Teens & Adults J.J. DaleDale MunroMunro with Asperger MSW, RSW, FAAIDD Syndrome: Regional Support Associates (London) Creative Psychotherapy Creative Psychotherapy Redpath Centre & [email protected] Treatment Approaches (519) 433 -7238, Ext. 2107
I’m Speaking Today as a … 39 Years Individual psychotherapist with Asperger ’s Family Therapist Syndrome!
Couple Therapist
New Article
“An Integrated Model of Psychotherapy for Teens and Adults with Mission!Mission! Asperger Syndrome ”
Journal of Systemic Therapies Fall 2010, Vol 29, 83 -97 Agenda Raise awareness of needs of Agenda adults with AS! Focus on Teens & Adults with AS
Help families! Discuss Counselling , Treatment & Support Approaches [What happens after the diagnosis is made?]. Improve counselling , treatment & support Discuss cases/real people. services!
Common Asperger Myths Strengths & Assets [revised from Gaus , p. 34 -36] [revised from Gaus , p. 36 -38] Only a childhood disorder. Creativity & “Unconventional ” View of World. Always aloof & uninterested in others. Have no relationships. Honesty Do not make eye contact. Sense of humour . Lack insight & empathy for others. Responsive to structure & routines. Are intellectual geniuses. Willingness to Observe & Evaluate Just a mild form of autism. Self, & are often open to feedback. Cannot benefit from counselling .
Most Alone & “David ” Misunderstood People! 61 Two university degrees Look “normal ”! Obsessed w/ computers, Star Trek, washing machines No longer can find a job, marriage dissolved, Becomes evident when bright individuals fail to son has disowned him. finish school, dev friendships, date, drive, or Two weeks ago, diagnosis →→→ great relief retain employment. Police, gov ’t & utility companies Public mischief When relationships break down, & emotional I feel like an alien …. & behavioural problems increase. Prevalence of AS FORGOTTEN PEOPLE ! Lack of support for these adults One in 210 -280 children (Attwood) is a human rights issue every One in 300 children (John Robert Brasic ) bit as important as that of any Male 4:1 other civil rights group since the 1940s! ______ Teenagers Psychological problems are the rule , rather than the exception! LITTLE KIDS WITH A.S. DO GROW UP!
May be Systemic Recent Presenting Problems Marital issues (40, 65) 57 year, old, unemployed man, hates police Parenting problems Biases towards Gay, anxious & isolated Marriage preparation Highly anxious, Convicted/possession of avoidant,sleeping under providing Clinical child pornography avoidant,sleeping under bridges. Stalker/Stares/Touches Fear of retirement too much Fear of retirement Services to Men! Depressed, suicidal, Substance abuse can ’t finish high school. Anger & rage issues Paranoid & delusional. Can ’t distinguish fantasy 16 automobile accidents. Similar to male survivors of from reality (games, etc) 16 automobile accidents. Contamination fears childhood sexual abuse Failure at school Obsessed w/ getting Repeated job loss. girlfriend Wants to move Calgary Stabbed self in neck Can ’t get writing going. But we can ’t forget the females! Baby stillborn
SKILLSKILL UnderstandingUnderstanding thethe basicsbasics ofof DSMDSM --IVIV --TRTR diagnosis!diagnosis! There are 5 Disorders in the THOROUGH Family of PDDs PSYCHOLOGICAL Autistic Disorder ASSESSMENT, CLEAR Asperger ’s Disorder DIAGNOSES WITH PDD -NOS RECOMMENDATIONS Rett ’s Disorder Childhood Disintegrative Disorder Some welcome/proud of diagnosis Some highly defensive 3 of these fall on the Autism Spectrum: 67% have mood disorder 67% have mood disorder Autism, Asperger ’s, PDD -NOS
Asperger Syndrome
Complex neurologically -based psychiatric & behavioural condition on the high functioning end of the autism spectrum. Only Developmental May be impairments in: Disability without an -Social relations -Communication/information processing Intellectual -Sensory & emotional responsiveness -Movement & coordination Impairment! -Independent living
Restricted repetitive interests
Not mad, bad or defective, Diagnostic Confusion? but have a different way of High Functioning Autism is not a diagnostic but have a different way of category. thinking! Nonverbal Learning Disability has a similar [Tony Attwood] presentation. Early diagnoses of Asperger (mid -late 1990s) actually Autistic. Process Information PDD -NOS w/ average IQ. Schizotypal Personality disorder Differently ADHD OCD Spectrum Within the Label Only Thing You Can Say … Bright individuals with “very autistic ” traits (e.g., Rainman ) “When you meet Tormented & delusional Immature, social phobic, reserved, one individual w/ highly anxious Pedantic, absent minded, ‘nerdy ’ AS, you have met Somewhat eccentric, married, one individual w/ working, raising family ‘Superstars ’ AS! ” [Myhill & Jekel , 2008]
SKILLSKILL HauntedHaunted byby UnderstandingUnderstanding HistoryHistory History!History! Bettelheim
Dr. Hans Asperger (1906 -1980) Austrian pediatrician ( U. of Vienna) not a Nazi! 1944 landmark paper “autistic psychopathy ”
Published 350 papers
As a child, reported to have AS traits (remote & lonely child, difficulty making friends, talent for language)
Daughter, Maria, child psychiatrist in Switzerland. Clinical Question WhoWho ’’ss YourYour AspergerAsperger Hero?Hero?
