Having just gotten back a response from my initial inquiry to a potential new psychoconsultant, I now have a copy of what I’d submitted through their online form, which I said I’d have included here had I thought to save it.

How can we help?

I am a midlife-diagnosed adult autistic (with anxiety/OCD co-morbidities) looking not for “treating” my autism (that’s not a thing), but for the helpfulness of regular “check-ins” with someone, as well as to hone and refine (and potentially develop) accommodations, mitigations, and self-advocacy. It’s important to me to find someone who understands that the socially-performative aspects of therapy in and of themselves are problematic for an autistic brain. Bonus points, therefore, if it’s possible to do outdoor walk-and-talk therapy. I’m especially interested in someone who is responsive to the idea that in many ways the autistic brain, esp. with sensory sensitivities, effectively is being subjected to mini-traumas (feel free to ask about my blogging about this).

I’ve found it difficult to condense everything I think a potential psychoconsultant should know up front before attempting to have a conversation with me. It’s still too long for what should be an elevator pitch, and yet the shortest I’ve yet managed.

Today during one of my intermittent checks of the web for psychoconsultants who are (1) local enough, (2) covered by my insurance, and (3) potentially applicable to a midlife-diagnosed adult autistic with Opinions About Autism And Psychotherapy, I found a place that’s a fifteen-minute bus ride away. Only one of the relevant people on staff currently is taking new clients; I sent an intake inquiry. I forgot to save a copy of what I sent them via their online form, otherwise I’d include it here. I don’t suppose browsers somewhere temporarily save web forms you’ve submitted?

“Backchannels accommodate neurological pluralism,” writes Ryan Boren, “while fostering the serendipity of networks.” Serendpity, indeed, as also today Paul Bausch linked Basecamp’s guide for internal communications. When I read Basecamp saying things like “writing solidifies, chat dissolves”, “the expectation of immediate response is toxic”, “communication shouldn’t require schedule synchronization”, “time is on your side, rushing makes conversations worse”, and “communication is lossy, especially verbal communication”—well, let’s just say that I’m reminded that for all intents and purposes I’ve suggested that email as a psychotherapeutic channel might “accommodate neurological pluralism”. By all means, let’s “bring the backchannel forward”.

In over the transom this weekend from Research in Autism Spectrum Disorders is a discussion of anxiety as it relates to treatment of autistic patients. It’s limited, if only because it revolves around talking only to eight people, and all eight of them only practitioners, and I think I only have a few quick things to note.

First, it strikes me as peculiar but perhaps not unsurprising that seven of the eight practitioners involved “indicated that psychological therapy was often very difficult for their clients on the autistic spectrum, due to challenges in identifying and understanding emotions” apparently without considering the possibility that since not just the methods but the formats themselves of psychotherapy are designed for and around neurotypical brains, a therapy sessions might itself be stymying the autistic brain’s monotropism.

Speaking for myself, even in relatively stress-free situations I’m limited in the degree to which I can multitask in socially-performative situations. In the high-stress socially-performative circumstance of a session of psychotherapy? You mostly can forget about it altogether.

Where’s the discussion, then, of the idea that psychotherapeutic formats themselves might be causing cognitive stress—or distress—in autistic patients, and how that might explain the “challenges in identifying and understanding emotions” these practitioners are identifying as a result of these sessions?

Second, and just as peculiar-but-unsurprising, is that in the paper’s section discussing the study’s limitations, nowhere do the authors suggest that talking only to practitioners and not to any actually-autistic people might be such a limitation.

Third, and all of that said, there’s at least an indication from these eight practitioners that absent much real empircal guidance on anxiety in autistic people, some practitioners are taking that as motivation to try to adapt existing therapeutic approaches to an autistic specific and to “think outside the box”.

Unfortunately, I continue to search in vain for such a practitioner covered by my insurance, and so am left only with a forthcoming phone appointment with my primary care physician to discuss medication to help address the anxiety spikes of the last few months.

“It’s important to note, though,” writes Sara Meyer, “that in ABA, ‘best’ means most efficient at changing the behaviour, not ‘best’ in terms of the long range well-being of the client.” Remember this when ABA proponents proclaim that it’s the only “evidence-based” treatment for autism. The evidence is only of a change in behavior, not of any alleged recovery, which isn’t a thing. Also keep this in mind when it comes to general psychotherapeutic support for autistic adults, since most therapists, counsellors, and social workers sense of autism likely is defined by those industries’ general acceptance of ABA as the leading treatment for children. Which doesn’t mean they think ABA is for adults, too, but often will mean not tailoring treatment for autistic brains.

Thanks to the folks at Unpaywall (“an open database of 24,420,070 free scholarly articles”), I’ve finally been able to read an article from the Journal of Clinical Psychology called, “The impact of accommodating client preference in psychotherapy: A meta‐analysis”.

Among the paper’s findings is that “clients whose preferences were not matched or who were not given a choice of their treatment conditions were 1.79 times more likely to prematurely terminate than clients who were matched to their preference or who were given a choice of their conditions”. The authors also found “a small, but meaningful difference in outcomes in favor of clients who were given their preferred psychotherapy”.

In the end, they concluded “that accommodating client preferences exert a positive influence on therapy dropout and treatment outcomes” and recommend that such accommodations be identified and enacted.

My interest in this paper stems from something I’ve written about before: the need to adapt established methods of psychotherapy not only to “client preference” but to client neurotype.

In the case of something like autism, many of whose elements seem to work upon the brain in ways that are very similar to trauma (if not, in fact, ways that are actually trauma), this might mean having to address the fact that much of typical psychotherapy is conducted in small, claustrophobic settings, involving both socially-performative interaction and intense literal observation by the therapist.

These all are things that themselves, and in any other environment, can tend to create stress for the autistic brain. There’s no reason for that suddenly to be untrue in a psychotherapeutic setting. With the lack of escape, these stressors arguably could be even greater in that setting.

So, if it’s generally true that accommodating simple client preference can reduce early termination of treatment while increasing meaningful treatment outcomes, surely it’s specifically true that accommodating an autistic brain’s actual susceptibility to sensory and social trauma is at least as important.