Therapy? How do you find a therapist that doesn't suck?

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vvvvv
Tufted Titmouse
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23 Aug 2020, 9:27 pm

I recently tried therapy again and it did not go over well. This was the first time I had tried it after receiving an AS diagnosis and just a couple sessions made me remember exactly why it never went well in the past.

I need therapy to address substance use, trauma, depression, etc. not AS, and people continually tell me that seeing a therapist is what I need to get better in those other areas. I want to agree and I do but I also have tried it and what I've experienced is that treating these things in someone with AS is very different than in an NT. I think therapists in general just have to act differently.
Or at least this is what I've observed because I've hated every therapy session ever. It's always been a conversation, them listening or whatever and trying to make me feel comfortable and empathized with, but that does the opposite for me. It makes me more uncomfortable and I'm not going there to feel listened to. I also don't have anything to say either. There's nothing that comes to mind when they're like what happened this week, or what do you want to talk about today. Like I don't know, that's why I'm here.
Like in a recent session I could analyze all the things she was doing and I later realized she was trying to get me to have an emotional reaction to something so she could identify some kind of trigger or talking point. Of course, this didn't work because I have AS and I am a master of behaving correctly in response to triggering questions. That and an indirectly related sentence isn't going to create a genuine sequence of emotions in me, at least not the type she was looking for. I would have prefered she just be direct and tell me what she wants from me. I told her in the beginning that these kinds of things have gotten in the way in the past.

Ultimately I'm at a loss. I feel like I need outside help for other issues but because my brains process is so fundamentally different no one knows how to help. Does anyone else have experience with this or feel similarily? Did you figure something out?



AuroraBorealisGazer
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23 Aug 2020, 10:17 pm

vvvvv wrote:
I recently tried therapy again and it did not go over well. This was the first time I had tried it after receiving an AS diagnosis and just a couple sessions made me remember exactly why it never went well in the past.

I need therapy to address substance use, trauma, depression, etc. not AS, and people continually tell me that seeing a therapist is what I need to get better in those other areas. I want to agree and I do but I also have tried it and what I've experienced is that treating these things in someone with AS is very different than in an NT. I think therapists in general just have to act differently.
Or at least this is what I've observed because I've hated every therapy session ever. It's always been a conversation, them listening or whatever and trying to make me feel comfortable and empathized with, but that does the opposite for me. It makes me more uncomfortable and I'm not going there to feel listened to. I also don't have anything to say either. There's nothing that comes to mind when they're like what happened this week, or what do you want to talk about today. Like I don't know, that's why I'm here.
Like in a recent session I could analyze all the things she was doing and I later realized she was trying to get me to have an emotional reaction to something so she could identify some kind of trigger or talking point. Of course, this didn't work because I have AS and I am a master of behaving correctly in response to triggering questions. That and an indirectly related sentence isn't going to create a genuine sequence of emotions in me, at least not the type she was looking for. I would have prefered she just be direct and tell me what she wants from me. I told her in the beginning that these kinds of things have gotten in the way in the past.

Ultimately I'm at a loss. I feel like I need outside help for other issues but because my brains process is so fundamentally different no one knows how to help. Does anyone else have experience with this or feel similarily? Did you figure something out?


Could you search for ones who specializes in AS?

I've often wished when searching for medical doctor that one of the filter options was "doesn't suck" :P .



XSara
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24 Aug 2020, 8:09 am

when you go to a therapist for the first time they're going to try to interview you to know some things about you. you should interview them in return. ask them questions about autism and you other problems, hard ones, test them, and see how knowledgeable they are.



emotrtkey
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24 Aug 2020, 8:12 am

I recommend skipping the therapist and going to the library to read some books written by highly rated expert therapists. You get above average therapists, can go at your own pace, no one needs to guess or make assumptions about your triggers, and you can use what helps you and ignore what doesn't. If you want a therapist, it probably won't work well unless you're willing to be yourself and be honest with yourself and the therapist about how you feel instead of trying to hide or mask differences. There are also websites that are helpful. The information on https://autismcbt.wordpress.com/ helped me the most.



vvvvv
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24 Aug 2020, 5:02 pm

emotrtkey wrote:
I recommend skipping the therapist and going to the library to read some books written by highly rated expert therapists. You get above average therapists, can go at your own pace, no one needs to guess or make assumptions about your triggers, and you can use what helps you and ignore what doesn't. If you want a therapist, it probably won't work well unless you're willing to be yourself and be honest with yourself and the therapist about how you feel instead of trying to hide or mask differences. There are also websites that are helpful. The information on https://autismcbt.wordpress.com/ helped me the most.


It's not that I was purposely masking anything. I always answered openly and honestly as myself. I'm never sure what kind of answer the therapist is actually looking for. I answer the way I would but ultimately I don't know what I'm supposed to be doing when I'm in therapy, I'm not trying to hide anything I just don't know what they're trying to find and they haven't been great at just being direct (which I realize is often something people DON'T want, but is something that I do). Also thankyou for the link I'll definitely read more from there.



emotrtkey
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25 Aug 2020, 2:28 pm

vvvvv wrote:
It's not that I was purposely masking anything. I always answered openly and honestly as myself. I'm never sure what kind of answer the therapist is actually looking for. I answer the way I would but ultimately I don't know what I'm supposed to be doing when I'm in therapy, I'm not trying to hide anything I just don't know what they're trying to find and they haven't been great at just being direct (which I realize is often something people DON'T want, but is something that I do). Also thankyou for the link I'll definitely read more from there.