Possibly Asperger ’s
Steven Spielberg Moe Norman Nikola Tesla -Greatest ball striker Vincent van Gogh -Unusual swing/accuracy/fast Gregor Mendel -33 course records/17 holes in one Andrew Lloyd Webber -Won many tournaments Albert Einstein -Pants over ankles/stained shirt Bill Gates -Case of coke/day Thomas Edison -Debt -ridden/sleeping in car Ludwig Wittengenstein [philosopher] -Fifth hole Charles Darwin Mozart Carl Sagan Glen Gould Thomas Jefferson -Diet arrowroots/scrambled eggs Bobby Fischer -Obsessive work habits/music Elvis -Sensitivity to light, sound, temp. Temple Grandin -Wore gloves/no hand shaking Donna Williams -Wouldn ’t perform after age 31 -Wouldn ’t perform after age 31 Catherine the Great -Amazing memory “Jonathan ” SKILLSKILL Left home to attend college Harassed by some in residence. Being Aware of Door slimed, money stolen, called names past Harassment Fake 911 suicide call Marks have dropped & feels & Bullying! hurt & confused
Low self -esteem, gullibility, hypersensitivity to criticism, approval seeking, social naivete SKILLSKILL
Leave individuals vulnerable ( “predator magnets ” to -Cyber bullying Recognizing -Ridicule, teasing -Physical or sexual abuse Comorbidity !
Precipitate paranoia or post traumatic stress
“Gloria ” Mental Health Concerns [V. Gaus ]
16 “The mental health problems often are related to Smokes dope every day & abuses their attempts to fit in with society. ” alcohol Believes her keys & money are “A history of isolation and a sense of failure leave contaminated the adult tremendously vulnerable to anxiety and mood disorders. ” Cuts herself on occasion mood disorders. ” Believes terrible people are scheming to exterminate everyone with AS. But adults have not missed the boat. They can still learn and grow! Mental Health Concerns
Anxiety (OCD, GAD) SKILLSKILL Depression Suicidal ideation Phobias, Fears, & Paranoia Understanding Delusional Disorders Behavioural disorders (verbal & physical aggression) “Executive Self -injury Eating disorders (women) Function ”! Substance abuse/Self medication
Problems With “Mary ” EXECUTIVE FUNCTIONING Transitions 17, superior IQ Initiating Organizing Generalizing learning Takes 90 min. showers & 3 hours Planning Working memory Monitoring to get ready for school. Self -monitoring Flexibility Regulating Bedroom “an absolute mess ”. Making choices Making choices emotions/behavior Impulse control Therapist discontinued sessions Time & space Switching attention because late or forgotten. Mental flexibility because late or forgotten. Keeping appts Homework/chores Multi -tasking Goal setting
Keep in Mind … “Asperger Time ” Highly Intelligent …, [Brenda Smith Myles in Gaus , p. 72] But Lacking “Half done in twice the time! ”
Lifeskills /Adaptive Families/professionals need to pace themselves, so they don ’t overwhelm Behaviour !* the individual. Considerable knowledge & verbal skills Anger management, Anxiety, Depression E.g., may need multiple meetings to gather all necessary information & *RSA eligible to develop a working relationship. Inability to Fill “Empty Time ”* The Need for an Summer vacation ””ExecutiveExecutive Stat holidays Retirement SecretarySecretary ”” Empty weekends
Loneliness + Depression *People don ’t understand this!
SKILLSKILL “Gordon ” 18 Understanding Shaves only half his face. Trying to understand what Theory others are thinking is a mystery. Has no real friends, except a gay of Mind! partner who is losing patience with his insensitivity.
