SG versus Therapy

I’ve said this briefly before, but I have seen this line crossed so many times now that I decided it needs an entire post. Just to forewarn you, this may turn into a bit of a rant because this is a subject near and dear to me.

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Spiritual guidance (SG) and therapy are NOT the same thing. They are also NOT interchangeable.

Speaking as a guide, I would never attempt to diagnose or treat a mental health issue. Even with my background in counseling, I am not licensed, so this is not within my scope of active practice. If I feel that therapy would benefit the client, I will readily and gladly recommend it. Having opportunities to engage in both SG and therapy can be extremely beneficial; it allows for both mental and spiritual healing with professionals working within their proper boundaries and areas of expertise.

Speaking from the experience of working as a therapist, I get alarmed when I see guides start to act more like therapists. Guides have a unique duty and focus, which is the spiritual well-being of the client. This is not the same as the mental well-being. There are many aspects of spiritual practice that, in a mental health setting, may appear to be signs of pathology. Visions could equal hallucinations. A bond with nature may be seen as delusions of grandeur. I like to use the “harm question” to distinguish the two: is this person’s beliefs or experiences causing harm (of any kind) to themselves or others? If not, SG can continue. If so, I will get other professionals involved promptly.

The other issue with blurring this line is the flip side of the coin: guides who are unable to recognize mental health issues at all. I have seen a self-proclaimed guide completely miss what to me were obvious signs of depression in a client, and instead they chastised the client almost relentlessly for being “unmotivated.” The client was called lazy, insubordinate, childish, etc. The “guide” threatened to abandon the client and stop communicating with them if they didn’t do as they were advised.

This is not good therapy or spiritual guidance. Honestly, this isn’t even respectful. This is bullying. Rather than punishing a client for not following instructions (which, by the way, you shouldn’t be spending your time as a guide doing, anyway), a guide would seek to understand the roadblocks that the client is putting up. A good therapist does this as well. There is always a reason for blockages, and they are rarely there just because the client is “lazy.” Punishing the client by fussing at them or threatening to basically abandon them is not going to get you to the reason. It only alienates the client or leads to dependency with the client constantly trying to please the guide. The client in this example should have been referred to a therapist to address the depression symptoms.

I could probably go on forever with this post, but those are some of the bigger issues I’ve seen when two different practices/approaches collide in ways that they shouldn’t.

Can you think of other ways that these lines could be blurred, and/or how to prevent this from happening?

Parents, We Need You.

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First, yes, it’s been awhile. A lot has been going on over here, including some big decisions that will probably be announced in the June site update.

A recent situation has caused me to take a hard look at the idea of “parent buy-in.” It’s a bit of a buzzword/concept in my field, and it centers around the goal of getting the family invested in our therapy work. Too often, I see parents who simply hand their child/children off to the therapist/interventionist/specialist and basically say, “Here, fix them.”

The truth, parents and guardians, is that we cannot “fix” your child. First of all, many of us don’t really like the idea of “fixing” anyone. It implies that the individual is broken, inferior, or not up to some invisible set of societal standards. Second, we are in your home/community or you are in our office a few hours a week.

In order for your son or daughter to become the best that they can be, they need YOU.

In order for us to be able to find those sparks in your son or daughter, we need YOU.

I always try to tell families at the very beginning that this is a team effort, and everyone must be invested in it. The clients I worked with who blossomed the most were the ones who had the support and follow-through from their parents/guardians, their siblings, and even extended family. The families who were sponges, hungry for information, skills, and concrete examples…these were the cases that led to more fulfilled lives. No, the child didn’t get “fixed.” The child got love and acceptance, and that made them work at becoming more confident, loving, and ready. All children want to receive acceptance and praise from their parents/loved ones, I truly believe that.

When the families meet us at the table, ready to make the world of their family unit a better place, amazing things happen. I’ve seen it over and over again.

I have a saying when meeting families: “My end goal is to essentially be fired because you don’t need me anymore.” I don’t want your family to become dependent on me or my team. I want you to apply learned skills and build relationship bonds so that you don’t need my “expertise” anymore.

Us professionals want to see the child AND the family unit flourish and thrive independent of any services or interventions.

This needs to be everyone’s goal.

