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Autism/Aspergers – Working together in the therapy room (mini-series- pt.6)



Hi, and welcome to this week’s post, part 5 in my series about working together in the therapy room with autistic clients.

This week I’d like to talk about what goes on in therapy. There might be “set-backs”, there might be a need to set clear goals in order to set the client up for success, and using problem-solving approaches might help with this.


Read part 1, 2 , 3 , 4, 5 here.

I’ve also written a few posts about what to expect on your first counselling session (read part 1 and part 2 here).

You can also click here for my other posts on Autism.


For these posts, I’d like to reference Katherine Paxton and Irene A. Estay’s book called Counselling people on the Autism Spectrum (chapter 3)


In the intro for this post I wrote “set-backs”.

This is something that I don’t consider the correct wording, but clients might use this language, so let’s go with it.

I trust in the work that we do in each session with my clients.

Sometimes therapy is counter-intuitive.

Clients might get worse before they get better, and riding that out might be tricky to understand or grasp.


Explaining – psychoeducating – an autistic client about the fact that this is going to happen and how it might look like, in general terms, might help keep the anxiety about these “set backs” to a low level.

Working through the anxiety of feeling like we took some steps forward and coming back for a future session thinking that the work has been undone is something I’m familiar with.

It happens with both autistic and non-autistic clients. It’s all part of the process.


Using visual aids or diagrams might help clients understand this and trust that what they’re doing is getting them ahead rather than falling behind.

I trust that, in the way we work in the room, once we have taken steps forward, we can never go back to square one.

There might be the chance of going back 3 steps but never the 10 we’ve already walked.

The change that happens is organic most of the time, and if it hasn’t “clicked” yet, then it just means we need to continue working until we have reached the full depths of the origin of the issue.


Therapy is like an archaeological dig or a police investigation. We are connecting the dots, putting things back together in order to get a clear picture and set goals to move forward.

Setting clear goals is something that I don’t do in an overt fashion with my clients, but it might actually be very helpful to focus the mind of an autistic client.


Using problem-solving approaches might be ideal to support an autistic client with what they want to work through.

There might be the need for some flexibility within the goal and how to reach it, following my usual way of working (free association) but having that goal will allow us to focus and possibly measure the changes as we go through the sessions.

Figuring out in therapy how to get from A to B, and what will be helpful to each individual client is important and is something that we learn together as client and therapist.


Until next week…


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Autism/Aspergers – Working together in the therapy room (mini-series- pt.5)



Hi, and welcome to this week’s post, part 5 in my series about working together in the therapy room with autistic clients.

This week I want to talk about transitions, anxiety, autonomy, self-esteem and self-talk.


Read part 1, 2 , 3 and 4 here.

I’ve also written a few posts about what to expect on your first counselling session (read part 1 and part 2 here).

You can also click here for my other posts on Autism.


For these posts, I’d like to reference Katherine Paxton and Irene A. Estay’s book called Counselling people on the Autism Spectrum (chapter 3)


Transitions


I’ve been working with autistic adults and young people for 11 years now in the care sector, and 5 years with counselling clients.

Something that’s clear from this time, is that transitions can be hard!

Staff change-overs might cause distress as there might be more people walking around and therefore maybe more noise and uncertainty for that half hour.

It has been easily alleviated by staff coming in straight to the office, to keep the environment calm and familiar for the individuals.

A social story (mentioned in the previous blog post) might be used to inform the residents about who is leaving and who’s taking their place. This brings reassurance and calm to them.


In the therapy room, it might help to stick to the same time and day for sessions, as well as having a routine set for the hour.

I’d say the best way to do this is ask the client what would work best for them at the start of the session, during the session, and at the end of the session.

At the start of the session, the therapist might have arranged the cushions in a particular way, left some stimming objects (like a stress ball or playdough or something else) near the client’s chair which they can access if needed.

The client might bring their own, which is very welcome in my room as it will be helpful for the client to have familiar things, especially at the beginning of the process.

