The Choice Between Social Work And Social Control

One of my big issues these days is whether or not forms of psychotherapy designed for the typical necessarily work for the atypical. It popped up again this week in a Spectrum piece on OCD and autism.

Three of the callers mention CBT, which can help people understand and manage their obsessions and compulsions. As with other talk therapies, though, CBT isn’t always effective for people with autism. The therapy did not help Slavin, for example.

He suspects that he was unable to follow his therapist’s approach due to his auditory-processing difficulties and cognitive inflexibility, which he attributes to his autism. “Many people on the spectrum have a problem picturing a situation and picturing how it could have a different outcome, so traditional CBT doesn’t always work,” he says.

A couple of things to mention here.

First, I note that the first part of the above acknowledges that, in general, traditional talk therapy does not necessarily just transfer over to the neuroatypical, which is an acknowledgement of which I would love to see more. Second, that bit about “picturing a situation and picturing how it could have a different outcome” directly relates to things I’ve written before about stimuli, reaction, and response.

Lately I have once again been browsing around for therapists or counselors covered by Health Share of Oregon (my OHP coordinated care organization) who have experience with and knowledge of the autistic, especially when it comes to adults, even more especially if it’s with the late-diagnosed. It’s increasingly evident that this search very well could be an impossible mission.

Just the other day I happenstantially ran across a survey from a (potentially dormant?) group called OHP Mental Health Providers for Quality Care specifically asked Health Share members if they’ve “experienced challenges accessing mental health care”.

Why, yes. Yes, I have.

When I search for therapists or counselors who deal with autistic people, I pretty much assume that anyone who emphasizes “social skills” or “coping skills” is focused on helping autistic people mask better, not, say, helping them know how to recognize when their limits might be approaching.

I don’t need “coping skills”, per se, barring maybe developing a more well-honed sense of when I’m in a moment where I can just yell a “motherfuck” or two, stop and stare at the floor, breathe, and then move on rather than escalating things by throwing my broom and dustpan or my travel mug across the room.

Just the other day I had two household mishaps, one involving a broom and some spilled cat litter, and one involving a travel mug with a stuck lid. That I managed in each instance not to escalate is evidence that I’m already honing this particular “coping skill”, but these also were circumstances in which these moments were the only pressuring stimuli I was dealing with. Not having been surrounded by stressors, I was able to make these moments ones of stimulus-reaction-pause-response rather than stimulus-reaction-is-response.

I need a therapist or counselor, however, who understands that while such moments are possible, there also will be situations where “mindfully” being able to grab that beat, that pause, will be completely impossible. Shutdowns and meltdowns are going to happen, whatever the surrounding typical world might think of them.

If we’re talking about developing “skills”, isn’t the necessary skill here maybe more about developing a better sense of how many spoons you think you might have for any given day, adding some wiggle room, and then laying out your day accordingly? But then also recognizing that sometimes the world is going to overwhelm you and when it does you should feel neither shame nor guilt about it?

The other day I saw the website of a therapist who talked up neurodiversity but had autism listed under the heading of “learning disabilities”–technically “differences” but that’s what people say when they don’t feel comfortable using the word “disability”. Thing is, autism is a disability, but it’s not a learning disability. Throw around the word “neurodiversity” on your website all you want, but if you think autism is a learning disability, I want nothing to do with you.

Here’s the thing.

I need therapists and counselors specifically to define what they mean by “social skills” and “coping skills”. If what they mean is developing better camouflage because that’s supposed to make it easier for me to move through the world, then they don’t understand a thing about what’s actually going to help autistic people. For many of us, masking is a form of self-harm.

If by “coping skills” you mean the sorts of things I outlined above, maybe we’d have something to work with. If by “social skills” you mean, say, mapping out ways to express to other people that I’m having a really difficult day and can they please not impose upon me at the moment, and do so in a manner that’s both adequate to my own needs but not needlessly brusque to others, maybe we’d have something to work with.

But if by social and coping skills you’re talking about how to move through the world without overly disturbing neurotypical standards, then you aren’t engaged in psychology or social work, you instead are engaged in a form of social control.

These professions and these activities should not be thought of solely as efforts to heal and help the individual, but to heal and help the society around the individual. As much as they have the responsiblity to help the atypical learn how to move through the typical world around them as authentically and with as little self-damage and distress as possible, they also have the responsiblity to teach the typical to empathetically make more room in society for the atypical. They ought not only be private actors but also public ones.

There’s an old and semi-apocryphal aphorism that the job of a newspaper is “to comfort the afflicted and afflict the comfortable”. So, too, the job of the psychologist and the social worker, the therapist and the counselor.