Autism and Transactional

Analysis

Dena Marshall

Transcript

www.onlinevents.co.uk

Transcript

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Conferences • Interviews • Training

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First published 2014

Copyright © John Wilson 2014

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Individuals with Autism (usually higher functioning Autism/Asperger Syndrome) will

frequent the therapy room, largely undiagnosed; seeking solutions to their relational,

emotional, and social issues.

These clients can have a major impact on the practitioners normal way of working,

potentially effecting both the therapist’s and the client’s self-worth. It’s important for

practitioners to have a good understanding of Autism, whether or not they choose to

work with this diagnosis. This understanding can primarily lead to identifying the

condition in order to work with the client effectively and/or refer on to another

therapist or agency.

From a primary care situation, TA can be useful to both the staff and family to gain a

deeper understanding of Autism, and how those on the Autistic Spectrum

communicate with their outside world. Treatment plans can be created around TA

concepts to help those with Autism meet their psychophysiological needs and

consequently enable them to have a good quality of life.

My background in working with individuals

presenting on the Autistic Spectrum goes back a

long way. During my early training as a

psychotherapist I was working in primary care within

an Autistic Community setting. I started looking at

the theory I was learning and applying it to my work,

and started seeing positive outcomes for the clients,

their family, and the staff. Since then I have been

passionate about what TA can bring to the lives of

those with Autism, especially within the

psychotherapeutic setting where I notice how easy

this diagnosis is to miss – along with the client too. I

have been practicing in Cornwall since 1999, and have had the pleasure of working

with many clients presenting with Autism, all of which have helped me challenge

myself, learn, and grow.

So come along and join in – I hope to have the live chat to hand so we can all have a

good discussion around this topic.

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Autism and Transactional Analysis

Dena Marshall

John: Hello, everyone. Welcome to our TA Tuesdays event, “Autism and

Transactional Analysis” with Dena Marshall. A very warm welcome to you

and to Online Events, Dena.

Dena: Hello, John. It’s good to be here, as everybody says. I’m good to be here in

my house, but it’s good to be with you virtually.

John: Thank you for having us in. We appreciate being with you in your home

today. It’s fab. Of course, a warm welcome to everyone who is joining us live

on the website. I have been teaching a new Scottish word, Dena. We’ve

been blathering away.

Dena: I’ve forgotten it already. Blathering.

John: We’ve been blathering away with everybody in the chat room for the last 20

minutes. That’s been nice. If you’re just arriving, it’s great to have you here.

Dena, you can see the chat room on your other laptop. I know now

everybody gets in the chat room but if you do want to, please feel free to do

that.

Leilani is here as well. We want to say thanks to Leilani for organising TA

Tuesdays. This is six months we’ve done already, which is incredible.

We’re really pleased to be doing this event on autism and TA with you,

Dena, as a way to wrap up our programme for the summer. It feels like a

great way to finish.

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Dena: Is this the last one of the official summer?

John: Yes. Saz and I are going to take a break for a month. Can you believe it? We

will be back in September. We’ve got a full programme all the way through.

We’re looking forward to that.

Dena: Excellent. Good stuff.

John: Maybe to get started we could hear a little bit about you, Dena, and our

usual where in the world are you?

Dena: I’m in sunny Cornwall in St. Austell which was made a bit famous by the

Eden project. Unfortunately, we have more visitors now in Cornwall than we

used to. St. Austell’s got really bad infrastructure. For me, six weeks of

staying indoors and ordering or shopping online is called for during summer

holidays. It is a nightmare out there.

People don’t know how to drive in Cornwall either, but it’s a beautiful place.

We do lots of kayaking, hiking, snorkelling and all sorts really. I’m one of

these kinds of people that enjoy where I’m living rather than take it for

granted.

If I go upstairs and get my binoculars out, I can see the sea, but I’m about

five minutes’ drive away to get to the coast. It’s pretty special. It’s a special

place to live.

John: You love it. I guess you live in a fantastic part of the UK. This year you’re

getting a summer where you can enjoy it.

Dena: We’ve had three bad years. This year has just been absolutely lovely.

John: That’s great. Thank you for giving us a sense of where you are. It would be

nice to hear a little bit about your professional journey as well and the kind

of things that you’ve done to bring you to here.

