CBT and Asperger's ?

[object]

Hi,

 

I was wondering if anyone has had CBT? I have just started it (for the second time) for anxiety and depression. I have trouble with new situations, change, noise, people and these definately contribute to my anxiety and depression. The problem with CBT is that it does not really change the causes - just how I think about them.....

 

I want to give CBT the best shot but as the practitioner (I believe) has little knowledge of Aspergers I think it might not be successful. I am a little unsure what we are trying to do and achieve also.

 

Has anyone any ideas of how I can make the seesions more succesful? How has it worked for you?

 

Edited April 18, 2013 by object

[Willow-Tree]

I did have CBT for a while. I had just stopped going to school due to bullying and the aim was to get me back into school. I went from never wanting to return, ever, to being settled again in a new school, happy about it. I really can't say how it worked, but it did. It felt sly...I just talked about things, and we made plans and drew things which helped me describe my feelings - like spider diagram type things and what not, and then all of a sudden I realised I was in school again!

I would probably be okay to do it again, I felt like it was a relaxed experience. I think I went for around a year. She seemed to be fairly understanding about my Aspergers, though she wasn't a specialist in the area.

[BruceCM]

Not had it, dunno if this info might help, though? http://en.wikipedia.org/wiki/Cognitive_behavioral_therapy Sorry, I'm sure you can google yourself....

[luteman]

I have been referred for CBT to help with my anxiety although I haven't had any sessions yet. From what I've read there is evidence for CBT being effective especially with anxiety disorders in people with Asperger's syndrome.

 

I looked at some stuff on the Network Autism site and that suggested that the therapist could adapt the CBT using a more concrete, structured, tangible and visual approach e.g. worksheets, thought bubbles etc. There is I believe information available on adapting CBT for people with aspergers that the practitioner could access.

 

Good luck anyway. I hope it works out for you.

[object]

Thanks all,

 

The general consensus is that CBT can be useful then. I just don't see how it can work for me though?

 

I am not sure how I could bring up with the counsellor the subject of her accessing AS/CBT resources. She might get offended?

Edited April 19, 2013 by object

[object]

I just found this:

 

'A study published in 2012 evaluated the cognitive skills of children with ASD and compared them to those of typical children. The children with ASD had the skills required for CBT in almost every instance. They were able to distinguish thoughts, feelings, and behaviors, and to work on altering their thoughts. Their only area of difficulty was in recognizing emotions.'

 

Lickel, A., Maclean, W. E.,Jr, Blakeley-Smith, A., & Hepburn, S. (2012). Assessment of the prerequisite skills for cognitive behavioral therapy in children with and without autism spectrum disorders. Journal of Autism and Developmental Disorders, 42(6), 992-1000.

[indiscreet]

Some years ago I had CBT in connexion with my difficulties in social situations and being away from home I didn't find that it had any long-term effect.

 

I can see it working in situations like Willow-Tree's problems with bullying at school, since that's something specific and you don't have to be on the spectrum to suffer from anxiety/depression because of bullying. I wonder, though, whether in the case of people with autism/AS the problems are so intrinsic to the condition that CBT won't be effective - unless the therapist concentrates on helping the patient to find ways of living with the basic problem rather than attempting to eradicate it.

[object]

Hi indiscreet,

 

I agree that the therapist should concentrate 'on helping the patient to find ways of living with the basic problem rather than attempting to eradicate it.'

 

The causes of my depression and anxieties are more circumstantial rather than biological for example - the root lies with my Aspergers Syndrome. i think what would be most helpful for me would be practical support with regard to making a practical difference in my life. Which in turn would reduce my depression and anxiety . Maybe help with changing my job and coping with noise or strategies around dealing with people. If the NHS is spending money on CBT then why not on more useful support instead?

 

i sometimes think that what would be most helpful for some AS people would be an advocate to just help them deal with life, as opposed to 'talking about their feelings'.

[luteman]

Hi object,

 

I appreciate your point about how to bring this up with the counsellor. That could be tricky and I'm not sure how this could be done.

