Private Practice Mini Series — Ghosted: the private therapist initiation rite


Hi, and welcome to the third post in my Private Practice mini series aimed at practitioners in private practice, and anyone who works one-to-one with clients.

In the first post of this series, I wrote about creating the mental space that leads clients to find us.

Last week I wrote about calling things into being.


This week I want to talk about those difficult times when we book clients and they either don’t show up, or they have their first session and never contact again.

This is a very tricky situation, that can leave practitioners feeling insecure about their capacity as therapists, or bringing that impostor syndrome to the forefront…or even more, wondering what it is they did that made the client “ghost” them.


I am speaking from personal experience here.


As someone that also had a start in private practice and all that entails, I can say that ghosting happened to me too.

As a supervisor, I really like Scaife’s model (read my post on that here). He talks about responsibility and gives the supervisor, the therapist and the client a set of responsibilities.

I will start with what I’ve experienced as a therapist starting out in private practice and generalise it to other practitioners. Then I will discuss what I think happens from a client’s perspective (some not all possibilities).


In regard to the therapist, I would say that our responsibility is to hold the space for the client, where it’s safe to process and work through difficult stuff.

When we are starting, we are “desperate” (my own words, not calling anyone that although I’m sure some of you reading this can relate) – urged might be a better word, to retain and find clients to fill our time slots and help us start earning an income from what we trained so hard to do.

This urge might communicate over to the client. Unconsciously of course.


I am psychodynamically trained (now working integratively) so I believe that the unconscious to unconscious communications are very powerful.

We might not verbally be saying to the client “please keep me as your therapist, I need you”, but that’s what we might be communicating in many other ways we’re not aware of.

Now, just being aware of this is a great starting point to not put that burden on our clients.

A burden that might lead them to leave.

Apart from this, I don’t think there’s anything else that I can say right now to point the responsibility of a client ghosting a therapist, on the therapist themselves.


Let’s turn to the client’s responsibility.

Sometimes a client books a first session and never shows up.

It might have taken all of their energy and might to contact and book the appointment, but might have realised that they’re not ready yet, or that it’s too scary to attend, or something might have happened that led them to not need therapy anymore.

Sometimes they let us know, other times they don’t. It can be enfuriating, but we can’t take it personally. We might never find out what happened. We might have to live with the “not knowing” of why we were forgotten by our new potential client.


I find that as we spend more time as private practitioners, we get better at setting boundaries and trusting ourselves, and valuing ourselves as practitioners, and this happens less and less.

But when we are beginning, these things might not communicate as much through our contract, or our verbal and non-verbal communications. It’s an art and it’s developed slowly and gently, as we work with more clients and spend more time acclimatising to the realm of private practice.


Other times, a client arrives for their first session, it seems to have gone well, and they never book another session again.

For some clients, the catharsis that happens in a first session might have been enough.

Or it might have been too much to start talking about something that was only in their minds up to the point they started talking about it with their new therapist.

Ideally they’d let us know. But as above, sometimes they don’t.


We must err on the side of trusting our abilities and capacity as qualified and experienced therapists (we have, after all completed quite a few hours in placements before setting up our private practice!), and consider what is our responsibility and what is our clients.

Taking it to supervision and getting reassurance and clarity about what happens when we’re ghosted by clients will build us up, help us set clearer boundaries, possibly rewrite our contracts (I’ve rewritten mine many times, mainly adding stuff as time goes on!) and work on our initial contacts with clients, and how we feel about ourselves as therapists.

I hope this post has been helpful, or at least food for thought. I welcome your feedback and comments.


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Private Practice Mini Series: Calling things into being by speaking them out.


Hi, and welcome to the second post in my Private Practice mini series aimed at practitioners in private practice, and anyone who works one-to-one with clients.

Last week I spoke about creating the mental space that leads clients to find us.

Next week I want to talk about something that I see happens a lot when we start private practice: clients “ghosting” practitioners.


This week I want to focus on something that I see as “working in the background”, in our favour.

I was chatting to a colleague once and I said something about a plan I had for the next year.

Now taking into account that this colleague didn’t know me for long, what he said marked me.

These are almost his words, verbatim: “yes, I am sure you will achieve that. Everything else you’ve said you’d do, you’ve accomplished so far.”


That got me thinking…


What is it that I’m doing – apart from taking steps towards fulfilling what I’ve said I wanted to do in the first place – that is getting me to achieve that goal?

In having conversations with other people, I started to piece things together and realised a very valuable lesson:

When we call things out….when we name the things we want in life…they will come to us, sooner or later!


Everything we do gets us closer to our goals.

Everything we say gets us closer to our goals.


