Spectrum Therapist in Action

OK; so I’m an autistic therapist. It’s not that I’m working with that many autistic people; but I, as the therapist, am autistic.

Does it make differences in how I work? Yeah, I think so. But I’m not sure exactly what those differences are.

Here’s an example from the last couple of days. Yesterday was my day of in-home visits. One fairly new client is in assisted living. She was recently put there against her will by family members. She’s trying to adjust, but is depressed much of the time.

Yeah, I’m doing some usual things. I’ve referred her for medication evaluation. Through referral I got her a case manager to help her looking at other living options and to help her find ways to get to community events. We talk about her feelings, her day’s activities, and her nightmares.

But, her depression is well grounded in reality. She’s in a living facility filled with people who have dementia and Alzheimer’s, whereas she only has physical limitations with her keen mind fully intact. But her eyesight is fading, and she can’t read much.

But reading books has been the best antidote to her depression. Yet she has so few people helping her. I check out audio books for her from the library, and then return them. She had a local society for the blind loan her an audio player. But, one day she was discouraged that it stopped working. I looked at it. It didn’t have CD in it. Another time it stopped working, and she was getting depressed again. I looked at it – it needed a new battery. Last week, she gave up because the earphones that came with the machine were falling apart. I taped them together, which helped a few days. But I knew they wouldn’t last, so I picked up a pair of earphones at a local store. I inserted it into the jack and VOILA! She had books to listen to again! There is so little staff around to help with things like that. She has few friends or family who visit.

She also wanted to watch movies, and she had an old DVR. I couldn’t figure out how to hook it up to her TV, so I took it home to work on and loaned her my own DVR, which I had recently purchased from eBay but hadn’t gotten around to using.

I check out some DVD’s from the library and got it hooked up. As I was sitting on her floor surrounded by wires and parts, she quipped, “How much do you charge for this work?”

I said, “Oh, I just bill my regular therapy fee. This is, you know, therapy! It’s bibliotherapy and cinematherapy! Perfectly legitimate therapies!”

She laughed, noting that they certainly worked for her.

Yesterday, she was depressed again, not having been able to make the transition between TV and DVR. I tried, and I couldn’t either. It seems a nurse had come in and reconnected it a way that didn’t work. I worked with wires until it worked again. Then we practiced how to the transition a number of time. She was beaming when I left!

I was concerned she’d still have trouble running the machine, so I told her to call me today and let me know how it was going.

She called very frustrated. The DVD was just playing a preview and she couldn’t get to the movie. I don’t watch that many movies myself. But I had noted that many newer DVD’s have a whole menu of things you can look at; only one of which is the actual movie. I talked her through locating the menu, and finding the button to highlight “play movie.” I gave her some things to try.

I didn’t hear for a while, and was thinking I might need to drive over this evening to help her get it. I was thinking a big board with the a diagram of the remotes with major keys colored so she could see which ones to press. I called later it check in with her. She was SO happy! She had it working!

I laughed and whooped in excitement! I said this was a great step forward in her therapy – a way she would decrease her own depression!

We laughed. I was happy that she had a week’s worth of movies and audio books, and had new earphones for the CD player.

I’m sad thinking how many older and disabled people are overwhelmed by such simple things. They don’t have someone to get a new battery or check out books from the library. Sometimes little things can cause big depressions. And other little things can help that depression dissipate.

I’m not sure how many of my colleagues do all of things for a therapy client. I don’t think that many. But it’s the only way I am fully engaging all of me – including autistic me – to help the person find solutions to all of things in their environment that contribute to their depression. Perhaps I start by looking at the simple and obvious, and addressing it in way I can.

 

Wed, Oct. 15, 2014

 

As usual, I hit the snooze button a few times. It’s so hard for me to wake up, and hard to start the day. Once I’m going; it’s fine. It takes me a minute to remember what day it is and what I have scheduled for the day.