“Mind/Face Blindness ” [Theory of Mind, Attwood 114 -123] Difficulty with … “Mind reading ” Empathy [may feel too much] Reading social cues, eye messages, & tone of voice. Literal interpretations [“Let ’s toast the bride ”] Being considered rude or confrontational. Bluntness & honesty. Failure to see need for apologies. Sense of paranoia. Being argumentative with less remorse. Delayed reactions making others perceive individual as unusually formal or pedantic. Exhaustion – “I’m all peopled out! ” SKILLSKILL Recognizing Limitations in Pragmatic (Social) Language
Pragmatic (Social) Language One individual equated trying to Ability to understand body language & participate in a conversation to non -verbal communication. May speak too loudly or softly, delay watching a fast -moving puck watching a fast -moving puck answering, repeat themselves. during a hockey game. “Just when Interperonal boundaries may be violated, it lands somewhere sufficiently to & person may seem blunt, disrespectful, focus on it, it flies off quickly in politically incorrect, blunt. another direction ”. Unable to understand joking -around, sarcasm, lying or coercion. (Dr. Lillian Burke) sarcasm, lying or coercion. May interpret colloquial language
literally [“She killed herself laughing. ”]
“George ” SKILLSKILL 26 Fascinated by R.C. ( “I’m a Coping with Catholic ”) & astrophysics. Takes one university course at a Fixation on time, so can savor each tiny bit of scientific info. Special Interests Will talk about interests with anyone who will listen including strangers. Special Interests
Transportation Computers, Internet Weather & games SKILLSKILL Languages, Science fiction (Star Trek) Literature, Creative writing Collecting (comic Recognizing books, movies) Artwork (sharp edges such as Pokemon , Anime) Sports or games Geography History (Titanic, Civil Sensory Religion Sensory War, Antiques Roadshow ) Unique (washing Math, Science machines, 1950s, Engineering sparkplugs, lawn mowers, police & the law, animals Sensitivities! Astronomy such as elephants, meat)
Sensory Integration “Mohammad ” “SENSORY DEFENSIVENESS ” 17 Tactile light touch, wear certain clothing, remove labels, Only eats meat, cannot tolerate crunchy hair washed, avoids dirty hands (glue, sand, mud) food, e.g., fruits & vegetables. Auditory sounds & noises, hands over ears Tears our distracting tags inside collars, & finds wool too itchy. Visual hypersensitivity to light, gaze avoidance Smell of toothpaste “injures me ” and he Oral -motor brushing teeth, dentist visits wears sunglasses all the time ( “brightness Olfactory intolerance of odours , gagging hurts ”). Vestibular (inner ear related) movement or unstable Refuses to pray at mosque because surfaces, motion sickness, difficulty with steps or crowds overwhelm him escalator, body whirling, jumping, spinning Proprioception appears clumsy, odd posturing Behaviour greatly troubles his family. Can “shut -down ” if overstimulated !
Occupational Therapists “Synaesthesia ” Can Recommend
Stimulation of one sensory or cognitive pathway leads to automatic, involuntary experiences in a second (senses cross -wired). Sensory Diets E.g., sounds perceived with sensations of colour (coloured hearing), texture, scent or flavour . Remove clothing tags Hearing sounds in response to visual motion & flicker (e.g., fireworks, clattering dishes, dog Weighted vests or blankets barking, music). Activities or exercises
Can be bewildering. But others do not see this as a handicap. Psychotherapist Can … Turn off lights in therapy office. Use white noise machine or specific background music. SKILL Allow some rocking & self -stim . Avoid hand shakes. Understand sensitivities to medication. Advocating for Offer comfort drinks (e.g., herbal tea). Use Verbal Deep Pressure (Speak quieter, more slowly but assertively, more succinctly & maintain gentle eye contact). More Services Manage aromas. Recognize affect on sexual relations, work and social environments. Others?
Profound Sense of Society is more comfortable AMBIVILANCE! comfortable dedicating resources to adults with more obvious disabilities (e.g., severe WHO WILL PROVIDE intellectual or physical SERVICE? intellectual or physical challenges)!
Because of So Few Services … Effective Model of Severe depression, anxiety; & sometimes paranoia. COUNSELLING Loneliness & broken relationships Substance abuse Other behavioural concerns (anger, “rage ”, && stalking, etc.). Terrible isolation, many lives empty & TREATMENT! disorganized! Clinical Skill NECESSITY OF BEING UtilizingUtilizing HelpfulHelpful POSITIVE! The professional has to be the most positive person in Theory!Theory! the room!
1. Strengths -Based/Positive 2. “Chaos/Complexity Theory ” Psychology Theory [Dennis Saleeby ; Martin Seligman] Nonlinear change What ’s right (not wrong)! Families/Professionals equals (coaching)! Possibility of very rapid change/ ’tipping points ’ Resilience/Hardiness/Rebound from Disorder, instability & change are normal tragedy/ Tranformation ! People function best when close -knit Membership needed/Loyalty/ Humour ! organization & boundaries – but not too close Culture/personal stories valued! Therapists [Carl Whitaker] “Crazy like a Not victims! fox! ” Change occurs when strengths supported! -Paradox -Unexpected -Frankness Empower/Use talents -Absurdity/exaggeration -Be human! liberation/dreams!
