Advice needed re counselling

I had to take a few days off work last month due to anxiety and depression and the doctor recommended a local counselling service as he though I would benefit from CBT. Since then he has assessed my AQ test results and confirmed I have aspergers and offered to refer me to a specialist, which I have not taken up at the moment.

I have returned to work and made a change in my life to lower the stress, and have been reading a lot about aspergers, which is helping me to understand myself and recognise when I'm getting stressed so I can try to calm myself down. 

I haven't had any counselling sessions yet and my first assessment appointment is due next Saturday. I started wondering today if it is going to be of any help now that I seem to be coping OK again?  I've heard that some aspies don't find CBT helpful. Does anyone have any advice or experience with CBT they would be kind enough to share? 

Thanks 

  • Thanks for the link to other posts, Socks,  and thanks to Peachi for sharing your experiences. 

    One of the other posts discussing CBT linked to a pdf of slides for a presentation about it. There was an example exercise which asked people to imagine they were stuck in a traffic jam, then to write down one automatic thought that would lead them to feel each of the following emotions: anxiety, depression,  anger, guilt, feeling relaxed. When I tried this, I went straight from imagining being in a traffic jam to experiencing anxiety - no recognition of a thought process leading to that state. Is this one of the differences between me and a NT person? Do any other aspies identify with my experience?

    The central approach for anxiety was "do the thing you cannot do" - stop avoiding, safety seeking and thinking the worst, and use graded exposure to overcome fears. I understand the concept of exposure, but I don't think it works so well with aspies. I hate lifts. I lived in a 6th floor flat where I used the lift daily before I moved to the 1st floor flat where I now live, and where I take the stairs. I feel much more relaxed where I am now and when I went back to check my previous flat after moving out, I felt very uncomfortable using the lift again. Another problem in my old flat was that there was a night club behind it which pumped out thumping music until 3 or 4am on various nights, not usually less than 3 nights in any week,  and my reaction to that got worse over time,  not better - I started getting night time panic attacks.

    I'm sure some people on the Autistic spectrum find counselling / CBT helpful, but I don't think it's for me. I think that learning about myself and being less hard on myself as a consequence, since learning I'm an aspie,  is helping a lot. 

  • Former Member
    Former Member

    CBT is discussed regularly on the forum http://community.autism.org.uk/search/node/cbt and it excites very strong feelings as some people have hopeless counsellors and in some cases people go in expecting magic to happen. Counsellors are only human and they are sometimes very lightly trained - they are not psychiatrists.

    CBT involves challenge. They should challenge your current, ingrained ways of thinking and nudge you to look at things in a fresh way. Things are not as black and white as they seem to be. Autistic thinking leads one to be very categorical e.g. the counsellor is fantastic or the counsellor is hopeless and this tends to lead one to think that the sky is falling in when, in fact, things are not great but they are not hopeless.

    CBT also involves some effort and commitment on the patient's part. You need to be open to challenging yourself and accepting that your life is going in a different direction to how you imagined it. Again, do not expect miracles. Do accept there are limits to how much or how fast you can change.  

    Reading some of the above though should lead one to be wary. If the counsellor has provoked a meltdown then you should walk away and find someone else to deal with. Do not however, give up on the CBT idea - it is the recommended therapy for someone with autism and the alternatives (medication or a life of continued misery) are even less attractive in my opinion.

  • Hi Pixiefox,

    I totally agree with Johnsb, you must find someone that understands and is versed in Aspergers.

    I was given 'therapy' through my work and they assigned me to a coach (not even a counsellor).  We aranged to meet and when we sat down for our initial chat he looked at my notes and said "I'm going to have google High Functioning Autism"...the alarm bells were ringing for my immediately and I should have left, but as work had paid for the session I felt obliged to continue. Needless to say it was extremely distructive for me personally; the coach had me doing a specific exercise that actually sent me into a full on meltdown and had me in floods of tears. Then to make it worse he kept on pushing me saying "it's good for me to see a meltdown as I haven't seen one before!" He was also very poorly versed in my condition and had no understanding o HFA (when I told him I wasn't very good at maths he said "I thought autistic people were all good at maths, you're not very autistic are you?") Anyway, it was so bad that after the session I had to be sent home from work and spent the next three days in a mute state where I spoke to absolutely no one. It was very very destructive for me and my thought process, my anxieties have been bad since; I now seriously am back to square one again and struggling with all the little things in life that I seemed to be getting a handle on.

    Needless to say I cancelled all my future appointments with him and I am now seeing a pyschiatrist who specialised in females with HFA. We have an amazing rapport, I trust her and she actually understands all those finer nuances of my problem that most people just don't understand. I am currently having CBT but without the 'B' bit (my behaviours are pretty much already what you'd expect from a regular person so I am having to try change my thoughts only!) At the moment I can't say I am getting much from it, this may be because I am still only a few sessions in, it may be because I am still coming to terms with my brand new diagnosis...I don't know. Either way or whatever path you chose the ony decent bit of advice I can give you is for your own sanity, state of mind and general health....find someone who knows, understands and deals with Aspergers specifically xx  

  • Although both NHS counsellors I saw were supposed to do CBT, I don't think they actually went through the process. We seemed to just talk about things. It was all about encouraging me to think positively though. One of the other counsellors I saw privately told me I should go outside my comfort zone. This is all good advice that I read in many places too. But, I think staying within my comfort zone, and considering the negative side of things, has helped to protect me. I got into my current situation by having a real "can do" attitude, and going outside my comfort zone, even though I still thought it through carefully, and put what I thought were very sensible and practical provisions in place to deal with potential problems.

