News and Notes from The Johnson Center
Psychotherapy for People on the Autism Spectrum
JCCHD | Mon, June 18, 2018 | [Autism Treatment][Community]Psychotherapy can address some of the skill delays, secondary symptoms, and comorbid conditions that are often associated with autism spectrum disorders (ASD); however, therapy approaches that are successful for people with ASD might be different than those used for the general population, and a skilled and experienced therapist must take this into account.
Here are some areas in which psychotherapy might benefit someone with ASD and things to consider when looking for a therapist.
Who might benefit?
Many people believe that individuals with ASD cannot receive psychotherapy due to cognitive and/or language challenges, or they believe that only people with “high functioning” autism can benefit. While it is true that people with autism who have high levels of insight and need low levels of support in most areas often make the most noticeable progress in psychotherapy, it is also true that even those people with more significant challenges can learn new coping skills with enough self-awareness. An individual who is nonverbal but has another way of communicating can experience interventions and learn new skills just as well as a verbal individual. Someone with low insight but who is aware of their internal and external experiences can learn to share those experiences and gain support.
What challenges might psychotherapy help?
• Anxiety – Providers in the field of autism are increasingly recognizing the link between anxiety and autism, and psychotherapy can provide a safe place to process the world, express feelings, and learn coping strategies. You can learn more about anxiety and autism in The Johnson Center’s webinar available on YouTube: https://www.youtube.com/watch?v=om8Qj6uJmzU.
• Alexithymia – This term refers to the inability to recognize emotions in the self or others, a trait commonly associated with autism. Just because someone does not recognize the emotion, however, does not mean they do not experience it. Someone with alexithymia can struggle to manage their responses to stress, for example, because they don’t recognize feeling angry or scared but still act on that feeling. It can also make forming connections with other people more difficult. If we can’t connect with someone emotionally, we can’t empathize with them or relate to their inner experience.
• Trauma – Most people think of trauma as severe child abuse, a soldier’s experience at war, or a horrific accident. While those things are certainly traumatic, we can’t underestimate the potential trauma of adverse social experiences or overwhelming sensory stimuli.
• Social skills – Psychotherapy is a safe place where an individual can process social experiences; gain perspective on challenges; learn skills to take others’ perspectives, empathize, and follow social expectations; and practice relational skills within a supportive, secure, and safe relationship.
• Emotion regulation – Emotion regulation is the ability to experience an emotion at a level that allows most optimal functioning. Too much emotion or not enough emotion can both be problematic in most scenarios—behaving ”inappropriately” because our emotional intensity doesn’t match others’ expectations. Emotion regulation is a skill that is learned over time, but this can be especially difficult for individuals with autism and ADHD. Psychotherapy can provide skills and strategies needed to experience emotions without becoming overwhelmed by them.
• Obsessive-compulsive and related disorders – Rates of comorbidity between autism spectrum disorders and obsessive compulsive disorders (an entire class of disorders) are high—meaning they often occur together. Although autism can include symptoms like rigidity, rituals, and compulsions, when these get to the point that they interfere with daily functioning, they can be classified as separate disorders and treated as such. Obsessive-compulsive and related disorders are rooted in anxiety, and there are very effective cognitive-behavioral strategies that can help.
Considerations when Looking for a Therapist for a Person on the Spectrum
1. Consider developmental age rather than the chronological age of the person seeking therapy. For example, if a person is 18 but is developmentally in second grade, the therapist needs to use the types of techniques and interventions he/she would use when working with a second grader—bringing in things like play, art, and simpler language but in a way that does not make the person feel as if they are being treated as a child. When choosing a therapist, consider the ages of clients they have experience with and whether or not that matches the developmental age of the client rather than chronological age.
2. Look for a therapist who has significant knowledge about and experience with autism. This does not necessarily mean that the therapist only does psychotherapy with people with autism. Look for someone who truly knows and understands autism, as the clinician needs to be able to identify symptoms associated with autism to effectively treat the client. For example, if a client brings up a topic or a fear repeatedly, a psychotherapist working with a neurotypical client (a person without autism) might conclude that anxiety is present and explore that topic at length. In someone with autism, that topic or fear might be a perseveration—the excessive repetition of an action or speech about one topic. Unlike exploring an intense topic with a neurotypical person, engaging in a perseverative topic with someone with autism can often make it worse. Instead, when a psychotherapist knows how to recognize perseveration, he/she might conclude that there is likely stress, anxiety, or another need for coping behind it and shift the focus to providing calming strategies and support.
3. Deconstruct the “people pleasing” responses. A successful therapeutic relationship is an honest one in which both parties can give feedback and responses that are genuine, without fear that they will be letting the other person down or causing strain on the relationship. In some cases, and even more so for individuals with autism, clients tell the therapist what they think he/she wants to hear rather than sharing their true experience. There are many possible reasons for this, and the therapist needs to be able to identify when this is happening and explore the deeply seeded beliefs, emotions, or skills delays resulting in this response.
4. Think about confidentiality. Unless a caretaker is awarded guardianship, an individual becomes an adult at the age of 18 regardless of their developmental age. Confidentiality is the protection awarded to the relationship between a therapist and an adult client that prevents the therapist from disclosing any information shared with anyone else, except under specific circumstances. You might talk with potential therapists about how they would handle clients with developmental delays who are over the age of 18 but without guardianship in place, as challenges can arise. For example, a parent, caregiver, or other person may need to be present to help with communication between the therapist and client, and some information may need to be shared with the financially responsible party if that party is not the client. Even if the therapist has the client sign a release allowing this sharing of information, how does the therapist know that the client is able to give informed consent? It can be beneficial to talk to the therapist before starting psychotherapy with him/her to iron out details like this and know what to expect regarding confidentiality in this situation.
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Just like any therapeutic intervention, it is important to access services from experienced, knowledgeable, and dedicated professionals who are committed to understanding the challenges, strengths, and needs that are most relevant to the person seeking assistance and support. At The Johnson Center for Child Health & Development, we take counseling for people on the autism spectrum very seriously and are proud to offer services from clinicians who are dedicated to serving the needs of our community. It is our goal to ensure that appropriate intervention and support is available to anyone in need, regardless of their financial circumstances. Assistance seeking insurance reimbursement, grants, and a sliding fee scale are available for people in need of support.
For more information about psychotherapy for individuals with autism or to learn more about The Johnson Center’s psychotherapy services, contact us at 512-732-8400 or .(JavaScript must be enabled to view this email address).