 

Maybe if you make the counsellor aware of any particular difficulties you have due to your Aspergers then hopefully they would adapt things accordingly to make the sessions more useful to you. I had my initial telephone assessment this week and the practitioner I spoke to said that they offer telephone as well as face to face sessions. I explained that I find telephone conversations very difficult so she said they would offer me face to face sessions.

 

You also made a good point about CBT not changing the causes. I suppose it could help if you focus on particular problems and explore your thinking and coping strategies in relation to those. Maybe I will have some more thoughts when I have had some actual sessions.

Thanks all,

 

The general consensus is that CBT can be useful then. I just don't see how it can work for me though?

 

I am not sure how I could bring up with the counsellor the subject of her accessing AS/CBT resources. She might get offended?

[Shnoing]

... i sometimes think that what would be most helpful for some AS people would be an advocate to just help them deal with life, as opposed to 'talking about their feelings'.

I've found out by now that (a.) yes, I have feelings all right, but (b.) the energy required to put them into words is obviously so much more than among neurotypicals that I prefer not to talk about them (even though I can, when properly motivated), and (c.) the requirement to "talk about my feelings" (when stated by someone else) induces a very strong feeling of unease and avoidance which has nothing to do with my feelings before I'm asked to "talk about my feelings", only with the present situation. ... Just like asking a wheelchair user to walk around so you can see where his problems are.

What has worked, though, are group settings where several persons talk about their feelings re. a case (case supervision).

Edited April 21, 2013 by Shnoing

[object]

I am just back from my third CBT session. I am feeling very stressed and worried by it and am not exactly sure what happened.

 

I presented the therapist with a typed document trying to explain what I was thinking. It included:

• My concerns that I may be misunderstood or I might misunderstand.
• That I am worried she will be offended by my input and feel I am criticising her.
• Questions about her abilities and previous experience/knowledge of Asperger's.
• Questioning the purpose of the CBT and what can be achieved.
• Possible strategies regarding email, written summaries and structure of the sessions.
• Why CBT may have failed previously.
• Objectives such as creating a 'personal profile' and 'list of current concerns' (I am working on these now).

I tried to explain:

• how I wanted to get the most out of the sessions.
• that I felt I was not able to express myself very well.
• that I was frustrated by the Neurotypical perspective of the sessions.

Anyway I am not sure if I offended the therapist or not. The outcome is that she is going to contact her clinical lead to see if there is another service that might be more useful or failing that maybe discharge me. I am not sure that I actually said I wanted to be discharged? Maybe thats the impression I gave? I suppose it isn't the most suitable support but I don't have anything else. Maybe I am expecting the wrong thing from CBT? I just wanted to discuss the points I had raised. I just think that the communication between us doesn't work properly as we are on different wavelengths somehow.

 

My girlfriend is going to phone her up and then hopefully tell me what happened.

Edited April 22, 2013 by object

[tmob88]

Hi Object

 

I think you were very right in bringing your concerns to the session and raising them with your therapist. CBT can be effective with all types of psychological problems, particularly anxiety and depression, but it is so important that the client and therapist or on the same page.

 

And I think your right in raising your thoughts about the sessions being delivered from a "NT" perspective. I had the opportunity to write a paper on CBT and AS and one of things I found was that modifying the CBT so that it would be more "AS specific" increased the likelihood that therapy would be successful.

 

If I was advising a friend with AS in regards to CBT, I would really recommend that he/she finds a therapist that has at least a decent grounding of information about AS or ASD in general; the relationship between the client and the therapist is so important and if your not going to understand each other it can become difficult to get anywhere.

 

I've had the opportunity to study both ASDs and CBT so if there's anything I can help you with, PM me.

 

Good luck buddy,

 

T

[Shnoing]

I presented the therapist with a typed document trying to explain what I was thinking. It included:

• That I am worried she will be offended by my input and feel I am criticising her.
• Questions about her abilities and previous experience/knowledge of Asperger's.

I tried to explain:

• that I was frustrated by the Neurotypical perspective of the sessions.

Anyway I am not sure if I offended the therapist or not. The outcome is that she is going to contact her clinical lead to see if there is another service that might be more useful or failing that maybe discharge me.

