1. A barrier to a good working alliance (therapeutic relationship) with the therapist, due to autism’s ‘socio-communication’ characteristics.
2. Difficulties with interoception (our ‘body feelings’) may reduce awareness of sensations and emotions.
3. Issues of cognitive flexibility may affect one’s ability to consider alternative possibilities (e.g. in terms of thoughts, beliefs and behaviours).
4. Sensory sensitivities may affect the efficacy of practiced tasks between sessions.
Is autism hyperfunctioning of neural circuitry?
One interesting theory (developed by Kamila and Henry Markram, and Tania Rinaldi) proposes that autism is a mental overload. The Intense World Theory proposes that autism may be described by hyper-perception, hyper-attention and hyper-memory, with the brain’s major functions working at increased capacity that leaves little ‘energy’ for social interactions.
The Intense World Theory also supports the idea that rather than a lack of empathy (a common myth), autists experience over-sensitivity in the field of empathetic responses. Many autists agree with the concepts behind these theories, and the idea of hyperfunctioning of neural circuitry, and a state of over-arousal for autistic individuals. The lack of energy’ (or spoons – see this blog for a definition) for social interactions extends to talking therapy too!
Socio-communication and autism
Many aspects of autistic social presentation are described by diagnosing clinicians as being ‘atypical’ in autistic individuals, including abnormal facial expressivity, irregular use of gaze, lower rates (or unusual timing) of expressive gestures, and unusual speech patterns.
These communication differences sometimes mean that autistic people may find socialisation difficult if it feels out of their control, includes large numbers of people, is worsened by sensory issues, or relates to areas that are difficult for them – for example, induces social anxiety, shame or embarrassment.
(Of course, some autistic people, although this isn’t exclusive to autists, are non-verbal, or can communicate verbally at different levels on different days. This warrants a different conversation and another blog post – one for another day!)
Autists may also sometimes feel ‘overloaded’ – through the experiences of their day, the surrounding environment, and any number of factors that have consumed their ‘emotional bandwidth’ on that day, or at that time.
Talking at length with them, and talking at all sometimes, can be an extra drain on their bandwidth and resources.
Hence, because autists may communicate in subtly different ways, talking therapists may need to adjust their processes to suit the individual.
Why autism’s ‘socio-communication’ characteristics are not a barrier to Hypno-CBT therapy