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     [The following Email exchange illustrates the typical problem an adult with AS has when encountering a counseling professional.  The therapist holds a Ph.D. and an MSW.  Knowing that he would benefit from cognitive behavioral work, he sought her out based upon her representations and experience as a CBT specialist.


      The therapist charges $145.00 per hour.  This exchange followed the client's confusing intake visit costing $212.50.  Throughout the session, the therapist insisted on deference to her expertise in a struggle for power inappropriate for any counseling professional in an introductory session.  As you will note below, outside the session she continues to demand it.


     The client was confused by the "homework" assigned by the therapist.  He has substantial short term memory issues which flare up when he gets anxious.  After struggling to understand for three days, he sought clarification.   She had a 72 hour cancellation notice requirement, and he was up against her deadline.  In a telephone call, he left a message asking her to explain the work he was to do.  Not having heard from her despite his early morning call, he wrote an email at noon.  He left a second telephone message later in the afternoon.  The following material is actual email text, unedited.]


His first Email message:




     I can't make sense of the assignment.  I've left a message for you on your voice mail.  I first called about eight or so in the morning.




Her First Response:


Subject: Re: "Second Call"

Date: Tue, 25 Apr 2000


Hi R,


     You are probably being too concrete.  Allow yourself to acknowledge little R..  Take out his picture and love him.  I know that you cut off those feelings a long time ago, so this is why it is hard to connect with the assignment.  However, the unconscious understands everything and will comply with your request, even if your conscious mind balks.  Leave it at that and we will follow through with more intense work at our session.



Her Second Response


Subject: Re: "Second Call"

Date: Tue, 25 Apr 2000


Dear R,


     I understand your worries.  But I must insist that we do therapy in the office, not over the phone or e-mail.  I will lead you into the techniques you need to handle your feelings and those of others.  Part of the problem with your disorder is trust.  You have none and will have none with anybody.


     Unfortunately you will have to trust somewhere to get your goal accomplished.  Your verbal skills are impressive, but they are not a disguise.  If anything, the excessiveness of your analysis gives you away.


     We will work on this too.


     I do not have a specialty in treating clients with Asperger Syndrome. However, I have a great deal of experience with cognitive behavioral therapies  and I have worked with autistic children.  My daughter has a classmate with AS that causes my daughter no end of consternation so we frequently discuss strategies to deal with this girl.


     If you still need to be sold,  I suggest you cancel your appointment and continue your search for the ideal therapist.  If you are willing to knuckle down and work at something that frightens the heck out of you, then I am game.  Please call to confirm by Wednesday.




His Second Email


Subject: Re: "Second Call"




     Concrete thinking is a bell-ringing diagnostic criterion for Asperger Syndrome.  Just telling the client not to think in a certain way or to put that paradigm aside to get at emotions is not effective.  That's why I know that CBT will work.  Theory of mind issues are an impediment with me.  They can be addressed through specific, programmed behavioral scripting.  From my past experience with many kinds of psychodynamic therapy, I know that my receptive challenges in identifying general feeling states has been the barrier. 


     Do not mistake my facility in verbal expression as indicative of an equally well-developed skill at perceiving emotions, which first means recognizing that I know how to look for them.  Maybe some infants can swim by being thrown into the swimming pool and paddling naturally.  Not me.  My process for receiving emotional messages first requires that I either use the tools I have to perceive my emotions--and I really have to know I have them--or get them and learn how to use them.


     You are going to find that many of your tools don't work for a person with AS.  If there is to be a working relationship, you must first understand my vocabulary and my logic to determine whether we are on the same page.  At this point we aren't.  I know what you "say;"  I simply don't understand.  There is no third party payment scheme that allows me to ignore the fact that your time is "worth" over twenty times per hour more than what I earn when I am working in the employ of others.


     I don't have the time or the money to bring you up to speed about the disability if you've had little experience with it.


     I didn't really ask you about whether you've worked with persons with AS, and what the results have been.


     Now is "your time" to sell yourself and convince me that you "get it."  At this point I'm not feeling good about your response, and wonder whether it would be worth while to even keep the second appointment.


     Please respond.



     Here's my pager number if I'm not immediately available by phone:  503-XXX-XXXX




     She did call.  R felt patronized, belittled, and bullied by her tone of voice and repetition, almost verbatim, of what she said in her Email.


     The client cancelled.


Copyright Issues


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