There is a lot of power in what we say and confess to ourselves and to our friends, family and colleagues!

I really do believe that trusting that what we want to happen will happen is a great way to achieve our goals and live more fulfilling lives.

This is how I’ve been building my practice.

I guess it’s been discussed before in books like The Secret an the Law of Attraction, and such. But until you experience it yourself, it won’t mean much.

This goes hand in hand with what I wrote to you about last week – if we create space and name the things that we want to pass, they will most likely happen.


Another thing I live by is this “what I’m doing now, will help in the future, somehow”.


A clear example is a colleague I’ll be partnering with soon. I met her nearly 7 years ago now at a training session, and she remembered me from that, and now we will be working together!

Yes it’s 7 years later, but the point it, we plant seeds and they grow and flourish when it’s their time to do so.

The key is to plant the seeds, either by doing something, saying something, while taking the steps and planning towards what we want for our lives and businesses.


So get talking, get confessing openly with yourself or with your tribe, those things that are dear to your heart, that will bring your goals to fruition, and your lives to be more fulfilling and more like how you want them to be.

Whether that means having 5 clients, 10 clients, 20 clients…working only 2 days a week…having various sources of income and ways of supporting people with your business…whatever it is…speak up and see it happen!


Until next time…


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Private Practice Mini-Series: Creating the mental space that leads clients to find us


Hi, and welcome to this mini series aimed at practitioners in private practice, and anyone who works one-to-one with clients.

This will be a three-post series where I’ll be talking about

1. Creating the mental space that leads clients to find us

2. Calling things out so that they become a reality in our lives and businesses

3. Ghosting: a private practitioner’s initiation rite of passage


I’ve been in private practice for nearly 7 years now, and I’ve learned a lot.

Some things I wished I’d learned when I’d started, but that’s not always possible.

It is because of this that I’ve launched some services (free and paid), like this blog, to support practitioners that are just starting out now, to know about things that will get them started with more knowledge than I had when I started.

Now, don’t get me wrong, I like how things have panned out. I love how my practice and life are going. But I know this might not be the case for everyone.

Keep reading if you want to find out about this week’s topic and what I mean by creating mental space.


I’ll write a bit about how I started out and how I got to where I am today.

In 2013, I decided to launch my website and get online on directories so I could get clients. I was also working 37+ hours at a care job (which I enjoyed, but my sights were changing more towards full time private practice, only a dream at this point!).

From that point onward, I had started to lower my hours at that job and spending more time on counselling.

The first two years I didn’t have that many clients. Which was fine because I was renting a room and finding it difficult to find the right times to fit clients anyway.

In 2015 I got a Senior Care Officer contract at a children’s home, which was temporary until November. When that contract finished, it gave me the freedom to work as relief staff, which meant I could choose what days to work and what days to dedicate to my private practice.


This is where it starts to get good!


A month or so before my Senior contract ended, I started thinking more and more about dedicating Mondays and Thursdays to private practice. Just thinking about it did something…

It was almost magic!

By the time my contract ended, I had quite a few more enquiries.

I booked them in, and by the end of the year I’d gone from 1-2 regular clients to 4-8 regular clients!

I got a contract as a support worker in the same children’s home on February 2016, but took only 16hrs per week, which meant I could still dedicate Mondays and Thursdays to counselling and building my business.

My manager there has always been kind enough to accommodate my other responsibilities outside of that job. And as I was working very part time only, it was all good.

That year I did my last waking night shift. That’s how I started letting go of doing extra shifts and focusing more on my private work. By mid 2017 I stopped doing extra shift.


Another dramatic shift came about when I decided to finally give blogging a good chance and take it seriously. This meant taking promoting my blog seriously as well.

And this in turn meant posting regularly and consistently on social media.


I was still counselling Mondays and Thursdays, but decided to start offering sessions on Wednesdays as well.

I got more clients. I also started offering supervision.

I created the mental space for those clients and supervisees, and lo and behold, they contacted and booked!


My last two years at the care job were spent daydreaming about only running my own business.

I planned for it.

I made the mental space for the clients that I needed – a mix of counselling, supervisees, coaching and tutoring clients.

I also started thinking about other services and products to offer.

I wrote 20 Self-Care Habits, which came from a series of blogs I wrote.

I began planning other avenues of income and work.

In July 2019, I left the care job. I miss the social aspects of it and the young people I worked with.

But it wasn’t for me anymore.


I worked 11 years as a support worker in different areas. It gave me lots of knowledge that includes being able to offer counselling to autistic and other neurodiverse people.

My practice is now full to the brim. My products and services are being created slowly but surely.