Dena: I guess I’m lucky because I was able to attend a transactional analysis

psychotherapy training course back in the ‘90s. It was one of a kind really. It

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only ever happened once, and then it kind of went back up country. I was

lucky to be part of that.

I finished my training in about 2000. I started seeing clients in 1999. In 2002

we set up an organisation. I say “we.” I do apologise. It’s a bit symbiotic with

my husband, Mark, who was doing the same thing basically. We set up

ongoing support in 2002.

We haven’t looked back really. We’ve just grown from year to year. We’ve

separated our house off. Where you can see, where I am now, is called our

training room. It’s small group training, eight people maximum. I run groups

and meditations in here.

Then next door we’ve got a dedicated client room as well, a dedicated client

bathroom and client kitchen. It’s all set up. We split off half of our house to

dedicate to our business, which works really well.

John: What a great environment. The time has flown by since your training. You’re

really embedded into the community as a service. That’s great.

Dena: With regard to autism, when I started training, I basically worked in primary

care. It was natural to start applying some of the theory because what you

like when you’re training is enthusiastic with all of the theories that you

learn. Then you go around people-watching and all that.

I was applying it not only how we as staff are all interacting with those with

autism but how they were interacting back, what ego states they were in

and all of that.

I started to play around with some transactions and immediately saw a

result. It went from there. I did some presentations and wrote a paper on

autism and transactional analysis looking at ego states. It started from there.

I’m pleased to have that experience for probably about eight to 10 years of

working with autism. It’s given me this fantastic base on an intuitive level.

When somebody walks in, there’s something there. Are they or aren’t they?

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It’s very tricky sometimes to diagnose on the higher functioning side of

autism.

I’ve been really passionate about it ever since. I was passionate back then as

being an advocate for autism to give them a good quality of life and put in

programmes in primary care where they would respond well, have less

incidents, be held less and all of those kind of things.

I think transactional analysis is a tool that goes amazingly well with autism.

Hopefully, we’ll discuss some of that in a bit.

John: You’ll give us a sense of some of the things that TA can do to support

someone with autism. I think also it’s so important when you have a client

come in to see you for the first time, you might have a sense that, as you

were saying, someone has that higher functioning on that continuum or

scale.

Maybe as therapists we miss some of that. That can have a real significance

in how we approach someone therapeutically or perhaps couples who are

coming to see us who have an experience of autism.

Dena: Yes. Most people who have come in have relational problems, those either

diagnosed or undiagnosed. A person diagnosed with autism or Asperger

Syndrome normally comes in and almost knows that they want support with

some emotional issues.

I find a lot of undiagnosed coming in having social issues where their partner

has said they’ve got some kind of social disorder. They have this big label,

but they don’t know what to do with it. They have lots of problems within all

of their relationships, including work.

I’m really passionate about therapists being able to spot that on whatever

level. I will hopefully explain how we do that as therapists in a very easy

way, actually.

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I do recommend that therapists learn about autism, whether that be just

googling that online. I’m not necessarily going to go into exactly what autism

is.

I’ve got the diagnostic criteria. It’s massively changed from the DSM4 to the

DSM5. There have been some big, controversial changes and not the

changes I think are particularly useful personally. That’s up for debate,

maybe not for tonight but maybe we do another one.

John: Of course. There’s a lot to squeeze in. Those are two important things. Why

might we notice? Someone might not know that they have an experience of

autism.

Dena: On a very quick explanation, autism is explained as a triad of impairment. I

don’t know about you or anybody else in the chat room, but the impairment

side gets to me. I really don’t like the word. I think it almost puts people in

the disability kind of position.

The triad I’ve written on the board here. Basically, they reckon it’s a social

and emotional interaction impairment, an impairment of social

communication language. The bit that I disagree with is an impairment of

imagination and flexibility of thought.

This is my explanation of autism, and I’m talking about Asperger’s really, the

higher-functioning, because we won’t get full-blown autism into the therapy

room, or not usually unless it’s part of an organised therapeutic event.

It’s a sensory input and interpretation and a brain organisational problem. In

other words, it’s how we normally understand what comes in on a sensory

level, and we have all these processes going off in the brain to deal with

what we see, hear, feel, taste and smell. Anybody with autism will not have

the same wiring.

