Therapist DOs and DON'Ts

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After reading through some of the threads here, I found a lot of valuable information for people like me who are therapists to patients with autism or Asperger's.

For me it would be very helpful to see a list of DOs and DON'Ts, and maybe it would be a nice release for some of you who have have positive and negative therapy experiences. So I'll start, and hope someone continues.

DO: use a solution-oriented approach.
DON'T: ask "How does that make you feel?"

Oh I would give anything to be able to go to therapy and learn coping skills and get a definite diagnosis but I have no healthcare. Anyway I would say DO : use techniques that are structured according to the individual rather than the diagnosis. DON'T : " everything will be okay". I just know that some things won't be ok.

Last time I saw the psychs who evaluated me (who are also into therapy) they repeatedly asked me if I feel alright. I know this was well meant, but leaving me with disturbing questions in my mind combined with this resulted me being in a 6 day long down period...

Just because I have above average intelligence and I seem quite high functioning doesn't mean I couldn't have difficult problems in my life that virtually tear me apart (that supposedly I can and should solve using my intellect). In fact, it would be wise to assume that I can also hide my problems better, and they should act accordingly.

I think I'd love it if somebody asked me how an event made me feel, so I guess that's one rule that doesn't apply to everybody.

Using a solution-orientated approach - not sure - I began to think of one of my counsellors as Mr. Rock Bottom because every time I was a bit pissed off he would try to impose his Rock-Bottom theory on me, the idea that to grown, you have to break down your psyche until you feel you have nothing left, and only then can you rebiuld yourself, because the original architecture had dead ends in it that couldn't allow growth until the building had been demolished. But perhaps he was right, and just needed to avoid sharing his theory rather than avoiding using it? And I agree that if the client can't accept that they're there to look for solutions, how can progress be made? So I guess it's good if a counsellor is thinking in terms of "what's the problem" and always nudging the client into the kind of taking that can bring them to realise what that problem is - sometimes even just bluntly saying what they think it might be.

I think everybody is different.....for me, I recoil from anybody with the slightlest whiff of superiority - no guru trips, no overt leadership. I much prefer the feel of nondirective therapy, but I see how that can just end up in a random reverie of thought that never gets anywhere......clearly the counsellor needs to be able to direct me into examining an area that is likely to give me a valuable insight.

A light touch with directiveness is probably the best thing for me. The moment I think somebody is angling for control over me, all is lost. And I've heard that from others.

DO be aware of transference, and DON'T counsel if you don't know how to handle it professionally. That's tough on men, because women usually make the best counsellors in terms of being sensitive and easier to talk to, but it's probably better for a man to have a male counsellor if he's lonely. I never fell in love with a counsellor, but I've heard that it happens, and spouses can hava a hard time coping with the thought of their partner being so intimate with an opposite-sex counsellor, which isn't IMO really right even if there are good safeguards built in.

Think twice before imposing a face-to-face session......an Aspie can feel invaded by that, and may do much better if they can sit away from the counsellor and avoid eye contact. Naturally, DON'T counsel Aspies unless you have a good understanding of their quirks.

Do keep a sense of the client's changing mood. That should inform the choice of technique better than a static approach.

Mostly I think a good counsellor should always be asking themselves "where is this client at?" - each individual has their own do's and don'ts, which can change as the relationship with the counsellor changes. One client may be violently opposed to any interference to his talking, another may be crying out for somebody to guide his thoughts and tell him what he's doing wrong.

Good luck! Counselling is a highly-skilled thing and I'm not surprised there are so many bad counsellors. I'd do it myself but I just don't have the social imagination/intelligence to work on more than one client at a time, and my partner would always get that, although of course there I have to handle the transference two ways, so it's rather a different calling, though a lot of the techniques work.

I agree with lots of whats been said (Not all mind you, but much).

Seeing as my current issue is a lack of health insurance, I could suggest:
DO: Have a way of making your care available to low income
DON'T: Treat people like not worth your time because times are hard and finding affordable Health Insurance is like finding a needle in a haystack......

Ta,
Aldran

Do give lots of encouragement
Don't always focus on the negatives.

Thanks for the responses so far. For those who have not been in therapy or for whom it is not an option, can you think of what you might want a therapist to do with you if you had access to one who is familiar with autism? Or what would totally turn you away?

Also, any info pertaining to what might have been helpful to you as a kid (say age 11-18 ) would be really helpful to read about.

