Snap Decisions: My Confused Eighth Sense

One of the reasons I worried about writing a blog like this, is that although my autistic brain retains a lot of information, it isn't good on stuff like references. I will try to add some as links, but mostly this is from memory. 

Last week I went to the National Autistic Society's professionals conference  (which I will blog about next week). One of the keynote speakers was Dr Wenn Lawson who spoke about something called Interoception. 

Interoception is called the Eighth Sense of the body. Unlike the other senses: smell, taste, touch, sight, hearing etc which are about the interaction between the body and the world, interoception is an internal sense. It informs us if we are thirsty, tired, hungry... or even sexually attracted.

Interoceptive difficulties can mean we forget to eat lunch when carried-away with a project (or Facebook!). Everybody has introceptive difficulties at times. Autistic people however, people with trauma, ADHD, dyspraxia, severe depression... can have more persistent difficulties with interoception. 

Listening to this talk, I realised how often I struggled to remember to eat meals - and to regulate my eating. I now use meal replacements for two meals a day so at least I'm eating regularly and don't over-eat in the evenings. I forget to drink until I'm dehydrated, I don't go to sleep when I'm exhausted... generally I have to work hard, put routines in place, so that I don't ignore my body's needs. I have noticed a lot of autistic people have trouble maintaining a healthy weight (under or overweight). I wonder if that is due to interoceptive difficulties? 

But interoception isn't just about these more straightforward sensations, interoceptive difficulties can also affect more complex behaviours. For instance, we may take a long time to recognise how we feel about something. I'm pretty sure I fancied people as a teenager, but it wasn't until my twenties that I recognised the feeling as sexual attraction. Before that, I had assumed that neurotypicals, in films, books and pop songs were wildly exaggerating this sensation of attraction! To me, it was a vague, almost unnoticed sensation; Like that feeling you get that you've forgotten something not terribly important. 

What I learned about interoception is that for me, it is as if the sensations are out of focus and gradually come into view. But the important thing to remember is that those sensations are there - just unrecognised. 

For counsellors, by the way, interoception is important to know about. Maybe the client isn't 'repressing' their sexual attraction - maybe they literally haven't noticed it? Maybe the overweight client doesn't have psychological issues causing him to overeat. Maybe he just doesn't sense when he's full? It is important to talk to the client about how they sense things like hunger or sexual attraction and listen to what they say with an open mind.

Always consider the possibility that you're looking at a neurological impairment rather than a psychological problem. 

I was reminded of a person I worked with recently, who has terrible time management problems. Have they, as they believe, a psychological issue around control and timekeeping? Or do they simply have interoceptive difficulties around their sense of time? If it is the latter, all the talking about their childhood in the world won't fix it; a time management app might help though! 

But what have interoceptive difficulties got to do with snap decisions, as per my title? Well after blogging about my difficulties in counselling training for some weeks, I decided to switch to another school for my Diploma. I intended to blog about this decision, but it was a delicate thing, because some of my reasons are private. So, instead of blogging about my reasons, I'm blogging about how I processed those reasons into my decision to resign. 

During the conference, I was musing about how I came to important decisions. To many people, autistic people like me can appear to make very sudden, life changing decisions without much warning. I can invariably give you a nice pros-and-cons list with reasons for my decision. What seems to be 'missing' is the run-up to that where I talk to my friends and mentors, talk about problems, explore various options, talk about how I feel etc. Sure, I shared my concerns, told them things I wasn't happy with, but in a neurotypical, talking about minor irritations at work doesn't usually proceed a sudden resignation. 

So, this is how I can explain it: I became unhappy with my course gradually, but I did not register that 'unhappiness' as such, until it had built up to a certain level. This, by the way, is the reason autistic people may appear fine one minute and in total meltdown the next. This lack of awareness of my own emotional state is a feature of my interoceptive difficulties. 

But there is another feature of autistic processing, which Dr Wenn also touched on in his talk: difficulties with 'Big Picture' thinking. 

My interpretation of Dr Wenn's point was that neurotypicals (non-autistic people) solve complex problems top-down. That is rather like drawing the lines round the picture and then gradually colouring it in. So, the 'Big Picture' is "I am unhappy with my course" - that is where they start - and then they gradually fill in the details as they process their thinking. So, the solutions, including 'Resign from my course' are considered right from the start. 

But autistic people like me can't do Big Picture thinking. Instead, we have (as per the diagnostic criteria) "excessive attention to detail and parts of the whole".

So for me there is no drawing I have to colour in, for me it's more like a jigsaw with pieces missing. I was not aware of the overall Big Picture, only of individual difficulties I was having, each like an isolated puzzle piece, placed on the table. Only when sufficient puzzle pieces had been collected was I able to shuffle them about until a picture emerged. "Ah huh!" I say, "I can see the Big Picture now". (This by the way relates to the Pattern Matching I discuss in my previous blog 'My Autism Superpower').

The puzzle pieces are the various feelings and sensations I have which are numbed by interoceptive difficulties. As with so many things in an autistic person's life, I am having to use my cognitive abilities to compensate for my impairment, using my reason to metaphorically place the puzzle pieces on the table and shuffle them around to find the picture. 