It’s a bit like dyslexics. I’m slight dyslexic. I understand it from that point of

view because if somebody said to me in the middle of driving and I say,

“How do I get from here to there?” they all look at me with this quizzical

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look on their faces and say, “Are you joking?” because I can’t do it. I actually

can’t do it, as much as I rehearse and remember the route when I’m in it.

I really have a job understanding where I am, so I can understand a little bit

about what it might be to have those wires cross and things coming in not

being interpreted in the way that we take for granted. That’s a quick

introduction. I have another, John, which you know about.

John: I think that’s a great introduction in terms of description, but we’ve got

something a little bit experiential too.

Dena: We have, and I will get to the chatroom. I’m really keen to get interactive.

What I’m going to do is give you a little experience of what that might feel

like for somebody who might not be able to process sensory information in

as we do. By the way, it’s called neurotypical for a non-autistic person if we

get the terms right.

To everybody in the chatroom, what I want you to do is notice what you

notice. I’m going to do this for about 30 seconds.

John: The idea of this is, if we are neurotypical, to have the kind of experience that

someone with autism is having.

Dena: What I’m going to do while this is going on is read out the criteria for social

communication, John. This is specifically in social use of verbal and

nonverbal communication that is manifested by all of the following.

There’s deficit in using communication for social purposes, such as creating

and sharing information in a manner appropriate for the social context.

I’m going to look at the chatroom, and I want to know what you noticed.

What did you notice? I moved purposefully backward and forward. There

was sensory overload, most definitely.

John: If we say back some of things that are being experienced in the chatroom,

there’s overload of sound, too much going on and trying to concentrate on

one thing and then losing it.

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Dena: That’s really great because that was what I was hoping for. Some people are

going to find the visual and not being able to see my face because I was

going backward and forward.

It’s really great that there is a difference in the chatroom. Some people

focused on what they could hear and that it was an overload on sound. They

could concentrate on what I was saying underneath.

There are some people that it was the metronome. Maybe it was the sound

from that or because it was right in the middle of my face and eye line. You

wouldn’t have been able to see expressions.

Others concentrated on me moving backward and forward, and not getting

that spatial settlement of me being in one place and able to concentrate.

The sound breaking up wasn’t part of the experiment, but it could have

been.

That’s really great that it’s not just one person or a few people all focusing

on the same thing. That’s a lot like Asperger’s because they will have

problems interpreting information in different areas.

Sometimes it will be on sound. For other people it will be with touch.

Obviously, I can’t demonstrate that in that exercise. For some people, it will

be clutter around the room or too many people talking at once. It might just

be the visual side of too many people, like going into a supermarket.

It might be on the level of noise front that might be okay, but then with the

fact that there are a lot of people there they will then get overwhelmed.

One of the things that I think is really important with anybody walking into a

therapy room is really to note what their social problem is. I like to

differentiate between.

Somebody has a problem with social aspects because they feel shameful.

Then they get to recall how shameful they feel, and you can feel and smell

shame in the therapy room if you’ve been doing it long enough.

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Those with autism don’t tend to bring the shame. They tend to just bring the

discomfort and overwhelm as being the biggest problem of social activity, as

well as not knowing what to say or the responses to give. They will either

inappropriately respond or withdraw. There are two different extremes

there.

I’m just going to have a look at the chatroom, John.

John: There was a comment there about a client who would notice the clock

ticking in the room.

Dena: Yes, it’s really important. If you do ever establish that your client might have

Asperger’s, I think then it’s asking them, “What do you notice? What would

be easier for you? What would be more useful?” Of course, I’ve got a loud

clock in my therapy room. You just take the clock out, and it’s absolutely

fine.

It might be that you draw the blinds or move to a different chair if it’s

comfort. There are all sorts of ways that we as therapists can really help

clients who come in with Asperger’s. However, that doesn’t say how to

recognise undiagnosed Asperger’s as it arrives on your doorstep, as it were,

which was one of the questions. I will go on and answer it. It’s a good

question.

Katie asked how I would define inappropriately. It leads on how do you

really spot someone with a potential diagnosis? I think the first thing you will

notice is they are an adult ego state, and they will seemingly be in an adult

ego state.

On an intuitive level, there will be something not quite right. If we go to Eric

Berne, it’s looking at the behavioural diagnosis but also the

phenomenological and social diagnosis. How do I feel in response to this

client?

