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 www.harrietlerner.com .
Monday, December 14, 2009
Asperger’s: The Itchy Tag Effect
Most of us familiar with the basic symptoms associated with Asperger Disorder understand that people with Asperger’s often seem hypersensitive. Children with Asperger’s today often readily voice their discomfort with textures, noises and scents they find uncomfortable, and this discomfort has become, if not an accepted diagnostic criteria, a very familiar phenomenon for parents.
In their April, 2009 article Talent in Autism, Simon Baron-Cohen et al. describe sensory hypersensitivity, a form of enhanced perceptual functioning typical of many individuals with autism spectrum conditions (ASC). Indeed, the article states that “studies using questionnaires such as the sensory profile have revealed sensory abnormalities in over 90per cent of children with ASC.” How individuals process information (both cognitive and sensory) may be highly impacted, even organized according to, these differences: and the differences may cause distress, but also predispose to unusual talent.
In my practice, adults with Asperger's frequently report highly sensitive senses of taste, touch, hearing, sight and smell. Sensory oversensitivities often reported by adults with Asperger’s include:
Tactile: oversensitivity can cause the individual to feel physical sensations such as light touch, itchy fabrics, hugs and bare feet as unbearable.
Visual: oversensitivity can cause the individual to find fluorescent lights, bright sunlight, flashing lights and overly stimulating visual environments (e.g. casinos) to cause great discomfort.
Auditory: oversensitivity can cause the individual to find auditory input to be impossible to ignore. Foreground and background noises can compete with one another, leaving the listener unable to selectively attend. Shrill or high pitched noises, such as those of dental drills, children’s squeals or shrieks, and blenders can cause extreme discomfort. Discordant music can cause discomfort.
Gustation: oversensitivity can cause the individual to feel uncomfortable with new tastes, or to find them intolerable. Children with gustational oversensitivity can prefer the same foods over and over again, refusing new foods and finding new flavors distressing.
Olfaction: Current research does not support evidence of oversensitivity for the sense of smell.
Clinicians who work with adults with Asperger’s often find that this sensory hyperacuity has been coped with and channeled in creative ways. Following are some of the positive coping mechanisms reported to me by clients who have struggled with sensory oversensitivity without knowing exactly what the problem was.
Clients who struggle with tactile hypersensitivity often:
• Wear soft, heavily washed, loose-fitting clothing, such as t-shirts and baggy shorts
• Avoid body piercings and tattoos
• Find showering unpleasant due to oversensitivity to sensations of water and changes in temperature
• Remove tags from clothing, which can be itchy
• Choose specific brands of clothing, underwear and shoes which provide minimal restriction
• Find ways to gain tactile input which is soothing, such as hair-pulling, hair twirling, hand tapping, etc.
• Enjoy stroking soft materials, such as the fur of cats
Clients who struggle with visual hypersensitivity often:
• Avoid visually overwhelming environments
• Wear sunglasses or hats to minimize bright lights
• Remove lamps or bulbs in work areas to reduce glare
• Cover fluorescent lights
• Close blinds during work time to prevent interruption by visual stimuli such as passers-by
• Keep work areas neatly organized to prevent becoming visually overstimulated
• Find visually predictable environments, such as video games, rewarding and comfortable
Clients with auditory oversensitivity often:
• “Tune out” when conversation becomes too overwhelming to attend to
• Avoid interacting in crowded settings, such as parties, or use substances to mediate oversensitivity
• Rely on electronics, such as iPods, to provide predictable auditory stimulation
• Wear noise-cancelling headphones when concentrating or meditating
• Spend quiet, solitary time to “recover” from overstimulating experiences
• Avoid telephone and cell phone use to minimize unanticipated auditory input
• Hum, sing or make noises to cancel out noises beyond individual’s control
• Listen to music excessively
If you have noticed your own or a loved one’s sensory hypersensitivity, be sure and treat it as condition to take seriously. Some researchers (see Belmonte et al., 2004) hypothesize that this sensory “magnification” may result from neural overconnectivity in sensory parts of the cerebral cortex. While research on brain structure and development differences is still being conducted, sensory oversensitivity in adults with ASC is well documented, and is most likely physiologically based.
Implementing some simple interventions can help the individual with Asperger’s feel much more comfortable in the world. An increase in sensory comfort can have drastic effects on cognition, avoidance behaviors and the ability to attend to other stimuli. Many of my clients report irregular sleep/wake cycles, with much “down time” spent recovering from situations which cause sensory overload. Taking care of yourself ahead of time when facing a sensory challenging setting can prevent “sensory hangover”, and is part of taking care of yourself.
Stay tuned for more on how sensory oversensitivity may be a contributing factor to talent and giftedness so often seen in adults with Asperger’s.
