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Roger N. Meyer "...of a different mind "
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ESTABLISHING THE WORKING RELATIONSHIP
Observations on Counselor Sensitivity to the
Dynamics of Counseling with Asperger Syndrome Adults
Copyright 2001 Roger N. Meyer
 

 

Abstract

 

     [This paper is based upon a response to a vocational rehabilitation counselor requesting information for an in-service presentation to counselors and special education professionals.  The author presents several recommendations for best practices in supervision and with the counseling dynamic.  The paper outlines the mindset of many adults diagnosed with High Functioning Autism (HFA) or Asperger Syndrome (AS) and the significance of first-impression to the success of the intervention.  Implications of individual counselor and agency cultural attitudes towards clients presenting "new diagnoses" are discussed.]

 

     My current counseling work with AS adults is heavily influenced by the writings of Herbert Lovett, Ph.D., and extensions of his work by David Pitonyak, Ph.D., Anne M. Donnelan, Ph.D., and Martha R. Leary, MA, CCC-SLP.  All of these authors operate from the paradigm of caring listening and recognizing that the client is "saying" things with behavior and words difficult to understand and tolerate.

 

     When working with persons with autism, the pacing and intention of the counselor and others involved with the person are critical.  Individuals with HFA/AS have extraordinary antennae for sensing the existence of hidden agendas and unstated presuppositions.  While they may not know what the other person's agendas are, they do know "that" they are, and this sixth sense, expressed often in hypervigilance or a variety of distancing and cautionary behaviors and expressions is a hallmark of the initial moments of the intervention.  Failed understanding of this feature of autism leaves the counselor no room for error.  Individuals with autism often respond from the point of view formed with their first impression regardless of changes in the following moments.  Once an unintended, often unsensed barrier is created in the first moments of contact with a person with HFA/AS, it may be virtually impossible to "undo" the mindset of that person.

 

     Working with persons with autism is like working with those profoundly affected by Post Traumatic Stress Disorder.  Many behaviors and reactions are clinically similar.  The difference lies in the perseverance of these behaviors for persons with autism.  They resist ordinary therapeutic logic and the application of traditional rational or talk-therapy approaches.  Counselors unfamiliar with the logic of an autistic client often find themselves in power struggles over which logic, theirs or the client's, will prevail.  If this struggle becomes the primary feature of the client/counselor relationship, the relationship will fail.

 

     As a primary introductory reference to cognitive behavioral therapy, readers should consult Tony Attwood's article on the modification of cognitive behavior therapy approaches for use with persons "with" available on his web site.   Dr. Attwood often spends an entire day presenting information to parents and professionals regarding the effectiveness of such techniques with children, adolescents and adults.  We both agree that they work.  We both also agree that using "anything that works" is essential.  Slide show content from that lecture is also available on Dr. Attwood's web site.  He frequently updates that information.  Two transcripts of Dr. Attwood's full-day sessions with spouses of partners on the spectrum reveal the frustration as well as the success of persons who have sustained relationships with the relatively small number of HFA/AS adults who form partnerships.  Those transcripts reveal "the other side" of the common relational challenges in a charged adult relationship than is found in the pages of the growing number autobiographical books written by persons on the autistic spectrum.

 

     Listening to and following the subtle invitations for interaction of the person with autism frequently leads an effective counselor into uncharted territory.  It goes without saying that "one size fits all" and similar categorical thinking is not simply ineffectual; it is in fact highly damaging to the intervention efforts of counselors who only "think within the box."

 

     Assigning a counselor or other special services person to a person with HFA/AS must be based upon the supervisor's understanding that the intervener should be expected to be a natural, impromptu problem-solver.  This means a maximum of trust between supervisor and counselor that the counselor must remain free to be eclectic in approach, flexible, and free to use unorthodox approaches, even those ordinarily considered "unprofessional" from the point of view of the agency's expectations regarding routine interaction between client and staff.