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There will be something not quite right that you can’t quite put your finger

on. That is the first sign that I always pay attention to. This person seemingly

has a lot of adult ego state.

What I mean by that is they seem really functional, able to solve problems,

here and now in the moment, and quite rational, but for some reason I can’t

quite put my finger on it.

I think Berne’s diagnosis plan on how you diagnose clients is really important

when assessing clients. You get that sense. It’s looking at their social

interaction, historical diagnosis, how you feel in reaction to them, the

phenomenological and what’s happening right now in this moment with

them.

He goes on. Basically, he splits that down even further. He says, “What is

their demeanour? What are their gestures?” It’s noticing their voice and

their vocabulary. I think those are really important in diagnosing yourself if

they may have Asperger’s.

Their demeanour may be slightly different. Again, this is to do with sensory

aspects because what we do know about the autistic brain is that it’s usually

bigger than a normal brain and it has a lot more neurons firing off, but they

tend to be more local rather than wider over the brain.

They would have a difficulty functioning, so their frontal lobe system with

the amygdala and having that to and fro. They tend to have more activity

going on, but it tends to be more local.

That often sometimes has to do with actions, so I’ll talk with my hands like

this. You may notice that somebody might be stiff or hold their body in a

strange way that you might ask about.

The gestures that they might use might give you a clue because often there’s

a lot of dyspraxia that goes along with autism. There are a lot of

interruptions in the signals that come to the movement, and that’s often

from the mid-ear.

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You’ll see people who often move their head around if they need more

stimuli, or they might be still because they’re frightened of the stimulus that

happens. They’re hyper-aroused in that area.

There’s loads of stuff like that. Neuroscience is awash with factual

information about how different the brain is, which is fascinating. On an

actual level in the room, I think intuitive has got to come really high on the

list to spotting anybody who might have this.

John: It sounds really important. You’re in what feels like an adult-to-adult

transaction, yet there’s something that just doesn’t feel right and that’s out

of place. When we see those other things happening too, that’s really

interesting about the gestures or head movements.

Dena: There’s voice and vocabulary as well, and being monotone. In this

transactional analysis, we have this set of criteria. When somebody is

monotone, we might think, “Schizoid.” We might go along these diagnostic

lines. In fact, sometimes that actually gets in the way because we may take

for granted that everybody is able to pick up on ulterior transactions.

It is a big one in Asperger’s world because they take things very literally,

they can’t see expressions, they don’t pay attention to body language, or

they look away and don’t maintain much eye contact, so they don’t actually

take in the information.

We may have an idea that most people are able to understand the third rule

of communication, which is the psychological one, that we would pick up

everything on a nonverbal level over an 80% mark when you’re working at

somebody who wouldn’t.

It’s not because their skills aren’t there. It’s because their brain is not wired

up to do it in that moment. This is really important because people with

autism and Asperger’s have empathy. It’s one of the things that is bandied

around a little bit as a controversial issue.

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If we talk in TA terms, I’m hoping most people know a little bit about TA

since we’ve been going for six months. What happens on an energy level is

we move quite quickly between ego states.

One minute we’ll be very factual in adult ego state. Then we might go into

child ego state and do all our normal bodily behaviours and the thinking and

feeling that goes along with that. Then we might slip into parent and flit

between the two.

What happens with people with autism is that they have the ability to go

through all the ego states different to us. I just think it’s a rather sticky affair.

It’s rather slow. Sometimes when things are in the moment, like intimacy,

we would view somebody as being rather cold and distant.

Actually, if you catch up with them an hour later, they might say, “I feel

connected with that.”

John: When you say sticky, what are you describing?

Dena: I have to confess this is my husband’s idea.

John: You’re going to give Mark credit.

Dena: Absolutely. He got the idea as I was talking about it. It was this sludgy, sticky

energy that didn’t flow easily from ego state to ego state. It would either get

stuck or some would stay behind, or it would just be a really slow process.

He used the analogy of olive oil compared to a really sludgy, sticky oil. It

wouldn’t move as fast. That’s another thing that we look for in the therapy

room. It might be that we experiment with ego state swapping and see how

the client reacts and whether they’re able to get into other ego states or

whether it’s a slower affair.

John: When you say ego swapping, is that like an invitation into another ego

state?