3. Systems Theory Clinical Skill
View people as part of many social systems Whole more than sum of parts/ Looks at “big ProvidingProviding picture ”! -e.g., spirit, unique history, stories, private jokes, shared exp eriences -Sessions with whole families together -Achievement, tragedy & joy IndividualIndividual When part of system is changed, entire system is changed (death, leave home). “Homeostasis ”/Balance ²²² resistance! PsychotherapyPsychotherapy When one improves, another gets sick! Throw Out a Supportive Angry/Anxious People Lifeline “Verbal Deep Pressure ” Isolation breeds loneliness & paranoia. Speak … More quietly, but firmly Therapist must throw out a supportive lifeline to individual who More slowly is drowning in a dominant world More succinctly perceived as chaotic & inflexible. Gently maintain eye contact Ignore! Can reduce self -doubt & self - Ignore! criticism.
Psychotherapy Most … Just “talking (working) it through ” is not Most … enough. Shorter, but more frequent sessions. Seem to really benefit from Have main points of sessions typed & made available for client to review/process. formal “Talk ” Tap into person ’s sense of humour ! psychotherapy sessions. Encourage readings from others with AS. Therapeutic exaggeration May need to interrupt more [Gaus , p. 206]. Sometimes their Reminder calls. Most don ’t mind older therapists. spouse/partner or parents MAY BE LONG -TERM! [Attwood p. 318, Stoddart p. 91] needs the sessions more!
Who Can Benefit from Verbal Psychotherapy? Often a Battle of Minimum level of concentration/attention Intellect! Reasonable memory/Some for insight. Generalization of learning outside office. Therapist is tested! Can label feelings a little/Verbalizes well. Must show deep respect person ’s Shows up for sessions fairly regularly. intelligence! Reading ability. Can sit in a chair for at least 30 minutes. Long term therapy sometimes needed. Do you understand AS? Are you bright enough? Learn to Speak the Clinical Skill Individual ’s Language ! BuildingBuilding The therapist must be extra mindful of the words he/she is A Helping using, ensuring precision to A Helping the point of pedanticism ! RelationshipRelationship (Gaus , p. 73 -74)
Assessment Dale ’s Approach
Do Bio -Psycho -Social History Persistence, high energy, optimism, flexibility Knowledge of community resources Request past assessment or Be satisfied with small gains professonal reports Focus on “Here & now ” Avoid jargon Be hopeful! Be mindful of “broken spirits ” Remember the power of simplicity …
Be a Good Host! Strategic Use of … Casual ‘small Talk ’ Frankness
Humour Empathic Listening Motivational speeches/ Cheerleading
Sharing a Coffee Reading material Teach a Vocabulary to identify Resisting the Diagnosis … & label feelings … Many only feel fear, sadness & anger, or just anger or rage , but no joy (Grandin , Who ’s Your 1995). Others trouble recognizing more subtle emotions, e.g., confusion, embarrassment, Asperger jealousy, anxiety, suspiciousness & happiness.
Hero? Helps teach safe, cathartic & socially appropriate outlets for expressing emotions.
Clinical Skill Families May be Struggling Combining Kevin Stoddard (1999) Fears about future emotional breakdowns, how to deal w/ aggression, & whether relative will Individual & ever be able to live and work independently. Family Therapy Request written permission
Who Is Your Real Family Health, Stability Client? & Support probably is … Who ’s in the most pain? The most important variable in -Partner/spouse? ensuring a positive future -Parent(s )? (regardless of the level of current -Siblings? psychological distress)! -Individual? Celebrate Successes!
Normalize … High school graduation Finishing one year at college or Typical university 1st anniversary living in own Behaviour ! apartment.
Cheerleading! “That ’s not Asperger behaviour ….That ’s Therapeutic affect! normal young adult/middle age stuff! ’
REGULAR SUPPORT/ The Need for an PLANNING MEETINGS Competent chairperson -90 minutes max. -Keep on topic ”Executive -Deal with interruptions ”Executive Assemble the paid/unpaid people needed to resolve the current & future problems. Keep minutes & distribute to key people not be SecretarySecretary ”” able to attend (e.g., psychiatrist). Brainstorming/Information sharing
Have fun! Therapeutic process!
“Reframing ” Identify the negative thoughts. Then people ClinicalClinical SkillSkill are taught to re -think, in a more constructive, less emotional & more rational manner, their description, thoughts & speech about a LearningLearning ““thethe particular person or situation. e.g., describing someone as “depressed ” rather than “lazy ” NameName ofof thethe e.g., reassuring anxious people that they “good parents ” e.g., anger = hurt /// resistance = fear GameGame isis e.g., “You ’re intellectually bright! ” e.g., “You are not a victim! ” e.g., “You call him antisocial …I see someone ReframeReframe ””!! who has theory of mind deficits! ” Professionals Who Use Reframing ClinicalClinical SkillSkill Find their relationships with individuals & families improve!