I realize you weren't doing it on purpose. I'm just saying therapy is more difficult for you and the therapist if you're autistic since you may not understand yourself very well and most therapists don't understand autism very well which is why I relied on books and websites. Therapists avoid being direct because many people in therapy are very sensitive and get upset easily. If the therapist is direct, many of their patients will get offended and never come back.

There are different types of therapists and therapy styles. Counselors mostly just listen because some people are lonely and just want someone to talk to or they're frustrated or angry and want to vent. Some therapists (psychoanalysts) will talk to you about your childhood to find stuff that contributes to your current problems. Other therapists use CBT to try to help you understand your problems and think about things differently to help you get better. If someone is depressed, they may tell a therapist things like "No one likes me. I'm such a loser", "I'm never going to get a job. No one wants to hire me because I'm different." Then, the therapist will show how those thoughts are distorted (overgeneralizations, predicting the future) and explain how negative and distorted thoughts are contributing to their depression and how to think differently (for example, focusing on the facts without interpreting them since depression can cause people to misinterpret things in overly negative ways).

One of the treatments for trauma is similar to the classical conditioning described on the "sensitivity to criticism" page on the website I linked to where your mind associates the trauma (and anything related to it or that reminds you of it) with the emotions you felt. After they helped you think about it differently to reduce unwanted emotions, they'll often use gradual exposure therapy to help reduce conditioned responses to it.

I don't know much about substance use treatment other than many people use substances to escape painful emotions (such as depression or trauma that happened to them). I'm sure treatment includes addressing those problems and finding healthier alternatives to cope with them.



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26 Aug 2020, 8:07 pm

vvvvv wrote:
It's not that I was purposely masking anything. I always answered openly and honestly as myself. I'm never sure what kind of answer the therapist is actually looking for. I answer the way I would but ultimately I don't know what I'm supposed to be doing when I'm in therapy, I'm not trying to hide anything I just don't know what they're trying to find and they haven't been great at just being direct (which I realize is often something people DON'T want, but is something that I do). Also thankyou for the link I'll definitely read more from there.
Knowing what a therapist wants to hear and being able to deliver that answer in a believable manner can make or break your therapy experience. So your concern is a very good one. Most therapists have some semblance of a conscience, so if your answer is "wrong", they'll simply not believe you or pretend not to know what you're talking about. But sometimes, your therapist will retaliate for you "not cooperating" by triggering your buttons until you turn into a crying emotional wreck.

I started a thread, dating a while back, called "Powerful Therapy Hacks 'They' Don't Want You To Know About". (link: viewtopic.php?t=383445) It talks about "managing up" your therapist---that is, tricking them into cooperating with you. Some are blatant, some are subtle, but they're all based on real-life experiences and studying the legal system. (State laws may vary.) Here are some examples from the thread, in no particular order.

* RELIGION
Pretend to be devoutly religious, if you're not actually like that. Bring a pocket-size Bible to the sessions. Make Biblical references while you talk to the session. It gives you social proofing of your fellow believers, as well as god himself, so your therapist will be less likely to mess with you.

* EMOTIONS
Therapist love emotion talk. Your job is to memorize emotion words, and keep repeating them in conversation as much as you can stomach it, and provide a justification for each emotion you "felt", true or not. It's like giving a presentation at work or talking to the judge in traffic court.

* OUTFIT
Dress more formally that your therapist. At the minimum, wear a shirt and tie for men, and the equivalent for women. Your goal is look like slightly intimidating and nonthreatening at the same time. It's a hard balance, but it can be done.

* CRYING
Therapists delight in making their patients cry, usually as a power game in the guise of "teaching you to open up". You can produce actual tears like this. Put some onion paste into a small ziplock back (a.k.a. "dime bag" used by drug dealers), and hide it in your pocket. Then when you need to fake-cry, discreetly stick your finger into the onion paste, and rub it under your eyes.

* MONEY
When your therapist gets too abusive---and they usually will---stop it the quick and dirty way: threaten to stop coming. Your therapist wants the easy income from your sessions, so you can hold it over his/her head.

* TAKING NOTES
During your sessions, take notes, and make sure you write vigorously, with a slightly angry look on your face. It will intimidate your therapist into treating you better, because you're recording what goes on in the session, and have the power to use it against him/her.

* NO SELF-DIAGNOSING (if you use nothing else, use this hack)
Under no circumstances ever self-diagnose. Therapist HATE that for some reason, and it really angers them when patients self-diagnose. They may retaliate against you by pushing at your emotional buttons to make you cry. So for example, never say "I have depression". Even though most therapists are blithering idiots, they still want to feel smarter than their patients. So let them have that: talk about your symptoms only, and let them do the diagnosing part, and praise themselves for a "job well done". For depression, describe a low appetite, insomnia, listlessness, lack of energy, etc.

* REVERSE PSYCHOLOGY (corollary to last one)
When listing your symptoms---to self-diagnose without actually doing so---use reserve psychology. After you list your symptoms, say something like: "All this sounds like depression, but there's no way I could have it. I'd be embarrassed as hell if I did." He/she may ask why you'd be embarrassed, but you can say you're worried about your insurance company raising your rates. Why does this work? Your therapist will want to be right and have you be wrong. So they'll play right into your hands: giving you the diagnosis you knew all along.