Dena: Sit down, John. You did it. You went into child ego state.

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John: Wow! That was amazing. That can happen really quickly.

Dena: It’s much more subtle with a client. We do that anyway. We naturally

change ego states in the therapy room. If you notice that the client doesn’t

respond as quickly, it is a good sign that they may have it if you’ve got other

signs that are going on as well.

John: Can you put me back into my adult?

Dena: Sorry, John.

John: There’s a lot going on in the chat room. There are a lot of great questions.

Dena: If anybody’s got any questions that are further up and you want to re-ask

them further down, I’ll be able to see them. “Are you finding that there are

more clients in adulthood getting a diagnosis?” Yes, but I’m finding more

clients coming in without a diagnosis.

John: They’re clients who are not aware.

Dena: Yes. As counselling and psychotherapy becomes more of the norm and more

socially acceptable, that’s steadily on the increase. Because of that okayness

of coming into therapy and using a therapist, there are more people coming

into therapy generally.

It’s a natural happening that some of those people will have anxiety, fear,

and social problems and will seek out a therapist because they think or their

partner thinks there’s something wrong with them and they need to go sort

themselves out.

The problem comes when the therapist deals with those the same as

somebody without autism because we would presuppose that their brain is

working in a perfectly functional wired state.

We would presume that they would be able to go in the third rule of

communication, the nonverbal psychological, so that they would pick up on

the subtleties of what happens in therapy.

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We might go down the line of injunctions. Injunctions are nonverbal

messages that parents give to their children that we then embed in our lives

and live by them or counter them.

You might think somebody had a don’t think injunction and that they were

brought up with parent messages like don’t think, don’t feel, don’t belong

and don’t be close, when it’s not an injunction issue.

We as therapists might go down the road of looking at what’s called

decontamination of parent ego state. In other words, get those messages

out of the adult ego state because it might be putting down.

Let’s de-confuse the response to those messages so that the child feels a bit

freer and is more able to live their life in a much better way for themselves.

When it’s not an injunction issue, what often happens is the client leaves

thinking, “Nobody can help me. It’s just me.” The therapist can often think,

“I didn’t do very well there. I need to look at why the client left and why we

both felt unhappy.”

Self-esteem and self-confidence can affect both sides. All it takes is a little

change in how we work with people with autism. One of the hardest things

is losing the ulterior transaction element of things. In other words, to be

present in the here and now, to be blunt and to say what you mean.

I once read the English language has more words than any other language

because culturally we are good at explaining what’s not really explainable.

We skirt around the edge and don’t say what we mean. We do that as a

culture.

We find the Germans sometimes rude because they’re much straighter in

their language. We class the deaf community sometimes as being quite rude

because they use less language. We have the same response to a lot of

Asperger’s because they’re very direct and straight.

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If we mirror, match and have rapport, it’s to not be afraid to be really

straight and to say, “I’m thinking of an Asperger’s diagnose here,” straight

off. A lot of them are relieved. “I’m not saying it is a diagnosis. I’m saying to

go read about it. Come back and tell me whether you have it.”

They’re the only ones that can do that because their communication of

what’s going on for them will be hampered within the therapeutic arena.

Communication is a big issue. They’ll feel and think things. They won’t

necessarily know how to communicate that in a social way.

John: They might be struggling with that communication, and our response might

be to be what we consider tactful. That would be really unhelpful. We’re

skirting around something that could just be, “What about Asperger’s?”

There’s a question about this in the chat room. “Would you encourage a

client to seek a formal diagnosis?”

Dena: I’ve seen a lot of diagnosed and undiagnosed people. I have never suggested

it once, but that’s my personal way of doing things. It depends on the client

and the therapist. Maybe it’s something you explore together if they want it.

Psychotherapists can diagnose and help with the diagnosis within the

therapeutic contract. That’s something else I’ve never done. I’ve never given

an absolute definite because I like to say it’s just a wiring problem. Let’s

normalise it.

There are things that wiring problem excels. In other words, it is not a

problem.

John: It’s a wiring difference, perhaps.

Dena: Most definitely. Some traits, like focusing on particular interests, can really

blossom in certain environments.

An example would be an employer. If you’re thinking of employing anybody,

put it out there. If you have somebody come to your interview with a

diagnosis, grab them as soon as you can because they are loyal, dedicated

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and very good at creating routines, which means they get very quick at what

they do.

