Therapy

Yeah, that specific aim is a really important one I have found. My tactic, and it was the only one I could develop at the time was 'what's impacting my life the most right now?' That is what led me to my answer.

I've tried therapies both on and off the NHS. My impression, and it isn't statement of fact just my experience, is that most counsellors and therapists are trained to be somewhat narrow in their approach. The NHS mostly wants CBT, so most NHS counsellors seek to try and circle back round to CBT because it's all they really know. That might also answer TheCatWoman's question too about holistic approaches. It's not the 'standard' approach and unless you actively request it, maybe they're disincentivised from utilising the approach?

You specific aim can actually be really simple though: I'm feeling depressed and want to talk through what's been stressing me out.

Another example I was given was: 'I don't understand what's causing these feelings of [insert feelings], I'd like to some help to discover the cause.'

Obviously, I'm not a professional and I'm sure some professional would scream at me for saying this stuff. It is after all purely my experience and my uneducated perspective.

Either way I hope you find something that helps.

A fair point. She did say last time we could just talk for the rest of the sessions if that's what I'd rather. I just want them to have some meaning because they're limited.

You can do therapy holistically by just being allowed to talk through whats going on with you at the time of the appointment. It might seem disjointed but patterns will emerge and as you deal with the immediate stuff the deeper things will come to the fore. You shouldn't need to have everything so pigeon holed, it's not really a case of this sort of therapy being good for that sort of problem, it's not like a drug regime and I feel that the NHS seems to think it is and is doing everyone a disservice by treating it as such. You shouldn't be having to make this sort of desicion really, the therapist should, how do you know what sort of therapy you need? If you went to the GP, they wouldn't ask you what sort of antibiotic you wanted.

I don't know and I agree trying to separate them is difficult but I have no idea how you do therapy holistically and nothing she's suggested so far seems to fit into that category.

Social anxiety is a big thing but the problem with treating this is they just want me to do things that make me socially anxious. For neurotypicals this can bring down the social anxiety and maybe it works for some autistic people but I know for certain it won't help me, it would just increase my anxiety by a lot.

Being judged is another big one. This covers not only the social but things like getting things wrong. I did raise this issue but the therapist then went down the line of have you asked them. No of course I haven't asked them, I'm socially anxious and rubbish at communicating. 

The other big one is uncertainty. Again the general approach to work on this seems to put yourself in uncertain situations. Well that's been my entire life and I still struggle and I need some level of certainty in order to survive. So I don't know how I improve that issue.

My evenings are the worst time as I have time to think. We tried to work on this but got stuck in a loop because she kept asking me what would help and I kept saying I don't know nothing I've tried has worked. She kept saying well what would you want to try and I'm like if I knew the answer to that I probably wouldn't need the help of a therapist.

Why can't you be treated holistically? All of your issues will be interconnected and I think trying to seperate them is a bit pointless.

You said you wanted to improve depression and anxiety.

Seems you want to look at what makes you anxious. If some things do and some don't, then what is the difference. What is it you are worried about. What negative outcome do you fear and does that come from somewhere.

If you are anxious about everything, then are the tomes of day or places that are less bad. Is there a pattern. You could try writing things dow

I think a lot is just fear of newness. So make things less new, try to do more thing, maybe with some help initially to build confidence.

For the depression, assuming you are not just burnt out and overloaded in which case fix that, what is it that you don't have that you would like to have. Are these things true, i.e. fact check them. Are there are simple things you could fix. Small wins will build.

Only you know you, so you might need to be a detective.

Your therapist ought to try to steer you

I didn't know where to start so just info dumped everything bad that had ever happened to me. It was traumatic as I revisited everything. I did it myself then just presented it all and hoped to find an answer. Partly it was just unburying things, but mostly it was the prompts and help to understand them that helped.

When you are not hiding things and you understand them you have less to fear and you feel more in control.

Thank you. My therapist is trying to understand but I don't think she's really getting me at the moment or what would help. I find it really hard to explain so I don't think we're quite gelling at the moment.

I think part of my problem is I'm struggling to have a specific aim. I just want something to get better. There's so many aspects to my mental health, I just don't know how to pick the right one.

Talking Therapy (counselling) was certainly helpful to me. It did however require me to advocate for myself and ask for in person counselling. Neither phone, nor video call works for me. A neurotypical person only receives like 5% of all communication when they only have voice to go by. Video calls also minimise the available information. So for me, I like to give myself all the information to potentially give me a higher chance of interpreting tone, and reducing misunderstandings. 

The last counsellor I worked with attempted to take an approach that highlighted Transactional Analysis. This was before I had my diagnosis, and officially considered myself autistic. It was helpful though. So to, was Psychodynamic Therapy. It's difficult to come across on the NHS, but it can have its uses. Both require you to be honest and fairly open to the process. So that means a counsellor or therapist that you trust, get on with, and feel understands you.

The most important thing I think is going into counselling with a clear idea of what you are hoping to achieve. 

For example, I've self-referred for counselling again post-diagnosis. My aim and the answer I'll give when they ask 'what do you hope to achieve' is: to put the autism diagnosis into context. To explore how it has affected me in the past, and reanalyse what I consider to be 'normal'.

Previously, my aim in counselling was to work on some long standing traumas and understand how the past experiences were affecting what I thought was depression. Having that clear idea of what I hoped to get from the process aids both yourself, and the therapist to understand where you're going. What the point of the process is.

Standard CBT did nothing for me, apparently there are versions that are designed for a neurodivergent brain but I've yet to encounter it.

I been doing therapy for around 4 months and I decided to be as open as possible.

At times it has been really difficult but hopefully worthwhile. I have a greater understanding of the differences in the way I think and process things that may differ to neurotypical people.