Individual & families ultimately SettingSetting ProperProper become healthier, cope better, more cooperative; and begin to spontaneously reframe themselves. Boundaries!Boundaries! *Changes the narrative/story!
“Boundary ” Physical, psychological & spiritual space person creates around self. Loosen Boundaries – e.g., try dating, Defines how you relate to others & how you returning to school or attending AS support are willing to let them treat you. group. W/o clear boundaries, you ’re vulnerable to physical or emotional violation. “The simple act of strengthening boundaries Tighten Boundaries – e.g., parents is often enough to begin a powerful healing with overly dependent daughter; avoiding process! ” [Nichols & Schwartz] bullies, etc..
Unrealistic Family or ClinicalClinical SkillSkill Professional Expectations Can Sink the Person! ManagingManaging Often respond poorly to too much outside pressure! ‘‘FalseFalse HopeHope ’’ && May have limited work potential May find higher ed. overwhelming Expectations!Expectations! Poor hygiene/disorganization Forget, or be late for appointments Break down after job promotion Pace Yourself … Help re -calibrate expectations. This is a Marathon, “This is a …. not a VERY COMPLEX Sprint! SITUATION! ”
Cognitive Therapy Principles Clinical Skill All your moods created by thoughts, perceptions, beliefs Using Cognitive - Thoughts contain gross distortions. Changing your thoughts (re - Behavioural thinking) can get rid of Strategies depression/anxiety. Evidence -based.
All or Nothing Thinking: Black & white, good or bad, smart or stupid, beautiful or ugly. It ’s hard to see things in shades of gray.
“Cognitive Distortions ” Catastrophizing : Exaggerate the negative outcomes of an realtively minor incident. E.g., “I lost my car keys, so I will develop Alzheimer ’s”. Or “My boss reminded me of a deadline, which means he is going to fire me! ”
Should Statements: Having a strict set of rules & exaggerate consequences if Ways Your Thoughts rule is violated. E.g., “I should keep my room organized at all times or else I am irresp onsible. ” Or “ Bank tellers should always be polite or be fired! ” Play Tricks on You! Personalization: You overestimate your role in the actions of others, including strangers. “My professor did not call on me when I had my hand up because sh e thinks I ’m stupid. ” Or “ A store clerk gave me the wrong change because he knows I ’m a sucker! ”
Labeling: Engage in negative name calling of yourself or others w/o eviden ce. “I’m a loser because I couldn ’t get the date [or job]! ” Or “He is a selfish bastard because he wouldn ’t help me with my project. ” Practise Positive Affirmations “I am a good & decent man! ” “BRAINLOCK ” “This will blow over. I am Free Yourself from Obsessive - never defeated! ’ Compulsive Behaviour “I am a strong & worthy person! ” “The coolest people in the Jeffrey Schwartz, M.D. world have Asperger ’s!”
Repeat 5X a.m. & p.m.
OCD is an insatiable monster. The more you give in, the hungrier it gets! But a strong -willed, motivated person can overcome it. OCD is primarily a biological problem. Obsessions : Intrusive, distressing , repugnant thoughts/mental images ( eg , vulgar thoughts, dirt & contamination, align objects just so, sexual, blasphemy, Research shows that cognitive -behavioural violent thoughts, repeating words & phrases, superstition) therapy alone, actually causes chemical changes in the brain of people with OCD! Compulsions : Behaviours performed in vain attempt to exorcise fears & anxieties caused by obsessions ( eg , cleaning & washing, doing something until it ’s just right, “It ’s not me, it ’s my OCD ” is a stress reliever hoarding & collecting, checking door locked, iron or that enables them to focus more effectively on catastrophic disease, pathological slowness carrying out getting well. routine activities, blinking or staring, reciting silent prayers to make bad go away)
Four Steps to Treatment Families & OCD Relabel : “It ’s not me, it ’s my OCD! ” It ’s simply a silly little obsessive thought/compulsive urge. Involving families is essential. Although cannot force individual to get Reattribute : “It ’s not me, it ’s my brain! ” It ’s the well, family can take charge of their own way my brain is wired/a biochemical imbalance. lives, refusing to participate in enabling Silly mental noise. symptoms. Family must take a stand! Don ’t pamper Refocus : Learn to ignore or work around the OCD. or indulge the person ’s OCD (or face Shift gears. Do another behaviour you enjoy learned helplessness). (Fifteen Minute Rule). “Don ’t enable the OCD – enable the behaviour therapy! ” Revalue : Obsessive thoughts & compulsive behaviour are worthless distractions to be ignored. A Rule -Driven Learning Style
Can only phone family once/day (rather than 10).
