Truth be told, I am Autistic ...
and here's the story ... it's all about story right ...
At age 54 and 20 years of clinical practice, I was inspired by a client's courage to engage in a full battery of Psychological Testing (at my request) to get a broader and more evidenced-based perspective on their unique set of diagnoses. This particular client's clinical documentation declared a diagnostic cocktail: BiPolar, manic; BPD; Schizophrenic; ADHD; Substance Use Disorder. Yet every time we met for a session this diagnostic cocktail of puzzle pieces did not match up with this amazing individual before me week after week.
Knowing the value of Psychological Testing I advocated (aka) "sold" them on the idea. When we read the report we both cried, "High Functioning Asperger's". No wonder some of his medications never worked, the self-medication with substances, the repeated self-harm (since age 3), the exacerbation of ADHD to a manic frenzied binge. We cried some more. Breath. We re-wrote the Treatment Plan to accurately reflect triggers for anxiety, depression, daily suicide ideation, daily self-harm, daily substance use, and intense bouts of emotional dysregulation. We made a lot of phone calls to their network of supporters. We got their medication adjusted. We engaged in a higher level of care via a community-based program ACTT.
In my mind while having the above exchange, I heard myself say, "This looks all too familiar ... This profile looks a lot like me." So, I went and got tested myself. The tester, a Ph.D. psychologist, voiced not seeing why a formal diagnosis was necessary given my age and career. I argued it's value at my age and as a clinical professional and won. I did seek a second opinion from another psychologist, expert working with autistic individuals who confirmed the ASD diagnosis and validated my story and affirmed my being an effective clinician moving forward.
Yes, I am Autistic ... part of the "lost generation" who did not get the support, understanding, and/or accommodations that are available today. I was bullied. It was violent. And yet, like many of the "High Functioning Asperger's" community finished graduate school twice, have a full-time job, and relationship issues all to common for ASD adults. Our reality, our daily life is a mixed bag exhilarated by our passions for computers, visual arts n hand crafts, animals, human rights, the environment and frequent bouts of debilitating anxiety, globally high suicide rates, often obsessive, bouts of debilitating depression, likely PTSD and dissociation, and/or grief reflecting many types of loss over our lifetime. History is showing, we are amazing, creative, resourceful and skillful people. Dr. Temple Grandin spoke truth, that if it were not for us "we'd still be in caves."
It's 7 year later and I am 61. Private practice is my bread and butter. I enjoy being the owner and working with and for "my peeps"! I utilize a variety of clinical and social media resources to structure our work together. Most ASD adults already have a few good life "hacks". My task is often to tweak those and add a few more to the toolbox. I am a life long learner believing one can always add to the toolbox. On September 12, 2020, I completed the National Autism Academy's 29 hr Certification program "Training for Professionals Serving ASD Clients and Their Families" approved by the National Association of Social Workers. This is an Applied Behavior Analysis (ABA) model, which I do not endorse, but I did learn a lot. Summer of 2021, I completed PESI's Certified Autism Spectrum Disorder Clinical Specialist training. Evergreen Certification # 978515. Summer of 2021, I also completed PESI's Certified Personality Disorder Treatment Provider training. Evergreen Certification #362000.
As a Social Worker, yep this makes a difference in your therapy experience,
My charge as an LCSW is to do no harm, to prevent self-harm of all types including suicide. In most clinical settings “active listening” is a given, understood to happen. When providing outpatient individual therapy to autistic individuals “active listening” is an intervention of merit, (a bearing witness too) being both reasonable and necessary given this client’s conditions and current standards of clinical practice thus forms the basis for therapy with autistic adults thus meeting the criteria of medical necessity. Autistic individuals frequently feel dismissed, not heard or seen, or accepted for who they are, hence the high rates of co-morbid anxiety and depression, self- isolation and extremely high global rates of suicide*. Autistics often live as the “walking dead”, living in emotional suicide. Given autistic folk are not mentally ill or retarded, but neurologically different are often living and working in environments that are physically and/or mentally debilitating (aka fuel for suicide). Autistic adults reveal themselves through story, intricate layers and webs of interconnection unlike neurotypicals. To be allowed to share the whole story, to be actively listened to, to be seen, to be accepted is incredibly important. One-way autistics process an experience is to repeat the story multiple times, each time considering various aspects. “Active listening” allows this external process, hearing themself tell the story is out loud, without judgment and evaluation held in the mind (bias) into reality (hearing one’s own truth with a witness) makes real what happened and draws from the evidence-based model of Prolonged Exposure Therapy from VA, where repetition of the event, often a traumatic event, allows for the “victim” to become the “owner” of the story and metaphorically walk away from the event with their humanity intact. “Active listening” is a slow and steady, safe therapeutic intervention for autistic individuals. It is the base of forming trust, the base for a therapeutic relationship. Trusting a stranger (the therapist) as an autistic person, who has most likely already been bullied and/or harassed requires significant energy and change. And change is hard for autistic folk. Outpatient therapy is medically necessary to keep this person alive, literally and emotionally. That my clients are seen and heard by an autistic clinician … it’s a game changer, a lifesaver.