Despite my interoceptive difficulties and my struggles with developing the Big Picture, a picture does finally emerge. I see the pattern and having processed everything there is no need to second-guess. The conclusion is clear: I must switch courses if I am to successfully complete my training. 

National Autistic Society Conference on Autism, Sex & Gender May 2019, Review Pt 2

Lunch at the NAS conference (which was just before Geoff Evan's talk, reviewed in Part 1) was a buffet and I was lucky enough to be sat next to some of the speakers - pretty impressive people! I had a moment of embarassment when I tried to explain the Person-Centred Approach counselling training to a woman who turned out to be a senior psychotherapist (in, you guessed it, Person-Centred Approach), but it seemed no offence was taken.

I reflected on how rare this is - for me to make a mistake like that and have the 'victim' of my mistake do no more than laugh good-naturedly, without judging me for being arrogant, or disrespectful etc. (my facial recognition is, like many autistic people's, a bit rubbish so I may even have met her and spoken to her earlier in the day!). It was nice not to have to be constantly on my guard against social errors like that. 

I didn't attend everything in the afternoon, so I'll talk about what I did attend.

Healthy & Rewarding Relationships - Dr Wenn Lawson

The second talk by Dr Wenn that I attended was about three main areas for autistic people in relationships: The first that autistic people have a different 'cognitive style' to neurotypicals, so in relationships it is important to acknowledge those differences.

Secondly, that autistic people need good communication, which takes into account differences such as a single-minded approach and a tendency to be literal/concrete.

And thirdly, that autistic people have a sexuality (even if its asexuality), it is relevant and sexuality in relationships is a two-way street - your sexuality as well as my sexuality.

Dr Wenn reiterated his earlier points about interoceptive difficulties possibly making it harder for an autistic person to discover their sexuality (we are typically older than neurotypicals when we figure it out). He also discussed how single-minded focus, an autism strength in so many settings, can be a difficulty in relationships, in which it is important to understand your partner and where they're coming from.

He shared some interesting stories about relationships in which communication went awry - 'Tom and Sally'. Tom is autistic and doesn't tell Sally what he's thinking because she doesn't ask (she isn't interested, he concludes). But Sally feels Tom is secretive and doesn't want her to know (as he doesn't volunteer information). Both of them emotionally withdraw from the other out of self-preservation. Their relationship is saved when a therapist (Dr Wenn, perhaps?) helps them see their different cognitive styles and different ways of communicating.

This reminded me of a story I once heard of a man whose wife of 50 years said to him,

"You never tell me you love me!"

And he responds (using 'autistic logic'), "I told you I loved you on our wedding day, and I would have told you if my feelings had changed".  

To her, his lack of verbal affection revealed a cooling off of his feelings. To him, her demands for verbal affection implied a lack of faith in his honesty!

But the take-home, I felt, from Dr Wenn's talk was that autistic people do have a sexuality, and it isn't going to go away just because you don't talk about it (there is an historical issue with seeing all disabled people as non-sexual beings).

He did discuss asexuality, which is complex and doesn't necessarily mean a person never wants sex (sex for an asexual person often fulfils a slightly different function to sex for sexual people). So, he wasn't saying that all autistic people are sexual, but that we should all be educated and informed, not just about 'how to do sex properly' (my words) but about relationships and different sexual identities. 

Professional Support (for gender incongruence) - Getting it Right, at the Right Time - Dr James Barrett

Dr James Barrett is the lead clinician at Charing Cross Hospital Gender Identity Clinic, an NHS clinic for adults with gender dysphoria. He has worked in the field of gender dysphoria for over 30 years. His interest in autism came about because of the disproportionately high numbers of patients coming to him who also had autism. Charing Cross's own statistics suggest a level of autism in the gender dysphoric population which is at least ten times that of the typical population.

Much of Dr Barrett's talk was about how to be sure that the autistic/GD individual was not being misunderstood or conflating autistic 'intense special interests' (aka 'perseverations') with genuine gender dysphoria. He talked a lot about the sensitivity required to give such patients time and space (repeating Dr Wenn's earlier advice re interoception). 

At the same time, he strongly advocated supporting the individual to express themselves how they saw fit - especially applicable to learning disabled autistic individuals in residential care, who may be asked to cross-dress 'in private' due to it being perceived as a sexual act, rather than an identity expression. 

Dr Barrett told us a delightful story about an autistic person, assigned male at birth, tall, bearded, muscular - who nevertheless wore dresses and refused any medical support for transition on the grounds that they were female, regardless of their body. Dr Barrett was concerned for her safety, but nevertheless acknowledged that she probably coped better with her gender dysphoria than anyone else he'd met. 

Which did lead into an interesting discussion about autistic trans people and safety. Dr Barrett reported research that showed that the more comfortable with their appearance a person was, the less likely they were to be victimised.

"'Dressing down'," he said, "encouraging an autistic and/or learning-disabled person with gender dysphoria not to dress overtly masculine or feminine, doesn't relieve gender dysphoria and so can make the person more likely, not less likely, to be victimised". 