MAKINGMAKING Limit Pokemon talk to five minutes.
University studying from 4 -6 and 7 -9, on Monday, Tuesday, Wednesday, Thursday and RULESRULES Sunday.
Friday and Saturday nights are mom & dad private time.
Basic Rules [Attwood re: Luke Jackson, p. 84 -5]
Don ’t invade personal space! Don ’t stare at others on the bus for any reason! Don ’t comment on people ’s bodies, good or SystematicSystematic bad! Don ’t tell ‘dirty ’, sexist, racist, homophobic jokes DesensitizationDesensitization Don ’t make sexual innuendos! Don ’t hug or touch people, unless it ’s a family “Baby Steps …” member, or the person agrees to be your [dentist, haircuts, internals, blood-work] boyfriend/girlfriend!
Relaxation Techniques [Tony Attwood, p. 161] Adults with AS ANGER Become anxious MANAGEMENT 30 IQ drop CONCEPTS Become angry 60 IQ drop “Stop/Think/Go Anger & Jealousy Management ” “Role Play ” Practise
Write script, role -play & rehearse your response & revise as needed.
Experiment with various words, phrases & strategies.
14
PROCEED W/ CAUTION & More TEAMWORK!
Traditional Anxious/Angry People with Powerful Personalities … Behavioural Powerful Personalities … Can Create Chaos, Gain Approach Control of a House, or Play People Against Each Other!
Positive behavioural approaches needed for extreme OCD, hoarding, poor hygiene, extreme executive functioning problems, verbal aggression or violence. ClinicalClinical SkillSkill Do a functional analysis (ABC) Approaches may include incentives, environmental rearrangements, or more natural consequences (calling police). ReRe --ComposingComposing
Intent is to assist the person to gain control of situation; then encourage them to learn to thethe Narrative!Narrative! manage their own behaviour ! A Narrative Approach Questions Deconstruction/Separating the problem from RE -AUTHOR PERSON ’S LIFE the person: “What does depression whisper in STORY! your ear? ” Liberation & pride. Unique Outcomes or Sparkling Life Moments: Avoid judgements – eg ., normal Vs. abnormal. “Was there ever a time when you were able to socialize more? ” Focus on social justice/View problems in political sense. Preference: “Was this way of handling things Letter writing to clients (David Epston ) better or worse? ” Respect intelligence! Meaning: “What does it say about you that you were able to do that [successfully]? ”
Public Journaling Speaking/Writing Builds self -esteem & confidence
Also, keeping a log of their Allows person to play the expert role, that often is comfortable for person with AS mood swings, antecedents, Often more comfortable than average person daily struggles & successes. Therapeutic affect!
Fitness as a Stress ClinicalClinical SkillSkill Reliever & Emotional Restorative! PrescribingPrescribing [Attwood, p. 206]
PhysicalPhysical Need a paid or volunteer worker More independent people: biking, Exercise!Exercise! swimming, hiking, running, etc. The old guru therapist instructed students to always watch the eyes of the individual & families ClinicalClinical SkillSkill who come for counselling . On first meeting, their eyes are dead, hollow, tormented, dark with discouragement, numb, blind with pain. But always watching the eyes, the nurturance & MendingMending insight of therapy can offer spiritual healing. Eyes come alive & start to sparkle with hope & possibilities. “Sparkle ” is a concrete, quasi - empirical outcome reflecting a belief that the eyes ‘‘BrokenBroken SpiritsSpirits ’’ are the window of the soul.
Dale Munro (2010)
Mindfulness Training SOLITUDE … “Relaxation Response ” [“I’m all peopled out! ”] Breath in through your nose … and hold it.
Blow out through your mouth …and As one of the most (silently) say “one ”.
effective emotional Repeat ….
restoratives! Allow air into your abdomen.
Psycho -Education ClinicalClinical SkillSkill Asperger Syndrome Providing Mental Health Psycheducation Treatment methods
Stress Management Bibliotherapy Lesson 1 : Explaining AS (e.g., careers that value of ‘thinking outside the box ’ thinking style)
Lesson 2 : AS need & must have social relationships. COUPLE Lesson 3 : AS do demonstrate empathy. COUNSELLING Lesson 4 : Can be successfully employed.
Lesson 5 : Are often good candidates for psychotherapy.
Unlike Other Developmental Disabilities Couple Therapy Often spouse/partner of person with AS is struggling!