This wiring difference is like anything in life. In some areas, it’s going to fail

them. It’s going to be difficult. Social elements can be really difficult, but

there are going to be things that they do really well.

John: That’s helpful to catch that. We’re getting some feedback in the chat room.

Dena: “Do you ever wonder if it’s possible that your TA training may get in the way

of seeing each client as an individual?” Every single client that comes in is an

individual. No is the answer to that.

In fact, I’m doing a TA Tuesday. I am talking about autism and TA because

it’s focused. In my normal practice, I’m a very relational therapist. I use

transactional analysis, NLP, bioenergetics, body work and karate. The

answer to that is absolutely no.

They’re still talking about confusing an individual with a diagnosis. You agree

to work with that if you know a little bit about Asperger’s and you’re willing

to challenge your own method and how you work. It will definitely be

challenged if you work with somebody with Asperger’s.

You have to think outside the box and work in a different way. You have to

come out of your autopilot and be mindful that this isn’t about this person is

ever going to be able to cope with noise or touch, but they might be able to

lessen it.

They might eventually get there, but it’s such a slow process, and much

slower than a neurotypical or non-Asperger’s client. We have to be really

mindful. It is different. Actually, it can be quite refreshing because you can

be really straight without worrying about that and have it out on the table

and discuss it.

John: In some ways, it’s the opposite of what we might do relationally in terms of

those nuances like having empathy. Maybe that’s not going to work. It’s got

to be straight on the table.

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Dena: Yes. Somebody has just asked, “Do you find you get drawn into games?”

That’s a great question. Somebody with Asperger’s will not understand the

conception a functioning level of ulterior. They don’t know what it’s for.

They won’t recognise the signs.

They can learn to ask and to say, “That expression means this and I can ask

you about it.” Unless they have that strategy and they learn it, they won’t

know something else is going on. They will learn it as a routine. In other

words, they’ve seen it and they think, “This is how to behave in a social

situation.” They learn it so it’s like a routine. It’s not really a game. It’s going

through the motions.

Other than that, they don’t play games. The answer to that is no, but how

lovely it is when they realise that games exist, to teach TA as part of the

whole, and to say, “These are ulterior transactions. This is what goes on. This

is what to look for. This is how you deal with them. This is how you get out

of them.”

That’s what I mean about refreshing. It is really refreshing that they are

straight up. They often don’t play games at all. That’s nice as a therapist.

John: There isn’t anything else going on. It’s just the therapist and the client.

Dena: There are a number of things that are real revelations in terms of teaching

TA as a therapist to an AS client. Games is one of them.

What’s great about TA is you can say, “That’s parent ego state.” We have

some set parent ego state expressions. We have individual ones as

individuals, but there are some that culturally are everywhere, like hands on

the hips or wagging of the finger.

It’s the same with adult. There’s the monotone voice, and there’s the child

ego state. There are certain aspects of each ego state that you can teach on

a behavioural level.

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This is what it looks like and sounds like for them to be able to ask questions,

especially if they’re in a partnership and they’re having a job understanding

their partner and their emotions.

You can teach them what emotions look like. The links between having an

emotion and the cognitive processing of communicating that emotion are

going to be massive for somebody with Asperger’s.

What you can teach them on a cognitive level is how to recognise what

sadness, fear and anger feel like, and then how practically to work with that

either with another person or their own anger.

You give them permission to not have to work that hard. It’s okay you can’t

communicate it. We can do something about that. It is very different the

way you would work with somebody.

I will be producing a paper after this. I’ve already half written it. It goes

through the basics of TA, so rackets, ego states, transactions and strokes. I’m

going to list it in a way that says we almost take for granted that people can

do this functionally.

Then we look at how an autistic person can’t do that or they have difficulty

in doing that, and then what to do in the therapy, how to be, and how to

actually help that person move on.

I find work with Asperger’s clients shorter than non-Asperger’s clients. They

pick these things up really quickly and they’re real revelation stuff because

they work in routine, logical sequences and set ways.

If you can give them a set way to work with, they can go away with these

skills and use them in a way that would be beneficial for them.

John: That sounds like a great paper. I hope you finish that one soon.