Thursday, December 3, 2009
A poem written by an adult with Asperger's was shared with me. It follows:
i have built and live in all around me
a castle made of glass for all to see
it reflects the sun in a dazzling way
so as to keep the intruders at bay
it stands atop a verdant hill
away from where the villagers mill
its clean façade a temple makes
for clean efficient infallible grace
its prism walls do split the light
till rainbows do my soul ignite
i sit at my window and i see
how the others live away from of me
they live, laugh, cry, work, love, hate and die
while i first count the clouds, then stars in the sky
and though their homes sink and sag and then fall
my castle stands silent immovable through all
its construction is clockwork, its lines perfect clean
no fault can be found in its faces seen
i tell no one the castle is cold in the night
that its rooms are empty, its windows sealed tight
its walls are clean but cannot hold fast
and they give scant protection when stones are cast
and when the clocks strike midnight, morning, noon
it is only me in my still quiet room
and the castle i built for silent safety
is locked by the one with no key, no key
Saturday, November 28, 2009
Asperger’s is a T.V. with One-Channel Reception
As many of us have, I’ve often noticed couples in which one partner has Asperger’s struggle greatly with communication, especially when discussing highly emotional subjects.
But what does this really mean?
It means different things for each partner.
For partners with AS, understanding the different channels of information can help. Couples communicate largely through behaviors, but we’ll concentrate on the senses as channels:
I’ve seen conversations such as this work beautifully:
Partner #1: I’m upset and I want to talk with you. What channel can I use?
Partner #2: (Takes a minute to think before responding) Auditory
Partner #1: (Closes eyes, leans back, lowers voice) O.K. When you walk away in the middle of my sentence, I think you are bored by what I am saying. I think you know it comes across that way, and that you are willing to hurt my feelings. I feel really sad about that. I want you to stop walking away when I’m talking and let me finish my sentence.
Partner #1: I’m sorry your feelings got hurt. That was not my intention. I was distracted, not bored. I couldn’t stay focused. I will remember this and not walk away while you’re talking.
Partner #2: (Crying) I want you to be interested in me.
Partner #1: I am, it just doesn’t always show.
Believe it or not, this dialogue worked. This couple had been working hard on communicating, and was beginning to enjoy the fruits of their hard work. Partner #1 was soothed by this interaction, and Partner #2 was left not feeling attacked, but informed. Partner #1 was able to share feelings, thoughts and a request. Partner #2 was able to hear this information, and because there was no overwhelm, the information was not just received, but digested. Because the couple consciously worked at reducing interference, and focused on communicating in a low-key manner via one channel (auditory), Partner #1 was forced to reduce reactivity, and Partner #2 was able to receive and assimilate information. The result for both partners was increased clarity.
“This is ridiculous! Who can do this?” is a question I’ve been asked, with much outrage, by partners without Asperger’s. In truth, it is challenging. The key, perhaps, is trusting that your partner with AS cares. Keeping this in mind can serve as a foundation for this difficult communication work.
The benefits? Your relationship may not be fraught with mind games, drama and chaos which develop and become habit in many relationships. Do you want it easy? Or do you want it to work?
Your relationship may not be inherently easy, but with practice, it can become more automatic and natural. And it can work beautifully.
Stay tuned for more tips on “One-Channel Communicating”. Please feel free to leave feedback in the comments section.
Tuesday, November 24, 2009
Asperger's and the Holidays - Face them with Open Eyes
In my private practice I’ve noticed a trend. Around November, old, current and new clients call wanting to schedule sessions to talk about one topic: the holidays.
The trend is not surprising: most therapists find themselves busy at this time of year, when expectations and realities can clash, and even the most mature find themselves stuck in teenager roles and feelings long since discarded.
But for a therapist who counsels adults with Asperger’s the increase in client need may be surprising to some. Aren’t Aspies supposed to be unconcerned with the judgments of others, even family members? Don’t Aspies face holiday family time with few, if any, expectations for intimacy or fun? Don’t Aspies who find themselves alone during the holidays consider their solitude a “Get Out of Jail Free” card, rather than a reason for loneliness or depression? After all, Aspies don’t really seek out relationships, right?
If any of these assumptions sound familiar to you, beware of the Aspie Stereotype, which pervades media (think “Rainman”), research teams (think “Yale”), pop culture (think SNL’s “Nick Burns: The Computer Guy”) and even some therapist circles (not me!).
Contrary to popular notions regarding Asperger’s, many clinicians, those who work in the trenches with adults struggling with the challenges of Asperger’s, find their Aspie clients confused and overwhelmed by the holidays.
Most of us harbor conscious or unconscious expectations about the holidays – how they should feel, who they should be spent with, how tall the tree should be, who should host dinner…the list can go on. A lack of awareness of one’s own “rules” regarding the holidays can set the stage for confusion, disappointment, impulse coping skills and depression.
