I have treated so many adults on the spectrum. A few successfully.
And what I learned in school has proven barely relevant to the process.
Clients who come in trapped in the prison of their mind are in a fight for their lives. No clinician, no person, can ever win a battle to break into the fortress.
It's what the fortress is guarding against that needs addressing. Most clients I've met are dying of loneliness.
Most are guarding, full time, against a pervasive and nameless panic, or, in Sylvia Plath's words, the "o-gape of complete despair".
To imagine I might outsmart a client's mind, as it builds and rebuilds its walls of protection, is to have no understanding of my own limits.
I hope that, as we develop more and more complicated ways to name and talk about symptoms, we will eventually come to the simple understanding that to learn to give and receive love, after one has learned to live without it, is the bravest, most heroic journey.
It is the only journey. The rest is walking in circles.
Wednesday, October 11, 2017
Thursday, January 29, 2015
Adults, Autism and Snipping
We’ve probably all heard about (or felt)
imposter syndrome. In my work with adults on the spectrum, I notice that many
of my clients struggle with some version of it. Even those who have achieved
success in academic, professional, financial, and even social contexts struggle
privately with the sense that none of it is real.
In contexts they’ve mastered they can appear
socially adept (or so good at their jobs that social deficits are pardoned).
But outside of a mastered context (whether the context is reddit or academia
seems of little relevance), many struggle with something beyond social anxiety.
I call it social panic.
How then are these adults able to function so
well in these mastered contexts? It baffles both my clients and their loved
ones. There are probably a number of ways to understand the discrepancy, and
one way I describe it is via the idea of snipping.
Snipping is my way of describing how people
with certain default styles cope with emotions that are beyond his or her
capacity to handle. Under extreme stress, some of us snip the connections that
bind us to parts of our own experience. It might be a foreign concept to
someone who has never experienced it, but many of my clients recognize the
phenomenon, though they’ve been unaware of it or unable to describe it.
For instance, many of my clients are
intellectually gifted. Their methods for processing reality may already differ
a bit from those with less specialized brains. If the emotional load involved
in processing reality in this way is too large to handle (as can be the case
with those who perceive patterns and detail that remain out of awareness for
most of us), adults on the spectrum have the option of snipping their awareness
of the emotions.
This is not necessarily a neurological reality (though I wouldn’t be surprised if it gets backed up by imagery sometime soon), but it is a way to describe the emotional shutdown so many clients experience, an experience they always describe as involuntary. I’m guessing if I had the option to do some snipping to avoid painful emotions I might rely heavily on that technique for managing everything from boredom to stress to grief.
This is not necessarily a neurological reality (though I wouldn’t be surprised if it gets backed up by imagery sometime soon), but it is a way to describe the emotional shutdown so many clients experience, an experience they always describe as involuntary. I’m guessing if I had the option to do some snipping to avoid painful emotions I might rely heavily on that technique for managing everything from boredom to stress to grief.
Some clients snip not just their awareness of
their emotions, but their awareness of their bodies, of time, of events taking
place around them, of identity itself. Because of this snipping, they may be
(in ways that seems almost genius – and maybe are) able to transcend typical
limitations associated with the body (think of the busy programmer who forgets
to eat or go to the bathroom), time (think of the musician who has been trying
to master a piece for 12 hours straight), events around them (think of the cool
mindedness of the non-reactive stance you’ve seen in the midst of conflict) and
even identity (think of the adult who transcends typical limitations of gender,
and even ego).
The snipping phenomenon can be a great tool,
obviously, but like most coping styles, it appears to come with both benefits
and costs. The benefits seem obvious: untethered from ego and emotion, my
clients can often think in ways others can’t. Awareness of ego and emotion, especially,
compete for attention and energy; divorced from these sources of internal
resource depletion, clients on the spectrum can immerse themselves in music,
programming, philosophy, etc. in ways that a more diversified brain might find
out of reach. Clients often dazzle me with their perspectives and intellect.