    I think the problem wasn't the physical aspects of what I was doing, it was the people situations I had to deal with. I think I could have dealt with the practical problems, although they were, and still are, pretty challenging, but I couldn't deal with the people I came across. I've never had to deal with such difficult people. I've been lied to, taken advantage of, and just been unable to make the strong connections I need with the good people I needed to get involved in what I was trying to do. It's only through this experience that I started to realise I've always had a real problem connecting with people and dealing with difficult situations. I'm not aware of anyone spotting this, until it was too late.

    From what I can see, counsellors are doing the job they're trained to do. They don't do diagnosis, so it's like sending someone with a broken leg to a specialist in broken arms, and wondering why you get your arm put in plaster, and fall over in agony when you try to stand up!! The GP I saw during what I thought was my "mid life crisis" just asked what I wanted him to do about it, and when I muttered something about "giving me a checkup or something", he sighed loudly and said "oh well, I'll refer you to a counsellor". And that was it. A counsellor was the only option, with no opportunity for any sort of assessment or diagnosis. The place I went to privately while I was waiting for NHS counselling was no help either, as they seemed to diagnose anyone who went there as being co-dependant, and applied a one size fits all treatment.

    10½ years after visiting that GP, I may finally get the right answer in a few weeks, and just maybe get to see people who are trained to deal with the right problem.

    That's why I'm a bit wary of counsellors!

  • I had CBT, in my opinion, it is very difficult for an Aspie. The medical professional running the CBT should have an awareness of autism and aspergers, so they know it is difficult to make a change, and how body language you are showing in the sessions may not affect your feelings, along with the sensory side of things. Personally, I can see how CBT could help me in the future, but I feel counsuelling the best option for me to start with.

  • Thanks John. 

    I was curious about what CBT involves and I found this description on a counselling website;

    "The premise behind CBT is that our thoughts and behaviours have an effect on each other, and by changing the way we think and behave - we can ultimately change the way we feel about life. The therapy examines learnt behaviours and negative thought patterns with the view of altering them in a positive way."

    One simple example of negative thoughts I've seen described is where a friend walks past and ignores you, and you assume they no longer like you, whereas they may have just been distracted and did not notice you. I have what I term "hyper-awareness" - I'm always aware of the people around me, and husband and my only real friend both have this awareness too, so it wouldn't happen with them and I'm really not bothered whether anyone else likes me. 

    I'm not sure what negative thought patterns encompasses: I know a lot of people with depression don't like themselves, but I generally have a positive view of myself. I do get a negative view of others when they criticise me in an unkind way, but usually a person who does that to me is not liked by quite a few other people, so I think I have the right to be upset with them, particularly if they don't apologise when it's obvious they've upset me. 

    A lot of my behaviour is learnt, obviously, but mostly that's to fit in and communicate with others in a way they find acceptable. My reactions when anxious are much more on an instinctive basis - I panic, I sometimes get a flight response and want to run away, and I find it hard to not get emotional. I used to think I could learn not to react like that, but now I understand that I can't. I'm now more mindful of when I'm starting to get anxious about silly things like the bus being late, or getting overwhelmed by having too many things to do at once, and I'm already working on dealing with these fairly successfully. I'm even starting to manage better when people let me down and lie to me - I've started to expect this behaviour from certain people so it's not so unexpected when it happens and to be determined not to get obsessed about it, because I've reasoned that me getting stressed over it only hurts me, it certainly doesn't appear to bother them. 

    I don't see though how anyone can help me deal successfully with the situation where someone starts criticising me unfairly when I'm least expecting it, which is really bullying behaviour as far as I'm concerned.

    I'm supposed to fill in a long questionnaire the day before my appointment, and some of the questions are difficult to answer, which is off -putting. I just don't know if it's going to be worthwhile. 

  • When I had my "mid life crisis" ten years ago, I saw a variety of counsellors, and was misled into thinking I was well on the way to being "cured" of whatever had been troubling me all my life, and ended up in the biggest mess I've ever been in, that I'm still stuck in.

    In his book "Complete Guide to Aspergers Syndrome", Tony Attwood strongly recommends CBT, but says it must be done with a counsellor who understands Aspergers. He doesn't say why, but I assume it's because they will help you to adapt, rather than try to cure you.

    So from my experience, I wouldn't go near a counsellor who doesn't understand Aspergers, although I'm not sure that's an option the NHS would offer through a GP. I've no idea what might be available if/when I get my diagnosis next month, but the NHS CBT counsellor I saw some years ago via my GP didn't know anything about it, as I had just done my first online test a few days before my last session with him, and he told me that when I mentioned it to him.

    I'd certainly ask anyone you see what their experience with Aspergers is, and be wary if they don't have any.