 

     By definition, persons diagnosed with autism demonstrate unorthodox thinking and behavior.  Counselors working with such persons must not only expect such a presentation, but also be able to instantaneously adjust their working style in seeking to understand this special vocabulary and what the client is "saying."  For a counselor to be effective, he or she should not feel that they are being "given so much rope, but no more" by their supervisors.  Such strictures front-load the intervention with unstated limitations that the person "with" will sense immediately.  Either the counselor is trusted by the supervisor or he/she isn't.  This is a strong test of the effectiveness of the supervisor's own ethical and professional conduct boundaries.  Preliminary discussion between the counselor and supervisor about this issue should precede any assignment to an HFA/AS client.  Counselors should be free to consult with their supervisors on boundary and ethical issues that inevitably will arise between them and ASD spectrum clients.  A salient feature of HFA/AS is of impairment in acquiring and practicing communication and social skills.  Deficits in this area of functionality drive their challenges in understanding emotions, regulating affective states, understanding boundaries, and intuiting unwritten rules of social intercourse and institutional culture of all kinds.

 

     Unwillingness of either the counselor or the supervisor to make such an arrangement in advance of the first meeting with the client may doom the counseling relationship.  If either the counselor or the supervisor feels that such an arrangement is not possible, alternate agencies or service providers should be considered in determining whether a primary relationship with the client at that agency is possible at all.  Contracting out some aspects of the agency's services may prove a more effective approach to meeting the client's needs, rather than merely satisfying the agency's written or unwritten institutional cultural expectations by "going through the motions" of routine service delivery.

 

     It is safe to say that in the past, most adults on the spectrum have had extremely negative experiences with agencies and most "helping" professionals.  This is a real phenomenon with history going back to very early childhood.  Individuals diagnosed on the autistic spectrum are subject to temporal-spatial memory distortions not immediately apparent to the observer.  When a client self-reports these experiences, the client's recollection and orientation to those events must be accorded full legitimacy by the counselor.  Regardless of whether such reports comport with the observations or reporting of others at the time of those events, accepting the "I-centric" character of these memories expressed by the client must be considered baseline information.  The impact of negative experiences reported by the client must not to be discounted or minimized by any verbal or non-verbal statement by the counselor that the client should differently experience the "current" intervention.  At first, the client may not be open to hearing this.  Before providing any description of services, the counselor should first ask the client to disclose their expectations regarding the agency.  It will become immediately apparent that the question itself provides a positive starting point for gaining information for both the client and the counselor.  At that point, the client may be in one or another states of mind or they may switch back and forth.  The client may be very suspicious regarding the benefit of services to be offered, or, in the alternative, he/she may be very naive and trusting.  Both are not good places to "be," but there you have it.  While Individuals on the spectrum are also known for their black and white thinking, they are also subject to confusion or difficulties with affective expression.  It is more than likely that they may simultaneously express contrary or incompatible expectations.

 

     The counselor should expect any thing and everything as an answer.  The client's statements may be quite unfocused.  They may either ramble or be extremely taciturn or alternate between extremes.  There may be great difficulty in providing a coherent, fluent answer.  There may be considerable backing and filling, confusion regarding temporal sequences, efforts to perfect details that test the counselor's patience, and frequent sidetracking or loss of the train of thought.  In the middle of the response, the client may be quite unsure about the question and show signs of distress, or ask that the question be repeated.  The counselor should be prepared not only to repeat the question, but to use different words in an effort to see which words "fit" the internal logic that the client uses in organizing and expressing such information.  What happens during this stage of "tuning in on the client's wavelength" will determine whether the relationship will be successful or not.  To put it bluntly, there is no second chance.  If this initial intervention fails, it is most unlikely the client will be open to further contact.

 

     It may be easy for agency policy makers to dismiss the single experience of working with a difficult HFA/AS client as an aberration or a temporary hiccup to the smooth provision of agency counseling services.  Such thinking is inappropriate and counterproductive to the challenge HFA/AS clients pose to institutionalized agency counseling dynamics.  The unpleasant fact is that in using any standard criterion of successful intervention outcomes, such persons have not been served well by individual or agency counselors.  Actively involving the client in determining the appropriateness of agency involvement, or the extent of the primary involvement even were the agency to retain a "cover responsibility" for services while contracting out some critical pieces of the work will affect the agency's perceived capacity to serve the needs of more than that one person.