“Ah, yes,” I remembered. “This is Wednesday.” That is the longest and hardest of my days. I am on the road all day doing in-home visits.

I need to have everything organized before I leave: any paperwork for clients, my phone, any phone calls I needed to make. My dogs. I have two little “therapy” dogs I use in my work [not officially licensed]. They love to come and I love their company – as do many of the clients. But it looked to be a hot day, and they would have to spend to some time in the car. They got left home.

I would be starting the day with my own therapist. She had been away the previous week, so I had a lot to talk about. I jotted down a few notes before getting out of bed of what I wanted to talk about. I planned to talk about my recent Saturday with the Aspie support network in my state. I’m in the process of being prepared to be a peer group facilitator. It had gone well, and I was told that I’m now an official group leader. I’m so glad. The groups are so important to my own recovery, and I want to help other Aspies. From my years of social work, I’m comfortable leading groups. But being a peer leader is a different role, and I’ve needed to adjust to it. I’m also glad since there were no women leaders of the regular groups. There was a woman for the woman’s group, but it only meets a few times a year.

I looked in the closet to find something to wear. I really identified when Rudy Simone [Aspergirls] said that Aspie women are often most comfortable in jeans and a tee shirt with a simple haircut. That is certainly true of me. I hate wearing dress-up clothes. I’m usually uncomfortable in dresses. I can’t stand stockings. Can’t walk in heels. I hate to fuss with my hair.

I can dress casually seeing clients, but I’ve upgraded from tattered jeans and tee shirts. I have a number of comfortable slacks; some jeans; and a lot of simple tee shirts. I’ve had to remind myself to get some tops with a pattern or design. Otherwise, I only have plain-colored slacks and plain colored tops. I have some long sleeve for winter, with some sweaters.

I picked jeans and a white top with sweater. But as I put the top on, I saw a stain. I cursed. I’m ALWAYS spilling or dripping things on my white blouses. Well, on all my blouses; but they show most on white. How do others keep white clothes? Usually, I can’t wear a white blouse more than a few times before relegating it to the “casual” drawer; or always having a vest or something over it.

So I switched to a light pastel and sweater.

I was running late. [as usual]. Didn’t have time to fix tea or pack a lunch. I’d get something along the way.

I drove the 20 minutes to the next town and popped into Dunkin Donuts for an iced tea to take with me to therapy. I pulled into her parking lot, and started to organize materials I was taking in. Then I noticed a call on my cell phone. I checked, and was the office of my therapist saying she was home sick. Bummer! The call had come in about 45 minutes ago. How did I not hear the phone at home? How did I not check my phone before leaving the house? I was disappointed not to see her – esp. since she was away last week – but, even more, I wish I had had that extra time at home.

Ok …. An hour before next appointment. Maybe I’ll go back to Dunkin’ Donuts and drink my tea in there while using their Wi-Fi and read my Kindle. Was it OK to drink a beverage that you had purchased earlier? I figured if my drink were from somewhere else I shouldn’t walk in there to sit down and drink it. But it was their drink!

I sat along the counter. I tried to connect to the Wi-Fi they advertised having. Oops – I’d need to get a card from them to use it. Did it cost something? How would I get it? How use it? It was too much to bother with.

I continued reading the most recent book on my Kindle: Nerdy, Shy, and Socially Inappropriate, by Cynthia Kim. I loved her blog and books about her adult diagnosis with Asperger’s/Autism.

I was deeply engrossed in the book when I noticed that a woman next to me was sweeping the floor and moving chairs back and forth. She pointed to the chair next to me and asked, “Is anyone sitting there?”

“Uh, no; I’m alone.” Geez, was that a subtle cue that they wanted me to leave? Because I didn’t have a companion? [Others sat alone at the counter.] Or that they noticed that I walked in with an already-purchased beverage? Or that I had been there long enough and my beverage was almost gone? Or, maybe, there was no hidden meaning in the question; just trying to figure out which chairs to sweep under. I couldn’t till. So, I figured I’d better leave.