To illustrate his point, he made the analogy of him dressing in full Highland dress in Oxford Street. People might be surprised at his posh English accent, but from his appearance they would probably assume he was Scottish (he's not) or a fan of Scotland. Conversely, if he dressed in a pinstripe suit and a bowler hat, they might assume he was a banker, even if, on talking to him, they'd discover her knew less than nothing about banking. If, however, he mixed it up, wearing a kilt and bowler hat, carrying bagpipes under one arm and a briefcase on the other, one Highland brogue and one polished Oxford, one white sock with tassels, and one grey sock - people would think he was... well he asked for suggestions and some of them were unprintable! Mostly mocking, some claiming he risked violence. The point is, you are safer and less attention-drawing if you express yourself confidently and with purpose. 

Someone asked about openly non-binary people, and although this analogy doesn't really work, the reality is that a confident non-binary presenting person would still be safer than someone 'dressing down' to try to blend in. Being 'out and proud' at least in many parts of UK, is probably safer than trying not to be noticed.

I'd love to see some research to prove this, but so far, I only have Dr Barrett's word and the anecdotal evidence of gender nonconforming people in my life. 

Dr Barret then went on to discuss sexuality in the contest of autistic/GD people. He shared that many of his autistic/GD patients found a welcome (and some relief from their gender dysphoria) within the Cosplay community. And with regards to finding sexual partners, many felt much safer in the BDSM/kink community, where consent is very explicit and boundaried (with safe words etc) and often even written down in advance, than (to quote Dr Barrett) "...down the local disco"[sic]. 

This statement caused a wave of disquiet among a vocal minority of the delegates, who were muttering about 'putting children in danger' etc. even though we were very clearly talking about consenting adults here.

I was put me in mind of Dr Wenn's comments about how autistic people have a sexuality and it isn't going to disappear just because you disapprove of it. I wondered, were they offended at the idea of a doctor saying something positive about the BDSM community? Or because the participants were autistic people? And why mention children when that wasn't the context? Were they subconsciously infantilising adults with autism? Or was this just knee-jerk 'kink-phobia'? 

From their reactions later in the conference, I have to wonder if they simply fail to see autistic people as adults?

Much of the rest of Dr Barrett's talk, whilst acknowledging the differences for people with autism and gender dysphoria intersectionality, equally applied to neurotypical gender incongruent individuals.

A lot of the controversy in the media these days see gender dysphoria in terms of medical treatments, believing (falsely) that patients are being rushed into irreversible surgery and medical treatments. But Dr Barrett's talk was from a completely different direction - that of supporting people in exploring their gender differences. He talked a lot about 'regretters' - trans people who regretted medical transition but pointed out that the figures were less than half a per cent (lower than almost any other medical treatment on the NHS). 

Those 'regretters' he talked about numbered 16 patients, of whom 2 had physical problems, 2 weren't clear why and only 2 declared they were not, after all, trans. 12 of the 16 were due to lack of social support in their new gender presentation - family rejection, transphobia, prejudice at work etc. In other words, Dr Barrett said, people were causing the very problems they claimed to want to prevent by denying trans people medical support for transition!

What came through very clearly in Dr Barrett's talk though is that medical support for transition should be about supporting the individual, autistic or not, to find the way of being which is most comfortable for them. For some, relieving gender dysphoria is about crossdressing in evenings and weekends, for some, it's about living 24/7 in their preferred gender presentation, but maybe not requiring anything more but social support, for others, like Dr Wenn himself shared, it's about 'the full works" (as he called it). 

As Dr Barrett explained, gender dysphoria is a horrible condition, leading to appalling mental health, self-harm and even suicides. Relieving GD isn't just about doctors like himself - it is about all of us being understanding and supportive of trans and non-binary individuals, allowing them to find their own ways. 

Personal Reflections

After Dr Barrett's excellent talk, I felt I needed to take a break. There were some individuals in the room who seemed harsh and angry, which made no sense to me, but I wandered downstairs and got some coffee while I had a think about things. 

The next event was a Panel Discussion, which I was sorry to miss as the panellists were all autistic people with an interest in autism, gender and sexuality. However, when I returned to the hall towards the end, I realised there was lots of shouting. Some of the delegates, it turned out, were simply there to make a protest against trans people. They threw some horrible leaflets about and were verbally aggressive, refusing to leave. It was very distressing, especially since their favourite targets seemed to be vulnerable autistic people, who'd come to a professional conference, not a political rally. 

I gathered the protest started after a brief discussion on pornography. I was told that a panellist was asked how to stop young people looking at pornography. As I understand it, her answer was about how to educate young people so they can be aware of how deceptive and unreal most pornography is. She did not, apparently, come up with any ideas how to stop young people getting on porn sites in the first place. 

The protest aside, I felt it was a shame this issue wasn't discussed properly. Autistic people find it hard to learn about sexuality because so often we are protected from it. Also, we often require information that is direct to the point of blunt, clear, concrete and non-judgemental. This is invariably not what we get in school, and in the playground, autistic kids are rarely party to the sorts of conversations going round the neurotypical kids. I can remember myself feeling horribly ignorant and naive, wondering about sexuality but really not 'getting it'. 

