Therapy

DBT = Dialectical behaviour therapy - an adapted form of CBT (cognitive behavioural therapy).

I can see how it'd be a positive but I'm just not sure that's how my brain works. I guess I could be proved wrong but I'm really not a visual person and I wonder whether that's a bit of a block.

I struggled at first, because my first session she gave me oil pastels and a blank sheet of paper and said “Go” lol. I ended up making this ugly arching line across the page made of a rainbow of different cold colors, and while it wasn’t very pleasant to look at, it gave us a lot to talk about and it did feel good to make.

Later she gave me specific tasks like “make me a paper maché mask,” but usually it was just “hey I’ve got these cool ____, would you like to make something with them?”

But yeah, if you’re uncomfortable with the idea of art, no big deal. Just something to think about since it’s a totally different approach than the typical forms of therapy.

She's done the what does it feel like stuff. We worked through that for a couple of weeks. We haven't talked as much about the thoughts and inner voice. I don't always know the answers or find it hard to explain and that is making it slow progress I think. It's the next step that seems to be a big stumbling block at the moment. I think we're both aware there is a limited number of sessions as well which maybe makes it feel more pressured.

I'm not sure I'd have the imagination for art therapy. I can do very prescriptive tasks with instructions or something to copy but if you just give me a piece of paper and a pencil or paint, I just wouldn't have a clue what to do. 

I think I would have had the option for DBT but they do it as group therapy and I had requested individual therapy. I just don't think I'd be able to engage in a group, I'd be too self conscious.

Whats DBT?

I'm just ASD, no ADHD for me but I hope I can be helpful nonetheless.

I managed to get group DBT through my university. I found it was very useful. It was very focused on practical strategies for managing certain things and the biological mechanisms behind reactions and feelings and separating them out and tackling them. It was very good for me as it was decided CBT would probably not work for me due to a variety of factors. I was recommended for it by a university councillor and my college nurse. 

In general very successful for me. Not a 100% solution but I don't think anything would be, and I'm miles better than I was two years ago, probably largely as a result of the DBT given not much else exterior changed in that time. It did take quite a lot of work, there was homework every week and discussions and you were expected to practice these skills regularly outside of sessions in order for them to become successful. But it was understood that not every technique is successful for everyone, and a big part of the course was learning what was good for you vs what wasn't suitable, particularly when it came to distress tolerance. I still use the skills regularly, that is rather the point. 

It is also most often delivered in a group setting. For some people this is too much to handle, with help it worked out better than I thought it would.

I needed some accommodations to take part, which were mostly around managing the stimuli in the room, one day when there was building work going on in the neighbouring building I needed to wear earplugs and I also had to do that for some of the 'thought sorting' exercises as , I had to have some things adapted for mindfulness sessions due to sensory sensitivities, but in general they were extremely accommodating. I did set that up before hand though so that all the staff were aware of what might be particularly challenging for me. It was also in a very large room for the number of people, so although I did leave one time for a break, most of the time I was able to just move to the back of the room for a little bit to stim and recalibrate. 

I am however aware that DBT is very hard to get hold of, particularly on the NHS, and is sometimes considered a specialist skill or programme to deliver. Most other clinicians I've spoken to are amazed that I have managed to get DBT.

Therapy is hard work and important work too and you often feel worse before you feel better.

If I were your therapist I'd be asking you to talk about the last time you felt anxious, maybe it was coming to this appt? I'd be wathing your body language and mirroring it, this not only shows that I'm actively listening, but I'm able to feel where in the body you hold anxiety. Everybody holds it differently, some grit thier teeth, others cuddle their bodies protectively and maybe even curl up. I'd ask you about your posture and to concentrate on the feeling and how its effecting your body, I'd then ask you to slowly get out of that postion and ask you to tell me how it feels. We'd be talking about that specific instance of anxiety and your reactions to it where the anxiety comes from, is there a voice/s of critical people in your past that are telling you things, like everyone is on the bus is looking at you and thinking how stupid you are and explore this. I'd definately take the approach of starting on the outside and working inward, developing coping strategies along the way. I wouldn't be putting any pressure on you to tell me of the big stuff, you need to build confidence in yourself, the theraputic process and me before that.

I do think art therapy is brilliant, people think you need to be able to draw and paint, but you don't, if anything I think its an advantage not to be able too. The therapist shouldn't be interpreting what you create for you, its a way into your world. I've used this before, but its worth repeating, its came up in my training, we're given a picture, of a house, with lots of flowers in the garden and a bright sunny day. When asked what we thought, most people said what a beautiful day and what a lovely happy pictrure it was, what they'd failed to see was a small weeping face at an upstairs window, this was a picture of a hay fever sufferers nightmare.

That's interesting. I'm not very imaginative so I don't know how good I'd be at that but it's great it worked for you.

That's interesting. I'll check it out.

It is interesting to hear the perspective of someone on the other side. 

I'm not sure it's a particular therapy, she hasn't said a name.

At first she wanted to recreate the physical feeling of anxiety like tight chest when I'm not anxious to try and teach my brain that it's ok. But this made no sense to me because my issue isn't that I think I can't breathe, I know I can, I just dislike the feeling. I also know that feeling anxious doesn't mean the thing I'm worrying about will happen, I can rationalise that. I just can't completely switch off from it because I also know that sometimes it does.

She seemed to accept my reluctance with the strategy and moved on to what does work. The only thing that ever works is distraction but I can't decide when I'm going to be distracted and it's certainly not a consistent strategy. She talked about when it's better I'm in work and multi tasking so maybe the distraction needs to be 2 levels. But I'm too exhausted at weekends etc to keep that up and I don't know anything that works well as a distraction at home unless I'm hyper fixated. She told me to think about it but when I see her again my answer is still going to be I don't know and then no progress is being made.

As far as the root causes of my anxiety go, I'm anxious about so many different things, I wouldn't know where to start or what the root actually is.

I am aware that there is some past stuff that I think probably needs dealing with and I mentioned that in my first session but I didn't feel able to tell her what it is. I don't know how I'd manage to talk about it and work on it in therapy if I can't even tell her about it.

Therapy is hard!

I’m not sure whether you’ve seen me mention this book before, but it might be of some help to you.

It discusses various types of therapy and counselling, together with advice on choosing the right therapist or counsellor - all from an autistic person's viewpoint. Several of us here have found it very useful:

The Autistic Survival Guide to Therapy

Post diagnosis, after having read the book (and having previously had CBT without benefit), I chose to have a course of counselling with a counsellor with experience in helping neurodivergent clients.

AuDHD with anxiety/depression here.

For me, the therapy that helped me the most was art therapy. We spent some of our time talking about learning more about Autism and strategies for maintaining anxiety/depression, but a good chunk of time was spent creating art. I am TERRIBLE at art, so I was uncertain at first, however even splashing random colors on a sheet of paper was cathartic and made for good conversations with the therapist.

Without knowing what you're being offered it's hard to advise, do you have to go for a particular type of therapy/counselling? Can you not just talk more generally and start exploring the roots of your anxiety? In my experience as a counsellor, many people come and not know what they want to talk about and don't really know why they're there, only that they need help and it can take a few sessions before we find out anything useful. Most people don't come in and say I want to talk about x y and z, its a slow process of getting them to trust the therapist/counsellor and to open up, 4 to 6 weeks is quite normal before you really find out why someone's there. It's a frustrating process, but that is part of the process.