If you have Asperger’s, you may be surprised at your own “automatic” answers to questions such as:
Should holidays be spent with friends or family?
Should loved ones exchange gifts, or not?
Who should travel where for the holiday celebration?
Tinsel, or lights?
While these questions may seem trivial, they’re not – and often they shed light on our automatic thoughts that go unchallenged and cause problems. For instance, if your “rule” is that Christmas or Hanukkah is a commercialized money-making holiday to benefit department stores, you may refuse to participate, and thus miss genuine opportunities to connect with loved ones. If you automatically decree that holidays should be spent with family or friends, you may miss the comfort that solitude can bring you.
Please don’t fall into the trap of trying to live up to what you think “normal holidays” (an oxymoron) should be like. Holidays for Aspies are often riddled with “shoulds”, which trigger resentment and resistance.
Adults with Asperger’s who give themselves permission to meet their own unique needs for togetherness and solitude, fun and rest, engagement and disengagement, often find themselves less pressured, less anxious and more accepting of themselves and others. This balanced approach can prevent total shutdown mode, which is a natural response to overstimulation and helplessness.
Here are some tips Aspies may find helpful:
Plan for taking breaks during visits. Examples are taking a walk outside, taking a nap with a book, taking some quiet time for deep breathing, taking a quick ride or offering to run an errand in the car, playing a video game with someone or alone, or announcing a time-out and removing yourself from the group.
Schedule realistically. Over scheduling during the holidays can lead to burnout when being around people is gratifying, but stressful (or just plain difficult). While it’s great to push yourself to socialize, the holidays are a time to be reasonable – don’t expect yourself to go from no parties to three or four in a month.
Beware of the lure of substance use. Many of us rely on the cocktail or two to help ease party anxiety. While there may not be too much harm in this, most clinicians see a surge in substance use during the holidays, which can lead to hangovers, a shaken sense of self, embarrassment, or worse. Remember that as long as you’re using substances to quell the anxiety, you’re not truly growing in your ability to handle social situations.
Be extra kind to yourself. This sounds corny, and it is. But think about it: we spend so much time during the holidays thinking about giving to others (or avoiding it!), but how much do we think about truly giving to ourselves? This is the time to use kind words and actions to take care of yourself. Ideas include buying or checking out a new book, going to the movies alone, eating a favorite meal, spending quiet time petting the cat.
Seek help if you need to. Holiday therapy can be a temporary bridge to January 2!
Here’s to your success in creating a holiday this year that you can anticipate with groundedness and optimism.
Monday, November 16, 2009
The Case for Mastering the Art of Eye Contact - Part I
Adults with Asperger's often have difficulties modulating appropriate eye contact. Because many do not pick up the skill automatically, they must decide whether to master it with direct intention and action. Appropriate eye contact is often fundamental to effective communication, so deciding to master the skill is a no-brainer, right?
Why do so many adults with Asperger's continue to avoid eye contact, even when they're aware the avoidance can cause others confusion or worse?
The answer may have to do with how Aspies experience eye contact and direct gaze. Research back in 2005 published in Nature Neuroscience lent some insight into why autistic children avoid eye contact: they perceive faces as an uncomfortable threat, even if they are familiar.
Kim M. Dalton of the University of Wisconsin-Madison and her colleagues studied 27 autistic teenagers who looked at pictures of faces while a magnetic resonance imaging (MRI) machine scanned their brains. Also tracked were the subjects' eye movements as they studied the images. When the image included a direct gaze from a nonthreatening face, brain activity in the amygdala--a brain region associated with negative feelings--was much higher for autistic children than it was in members of the control group. "Imagine walking through the world and interpreting every face that looks at you as a threat, even the face of your own mother," remarked study co-author Richard Davidson, also at UW-Madison.
The results also indicate that while a brain area associated with face perception, known as the fusiform region, is fundamentally normal in autistic children, it does exhibit decreased activity. This could result because the over-aroused amygdala makes an autistic child want to look away from faces. Further, when subjects with autism averted their gaze away from the eye region of a face, they showed reduced activity in the amygdala, suggesting that the gaze aversion is serving a functional purpose.
If you have Asperger's, you may want to pay attention to how you feel when making eye contact during conversation. Does it make you feel nervous? Overwhelmed? Frightened?
Little wonder many Aspies struggle to make eye contact while simultaneously tackling conversation, which may also be challenging. Is it worth it to Aspies to force themselves to make eye contact and endure the barrage of discomfort associated with it? This question is complex, both practically and philosophically. Yet it's widely agreed upon that decreased eye contact, or gaze aversion, during conversation can be interpreted as a sign of depression, dishonesty, disengagement, or any number of unpleasant messages.