The costs involved in snipping are sometimes
immediate (such being unable to participate in a charged emotional situation
that demands emotional engagement) and more often long-term (a life that runs
like a machine but lacks vitality). Clients sometimes store negative emotions,
such as fear and grief, in their bodies – digestive problems, sleep
disturbances, jaw clenching, etc. – and even more often suffer symptoms such as
difficulty harnessing attention and swings in motivation, as well as compulsive
productivity alternating with periods of disassociation. Snipping can allow a
bright person to block out fear so s/he can develop and express intelligence
and think in ways that are exciting, but the fear has not truly been dealt with
and transcended. It has been avoided, and - out of sight - it may even have
grown.
The adult who has built not just coping
mechanisms, but a life and a career (or even an identity) on a foundation of snipping
maybe very wary of changing the system. I think this wariness is wise! When
changing how one processes and interacts with reality, things tend to get
shaken up. Who is to say it will be worth it in the end? A therapist who
promises that it will be “worth it” is promising something she cannot know, and
certainly cannot ensure. The client who ventures forth to change the snipping
system must want something that s/he might not even be able to name. And s/he
must have, to some extent, faced the reality that the system is breaking down,
or is limited in ways that have come to be unacceptable.
When working with clients on the spectrum who
have a snipped connection, I don’t make promises and I try to remain cognizant
of the reality that I can’t sell the worth of knitting together that snipped
connection. Realizing that a beautiful system of rationality and logic is limited or inadequate can be
both painful and frightening. I have compassion for the pain of the
realization, a respect for the difficulty of the path, and a willingness to
walk with the client who dares to embark on the journey.
Sunday, April 20, 2014
Adults on the Spectrum - and the Ted Bundy Question

"I am not like Ted Bundy – but
I could be."
I used to be very puzzled by this – after all, I’d hear
these proclamations from the very best of people. In fact, most of my adult
clients could be described as conflict-avoidant, even in situations in which
they feel threatened (rare in adulthood, maybe, but more common under the label
of “bullying” in childhood). These clients are gentle, never cruel to animals,
and certainly not the type to take pleasure in the suffering of any sentient
being. Yet they come in so unsure of their basic nature, and they tell me this:
“I am not Ted Bundy, but I don’t know why.”
A knee-jerk reaction in this case might lead a well-meaning
friend or even therapist to brush aside such concerns as silly. But I think
clients sense they are different – that though they don’t act in ways to
deliberately harm others, the reasons behind their non-violent nature are
different than the reasons shared by most. I think they may be right.
Many of us rely on a kind of shared emotional experience to
guide their ethical behavior. It’s easy to imagine another’s fear, or pain, in
the moment – it conjures up our own feelings of fear and pain, and that alone
is enough to serve as a deterrent. But what if that kind of imagined experience
wasn’t so automatic, or instant? This is the case for many clients. They find
another path for managing their ethics in the moment – sometimes these look
like the “rules” so often mentioned in ASD literature.
It’s the autistic adult’s wonderful workaround for a system
(social, emotional) that’s not available and instant enough to guide ethical
behavior. And this compensating system can really shine in moments when what’s
ethical may cause another pain or discomfort – think of the last M.A.S.H.
episode – so wedged in our minds because many of us could understand the horror
of being faced with having to choose between the survival of many and the
survival of an infant. There are times when ethics must be applied in ways that
violate our sense of that automatic empathy we rely on for a moral compass
function. So many clients on the spectrum can operate in settings (corporate,
etc) in ways that transcend the emotional comfort of others, and even
themselves, to do what’s right. This makes for less inclusion and social
comfort for the client, but they endure (when many empaths do not).
As I’ve written before, I often find that adults on the
spectrum are highly sensitive. But that doesn’t mean that the sensitivity is
available in the moment, especially in social situations. Relying on ethical “rules”
is a wonderful compensation, when immediacy is important. But this doesn’t mean
that inside, many of the same feelings that move most of us aren’t alive and
well.