I can well imagine a bright, curious autistic young person hitting the internet to find out the answers to their questions. Personally, I would much rather they had information from parents and teachers rather than PornHub, but I am not so naive as to believe they won't come across pornography at some point. After all, autistic people invented the Internet! And autistic people need to know how to cope with it - we also need to know how to be safe (psychologically as well as STIs), we need to understand informed consent and we need to understand the law. For instance, a pertinent one these days is about not sending underage partners sexual pictures via their phones. 

It was a shame in a way that I couldn't engage in this discussion due to the protestors, but I did think there was irony in it: so many autistic people like myself worry constantly about being socially appropriate. We try so hard to be polite and inoffensive, but sometimes we mess up. And yet the socially inappropriate people weren't the autistic delegates! 

The end of the conference was somewhat marred by these events and many of us were quite shaken up. I don't think I've ever seen such hatred and fury directed at people in my life. It was shocking and horrible. 

However, it didn't stop all of us getting a tremendous amount out of the conference and I was thrilled to hear of their plans to run it again next year. 

 

National Autistic Society Conference on Autism, Sex & Gender May 2019, Review Pt 1

When I booked to attend this conference, it seemed the perfect confluence of my interests in working with the LGBTQ+ community, and the autism community. I assumed that a few autistic people might represent this intersection, but I was in for a surprise. It turns out a lot of autistic people are not straight and/or cisgender.

Arriving at the conference was the stressful bit - no clear signage on the door, my helper and I circumnavigated the entire giant building looking for the entrance. By the time we found it, I was in full meltdown mode, unable to stand still or pay attention to the reception properly. But I figured, if you can't have a meltdown at an autism conference, when can you?

The easy-going approach of the delegates quickly relaxed me though. Most people were professionals working with autistic people, but a surprising number of them were autistic themselves, or what my friend calls 'High Functioning Neurotypicals'. People like Carol Povey, the NAS's Director of the Centre for Autism, with whom I chatted at the door (I'm assuming she's neurotypical - if I'm mistaken, apologies Carol!). 

The facilities were light and airy, despite the great age of the building, and hot drinks and cakes were provided in abundance. So even though there were a lot of people there, I felt at ease. 

The theme of the conference was autism, gender and sexuality, and was presented in a respectful, open-minded and enquiring manner. There were some less than open-minded delegates there too, but I decided to ignore them. There's already enough hatred in the world in my opinion.

To paraphrase Dr James Barrett, the lead consultant at Charing Cross Hospital gender clinic (the largest clinic for gender dysphoria in Europe?):

"When parents are told their child is autistic, they should also be told that there is a fair chance their child is not heterosexual or cisgender"

I didn't attend all of the talks, as it was hard work, but here's the talks I did attend:

Autistic and LGBTQIA+: life experiences and life opportunities - Jonathan Andrews

Jonathan is a trustee of Ambitious About Autism and is the youngest person ever to sit on the board of LGBTQ+ charity, Stonewall. His particular interest is social mobility. I was interested in the way he talked about social mobility as not just about deprived groups slotting into privileged set-ups, but about changing those set-ups to be more inclusive.

"It's not so much about changing the person to fit but changing the workplace to fit LGBTQ+/autistic people". 

As one of those LGBTQ+/autistic people myself, this is music to my ears, but also feels a bit utopian. Still, progress has been made - I remember years ago having an argument with an NAS employment person because I felt most autistic people would never be able to cope with work.

I based that on my own experiences - I worked hard, I was honest, I did what I was told... but still, I was often laid off, or told it just "wasn't working out", and often felt so stressed it made me physically ill. I struggled to 'show initiative' (ie work out the unspoken requirements), I annoyed people, my social skills weren't good enough, I was often bullied and lived in constant fear of being fired. At the time, my self-esteem was so low, I felt I probably deserved it, that I needed to 'try harder'. Looking back, I realise how intolerant my employers were and how simple things such as giving me clear job specs, could have made all the difference. 

More recently, I have struggled to explain to employers and educational establishments what accommodations would help. Jonathan gave us the term "Soft Adjustments" for what we need - LGBTQ+ and autistic people - in the workplace.

'Soft Adjustments', he said, are about awareness, confidence (on the part of the employer) to ask questions, without being scared of getting it wrong. It is about a different mindset.

"Best practice," he said "Is no good without hearts and minds". 

Most importantly, the burden of shouldn't be on diverse people to educate the employer - employers need to meet us half-way. This absolute stated a problem I've felt lately in feeling as if all of the burden of meeting my disability needs is on my shoulders. People ask me what they should do, how I want them to help me. But it isn't a list, it's a conversation! I need to have that conversation, to mutually explore solutions with my employer or tutors, to be able to try things out and see if they work - and no issues if they don't.

In summary, Jonathan says that when encountering diverse people, especially those with complex intersections like LGBTQ+ and autism, we should:

          Listen * Believe * Ask respectfully * Research information

Autism and Gender Identity - Dr Wenn Lawson

In my world, Dr Wenn Lawson is a bit of a rock star. His book 'Life Behind Glass' was one of the first books I read following my autism diagnosis at age 34.