Answering the question is further complicated by research on gaze aversion and its relationship to information processing. When people are engaged in difficult cognitive activity (e.g., retrieving information from memory, on-line processing, speech planning), they typically look away from the object upon which their attention had previously been focused (be it a face, book, VCR monitor, etc.). This tendency may be heightened in adults with Asperger's, who have an extra load of processing to deal with when making conversation, and an extra load of threat to deal with when making eye contact.
While there's little question that many folks with AS find eye contact unnecessary and/or unpleasant, there's also little question that most Aspies are capable of enduring enormous discomfort in their efforts to connect with others. Being informed and educated about your own reactions, and the basis for these reactions, to eye contact can be the first step in addressing changing your automatic tendencies when the benefits outweigh the challenges.
Stay tuned for tips on how you can work on selectively increasing your level of eye contact with others during conversation.
Sunday, November 15, 2009
It's Not What You Said... It's HOW You Said It!
Imagine a couple, Sarah and Simon, talked together about a recent spat. As they revisited their argument, Sarah asked Simon, "Why did you say that?".
How Sarah used tone could have made all the difference in Simon's deciphering of the question's meaning. Emphasis on the word "say" would most likely imply the Sarah's level of shock - the more emphasis on the word, the higher the shock.
"Why did you SAY that?" implies that Sarah thinks something shocking was said, or that Sarah was surprised by what was said.
However, let's imagine that Sarah put vocal emphasis (via tone increase) on the word
"you". This might imply a completely different message. It might imply a confusion not with what was said, but with the fact that Simon said it, rather that someone else.
"Why did YOU say that?" implies questioning who said it, not what was said.
Now let's suppose that Sarah assumes that her question's content is understood by Simon. But let's also assume that Sarah assumes that the question's TONE is understood, a tone which clarifies and qualifies the question's meaning.
If Simon has Asperger's, it's likely he'll understand the question's content meaning, but not the question's implicit meaning, its tone. He may answer the question that was asked, but not answer according to the WAY it was asked.
When receiving the answer to the content question, Sarah becomes frustrated. "Why don't you get it? You just don't get it!", she replies. Both are stumped and frustrated.
But understanding how people with Asperger's - and how people without Asperger's - interpret implicit communications like vocal tone can take all the mystery out of these kinds of misunderstandings.
Adults with Asperger's may have a hard time understanding the messages many send utilizing vocal tone. Being content-driven, they may not attend to changes in vocal tone which partially determine the meaning of verbal communications. Without a well developed sense of Theory of Mind to rely (the ability to attribute mental states(beliefs, intents, desires, pretending, knowledge, etc.) to oneself and others and to understand that those of others may differ from one's own), adults with Asperger's are often left playing a painful and confusing guessing game, especially during emotionally-charged interchanges.
How to Clarify Communications between Aspies and Non-Aspies
Clients have found success in limiting the amount of "guessing" occurring during interactions. Couples can do this by first understanding the differences in how they each process information, and consciously limiting the role tone plays in conveying information. This can be especially important during heated discussions, when tone can become escalated and overwhelming for people with Asperger's, causing withdrawal and avoidance.
If you and your partner are aiming to discuss a heated topic, you may benefit from two strategies:
1) Tone it down. This can be difficult when emotions are running high, but is necessary for productive communication. Try speaking quietly and calmly, using little intonation to get your point across. If you have Asperger's, let your partner know that his or her efforts to do so can help you listen and hear better when they are speaking to you.
2) Ask and answer. This technique is a form of active listening, a popular communication skill for any couple. It involves listening to what your partner has to say without interrupting. Aspies may benefit from looking away from their partner during this time. When your partner is finished talking, ask questions. "Do you mean...", "What I'm hearing is....", "Am I right in thinking you're saying...". Consider this technique to be information gathering. When you've asked all your questions, see if you can re-state your partner's message, getting the "gist" of it. Your partner's feelings of being heard can increase dramatically, and your sense of competence can, too.
But This Seems Like a Lot of Work!
It is. Having drastically different ways of taking in and processing information can make communication feel laborious. But it can also be a source of humor and fascination. Working to understand each other is in itself a step in the right direction, and though it takes patience and hard work, the rewards are significant.
For more information on research on communication and Asperger's see http://www.springerlink.com/content/a8twehlyfkk21eef/ and http://www.springerlink.com/content/a8twehlyfkk21eef/
Also, visit www.terratherapy.org for new therapy updates.
Friday, November 13, 2009
All Cats Have Asperger Syndrome
"Congratulations," the psychologist said to his 11 year-old client, "you have Asperger's."
Today, being diagnosed as "on the spectrum", comes with perks. People assume you're smarter than average, and often they're right.
All Cats Have Asperger Syndrome, Kathy Hoopmann's new book for kids, is used by parents and clinicians alike in explaining to kids just what "Asperger Syndrome" means. The book is funny, dead-on and has a strangely intuitive appeal. After all, cats don't need to run up, tail wagging, when you get home. They're not barkers, and are content to simply leave your lap without a backwards glance when they're done being petted. Interaction with cats seems streamlined, without all the fuss and fanfare associated with canine communication.
