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.

My Autism & Me: Fighting the fear

I’m autistic.

No, I’m not Rain Man, I’m not a mathematical genius. No, I can’t draw London from memory, or recite Pi to a million places. I’m just an ordinary mum. I do crafts, walk the dog, hang out in coffee shops with my mates, rant on Facebook about the wrongs in the world and have an obsession with romance fiction. I’m probably not all that different to you. And I want the same things you want: the love of family and friends, a comfortable home, people who understand me and a sense of place in the world.

I’m not a psychopath. I do care - possibly more than is good for me. I am not ‘lost in my own world’, nor was I ever, except for my love of daydreaming. I don’t particularly lack empathy, although I do sometimes struggle to ‘get’ people I don’t know well, and I am terminally incapable of taking a hint.

I’m not insane and I’m not stupid. Well, I have a degree in political science and I’m not delusional (as far as I can tell).

And I’m not exactly like other autistic people, and they’re not exactly like me. I’m unique, like everyone else, as the Internet meme goes.

what is it like to be autistic, people ask me? Well, for a start, I’ve never been anything else, so that’s kind of difficult to answer. I might as well ask my dog what it’s like to be a dog. Even if he could talk I doubt it would be enlightening. When has he not been a dog? But it did occur to me I could share with you a little of what my life is like: 

Emotionally, my life comes in waves.. Despite my autism, I like people. I like getting to know new people and finding out about them and what we have in common. But I can get socially isolated if I don’t watch myself, and bored and under stimulated. So I wake up one morning and I think “Right, I want to try this new voluntary job/making friends with the neighbours/trying this new activity”. I’m anxious, but I put it aside. This will be great. This will be so much fun and I know I can do it! I just have to push myself and be brave.

The wave is on a gentle rise.

I reach out, I offer my services, I offer my friendship and at first, everything is fine. I’ve found a new activity, a new social circle. This time it’ll be okay, I tell myself. Meanwhile, my anxiety at being out of my comfort zone is rising. I control it. I won’t let it get the better of me. But I make social errors, and every time, my confidence drops - I miss a hint, I say something that makes a person frown, I mess up on a task I’ve been asked to do… My anxiety rises, like a great wave that seems to suck water from the beach.

When I’m on my own, there is a war in my head between worrying about what I’ve said, what the new people think of me, and whether or not I can actually do what I’ve offered to do. I fight to stop my mind going down that road: It’ll be fine, most people are nice, most people make allowances if you’re kind and sincere. I’ll be fine.

I start to doubt myself. I’m not as sure I can do this. What if it all blows up in my face? I’ll have failed people, or got in the way, or wound people up; and that is even worse, in my eyes, than being unpopular. The slightest frown or odd look from my new friends, and I’m struggling to stop my mind from going into a tailspin. What if they hate me? No, I remind myself, people rarely hate other people. Hate takes effort. They may be mildly annoyed at best.

The thing is, I can’t be sure. I don’t mean to be paranoid, but you have to understand your facial expressions, your body language, are so much Greek to me. I have no clues to judge, to see your reactions to what I’m saying or doing. You may praise me, but are you sincere? I often miss sarcasm. You could be a lovely person, or a bully. I have no way of distinguishing. And in the past, so many times, I have been disappointed by a friend I thought I had, who turns round and rejects me - presumably driven to it by my inability to take the hint. I try not to think about that. I try to push through the hurt and the fear and be brave, be calm, remind myself I’m OK.

The wave starts to peek, racing towards the shore, picking up debris as it travels.

I start to screw up. I fail to do something I’ve promised to do - I don’t know why. I just procrastinate, try to avoid thinking about it because its too stressful. I mistake intentions and misunderstand instructions. I turn up at your house in the middle of dinner and I phone you when you’re about to get in the bath. And in the attempt to not think about scary things, I forget a few important things as well. I forget that meeting, I forget to bring the paperwork, I forget to fill in that vital form.

You get angry with me. You may not shout or show it openly. That’s worse. I sense negativity, but I don’t know why. Are you angry, disappointed, sad? Have you a headache or am I a headache? Or is this just paranoia that I’m making up inside my head? What can I do to make it right? I have no idea. Thinking about it hurts. I want a new friend, a new activity, but engaging with the world is confusing, frightening, out of control. I want to retreat. Go back to my quiet world, even if I’m bored and lonely. I want to be doing familiar things with familiar people. People I don’t have to work so hard to be with. People whose conversations I don’t have to analyse into the small hours, trying to cover over mistakes..

Then the wave breaks. I am awake until dawn, heart pounding, mind fixated on what I’ve said, what you said, what happened, what is real, what is just fear talking… I can’t remember your face, your expression. I try to guess what you’re thinking, but I cannot trust you if I ask.

People don’t say what they mean. I know that sounds bad if I say it. It sounds like I’m making you out to be a liar, but I’m not. I know you mean well. I know everyone means well. You don’t criticise people just because they screw up a bit. You don’t want to hurt. Neither do I. That’s the tragedy: neither of us saying what we mean because of fear, because everyone wants to be liked, to be admired, to be respected. And I don’t know what I’d have you do - either way, I’ll be hurt, I know, so its not as if telepathy would help, even though I fantasise it would. The fundamental problem is, you are an unknown quantity, and for me, an unknown person is like the deep ocean. There may be treasure, down there, beneath the waves, but to get to it I have to hold my breath and dive and dive, but not too far that I cannot come back up. I am brave until I start to run out of air.

So the wave breaks, and everything is swept away. You lose your temper with me; I’m fired from my voluntary job. They tell me I “not a good ‘fit’ with the team”, I’m “maybe better suited to something else”, you “can’t deal with the drama in your life”. “It’s not you, it's me”. I am both relieved and disappointed, hurt and frustrated, and castigating myself for one more letting the fear rule me. But at least now I can rest.

For a while, things are peaceful, my anxiety retreats, but I know that before long I will try again, and again, and sometimes it’s worth it. Sometimes I reach that treasure in the bottom of the sea and sometimes the waves don’t get too big. And when I despair and swear to myself not to bother, not to face that mental pain, I look at my friends and I look at the things I’ve achieved, and I think “It’s worth it”. 

And besides, I have a bigger fear: the fear that I will stop fighting this wave and be swept away altogether.