Dena: I’ve mainly written it. I will make that available. I’ll give you a copy. You can

dish that out to whoever wants it as part of a programme or whatever. It will

also be on my site. I’ll probably post it as well on the blog.

onlinevents.co.uk

John: That would be great. As soon as you get it ready, we’d love to send it out to

the Online Events mailing list. That sounds so useful.

You did mention a previous paper. There was a question near the start. Is

that available?

Dena: It is actually. I created something called a hungergram. It was partly the idea

taken off an egogram. I can’t remember off the top of my head who did

that. It’s basically a little bar chart. It’s looking at the need systems. It was

mainly in primary care, so it wasn’t necessarily related to Asperger’s in the

therapy room.

It was related to primary care where there are no touch policies. There’s no

facility for it. You have this pattern of this lull. Then they build up stress and

they have this meltdown, breakdown or massive incident, which is incident

hunger. Then it will settle down again and the cycle will start again.

I wanted to look at what needs are being met with individual, how it was

being met negatively and positively, and then basically put in activities that

were appropriate for a primary care organisation, like massages and things

like that for the contact.

There’s a sexual element if they were adults to actually supply them with

some porn material and things like that so that they could learn about

privacy and actually get some of their sexual needs met.

It was about looking at how they could be met positively rather than just

ignore them. It was a great success. We implemented it in the house that I

was working in at the time. I wrote a paper on the results and how it

worked. There was more involved than that, of course.

Will it be available? It’s on a floppy disk somewhere, John.

John: Oh my goodness!

Dena: I still have to get a computer with a floppy disk.

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John: That sounds like such an important piece of work. It had an impact on the

services that you were involved in. It’s something that shouldn’t be lost. A

floppy disk is one step to the Stone Age.

Dena: I also did a presentation on the development of autism. The world of autism

has changed.

A girl called Carly Fleischmann is severely autistic. The parents were told

that she wouldn’t exceed a mental age of 6. Basically, the parents didn’t give

up. They gave her therapy every day trying to get her to do different things.

They were doing picture association. “This is a picture of an apple,” and all

those kind of things. She had 30 to 60 hours a week doing this therapy. They

kept it up.

At 11, she walked over to a laptop and typed in, “Hurt teeth help.”

Everybody said, “What?” From that, she’s got her Facebook and Twitter

pages. She’s written a book. She’s got her own website. I’ve given you the

links. If you could distribute those, that’s brilliant.

She has changed how we look at autism because she is intelligent and

articulate. Nobody taught her how to spell. She did that by herself by these

word association exercises and picture exercises that she did in her theory.

She’s just amazing. I follow her on Facebook. I’ve got so much admiration for

this young lady. She changes how we look at autism. She still can’t speak.

She still looks like a severely autistic person. You just don’t know.

We look at these individuals no matter where they are the spectrum. Who

are we to make judgements about their mental age when actually we really

don’t know? This is why more and more it’s going along the illness of the

brain not being wired up rather than being a disability. It’s fascinating and

scary stuff.

There are some YouTube videos. They’re very scary because you’ve got a lot

of people with autism out there and certainly in primary care they get talked

to like children or like they’re mentally impaired. What if they’re all not?

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John: There could be tens of thousands of children who are thought to not be able

to function, but they’re functioning differently. That is scary. They may not

ever be seen or made contact with properly. I really appreciate you saying

that.

There’s a question that has been asked a couple of times in the chat room.

“Do you think the skills and the work that you do with Asperger’s clients

becomes part of them or is it a learned behaviour pattern?”

Dena: I think there’s a bit of both going on. They need to put everything in routine

in order to function well. Behind that on a psychological level, there’s a real

okayness. There’s a normalising and saying, “You are okay the way you are.

You just need some extra skills.”

They learn these new skills on a very routine level. It’s really useful to know

what questions to ask with a particular expression, to know to ask for space,

and to know to say to somebody, “I’m feeling overwhelmed,” instead of just

feeling overwhelmed and not telling their partner they feel overwhelmed

and then beating themselves up.

There’s a mixture. They like a lot of permissions to be who they are and

accept themselves for who they are and know that they can also do

something to make their lives better.

John: That sounds really powerful to know, “I’m okay. Here are some things I can

learn to ease the communication between someone who thinks of processes

differently from the way I do.”

Dena: I find a lot get really relieved when they hear that they can do something.