I've come to realize that depression is just my status quo. It's compounded by alexithymia and a dopamine reward system that just doesn't work.

Understanding my stress (bucket) triggers and trying to find ways of reducing their impact.

The whole acceptance thing is proving a tough nut to crack but I'm hoping this will come with time.

I think I agree that therapy potentially isn't very useful for me. I don't think talking therapy has much chance of working but I'm also aware that that mindset will limit it's chances of working too.

I have made changes to my life to make to more audhd friendly which has helped but there are areas of my life where that is difficult to do. For example, I struggle with keeping on top of every day housework and find this overwhelming but I can't afford a cleaner and I don't qualify for PIP so it's difficult to help with that. Pretty much anything I do in life does cause me anxiety but doing nothing doesn't help my mental state either so it's a difficult one. I also really struggle socially and limit this because I find it so difficult but I do crave some sort of social interaction. Because I find it difficult I've spent most of my life being rejected and feel this rejection really badly (common with neurodivergency I know) and it's these feelings that I really struggle with and are a huge trigger for my low mood.

Thanks for your reply. It's so useful to get an answer from someone who can see both sides.

Somewhat damaged.. said:

Just finished a really good book by Steph Jones called the Autistic Survival Guide to Therapy. Deals with all of these topics. She's autistic and a therapist. I recommend it to all my colleagues now.

I also found it immensely helpful, and I recommend it here regularly - as I did a few days ago in this thread, for example.

I've had A.C.T therapy (acceptance and commitment therapy). I found it useful as an autistic adult because it's about living a life in line with values that create a meaningful one.

I'm also a therapist so have a foot on both sides of the experience. I honestly don't think therapy is that useful for ASD/ auDHDers. The premise of talking therapies is to return someone to a state which is defined by neurotypicals as one which will cause the least challenges. Hence we all tend to find CBT mega frustrating.

I've realised that it's useful to see if creating an ASD (in my case) friendly life makes the difference first. Took me ages to answer the question 'do I get depressed or do I get burnout and meltdowns because my life is not user friendly for my ASD brain?'. 

That said, the incidence of co-occurring conditions in our community is high. Unfortunately I don't think most therapists are able to spot the difference between burnout and depression. Just finished a really good book by Steph Jones called the Autistic Survival Guide to Therapy. Deals with all of these topics. She's autistic and a therapist. I recommend it to all my colleagues now.

They are every week but I have a limited number of sessions because it's on NHS. I'll look up person centered therapy, thanks.

Hi. I have been having what my therapist calls Person Centred Therapy for about 2 and a half years now. 

I have actually found this the most helpful therapy I have had before. Like you, CBT was not great, it was a constant struggle against my own brain. 

I can also understand the need to fill sessions. Sometimes I think it's because I just don't have much to talk.about or not in the.mood to talk. Both are okay. 

May I ask how often your sessions are? I feel I do better with longer inbetween sessions. When I first started it was every week and it just didn't work for me. I now have a session every 4-6 weeks, with the option to change if I feel I need to.

I think there are 2 options.

1.Start wit what is causing you the most immediate issues.

2. Don't try to decide, let them decide. Maybe you need someone else to see the picture and work out the best route. You might be missing something or have faulty thinking. This was one of my issues.  

So you can make quicker progress it will help to write stuff down. It allows you to order your thoughts, makes sure you don't miss stuff and removes the pressure to remember what you want to say in the session. You can also email it on advance. I did this a lot.

My issue is there are a lot of problems and I'm not going to be able to fix them all so what do you pick to work on. It is also difficult to differentiate between autism and mental health.

The NHS makes this difficult unfortunately. She seems to have some knowledge of autism and did agree that CBT was not the right thing. But I don't think she truly understands what it is like to be autistic so in that sense you're right, I'd be better having someone that has experienced those things.

Hi, I tried lots of different types of therapy including CBT but also others- nothing worked, some caused more harm than good. The first thing that has worked is finding a counsellor who is autistic himself and mainly works with neurodivergent individuals. I have to admit at that point I had given up on therapy but my university offered to help towards the cost of a specialist therapist so I gave it a try and I have continued- it is so so much easier to talk to another autistic individual and there are so many things that I don’t have to explain and I just feel like this is the first time therapy has actually been helpful. I found this counsellor via a website where neurodivergent counsellors can advertise their services (of course make sure whoever you see has appropriate qualifications and accreditation). I know that it can be really difficult to get specialised support via NHS , but if going privately is an option, maybe you could consider finding a therapist that is neurodivergent themself or that at least has experience with neurodivergence 

I think a lot of it comes from within. You talk to someone about what your issues are. You try to get to where that is coming from, what you are afraid or worried about. They provide some guidance and offer suggestions if you have some preconceived ideas, biases, cognitive distortions, or errors, which allows you to be a bit more clear on your thinking. 

I don't think you go to them and say what shall we talk about. You need to know what you have a problem with and what sort of end result you want. You have to be completely open and honest, including with yourself which can be the hardest. You need to have no fear, shame,or embarrassment, which is what foolishly stopped me for 3 decades.

My main issue was confusion, so someone to check my ideas against, once I had the courage to just tell them everything, was enough. I then spent 20-30 hours researching between sessions and thinking deeply to figure out what was up.

I did kind of re-traumatise myself. But my obsessive mind revisiting things 3-4 times a day for months has gradually worn that down again.

My main realisation is I might have screwed up my life and no therapy will act like a time machine and send me back 30 years which is what I really want. I may also be indulging in fantasies and have unrealistic ideas, I don't know. I will have a diagnosis in a few weeks, then I will know where I stand. Maybe I am just a  bit old-fashioned crazy.