If you're an adult with Asperger's, you probably didn't receive a congratulatory handshake when you received your diagnosis, if you received a diagnosis at all. This book is for kids, it's true. But it's also for past generations of Aspies, who may have missed out on the feel-good atmosphere surrounding the spectrum today.
If you're an adult with Asperger's, you're not alone, and deserve congratulations for getting through this much of your life without the benefit of school IEPs, sensory interventions and social skills classes.
You deserve a high-five.
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.
6. MAGNIFICATION (CATASTROPHIZING) OR MINIMIZATION: 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 http://www.feelinggood.com/
Tuesday, November 10, 2009
Undiagnosed Asperger's Leads To 'Life As An Outsider'
Listen to NPR's interview with Tim Page, author of Parallel Play: Growing Up with Undiagnosed Asperger's.
Enjoying the Strengths of Asperger's
Asperger's Disorder is just that - a disorder.
Or is it?
A new wave of people determined to own - and enjoy - their Asperger's status has emerged, and the wave has many clinicians questioning our tendency to pathologize. As we enter a new age of appreciation of diversity, from race to types of intelligence, why, when it comes to Asperger's, are we stuck with diagnoses and tests, therapies and interventions?
One clear answer to this complex question is the notion of distress. An adult with Asperger's (or something close to it) who is in distress as a direct result of the disorder should have access to help. Not help erasing his unique characteristics. Not help being like everyone else. Rather, help enjoying the strengths of Asperger's and minimizing the depression and anxiety that can come with being different.
"That's ridiculous," I hear in the therapy office from some clients, "what good can come of having a developmental disorder?"
But enjoying the strengths that come with the package of neurological differences we call Asperger's is not a new concept. For instance, in their 2001 bestseller Now, discover Your Strengths, Marcus Buckingham and Donald Clifton, Ph.D. set out to identify styles of information processing that affect the workplace. The result was a spread of over 30 different relating and information processing styles. This was not necessarily a new concept. What was new was how these different styles were judged: not according to a black and white system of good and bad, but as all strengths to be cultivated, utilized and enjoyed by employees and employers alike.
For instance, one theme, the "Analytical", is a familiar style to many Aspies. "You see yourself as objective and dispassionate. You like data because they are value free. They have no agenda....It is hoped that your analysis is never delivered too harshly. Otherwise, others may avoid you..." (page 86). Depending on one's perspective, this strength can be perceived as a skill set, a style, a character flaw, an indifference to people, and on and on. It is up to each individual person with Asperger's to train his or herself to focus on and enhance strengths.
A second theme described is the "Deliberative", another style which resonates with many Aspies. "You are careful. You are vigilant," the writers assert, "You are a private person. You know that the world is an unpredictable place. Everything may seem in order, but beneath the surface you sense many risks. You like to plan ahead so as to anticipate what might go wrong....If some people don't like you because you are not as effusive as others, then so be it." (page 94). Depending on one's perspective, this strength can be judged as responsible, anxious, obsessive- compulsive, non-spontaneous, and on and on. Again, it is up to the individual with Asperger's to see the beauty in this strength and invest in it.
We all want to find ways to identify, enjoy and share our gifts. Have you identified yours? Are you enjoying them? Sharing them?
Saturday, November 7, 2009
Mobile Electronics: Do they Help or Hinder the Aspie?
When I ride the bus I am struck with just how different the riders look from how they might have looked just ten years ago.
Of course I am not the first to notice that people are largely in their own bubbles - ears occupied by headphones, eyes occupied by screen. The chit chat, the shared human experience of bus-riding - that awareness of being part of a group of human beings engaging in the activity of travel via public transportation - has changed.
Critics call this dependence on electronics dangerous. Electronics usage, largely a solitary activity (at least in the physical sense), prevents people from connecting with others, and increases isolation, which can be damaging for people who already struggle with socializing. Penelope Trunk writes in the March 19, 2006, Boston Globe,“The human moment is a quality of interaction you don’t get from computers, or even the phone.”
But defenders of technology assert that the people who use technology while in group settings are often the very individuals who would have avoided socializing anyway. Technology, they propose, just gives them a comfortable way to avoid it.
But is it too comfortable?
The issue may not be black and white, however, at least for Aspies. Exposure Therapy, a form of cognitive-behavioral therapy, is a well-researched avenue for facing and overcoming sources of anxiety, such as simple phobias. The therapy involves the creation of a program of steadily escalating steps or challenges, which work towards a final goal of reduced or eliminated anxiety responses. Reducing interactions with others to near zero may prevent Aspies from receiving the very therapy that might reduce discomfort in social situations: real-time interactions with others, with their messy outcomes and unpredictable paths.
