During my training I often have to practice my counselling skills in simulated sessions called 'skills practice'. When I'm the 'client' I love it - I find acting so freeing. No expectations on me, I just pretend I'm someone else, tell a story, channel a neighbour, acquaintance, or the woman who told me about their troubles at the bus stop (as often happens to me). Maybe I could be a professional skills practice stooge? But when I'm the 'counsellor', sometimes it goes wrong.
The other day, for instance, we had to practice 'contracting'. That's the stage of counselling in the first session, where you have to lay out your stall, ensure the client is able to give informed consent and cover such things as your training levels, limits to confidentiality (including some legal bits), complaints procedures etc.
As I'm quite new to a lot of this information, I found it a lot to hold in my head. Add to this that the law changes a lot, and there is a split between what is the 'business' end of contracting (fees, cancellation policy, professional details etc), and what is the bit for the client (how you work etc) ... it's a lot to remember. And then I have to remember all my counselling skills, 'read' the client's body language, try to tune into the client's point-of-view, hear their story... It is hard for any student. For me, as a student with autism, it was even harder.
Because being autistic, there is a level of mental processing I have to do just to conduct a conversation - I cannot filter out extraneous sensory stimulation, for instance (the buzz of the air-con, the vibrating cell phone somewhere in the building, the voices from the next room...). I am good at reading body language and expression, but unlike a neurotypical student, this is a conscious process for me. I have to scan and note the significance. It isn't instinctive.
Then there is the fact that I'm being observed. Automatically, I will try to 'read' the observer too! It is a coping strategy I've developed over years, to try to track everyone in the room, to check I am behaving appropriately. I cannot easily just switch that off because I am supposed to forget the observer. So, some of my attention is on trying not to pay attention!
Developing Hypotheses About the Client
Of course, I am new to counselling, so the counselling/listening skills I am using aren't automatic either. My priority in this exercise is contracting, but still, I am training to put the client first, so I am constantly aware of what the client is saying, how they're saying it, developing hypotheses about what that might mean, tracking the narrative, noting significant points.
For example, client says "Well I was thinking that after my divorce... and I told my boyfriend..." (My inner dialogue says: OK, so divorced but moving on or moved on? Potential for relationship with boyfriend to follow same negative course. Is the client wanting to decode what went wrong with the divorce? Or is that a red herring?).
But of course, this is during the contracting phase of the session, so I have to make a mental note and put that aside and focus on the contracting. As I'm contracting, I'm trying hard to phrase it right and not alienate the client.
As an autistic person, I would naturally rattle off facts like a shopping list, with little or no emotion or empathy (autistic people are famed for our 'blunt affect'). I can't do that here, of course, so I have to inject some emotion into it, so the client doesn't feel I'm cold towards them (rather than cold towards the material - especially the legal stuff). My natural defence mechanism is humour. But humour is a tricky thing, especially with distressed people who are sensitive and not in the mood for joking. Yet another strategy for coping with my autism closed down.
For example, I need to tell the client that sometimes, I may need to breech confidentiality. I could just say it: "If I feel there is a risk of harm to yourself or others, I may have to breech confidentiality". And for some clients, that would be fine. Others... a client who is highly anxious may take that personally, almost as a threat. So, I have to couch it in more sensitive terms. This would be relatively straight forwards with a real person in front of me - I'm good at sussing out how to speak to different people. But in this situation, we're acting, and I have to pretend the client is... well who? Most of my colleagues are excellent actors, but still, their responses are not real responses.
Who is the 'Real' Client in Practice?
It is as if there are two layers: the real colleague, and the acted 'client'. I can see both at the same time. So, in this scenario, I may go with "I may need to share my concerns with a more senior counsellor" (having memorised that phrase for later use). I have to memorise a lot of stock phrases as I find it difficult to word things precisely in the moment. Searching through my 'database' of appropriate phrases also takes some of my concentration. This, of course, takes away much of the authenticity of my presentation - the client knows when it is rehearsed. We are told in most context to be 'congruent', authentic, "Don't put on a persona, just be real". But is that actually viable for an autistic counsellor? What would a session look like? I'll come back to that in a moment.
In the meantime, I am in my skills session and my brain is working overtime. All of these thoughts, rules, sensory overload, observations, recalling suitable phrases are whirling through my skull. Suddenly, it all stops. My brain freezes, goes blank, I cannot think. That is an autistic shutdown. It's not an anxiety attack. Strictly speaking, it isn't even anxiety, although it may look like that, and I may even use those words (lacking any easy, quick way to explain it to neurotypicals). My brain has just stalled. Which is frustrating, embarrassing, alarming (what will people think?). And then I may be told (although not in this case thankfully), that I need to deal with my 'anxiety' in personal therapy. Only it's not 'anxiety' really, it's how my brain functions. Therapy won't fix that!
What if the Session were Real?
So, back to the question: "What if it was real? What if this was a real counselling session?" I haven't had real counselling clients yet, so I can only surmise based on my pre-training support and help I gave to people.
Much of this internal processing would have to happen - I'm used to it, and I'm good at it. People seem to find me easy to talk to, easy to confide in, and having had various roles where confidentiality and professional limits were relevant, I find it easy to give the disclaimers "You know I'm only a volunteer, don't you? I'm not an expert or anything" etc. I have done 'contracting' of a sort in the past. And I've never struggled with it as I did in skills practice. I think this is because I'm:
- Clear about my role
- Able to 'read' the person in front of me
- Not being critically observed
- Able to be my true self, not in terms of being 'real' emotionally, but behaviourally.
Autism is a disability that effects social behaviour and social presentation. For all the talk of 'congruence' I wonder how open the counselling profession is towards people who don't 'act' like the norm? In order to qualify as a counsellor, I have to find the middle way between being 'me' (an autistic woman) and being what is expected. My challenge at the moment is to explain meltdowns and shutdowns (which look like panic attacks or freezing) in a way that doesn't lead the neurotypical professional to conclude that I am unsafe or incompetent.
The question has been asked of me "What if you have a meltdown or shutdown in front of a client?"
This question betrays significant misunderstanding. Firstly, for the reasons I've illustrated above, me and a client, alone in a room is considerably less 'overload' than a training session. Secondly, even if I were to feel overloaded, I am able to control it to a significant degree. My ability to 'mask' overload, shutdown and meltdown has a significant cost in terms of my mental health, but in the short term, I can delay. It is not like a panic attack that comes out of the blue. And lastly, meltdowns and shutdowns are not an inability to cope with overwhelming emotions: meltdowns are not breakdowns.
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