Hi, and welcome to part 5 in my series about working together in the therapy room with autistic clients.
In this post, I want to talk about transitions, anxiety, autonomy, self-esteem and self-talk.
For these posts, I’d like to reference Katherine Paxton and Irene A. Estay’s book called Counselling people on the Autism Spectrum (chapter 3).
Transitions
I’ve been working with autistic adults and young people for 11 years now in the care sector, and 5 years with counselling clients.
Something that’s clear from this time, is that transitions can be hard!
Staff change-overs might cause distress as there might be more people walking around and therefore maybe more noise and uncertainty for that half hour.
It has been easily alleviated by staff coming in straight to the office, to keep the environment calm and familiar for the individuals.
A social story (mentioned in the previous blog post) might be used to inform the residents about who is leaving and who’s taking their place. This brings reassurance and calm to them.
In the therapy room, it might help to stick to the same time and day for sessions, as well as having a routine set for the hour.
I’d say the best way to do this is ask the client what would work best for them at the start of the session, during the session, and at the end of the session.
At the start of the session, the therapist might have arranged the cushions in a particular way, left some stimming objects (like a stress ball or playdough or something else) near the client’s chair which they can access if needed.
The client might bring their own, which is very welcome in my room as it will be helpful for the client to have familiar things, especially at the beginning of the process.
Leaving the windows open or closed has also come up in my sessions, and I make sure I ask the clients what’s better for them. This will change as the therapeutic relationship changes and the room becomes more familiar to the autistic client.
During the session, checking in often about how the session is going and how the client is feeling, what needs changing or working on, will be helpful and reassure the client that they’re being heard and understood.
At the end of the session, the client might need a transition “ritual” or a few steps that might help them close down what was opened up during the session.
Maybe some processing time or some checking in with the surroundings and the next steps.
It is all person-centred, so this will be different for each client, as their transitioning needs and experiences might also be very different.
Anxiety
I’ve previously written some blog posts on anxiety, which you can read here (part 1, part 2, part 3)
Anxiety with autistics can be linked to transitions.
Sometimes an advanced warning with plenty of time to process might help the client with the transition by helping keep the anxiety at bay.
Other times having such an advanced warning might be anxiety provoking in itself. Keeping the warning to just before the transition is happening might be helpful in these cases.
Keeping clear on what’s going to happen next, and sticking to what we say, can be really helpful.
In the therapy room, if we say the session will last 50 minutes, make sure you stick to this time.
Ask the client whether a 5 or 10 minute warning would help, or whether you just end the session at 50 minutes without much warning.
A cue such as grabbing my diary to schedule the next session might become a transition clue for the client that the session is ending. This might develop naturally or as part of the conversations and agreements in session 1.
Do read my series on anxiety for more on this topic.
Autonomy
As part of the ethical frameworks I work under, respecting the client and providing a space for them to be autonomous is essential, and ethical, in the therapeutic relationship.
By asking questions like the ones described above, we are setting the client up for going from depending a bit on the therapist to understand their inner world and their relationships, to learning how to tap into these on their own, as time goes on.
The goal with therapy is not to keep a client forever, it’s to enable autonomous behaviours and thoughts, through practice.
By observing what goes on in the therapy room, which is usually a reproduction of what goes on in the client’s everyday world, and discussing their everyday events and past situations, the client becomes able to process their thoughts, emotions and events on their own, slowly through their therapeutic journey.
Seeing clients come into the room and talk about their progress with setting boundaries or asking for their needs to be met, or having an “a-ha” moment about something we’d been discussin in therapy, is so rewarding and it is great to see the therapy taking an effect in the clients’ lives.
Autonomy is essential in the client’s self-esteem and ability to live their best lives. Of course other aspects are also involved.
Estay and Paxton call this self-monitoring in Chapter 3 of their book.
Self-esteem and self-talk.
Focusing on the positive things clients say to themselves can be helpful when negative self-talk has been taking a hold of the client’s life.
Self-esteem can increase and the client’s moods and how they go about their daily lives can be impacted greatly by focusing on the positives.
I read somewhere (can’t remember where) that thinking that is not reinforced will be come extinct.
The same goes with thinking that is reinforced. It will be at the forefront of the client’s mind.
So if we don’t reinforce negative thoughts, then we can focus on the positive ones.
This seems to work well for autistic clients, and I tend to use it with many of my clients, in one form or another.
Keep speaking positive into your life, and I’ll see you again for the next post in this series.