Dr Wenn is an Australian research psychologist (who loves his fMRI scans!), world renowned autism expert and came out quite recently as a transgender man. He is also autistic himself and cheerfully incorporates his lived experience with his scientific research. 

One of the difficulties I have with training as a counsellor is that I am curious, but I don't always know the socially appropriate way to ask questions. What I liked about Dr Wenn is that he made it clear that he was happy and relaxed to answer any questions - even those appallingly inappropriate questions that even I know not to ask a trans man! 

For me, the questions I wanted to ask were "Is it OK if we mention your 'deadname' with reference to your older books, so people know it's you?". He assured me, privately that this didn't concern him at all, although he feels his deadname was actually a pseudonym. Millions of copies of his books, with his previous 'pseudonym' are out there in the world, after all. 

It occurred to me that if people want to be more supportive of autistic people, maybe be a bit more open about what is and is not 'appropriate' to ask? Or at least, not assume the worst of us if we do ask the 'wrong' questions? 

Much of Dr Wenn's talk was on his research into Interoception, the Eighth Sense I blogged about previously.

Interoception is a complicated concept and I grappled to understand it. I was concerned, particularly re. the less than open-minded people at the conference, when Dr Wenn was talking about how to tell if a client had interoceptive difficulties due to their autism, or genuine gender dysphoria. He explained how the two could be confused, especially since autistic people can be excessively socially compliant.

For instance, a boy likes wearing skirts because they are cooler in the summer. He likes skirts because they relieve sensory discomfort, but then he is told "Skirts are for girls". He concludes, therefore, using logic, that he must be a girl. He tells his parents this, who immediately worry he is trans. Actually, he may not be, but it takes good psychotherapy, and a lot of listening and unpicking of social understanding to figure this out. 

Dr Wenn also explained how interoceptive difficulties could explain why an autistic trans or gay/bi individual might take longer than most to figure it out. Actually, identifying feelings as sexual attraction or gender identity could take a lot longer. Dr Wenn himself came out in his 60s! 

So, Dr Wenn was clearly not saying all gender dysphoria is interoceptive difficulties, or vice versa, but rather we need to give autistic people time, listen to them, help them unpick their personal, genuine feelings from social compliance and allow them the freedom to explore their identity without pressure. As a trainee counsellor with a lot of Person-Centred background, this resonated strongly with me. 

My fears are that Dr Wenn's research could be misinterpreted by people with an antagonistic ideology. 

Being Safe - Geoff Evans

I ended up in Geoff's talk on safeguarding vulnerable adults by accident, having thought the talk had little to do with my intended client group. But it was actually really informative.

Geoff is an Independent Autism Consultant, with a background in education and safeguarding. His talk came with many poignant anecdotes about how, by keeping learning disabled and autistic young people ignorant and naive, we effectively put them in a 'prison of protection'. They go out into the world with no idea how to keep themselves safe.

This especially applies to LD and autistic people who are LGBTQ+ - often sex and relationship education in special schools and units completely ignores non-reproductive and non-heterosexual sex. Such youngsters, when they hit adulthood are frequently victimised and exploited. 

To add to this, in schools, children are constantly told that they have to comply "You're not allowed to say 'No'," he said. "So what happens when you go out into the world and someone orders you to perform some sexual act. Well, you've never been allowed to say no! Your feelings have never mattered. And this is worse for special needs kids whose behaviour is often heavily controlled, due to fears of 'safety' '

He gave the example of a 15 year old kicking off in a classroom - they need to be 'controlled' in that scenario, for obvious reasons, but ways of controlling behaviour are about coercion, not teaching the child why.

He then gave a harrowing example of a young man who was lured into the public toilets on the promise of £5 for his Playstation. He had no idea what the perpetrator intended to do with him but was entirely focussed on the reward. The boy was arrested for soliciting! (fortunately, it was sorted out, but illustrates the way we fail to protect young people). 

In summary he said we need to educate young people to understand the world, give them more freedom (to make mistakes) and be much franker and more direct about information. 

_______________________________________________________________________________

One of the big difficulties I have with writing a blog like this is that old autism diagnostic problem of "excessive attention to parts of the whole", or in other words excessive attention to detail. That makes writing a 'big picture' blog of what the conference was like a bit tricky. Hence, I haven't tried. I have just told you what I learned and hoped to have reported (and quoted) it accurately. 

So, I'm going to return to this subject later in the week and tell you a bit more about what I learned and how I experienced the conference, in Part 2.

My Autism Superpower: Seeing the Hidden Pattern

 I've said a lot in previous blog articles about the problems of being a counselling student with autism. But are there any advantages? In a conference the other day, I asked a question from the floor about training as a counsellor when you have autism. One of the organisers whispered to me, as she passed me the mike, 'Autism is your superpower!'

Sometimes, the difficulties of my ambition almost overwhelm me. In order to qualify as a counsellor, I need to succeed in the most difficult environment for me: in groups, with lots of distractions, and a majority of colleagues who do not understand my difficulties, or even doubt that I have them.

But of course the job I want to do doesn't involve coping with a class of 15 people or being observed while I practice 'counselling' a classmate who is pretending to be someone else. It sometimes seems ironically unfair, but that is how it is.