More books are in the pipeline, as well as collaborations with colleagues and companies to create more mental space to help more clients and colleagues with their lives and careers.


Those who know me will know that I didn’t write this to brag. I’m more in awe of how things are going than anyone else!

I wrote this to show my fellow colleagues what is possible when we work hard, when we get the training, CPD, support from one another, and put ourselves out there.


I hope this post has been helpful to those starting out, and allowed those more seasoned practitioner to reflect on the amazing journey we’re all in…

…doing what we love, whilst at the same time helping our clients and colleagues get back on track, or get their businesses going.

I look forward to writing to you next week.

Until then…


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20 Self-Care Habits – Colleague Collaboration (Book Review)

Hi everyone!

I’ve just been given a brilliant review for my book, 20 Self-Care Habits, which was published 31st July 2018.

It’s been quite a journey and it’s always nice to hear how someone is benefiting from what I’ve written.


Everything I do is aimed at helping people. Helping them get a head start, learning from what I’ve learned in the past, from personal experiences but also from others’ experiences of putting my suggestions into practice.


In this occasion, my colleague, Pat Capel, reviewed my book for his website, and I’d love you to read it.


I think it’s better to hear feedback from others than from the author themselves sometimes – cause I would be biased to say it is a good book 😉

Anyway, I trust that you’ll enjoy reading Pat’s review and other stuff on his page – it’s really good stuff! (see, now I’m giving you feedback on Pat’s stuff, which is really good to be honest!)

If you haven’t read 20 Self-Care Habits, or my other reviews on my website, then have a look at Pat’s take on the book.


Here’s a snippet of what Pat had to say…

“If you are someone who is wondering what “self care” is or what you can do to take better care of yourself, I would suggest giving this book a read.  In this book, Karin explains and guides you through what it means to take care of yourself.  Our modern world can be tricky and yet she explains simple and practical strategies that you can start your new self care regime immediately. “

Pat Capel, http://www.patcapel.co.uk

Enjoy reading the review and spend some time exploring Pat’s page, and my own book page, reading even more reviews on the book.

I look forward to hearing your feedback after you’ve read 20 Self-Care Habits.


For more on Pat, follow him on Social Media:

Pat CapelPsychotherapist and Counsellor

Website:    https://www.patcapel.co.uk/

Facebook:  https://www.facebook.com/patcapelpsychotherapy

Twitter:      https://twitter.com/pat_capel

LinkedIn:    https://www.linkedin.com/in/pat-capel-b9b176b7/

Instagram: https://www.instagram.com/patcapelpsychotherapist/?hl=en


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Practical Steps to Blogging – part 2


Hi, and welcome to part 2 of this mini-series on blogging!

Last week and this week I’ll be talking to wellbeing professionals, including coaches, counsellors, psychotherapists, and anyone that looks after the wellbeing of their clients in one way or another.

click on any of the images in this post to go to the workshop page

This week I’ll focus on the scheduling and timing aspects of blogging.


 Here are some top tips on scheduling and getting your writing done:


Make it easy for yourself

As human beings, we like to over-complicate ourselves.

I say simple is better! Review regularly how you’re doing and how your writing is helping or making things more difficult for you, and plan your next writing sessions accordingly.

I’ll talk a bit more about this in the workshops.

Consistency is key!

More than the length and the amount of posts it is all about showing up regularly for your audience!

Figure out what length your posts will have and how often they’ll appear on your feeds, and stick with it.

It’s ok to reassess, I’ve done that so many times I’ve lost track!

Pick your battles

Make sure you give yourself plenty of time writing and plenty of time to look after yourself

Ideal times to do each aspect of our work and personal lives is important.

During the workshops...

I’ll be delving in deeper in to the above aspects.

We’ll also be talking about what else to do with your blog post apart from writing it and posting it.

Plus! You’ll get a chance to ask questions and work together with like-minded colleagues who are starting or continuing their blog writing journey.


Getting your message out there can be fun (I particularly love writing!) and it’s a great way to get yourself known to your colleagues and potential clients.

There’s so much to learn from you. Let’s get that message out!


Until next week…


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Practical Steps to Blogging – part 1


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

Today and next week I’ll be talking to wellbeing professionals, including coaches, counsellors, psychotherapists, and anyone that looks after the wellbeing of their clients in one way or another.


There are a few reasons for me writing this blog post mini-series now.


1. Blogging revolutionised my practice, and I am eager to teach more people how to blog to revolutionise their practices by following practical, simple steps.

