counselling

Just out of interest: In what way does it not help? The counsellor doesn't understand you or their techniques don't seem to fit you or you don't get better or...? I'm just asking because I found exactly the same up to the point you have described so far and it really surprises me that they couldn't do better. I was told I must be too rigid for CBT but somehow I don't quite agree that it's only me who can't make it work. I found this self-help-book-like low intensity CBT rather upsetting because to explain certain concepts they used examples and these examples were just so far away from any issues I had, in fact I sometimes wished to have the problems these example people had. It's not because I can't do abstract thinking. If a counsellor asks me again and again how something makes me feel, I respond and then she isn't satisfied and tries to find different words for my feelings (which do not fit), then I wonder if she is perhaps too rigid to divert from the questionnaire she must have in her head or to accept answers that don't fit the catalogue of answers she will have in her head too. Or another one told me every week that work is too important for me. Everything that I told her is important to me too didn't count, no idea why, she never explained it. I don't even know what would have counted. Well, if I'm too rigid because I can't stop work being important to me, then is she not just as rigid if she can't stop telling me that it's too important to me (which I think is objectively seen not even true when things at work are fine, but they were everything but fine and therefore I couldn't switch off the (as it turned out totally justified) worry, which perhaps I could have if work wasn't important, but somehow she missed the point). They found me flat and it seemed to irritate them - isn't that a bit rigid too? They could just have decided that this is how I am when we discuss upsetting topics and that's it. Somehow it made me wonder if others do really respond as expected.

I've had a few sessions with a counsellor as part of the ASD assessment now, she has mild ASD herself. No idea if it will help but she is the first counsellor who doesn't constantly get things that I say wrong. She sends me a letter after each session summarizing what was said and I'm absolutely amazed how accurately she describes my feelings. It's just what I've said really, so in a way I would have expected everyone to get it right, but perhaps the others did listen, then interpreted it the way they or some other people would feel and then concluded that I felt the same but couldn't express it adequately (maybe because I'm not a native speaker or so). Guess someone who constantly gets me wrong will never be particularly helpful, so chances may be better this time. 

So to make it short, I totally agree with QuirkyFriend that you need someone who has experience with people with ASD, otherwise they will be busy all the time making you fit into their (rather rigid?) concept instead of developing a concept around you.

Thank you for your reply Oktanol.  I would say more or less everything you have written applies to me too.  In my area the NHS provides CBT but it is very much aimed at people with depression and anxiety.  I do have some depression and anxiety but what I really want is some "life training" on how to negotiate life in a neurotypical world.  My depression and anxiety originate from there...   If that makes sense.  It's the CBT that's rigid, not us... :)

Very true. The research evidence says CBT ain't much use for neurodiverse people

Very true. The research evidence says CBT ain't much use for neurodiverse people

Hi Recombinantsocks (I still get mental pictures of my odd sock bag with your user name)

I think one of the problems with CBT was best summed up by my big sister who has children on the spectrum but has no diagnosis herself (a classic example of ND success because her special interest is now a big part of her job).

She had a course of CBT, but found herself thinking "but I already do this most of the time and I've now got to the point where I can't rationalise these problems, they are too big"

She like me benefitted from mindfulness (adapted slightly to compensate for some ND quirks) and does well on Venlafaxine rather than the SSRI class of drugs.

We both use TA, particularly when dealing with family challenges such as our most NT sister being particularly insensitive to things such as the need to plan!

Recently she's been amazing helping me come to terms with the possible future we will be dealing with in a woefully under resourced system for supporting adults with spectrum disorders. A real example of directive counseling about how to look after myself and SO while still doing the advocacy.

I personally believe the single most important factor in successful therapy is the therapeutic relationship...and finding a good match is critical. Having said this I do counsel others and one of my biggest successes was with someone I never expected to return after each session because I didn't sense a connection. She clearly did and she was so appreciative of the tools and skills based approach I took on behaviour change.

Provoking and challenging a patient is not regarded in T.A. as beneficial - whereas as to facilitate and enable them is.

Provoking may not have been the best word to choose and I certainly didn't mean challenging in a confrontational manner.

English isn't my strongest subject! I did look up https://www.collinsdictionary.com/dictionary/english-thesaurus/provoke though which has two meanings for provoke. 1. to anger insult or annoy 2. to rouse cause or produce. I definitely meant the second of these two alternative meanings.

recombinantsocks said:

All they can do is to provoke the patient into challenging themselves about their own behaviour.

Provoking and challenging a patient is not regarded in T.A. as beneficial - whereas as to facilitate and enable them is.

Very true. The research evidence says CBT ain't much use for neurodiverse people

That might be literally true. i.e. it is less likely to work for neurodiverse people. That does not mean that it does not work for any ND people. It does not mean that it cannot work.

CBT, and other techniques like TA etc, rely on people realising that they need to change their behaviour. It does not mean that they have to change their psychological traits, reflexes and impulses but you have to be able to learn to respond differently to "attacks" from your social surroundings. You have to learn to be more defensively skilled in understanding yourself and understanding what sets you off and what gets you into trouble.

A therapist cannot force a patient to come to this realisation. All they can do is to provoke the patient into challenging themselves about their own behaviour. I think A lot of people fail to take advantage of therapy because they expect the therapist to do all of the work; i.e. to perform a cure on the patient. CBT does not and cannot work like that. People expect to go to their doctor to get some medicine to cure their disease but a lot of mental health requires the patient to do the work themselves.

:(