Leaving the windows open or closed has also come up in my sessions, and I make sure I ask the clients what’s better for them. This will change as the therapeutic relationship changes and the room becomes more familiar to the autistic client.


During the session, checking in often about how the session is going and how the client is feeling, what needs changing or working on, will be helpful and reassure the client that they’re being heard and understood.

At the end of the session, the client might need a transition “ritual” or a few steps that might help them close down what was opened up during the session.

Maybe some processing time or some checking in with the surroundings and the next steps.

It is all person-centred, so this will be different for each client, as their transitioning needs and experiences might also be very different.


Anxiety


I’ve previously written some blog posts on anxiety, which you can read here (part 1, part 2, part 3)


Anxiety with autistics can be linked to transitions.

Sometimes an advanced warning with plenty of time to process might help the client with the transition by helping keep the anxiety at bay.

Other times having such an advanced warning might be anxiety provoking in itself. Keeping the warning to just before the transition is happening might be helpful in these cases.

Keeping clear on what’s going to happen next, and sticking to what we say, can be really helpful.

In the therapy room, if we say the session will last 50 minutes, make sure you stick to this time.

Ask the client whether a 5 or 10 minute warning would help, or whether you just end the session at 50 minutes without much warning.

A cue such as grabbing my diary to schedule the next session might become a transition clue for the client that the session is ending. This might develop naturally or as part of the conversations and agreements in session 1.


Do read my series on anxiety for more on this topic.


Autonomy


As part of the ethical frameworks I work under, respecting the client and providing a space for them to be autonomous is essential, and ethical, in the therapeutic relationship.

By asking questions like the ones described above, we are setting the client up for going from depending a bit on the therapist to understand their inner world and their relationships, to learning how to tap into these on their own, as time goes on.

The goal with therapy is not to keep a client forever, it’s to enable autonomous behaviours and thoughts, through practice.

By observing what goes on in the therapy room, which is usually a reproduction of what goes on in the client’s everyday world, and discussing their everyday events and past situations, the client becomes able to process their thoughts, emotions and events on their own, slowly through their therapeutic journey.

Seeing clients come into the room and talk about their progress with setting boundaries or asking for their needs to be met, or having an “a-ha” moment about something we’d been discussin in therapy, is so rewarding and it is great to see the therapy taking an effect in the clients’ lives.

Autonomy is essential in the client’s self-esteem and ability to live their best lives. Of course other aspects are also involved.

Estay and Paxton call this self-monitoring in Chapter 3 of their book.


Self-esteem and self-talk.


Focusing on the positive things clients say to themselves can be helpful when negative self-talk has been taking a hold of the client’s life.

Self-esteem can increase and the client’s moods and how they go about their daily lives can be impacted greatly by focusing on the positives.

I read somewhere (can’t remember where) that thinking that is not reinforced will be come extinct.

The same goes with thinking that is reinforced. It will be at the forefront of the client’s mind.

So if we don’t reinforce negative thoughts, then we can focus on the positive ones.

This seems to work well for autistic clients, and I tend to use it with many of my clients, in one form or another.


Keep speaking positive into your life, and I’ll see you again for next week’s post.


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Autism/Aspergers – Working together in the therapy room (mini-series- pt.4)


Hi, and welcome to this week’s post, part 3 in my series about working together in the therapy room with autistic clients.

This week want to talk about some alternative ways of working that might be helpful when communicating with our autistic clients in the therapy room.


Read part 1, 2 and 3 here.

I’ve also written a few posts about what to expect on your first counselling session (read part 1 and part 2 here).

You can also click here for my other posts on Autism.


For these posts, I’d like to reference Katherine Paxton and Irene A. Estay’s book called Counselling people on the Autism Spectrum (chapter 3)


Carol Gray’s writings (In Paxton and Estay) highlight the fact that using visual aids in the sessions might help our clients process what they’re bringing to their sessions.