To answer your first, I know what Im looking for right now, even though I don't have the money to really seek it. Basically a Diagnosis (And to clarify, Im looking for outside confirmation, for my own peace of mind) about Asperger's and wether I fit it or not. Im pretty confident I do, but that little niggle will probably be there for a very long time if Im unable to seek a proffessional outside opinion. After that, I don't really feel like I need therapy, Im doing ok, could be better could be worse, same as anyone I suppose.....

What would turn me away? Preconceptions, in a word. A feeling of trying to fit me in a box I don't feel is for me or describes me, OR, a feeling of a rush to do so. IE, If I feel you're not willing to work with me and what I know or how I feel, I'm not gonna stick around.

As far as what would have been helpful as a kid? Well, I never saw a therapist when I was a kid. Closest I got was a "School Counsellor" who was overworked with far more problems then I had...... This board is littered with 18+ Diagnoses, because in my mind we don't have enough knowledgeable people in our school system watching for things (Though admittedly, this isn't a fault of specifically just the school system. It could also be caught elsewhere, doctor's offices and what not, but screening procedures would have to be developed for as many possible chances to screen a child before they get older as possible)

I also feel that, living in area with supposedly some of the most reputable Medical Staff and Facilities, there is a distinct lack of available care to those with out easy means to get it (IE, a surplus of Cash to dump in it), and in the area of Asperger's and Autism specifically, an Egregious lack of any information, support, willingness to find or even apparently look at, or deal with Adult Aspergers/Autism. I do a Google search for the Seattle Area, and 98% of what I find comes up with the words "Kids" or "Teens".......

I don't know if that helps or not, but Good Luck regardless,
Aldran

I have never seen a therapist (or any mental health professional, for that matter), but I have heard of many instances in which a therapist expressed skepticism at the possibility of an AS diagnosis because the patient was socially competent. I was thrown off the trail of my own self-diagnosis for years because people seemed to regard social functionality and any form of autism as mutually exclusive concepts. I happen to function very smoothly in most social situations (specifically, the ones that I'm prepared for and comfortable in). However, after a lot of research and reflection, I've come to recognize that most of my social interaction is a highly complex amalgamation of mimicry and learned social behavior, not spontaneously generated.

Also the more I learn about the subject, the more general differences between genders affected by AS seem to crop up. I think the way I deal with AS and people's perception of me has a HUGE amount to do with being socialized and regarded as female.


Thanks for taking the time to research this topic and ask questions!

Therapy or counseling is just an absolute DON'T for me. I never had a good experience with it.

My high school guidance counselor used to complain to me about the other students who came to see her. It was kind of obvious she didn't really enjoy her job. She complained about having to listen to them and it made me wonder if she complained about me to the other students. It also came off like she was passive-aggresively complaining to me about having to meet with me. I think this goes without saying, this is a huge don't.

When I was 15 my school required me to see an outside counselor, who was being trained by a psychologist so I had to see them both. By that time I was very well versed in psychology, as I had been reading college psychology textbooks and the like for a few years. They tried to use a lot of "tricks" on me and I understood every one of them. After several sessions they told my mother they could not make any progress with me because I already knew too much about psychology. So, don't try to use any classic tricks of the trade, especially on intelligent, well-read people because they will see right through you.

Another one is when the counselor visited my school, we had to talk in a room next door to where the intercom system was located. The walls were thing so when the headmaster used the intercom, we could always hear over the intercom that someone was being counseled in the next room over. You could hear pretty clearly what was said and people in class would snigger over it. When I had to go in that room, I told the guy I did not want my conversation broadcast to the entire school over the intercom, and he did not take me seriously. If people have concerns about their privacy, take it seriously and be respectful.

The biggest failure they all made was taking an "emotional" approach to understanding me rather than considering whether I might have actual neurological issues. Don't try to find an emotional basis for every issue.

One thing I think is crucial is assessing someone's emotional understanding. ASD is all over the place in this regard. Asking someone how they feel - as you already pointed out - is useless. Also, remember that what a description or explanation of a feeling may mean to you may not be what someone means. Sometimes 'happy' is just the opposite of sad. Be cognizant of inappropriate emotional responses. I know i suffer from this quite a bit and it has always been treated lightly or denied altogether. It is extremely troubling to, say, not feel grief at the loss of a love one - at least not the way everyone else does. There really is no way to coax the 'appropriate' way out. There really needs to be a system that recognizes an ASD person's feelings and their expression of them as valid in their own right and to remove the guilt of not expressing them the same as others.