So, what do I do well?

1. Narrative ‘Rote’ Memory

Well, for one thing, I have an unusual memory. I can't remember my own bank PIN code which I've used for years, but most textbooks, as long as I get the gist of the theory, I remember most of it. Not word-for-word, but significant parts of the book I will remember from a single reading... friends joke that they try to catch me out with questions about things I can't possibly know anything about, and I can usually come up with something. Especially stuff I am interested in.

Autistic people like me have 'special interests' or 'perseverations' (from the same root as the word 'perseverance'). I have always felt that if I could direct this ability to develop an intense interest in something at will, I'd probably have a Nobel Prize by now. Unfortunately, the autistic brain’s searchlight settles on what it will, and we have to accept that. Or work with it. Fortunately for me, my special interest is people, so remembering what they have said (at least the gist) is fairly easy for me.

What I focus on and find easy to remember is the ‘narrative’ – maybe I’ll get specific details wrong, but I’ll remember the story my client has told me. I’ll remember the notable details and those odd phrases that stick in my mind. Like the example I gave in a previous article, where someone mentioned, in passing, having a new boyfriend and then mentioned that they had been divorced. Instantly my brain will fix on those two facts and try to find the connection (if there is one).

And this is my real ‘autism superpower’: pattern matching.

2. Pattern Matching Humans.

Many people are familiar with autistic mathematicians or computer experts. In fact, it is a bit of a TV and movie trope: the autistic genius who can do anything with a computer but doesn’t understand people. There was even a Bruce Willis film a few years ago, called ‘Mercury Rising’ about a kid who was so good at pattern matching, he could decode anything (including the supercomputer invented to save the world, of course).

In real life, our pattern matching skills might be less impressive, but they are also not confined to computing and maths. I did in fact train as a computer programmer at one time. Turned out, I was adequate, but not much more than that: Definitely not gifted.

These days I prefer to just use a computer and not worry about how it works! It took me many years to realise that my pattern matching abilities weren’t actually turned towards machines and maths. Instead, I ‘pattern match’ people.

It is a fundamental belief in psychology that human behaviour is, at its heart, logical. Even ‘mad’ behaviour could be explained (maybe in terms of brain chemistry awry, or learned behaviour to cope with trauma, being expressed in inappropriate situations). I firmly believe that (although they say we know more about the surface of the moon than the human mind, at this point in history). Maybe one day we’ll have mind-reading machines?

In the meantime, we have to go by ‘clues' and the flawed method of talking to people and listening to what they say. Like any neurotypical, I can’t say how I can guess right how a person is feeling, when I do get it right.

I am presumably doing a lot of observations and calculations subconsciously. Probably this is me using my pattern matching abilities: comparing their body language with body language in known situations; memorising phrases and ways of talking I've heard before and linking one thing they say (“new boyfriend”) with another thing they say (“divorce”), developing my hypotheses, and then looking for further clues to support those hypotheses.

So maybe I’d guessed their feelings about their divorce were tainting the current relationship? I’d then look for clues to support or contradict that hypothesis.

Autistic people like me tend to process non-verbal communication in a very conscious, learned way. I like to describe it as having a ‘database’ of behaviours on which I can draw. My rote memory can rapidly compare and contrast what I’m seeing in front of me with past experience and make accurate guesses.

It is important I do not mistake my ‘guesses’ for absolute fact. They are only working hypotheses until the client gives me their view on them. But often, I have found that people are surprised and say “Wow, I think you’re right! That is what I mean!”. Other times they may agree with me, but not be ready to hear it; or they may totally disagree with me and find me completely wrong.

However, provided I am sufficiently 'tentative' (as Carl Rogers recommends) even disagreements can provide excellent fodder to work with. It provides me with more information about the client's point-of-view and facilitates better communication in future. I tend not to forget when I’ve been corrected. I also find a humble counsellor is one a client finds easier to trust: If I get it wrong and have no problem admitting that, then the client knows they can argue with me safely, without upsetting me.

3. Focus = Really Paying Attention

My final autism superpower is paying attention.

I have written previously about how hard it can be to pay attention to anything, in a big room, full of people, traffic noises, air con, a watch ticking, a mobile phone vibrating… Sensory overload.

But when I am able to be quiet and still, such in a counselling room, my focus can come into its own. When I am focussed on someone, I am completely focussed. And such focus, with active listening, is a powerful thing. Particularly when so many clients presenting for counselling, especially the autistic ones, have experienced not being heard, not being paid attention to.

As an autistic client myself, this is my overwhelming life experience: that of not being really listened to. Like many autistic people, I tend to be pretty direct and literal when I say things. So, if I say, “I can’t do that”, I mean I can’t do that. Not that I lack confidence, or I’m being stubborn, or attention seeking. I probably mean “I lack the information I need to complete this task”.

With all clients, especially autistic ones, really paying attention to what they say, and how they say it (being aware that often autistic people have atypical body language and ‘blunt affect’ ie little expression even when highly emotional), is an important skill in counselling. So given the right environment, my autism can mean a client, who finds it difficult to feel heard, can finally experience that.