 

     Whenever a HFA/AS client seeks counseling service, the client's mere presence sets an agency agenda into motion prompting an examination of its competence and future policy and practices in working not just with the singular client, but with the community's entire adult HFA/AS population.  Counselor and administrator responses can initiate a positive pattern of practices leading to a system-change needed to serve such clients effectively.  The agency will assuredly benefit from these discussions even if the needed system change cannot be made at this time.  Word of mouth and agency "street reputation" is an important factor in building acceptance by any new client population.  Community acceptance reduces the incidence of inappropriate referrals and even for non-profits and agencies, improves bottom-line figures.

 

     The individual client must also be acknowledged at the center of that decision-making process.  For many persons with HFA/AS, this may be their first positive experience with any community service agency.  Even if the client determines that the agency cannot serve his/her needs, the client will leave the experience knowing why that is the case, and that agency limitations are not a product of personal fault or shortcoming.  That has been an impression consistently provided to them by other "experts" in the past, and persons with HFA/AS ruminate on those experiences.  Hopefully, the present experience will provide a contrast, a positive example of options and hope, rather than reconfirmation of their deficits and limitations.  In closing the contact, the client should be encouraged to explore other options using that knowledge as the basis for informed choice in selection of alternate service providers.

 

     Agencies and institutions guided only by what is printed in hard copy journals and books must be mindful of how behind the state of the art such materials may be.  It is safe to say that with few exceptions, articles and books published prior to 1995 contain highly questionable information about high functioning autism.  Agency managers and counseling professionals must be open to the prospect that the best experts in the field are those on the ASD spectrum.  In view of what is not known about effective interventions with adults, professionals first learning about ASD and all of its permutations will find that some persons "with" are effective self and cause advocates.  Professionals find this notion hard to accept.  Because of a singular interest in their condition many such persons have the most current information available from the electronic literature in the field.  It goes without saying that they are experts about themselves.  I urge supervisors and counselors to seek consultation from persons "with" who are experienced in providing guidance and first-hand knowledge to counseling professionals.  For counselors seeking answers "now," the best source of information may be sitting right across from them.

 

     For counselors new to working with persons with HFA/AS, I feel it is a best practice for these issues to be considered before the first encounter with the client.  To both parties in the intervention, first impressions are critical for the relationship to be successful.

 

 

References

 

Attwood, T. (2000) Workshop for Partners of People with Asperger Syndrome Transcript, May 2, 2000, Coventry, England, National Autistic Society.  http://www.oneworld.org/autism_uk/family/attwood2.pdf

 

Attwood, T. and Gray, C (2000) - The Discovery of "Aspie" Criteria; http://www.tonyattwood.com/paper4.htm

 

Attwood, T. (1999) Modifications to Cognitive Behaviour Therapy to Accommodate the Cognitive Profile file of People with Asperger's Syndrome; http://www.tonyattwood.com/paper2.htm

 

Attwood, T. (1999) Practical Strategies Conference Transcript, March 22, 1999, London: National Autistic Society http://www.faaas.org/attwood/attwood1.html

 

Attwood, T. (1998)  Asperger's Syndrome - A Guide for Parents and Professionals.  London: Jessica Kingsley Publishers

 

Baron-Cohen, S. (1995) Mindblindness - An Essay on Autism and Theory of Mind, Cambridge, MA:  MIT Press

 

Cohen, E., and Cohen, G., (1999) The Virtuous Therapist - Ethical Practice of Counseling and Psychotherapy, Belmont, CA: Wadsworth Publishers

 

Donnellan, A, and Leary, M, (1995), Movement Differences and Diversity in Autism/Mental Retardation - Appreciating and Accommodating People with Communication and Behavior Challenges, Madison, WI: DRI Press

 

Fisher, R., and Ury, W., (1991) Getting to Yes - Negotiating Agreement without Giving In, Auckland NZ:  Penguin Books

 

Klin, A., Volkmar, F., and Sparrow, S., (2000) Asperger Syndrome, New York: Guilford Press

 

Lovett, H. (1985), Cognitive Counseling and Persons with Special Needs - Adapting Behavioral Approaches to the Social Context, Westport, CN: Praeger

 