So while I can understand why clients come in with an
unsettled feeling that they could be Ted Bundy, I know that, via one system or
another, they aren’t, and won’t be.
Saturday, April 5, 2014
Adults on the Spectrum: The Emotion Exoskeleton
Emotions are funny things. They can be a source of immense joy, as well
as immense pain. I think of them like a
deck of cards we each have; trading positive cards can be a lot of fun. The
healthier your relationships are (with others and yourself), the more enjoyable
this trading becomes, the safer the game.
Like most things, how people experience
emotions seems to run along a spectrum.
Some people feel emotions powerfully and readily. Others feel emotions less readily, and when
they do, the emotions are muted. When I
think of how my clients experience emotions, I think about what happens when
emotions are unpredictable, indefinable, uncontrollable.
Many of us have a kind of internal “emotion skeleton”
we use to arrange emotions; part of development involves a kind of coalescing
of emotional experiences (between the individual and the environment, the
individual and others and the individual and self). Factors like experience, relationship modeling,
attachment and physiology help us understand what emotions we hang close to the
heart, what emotions are more peripheral.
This internal structure helps us organize and control emotion, such that
over time we have a sense of solidity and control.
But sometimes this process of bone building
is interrupted. Emotions are too
powerful or chaotic, or one’s environment requires a level of development not
yet reached. When this happens, the
development of an internal mechanism for structure does not proceed as it
should. The internal skeleton needed to
manage and understand emotions has not developed as it has needed to, leaving
the individual feeling an internal sense of chaos. It prevents a cause and effect kind of
understanding of emotions from emerging, and leaves the individual vulnerable
to emotional overload, and therefore a kind of mistrust of emotions. Without that internal structure with which to
organize emotions, feelings become hugely disorganizing, and even scary.
To cope with this phenomena, clients do a few
things. They may limit their access to
emotions (“shutting down”) in order to
increase their sense of structure and control.
Keeping feelings out of awareness is one way to preserve what internal
sense of calm and order there is. Many
clients erect exoskeletons of one
sort or another. Examples are:
- Visualizing what’s to come
- Withdrawal
- Constant engagement in emotionless systems
- Substance abuse
One of the most common I hear about is
visualizing what’s coming next – by having a vision for events, a kind of
imagining of the future, many control to the extent they can the element of
surprise (nothing ushers in emotions quite like surprise!). This exoskeleton serves to shield from
environmental triggers, and can work great, except that (by definition) an
exoskeleton is not flexible. Changes of
plans can be jarring, cracks that allow emotions to flow in unexpectedly. And when you’re depending on an exoskeleton
to protect you from the emotional impact of your environment, it can feel scary
to encounter those cracks.
Another kind of exoskeleton is
withdrawal. Clients talk about
withdrawal in lots of ways; some withdraw into their own mind when potentially
overwhelmed or bored, some withdraw physically into their homes or rooms. Some use machines to withdraw – gaming
systems, computers, etc.
When in relationship with someone who has
erected an exoskeleton, it can be confusing.
The individual might seem more interested in controlling the schedule
than in connecting, or more motivated to game in the evenings than to talk. I’ve seen so many couples struggling with
this, seeming at war – one partner trying to pry the structure from the other’s
hands in order to connect. This always
backfires of course – the structure is needed to make connecting even possible. The more one partner pries, the harder the
other clings to the structure.
Sometimes it seems couples have made an
unconscious agreement with one another – one intends to provide the structure
and benefit from the emotional life provided by the other. The other agrees to
provide the emotional life for both, while benefitting from the structure
provided by the other. This could be a great arrangement, and it is in theory.
Usually, however, each partner actually craves more balance than this system provides.
Most healthy relationships require a working skeleton on the part of both
partners.
When addressing the challenges with personal emotions
so many clients on the spectrum seem to face, one difficulty in particular
arises: almost all of my clients have a well-developed understanding of
emotions in theory. They’re all intelligent, so the idea they don’t know the
difference between frustration and rage is a little insulting. What’s difficult
is not theoretical knowledge – it’s recognizing emotions on a personal level.
