Hello. It's a bit tricky for me to write at the moment. I'm trying to get thoughts and feelings in order, but it feels daunting. Not a huge amount has changed for me since I was last on these forums nearly a year ago, but what's prompting me to ask for thoughts is as follows.
I have been paying for a (neurotypical) 'mentor' who among other things thinks I should seek an assessment for ADHD on top of my autism diagnosis. I wasn't particularly convinced it would be useful, but went via my GP & almost accidentally did the IAPT (primary care psychology) screening.
It was quite difficult to explain to the IAPT assessor on the phone what I wanted, and I had a lot of problems with their standard questions. I have a problem with paperwork and forms anyway, but their 'PHQ-9' measure to screen for depression was difficult because it requires an amount of self-monitoring that doesn't come easily to me, and it gives choices such as 'not at all' and 'on a few days' without 'on one day'. I do however realise I am very prone to depression and I've been more or less depressed for over half my life. Since my diagnosis three years ago though, while I've still been depressed almost as much, I've been thinking more about being autistic.
So the assessor mentioned 'behavioural activation' as possibly helpful to me, and I ended up with six sessions of standard CBT, of which I've had three. I identify strongly with 'alexithymia', which I define as not knowing what I feel. In some ways, knowing it applies to me and other autistic people a lot, it feels like something I can use to separate myself from depression. I still get affected by other people's emotions.
I did warn the current psychologist/therapist about autism and alexithymia, and apparently they don't have any CBT adapted for autism (I know it exists). I still get a standard 7-column sheet ('Situation/trigger', 'Feeiings/emotions', 'Unhelpful thought', 'Evidence for unhelpful thought', 'Evidence against unhelpful thought', 'alternative, more realistic and balanced perspective', 'outcome'). I explained that I have coping strategies to avoid depression, including distraction from negative thoughts (also acceptance, compassionate responses, broadening perspective, and activity), and just because I'm still depressed doesn't mean they're not working. The therapist slightly misinterpreted my desire to 'avoid' being depressed and said I need to face up to the thoughts and challenge them rather than avoiding them. Of course long-term I want to avoid being depressed as much as I can.
So it was perhaps surprisingly easy to drop the coping strategies. Predictably, I'm now much more obviously depressed than I was a couple of weeks ago, and I have accumulated a few 'unhelpful thoughts'. Those thoughts may be associated with the depression, but I'm not sure they cause it. So this may be the low point before I start challenging them. So far trying to assess them has either confirmed them, found it difficult to say anything one way or another, or replaced them with a more compassionate response but not had any effect on mood. (My last therapy was over two years ago and was group psychodynamic, and it was one of the most frustrating experiences of my life. I pretty much ended up despising the therapist for wasting everybody's time, particularly mine. I feel like I should warn people about psychodyamic stuff, but have generally supported CBT up to a point.)
I realise it's possible that my strategies for coping with depression have deepened the alexithymia. I had suspect that among other things these can mean that I don't face up to longer-term tasks, like developing a career. There probably are healthier alternative tactics.
I'm even more tired and useless at the moment. It seems to be up to me to research adapted CBT, but I haven't been able to do so. Any thoughts?
Sorry to hear that you are going through a tough time. CBT is ok if your brain works the way NTs expect. However, I believe our cognitive processing works differently. Have you looked at the counsellors directory? https://www.counselling-directory.org.uk/
Many of them offer a free initial chat/meet up which may help to find the person right for you!
As usual, it seems very much the case that we need to sort out for ourselves the support we need -once we have worked out what form that support should be
I'm due to start a course of "heightened" CBT for OCD soon... I'm still awaiting my autism assessment, so it's not autism adapted, which makes me really nervous. I'm also worried because I don't know what the "heightened" part means. Best of luck - I hope you find the support you need.
I'd never heard of 'heightened' CBT either. Maybe it just means a longer course, or with a more experienced therapist. My understanding is behavioural therapies can work well with OCD or phobias. I don't think autism-adapted therapies are available in a lot of areas (not mine, anyway).
Good luck to you too.
Going private (and possible reclaiming somehow) has crossed my mind. In fact the NAS directory found a therapist near me who seems interested in autism.
I know there's also
However, I think i'll continue with the next CBT session and they may have some suggestions how to deal with the negative thoughts I'm now supposed to feel bad about. If it's still making me feel worse, I can stop it after that.
Working out 'what form of support' might help has been very difficult for me. 'Systemic' therapy is the only thing that's helped and I suspect problem-solving skills (as applied to my life) may be useful. A lot of people diagnosed in middle age say they're just given the diagnosis and that's it. No advice or recommendations or counselling or anything.
By the way, it's just the coping strategies for when I'm alone that I've temporarily lost. I'm still masking or at least applying my acquired social skills when with other people. The only positive effect of letting myself be depressed I can see is that I might get a bit more sympathy. I also think complaining is a potentially useful coping mechanism...
Cassandro said:The only positive effect of letting myself be depressed I can see is that I might get a bit more sympathy. I also think complaining is a potentially useful coping mechanism...
Indeed. BTW. Its good to have you back on the forum
I am privately diagnosed without my GP's knowledge and I don't want to tell them because I don't need an official label, and quite frankly after my experience I don't want anything to do with them. However due to my issues I am also waiting for a CBT appointment. I have read much about it being orientated around NT issues and was warned by my assessor that it may not deliver much. I hope it may offer some coping strategies that may help, but I am forewarned and forearmed that it may not. I guess I will see when it happens.
Thank you - a longer course might be right actually. My previous practitioner (for anxiety) said I might need to take the OCD therapy quite slowly and do it in stages. Thanks.
That's understandable - I've found I have really mixed experiences with GPs. Hope the CBT is helpful.
I'm not diagnosed but luckily my cbt therapist had alot of experience in his personal life with asd
I've had a bad psychodynamic therapist where I ended up in melt down and panic attack. But then a good one who although annoying at times can be useful