Lovett, H. (1996), Learning to Listen - Positive Approaches and People with Difficult Behavior, Baltimore: Paul H. Brooks

 

Meyer, R.,(2001)  Asperger Syndrome Employment Workbook - An Employment Workbook for Adults with Asperger Syndrome , London: Jessica Kingsley Publishers

 

Meyer, R (2000) A Portland Tale - Mentors for "Impossible" People (unpublished)

 

Meyer, R., (2000) Autism Accommodations in Higher Education and Related Counseling Issues (unpublished)

 

Meyer, R. (2000) One Person's View of the State of Autistic Employment Endeavors in the United States (unpublished)

 

Meyer, R (1999) Counseling A.S. Adults - It's all in the Process, Autism99 Internet Conference, http://195.13.121.220/autism99/html/

 

Meyer, R (1999) Counseling Values: Job Development for People with Asperger Syndrome - Notes to a Beginner (unpublished)

 

Meyer, R., (1999) For Disabled Students: The Vocational or the Academic Track? (unpublished)

 

Pitonyak, D. (2000), What Do I Do Next....? - Supporting A Person with Difficult Behaviors After The Positive Approaches Workshop, Southeast Regional Training Institute, Imagine, 3694 Mt. Tabor Road, Blacksburg, Virginia  24060

 

Pitonyak, D., (2000) Supporting a Person who is Experiencing Post Traumatic Stress Disorder, Imagine, 3694 Mt. Tabor Road, Blacksburg, Virginia  24060

 

Siegel, D., (2000) The Developing Mind - Towards a Neurobiology of Interpersonal Experience, New York: Guilford Press

 

Slovic, R Islascox, Flannery, B., (1997) - New Tools for Person Centered Planning:  A Guide for Using Them, Oregon Transition Systems Change Project, Specialized Training Program, Eugene, OR: University of Oregon

 

Williams, D., (1998) Autism and Sensing - The Unlost Instinct, London: Jessica Kingsley Publishers

 

Willey, L., (1999), Pretending to be Normal - Living with Asperger's Syndrome, London: Jessica Kingsley Publishers

 

Wilmot, W., and Hocker, J., (1998) Interpersonal Conflict, Fifth Edition, Boston: McGraw Hill

 

About the Author

 

     Since 1997, the author has counseled adults with Asperger Syndrome with a wide range of issues.  The author's initial Rogerian person-centered counseling training began when he was a volunteer young adult counselor at a drop-in counseling center in the Haight Ashbury district of San Francisco at the close of the "flower power" days of the late 1960's.  This basic orientation has been supplemented by Gestalt training under the direction of first generation students of Fritz Perls, and Primal therapy by students of Arthur Janov in the 1970's.  He was active as an advisory board member for a neighborhood mental health center and the program committee of a community service center.  At the close of that decade, the author began his training as a mediator with students of the Harvard Negotiation Project.  He served as a volunteer mediator/trainer/trainer of trainers/case developer with Community Boards of San Francisco for eleven years.  Over the past three years, his work with adults has incorporated many of the techniques of cognitive behavioral therapy.

 

     Following his own Asperger Syndrome (AS) diagnosis, the author has directed a research project on adult employment, written an employment workbook for adults with AS (Jessica Kingsley Publishers, in press, 2000) and numerous articles on adult and youth counseling and parent/student special education advocacy.  He is co-founder of a statewide Oregon support and education organization (Oregon Parents United), founder and facilitator of an adult AS support group, and co-facilitator of a partners support group.  He is a private AS family and individual case manager and special education parent/student advocate.  As a disability advocate, he represents adults at community agency conferences and hearings.

 

 

Copyright Issues

 

This article is copyright, all rights reserved by the author, Roger N. Meyer.  It may be reproduced in single copy once for personal use, and in no more than ten copies total for educational purposes.  Fair Use is authorized for all purposes and under conditions established by US Statute and the International Copyright Convention, to which the United States is a signatory nation.  No person shall publish, distribute, copy, or by other means make this material available to others for purposes of personal gain or professional self-aggrandizement.  Individuals wishing permission to exercise other than fair use or limited distribution as outlined above must contact the author, in writing, and receive explicit written permission from the author prior to engaging in further use of this material.

 

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