In my past role as a support worker, I have used social stories for things such as transitions, staff changeover, leaving the house for an activity, room changes, and other similar things for the young people and adults I’ve looked after.


I have created a pictorial contract in a similar fashion, which has been received well.

When I send my contract to autistic clients, I might send the pictorial version along with it, and it’s in the client’s choice to open it or just read the non-pictorial version.

I’ve had positive feedback and I’ve been really careful as to not make assumptions over whether the client will be able to read one or the other. I send both and that way the client decides what is most helpful for them.


I have a whiteboard in my therapy room, which is generally for my tutoring students, but it’s been very handy in my therapy sessions too.

I have drawn or made diagrams of what we’re discussing, or clients have used the board themselves to explain how they process information and how they understanding something.

This helps me gain some insight into how best to relay what I’m trying to say, and meet my client where they are.

It’s amazing how visualising something can bring so much clarity! Sometimes words escape me – or my clients – and drawing it or making a diagram might help.


A third thing I use is physical tools and games. I have stress balls where the clients can see them, and I offer them if they seem to need them (some might not want to go near them as they don’t know who grabbed them beforehand! others are quite happy with talking and squeezing the stress balls during the sessions).

I also have playdough, skittles, draughts and a tiny bin where clients can write what they want to process or get rid of and put it in the bin (of course it’s not that simple, but the concrete, observable act, is a start and part of the process).


I’ve not done this yet, but if requested, or if I think it might be useful, I can make a summary of the session, either with the client or send it after the session, for further thinking and processing.

Another way of working is to use emotional thermometers, bar graphs and other tools to facilitate identifying and measuring emotions in a more visual and concrete way.

In my work, I try to bring clients (autistic or not) to think more in the “greys” rather than just black and white. Using the emotional thermometers and similar tools might help achieve this.


Estay and Paxton (pg.79) point out that some of these aids might be rejected as clients might feel that these are being used because of their autism rather than as a tool to help them. As I said before, I have used these techniques with all my clients, and I’d make sure that they knew this before using the techniques.


All of these will help with the thinking process, as well as with the processing of emotional content that the clients might be bringing into the room.


Have you got any more ideas that have helped with your own clients?

If you are autistic and have other ideas that might help counsellors understand what you need from us in therapy and how best to support you in your therapeutic journey, do let me know and I’ll be happy to add them to this post.


Until next week…


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Autism/Aspergers – Working together in the therapy room (mini-series- pt.3)


Hi, and welcome to this week’s post, part 3 in my series about working together in the therapy room with autistic clients.

In this post, I’ll discuss how autistic people might benefit from thinking about how many of their behaviours might be due to the fact that they are human, and not because of autism, although they might still be tinted by the different wiring that comes with autism.


Read part 1 and 2 here.

I’ve also written a few posts about what to expect on your first counselling session (read part 1 and part 2 here).

You can also click here for my other posts on Autism.

For these posts, I’d like to reference Katherine Paxton and Irene A. Estay’s book called Counselling people on the Autism Spectrum (chapter 3)


Let’s start with what I mean by some behaviour being nothing more than human behaviour.

There have been many instances where I’ve been talking to an autistic person and I’ve thought “hang on but I do that too”.

Now I’m not saying that our experiences, even though similar, aren’t experienced in very different ways.


(I felt “over-sensoried” the other day, but that was just because I hadn’t slept well and had lots to do and was getting overwhelmed to the point that I couldn’t have the radio on while working, for that few hours in the day. This is different from having a sensory sensitivity as an autistic, which doesn’t go away with a bit of sleep).


It is all about meeting the person where they are, and understanding how the situation led them to react a particular way, which might be similar to how I’ve responded but not with the same considerations.

It might be because I’ve been around autistic people, young and old, for many years now, and I can relate and really understand what’s going on.

It also helps building a relationship with my clients and getting to know them, their triggers, the systems they’ve created to help them with daily life, amongst other things.