That’s the most important thing because they often feel trapped and not

able to communicate in the way that they see other people communicating.

Even if it’s learned, it gets to rub off on their self-esteem. They think, “I had

this two-way conversation with breaks.” Either a person will withdraw and

not hold a conversation or somebody will hold a one-way conversation and

talk about themselves. They learn that there are breaks.

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They learn how to ask, “How are you?” Instead of going into this hour-long

elaboration of what they’ve been doing, they learn to do five minutes and

say, “How are you?” They see the response and how that works. Then their

confidence and self-esteem grow. They start to feel a bit more normal.

I would do things like mirror exercises to start to recognise their own facial

expressions so that they can learn it in others. I use a lot of bag work. Behind

me, I’ve got a 6-foot standing punch bag. I often use that as a boundary. A

lot of people with Asperger’s don’t necessarily know about personal space.

It’s about learning to touch the bag, what’s that like, getting close to the bag

and things like that.

I do karate exercises with the straightening of the spine and having a good

boundary in striking the bag. How different is that to coming in and getting

in somebody’s space? They start to learn about personal space, boundaries,

and how to separate that in their mind.

If they have a metaphor for it, they often can do it in their social

circumstances. They repeat it in their mind. There are all sorts of different

kinds of body work that works really well.

Cognitively, they do really well some areas and others they don’t. They don’t

quite understand certain things. If you do it on a body level as well as

cognitive, they might get a bit of both, or maybe they get both and integrate

them.

John: That sounds like a powerful way to teach and learn. It strikes me that some

of this is about a kind of education that hasn’t been offered them. If you’re

not processing facial expressions, here’s another way to communicate.

We’ve done six months of TA Tuesdays. It’s the last one before we stop for

the summer. You’ve really communicated to us how TA can educate and

help us understand psychological experiences. It can be so useful with

people with Asperger’s. That really explicit communication of transactions

and psychological experience is very powerful.

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I can see you thinking. I’m wondering how you’re doing at the end of the

hour.

Dena: I wanted it to be a bit more interactive, but I also realise it’s really difficult to

go over to the chat room all the time because it breaks it up, which is a

shame. I’ll be on for another half an hour. If anybody has got any questions,

I’m quite happy to tippy-tappy away there.

John: That’s very generous of you. It’s hard to imagine just how quick 60 minutes

flashes by. You have squeezed so much here. I feel really appreciative of

that. I know there are more questions and comments, so offering us a bit

more time in the chat room would be great.

Dena: My main passion is about clients coming out from us and getting the best

that they can get out of therapy and having that good experience.

As therapists, we have a responsibility to give anybody who walks in

regardless of their diagnosis a good experience, even if that’s referral if you

don’t feel like you’re up for the job.

The first thing is to learn about it. People with Asperger’s will walk into your

therapy room. I can guarantee it. They have the problems that are ripe for

therapy. I appeal to therapists to learn about Asperger’s and about how the

brain works around that. It won’t take too long. Then really hone in on

intuition skills that say, “Something is not quite right here.”

John: That’s a really important invitation. I’m sure the work that you’re doing and

going to do is a real contribution you’re making to the field. Thank you very

much.

Dena: Thank you, John.

John: I want to really appreciate the time that you’ve taken not just for this hour,

but for all the preparation that you’ve put in with your glass board.

Dena: That’s normally there.

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John: It’s lovely. Thank you for the experiential demonstration that you’ve given

us.

Dena: Thank you, John. Thanks to everybody in the chat room. I will chat to

everybody. I enjoyed that bit. Thanks for giving me the opportunity as well.

John: Leilani and I both leaned on you a little bit because we knew we really

wanted to have this session, so thank you for allowing that.

There have been a number of people watching. I want to just say thanks to

everyone who’s present, and particularly to Saz who has been online with

us. There have been a couple of technical problems, so thank you for helping

us with that.

We’ve had Crumbed in as well, our technical guru. Thank you for taking care

of the underlying bits of the website. Thank you to Leilani for the TA

Tuesdays programme that we’ve had and is going to go from strength to

strength. Thank you to everyone who’s been involved in that, including you,

Dena. I really appreciate it.

Until after the summer, I hope everybody continues to get a lot of sunshine

wherever they are, especially in Cornwall. We’ll see everyone in September.

Bye for now.