2. I’m presenting a series of workshops via onlinevents.co.uk, which launch with a two-part blogging workshop broken down in two days. This is the beginning of a series – still planning the following sections, but I can tell you that the next 2 (parts 3 and 4) are scheduled for December!

click here or any of the images in this post to go to the workshop page

3. I am a content creator and am now offering that as a service. Now, I don’t write blog posts for people, but I am offering helping out with outlines and other aspects of blogging as part of my Content Creation service.


This week I’ll talk a little bit about what to expect in the workshop, and some tips on how to start blogging. Next week I’ll focus on the scheduling and timing aspects of blogging.


 Here are some top tips to get you going:


Get your head around blogging

As with anything, having the right mindset before starting a task is important.

Don’t worry, your mindset will change as you start. Just get started and things will start making more sense!

Have a “thinking” session

Sitting down and coming up with things you want to write about is always a good idea.

Putting things down on paper will release those ideas into the real world and you will be able to see things more clearly, as you’ve made room in your mind for further thinking about these things.

There are lots more things to consider in a thinking session, but starting out with this will be a good starting point!

Practical aspects

When getting down to the nitty gritty of writing a blog post, considering the why, what, when, where, who and how are important.

Knowing exactly where you stand with your reasoning behind blogging will get you closer to becoming more at ease with writing and getting your message out.

During the workshops…

I’ll be delving in deeper in to the above aspects.

Plus! You’ll get a chance to ask questions and work together with like-minded colleagues who are starting or continuing their blog writing journey.


Getting your message out there can be fun (I particularly love writing!) and it’s a great way to get yourself known to your colleagues and potential clients.

There’s so much to learn from you. Let’s get that message out!


Until next week…


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Total Health Summit – 10th October



Experience “Total Health” by balancing body, mind, emotions, and spirit.


Total Health Summit™: Join us and explore tools and techniques to attain equanimity and unity of body, mind, emotions, and spirit.


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


This week I’d like to share with you about a project I’ve been collaborating with.

I’ve been talking about boundaries, meeting our needs and responsibility with Keith Engelhardt, the mastermind behind the Total Health Summit.

It’s been fun to record the interview with him and to interview a couple of colleagues!



So what’s this summit about?


The aim of this year’s online summit is to get more people to experience “total health” by balancing body, mind, emotions and spirit.


Achieve work/life balance and total health by:

Learning how to reduce stress.

Envision decreasing being overwhelmed by work or life.

Visualise learning how to find balance.


The varied knowledge and experience of each of the speakers will allow you to target different areas of your life: physical, mental, and spiritual.

The best part is that it is free to watch for a limited time!

The silver and gold passes are affordable and they come with yearly access community where you can continue to learn and share with like-minded people.


Find out who more about the speakers by clicking here.


Learning how to deal with stress, stressful situations and find balance in life is important, and there is more than one way to achieve it.

This is why I highly recommend tuning in on October 10th to the Total Total Health Summit.

I hope to see you there!


Counsellors Working with Neurodiversity – Facebook Group


Hi, and welcome to this week’s post.

I’ve been posting about Autism in my series, and I’d like to end this part of it with letting you know about a Facebook group that has been set up with the aim of supporting neurodiverse clients in the therapy room.


We created this group with the aim to bring counsellors to get together to discuss neurodiversity in a safe space.

Our goal is not only for therapists to know how to work with the neurodiverse population, but also to raise awareness of what neurodiversity and autism actually entails.


I watched a show yesterday and the guy was talking about diversity, but he said he like the word “representation” better.

It was very timely that I saw this, I think. He was talking about race but it applies here as well.

We want to represent the autistic and neurodiverse population in a positive and empowering manner.


It is because of the imbalance in information and inclusion of neurodiverse groups that we believe in working together, without creating an “us” and “them” environment.

With that in mind, in our group we use “I” statements when we are expressing ourselves, in order to keep away from it becoming polarised.

We encourage conversations, and using “I” statements, helps avoid confusion, misunderstandings, and provides a safe space to have all kinds of conversations, without the need to stop them or “close commenting”, which might happen but it’s been rare with the way we’re running the group.


We purposely sought out Lisa Cromar to be part of the group, as it would be silly to create a group for neurodiverse counsellors without having that voice in the group.

It brings that power balance back to just that – balance. We don’t know everything, we don’t have “insiders” experience as “NTs” which is why, behind the scenes, we ask Lisa to let us know if we’re on the right track or not.


We believe that, as admins, it’s important to keep communicating with each other.

We all have roles in the group, and communicating about each action that we need to take, is making it a safe place for us to admin but also a safe place for counsellors and psychotherapists to further the conversations and cause for the neurodiverse population.


