A packed house found Mark’s talk very informative with lots of examples to illustrate the points he was making. Mark has been working in Learning Disability Services for 20 years, and after some time realised the usual ways of working did not work well with autistic people, so decided to investigate further ways of working with this group of people. He trained as a counsellor seven years ago and applied his knowledge to teenagers and adults who he sees in his private practice.
The word autism comes from the Greek word autos meaning self, developed by Leo Kanner in the 1930s who was working with children diagnosed with infantile schizophrenia. Mark opened the talk with myths about autism – that autistic people are self-absorbed, lack empathy, cannot lie, are rigid and don’t like change. Actually autistic people can be outgoing and very talkative when they are with people they feel safe and comfortable with. They do find reading subtle changes in expression more difficult, are as inclined to lie as non-autistic children, and can also learn to cope with and manage change.
Mark then compared the medical ideas of autism with a diversity discourse. In the medical approach there is no cure for Autism, the purpose of interventions is to improve functioning. Medically it is seen as a triad of impairment in the following areas:
Imagination – repetitive play, narrow focus of interests and difficulty generalising
Communication – talks ‘to’ rather than ‘with’, difficulties expressing thoughts, feelings, and understanding the emotions of others
Social – ‘aloofness’, dislikes physical contact, does not initiate social interactions except repetitively
From a counselling perspective it may be helpful to view this as a Triad of Difference rather than impairment. The neurodiversity discourse emerged in the late 80’s and early 90’s as a reaction to the dominant medical narrative. It holds that humans are neurodiverse, and that autism is a divergent neural pattern. A person who is autistic is said to be atypical, while someone who has a typical pattern is said to be neurotypical. This approach values and recognises difference. The heart of the issue for autistic people is feeling misunderstood by others.
Mark then looked at Theory of Mind – the ability to imagine yourself from another person’s perspective, and work out what they can know, and therefore how they will feel and behave. We were introduced to the Sally Anne test. It’s easier to explain if you watch this short 90-second video clip: https://www.youtube.com/watch?v=QjkTQtggLH4. Baron-Cohen and team (1985) said when autistic children were asked where the ball was, 16 out of 20 said the box. He argued that the primary deficit in Autism was a lack of Theory of Mind.
When meeting autistic clients Mark described a feeling counsellors can have – that ‘there’s something missing’ – a sense of a missing connection or empathy. Autistic people often find eye contact uncomfortable and may have unusual styles of eye contact. This may be because of a processing overload – the person is overwhelmed by trying to process the information contained in eye contact, they can feel vulnerable and/or confrontational or eye contact can cause feelings of physical pain. With emotional regulation autistic people can have hypo-sensitivity (low sensation), and may not notice when they are thirsty, hungry or in pain, or hyper-sensitivity (high sensation) and can be overwhelmed by things like noise, light, or other people’s emotions. Autistic people will often separate off experiences (compartmentalisation) which to a neurotypical person would seem to be connected, e.g. not understanding why someone may feel angry today about something you did yesterday. They may also connect events together in unexpected ways.
Autistic people commonly have difficulties with relationships, e.g. they may form them but have difficulty maintaining them and may experience bullying and isolation. The Autistic person is usually unaware of their impact on others, being unable to make sense of what has gone wrong and can find the ‘rules’ around relationships contradictory and confusing. They may have an all pervading sense they are not like the people around them. It is often a strong sense of difference, and can lead to descriptions of being alien, wrong, defective or singled out.
Building trust with autistic clients is important, they tend to base trust on consistency and observation of overt behaviour rather than on a ‘feeling of trust’. Advice to counsellors would include having clear communication i.e. minimise metaphors, ask about eye contact – your client will usually tell you, wear the same / similar clothing, use muted colours and avoid strong patterns. Maintain consistency around beginnings and endings and match what you say with what you do.
Work with objects (e.g. toys) – clients will often readily project themselves into an object. Develop a language around emotions and make them explicit e.g. “your friend sounded happy to see you today”. Emotions can be scored on a scale of 1 to 10, e.g. “what are you like when your anger is a 7?” Use of emotion or mood cards can also be helpful (you can buy mood cards by Andrea Harrn). Finally, social stories is an approach developed to work with Autistic children. It has generally been shown to be a successful strategy to help Autistic people cope in social situations. They describe a situation, skill or idea, in terms of emotional perspectives, desired direction, how to get there and who can help.
Thanks Mark for an interesting and enjoyable evening.
HACP Committee member
Baron-Cohen, S., Leslie, A.M., & Frith, U. (1985). Does the autistic child have a ‘theory of mind’? Cognition
Other Comments from Feedback Forms:
“Expert presentation; enjoyed process of self-reflection;
Great illustration with stories as examples; great tools;
Liked the way you linked the ‘marble bucket’ throughout; succinct;
Loved the strategies, techniques and simplicity; wonderful insights;
Didn’t realise how much I knew and now feel more confident (more than one person said this);
Speaker conveyed a great understanding and empathy with his client group;
Engaging; inspired me; transmitted his passion;
What a great advocate for people with autism.”