Weeeeeell. She might be offended, but that would be a bit un-professional. You might tell (write) her, that you'd at least want to try to continue the CBT as an experiment, to see whether it works or not, and that her contribution will be essential for that goal. - You don't want to start it all over, do you? Hopefully, she'll understand.

Edited April 26, 2013 by Shnoing

[object]

Thanks Snoing and tmob88, i really appreciate your thoughts and insight. My girlfirend spoke to the therapise and I think that was really helpful. The therapist is now contacting 'Secondary Care Psychology' to see if there is someone who has more specific AS experience. i think that continuing the CBT would have been really difficult an I agree with you Tmob88 that 'it is so important that the client and therapist or on the same page'.

 

What you said about 'not wanting to start all over again' Shnoing is deffinately something that I felt. People are put on a waiting list and there are few services anyhow so it feels wrong to then stop the therapy. Also any time and effort invested is wasted too. It is hard work trying to explain your self with someone new. I also didn't want to just 'give up'.

 

hopefuly though I am going in the right direction now. I will have more info on Monday.

 

:-)

[indiscreet]

I've recently found myself in a similar situation. My GP arranged for me to "see someone" about my anxiety and depression, which has recently worsened as a result of mobility problems. During the first session I realised that what I was being offered was CBT. During the second session I said that I felt I needed someone who was familiar with AS and that continuing would not be productive. I think to a certain extent the therapist was relieved and she is arranging for me to see someone else in a different facility.

 

Like you, I felt it was maybe unwise to stop the therapy since it means going on another waiting list but I reasoned that any time and effort invested in therapy that's non-productive is a waste of both the patient's and the therapist's time - and the Health Service money.

 

So I think you've done exactly the right thing and I hope everything goes well for you.

[object]

indiscreet, thanks for your post, thats reasuring to hear your similar views and experience. I hope it all works out for you too. :-) Its nice to communicate with people on this forum who are on a similar wavelength....... not feeling like I have to justify and explain yourself from scratch all the time :-)

[lupuscandenti]

Object,

 

I hope i'm not too late with this topic. I haven't been on here for a while. It might interest you to know that i am on the verge of becoming a qualified person-centred therapist. Yes a therapist that is diagnosed with AS. I have been practicing for about 4 months now and have counselled both AS and NT clients. I feel that i have done good work with most of my clients but have really felt a deep connection to the AS clients. No surprises there. I feel that i really get my AS clients where i feel that NT therapists will never get as close as i do to clients with AS. I have also been a client in various therapies myself over the years and have had similar experiences to you, they just didn't understand my way of thinking. In my humble opinion the NT therapist will never fully get you and i think we all know why, they simply cannot relate to your experiences and way of thinking, it's alien to them, they don't think in the same way. Don't get me wrong i'm not pointing the finger at NT therapists and saying there not doing it right, it's just the way it is. Therapists have to go through a very rigorous training experience and they have to be constantly examining themselves and their practice, being aware of themselves, their emotions, their thoughts, prejudices and the issues that their clients bring. When they are faced with an AS client it's like they're trying to relate to a different species which is almost impossible.

 

Actually you probably know all this already, sorry got carried away with my own stuff........as usual. Perhaps what i'm trying to say to you is that i understand your feeling of frustration at the NT perspective of your CBT sessions and i wish i could provide some sessions of therapy for you as a fellow aspie and therapist.

[lupuscandenti]

Just another thought. Feels like a real shame that both Object and Indiscreet seem to have been more concerned with waiting lists and other practical non therapeutic issues. It's like you haven't been given the opportunity to relax in the therapy and really connect with the process over a longer period.

[indiscreet]

Therapists have to go through a very rigorous training experience and they have to be constantly examining themselves and their practice, being aware of themselves, their emotions, their thoughts, prejudices and the issues that their clients bring. When they are faced with an AS client it's like they're trying to relate to a different species which is almost impossible.

 

Lupuscandenti, do you have the same problems when faced with an NT client?

[indiscreet]

Unfortunately in my area of London the waiting time for ANY therapy/treatment tends to dominate one's thoughts and actions.

