Therapists vs. A caseworker? Will the doc say something?

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So to recap what has happened to me, for years I have suspected AS, and in the process of being treated for mental illness, occasionally a professional or a therapist would bring it up. But now I have started to go to therapists that are treating me as if I have AS and even changed my therapy from DBT group therapy to talk therapy. But it turns out my caseworker is not happy with this, she told me they are not doctors and cannot diagnose. All the actual psychiatrist said was "She needs the therapy, Asperger's or no Asperger's"

Where do I go from here??? My caseworker wants me to leave the therapists and get therapy somewhere else. I don't think I can get evaluated properly because I've been told that I'm very mild and admittedly I was impaired as a child but not so much as an adult. Also I have medicaid and I don't think I can get an adult evaluation.

Unless your therapist is hurting you I don't think I would quite trust your caseworker. Isn't her job to advocate for you, not agitate you? And if she is criticizing therapist's diagnosis, is she qualified?

Therapist is either qualified to make diagnosis to treat or works with someone else to do so in order to get paid. And I'm guessing they get paid? So they are or work with someone qualified to diagnose. Maybe not ultraqualified but likely more than caseworker.

Makes me angry hearing what caseworker is doing this, but I suppose she could have your best interest in mind.

Have you asked why the caseworker wants you to go elsewhere for therapy?

Last edited by Waterfalls on 16 Jul 2014, 8:10 pm, edited 1 time in total.

My diagnostician (with a Master's degree in counseling) was able to diagnose my Asperger's Syndome, but, because state laws govern the ability of therapists to diagnose, your state might not allow it.

Your mild-AS severity probably also includes one or two characteristics which you might want to improve. I used a link similar to this (http://psychiatrists.psychologytoday.co ... I&spec=251) to find my diagnostician. I also found, but didn't seek, therapy using the same web site.

Finally, I was able to use Medicaid to pay for my AS evaluation and factor diagnoses, but, because Medicaid is governed by state and federal laws, your state might not allow it. It is worth asking about.

medicaid should pay for it as long as its the right eligible doctor to do the "referral" of the testing. also, not sure about michigan, but in indiana they have special medicaid programs(waviers) that pays for stuff that the traditional medicaid wouldnt. (ex. BDDS Autism medicaid wavier)..

Maybe I'm over thinking this, but the issue of why there is no agreement on whether I'm an Aspie, and even the truth of I'm not sure myself, could be one of these factors:

I have AS and it's hard to tell because:
I'm female so it's not as obvious
I was more impaired as a child and I got over lots of my impairment (one doctor told me this)

Or I don't have AS and it looks like AS because:
I have higher than normal IQ and it looks like it a bit
I might have BAP, I do have an autistic close relative
I have bipolar and possibly ADHD which could be causing something like it

Is the caseworker qualified to contradict trained therapists and psychiatrists?

If not, the qualified people have the greater voice, don't they?

What specifically happened was I was sent to do some individual sessions with a facilitator of the DBT group. But she then saw AS and brought it up with me and she did the RAADS scale with me which came back positive for AS. She transferred me to another therapist in the same office who has dealt with many cases of autism spectrum disorders and she started therapy for it after giving me the AQ test to make sure. The caseworker and the psychiatrist are not happy because I was suppose to do DBT. The therapists in my state are not allowed to diagnose. I did have two therapists in the past think I have AS and also one doctor in the hospital. But one of my past doctors didn't think I had it and the therapist was arguing with him, lol.

But basically, my husband is claiming that the therapists are lying about AS in order for me to keep coming to see them. He though doesn't understand AS and even trying to get him to read stuff about it it won't sink in. He thinks she is diagnosing me with many different disorders, because he doesn't understand how the symptoms fit together.

Do you feel helped by what the therapist is doing? I think that's what matters.

And even if she isn't permitted to diagnose, I would think she needs to deliver a kind of therapy she believes will help you, not confuse or hurt you. You said it's dbt group therapy, maybe she thinks giving you the dbt techniques individually is better for you.

I think the important thing is whether you like the therapist and whether you think she can help you.

I don't know how the system works in Michigan.

Here are some questions you need to ask yourself to figure out where to go from here:

1. What is my biggest problem right now? (What symptoms am I seeking help for)?

2. Who is trained to treat this problem?

3. How do I get a referral to see this person?

Your caseworker can help you with Questions 1 and 2 if you are not sure. I'm assuming the title of caseworker means the person is supposed to coordinate your care and make referrals when you need them.

I was having problems with depression and anxiety bad enough I would meltdown and want to harm myself. I am currently not having those problems because I'm in a less stressful situation now and mainly the therapist is helping me with the relationship between me and my husband.

I don't know your whole circumstances but if it were me and the therapist is helping, I would say to the caseworker and psychiatrist that she is helping me and I like it and if I need something else in addition that I am ok with that but she is helping me and I don't want to give that up. If they think I need dbt group in addition I could try but this helps and I want to continue.

A turf war if that is happening over diagnosis and over who is in charge is utterly irrelevant to your needs. And those things always wind up with me getting hurt if I don't see them happening.

What I'm going to do when I see the therapist next is share with her the situation, if she does not know already because the caseworker was going to call her. and ask more specifically her background with ASDs and how confident she is that I really have this problem. Analyzing my situation over the course of years, I think the most likely scenario is that I was affected by it greatly as a child but as an adult I can appear normal especially since I am female and some people see it while others do not.

Talking to the therapist seems like a good idea.

This situation just makes me anxious for you. It seems like more complicated than what's on the surface because why are people fighting through you about the diagnosis? It's not like the therapist can't use dbt techniques with you regardless what diagnostic label she uses. She can.

I hope they can come together about this so you get the help you need.

I want to keep the therapist because she's really positive and is giving me good advice on understanding my husband's behavior that I don't understand. What I forgot to mention that came to mind is the fact that caseworker is going to lead her own DBT group very soon and she is hinting that is where she wants me to go instead of where I am now, would the caseworker get payed more if I went to her group or something?

Maybe. But the reason doesn't matter.

I've never done it but I'm pretty sure DBT isn't magic. And if there is a lot of group discussion it can get really confusing. So that's something to think about. I know I'm fine if one person is talking and lets people ask questions one at a time, but when people are taking turns in conversation.....it's hard to sort out and track everything that's happening. Maybe someone can explain more to you what it would be like before you do it.

I think it would take someone with a commitment to supporting people with ASD to help a person with ASD manage and be ok and even get something out of a group.

Talking to your current therapist seems like a good idea to me.

I'm no expert or anything, but I have been in therapy for a long time. For me, I keep the same therapist or psychiatrist as long as it helps me. If I feel like my needs aren't being met or I feel like I can't trust the person, I try to find somebody else to work with. Something to keep in mind when working with mental health professionals is that they all have their own biases. Their interpretation of a situation is not gospel, just their opinion based on education, life experience, and clients they have worked with in the past. Different mental health professionals can interpret things differently (as you have seen with this situation). They are trained experts in helping people with mental illness, but you know yourself better than anybody else. Do what you feel is right. That's my opinion. Do you think your case worker will give you flak if you don't do what he or she thinks is best?