Showing posts with label CBT. Show all posts
Showing posts with label CBT. Show all posts

Tuesday, August 10, 2010

Adults with Asperger's and Their Rules

Adults with AS often utilize an elaborate system of these beliefs, or rules, to organize their experiences, especially when they find themselves unable to understand what is going on around them in the social realm. Of course this is not a new concept – all of us utilize unwritten rules to help guide decisions and behaviors. Adults with AS might find themselves leaning heavily on rules – which are often inflexible – in an effort to understand social dynamics. Setting rules can be quite adaptive – being held in slavery to them is another story.

Problems arise when the individual constructs rules based on arbitrary or incorrect information. For instance, one man with AS grew up with a father who was a chronic worker, viewed leisure time as useless and unbearable, and passively criticized people who did not work as hard as he did. As an adult, his son with AS struggled living according to a “rule”: that he could only be a man when working. He experienced immense stress outside of the workplace, and hated vacations.

Becoming aware of his “rule” was very helpful to this man. Learning to become aware of, articulate and evaluate these rules can be central to understanding a huge source of self-judgment and self-criticism. This man began to systematically challenge this rule: did he really believe work defines manhood? Did he know of any “real” men who did not work? How could he lower his anxiety when engaging in leisure activities?

This scenario may not ring a bell for you, but you may find that you do adhere to other rigid rules – and you may find you become upset when your rules are broken. Rules can make the world feel safer – they can add structure to a seemingly chaotic and unpredictable reality. When rules stop working for you – and you start working for them – you’ll know it. You’ll find yourself becoming angry and frustrated. Others might complain of your bad attitude or rudeness. Your anxiety may climb.

Becoming aware of your automatic thoughts, or rules, is often the first step in replacing maladaptive rules with healthier rules that reflect your true values. We all have internal rules that help us navigate the social world, and being conscious of them can help you feel more relaxed and be kinder to yourself and others.

Friday, January 1, 2010

Asperger's and Couples Therapy

My name is Cary Terra, LMFT and I am a psychotherapist in practice in Seattle, WA. In graduate school I received much training in working with couples, and went on later to my practicum work, where I worked with couples struggling with issues of all sorts.

Therapists are trained to recognize and decode relationship patterns. There are many patterns, and no couple adheres to a single pattern all the time. But by and large the training prepares the therapist for recognizing these familiar dances couples do with one another. Recognizing these patterns is the foundation for any work with couples, regardless of the type of therapy used in treatment.
There are so many different approaches to treatment when it comes to couples, and of course there is much debate amongst professionals regarding which treatment modalities are most effective.

When it comes to couples in which one partner has Asperger Syndrome (or something close to it), research on effective treatments for couples is scarce. So what works?
Most research on therapy and adults with Asperger’s supports Cognitive Behavioral Therapy (CBT) techniques. This modality assists the client in identifying and changing cognitive distortions, thereby enabling him or her to change their resulting feelings and behaviors. This modality is well researched, and is built upon the assumption that cognitions preface affects. Of course it is useful to understand how our thoughts, emotions and behaviors are linked. Without this understanding, the adult with Asperger’s can experience their inner emotional world as a chaotic, foggy maze without a logical destination. Adding the logic piece to this world via CBT can demystify the land of emotion, easing the client’s anxiety and increasing the client’s sense of mastery.

Sounds simple. But is it?

CBT can be very effective, no doubt. But it does little to help the client clarify any issues originating in the unconscious. Unconscious motives, which often steer relationship choices, are often affect-laden, and often have little conscious thoughts associated with them. Thus, the individual with Asperger’s may see obstacles involved in a relationship with a specific potential partner, may find the relationship fraught with drama he or she finds unbearable, and may feel controlled by relationship anxieties and fears. Yet this same individual, even after identifying cognitive distortions and working to change behaviors, may feel viscerally drawn to the relationship, with little insight as to why.

Yet understanding why often feels necessary for a deep sense of clarity for many individuals.

In my experience, a blend of Cognitive Behavioral Therapy (CBT) and Family Systems works best. Family Systems is a modality which focuses on how systems of relationships evolve and are perpetuated, even passed down through generations. Writer and Systems therapist Harriet Lerner, PhD writes in her book The Dance of Intimacy, “An intimate relationship is one in which neither party silences, sacrifices, or betrays the self and each party expresses strength and vulnerability, weakness and competence in a balanced way.”

Family Systems attempts to assist clients in identifying blocks to this aim in their current relationships and past family relationships, so that these obstacles can be slowly removed in a way that fosters independence and dependence, in healthy balance.

