How autistic people & their talking therapist / hypnotherapist can create a therapeutic relationship – a guest blog by Kathy at Arrive Therapy.
If you’re considering cognitive therapy or hypnotherapy as an autistic person – maybe to help with areas such as anxiety, self-efficacy, confidence, relaxation, self-esteem, social anxiety etc – you may be concerned about whether it’s for you.
In our blog ‘Can hypnotherapy, Hypno-CBT and mindfulness tools help autistic individuals’, I wrote about possible barriers to taking up talking therapy or Hypno-CBT for autistic individuals – these included (but aren’t limited to) –
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
If you’re considering cognitive therapy or hypnotherapy as an autistic person – maybe to help with areas such as anxiety, self-efficacy, confidence, relaxation, self-esteem, social anxiety etc – you should work with a therapist who understands autism.
Some examples of what you should expect as an autistic client, if you’re seeking Hypno-CBT include:
1. The hypnotherapist knows that your body language (something that behavioural hypnotherapists take into account a great deal in their therapy) may present differently. E.g. your facial expressivity, use of gaze, expressive gestures etc may be different, and not indicative of what you’re feeling.
2. The hypnotherapist knows that your speech patterns may also not be indicative of what you’re feeling. As autists, sometimes we may seem ‘flat’ and neutral, when in fact we are very content or happy.
3. Your therapist knows that you may need extra processing time – this may be to find a certain word, visualise a scene, or process an emotion.
4. The hypnotherapist is aware that initially, the social anxiety presented by working with a new person (a stranger initially) may exacerbate the issue they would like help with. Understanding these issues and putting the client at ease means the required working alliance or relationship can progress.
5. The room (if it is a face to face meeting) is sensory friendly – the hypnotherapist can find out in advance any requirements regarding lighting that may need to be met. Factors like traffic noise, buzzing electrical devices and conversations from the next room, could all affect the working alliance for autistic people, in terms of distractions.
6. (It is important to note that working online, e.g. via Zoom, may be preferable for autistic people, as the online environment may be deemed to be more comfortable and ‘safer’, from a neuroception point of view.)
I hope this blog has helped allay fears about developing a therapeutic relationship or working alliance with the therapist, due to autism’s ‘socio-communication’ characteristics. We will look at some of the other areas listed at the start of the blog in forthcoming articles!