As a social worker, I also support and advocate addressing the"myths" of Autism. We are characterized, for example, as having no empathy. To facilitate our understanding of this and other "myths" I utilize Polyvagal Theory of Dr. Porgas and made practical for clinical practice by Deb Dana LCSW (www.rhythmofregulation.com) and Nonviolent Communication skills.
What is Polyvagal Theroy? It's a way of understanding our Autonomic Nervous System through the research of Dr. Porges "defining the ways autonomic nervous systems react to experiences and regulations responses", how this system "informs and initiates a response to help us safely navigate the demands of a day and outlines a hierarchy of three biological pathways" (Dana 2020)
What is Nonviolent Communication (NVC)? A "from the heart" dialogue process crafted by Dr. Marshall Rosenberg Ph.D. beginning in the 1960s as “A Way to Focus Attention” connect Dr. Rosenberg studied with Dr. Carl Young, who developed Person-Centered Therapy. Dr. Rosenberg was also well-versed in Cognitive Behavioral Therapy. NVC is a technique for more clear, empathic, non-judgmental communications proceeding through four areas of focus: observations, feelings, needs, and requests. NVC is taught as a process of communication to improve compassionate connection – to speak and hear what is alive in the other and within ourselves = self-empathy.
You might ask why is NVC relevant to our autistic community:
- NVC provides a “black n white” sequence, to facilitate real connections with practice;
- ASD folk – you and me – find ease, connect more easily, “black n white”, clear exchanges create ease request and receive something we need while living out our lives and ways to consider meeting the expressed needs of each other. It keeps our community safe and satisfying. The practice allows us to increase our capacity for compassion and then share this through wholehearted living.
- Facilitates setting boundaries so that we can live in our integrity “B.I.G. What boundaries do I need to put in place so I can work from a place of integrity and extend the most generous interpretations of the intentions, words, and actions of others” Dr. B. Brown, LCSW, Ph.D.
- “In traffic” how to stay in my lane – empathy to drive in different traffic patterns
- ASD folk often have difficulty understanding the behavior of others – their motivation seems odd or unclear, leaving us feeling … odd, weird, an outsider …
- This tool (questions for self and other person in conversation) can help us identify what emotions are engaged based on data … what need(s) are being met or not met.
Your Treatment Plan might include:
Autism Overview: (Adapted from Dr. Lester, PhD work with Disordered Personalities):
Learn Polyvagal Theory to support self-regulation
A. Increase Flexibility and Adaptability in Thinking, Feeling, Behaving
Enable them to handle life’s messiness and changing circumstances;
Stop “persisting in a behavior in the face of clear;
evidence it’s inappropriate and ongoing bad consequences.”;
Improve their resilience increasing psychological resources to enable them to deal effectively with different situations
B. Increase Self-Management and Self-Corrective Capability
Enable to self-adjust to get better consequences;
Enable to successfully manage their own internal arousal;
Enable to manage their own behavior for good consequences;
Enable to learn from their mistakes and get better consequences;
C. Produce Fewer and Less Severe Unproductive Escalations
Lower the “Drama” in their life;
Enable a more proportional approach to life;
Lower the frequency of upsets, arguments, and other escalations;
Attend to productive escalations with compassion and curiosity
D. Increase Use of Problem-Solving skill to Deal with Life:
Think of life in terms of solvable problems;
Enable to consider a variety of options;
Enable to tolerate that every solution has downsides;
Enable autonomy – ask for help, collaborate, empower
-Increase personal autonomy – as evidenced by increase the ability to "own" message; make observations without making inferences; recognize and verbally report feelings; identify the reason for feelings in terms of "because wants"; express wants in actions terms; ground thoughts and anecdotes in present feelings and wants.
-Increase awareness of Interdependence: impact as evidenced by “ability to receive wants as wants and not as demands, obligations, or duties”; “ability to receive feelings and wants as feelings and wants and not as personal praise or criticism”; and “ability to receive feelings and wants without evaluating the accuracy, morality or competence of the speaker”
-Increase competency regarding conflict resolution attending to impact of trauma ... "through generating want-oriented alternatives" as evidenced by – increasing "ability to generate alternatives in time, person, place and action dimensions" and "ability to differentiate protective and educational force from the punitive force"
-Increase personal sense of self-empathy and empathy for others as evidenced by learning and practicing Nonviolent Communication Model – “observation”, “feelings”, “needs” and “request” as formulated in Nonviolent Communication: A language for Life by Dr. Marshall Rosenberg PsyD.