For example, I know that when I’ve said to a client something like “I think this might be because you’re human”, it has been reassuring.

Sometimes clients will say they wonder if they’re that different, if it was their autism that led to that breakup or that conversation turning into an argument.

If we go with the thinking behind theory of mind, it might be a possibility that a social cue was missed and that led to the argument. But it might also be the case that the argument was going to happen anyway, cues or not, because the relationship was going in that direction.


We have to take these a situation at a time. Without context, what I’m saying might be misinterpreted as being dismissive of the autistic person’s experience.

As I write this, I realise that what I’m doing is seeing the person in front of me as a whole individual, yes with different “wiring” but still a human being.

And this is why it makes sense to qualify behaviours as “human” because we are all humans, with our particular individual differences.


Until next week…


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What’s the Whack-a-Mole have to do with my emotions?


Hi, and welcome to this week’s blog post.

I’m thinking, you’re either a regular reader of my blog or you got curious about the title.

Either way, I’m glad you’re here!


In this post, I’d like to address something that I believe in and that colours the therapeutic work that I do. It also colours my life if I’m completely honest!

I didn’t go looking for psychodyamic theory or its way of working, it kinda found me! (That’s part of my academic journey and for another post, if you’re interested.)


Firstly though, let’s talk about the link I’ve made between the whack-a-mole game and our emotions.

In this classic game, what happens is, you have a mallet and the aim is to hit the mole (sometimes a crocodile or another thing/animal) when it pops out of the hole. You never know where it’s gonna pop out so you’ve gotta be quick! You’ve gotta be on top of it and thinking very quickly indeed!

Our unconscious works in a very similar way.


If we have a situation, a set of emotions, an encounter with someone, or anything that affects us emotionally, it will continue to do so until we address it.

There is no time in the unconscious, so whatever happened 40, 30, 20, 10, 5 years ago (or more recently) will continue to affect us until we do something about it.


So just like the mole, the unresolved stuff won’t stop popping up in different ways in our life, until we look at it straight in the face and work through those difficult emotions and thoughts, and possibly relational difficulties, that it might bring us.

It can get tiring trying to think fast to keep these things under wraps…

Working through the difficult stuff will help in a massive way.

It might take a few months or even a few years, but once the change that happens when we process emotions comes to pass, then you’ll be forever changed.

It might be a massive change or a little change. But change nonetheless will help you live a better life, where you’ll be able to manage those difficult emotions with more resilience and calm than you were able to before you worked through them.


Now the whack-a-mole will forever be popping moles up and down the game. In a similar way, the unconsicous will always be trying to bring stuff up from within the deepest depths of itself.

But once we know what’s there (the mole) and how to get it under our control and it becomes manageable, smaller (through therapeutic processing), its effects will become less taxing or overwhelming in our day to day lives.

For lack of a better analogy, before working through, the emotional “mole” might have been big and overwhelming. After working through, it becomes small enough to hold in our hand, and therefore more manageable.

I tell my clients all the time, that we don’t get amnesia from therapy.

And that’s a good thing, because the things that make us who we are, with the strengths we have now, are sometimes those difficult things we went through and worked through.


Until next week…


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Trust your intuition…

Hi, and welcome to this week’s blog post!

I’ve got a few mini-series in mind, and one that’s in progress (Counselling Autistic People), to which I’ll get to in due course.


Today I want to talk about intuition – or what’s also known as our “gut feeling”.


Depending on how we were raised, and the events that we’ve experienced in life, we will be more able to trust our own gut without even thinking twice about it.

Others of us might have more difficulty and need to re-train our minds and bodies to listen to our gut.


As a counsellor/psychotherapist, I’ve been trained to trust my intuition in the therapy room, which generally helps my clients, as what I’m feeling might be a reflection of what’s going on for them.

Call it counter-transference, projective identification, empathy, it all leads back to our gut communication something useful to us.


Trusting our intuition isn’t reserved only for therapists.

It is a tool available for all of us, at one level or another.


