A review of the HACP day workshop held on Saturday, 28th October 2023 Karen Prouton explored: ‘Autism Informed Therapy – what do we need to know’ by Jacqueline Holloway
This was a well-attended, beneficial day. Karen is an excellent speaker who demonstrates empathic understanding of her clients, their issues and conditions. ‘What is Autism and how does
it impact those living with it’. A day of sharing knowledge, ideas, questions and needed answers.
Karen gave a potted history of Autism from the time it was completely misunderstood to where it is now with a Diagnostic criteria and the Neurodiversity Movement: In 1980 the DSM 111 considered ‘Autism Disorder’ a rare disorder. By 2000 the Neurodiversty Movement were discussing intersectionality (Judy Singer) which certainly helped the people experiencing a range of autistic issues. There are now neurodiverse communities and autistic therapists who have platforms where they can openly discuss issues, i.e. the rise in autistic diagnosis for women and how they present. Clients and their issues need to be seen through a ‘neuro affirmative lens’
Hartman et al, 2023: ‘Only when professionals fully understand the theories and mechanisms that create autistic people’s experiences, will this help non-autistic professionals to truly understand what autistic people face in difference contexts’. Autism is a neurotype not a disorder and Asperger’s Syndrome is not a diagnosis.
Seeing autism ‘as a difference, ignores the challenges autistic people face in everyday life’. Those supporting them will need to appreciate that autism is neurodiverse and to recognise its disabling factors. (NICE 2021) stated: ‘The term autism describes a pattern of ‘qualitative differences and impairments in reciprocal social interaction and social communication, combined with restricted interests and rigid and repetitive behaviours, often with a lifelong impact’.
NICE identified a triad of impairments:
‘Social relationships; social communication and flexibility of thought (imagination)
Social Interaction and Communication:
Eye contact is often avoided as being unacceptably uncomfortable; reduced sharing of information and unease with normal back and forth conversations; reduced initiation and responses to social interactions; difficulty in adjusting behavious to varied social contexts, and in understanding non-verbal communication, and with reduced imaginary play.
Behaviour, interests and activities: Also observed is stereotyped or repetitive motor movements; a strong preference for sameness and routines (helps with feelings of trust and safety); restricted interests that are very intense in focus; preference for physical aspects of play activities and hyper/hypo reactivity to sensory input.
Devised by Dr. Dinah Murray and Wenn Lawson over some years. It suggests the ‘autistic mind hyper-focuses on specific interests and activities and so anything that exists outside of those interests tends to be minimized or ignored.The autistic world is experienced as predictable, with landmarks and destination known and diversions are hard or confusing’. A cognitive theory developed by autistic people, states: ‘all humans need different mechanisms to deal with limited attention availablity’. Neurotypical people can direct attention to many things including primary task or peripheral ones’. Murray and Wenn explained, it is difficult or actually impossble for autistic people to do so, as attention to anything else is not possible when being in the flow state of their attention means intense focus on one primary task’. Expecting autistic people to keep swapping attention to other issues is not helpful – their attention span does not work like that.
Therapists’ empathic responses, a theory of mind, which intuitively and empathically works out what a client is thinking or feeling based on their tone of voice and body language. It is different for people with autism who have a more conscious process and may use their own experience to help them understand what is going on for another. Those with Compassionate Empathy go further, they feel they are alongside the client, which works when both are neurotypical, but for some-one with autism, it can be too intense, painful or overwhelming. Beyond empathy, autistic people’s internal desire is to take action and to do what they see is needed, which sometimes is not what might be needed by the ‘other’ and so difficult misunderstandings can arise.
Nick Chown, 2017: ‘an autism theory to enhance understanding of autistic people’s perception, reflecting the uniqueness and diversity of them. This function would help ‘manage thoughts, actions and emotions to achieve goals’. Attention is on planning, maintaining attention and focus which would enable bodily, cognitive and emotional self control to sucessfully meet aims or wishes. Karen said this not autistic specific theory but autistic people may experience benefits, such as in intersectionality and ADHD.
Perception and sensory processing:
Creating our realities using the eight senses: sight, hearing, custatory, olfactory, tactile, vesticular, proprioception (body position and the energy required for planned tasks), intero-ception (sensing inside our body needs), linked to alexithymia (emotions and body sensations). Autistic people have different perceptual mechanisms which may impact daily life and their anxiety levels. Sensitive intervensions can help Autistic clients understand differences in reactions to sensory stimuli, which may be through experiencing more extremes of: ‘over-responsivity – alerting; under-responsivity – under reacting/exhausting; or sensory seeking – craving more of a certain stimulus which is enjoyable or helps them to self-regulate. Other elements could be: Camouflaging (conscious and unconscious hiding of autistic traits in social settings); Masking (hiding behaviours or interests); Mimicking others’ interests or speech; Compensation (rules for small talk, eye contact). This will, of course, occur in the therapy room too.
Counselling rooms: Clients like to experience the therapy room as calm, clear, with acceptable light, quiet and actually always being the same each time. They may like soft colours or bright. The room may need to be shown to them before the first session to guage their thoughts and reactions; for them to know how to get there; what the building is like; where to park or which floor the room is on etc. Autistic clients notice if something has changed or moved. Some will react with curiousity whilst others may find it disturbing which could well be counterproductive.
Clients may have difficulty understanding who they actually are (Vance, 2021). It is vital they know what is expected of them in therapy, or from the therapist, right from the first meeting or conversation. Clients may be ‘under arounsed, withdrawn’; ‘just right, calm and alert’ or ‘over-aroused, shutdown’. It is important to guage how the client is at the initial stage as it may helpfully inform, both client and therapist, about the most helpful way to introduce future interventions and so benefit the therapeutic relationship.
This is just a small snapshot of the content Karen covered during this important and complex workshop. The feedback, which Karen appreciated, was excellent. Thank you, Karen for such an absorbingly informative day.