As a group, we understand that there is completely justified anger from both autistic and neurotipicals about the treatment of autistic people – the misunderstandings, the backchat, the looks.

General discrimination and lack of knowledge doesn’t help either.
What we are trying to do with our lovely group is work as a team, a mutually respected team of NDs and NTs.


This is a safe space to feel and be equals. We are all counsellors after all and that unites us firstly.

We are united in the cause to support and remove barriers between society and neurodiversity – this of course will take time, but if we change our attitudes and channel our anger and discomfort in a joint endeavour, then that will bring us further than if we “divide and conquer”.


This group is all about empowerment – to state your opinion, to be supported (within the limitations of a facebook group – it’s not a support or therapy group, or supervision).



If this group is something that sounds like something you’d like to be a part of, feel free to join via this link.


Before I let you go for today, here’s a bit on all the admins of the group:


Lisa Cromar

Lisa is a Person-Centred (PC) counsellor who specialises in working with autistic clients, she provides counselling at a college in the Northwest. Lisa also supervises and trains placement counsellors working at Cheshire Autism Practical Support (ChAPS), a charity which supports autistic people and their families. Additionally, she provides autism awareness workshops training counsellors in how to make counselling more accessible to this client group, increasing counsellor confidence in working with this group which is currently known to be generally low. She has Aspergers and has children with Aspergers and autism. 

Lisa is the author of the pioneering literature review: Exploring the Efficacy of  Person-Centred Counselling for Autistic People, published in the spring 2019 edition of The Person Centred Quarterly (PCQ) . Lisa’s eventual career goal is to assume responsibility for pioneering a version of person-centred counselling for autistic people, Lisa has just embarked on a PhD at The University of Chester to help to realise this dream


Sarah Williams

I’m Sarah and I work in a person centred way, in simple terms this means that I listen with empathy, and I will always regard you and your experiences with compassion and understanding. My approach is real and genuine. I am a specialist trauma counsellor, with over eight years experience working with survivors of rape and sexual abuse. Since qualifying I have counselled adults with autism (sometimes referred to as Asperger’s syndrome)

https://www.indigocounselling.co.uk/


Heidi Brown

I am a Person Centred Counsellor working in Manchester city centre, who enjoys empowering people to make the best decisions for themselves.

I work alongside people as they unlock their potential.

I love to see people grow and develop.

My specialities are autism and work related stress.

Www.heidibrowncounselling.com

Karin Brauner


I was born in Guatemala City, Guatemala, where I lived for the first 25 years of my life. I am now settled  in Brighton and Hove, which I love – I have access to the countryside, the city, the sea, and a melting pot of cultures and activities.

I have a private practice in Brighton and Hove and Online, working with Spanish and English speaking clients with a wide range of life difficulties.

My approach is psychodynamic at its base, but I adapt my therapeutic approach with each individual client, drawing from other modalities and work experience. I believe building good rapport and a good relationship with my clients will help both of us work together to gain insights and freedom from feelings that might be stuck in the past or left unprocessed or repressed.

You can find out more about Karin via the AboutMe page at the top of this blog.

Facebook Group Description

Welcome to ‘Counsellors working with Neurodiversity’. Set up as a resource and a meeting place for UK counsellors to share their knowledge, expertise, events, CPD courses and/or workshops. In the areas for example of Autism, Dyslexia, ADHD; although not exclusive to these aspects.

This group will not be discussing client work, please take it to supervision or contact www.k-brauner-counselling.co.uk/clinical-supervision. Admin will be monitoring strictly to ensure that confidentiality is protected. This rule is for client and counsellor protection alike.

Any posts that are deemed unsafe will be deleted. We hope that counsellors working with neurodiversity can come together here to help and support each other. With the aim of promoting the acceptance of cognitive difference, that seems to be stigmatised as negative within a more standardised model. If you join this group you are agreeing to the terms of use.

This Facebook group will use as default the term ‘autistic’ when describing a person with autism. A survey by the National Autistic Society (NAS) of 3470 which included 502 autistic adults found that the term ‘autistic’ was preferred by a large percentage of the autistic participants.

Please see below an extract from the NAS website which we support:-

‘The language we use is important because it embodies and can therefore help change attitudes towards autism. To reflect the findings of this research, the NAS has begun to gradually increase the use of the term ‘autistic’ – particularly when talking about and to adults in that group.’ We recognise, that there will be autistic people who prefer the term ‘person with autism,’ and it is obviously important to use each individual’s preference at those times.

For more information on the rationale behind this preference, please see links below:- https://www.autism.org.uk/about/what-is/describing.aspxhttps://journals.sagepub.com/doi/abs/10.1177/1362361315588200


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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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