Many on the spectrum are goal oriented. For me, talking about my problems doesn't nothing for me. It offers no relief, no comfort, no healing. All of a counselors suggestions end up denied because I have already examined my issues from every conceivable angle and have already tried to apply those suggestions to my situation with little success long before I met them. I have only attended counseling at others recommendation. Personally, I'm still not even sure what it is supposed to do. Apparently the simple act of talking makes others legitimately feel better. It won't do that for some portion of people on the spectrum. Talking is simply a way to share information. I was always waiting for 'the solution'. Here I was giving a counselor all this background, all this information - I honestly thought, at some point there would be a final conclusion. A report. A final plan. A finite end point. Try and be clear up front what the purpose of talk therapy is... in very simply terms. I have a decent IQ and a college degree... and I still can't really wrap my head around it.

I think therapists shouldn't be too hung up on what they learned once they start seeing people. They should converse in a human, natural way, rather than believe they have a role to "save" the person they're talking to.

Wow, great feedback. I've been able to take a lot from each person's response. A few statements really stood out to me:

I guess for many, the feeling of being taken seriously and above all UNDERSTOOD by someone is therapeutic in itself. I am starting to realize that there are some differences in this regard between autistic and non-autistic patients. What you say here, that all the talk brings you no relief whatsoever, is starting to become clear to me, but I wonder if this is the case for most Aspies? What you said about wanting to have a "solution" is something I've heard before. My ultimate goal is to help patients find solutions to their difficulties but obviously these solutions are really coping strategies, as there is no real "solution" to a person's way of thinking and feeling.



This is good advice that for NTs is probably as difficult to navigate as it is for people with autism trying to navigate the NT way of thinking. I am really interested to hear more about typical situations where there is, for you, no emotional reasoning behind a certain behavior, but where NTs ascribe emotions to it.



I concur! I have one such patient at the moment and find therapy with her quite difficult, because she is able to very elegantly maneuver social situations that do not come naturally to her. To the outside, it seems effortless, but it is totally draining her energy and causing her a lot of anxiety. It took years of struggle before she got a diagnosis and even now, she has encountered a lot of skepticism. Because she seems so "normal" on the surface, I forget how challenging it is for her to have a conversation with me, and she sometimes complains of exhaustion and even nausea. She also quickly feels I am getting too personal, which makes her feel uncomfortable, while I feel much of the time that I am holding back on asking about personal things that I would normally ask a NT patient without a second thought. It is very difficult for me to find the line between "too personal" and "too superficial". One example is having asked whether she gets along well with her siblings, and how she would describe their personalities, which was for her too personal but for me just a routine question in therapy. Hoping to get more views on this subject... what for an Aspie is "too personal"?

I'm sorry to read about how many negative experiences have been had in therapy but I can say from the therapist's perspective, working with Aspies is (at least for me, I am sure for others as well) extremely challenging. There seems to be a strong resistance to new ideas and suggestions for change which is quite demotivating from the therapist's viewpoint. At the same time it is a huge learning experience. The exhaustion I feel from trying to understand and get into the Aspie mindset for just a few hours a week is what many Aspies deal with every day of their lives!

Anyway, it looks like we've lost the DO and DON'T format of this thread. I guess it is not as simple as DO and DON'T!

Please keep the feedback coming!

I said this elsewhere but it bears repeating:

DO NOT try to put me in Group Therapy! I cannot stand that. I can relate better (well, communicate anyway) one on one. Talking to groups (except maybe clowning around, which I did a bit in School, but always from my seat!) is Verboten! I just freeze or have panic attacks. Plus, is it even relevent?
DO try to see me as a Unique individual, with a different take on the World than yourself.
DO not equate my problems with Personality disorders or Schizophrenia! (I'm guilty of it myself <cough>)
Do try to see me as someone who IS productive in Society & has overcome a long list of challenges.

Sincerely,
Matt

In general, I have the most constructive dialogue and the most personal revelations when I have deep, meaningful conversations that are more existential in nature. Talking philosophically about nature, humanity, society, etc. helps me to experience fundamental shifts in the perception of my personal life experience. Focusing too closely on my day to day life, or even my life in general, I think results in disorientation. You know, like, seeing the small picture and getting too wrapped up in the details.

I don't know if it's the case for other people with AS, but all of the things that I'm super into, it's because learning about or doing them somehow helps me understand and be at peace with "life, the universe, and everything".

Most therapists stop asking that after the 1st meltdown.

You sound legit though. I looked for a therapist on craigslist and it didn't turn out very well. I read "therapist looking for work", well later I found out it was a typo and the ad was supposed to be "The rapist looking for work". I'm sure he wanted to ask me "how does that make you feel?" but I got the hell outta Dodge.