I find that individuals with Asperger’s often pair up with partners who are emotionally driven and expressive. This can serve as a wonderful complementary dyad at first, but often over time the system becomes magnified in its intensity and polarity. Individuals in such relationships can benefit from striving for balance individually. If this does not happen, the Aspie adult can over time become dependent on his or her partner for a sense of emotional engagement, connectedness to others and “normal” appearance.

So how can the Aspie in such a relationship make gains towards balance? I have found many Aspie adults have had success with volunteering, joining special interest clubs and working on mindfulness. A therapist can also help with addressing specific trouble spots in a regimented way to help diminish anxiety and that “alien feeling” which can be a source of superiority, but also of confusion and pain.

Relationships can be extraordinarily challenging for adults with Asperger Syndrome. The stress of navigating intimacy for the individual with AS can be extremely high, and this is crucial information for both the Aspie and his or her partner to understand and respect. It is important to remember that if you have Asperger's and are in a relationship, you must take time to nurture your own unique ways of being in the world. This includes scheduled time for solitary activities and planned opportunities for engagement in special interest activities. I often tell clients that investing in these activities is like eating for the Aspie - it is non-negotiable, and going without it can cause damage to not only the relationship, but to the Aspie's mental health. This investment is part of, as Lerner points out, working towards individual competence and balance. And this balance can help prevent a host of relationship mishaps, such as dependence, resentment, passive-aggressiveness and more.

For more information on Harriet Lerner, PhD, visit her website at .

Friday, November 13, 2009

Cognitive Distortions and You

Back in 1980, American psychotherapist David Burns published a book which has remained a therapy standard since. Feeling Good: The New Mood Therapy was an instant bestseller. The book details the relationship between thoughts and mood, and offers research-based exercises for taking control of "automatic thoughts", and as a result, mood.

Burns identified ten common cognitive distortions, exaggerated and irrational thoughts, which can negatively affect mood. They are extremely common, and identifying them in yourself can serve as the first step in changing them.

Look over the following list and see if any of these distortions are habits of yours.

1. ALL-OR-NOTHING THINKING: You see things in black and white categories. If your performance falls short of perfect, you see yourself as a total failure.

2. OVERGENERALIZATION: You see a single negative event as a never-ending pattern of defeat.

3. MENTAL FILTER: You pick out a single negative detail and dwell on it exclusively so that your vision of all reality becomes darkened, like the drop of ink that discolors the entire beaker of water.

4. DISQUALIFYING THE POSITIVE: You reject positive experiences by insisting they “don’t count” for some reason or other. In this way you can maintain a negative belief that is contradicted by your everyday experiences.

5. JUMPING TO CONCLUSIONS: You make a negative interpretation even though there are no definite facts that convincingly support your conclusions.
a. Mind Reading. You arbitrarily conclude that someone is reacting negatively to you, and you don’t bother to check this out.
b. The Fortune Teller Error. You anticipate that things will turn out badly, and you feel convinced that your prediction is an already established fact.

You exaggerate the importance of things (such as your goof-up or someone else’s achievement). Or you inappropriately shrink things until they appear tiny (your own desirable qualities or the other fellow’s imperfections). This is also called the “binocular trick.”

7. EMOTIONAL REASONING: You assume that your negative emotions necessarily reflect the way things really are: "I feel it, therefore it must be true."

8. SHOULD STATEMENTS: You try to motivate yourself with shoulds and shouldn’ts, as if you had to be whipped and punished before you could be expected to do anything. “Musts” and “oughts” are also offenders. The emotional consequence is guilt. When you direct should statements toward others, you feel anger, frustration, and resentment.

9. LABELING AND MISLABELING: This is an extreme form of over-generalization. Instead of describing your error, you attach a negative label to yourself: “I’m a loser.” When someone else’s behavior rubs you the wrong way, you attach a negative label to him: “He’s a damn louse.” Mislabeling involves describing an event with language that is highly colored and emotionally loaded.

10. PERSONALIZATION: You see yourself as the cause of some negative event which in fact you were not primarily responsible for.

Cognitive distortions are characteristic of depression and anxiety. Adults with Asperger's are especially vulnerable to adopting distorted patterns of thinking. Cognitive Behavioral Therapy (CBT), a modality of psychotherapy which aims to challenge and change distortions, is the most researched and common form of therapy used to help people with Asperger's change the way they think about themselves. Often adults on the spectrum, when confronted with the illogical nature of some of these automatic thoughts, are eager to change them to adopt a more reality-based perspective.

If you find yourself engaging in distorted thinking, you can begin to replace the illogical thoughts with more accurate (and often forgiving!) thoughts right away. Remember, cognitive distortions which leave you holding the short end of the stick can feel like a form of perfectionsim. But they can often hold you back from enjoying life, feeling confident and reaching potential.

For more on David Burns, visit the Feeling Good website at