[lupuscandenti]

Hullo Indiscreet,

I certainly have more trouble relating to my NT clients. I try to focus on their emotions and reflect this back to them even though i have no idea what it must be like to be going through what issues they're bringing to the session. My aim is to get as close as i can to my client's 'frame of reference' and it is just much easier for me to understand an AS point of view and the logic and process that backs this point of view up. I do, however, have a strong belief in humans (NT or AS) and try to concentrate on the similarities that we all experience as members of the human species.

 

I appreciate the frustration of waiting times for therapy or treatment. Having an idealistic and pure idea of the good that therapy can do for people makes me feel sad that we live in a culture that is based around money not people's needs. I think i would be equally frustrated if i were in your position, i wish you luck in finding what you want.

[lupuscandenti]

Have just realised what a brilliant question you have just asked me. Thanks.

[object]

Hi lupus,

 

thanks for your input. :-)

 

 

I am no longer having CBT at the mo. I really didn't like the experience. The therapist did try to find me someone else with some AS experience but the only people in the area (NHS) had there remit changed a few years ago so that they now only accept learning disability and no longer Aspergers. So the way it is - CBT with non AS experience or nothing - :-(. I have to phone the therapist again when I speak to OH in work - I have been off work as I could not cope and the therapist thinks that she can help me go back to work.

 

I really don't feel at all understood and don't understand myself. I feel very low just now and am really struggling with where I live too. I just want someone to help me understand and then help me come up with some practical strategies. The CBT therapist just jumps to conclusions and gets carried away with things that arn't quite right - even though they do make some sense (especially to her). It all moves fast. I don't think she understands how difficult the whole process is just going to see her.

 

Its really hard communicating things to anyone. I just want someone to step in and help me - but I don't know what that would be, who it would be or how to go about that.

 

I have to see my Dr next week but am at a loss what to say.

[indiscreet]

 

 

 

 

I have to see my Dr next week but am at a loss what to say.

 

 

 

Object, tell him what you said in this post:

 

"Its really hard communicating things to anyone. I just want someone to step in and help me - but I don't know what that would be, who it would be or how to go about that."

 

 

 

:

Edited May 9, 2013 by indiscreet

[Aeolienne]

I've described my experience of CBT in an earlier thread. It looks like I will have to have CBT again to sort out my PTSD (see another thread).

[object]

Hey Aeolienne,

 

from your previous thread it seems like CBT doesn't work for you - why would you have it for PTSD? (other than giving it another go). My Dr said she had nothing other than CBT to offer. i have spoken with people at my AS support group and none of them have had success with CBT. I think it is maybe OK for thinking through things and developing strategies but it really depends on the therpaists knowledge of AS. It often seems to be very rigid NT focused and in my case the communication was not successful. For me it seems that CBT is based on changing yourself because you are wrong/ abnormal - it doesn't accept AS ways of thinking as normal.

[Shnoing]

... For me it seems that CBT is based on changing yourself because you are wrong/ abnormal - it doesn't accept AS ways of thinking as normal.

The assumption is that you have started the therapy because you want to change some behaviour. It's up to you to tell which one you want to change.

[object]

The assumption is that you have started the therapy because you want to change some behaviour. It's up to you to tell which one you want to change.

 

I agree. Maybe that is the fundamental problem with CBT and why it will not be effective for me.

[object]

The assumption is that you have started the therapy because you want to change some behaviour. It's up to you to tell which one you want to change.

 

.....I have been thinking a bit ,ore about what you said. I don't think I want to change my behaviour, I just want a bit of help coping with things. :-)

[Aeolienne]

Hey Aeolienne,

 

from your previous thread it seems like CBT doesn't work for you - why would you have it for PTSD? (other than giving it another go).

Because it's the only treatment option my local NHS trust is offering me.

[object]

Because it's the only treatment option my local NHS trust is offering me.

 

........I can relate to that ..... good luck

Edited May 24, 2013 by object

[Shnoing]

Ok, going back to your first post:

... I have trouble with new situations, change, noise, people ...

So, basically, you need a helper for those situations, because no amount of therapy will help you to cope just by yourself. Idk how it's organized in the UK, I'd start to look here: http://en.wikipedia.org/wiki/Services_for_the_disabled (re. the US) ...