Spouse May Drive Help partner develop a stronger support network! the Referral the Referral Individual/couple combination therapy (e.g., giving & receiving love) “A platonic relationship …more special than than a friend`! ” Promotion severe anxiety Five Love Languages – Gary Chapman
22 Things a Woman Must Know: If She Loves a Man with Asperger Syndrome FAMILYFAMILY Rudy Simone THERAPYTHERAPY
(2009) Be Prepared! Families more involved than Family Health, Stability usual …even with 25 or 40 & Support probably is … year olds* Well -read & ready to question you The most important variable in Powerful advocates (w/ political ensuring a positive future savvy) (regardless of the level of current Open to non -traditional approaches psychological distress)! Still involved with budgeting, nutrition, transportation!? *Almost diagnostic/Lillian B.
No. 1 Therapy Objective Giving permission
Couple/Parental Role clarification Teamwork! Boundary -setting
Establishes a foundation Assertive training
Two Minute Rule! Re -framing If argument lasts over Specialized counselling e.g., grief, anger management, ptstress , abuse two minutes, get Psychotropic medication away from each other! Psychiatric assessment other! SKILLSKILL Can instantly & FindingFinding thethe permanently like RightRight or dislike people … Psychiatrist!Psychiatrist! professionals! [Attwood, p. 318]
Usually Appreciate Psychotropic Psychiatrists who Medication Can be sometimes will use Good for Your Health! a conference model [Sloman in Stoddart , p. 170: “Medication is …protective of the brain! ”
[individual, family, social workers, psychologist, [T. Grandin , p. 113 -114: Tofranil around age 34] OT, or agency staff]
Lack of sexual information/confusion [social norms & laws]
SKILLSKILL Preoccupation with sexual material [porno]
Paraphilias [atypical means of achieving arousal via objects or Addressing rituals] Addressing Confusion about sexual identity/orientation SexualSexual Staring Inappropriately Anxiety about interacting w/ potential dating Problems!Problems! partners [social anxiety] Aversion to touch [tactile sensitivity]
Loneliness!!! Music, Drama & Art Therapy Speech -Language Excellent for people Pathologists who have trouble talking or limitations Assess comprehension/pragmatics Augmentative (scheduling, checklist reminders, with self -expression! social stories, rules)
The Importance of … Incidental Counselling …. MENTORS By front -line workers ad MENTORS hoc ….on the spot! Can be more powerful, than [Temple Grandin & Mr. Carlock , p. 99] psychotherapy or formal
counselling ! [Dr. T. Smith, U. of Rochester]
The Ethics of Decision- making SKILLSKILL UtilizingUtilizing Self-determination Full Responsibility Personal Choice Health & Safety Human Rights Non-violence SupportSupport Pleasure-seeking Respect for the Law Empowerment Emotional Stability Dignity of Risk Rights of Others Social Role Valorization Informed Consent Strategies!Strategies! Support Groups School Ending Not + Friendships Just a Transition, [History of being teased , ostracized & bullied] Robin Frkovic , AA It Can be Value their intelligence! a Crisis ! Relationships shared interests Mind/Face blindness Paranoia
Service dogs
Good Soulful Encounters CASE MANAGEMENT
Introduction service Who ’s pulling everything together? Coordinating & building cooperation! No charge Friendships & possible love Ideally led by the family with support in Friendships & possible love understanding/navigating ‘the system ’. relationships APSWs , or trusted friend/professional. www.soulfulencounters.com Advocacy Services, support workers, www.soulfulencounters.com funding, etc.
“There is probably a MeaningfulMeaningful high rate of AS Activities!Activities! among the chronically unemployed. ” Un - and Under Employment Function better when they have a Develop sense of purpose or Talents!* cause! Work Writing or art projects Advocacy *Often can use special interests (geography, math, astronomy, weather, trains, Star Trek, Etc. history, animals, science fiction, money, chess, lawn mowers, computers, history, music, sports)
MEANINGFUL DAY OPTIONS GailGail HawkinsHawkins [part - or full -time]
WORK paid or volunteer supported if necessary How to Find Work That Works Military, Engineering, Science For People with Asperger Syndrome HIGHER EDUCATION university or college Jessica Kingsley Publishers DAY ACTIVITY PROGRAMS 2004
8 Vocational Life Skills [Hawkins in Stoddard, p. 100 -107] Personal presentation (grooming, hygiene) INCOME Manners ( “please ”, “thank you ”) Boundaries (avoiding racial slurs, swearing) Flexibility (coping with change) Ability to ‘read ’ others (what they are thinking, feeling, personal space, etc) DISABILITY Eye contact DISABILITY Basic decision -making skills Attitude of self -Responsibility (the opposite of PENSION blaming others) PENSION “A Bachelor of Arts is often less useful than specific skill -based training. ” RESIDENTIAL Options ISIS THERETHERE Remain at family home ANAN Supported independent living A.S.A.S. Group living CULTURE?CULTURE? Independent living
“I am left wondering if individuals with AS are not amazed that they are the ones who are Outliers perceived as rigid and restrictive. No one knows better than these people about the stringent [Malcolm Gladwell] etiquette of the neurotypical world. They come to Need more than intelligence & ambition to be know the inordinate social penalties allotted for successful (e.g., professionals). incorrect posture, a flawed interpretation, an uncoordinated gesture, or an ill -timed response. ” “Outliers ” are those people whose achievements fall outside normal experience.