Autism, and What Psychotherapy Can't Do

In the 1940s, Leo Kanner, the psychiatrist who first coined the term 'autism' postulated the cause as cold, intellectual mothers, nicknamed 'Refrigerator Mothers". This idea was then further developed into the 1970s by Chicago professor Bruno Betelheim who perceived autism as a psychological disorder in children, caused by mothers he compared to Nazi camp guards (as a child, Betelheim had spent time in a concentration camp and compared such children to camp survivors).

These days, it is accepted that autism is a neurobiological, lifelong, developmental disorder, with almost certainly originates before birth. Autism is how our brains are wired; it is not just a difference in our psychology, it is not a psychiatric disorder, it is not an emotional disorder and it is not caused by cold parenting or subconsciously hostile mothers.

Well, I say it is accepted... there are some hold outs in the world of counselling and psychotherapy.

Only the other day, I came across a psychotherapist talking about the 'controversy around autism', by which they didn't mean the controversy over how badly treated autistic people are, or how far we need to go to get total acceptance, they meant the 'controversy' over whether High Functioning Autism existed as a disability at all! The myth of autism as a mental illness persists.

I have yet to find a psychotherapist or counsellor who will admit to this directly, however. Maybe they are worried I’ll ask them for evidence of their theories (there isn’t any) or maybe they don’t even realise this is what they’re thinking? On the other hand:

• *A trainee asked me "Yes, but surely, with therapy your autism should improve, shouldn't it?"
• A fully qualified psychotherapist said to me "I'd be interested to know why you cling to this concept of yourself as autistic?".
•  I was contacted by another, offering to introduce me to someone who had 'recovered' from their autism.
• And most common of all, people who have self-diagnosed themselves with autism (usually shy, introverts who resemble the stereotype) and later declared themselves cured! (Such people rarely accept an extrovert like me as autistic).

Not Fitting the Stereotype

I don’t fit their stereotypes: I’m not introverted, I like people, I enjoy socialising. I often wonder how confident I’d be in my diagnosis had I not been diagnosed by a world-renowned neuropsychology professor who said I was absolutely typical for high functioning autism.

So, what am I doing that leads people to doubt my mental health? Some of my neurotypical friends suggested the following:

1. My body language, tendency to talk a bit too fast and a bit too loud, and my obvious effort to ‘track’ large groups (hard work!) can be mistaken for anxiety by people who don't know me.
2. Tendency to be extremely open and honest about how I'm thinking, and feeling can be somewhat startling to people, who may experience false empathy. For example, I say, “I’m worried…” and they think “Wow, I wouldn’t say that unless I was really, really worried” [Note: neurotypicals often feel it it polite to under-state their feelings and only mention them if seriously pressing.] But unlike neurotypicals, I am not understating, I’m saying it how it is. And I’m probably only saying it now because you asked me how I was feeling! (see ’Can I be honest with you?’ below).
3. I can be muddled and disorganised. It's called ‘executive dysfunction’ and is a little-known feature of autism (also found in dyslexics). It is part of the way my brain works, but since neurotypicals can get like this when stressed, it adds to the assumption is I’m seriously stressed! But no, I’ve just lost my pen and am distracted by looking for it, that’s all. No biggie.

So false empathy may lead people to mistake a mentally healthy autistic from a mentally unwell neurotypical. But that false empathy is underpinned by the myths peddled by Kanner and Bettelheim, who offered psychotherapy as a cure for autism.

In their day, the psychotherapy was offered to the mothers (I shudder to think of the harm that did); these days, the autistic person themselves may be offered psychotherapy for their ‘mother issues’. But in neither case did it change one jot of the person’s autism, it just increases the social pressure on the autistic person to ‘perform’ neurotypically, if they can.

Finally, as a lesbian woman I am struck by the similarities between this and this dismal history of psychotherapy and homosexuality. To this day, there are so-called ‘therapists’ who claim to be able to ‘cure’ homosexuality. It destroys lives and leads to incredibly low self-esteem, depression and anxiety. And for all that, it doesn’t even work! All it does is encourage a person to hide their true self.

This is why all of the major mental health professional bodies – the British Psychological Society, the Royal College of Psychiatrists, the BACP, the NCS, the UKCP... have signed agreements, such as the Memorandum of Understanding published by the BACP, banning so called ‘Conversion Therapy’ being offered by their members.

Counselling LGBTQ+ people should be about helping them become comfortable with who they are, not trying to change them. Likewise, counselling autistic people should be able helping them be a ‘fully functioning autistic person’, not trying to change them into neurotypicals (firstly, that would fail, and secondly, in failing it signals to the autistic person that who they fundamentally are, is flawed, broken).

Maybe we need a Memorandum of Understanding for autistic people?

Of course, there is not an exact equivalence between sex and gender diversities and being autistic. Many autistic people may have behaviours they wish to change, which are causing them difficulties - behavioural therapies, applied sensitively and respectfully may be useful interventions.

And autistic people are more prone to all sorts of mental health conditions than the general population – growing up autistic is a neuro-conforming society is a strongly ‘adverse event’ But it is essential counsellors and therapists know what is possible, and what is desirable to achieve – and don’t fall into the trap of colluding with those who demand autistic people conform, no matter what the cost.