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Quick Tidbits

I’ve been having my own form of writer’s block for the past few weeks. I can’t tell you how many blog posts I have started that now sit idle in the Drafts folder. I will get to them, I promise. In the meantime, I decided to give some practical tips that I’ve learned/been reminded of by some of my new clients. We can always use tips, right?

  • For some of my older clients on the spectrum, a lot of anxiety is reduced when they are given the whole picture or situation first. We tend to assume that they will not be able to process everything at once, but giving information in little pieces (especially if they are directions) can also make them anxious because they don’t know what’s next. What I’ve learned to do is to give the overview first, and then each step afterwards as we hit it. For example: “Okay, we’re going to make lemonade today. We’ll need lemons, water, and sugar so that we can mix them together.” Boom, I just summarized the entire recipe. After I did that, the client walked me through the process, asking when he needed clarification. While he is what would be considered “higher functioning,” he still needed the anxiety reduction.
  • Many kids love the feeling of independently doing and choosing for themselves. Even if it is not a true choice (say, choosing between your two choices), the illusion of choice can be a great asset. I try to give my clients choices whenever I can. Sometimes they bounce the ball back into my court for me to decide, but I offered them the choice, and that goes a long way.
  • To my fellow workers: it is really easy to assume that a parent is just being bossy, lazy, whatever trait you believe you’re seeing that week. Try to step into that parent’s shoes. Most of us get to go home at the end of our day. For those of us without kids, we go home to stillness (most of the time). For our clients’ parents, their challenges and triumphs continue long after we’ve gone home. It’s just a few hours a week for us…it’s 24/7 for them.
  • That being said, workers, know your boundaries. You have to take care of yourselves before you can take care of anyone else. Our clients can pick up when we’re tired, hungry, or just plain pissed about something…and the result is usually a less than stellar session. Parents, we go through a different kind of burnout. We are not just worrying about the well-being and future of your child; we often have several more families we have to put equal energy and time into (or dozens more if you’re a case manager). We’re not trying to be rude or mean if we hold our ground on session times or availability. We’re trying to make sure we can continue to be the best that we can be for all of our clients, including you.
  • Workers, think outside the box. Not just with your clients, but also in regards to your job/position in an organization/your own practice. What are your strengths? How can you use them for the betterment of your organization/practice? Are you doing things that others are not? If others are doing it, do you have a unique spin or voice to bring to the table? Is there something you see in your client that others don’t?
  • This one goes to everyone: have fun. I’m serious. I work mostly with kids, and I see so many instances of family and workers alike getting so wrapped up in the goals and the data that they forget that they are dealing with a kid. I celebrate when a client has a “kid moment.” In that moment, autism wasn’t some horrific veil hanging over their heads (according to everyone around them). Autism was a way to really feel the sunshine and the wind, to appreciate every color dancing across a bubble. Autism led to a laughing fit to end all laughing fits. I’m not trying to downplay the challenges of this type of neurodiversity. It is a tough road to tread, nearly impossible at times. What I am saying is to really be in the present when it comes to those moments where the child is just being a child. I dare say that maybe, just maybe, you may want to join them there.

An Autism Wish List

I’m traveling/on vacation right now, but I wanted to share an amazing post with everyone about Autism Acceptance Day. The author, who is an autistic woman, made a wish list of what she hopes to see for autistic individuals in the future. Number four particularly resonated with me, as I know that I am still working on this due to being a product of my environment when it comes to autism services. The goal of “normal” is still very much the norm, so to speak, and I would like to help change that, starting with myself. I am still a work in progress. I may do an post just on this subject in the future.

Enjoy!

https://anonymouslyautistic.net/2017/04/02/autism-acceptance-day-wish-list/

The Bridge: The Approach

So I decided to title the series The Bridge, since that is essentially what you’re doing in this line of work. I hope that the series helps not only workers (whether a Specialist, Interventionist, Counselor, etc.) who are anxious about entering into this field, but also autistic people who may wonder why the heck we do what we do sometimes.

The first session is always the scariest one. Here’s the truth: no matter how experienced or confident you are, you’re going to be nervous. It’s a brand new client, and a brand new family. You (hopefully) know that you cannot approach this client exactly the same way you approach others, because you know that if you’ve met one autistic person…you’ve met one autistic person.