“Outside an AS culture there [still exists] a world in which neurotypical people appear to be living E.g., Bill Gates, top NY lawyers, safest pilots, easier, richer lives with unlimited potential … greatest mathematicians, Beatles, best hockey Perhaps this is why depression is an all too players. common experience for people diagnosed with AS. ” People with Asperger ’s Syndrome? Charmaine Williams
Great Success Needs … “Bernie ” IQ of about 130, but many other variables. 35, felt like ‘oddball ’ at school & in family. [Lewis Terman longitudinal Genetic Studies of Genius ] Families who actively take control of their Diagnosed 12 years ago. children ’s psychological/intellectual Severe anxiety, disturbing thoughts, interest in development. historic cars. Birthplace, the generation & lucky timing, even New marriage, social life & work in call centre birth date floundering. Structured summer vacation. Prescribed antidepressant. No one makes it alone. Referred to cognitive -behavioural therapist, borrowed from other traditions. 10,000 Hour Rule [practise complex tasks!!!] Asperger Hero: Henry Ford. Taught to label feelings, become more assertive & strengthen boundaries around bullies. Wife later included in some sessions re: “The Basics ” intimacy & parenting. People with AS Responded well to unflappable optimism, humour, verbal deep pressure style, Brain Recognize endearing qualities! Lock. Mindfulness: solitude, meditation Respect their intelligence & world Reframe AS as “today ’s coolest diagnosis ”. view [often history of being teased as “stupid ”, “psycho ”, “retard ”]. Psychoeducation session w/ family. Physical exercise w/ wife – power walking Two children AS – secured services. Listen carefully Talk slowly, Today succinctly, quietly, assertively & -Antidepressant -Booster sessions ignore! [Verbal Deep Pressure] -Wife Ex Secretary Rewritten narrative: supportive family, close Enjoy sense of humour! friend, re -ignited spirit, career in classic cars.
Build on Individual ’s Advantages of Having A.S. Sense of Humour ! Bright & Innovative: Think outside the box! Persistence & Tenacity! Mr. Dale Munro Not swayed by peer pressure/Teach us to do things on own terms! 633 Colborne Street, Suite 230 633 Colborne Street, Suite 230 Detail people! London, Ontario Well -developed sense of humour! Canada, N6B 2V3 As Partners: Honest, loyal, hardworking & faithful! Know how to ‘shut -down ’/Disconnect Earth Know how to ‘shut -down ’/Disconnect Arts, sciences and professions!!! Sol System Milky Way Galaxy Often excellent presenters/writers! Just this side of Heaven Many are happy just the way they are!
Suggested Readings Tony Attwood (2007). The Complete Guide to Asperger Syndrome . Valerie Gaus (2007). Cognitive -Behavioral Therapy for Adult Asperger “If the world was left Syndrome . “If the world was left Temple Grandin (1995). Thinking in Pictures . Temple Grandin (2004). Developing Talents . to you socialites, we Gail Hawkins (2004). How to Find Work that Works For People with Asperger Syndrome . Giesla & Christopher Slater -Walker. An Asperger Marriage . would still be in K.Stoddart, L. Burke & R. King (2011, in press) Asperger Syndrome in Adulthood J. Dale Munro (2010). An Integrated Model of Psychotherapy for Teens caves talking to and Adults with AS. Journal of Systemic Therapies , Fall 2010, Vol. 29, 83-97. Kevin Stoddart (2005). Children, Youth & Adults with Asperger each other! ” Syndrome . Liane Holliday Willey (2001). Asperger Syndrome in the Family: Redefining Normal . [Temple Grandin, in Attwood, p. 332] Liane Holliday Willey (1999). Pretending to Be Normal: Living with Asperger ’s Syndrome . Sexuality
Attwood, Sarah (2008). Making Sense of Sex: A Forthright Guide to Puberty, Sex & Relationships for People with Asperger Syndrome . Isabel Henault (2005). Asperger Syndrome & Sexuality: From Adolescence Through Adulthood. Sarah Hendrickx (2008). Love, Sex & Long -term Relationships: What People with Asperger Syndrome Really Want . Rudy Simone (2009). 22 Things a Woman Must Know If She Loves a Man with Asperger ’s Syndrome.