Published on 12, July, 2020
For about maybe seven months now, I've been using BetterHelp for private therapy. I can't say I've found there to be any progress, though I'm not sure I'm going in with the right expectations. My therapist tries to get me to reframe my thoughts. Use less negative language, try to imagine more positive outcomes to situations, that sort of thing. "What would it be like..." is her common language for this. To which my response is often along the lines of "Well that would be unrealistic because xyz". She also tends to point out my "yets" as hopeful, despite my assurance that it's just to avoid an absolute statement. I can't tell if I'm being too rigid and set in my ways, if her approach is ill effective for autism, or a bit of both.
For anyone that uses a therapist, how do you find your engagements with them?
That sounds like CBT. It works well for a lot of people. But I don't think it works so well for me, because the 'reframing' feels like criticism or gaslighting, which I have received enough of anyway, in life. It also seems kind of superficial - like, I can explain the 'right way to think' about a situation but that doesn't necessarily make me believe in it.
By far the most therapeutic way I can interact with someone is for them to truly listen to me and give me space to express thoughts and feelings in a natural kind of conversation. I know some autistic people like structured sessions with a clear goal but I need it to be only loosely structured, in order for me to build up the nerve to say what is really bothering me. If it's too structured, we get nowhere because I will stick to what I am (relatively) comfortable talking about.
I think it's a 'person-centred' approach but I'm not sure about the terminology.
A "person centred" approach worked well for me for a while. It is clinically recognised (in a NICE guideline for clinicians) that CBT needs adapting for autistic people. Of course that doesn't help if: 1) autism hasn't been recognised, or 2) if the clinician isn't aware of or isn't bothered about professional guidelines. Applying "normal" CBT methods is probably going to be hard or impossible for most autistic people.