Guest Post by Paul Hughes
Ever since I began treating clients diagnosed with Asperger’s Syndrome I’ve received emails from therapists faced with the prospect of their first autistic client. Here’s how they typically read:
“Hi Paul. I found your website and need to ask you a favour. I have a client with Asperger’s coming to see me on Monday and I wondered if you have a script for treating that?”
I’m afraid I don’t. Autism spectrum ‘disorders’ are for life, forever, for keeps. There’s no cure and no solution. There’s certainly no script.
There is, however, plenty of hope. There’s something about treating Asperger’s Syndrome that seems to scare a great many therapists when, in reality, there’s nothing to worry about.
You simply have to know what you’re dealing with
Autism was first formally identified in 1943 by Leo Kanner.
1944 saw Hans Asperger, working independently of Kanner, discover autistic qualities in people who would otherwise pass as being neurotypical.
Unfortunately, because Asperger wrote in German, it was left to Lorna Wing, in 1981, to finally publicise his work, and so the term ‘Asperger’s Syndrome’ was born.
It’s estimated that 0.3% of the population are on this end of the autistic spectrum – that means 200,000 people.
Only a fifth of these are female, but this is quite possibly because girls are harder to diagnose, as they are better at learning how to ‘fake it’.
The autistic triad of impairments
Those with Asperger’s Syndrome, that is, on the high-functioning end of the spectrum, may have less of a problem in theory, but sometimes their relative invisibility makes them all the more socially problematic.
Wing handily organized the problems commonly associated with autism into three groups:
1. Social and emotional skills
People with Asperger’s will commonly have problems forming and maintaining friendships and romantic relationships. They may have problems understanding their own emotions and they’ll often find working or playing in groups difficult and stressful.
2. Language and communication
This means that people on the spectrum will often find nonverbal cues, intonation, and ambiguity hard to read.
Sarcasm, irony, and double-entendre will commonly pass them by. They’ll often find social conventions hard to manage.
Ask them a question and you’ll get an honest answer. Careful! It may be brutally honest, because even white lies are lies, and therefore bad… right?
Ask them what they did today? Well, you did ask, and so you may get every detail. Expect them to pause so that you might get a word in? Well, sometimes they don’t, and you won’t.
3. Flexibility and imagination
Routines are very important to many on the spectrum. Try introducing change at your peril. One of my clients would have the same thing in her packed lunch every day for six months. And if you tried to change it? Meltdown time.
Empathy? Well, people with Asperger’s do have empathy, but it may need to be pointed out that event A will lead to feeling B.
Her dog died? Okay. They may not immediately grasp that sadness will ensue, and may have to be told. Once told, they’ll feel sad for that person, but will often find that emotion hard to identify.
Flexibility? Well, people on the spectrum, particularly as children, will often have an obsession that consumes them. Routines will be rigid. Things have to be done in just the right way. Choice? Often they won’t like it.
Remember the jam test?(1) Researchers found that offering half a dozen jam samples in a supermarket for tasting purposes led to greater sales than offering fifty or more flavours for people to try.
Too much choice is dazzling. Too much choice turns people away and leads to increased levels of stress. If this is true for neurotypicals, it’s still more true for those on the spectrum.
The triad of impairments, as you can imagine, can place people with Asperger’s at a significant disadvantage in life.
Hidden causes of misunderstanding
The vast majority of my clients come to me for treatment for social anxiety. They want friends and yet find them hard to find. They need love and yet don’t know where to begin.
Their condition is often sufficiently invisible for them to pass as ‘normal’, yet society will mark them down as ‘weird’, ‘eccentric’, ‘selfish’, ‘rude’ or worse.
Symptoms and sensitivities
Many of my Aspie clients will present with depression, OCD, generalized anxiety and an overwhelming sense of pointlessness, worthlessness and loneliness.
Some will present with sensory sensitivities, which cause the faintest smells, sounds, colours or sights – even just the flickering of a light – to be overwhelmingly powerful.
The world’s indistinguishable nuances
People are random. People are noisy. Children scream piercingly and with utter unpredictability. People say things they don’t mean. ‘Ten minutes’ means an hour and ‘I promise’ means ‘maybe’. How are people on the spectrum supposed to cope with all this stimulation?
Sometimes they don’t. Sometimes they’ll have meltdowns, which can strike others as akin to tantrums but which, in reality, are huge cathartic explosions. This will cost them jobs and friends, and will lead many to conclude that it’s safer to simply stay at home. We all know where this leads.
Helpful tips for treating Asperger’s SyndromeHelpful tips for treating Asperger's SyndromeClick To Tweet
- Be practical. Clear, practical, SMART, solution-focused targets are the answer.
- Teach mindful/self-hypnotic approaches to anxiety, depression or whatever it may be.
- Use anchors for calmness.
- Explore the client’s resources. These will often have to be explicitly coaxed from the client. They may not appreciate that quality A, B or C could be harnessed to help in situation D. They may not realize that the skills used in situation A could be used in situation B too. You may have to spell this out.
- Use clear, unambiguous and explicit suggestions. Embedded commands and all that jazz may pass them by.
- Be polite but direct. Remember that choice can be overwhelming, and people on the spectrum may become stressed at being offered too many possibilities.
- Be prepared to give more advice than you’d normally want to. Don’t do a Carl Rogers and keep throwing it back at them. They want help, not purist person-centred counselling techniques.
- Set practical homework based on carefully graded exposure.
- Praise your client. They may not realize that their success is a success.
- Remember that you understand human behaviour, but your client may not. Explain what to do in social situations and have your client rehearse it with you.
- Consider going out with your client and supporting them in their first steps.
- Tell those who have difficulty with eye contact (it is often an overstimulation) that looking at the spot where the nose meets the forehead is as good as eye contact. The other person won’t spot the technique and the client will avoid the discomfort brought on by real eye contact.
- Use previous successes to drive further forwards.
- Use indirect, Ericksonian methods. The triad of impairments means that the core meaning may not be obvious.
- Get all hypno-analytical. If an Asperger’s client tells you that their childhood was fine, you won’t have to dig around. It was fine. Asperger’s alone is enough to cause the presenting problems.
- Assume that family or partners understand everything about Asperger’s. They may need educating as to why their loved one behaves as they do.
- Get bogged down in analyzing feelings or hidden meanings of words employed by the client. This will prove fruitless. Remember, practicality is key.
- Use idioms, catchphrases or metaphors. Remember the triad!
- Use NLP. It’s too indirect.
Finally, DON’T LISTEN TO ME!
Really, don’t just listen to me. Bear everything I’ve said in mind, but remember that every client is different. Some will fit certain aspects of the description crudely summarized above, others will be much more advanced in their abilities.
There is no article that can neatly sum up such a rich, diverse and endearingly fascinating segment of humanity.
That’s it. I hope you’ll love working with these clients as much as I do.
Written by Paul Hughes, a UKCP-registered hypnotherapist working in Reading, Oxford, London, Thame and Wallingford, UK. He trains student hypnotherapists for the NCHP in Oxford. His eldest daughter has high-functioning autism/Asperger’s, and it was this that sparked his interest in the field. He can be reached through his website: https://www.resolvedhypnotherapy.co.uk.
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