And here they do tend to struggle: if I’m hungry, I might be angry. If I’m sad,
I might be depressed. If I’m anxious, I might be hungry. And so on. You can
imagine what a challenge this is when, say, a partner is asking for emotional
feedback on the fly.
But learning how to identify personal
emotions is a process akin to learning to drive – no matter how bright, you
can’t do it in one day. It involves a kind of brain conditioning, and starting
with the basics is a must. That theoretical knowledge of emotions won’t help
when you’re trying to figure out what you’re feeling in the moment; in fact, in
can get in the way. So adults on the spectrum are faced with having to resist
the temptation of traveling down a well-worn super efficient highway, and
choose instead to travel down a rocky and erratic back road they’re unfamiliar
with. This is tough to do when you’re a perfectionist!
If you were saddled with a big intellect, and
also with difficulty identifying and understanding personal emotions, would you
be able to set aside your ego and learn the basics?
It may be the only way to grow an emotion
skeleton.
Tuesday, December 3, 2013
The Outsourcing of Emotions: Adults on the Autism Spectrum
There’s this interesting phenomenon I notice amongst couples
I work with. It involves emotions, and
how partners work together to manage unmanageable emotion loads. They may not see it this way, but from my
perspective it looks as though they are unconsciously dividing up and sharing
emotions such that their partnership stays, although maybe uncomfortable,
intact.
As you probably know, lots of clients on the spectrum
describe feeling “flat”, or emotionless.
They seem to have identified only two
emotional states: undistrurbed and disturbed.
Distrubed emotional states are extremely uncomfortable and difficult to
recover from, so, logically, many try not to get disturbed in the first place.
Between the Aspie client and his emotions is an extremely
effective dam, and he feels little control over how wide, if at all, the floodgates are opened. While there may not be an accurate sense of what feelings
actually lie on the other side of this dam, what is felt is a real dread
of the size and intensity of these unknown emotions. Clients seem to spend much of their time
avoiding this dread, and occupying their interests and attention to this
end. They may spend time thickening the
dam walls, by caking on layers of avoidance through distraction, compulsive
working or even substance use.
This might work well, if only the emotions didn’t somehow leak
out from beneath the dam, or spill over the top. But, in fact, the dam does develop cracks.
Minor cracks can bring anxiety and irritability, while major cracks can bring
panic and apathy. The great, nameless fear is
that if the dam breaks, one might be engulfed, or even annihilated. And since, when feelings leak out, they
really do tend to be overwhelming, this theory gains credence over time.
In times where pressure mounts, the adult on the spectrum often
employ one of two methods for emotion management – 1) he more frantically
pursues his interests (because he’s increasingly desperate to distract from the
pressure of mounting emotion), or 2) he provokes the emotion’s expression in
his mate. I call this last tactic the outsourcing of emotions. It’s effective
in the short-term, but can damage the attachment between partners.
What might this look like in everyday life?
Say a family is attending a holiday party. Let’s invite in our favorite hidden autistic
adult, Joe.
Joe and his wife (we’ll call her Jane) and two kids are
preparing to leave for the event, and unspoken tension is high. Joe is experiencing anxiety, but it’s a
mindless kind of anxiety – he hasn’t really named the feeling, and therefore
hasn’t had the opportunity to really solve for it. What he does internally is a kind of
disconnecting from the people around him.
Joe is on auto-pilot, and has decided the family should
leave at 3:00 PM on the dot. He fails to
communicate this to anyone but himself, and instead imagines his family members
know, or should know, about the deadline.
Of course, 3:00 o'clock comes, and 3:00 o'clock goes, and no one is ready to leave for
the event. Except Joe, that is. He’s been alone waiting in the car for half an
hour.
Once Joe can silently stew that his family members are not
meeting expectations (of course there’s no way for them to meet expectations
they don’t know exist!), he has a reason – a righteous reason! – for
disconnecting. Joe hasn’t learned how to
rely on other people as sources of comfort; instead, they often feel to him
like sources of danger. Read on how this
becomes a self-fulfilling prophecy, once the afternoon continues to degrade.