I could move on along to my next appointment; meeting a hospitalized client, and then attending a meeting with the hospital social worker.

My client was glad to see me, and we talked about what the hospital stay was like for her.  She had recently had a fall, and broken some bones. She was headed to a rehab facility.

She was nervous about going and we talked through all the things she was worried about. I took down a list of questions to take into the meeting with the hospital social worker and case manager.

I’m always nervous meeting with other professionals. I’m more comfortable with the clients than I am with professional peers. I suppose for one thing, as the therapist, I set the general tone and parameters for the therapy. Meeting with other professionals, I’m worried that I may have picked up all of the subtleties about appropriate professional behavior and could miss something.

We talked about the transition to rehab, which might happen later that day. I brought in my list of questions. They have a number of concerns since she didn’t have a case manager. I said I was trying to get her one, but in the meantime was doing a lot of case manager tasks. They were concerned that wasn’t anyone to get her clothes from home. I said I could do it, and would check with her about it. They seemed very relieved that I would do these things. I’m always surprised when someone appreciates what I’m doing! I see the client in her home, so I’m familiar with her place. I think of myself as more than a therapist you might see in an office. I’m a bit of a community social worker as well, helping get clients hooked up with community resources – sometimes making phone calls on their behalf and giving them rides. It’s not a typically traditional model of therapy. But, I think that is one of my strengths as an Aspie social worker; thinking outside the box. I know that I really care for clients and am committed to their care.

So I talked with my client, who was pleased to have me pick up some clothes and gave me a key. I did so as quickly as I could, mindful of another appointment coming. But it felt good to help out in this way. There really wasn’t someone else in her life who could do this, and I often find myself helping out where no one else is. After I got back to the hospital, neither the social worker nor case manager were in their offices. I wanted to leave a note. Oops. No paper in my purse. I opened the office door – where we had just met a couple hours ago – and saw a memo pad on her desk. I took out a page and wrote the note that I had left the client her clothes, and she now had the key back in her purse. Then as I left, I wondered if I had just done a horrible thing. Was it rude – maybe even illegal – to walk into someone’s office when they aren’t there and to use paper on their desk to leave a note? Maybe no one cared. Maybe it was a terrible breach of professional protocol. I wasn’t sure.

I went to my next appointment, but the client wasn’t home. She didn’t have a phone; so I just left a note.

I called Jill in assisted living to see if I could come out then to see her.   She’s depressed about being in assisted living, and is trying to find ways to occupy her mind. She loves to read, but her eyes are getting bad. So I’ve been getting her audio books from the library. Easy for me to do, as I pass the library regularly. But hard for her to find others to do it.

We talked about her reactions to the recent books she had heard, and ways it was helping her depression. She wondered if she could play movies; she had a VHS player. I looked at it, and asked if she had any family members or friends who could help her connect. She didn’t. I said I’d get a couple videos on my trip to the library and stop back later and would see if I could connect it. I sat in my car for a few minutes to make sure I had her library card. She had given it to me before, and I remembered seeing it in my purse with other cards. But I couldn’t find it. Bummer. I’m always losing things – or rather forgetting where I put them. I went back in to make sure she still didn’t have it. She didn’t. Bummer. Maybe the library would give me a duplicate. I told her that the library might need to call her to confirm.

On to my next client; who was home, as always.   She has a great deal of depression, enhanced by some recent losses. We talked about her losses and depression, and ways to manage in the week ahead.

I was near the library then, so stopped in to get more audio books and videos for my client in the nursing home. I asked about getting a new card, and they said they did have to call her. But it finally got worked out. They gave me a card for her and a small one for me to put on my key ring. Perfect solution! Later that evening, I saw the old library card and remembered what I had put it: in the card slots with my cell phone case. I had had it all along. How many times do I search in the wrong place for something? Or actually look right at something, and don’t see it there.