So what is the first thing you do? Jump straight into what they’re doing? Parallel play nearby? Redirect them to an activity of your choosing?

Me? I observe.

I usually tell the family that the first session is the introduction session and that I’m taking mental notes. In my silence, I start to answer several questions and make observations. Let’s use a kiddo I will call Peter as an example. Peter will be a composite of several different clients I’ve had in the past. He will also be a younger client since many of you that the series is intended for probably work in early intervention. I will rotate my example clients throughout the series.

So when I walk into Peter’s room, the little tyke is paying me little to no attention. He is walking around, humming to himself, and then briefly makes eye contact. I make a mental note of about how long the eye contact was (maybe one second) and will keep an eye on how many times he does it. He then retreats into a corner of the room, on the other side of the bed. So he has some kind of coping skill; he knows when to remove himself from a situation if he feels anxious or unsafe. I don’t follow him over.

While he is there, I ask his parents for some information: preferred toys, daily routine (I take another mental note if there is a lack of one), gross motor activities (does he do a lot of jumping, running, spinning?), family participation (do siblings engage or not, and what is his usual response?). Is Peter overly cautious, or does he throw fear to the wind?

I’m not writing any of this down, but I am starting to build a Peter profile of sorts in my head. All of us do this to some degree with people in our lives, and I assume that Peter is doing something similar with me. These first impressions set the stage for the entire process, so I don’t want to cause him any unnecessary fear or anxiety. The biggest thing I try to avoid is pushing myself into his safe zone too much. For session one, I just want him to know that I am there, I will be coming back, and that I want to play. I tell him this at the start and the end of the session; just because he’s not looking at me, doesn’t mean he’s not listening.

Goal of session one: Recon

For session two, I plan to come baring items of interest.

Holding Space

Over the last few months, this concept has popped up numerous times in both my professional and personal life. It’s not as straightforward as traditional psychological terms and approaches, but I wanted to speak on my view of it since most of us will be in this situation at some point.

There will be moments where you simply won’t know what to say to a person. Perhaps they just lost someone, or are ranting madly because they’ve been wronged in some way. There’s really nothing you can do to help the situation. So, what do you do?

As a therapist, I’ve had these moments. I’ve had to be the solid pillar while someone’s life was falling apart. I’ve had to break seemingly bad news to parents about their child. I’ve had to sit with a teenager while her brother lay in a hospital, dying. In all of these situations, I had to realize that nothing I say is going to make the situation go away. I can’t remove the pain. The other thing I realized was that I could not bring myself to give some kind of rote response. “You’ll be okay” or “Everything happens for a reason” won’t cut it here.

Here is where the concept of holding space comes in. You simply make that space a container. In these moments, people often just need to express. There is no pressure to think up a solution for the person. They already know that you can’t do anything about it. They sometimes already know that they’ll get through it. In that moment, though, they need to process. They need somewhere safe to vocalize their frustrations, sorrow, confusion, and occasionally socially unacceptable thoughts.

Of course, this is easier said than done. In the therapy field, we are almost programmed to think up solutions, and we may think up some right at these difficult moments. A lot of times, though, that’s not what people need. They need to feel a sense of peace, to know that at their most vulnerable moment, you are making them feel safe. I have been on the flip side of this, where I expected a place to be able to express myself, and instead was reduced to tears by someone who felt that I needed a “reality check” at that moment. No, I didn’t. I needed to process my feelings, and I was demeaned for it. After that, I never trusted that person as a confidant again, and I learned how not to be with regards to future clients.

You don’t have to be a therapist to do this. Sometimes friends and family just need to talk, and maybe sit in silence for a bit. We are often so afraid of silence, when it can be an amazing gift. Silence allows processing, and it allows Spirit to enter the picture. To me, this is holding space: creating a safe, peaceful environment to allow another to process and express…and to allow Spirit to enter and help heal.

My Thoughts on ABA

I just realized that I have never given my personal viewpoint on the current poster child of autism therapy, Applied Behavior Analysis. I think this is mostly because I know that I have strong feelings about the subject, and because I was usually surrounded by proponents of ABA and didn’t want to rock the boat. Now removed from it for about a year, I can talk about it more freely and without the anxiety the environment gave me. Please understand that this is my personal opinion, grown from my personal experiences in the ABA field.