When finally Joe’s family members join him the car their
emotional states have all arranged predictably: Joe is sullen and removed, Jane
is frantically positive (trying to save the day from the inevitable), and the
kids are becoming increasingly hyper and disorganized. Once on the road, Joe begins driving with too
much intensity, his jaw set and his gaze focused solely on the road. When asked what’s bothering him, his reply is
“nothing”, though various sources of stimuli are now crowding in on his
consciousness – the noises, the sights, the chaos. Joe might truly believe at
this point that his irritation is due to the missed deadline.
He may snap at the children, park too far away for his
spouse’s taste, "sneak" an obvious glance at another woman – whatever the
behavior, chances are he’ll continue until some unspoken line has been
crossed. Once it has, Jane becomes
angry, and loses her temper. She’s
exhausted by the game they’re both playing, but unable to move differently in
this very familiar dance. “So many
outings go this way,” she thinks. “Why
do I even try?”.
Once Jane is angry, Joe can finally feel the sadness that
has been fueling his behavior all along; and in this, he feels saner. This seems so counterintuitive, doesn’t
it? But from Joe’s perspective, you see,
the situation – and his reaction to it – now makes sense. Joe finally feels like what he sees (his
angry wife) has justified his internal state (anxious, excluded). And Jane has
become the expresser of his angst; while he hangs back from the family, she has
become irritable and overwhelmed.
Unconsciously, she has taken on his unbearable emotions. At her own expense, she has served as an
emotional surrogate of sorts. Now Jane
is feeling many of the feelings Joe had in the first place – Joe has outsourced
his emotions.
The down side of this dynamic? It is unconscious – Joe has not slowed down
enough to identify, label, and communicate his distress (many clients don’t,
because they feel unaware or ashamed that routine family outings cause them so
much anxiety and confusion in the first place).
This outsourcing technique may save Joe the ego hit of having such
struggles, but prevents his true solving of the problem. What Joe actually learns, unconsciously, is
that these states really are unbearable – that his spouse can bear them better,
and will do so for him.
Jane is also unconscious to this process, and is thus
operating in the relationship in a way that damages her sense of self and
sanity. She may find, upon careful
examination, that she has functioned this way in relationships before,
especially in her family of origin (where we tend to learn these habits). Perhaps she’s so good at intuiting the
emotional states of others, that she confuses them with her own.
It’s so important to realize that there is no perpetrator
here – Joe and Jane are both victims of this unconscious system. These roles
and ways of transferring around unbearable emotion loads develop organically,
and both members of the partnership play along.
Each feels as if s/he has no other options – he hasn’t found a way to
deal effectively with his suffering without transferring it, and conveniently,
she’s confused his suffering with her own, and therefore can't resist feeling it for him.
The fascinating part about this is that, in general, the
outsourcing goes both ways. There are
plenty of times when the spouse does some outsourcing of her own – I hear about
it in sessions when couples are discussing how much anxiety builds when, for
example, guests come to the home. In
instances like these the roles are often reversed, with the Aspie partner
working hard to absorb her unbearable levels of anxiety, and her neglecting to
slow down long enough to truly manage her own emotional state. The process might look very different on the
surface, but a similar unconscious transfer of emotion is occurring.
Can we learn to operate differently in these
situations? Sometimes the patterns have
been relived over and over, over years and years, maybe even passed on from
generation to generation. It seems so
hopeless. But it’s not. The first step is to slow down and learn how
to label emotion states. I have many
clients who cannot tell if they’re hungry, sad, tired or angry. They skip over finding out, because they’re
not good at it immediately, and because it takes time. But it’s a crucial step to avoiding these
mood management techniques that exploit relationships and erode our attachment.
(BTW- thank you to B.H. for encouraging me to get back to posting!)
(BTW- thank you to B.H. for encouraging me to get back to posting!)
Subscribe to:
Posts (Atom)