So, how do we develop that trust that what is coming up for us, a gut reaction, a “walk away” thought, a “be careful” thought, or goosebumps all over our body, is something we need to listen to, for our own good?

Here are some ways I believe we can develop this important skill:


1 – Start small


Changing our mindsets and the way we do or think or react to things will take time and effort.

Tackling the big things might not be the best idea to start with, as we are not yet able to use our intuition in the best way possible.

Start small…for example: someone asks you for a cup of tea, and your first instinct is “I’m busy, I can’t possibly be making you a cup of tea, this is not the right time for this”.

It might be easier to trust your gut telling you “just say no right now” with something as small as making a cuppa for someone, than it would be something bigger.

The results of saying “No, sorry, I can’t make you that cuppa right now, can you get it yourself please?” will be massive!

You won’t resent your friend/colleague/relative for making you do something you didn’t have time for right now, and you won’t resent yourself for saying no.

Your intuition might have been telling you “if you do this, you’ll resent yourself and them! avoid that resentment and say no.”

I know this sounds trivial but building on this will help you with the bigger things in life.

Maybe you’ll need to trust your gut when driving – Do I go left or right, where is there usually less traffic? which road is safer for me?

Maybe it’s about accepting or rejecting a dinner invitation with someone you know deep inside will make you feel something you don’t want to feel (uncomfortable, judged, belittled, etc).

Why put yourself through things that you clearly don’t want to do and that your instincts are telling you “don’t do it?”


2 – Work it through in Therapy


In therapy, I believe is where we can really put this into practice.

Talking through situations with my clients is something I do on a regular basis.

Going through what happened and seeing things from a different perspective, as well as thinking about what we could’ve done differently in order to get the results we actually wanted…

Sometimes what we could’ve done differently is just listen to our gut…

Developing that keen ear for what we instinctively know is best for us is part of the therapeutic process.

At least when you come see me! Other therapists might work differently.

Listening to our gut is one way where we can learn to meet our own needs, prevent resentment of ourselves or those we love, as well as learning to set clear boundaries that will keep us safe from the things we really don’t want in our lives.


If you want to find out more about this, you can find my book and my facebook group via this link.


Until next week…


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Why have therapy in your own language? (and why I offer this service)

Hi, and welcome to today’s post, where I’ll be focusing on the importance of our native language when going to therapy.


I will focus on Spanish and English in this post as those are the two languages I speak fluently and to a native level.

This applies to other languages as well – substitute these as is convenient throughout this post.


The importance of having therapy in our native language will depend on many factors, such as when we started learning and speaking English (or another language), and how comfortable and confident we are with the language.

But we must be more than comfortable and confident speaking it fluently.

This comfort and confidence must also be in relation to our emotional language.



There are some things we learned to process in our native language that will be tricky to translate into our second or third language.

Here are some things to consider and think about, that point toward the importance of having therapy in our first language.


The use of language varies from very simple, to more complex, and being able to do this might require time and effort and practice.

As mentioned above, our ability to process emotional and more complex information in a second language will take time.

I was lucky enough to have moved here with a high level of English, but I know that this is not the case for many people that choose to move to another country with a language different than theirs.

I see clients that speak Spanish because they want to be able to fully express themselves and that means using emotional language that they’re used to since they were children.

It is not that they can’t communicate it in English, it is just that there might be no emotional link to the words in this second language, and that is an important aspect of processing emotional stuff.


When we are distressed, the last thing we want to do is try to find the words in a language that is not our first.

Moving to a new country with a new language that we might or might not be familiar with, is daunting in itself.

The culture might be radically or slightly different to where they moved from.

This in itself can cause a great deal of anxiety and worry.

Add to that trying to find services in a new country that we have no idea how it works (I had this when I moved here, not with the language, but with how to find a GP, how to sign up, where to go for this or that, and I had the language, it was everything else that was new! As time passed, my confidence grew and it was all fine, but it took time…)

Trying to navigate new surroundings and ways of doing things might get us into fight, flight, freeze reactions, and finding someone to speak to in our own language, that fully gets us, will be helpful in moving forward with our new lives.


