I think my mental health is fairly average, which sounds like an odd thing to say, but there we are. Basically I mean I’ve had short periods of depression as reactions to upsetting events and bulimia on and off for ten years from my teens (untreated, though I did mention it to Doctors a couple of times). However I’m generally on a reasonably even keel mood-wise, with a higher baseline of wellbeing since I’ve had a stable relationship/house/work in the past ten years.
As lots of autistic people have mental health conditions (partly caused by the stress of being autistic in a mostly non-autistic world) then many autistic people have had therapy. With or without a diagnosis. I’ve had quite a lot (all pre diagnosis), after originally doing a counselling course at college and joining a therapy group. This had the inevitable subsidiary function of helping me understand people and their motivations, as well as my own. I’m posting about this now because I realise that therapy has had quite a big impact on how I’m able to “pass” as neurotypical (for better and worse), but also on how I’m able to accept myself as autistic now.
Mostly, the counselling I trained in at college and had with therapists, was person-centred. That’s based on the precepts of the humanist psychologist Carl Rogers. It’s sort of the opposite of the behaviouralism (reward or punishment based learning) underpinning ABA & other autistic therapies. It believes that a client will grow towards being who they are in the context of a warm, genuine, empathic relationship with a therapist whose warm, honest acceptance, deep listening and reflecting-back of a client helps facilitate their warm, genuine acceptance of themselves. It’s powerful stuff. It unfolds gradually over time so is nowadays less attractive to finders and healthcare organisations than the quick fixes (some would say patches) and “measurable” outcomes of therapies like CBT.
I think I had accidentally found a very autism-friendly therapy-particularly with its emphasis on honesty and “congruence”-that is aligning how you experience the world with how you actually act. Also, shifting your value system from what other people/society think you “should” do, to what feels right to YOU. It was sometimes messy, confusing, frustrating and chaotic. As well as exciting, supportive, mind and heart-opening and empowering. It worked in conjunction with me becoming a writer and performer and facilitating other people to do those things. I tried to do that in a person-centred way too. It gave me a set of “rules” for being who I am. (Including permission to ignore the rules about who you should be!). Much as I think that it’s a bit crap that neither my GP or the local autism centre are able to signpost me to any post-diagnostic counselling, I feel lucky to have been equipped with some great tools I still draw on everyday. I’m also aware of how privileged I was to be able to pay privately for sessions over a period of about ten years (Between £35-50 for the individual sessions. I didn’t have a big income but at least had one, & saw it as a worthwhile investment in my wellbeing).
It feels important to mark this as an important part of becoming who I am now. There ARE alternatives to behavioural therapies which can help people be less anxious about who and how to be in the world. This post is more abstract than I’d wanted so I’m just going to end with some fragments I remember from sessions and courses:
The tutor lets us into the room for our “Introduction to Counselling”. “I’m really tired” she says, yawning. I’m baffled by how she isn’t faking perkiness-and intrigued. When she takes us through the “core conditions” of person-centred counselling I realise she was being “congruent”- aligning her inner self and her outer self. I become the world’ biggest fan of congruence.
If the counsellor forgets to do a “check-in” where all the group members talk about how they’re feeling, I nudge him so that we all do it. I love knowing how people are feeling rather than having to guess. My check-ins ramble and digress. Sometimes someone pulls me up: “But how are you actually feeling?”. I struggle to find where feelings might be.
Someone else in the group talks about feeling things in her tummy. She tells us how she wore a crop top to the gym after realising she’d been made to feel ashamed of her stomach when she was little. I begin to realise that my own tummy has feelings in it sometimes.
In my first session with a new therapist, she stops my long, rambling, digressive monologue complete with many sentences that start but din’t finish. She looks horrified. “Is this how you actually talk?” she asks. (NB: that wasn’t a very person-centered intervention).
In college, we pair up. Our partner talks for five minutes about a problem they have. We must listen & then feedback what they have said to them, including things we perceive they didn’t say, but implied. My partner listens to what I have heard and confirms what I had picked up: “It’s so much clearer when I hear it from you” she says. “You listening to me has helped me listen to me”. I start to take notice of stray thoughts and feelings that come into my own head, buoyed up by the knowledge that I can read people. One day the phrase “Midwives of silence” comes and I know that it describes this group.
A therapist tells me I seem agitated. (I didn’t know I was agitated). He suggests I do some deep breathing. I take deep breaths. I begin to feel more relaxed. “Not everyone learns emotional regulation from their parents” he says. As usual, I look unfamiliar phrases up in the psychotherapy books I’m buying by the handful. Now “emotional regulation” isn’t just words, it’s the calm after those breaths.
I recount some traumatic things that have happened to me. The therapist tells me I don’t seem to have feelings about these things. I know that I do, but I can’t tell him where or what they are. “I feel full/blocked/numb” becomes my way of wanting to convey this. “These feelings are behind a dam/buried/an unexploded bomb” I might later say. A downside of this talking therapy is that it lets me escape into talking, rather than feeling. Is that sometimes therapists facilitate talking rather than feeling.
A final metaphor: Imagine a console full of buttons and switches. The controls of my brain-body, like in the Pixar film “Inside Out”. Counselling means someone is helping me label the switches. “Sadness” for example, “Happiness”. Once labelled, the switch lights up more. Some others ping on and off in an irregular pattern. Me, and the other witnesses (counsellors/other people I’m congruent with) notice those lights. We point at them. They begin to light up more, for longer. To join up with other lights, forming circuits. “See that one?” someone says. “That seems to come on when you feel left out, it connects to that sensation like an elevator dropping in your stomach”. Another circuit is formed. Sometimes all the lights flash at once. Overload. I breathe deeply. The lights settle, twinkle like a city at night. Being seen and heard by others woke me up to myself (and others). There is still so much to explore.