I'm now seeing a therapist

Post Reply New Topic

Insurance will cover about 10 sessions, telemedicine. My goal was to see if he'd recognize ASD in me and make it official, or refer me to someone who could. I don't think I can afford an actual assessment out-of-pocket.

He said he doesn't diagnose officially, but he'd look at the manual - then he started getting hung-up on things that seemed trivial to me. Well, it was stuff about my childhood. He asked about any obsessions or interests, which I confirmed. For instance, as a kid, I loved maps (street maps, US maps, world maps). He then said, "Yeah, but did you go on-and-on about maps to kids in the lunchroom, like they told you to shut up but you kept it going about maps?"

As a kid, I was more quiet and could take a hint when people weren't responding. Or wasn't bold enough to keep going. So, that was a NO for him.

He also claimed he was a school psychologist, and I didn't seem Autistic to him. Something about me having good conversational skills. I told him, "Well, I'm damn near 40, I've had to survive by talking to and with people. Plus, you're a shrink. It's very cut-and-dry that you're being paid to listen to me, so this can't be seen as a 'regular' conversation."

He seems to think that any social and executive and sensory problems I've had/have can be solved with behavior adjustment. I'm skeptical.

If I do save up for an official diagnosis, can I be misdiagnosed over trivialities? What should I focus on when I talk to him next week? And, maybe I don't have it, but so many posts here from other users seem like the story of my life. Perceptions of what constitutes autism in the eyes of these professionals still seem to be very child-centric. Of course, those kids grow up, but don't grow out of their autism...

For those diagnosed in adulthood, what did the assessor focus on? What were the main things that suggested to them you were on the spectrum?

One thing that I found odd was that my assessor thought it was strange of me not to ask follow up questions when she told me she was from the same city as me.
I guess she focused on my childhood pretty much. I guess that makes sense since the adult me has learned to mask pretty heavilly, so that the traits aren't as obvious now.
I suppose what made up her mind was that she could check all the boxes. Not sure if there was something in particular.

/Mats

Thank you, mohsart.

As I suspected, it seems like adult diagnosis (or even entertaining an adult diagnosis) is still a reconstruction of childhood behavior. Still odd. All those Aspies much older than me who got diagnosed late in life had to go about their young adulthood and middle aged lives, seemingly learning or adapting or adjusting their behavior to get by. But it looks like diagnosis is still childhood-centric. So, adults are diagnosed based on generalities, but more importantly, childhood behavior...does this sound accurate for the adult diagnosed?

My psychologist not only assessed me, but she interviewed my mum over the phone. I had let mum know to expect a call from a psychologist but I didn't tell her it was about autism. So in my diagnostic report there's a fair bit of input from my mum.

I was diagnosed using the DSM IV-TR, so each criterion was met or not met. Plus I had an IQ test.

At one stage the psychologist took me out of her office into the lunchroom. She introduced me to some of her colleagues. I said hi and then turned my back on them and programmed the time into their microwave. At a later appointment I was told that what I did was pretty autistic. She wanted to see what I was like around people I didn't know.

I believe the interviewing of relatives is pretty standard procedure, my assessor interviewed my brother and one of my uncles; also the IQ and other tests is standard I think.

/Mats

I think this therapist you are seeing does not really understand Autism and he definitely does not understand Autism in adults. If I were you, the first thing I would do would be to switch to a different therapist. You are allowed to keep switching until you find someone you click with. Find someone who is very knowledgable about Autism in adults and Autism in females. Even if you are male, someone who understands Autism in adult females will understand that Autism can present differently than the stereotypes. Also make sure that the therapist you find listens to you and isn't arrogant or gaslighting.

The things you described in your original post are examples that should make a therapist definitely consider Autism. If you were obsessed with maps as a kid, that doesn't mean you had to be opsessively talking about them. Some Autistic kids are shy or just prefer to not talk to people.

So definitely look for someone else. That's the first step.

I agree with skibum. This therapist might not be qualified to do an Adult Autism Assessment. There is a standardized process they are supposed to follow, they are not supposed to make up their mind just by talking to you.

While I had an Adult Autism Assessment I don't want to share too much about what conclusions the Psychologist made based upon direct conversation with and direct observation of me. It's not that it is too personal (it isn't) but I think you should not go into an assessment prepped and planning how to interact. I think it is important you let the (competent) assessor meet you being yourself. I suspect anything else could taint the assessment results.

I think the most important thing in getting an Adult Autism Assessment is probably getting it performed by someone who is qualified to do an assessment--there is a standardized assessment process they are supposed to use and there are some questionnaires and some structured activities involved.

Based upon my experience (in the U.S.) my recommendation to anyone (in the U.S.) who wants an Adult Autism Assessment is: Ask your insurance provider whether mental health is covered and, if it is, whether an Adult Autism Assessment would be covered. And, get the assessment performed by a licensed Psychologist who accepts adult clients, has experience with Autism, and is willing to perform an Adult Autism Assessment. (My insurance provider told me the Psychologist had to have ABA credentials...that is wrong...ABA credentials are not needed to perform and Adult Autism Assessment! And the Psychologist's website is unlikely to mention Adult Autism Assessments because I don't think there is much business there.)