Feeling understood might mean we feel like we are sitting in front of someone that understands our culture a bit better because the common language, and also will understand our nuances, if we were to go into “slang” or more colloquial wording that a non-native speaker might not grasp unless we explain it.

I also teach Spanish, and with more advanced students I sometimes forget myself and start speaking in slang. They generally like this as they get an experience from a native’s perspective. They can see how people might speak when in the company of other Spanish speakers and they generally find it insightful and amusing.

In the therapy room, speaking in this same manner to a client, in a colloquial, culturally similar way, might help them feel less alone and at ease with their new lives.

Adapting to the changes might become more manageable if there is someone around that can help them through the uncertainty, distress when navigating these new ways of doing things and speaking in a new language too.

I’ve also done interpreting work for people, working with them through a benefits claim or a GP appointment.

Latin Americans in particular have a way with words that means we tell a long story about many things – not everyone, not all the time, I’m generalising – it is important that, in the case of myself as an interpreter, that I explain to the professional that I will let them know what the person is saying once they’re done telling their story.

It might be my therapeutic background, but I’d never interrupt and tell someone “get to the point” or “just answer the question” which is probably what the professional wanted at that point. Instead, I can explain to them “we are very wordy in our countries, it’s all fine, you’ll get your answer in a moment”.

Normalising for both sides might be important at this point.

If it’s just me and the client in the room, we can have a chat about the culture and how it might be different, what they’re finding tricky and how to navigate these new ways of being and relationg.

Realising they are not on their own many times brings peace of mind.

I have to say not all of my clients come in this kind of distress about the language or the new culture. It varies and it depends on where they’re originally from or what issues they bring to therapy.

It might be not related at all to the language, apart from the initial bond of cultural understanding and emotional processing.


Depending on the depth of knowledge of the language, therapists will be confident in working in a second or third language, and clients will be confident in coming to see them.

I’ll give you a personal account of my journey with the English language, and why I feel confident and comfortable working in both languages.

I went to a bilingual school, where the emphasis was more on speaking and writing in English – I can write much better in English than I can in Spanish because of this!

I also went to practice my English in the United States from the age of 9 until 18.

I therefore can speak, write, and connect emotionally in both Spanish and English.

This is why I have been able to work and study and set up my private practice with English and Spanish speaking clients.

It is a great feeling to be able to offer this service, and a relief for companies and clients alike that there is someone like me around for them to talk.

Distance isn’t an issue either as I work online, so people can contact me for sessions from anywhere in the United Kingdom and elsewhere.


In order for me to work in a third language (if I wanted to learn German or move to Germany, for example), there would need to be years of experience and practice, and even then it might be tricky for me to understand a native German’s emotional language in German.

I am of German heritage and “should” really get into my German learning, but I find it so hard to do at this older age. I might try to do it again soon. Who knows!

People have said to me, what if you moved to Germany and worked with German speaking clients?

Well, I could if they spoke to me in English, but then we have the same second-language emotional barriers as above!

Also….Why would a German client see me in a second language (unless they spoke English in the same way I learned it and were emotionally comfortable and confident in both languages!).

I would not be able to do so, I would not be confident or comfortable counselling someone in German, with basic knowledge of the language, and even less knowledge of how they process or talk about emotional stuff in German.

It would be very tricky and take a lot of time!

Add to that my aclimatising to the way things are done in Germany, which I imagine are very different from what I’m now used to in England and even more different than how I remember things from Guatemala.

Interesting experiment though, but not one I’m willing to try right now as I’m quite happy living here in the South of England.

More food for thought….


So, to sum up, therapy in our own language is very important for more than one reason.


Have you found any more reasons that I missed in this post?

Leave me a message and I’ll be happy to update or write a post on your comments and suggestions.


Until next week!


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