Yes Aspies themselves often report reduced anxiety in groups when able to rely, at least partially, on technology. "My iPod had become a security blanket," says one client with Asperger's, "without it I found the bus intolerable, and wouldn't even board before the headphones were in." Yet this very client benefited greatly from a self-imposed regiment of practiced, brief "chit-chat sessions" with riders. They key to his success may have been selective use of his electronic gadget in social settings, such that its function was not total escape, but a support gadget of sorts. After adopting a more balanced understanding of how to use his gadget for anxiety modulation, rather than total prevention, he was able to increase social interactions, lower their associated anxiety and gain a sense of mastery over a previously fear-laden situation: group transportation.
For Aspies, technology may work best as an adjunct to socializing, rather than a substitute. Awareness and self-monitoring are key to the success of the Aspie who aims to lower social anxiety and reduce reliance on mobile electronics. Aspies, like all, largely require both solitary and group connection. After asking teens about this very issue, Neal Starkman of The Journal writes in his March 1, 2007 article on communication and technology, "From their responses, it seems that young people want technology because it secures two basic needs that, seemingly contradictory, are crucial to their well-being: to be left alone, and to connect with others."
If you have Asperger's and and iPod, you may want to push yourself to interact when you can....for some, it may be the only way to ride the bus comfortably. For information on cognitive behavioral techniques and Asperger's visit www.terratherapy.org or http://www.nacbt.org/whatiscbt.htm
Thursday, November 5, 2009
Book Review - Look Me in the Eye: My Life with Asperger's
Look Me in the Eye: My Life with Asperger's is John Elder Robison's funny and poignant account of his own experience of Asperger's. the memoir is humorous and bold.
Donna Chavez of Booklist writes, "Robison's memoir is must reading for its unblinking (as only an Aspergian can) glimpse into the life of a person who had to wait decades for the medical community to catch up with him."
Asperger Syndrome and Central Coherence Theory
What is central coherence, and how can different drives for central coherence affect communication?
Allow me to share a vignette:
Shari and Kevin have just celebrated Thanksgiving.
Shari recounts her experience of the holiday in their couples counseling session. "I was exhausted," she states, "I had no time off from the kids or work to really prepare, had to clean and prepare the house and yard for company, shop, cook for 11 people, manage relationships with Kevin's family members and get this kids ready, ALL while keeping my cool. It was exhausting and miserable. I'm never hosting Thanksgiving again."
Kevin recounts his account of the same holiday. "It was quite lovely. We had turkey, homemade stuffing, homemade cranberry sauce, homemade pumpkin pie. I played chess with my brother and beat him four times, a personal record. I also made spiced cider that was delicious, and adjusted the recipe I normally use by adding peppercorns. It was a nice holiday. I'm looking forward to next year's celebration."
Q: Which person is telling the truth?
Q: Which is more valid, her perspective or his?
Is it truly possible for two people to have such starkly differing views of an event and both be referring to the same Thanksgiving? A resounding YES! Welcome to the duplicitous world of life with an Aspie, where there are no right or wrong perspectives - only different perspectives.
Central Coherence Theory
People with ASD often have difficulties with central coherence. Central coherence can be described as getting the point, or gist, of things. It is the ability to pull information from different sources, experiences and schemas, both internal and external, to glean a higher meaning. Lacking central coherence can leave an individual vulnerable to misinterpreting of situations and communications.
In our vignette, Shari was able to describe her experience in a global fashion, pulling relevant internal and external details in, while leaving less relevant facts out. This was important to her ability to communicate and justify her sense of misery. She knew, "intuitively, what facts to include in her efforts to incite in the listener a sense of empathy for her - after all, who wouldn't be miserable after participating in the holiday she described?
Kevin, who lacks a sense of central coherence, was not just largely unable to include the details of his or her emotional experience of the holiday. For Kevin, these details were irrelevant to his message - what happened during the event, what was eaten, etc. He was unaware that Shari was having a miserable experience, and could not understand, given the factors he attended to during the event, why she was unhappy. "He can't see the forest for the trees" is a common criticism heard by Aspies regarding their ability to synthesize information to get the gist of a situation.
People without ASD often have a high need for central coherence in their efforts to understand situations. Aspies approach situations in a detail-oriented fashion, often through one channel at a time. The disparity between these two approaches to understanding and dealing with life can cause distress in relationships, leaving partners feeling they "speak different languages".
De-personalizing Disparate Neurology
While opposite approaches to collecting and synthesizing information can leave couples frustrated at times, it is crucial that both partners remember that Aspies who attend to data which do not include feelings often are not doing so due to indifference. Remembering that neurological differences are often the underlying causes of these differences can "de-personalize" what might otherwise feel hurtful. Communication skills such as active listening can help couples learn to listen to each other with their hearts - and the language of the heart is universal.
