Person-centred counselling: working with autism

Counselling and therapy, Managing your mental health Leave a comment
Two main aspects of autism are relational difficulties and restricted behaviour. Photo by Peter Burdon on Unsplash

As a counsellor, although I don’t specialise in autism, I have had cause to work with a number of clients on or near the spectrum.  This article outlines a few aspects of working with autism, from the perspective of a person-centred therapist-client relationship.

OFFICIALLY, WHAT IS AUTISM?

There are two main aspects to a traditional diagnosis of autism (see also the DSM definition):

  1. Difficulties understanding and maintaining relationships, particularly aspects of sharing and reciprocity.  Also difficulty understanding or responding to subtle verbal or non-verbal nuance.
  2. Restricted or repetitive behaviour.  This could be an insistence on routines not changing, or a very focused, obsessive interest in one subject.

FROM THE CLIENT’S PERSPECTIVE

I approach counselling from a client’s perspective.  I am therefore less interested in aspects of diagnosis that other people use to categorise a client, and perhaps to control them.  I am more interested in ways to help a client live in a happy and fulfilled way.  From a client perspective, it helps to rephrase the above official diagnostic aspects to the following:

  1. I find it difficult to make and keep relationships.  I find other people’s meaning and intentions hard to keep up with.  The stress of this can make me upset.
  2. I like to focus on the things I am interested in.  I can’t always see or appreciate other people’s interests.

You will notice that this rephrasing is more sympathetic to the client’s own perspective.

TIPS FOR COUNSELLING CLIENTS WITH AUTISM

The following is a simple list of things a counsellor can try, in order to work well with autistic clients.

  1. I am clear and direct in explaining my intentions.  This reduces the pressure on the client, as they don’t have to guess where I am going.
  2. I am clear that I am unshakeably there for the client.  They are likely to have experiences of people leaving them and not standing still.  So it’s very helpful to be ultra-clear that I am predictably there for them.
  3. Over time, I make a safe space for the client to express their upset, in their own way, without being judged.  This can provide some release and freedom.
  4. I am prepared to talk about relationships quite mechanically sometimes.  It may be that the client can learn how to handle relationships, if the unwritten rules of social interaction can be codified.
  5. I am prepared to share the client’s interests.  This provides a richer world for communication and discussion.  Analogies and metaphors can be evoked which help to talk about relationships.  (“It’s like when, in a game,…”)
  6. Frequently, I ask the client what they are concerned about at the moment.  They may be holding something back because they don’t think it fits the rules of engagement.  I accept that they may or may not tell me.
  7. I create enough trust and rapport so that I can challenge the client, and the client can challenge me.  Mutual challenge, in a safe environment, is a great way of getting out of any restrictive comfort zone and developing relationship skills.  However, I try to judge any challenge so as not to overwhelm.

TIPS FOR CLIENTS WITH AUTISM

  1. You can be open if you don’t understand where the counsellor is going with something.  You can ask them to explain what they are doing or meaning or intending.
  2. You can feel free to ask for feedback in a form you prefer.  You may want written summaries, or diagrams, for instance.
  3. You can bring all of your interests to the counselling.  Some clients can hold back and be very self-controlled, because they want to ‘fit in’.  But your existing resources of kindness, concern, intelligence, curiosity and sociability will form the foundation of your development, so bring it all, even your more idiosyncratic hobbies and interests.  Everything is useful.
  4. You can feel free to stop occasionally and ask the counsellor how they are experiencing you.  This can be scary, but a good counsellor can use this to help you develop better connections with other people’s feelings and intentions.
  5. You can also feel free to tell the counsellor how you are experiencing them.  This helps the connection too.

TIPS FOR FRIENDS AND FAMILY

  1. You can let the client organise their own counselling in their own way.  They can then develop their own relationship with the counsellor.
  2. You can just act as you normally would.  The counselling doesn’t need to become a way of “correcting” the client, which is making your own life easier, not theirs.
  3. You can try not to be upset yourself by the client’s meltdowns and/or shutdowns.  It can be incredibly frustrating and/or worrying to witness extreme emotional reactions to events.  But you can just stay steady, as this provides boundaries and consistency.

Finally, some tips for those with autism in managing your own self-development:

SELF-DEVELOPMENT WITH AUTISM

  1. You can do it your way.  You will know what learning method works best for you.  If you need to keep notes, then do so.
  2. Relationships with others can be learned.  If necessary, you can develop some rules from scratch, and learn relationships like chess.
  3. You can seek out people who ‘get’ you.  These can be core friends who you can trust.
  4. You can have a moral dimension to what you do.  Your values may be different from parents or peers, but you can develop your own sense of right and wrong, rather than borrowing anyone else’s sense of right and wrong.
  5. You can learn non-violent ways of expressing your needs. When upset, it can be tempting to resort to controlling or avoidant behaviour.  But often a simple request, accepting that you might get a no, is simpler and easier than fight or flight.

FINAL NOTES ON THE “SPECTRUM”

Autism is very wide as currently defined.  Some affected clients will have associated neurological difficulties which make comprehension difficult, and others will be extremely intelligent and so-called “high functioning”.

This means that sometimes a client will be able to perform in many areas of life, but will suffer difficulties in maintaining close relationships.  This can come across as wanting everything their way, and alienating others.  But it is really a question of difference, not hostility.  If the difference can be accepted and respected, this can go a long way to healing families and friendships.

In fact, the spectrum is so wide, that we would all do well to understand that social difficulties, and obsession with one’s own interests, are universal problems among humans.  Empathy and mutuality are difficult.  We all get lost in our own worlds.  That’s why whole disciplined religions and organisations spring up to encourage cooperation.

I do believe that we are all “on the spectrum” to some degree, and that isolating certain people for not behaving neurotypically can be impoverishing for society.  It is often better to enter into each others’ worlds, than to pull others into our worlds and expect them to conform to our rules.  In this sense, for me, counselling is not a form of social control.  It’s a way of helping clients to be happy and fulfilled.

A WHOLE-PERSON PERSPECTIVE

Finally, I would add that sometimes, even if a diagnosis is present, it’s not necessary to focus on the autism, particularly if the client doesn’t want to. Just because we have legs, our doctor doesn’t insist on talking about our legs every time we walk into the surgery. It’s the same with our diagnoses. We are whole people, entitled to live a rich life. None of us is neurotypical. We are all just ourselves.

Often a client may wish to work with aspects of mental health that may or may not be connected with an autism diagnosis. Emotional regulation and cognitive attention, for instance, affect our relationships and mental health, but are not necessarily directly related to autism. A wide focus on the whole person is good.