I worked at an ABA-centered organization for a few years, so my thoughts do not come from a lack of exposure. The organization actually started out with a different model (and one of my preferred models), the Early Start Denver Model. Then, as Kaiser became more involved due to funding, the organization started to shift gears quickly. I gave it a chance, I really did. I listened to its proponents (some of which are/were friends of mine), got trained in several aspects of ABA, and created treatment plans based on it.

And I eventually hated every second of it.

Okay, hate is a strong word. Let’s see…each day that I worked there took a tiny piece of my soul away. Yikes, that sounded worse. It was true for me, though. Let me break down the reasons why I tried and eventually decided ABA was not for me or most of my clients:

  1. The obsession with fixing what isn’t broken. This is the basis of nearly every issue I have with ABA in general. I have never heard so many references to fixing someone as I have in that field. It is problem-focused almost to an extreme in some cases, and much of my training was solution-focused. That led to an instant clashing of values. I don’t believe autistic people are broken, they just have a different experience with the world.
  2. The therapist/interventionist/analyst is the expert. Um…no. A former boss of mine (who was deep in the rabbit hole of ABA) actually said of our clients’ families, “They’ll listen to us…we’re the experts.” Before I could stop myself, I blurted, “No, we’re not. The client is actually the first expert of themselves, then the parents are a very close second…we’re around third.” That boss and I butted heads from then on. Yes, I’ve studied a lot about autism, and I’ve had many autistic clients. Guess what, though? “If you’ve met one autistic person…you’ve met one autistic person.” In other words, we aren’t experts at all. Guides, maybe. Advisors, perhaps. Experts on autism? Not even close.
  3. Disregard/dismissal of any other approach. I may not be a fan of ABA, but I still respect it as a discipline and a psychological approach (even though quite a few of its supporters don’t want it associated with psychology because I guess psychology isn’t considered a true science…as I sit here with my two science degrees in psychology and counseling). Sadly, the other approaches, some of which I have seen work very well with clients, were met with almost mocking ridicule during my ABA experience. The often-repeated reason was that ABA is “evidence-based” and basically everyone else isn’t. This is a sad catch-22 to me: no funding is given to other approaches to give them an evidence base, and more is going to ABA because it is evidence-based. Good luck getting off that carousel right now. Also, the testimonies I see arising from the adult autistic community suggest that the psychological harm being done by some of the execution of ABA is real, and those voices are largely being ignored by the ABA community (at least to me).
  4. It simply does not fit me or my beliefs with regards to autism. Again, this is all my opinion, based on my experiences with the ABA approach. I don’t agree with the approach in general, and that’s fine. We can agree to disagree. What bothers me is the absolute takeover of ABA (along with “cure seeking”) in the autism world. Actually, it scares me. I have never seen such a monopoly occur in a field (except maybe Apple and the iPod), and when monopolies occur, innovation can be stifled. I have seen colleagues with amazing ideas get shot down repeatedly in ABA-centered organizations, their insights rendered mute. Then these same organizations wonder why they can’t keep solid employees.

Look at it this way: say you need to see a therapist. You got to your HMO doctor to ask for a referral, and they’re happy to give you a list. You notice that everyone on the list is a psychoanalyst. You say, “Um, this is great and all, but I really wanted a cognitive-behavioral therapist.” The doctor replies, “Nope, this is all we have.” You go to your insurance company, and get the same response. You have to choose a psychoanalyst because that is all that is offered. Your chances of getting anything out of those sessions just dropped significantly before you even walked through the door because you didn’t get to choose for yourself. Welcome to the current state of the autism treatment world.

This is what led to my difficult decision to work on the fringe of the field, so to speak. My work is now more developmental in nature, and with a much younger client base. My methods of building trust and a relationship first and foremost, of making the sessions fun and engaging, and involving the family whenever I can have not changed. I am much more happy here. Again, I am not to the point of chanting “down with ABA” (at least not yet); I think all of the different approaches can work in harmony.  However, there needs to be some additional educating to some of ABA’s followers on working with the autistic population, and other approaches need the opportunity to shine again without being shunned by the majority. Yes, ABA is now the majority approach. The ABA field can no longer use the “we’re the underdog” excuse.

No, you’re not. You’re the monopoly now.