Aspies are Robots: Stereotypes that Hurt
Back in 2006, researcher teams in the USA and Germany teamed up to assess empathy in adults with Asperger's. Their findings were published in the Journal of Autism and Developmental Disorders. The results were deemed surprising by many in the field at the time. Why? Because they contradicted many widely held beliefs about people on the spectrum, who are often described as "robotic" and "incapable of empathy". "They just can't read between the lines!" is a common complaint regarding Aspie adults.
Consider, however, the abstract below:
Who Cares? Revisiting Empathy in Asperger Syndrome
A deficit in empathy has consistently been cited as a central characteristic of Asperger syndrome (AS), but previous research on adults has predominantly focused on cognitive empathy, effectively ignoring the role of affective empathy. We administered the Interpersonal Reactivity Index (IRI), a multi-dimensional measure of empathy, and the Strange Stories test to 21 adults with AS and 21 matched controls. Our data show that while the AS group scored lower on the measures of cognitive empathy and theory of mind, they were no different from controls on one affective empathy scale of the IRI (empathic concern), and scored higher than controls on the other (personal distress). Therefore, we propose that the issue of empathy in AS should be revisited.
(1) Millhauser Laboratories (MHL-400), Center for Brain Health, New York University School of Medicine, 550 First Avenue, New York, NY 10016, USA
(2) Institute of Experimental Psychology, University of Dusseldorf, Dusseldorf, Germany
(3) Nathan Kline Institute, Orangeburg, NY, USA
This research is contrary to most stereotypical versions of the Aspie as cold-hearted and uninterested in the feelings of others. So why does the common stereotype persist? Perhaps it is easy to miss empathy which is heartfelt, but not explicitly expressed. Perhaps, in this case, the burden is on the typical partner, friend or loved one to do the reading between the lines.
Theory of Mind vs. Compassion in Asperger's
The couple was in the midst of a heated argument.
"Please stop looking at me like a dead cod fish!"
Believe it or not, statements like this from partners of adults with Asperger's are not all that uncommon. When confronted with a highly upset partner, some adults with Asperger's respond by shutting down completely, staring baffled at their partner instead conversing and adopting the pose of a....well....dead cod fish.
Often adults with Asperger's (ASD) are accused of by loved ones and friends, even coworkers, as LACKING EMPATHY. This is puzzling, as many Aspies report a heightened alarm system when confronted with emotional intensity. Do Aspies really lack empathy? Or are they shutting down when easily overwhelmed in emotionally charged situations, leading to a "non-empathic" presentation? Or is there some other explanation?
Theory of Mind
The typical individual, at an early age, develops the innate capacity to know and understand that other people have thoughts, feelings and desires that are different from his or her own. This understanding develops without effort, and is supported by the innate ability to engage in the nuances of interaction: body language, tone of voice, eye contact and other subtleties. This conceptualizing of "other" versus "self" is, what many researchers believe to be, the first step in empathy. In other words, it is very difficult to "empathize" with a separate person's unique experience without first understanding that their experience is just that - unique, or more aptly put, not the same as that of the self.
One of the most important milestones in theory of mind development is gaining the ability to attribute false belief: that is, to recognize that others can have beliefs about the world that are incorrect. To do this, it is suggested, one must understand how knowledge is formed, that people’s beliefs are based on their knowledge, that mental states can differ from reality, and that people’s behavior can be predicted by their mental states.
Researchers have investigated the false belief concept in intriguing ways. In one such experiment (often called the ‘Sally-Anne’ task), children are told or shown a story involving two characters. For example, the child is shown two dolls, Sally and Anne, who have a basket and a box, respectively. Sally also has a marble, which she places in her basket, and then leaves to take a walk. While she is out of the room, Anne takes the marble from the basket, eventually putting it in the box. Sally returns, and the child is then asked where Sally will look for the marble. The child passes the task if she answers that Sally will look in the basket, where she put the marble; the child fails the task if she answers that Sally will look in the box, where the child knows the marble is hidden, even though Sally cannot know, since she did not see it hidden there. In order to pass the task, the child must be able to understand that a person's mental representation of the situation is different from their own, and the child must be able to predict behavior based on that understanding. The results of research using false-belief tasks have been fairly consistent: most normally-developing children are unable to pass the tasks until around age four. Yet the test is often not passed by adults diagnosed with ASD.
Is Theory of Mind a necessary foundation for compassion? Compassion is a human emotion prompted by the pain of others. More vigorous than empathy, the feeling commonly gives rise to an active desire to alleviate another person's suffering. It is often, though not inevitably, the key component in what manifests in the social context as altruism.
