the minute I fire that therapist immediately. Group therapy is primarily designed for NTs, it took a very long time for my boyfriend to grasp this concept. It took me a very long time to explain how I process things. I think it is because NTs learn through empathy through others situations, while people on the spectrum learn very differently. (Much more analytical in many ways.)

No joke.

CB does work for people on the spectrum as long as the person understands the spectrum, and realizes group therapy is not a recommended course of action for those on the spectrum.