I can’t tell you how many times I’ve known autistic people to present for therapy to ‘fix’ themselves after they’ve been bullied. The wrong people are in the therapy room!

As for me, I have had years of being told to go into therapy because clearly, I had mental health problems. No sane person could be like me! So I went into therapy, and a couple of years later, I’ve realised I’m mentally very resilient and I’ve finally started to question the assumptions that better = neurotypical.

I am embracing my autism. Which wasn’t exactly the result my naysayers expected.

Can I be Honest With You? Autistic v. Neurotypical Honesty

 One of the first things you learn in counselling training is the necessity of 'congruence', which roughly translated is about being honest and being your true, authentic self in front of clients - not putting on a front.

So from the start, honesty and openness is promoted as 'the way' to be a counsellor. Which gets confusing when, as an autistic person, you discover that 'honesty' isn't quite what you'd imagine it to be. In fact, to me, if feels as if neurotypicals rarely say what they mean. Thus, even a statement like "Be honest" has to be filtered through my experience of what people actually mean, rather than what the words seem to mean.

For example, a tutor may ask me to say what I think about the course. This is a potential trap - what if I said everything I actually think, including the things which I know are probably unfair, just passing thoughts, or a faulty impression.? I wouldn't want to be unfair or unkind! But if I only say the good stuff, that won't come across as truthful (and probably isn't entirely). So clearly some negative statements are expected. It is hard to steer an appropriate course.

The irony, of course, is that few neurotypicals are aware of their 'lack of honesty' - it is second nature, mostly unconscious and invariably done for the best of motives.

Being that 'honest' is contrary to other counsellor values about mutual respect, empathy, unconditional positive regard etc. But it is confusing for an autistic person to work out how 'honest' is honesty?

I recently met a very experienced counsellor who had come a cropper with an autistic client on the issue of honesty. The story I relay is a dramatization of the actual conversation. I've had to take a few liberties to disguise identities and also because unlike this counsellor, I am not experienced (so any errors are probably mine). This counsellor is mostly person-centred, using a few other techniques eclectically.

His client arrived and sat down. They exchanged the usual pleasantries and basic 'contract' (all the stuff about fees, cancellation policy, confidentiality etc) and then the counsellor said, "What would you like to talk about today?"

The client frowned. "I don't know. What am I supposed to talk about?"

The counsellor, putting his best Person-Centred hat on said "Well it's up to you. You can talk about anything you want to talk about."

So, the client said "OK".

The counsellor sat back, expecting to hear about the client's 'presenting issue'. Instead, the client launched into a detailed critique of Netflix Star Trek versus the original TV series.

He tried to waylay the client subtly. "I was hoping you'd talk a little more about how you are feeling..." he said.

"This is about my feelings!" the client exclaimed. "I'm feeling upset about what Netflix have done to Star Trek!"

"OK, so you're upset?" the counsellor reflected. He admitted to me he had been hoping that the client was using Star Trek as some kind of metaphor or symbol for his emotional issues. The client, however, hadn't read the memo.

"I'm upset about..." he began, listing in detail (as only an autistic person can do detail) his grievances with the new show's writers. Realising half an hour had gone by and he'd so far only learnt about Star Trek, the counsellor tried to explain how counselling was 'supposed' to work, in a very person-centred way.

He added, by way of explanation, "You see, I don't know much about Star Trek..."

Which was fatal, as the client then felt he had a duty to educate the counsellor about Star Trek lore (this is what talkative autistics like me do if someone says they don't know something - fix the 'problem' of them not knowing).

By this point, the session was so far off beam from client or counsellor's typical expectations that the counsellor was forced to jump out of his client-lead, Person-Centred model and actively interrupt the client.

"I think we need to go back a few steps and talk about what your expectations are for counselling, and what I can offer you," he said. And then he had to explain his methodology, in more detail than he generally had to do for his students, let alone a client.

The client asked a lot of questions about his approach, the pitfalls, the counsellor's expectations and clarified "So when you said I could talk about anything, you didn't actually mean that?"

The counsellor was forced to admit, he really didn't. "So, what should I talk about?" said the client.

Picking at random from the original referral form, the counsellor asked the client about his anxiety issues. "Ah well they got worse after an incident at work. Would you like me to tell you about it?" said the client.

"Yes," said the counsellor, "I think that would be a great place to start".

***

I share this story because it perfectly illustrates how neurotypical 'honesty' is framed by expectations and limits that autistic people cannot take for granted. Low support need people like myself do not have low support needs because we don't think this way. We are not neurotypical. We have low support needs because we're learned to 'translate' what is said, into what is meant.

So, when I'm in college and they say "Be honest. Say what you really think", please don't blame me if I think "No way".

Because "what I really think" is probably ephemeral, or irrelevant, or inappropriate, or the verbal equivalent of an intrusive thought. The world is not generally ready for autistic levels of honesty.

So, can I be honest? If you say yes, don't be surprised if you get it with both guns blazing.

Meltdowns & Shutdowns in Counselling 'Skills Practice'

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:

1. Clear about my role
2. Able to 'read' the person in front of me
3. Not being critically observed
4. 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.