Though adult Aspies get stuck when it comes to understanding the WHY of another's emotions, they rarely seem to present with true indifference. Rather, many seem to adopt a position of indifference as a defense against an inherent lack of understanding of the basis for the emotions of others. It is, perhaps, this fundamental lack of understanding, COMBINED WITH an ultra sensitive and reactive physiological system, which leads to withdrawal. This withdrawal can leave loved ones feeling abandoned and uncared for, a recipe for problems in relationships.
"I love email," says one Aspie adult, "there's no overwhelm. I can read about my friend's upset without having to respond in the moment, manage eye contact, witness first hand things like crying and gesturing. Email is the grease of our relationship."
Before jumping to conclusions regarding your own or your partner's ability to empathize, remember that one truly cannot judge an Aspie by his or her cover. Professionals trained in working with autism spectrum disorders can help with adjusting terms of communication to prevent overwhelm and withdrawal, so that Aspies with compassion can be perceived as such.
There's nothing fishy about that.
Five Tips for Aspie Partners
In my psychotherapy practice, I often receive referrals for couples dealing with one partner's real or suspected diagnosis of Asperger Syndrome. More often than not, the partner who is frustrated and seeking therapy is the partner who has not been diagnosed.
Most of us know that adults with Asperger Syndrome (Aspies) have dramatically different ways of communicating and behaving in relationships. Some of these ways work beautifully! Some do not. If you are an adult who has been diagnosed with Asperger Syndrome, or suspects you might have the disorder, how can you begin to navigate the foggy, unpredictable, irrational land of intimacy? Following are five tips which may provide some beginning help.
1. Don't give in to feelings of hopelessness or futility.
Adults with Asperger Syndrome can at times feel overwhelmed by frustration. There are times these adults can feel that no amount of effort on their part can ever change their ability to understand how their partner operates. This is sometimes true - no adult can ever really become an expert on their partner's perceptions, thoughts, feelings and behaviors. The best strategy may be becoming an expert on yourself. This can serve as a foundation for learning new skills, having compassion for yourself and even learning to laugh at how different you and your partner may approach problems and issues.
2. Ask questions of your partner -gather as much information as you can about the situation you're facing together.
Faced with having to operate without an intuitive understanding of how your partner feels and thinks, you may rely on your logic and assumptions. This can be dangerous! Remember, your mind works differently than your partner's. A great strategy can be simply asking questions. For instance, instead of assuming that your partner is ready to end the relationship over a fight, ask for clarification. Good questions can include, "I'm wondering if you feel...." Or "Can you tell me more about that?".
3. Hold tight to the truth that your thoughts and emotions matter.
Though they may be expressed differently (or not at all!), your feelings and perceptions are valid, and are worth just as much as your partner's feelings and thoughts. This can be a difficult perspective to maintain, especially if your partner is articulate and quick. Remember, working out a problem is not a verbal jousting competition, though it can sometimes feel like one.
4. Decide how you would like to pursue and operate in relationships.
This takes thought. Do you want to connect with others? Do you experience loneliness? Do you want to increase your ability to talk about your inner world or negotiate problems? Not everyone aspires to these ways of relating. Decide for yourself if you do. If you decide to work to strengthen your connections, you may benefit from learning to monitor your "togetherness tolerance" - Aspies often are helped by frequent breaks, shorter visits, etc. Your level of need in connecting with others may differ vastly from that of your partner. This is fine, and may serve as a great balance for your relationship.
5. Find help. Often a cliche tip, there is no substitute for consulting an expert - a communication coach, a therapist, a well-written manual. Remember that though you may have not received the understanding of relationship nuance through osmosis, like many adults, you CAN learn skills that can close the gap you may feel between your ability to relate and the abilities of others.
One last tip - don't be too quick to judge yourself harshly. Aspies often provide wonderful advantages to their relationships, such as "groundedness", logic, a refusal to become violent or aggressive, a heightened desire to do the right or moral thing, an inability to participate in the emotional "games" so many adults struggle with in relationships, in intense sensitivity buried under layers of defense. As always, self-acceptance is the best position to take as you navigate the wonderful - and sometimes terrifying - frontiers of intimacy.
Book Review - Embracing the Wide Sky: A Tour Across the Horizons of the Mind
Daniel Tammet, author of Embracing the Wide Sky: A Tour Across the Horizons of the Mind, describes his life with high-functioning autistic savant syndrome. Daniel holds an official diagnosis of Asperger's, and many adults with Asperger's who read his biographical Born On A Blue Day describe his ability to relate the world of the Aspie mind to those without Asperger's as groundbreaking.
Tammet's newest book expands on such topics as the neurological basis for creativity, the benefits of meditation and training the brain to experience more happiness. The book is an excellent survey of the diversity and beauty of the minds of people who appear so different. He is a tireless advocate for Aspies, and believes stereotypes such as Rainman do much to confuse and bias the public towards those whose brains work a little (or a lot) differently.
Check out Tammet's blog at http://www.optimnem.co.uk/blog/index.php
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