I called my last client of the day that I was on my way, as I always do. She often falls asleep and doesn’t wake up to let me in. No answer on the phone. I drove over to her apartment place and buzzed her place. No answer. Well – maybe next week.

Back to Jill’s. She was thrilled with the new audio books and the tapes. It looked simple to hook it up. I tried it but it wouldn’t play. There were several different cords, so I tried another one. It also didn’t play.   A nurse came in with nightly medication, and seemed a bit surprised with the carpet strewn with cord and me behind the TV set!

I was disappointed – as was she – that I couldn’t get it. I thought she might need a different cord. I noticed that she also had a DVD player, and said I’d bring a DVD next week and see if we could hook that up.

She was disappointed at still not being able to see movies, but grateful for my time. We talked a bit about her week ahead, and managing her depression.

Then, I was in my car and on the way home! Hurray! The only place in the world where I feel totally safe is at home … preferably in my bed … preferably with my two dogs [and my cat, when she’s around.]. Pure contentment!

Wednesday is a hard day, in that it is so long. After 4 or 5 hours I usually feel some anxiety reactions and long to be home. I start to think of all the things that could happen to me before I get home and prevent me from ever getting there. It helps a bit when my dogs are with me.

 

This night I made it back safely to the welcoming woofs of the dogs, and was safe again

I’m startingFeatured image to read a book for an upcoming course: Thinking about You Thinking about Me by Michelle Garcia Winner. It’s fascinating material on social cognitive deficits, and the behavioral-cognitive approach.

I’m realizing how much I want more training – with Michelle Garcia Winner as well as getting certified as a Registered Play Therapist. It’s for all the reasons I’ve sought credentials in the past. I don’t know how well I’m doing, whether I know enough to be doing my work. I can live in fear and dread. The only way to alleviate it is:

1. Have thorough and reputable training in my areas of practice
2. Have a certificate or credential to validate that
3. Keep credential updated
4. Be part of a network of professionals for consult and supervision

I’ve been uneasy since I started working with children. I’m probably fairly good at what I do, and with more training will be really good. But I feel that I am completely incompetent now, and can become minimally competent. But I’m realizing I can deal with my chronic “incompetency” feeling by knowing I have good training, peers, and consultants.

I’m excited to be moving ahead with training and consultations. It’s a way to beat the “hell hole” of my mind’s existence. I’ve always done what I do because I feel God calls me, but living in dread of being found out to be incompetent.

The fear won’t go away. BUT I can bring accommodations into my life: I need to get solid training , the certificate on the wall, and the professional consults to feel competent. Why not give it to myself?

I Just Wanna Be OK

 

I’ve been so drawn to the commercial for Traveler’s Insurance with the sweet doggie trying to keep his bone safe. “I just wanna be OK today.” That is my goal for each day. If I can finish the day “OK,” it has been a good day. [I found that the song was written and sung by Ingrid Michaelson.]

I’ve spent much of my life in a deep, stifling pit. I’m all alone there, and I know that no one else in the world is in a pit like this. Everyone else lives up in the sunlight where they can see what’s going on and participate in the rhythm of life.

I am defective – there is no place I belong in the world. Defective in my family, my professions, with my friends. And charged with a life mission of trying to hide that fact from others. Even though I AM defective, I need to LOOK normal. It is essential that no one discover how deficient I am – or terrible things will happen. What, I’m not sure. As a child, maybe that Mom and Dad would feel like horrible failures to have brought such a misfit into the world. Now, perhaps that I’ll lose my professions, and people will be shocked that I have been working with others, while being such a fraud – pretending to be normal when I am really so defective. Is that possibly a crime?

If I were arrested and convicted to life in prison for a crime I didn’t commit, I’d feel that I probably deserved it, for living my life as a fraud. Often, I think that I just cause problems in the world and in people’s lives; and perhaps they would all be better off if I were behind bars.

Laura asked today if my goal of therapy is to stop going to the pit.