I agree, though I'll be honest: I'm already starting to feel like I need to prepare if I do go for a real assessment. I know, intellectually, I should be diagnosed (or not) by just being myself. And like you and others have said, this therapist isn't qualified. But it is disheartening hearing a medical professional seemingly imply I'm "not Autistic enough" in his worldview.

And maybe I'm not really Autistic. But I'm afraid that I am, yet I won't get the correct diagnosis based on the whims of one assessor if I didn't present a certain way in childhood.

Remember there are different kinds of medical professionals, it's important to get one whose expertise is relevant. Or...to a man with a hammer everything looks like a nail. (And if you've met one Autistic you've met one Autistic. Someone who met a couple of six-year old Autistics might not be the best person for doing an Adult Autism Assessment.)

If your insurance is covering you seeing this guy then maybe they'd cover an Assessment elsewhere? Or, at least let you switch to someone you had more confidence in?

It's pretty scary how few therapists actually understand Autism, especially in adults. And it's even more scary how arrogant some of them are. I had to go through quite a few to finally find the ones who were able and willing to respect me.

It was hard to find a shrink who took my insurance AND had openings, he was the first; and this is my first time. He told me flat-out he can't give an official diagnosis. He then suggested a place that doesn't take my insurance and isn't seeing new clients.

I asked him for his opinion anyway. I'm not sure how old the students he worked with were, but presumably no older than 18...a topic for our next session. He also said he has a client with Autism, and I don't "seem" like this particular client.

Me: Who diagnosed him?
Therapist: He was diagnosed in childhood
Me: Okay, so he's probably only in his 20s.
Therapist: Yeah.
Me: If he's only in his 20s and had the benefit of being diagnosed in childhood, his life may have turned out much differently than an almost-middle aged man who went without a diagnosis all these years.

The therapist then got a bit defensive: "Well, even if you are, you've come this far. I'm a BEHAVIORIST, I think we can work on your behavior. What good would a piece of paper do?"

He told me it's hard to get SSI/SSDI...I said that wasn't my goal, though I suppose it would be a good back-up plan. I also said having official papers may come in handy down-the-road, let's say in a bad work environment.

"Well, no," he said, "They may try to get rid of you instead of accommodate if they know you have a disability."

I told him I understand. But if I don't disclose and they're still trying to get rid of me anyway, it may be a good ace up my sleeve...bureaucracies tend to be frightened by official documentation. For some reason, he was so quick to try to talk me out of any kind of diagnosis from the magistrate. Maybe he's afraid of having his name attached somehow?

I may switch shrinks, or not bother if they can't assess. Still, getting back to adult assessment, it does seem as if childhood behaviors play a big part in the process, which can be a little scary. I may not accurately convey my childhood; could someone be denied a diagnosis because their childhood behavior wasn't convincing enough?

I was assessed at age 25 over 2 meetings, by a psychologist specialising in ASD. My parents accompanied me once, and the psychologist tried to reconstruct my childhood through an interview. That was not the whole story, though.

- I had to take HAGS, RAADS and BRIEF (my parents also did this one). No IQ test. I don't know if your therapist can let to take those, but it doesn't seem like he's able to evaluate the results.
- My body language was examined (without me knowing it).
- Less focus was placed on special interests, and more on social deficits/disinterest, in particular my lack of friends. She correctly identified my masking behaviour and the anxiety it caused. The area where friendships had always been lacking (and still are) is among people the same age as me.
- ASD and similar disabilities are considered taboo in my family so my parents denied any mental disability. Again, the psychologist correctly identified them as being in denial. Funnily enough, I rated myself as having no social deficits at all, so perhaps she thought I was so socially inept I didn't even realise it.

I guess it matters a lot what kind of therapist you get. It shouldn't take long if you get a trained professional. I don't think this particular person is right for you, if you want a proper assessment, tbh.

He's touching on some important points though. I've never had any advantage whatsoever coming from my official diagnosis, not when I was in trouble at work, and not in order to collect disability. It really amounted to little more than a piece of paper.

The only way it helped me in was to accept myself as I was, and work with what I do have mentally rather than what I don't, which you seem to already be doing.

Best of luck, though.

^^ Thanks. Out of curiosity, have you disclosed your official diagnosis at work? Like, if you got in trouble for something, did you ever try to inform them about it?

Well ... I did once, on a job five years ago. Things weren't going great from the start, so about 2 months in I explained I wasn't feeling well mentally and needed less tasks for a while. That was OK, and I started to recover, but then I was put in charge of a project I couldn't handle (including managing a team!). Things went downhill again, and I shared my ASD diagnosis with my team in an informal situation in hope of receiving some understanding. After that, the team was in mutiny and it all ended in a very ugly meltdown, with me walking out just 2 days before the deadline. My contract was shredded, my time was up, and it took me 6 months to find a new place.

After that, I haven't even considered sharing my ASD diagnosis. I've still faced mental problems at work from time to time, but at least the company has never turned against me in the way I described above.

I specifically asked them not to talk to my family. They respected that.