I responded, “I don’t know if I can reach that point. But I can decrease the amount of time I spent there; that’s already happening with the diagnosis and therapy.”

She asked, “Now that you have the diagnosis, do you still feel defective?”

“Not so much. I see myself with neurological differences. That gives me a disability in this society of N.T.’s. I have a disability. I can never NOT have this disability in this world, but I learn more ways of coping with it. That’s the hope that comes from the diagnosis – I can learn ways of coping with it.

So, now what? This defect has a disability diagnosis. Do I want to let go of all of my “safeguards” and just be “Aspie-blunt” all the time. Maybe in some situations. But, I think it’s unrealistic to expect to stay employed with that approach – esp. in people sensitive positions like counseling and ministry.

Maybe just continue, “as is” working very hard to hide my real Aspie self? This is an exhausting option.

Fiona Pettit O’Leary says: [in Irish Examiner 2-6-14]

As a teenager, I developed coping strategies. I found it exhausting just being Fiona. There was an ever-present feeling of disconnection, which I did not understand, so I denied its presence and covered it up in any way I could.

And Samantha Craft describes it this way in her blog: Everyday Asperger’s: Life through the eyes of a female with Aspergers.  [Feb. 10, 2012.]

We push back the conversational difficulties we experience, e.g., the concepts of acceptable and accurate eye contact, tone of voice, proximity of body, stance, posture–push it all back, and try to focus on what someone is saying with all the do’s and don’ts hammering in our mind. We come out of a conversation exhausted, questioning if we “acted” the socially acceptable way, wondering if we have offended, contradicted, hurt, or embarrassed others or ourselves. We learn that people aren’t as open or trusting as we are. That others hold back and filter their thoughts. We learn that our brains are different. We learn to survive means we must pretend.

What will it take to “be OK today”? There’s got to be something between “letting it all hang out,” and the life-long struggle to try to look normal. That is in between? A no-man’s land. Or a no-woman’s land. It’s up to today’s Aspies to explore it, and find ways to part of life’s energies without being depleted by the effort. The answer may be something different for each one of us.

HANDS UP … DON’T SHOOT

Theory of Mind

Aug. 15, 2014

A Black teen is gunned down in Ferguson, KS. There are demonstrations and speeches and on-going TV coverage.

It stirs up so much for me, on so many levels.

I can imagine being stopped by police, and not being sure what to do. Do I run? Put up my hands? I think of times someone has barked something at me, and I froze not understanding what I was being told. Recently, I was looking for a new address for a home visit, driving slowly down the street. I passed it. So, I thought, I pulled into a driveway and turned around the opposite direction. Two men were working in the yard, and signaled for me to stop. One yelled at me: “Don’t ever do that again!” I tried to ask what I had done. Was he mad that I pulled into his drive? Had I missed the drive and been on his lawn? I tried to ask what I had done, and he yelled ever louder. I could only say, “OK,” and get out of there.

Being stopped by the police is especially frightening to me. I’m afraid I won’t understand what I’m being told to do, and I’ll yelled at for doing arrested – and maybe arrested.

In this case, of course, Michael Brown seems to have done what he was told to do, and was shot anyway. That is really frightening.

It is all indicative of racism in our society, and in our police forces. I get that. But I get confused about figuring out people’s motivations for things.

Like the Chief of Police says he releases the name of the officer who shot Michael and also released a video of the victim stealing from a store shortly before. At first, he seems to me like a nice guy trying to get out information. And then commentators talk about it as a way of demeaning the victim. Ah, yes! It certainly could be. He’s trying to defend the officer by suggesting that the victim had committed a crime. The old boys network defends the white officer in power and demeans the black young man who was murdered in the streets.

I always start by thinking people are nice and doing their best. It perhaps helps me as a therapist. I like most everybody, and think all of us are doing the best we can. Then I can think about it further, and realize that we are caught in a system that is racist and classist – and that most of us unwittingly participate in the injustices.

It’s a big leap to accept that people are willfully acting in ways that express their racism or sexism or other prejudices.
I can be caught up in an unjust system and unwittingly perpetuate injustice. That I know.

But I don’t consciously and knowingly try to discriminate. I figure that’s true of everyone.

Theory of Mind. It took years to realize that not everyone sees things the same way I do.

In a way, it made it easier to part of the New Age counter-culture of the sixties. How could anyone support war – esp. in Viet Nam? It was so clear. How could our elders criticize our long hair, our torn jeans, our free love attitudes? We were right. Period.

I remember the moment I recognized Theory of Mind. I was sitting in a social work class on social policy issues. Our professor was a strong advocate of justice issues, and I admired him a great deal. I love the idea of community organizing and helping to organize people to stand up for their rights. But the prof challenged us with a complex situation in which there was right on both sides. It wasn’t good guys vs. bad guys. It was two groups of good guys who had different views and interests. How could we as social workers support both sides of a conflict?

Wow! Both sides right? What a concept!

Not only do some people see things differently from me, but they could be equally right to me. We could both be right.

That changed me a lot. It helped me as a social worker in working with families; recognizing that people need to listen to each other, accepting that the differing views could all be right and just for different people. That was enormously helpful in the parish, in which I didn’t feel compelled to join one side of a conflict, but rather to facilitate communication between the two sides.

It defined my style of leadership and of therapy.

Yet, I still hold to some values as being right but accept that people have different ways of honoring them. My feminist liberation theology training has left me without doubt of the importance of a just world and the eradication of racism, sexism, homophobia, etc. I still can’t accept that others could question those values. But I can accept people having differing views on what they mean and how to get there.

But, yet, I live on one side of the big issues of justice and peace and love. However, I try to bypass my Theory of Mind by reminding myself that there are many views of what that means and how to get there.

It’s made me less vocal, and more of a listener. The earlier me was always sure I was right, and would speak out quickly and firmly.

Now, I’m not sure of much of anything. So I listen a lot more to understand what others are saying.

The more I understand my “theory of mind,” the better I get at just listening to other people and trying to understand them instead of trying to convince others to understand my view, which is inevitably right.

It makes me a better counselor.

Aug. 16

Ah, it turns out that the Police Chief had been advised NOT to release the video of the theft at the convenience store because it could be inflammatory. And he did it anyone. It doesn’t seem that he was “working as a team” with the feds and others to make the best decisions in the interest of the community. As an Aspie, I try to work on teams, to get input from everyone, and to be part of a group decisions rather than going off on my own to figure out what to do.

Into the Wilds

I counseled autistic children and adults for years before discovering that I, too, was on the spectrum.

I am a social worker [licensed for independent practice] and have worked in my field for twenty-five years. I’ve worked with individuals and families where there was both addiction and mental illness. I’ve worked with women dealing with depression and anxiety from domestic violence. Increasingly, I found myself working with children on the spectrum and their families. In time, I came to see many of my own traits in autistic children. I went to a neuro-psychologist for a diagnosis, and I got it. Asperger’s Disorder [DSM IV] and Autism Spectrum Disorder, high functioning [DSM V].

Now what?

What does all of this mean for me as an adult woman of 67? What does it mean for me as a practicing social worker?

Seeking personal support, I’m continuing in therapy with the psychologist who diagnosed me. I’ve become active in our state’s Asperger’s ‘ support community.

Professionally, I’ve started a peer supervision consultation group for other clinicians who work with people on the spectrum. I’m the only one in the group is also on the spectrum, and I’ve shared that information.

I pay a private consultant to help me with the personal/professional interface of my practice.

Now I’ve started a blog.

This is a place to explore the journey of a 67-year-old autistic social worker, trying to make sense out of life personally and professionally.

This is a journey into wild, unchartered land. Yet, I know I’m not alone; other therapists out there are on the spectrum and I hope to meet them.

Please join me on this journey.