"One With The Dog"
Why One Must be "One With the Dog"
Imagine, if you can, going through life thinking you are interacting with others in exactly the same manner and you get criticized, punished, and/or ostracized. No one tells you what you did wrong or how to improve upon it. They simply slam you. Imagine the stress and anxiety of attempting to play with children on the playground or interact with your peers at cocktail parties and having to constantly wonder if you will be accused of performing a major social infraction. Imagine the self-doubt and poor self-esteem resulting from countless episodes of these types of social blunders. Imagine the feeling of loneliness and depression, despite your best attempts at engaging others. Is it any wonder why someone with Asperger syndrome/High Functioning Autism (AS/HFA) may want to seclude themselves from others and prefer to play video games in the confines of their bedroom?
Anxiety and stress are extremely common comorbid features associated with AS/HFA In fact, I believe they are a given. How can repeated episodes of the above situations not produce anxiety? But what can we do to help these individuals improve upon their situation? How do we decrease the feeling of walking on eggshells anticipating the next social blunder?
In the field of counseling, a variety of techniques are used to help individuals perceive the world with greater accuracy. Many reactions are self-induced and rapidly spiral out of control. When speaking to the counseling professions, I regularly hear of their frustration in that their clients will utilize the techniques taught in their office but frequently fail to spontaneously use them in real-life situations. How, then do we increase this transference of new information into daily activities?
Use visuals. It is amazing how flow charts, diagrams, pictures, etc. will increase the use of these skills. Most people think using language. We internally self-talk and guide ourselves through new and difficult situations thereby helping to reduce the stress associated with the unknown. But what if you don’t think in words? Temple Grandin’s book Thinking in Pictures describes the workings of her brain in visual pictures rather than in language. She guides herself using pictures, not words. Do the same with your clients. It doesn’t matter how brilliant they are or how verbally accurate they are. If you want them to carryover your ideas, then use visuals.
Use clear language. In short, be blunt. As a therapist you need to change the way you view things. We regard bluntness as rude. That’s because we manipulate others using nonverbal means. Body language, facial expression, eye gaze, and gestures all lend important information in helping you communicate displeasure to others. Think about it, you likely never say “I find your conversation dull and boring and I don’t want to continue with it.” Instead you use nonverbal communication to “say” to your conversational partner “Enough already!” But what happens if the person doesn’t read nonverbal communication as in the case with many people diagnosed with AS/HFA? They are waiting for you to tell them exactly what you want. As therapists we have to realize that these clients require a different strategy than those without the diagnosis. Doing so will not be considered rude. It is a technique to meet their unique needs.
The field of counseling is much more familiar with the following techniques to help reduce stress. If you want to be more effective with this population, it would be beneficial to incorporate them into your therapeutic toolbox.
Mindfulness – Based on Dharma Buddhist meditation, it increases awareness of emotions from within. It helps individuals discover what external triggers make them feel better or worse and how to incorporate these into their daily life. In my practice I refer to this concept as “Be one with the dog” as I have a Zen dog in my office.
Systematic Desensitization – As the name implies, it is based on establishing a hierarchy of fears or activities that create anxiety. It helps the individual to identify coping mechanisms such as breathing, relaxation, and or cognitive reappraisal, to deal with the increase in anxiety. It links these strategies to specific situations and exposure through structured practice while advancing through the hierarchy.
Social Cognitive Learning Theory – The concept behind SCLT is simple, behavior is learned through observation. That’s why I constantly stress social skills are learned by being shamed. A 3-year old will simply reach back and scratch his butt if it itches. A change to this behavior happens when he realizes he will be ridiculed and embarrassed if he continues to do so. This realization that people can, do, and will make judgments about you based on what you do or don’t do is the basis for social awareness and a core fundamental of SCLT. Personal changes can be made without changes in the environment. But think of the individual with AS/HFA’s response – “But my butt was itchy and you shouldn’t make fun of me!” He doesn’t correlate a cause-effect and expects the environment to change for him. Reality check. It won’t. When using SCLT, stress appropriate goal setting and self-regulation. Without these two components, change will be difficult.
Cognitive Behavioral Therapy – Change your thinking and you change your feeling. If you focus on the distressing part, you will continue a downward spiral. I use the concept of swirling around the toilet bowl. Why do that? Climb out as quickly as you can. I also ask what you do when watching a television show that you don’t enjoy. Everyone’s response is “Change the channel.” I then toss out a TV remote and tell him to change the channel in his brain. (Remember Thinking in Pictures?) Be aware of cognitive distortion in which dysfunctional thinking and incorrect assumptions interfere with appropriate decision making. These individuals have countless situations in which they have been accused of doing something that they weren’t (e.g. The child accused of hitting a girl and responding to the teacher with a simple “No,” causing the teacher to think of him as oppositional when in reality he was thinking “No, I was playing tag.”). As a result, they often can’t differentiate if a situation was an accident or a deliberate attack. This leads to retaliation for equality of pain. Try using Comic Strip Conversations to help develop a more appropriate thought process.
Dialectical Behavior Therapy – DBT is cognitive behavioral treatment that was originally developed to treat chronically suicidal individuals diagnosed with borderline personality disorder. It is support oriented. It helps a person identify strengths and builds on them so that the person can feel better about him/herself.
It is cognitive-based. It helps identify thoughts, beliefs, and assumptions that make life harder: “I have to be perfect at everything.” “If I get angry, I’m a terrible person” and helps people to learn different ways of thinking that will make life more bearable: “I don’t need to be perfect at things for people to care about me”, “Everyone gets angry, it’s a normal emotion. It is collaborative. It requires constant attention to relationships between clients and staff. In DBT people are encouraged to work out problems in their relationships with their therapist and the therapists to do the same with them. DBT asks people to complete homework assignments, to role-play new ways of interacting with others, and to practice skills such as soothing yourself when upset. These skills, a crucial part of DBT, are taught in weekly lectures, reviewed in weekly homework groups, and referred to in nearly every group. The individual therapist helps the person to learn, apply and master the DBT skills.
Other techniques helpful may include breathing exercises, progressive relaxation, body awareness, safe zones, quiet spaces, visualization, and lifestyle choices.
Whatever technique you use, it is critical you develop your client’s ability to increase his emotional intelligence. He has to understand what his body is telling him as well as read what other people are telling him. Not doing so assures a continuation of the cycle and doesn’t help anyone.
Imagine, if you can, going through life thinking you are interacting with others in exactly the same manner and you get criticized, punished, and/or ostracized. No one tells you what you did wrong or how to improve upon it. They simply slam you. Imagine the stress and anxiety of attempting to play with children on the playground or interact with your peers at cocktail parties and having to constantly wonder if you will be accused of performing a major social infraction. Imagine the self-doubt and poor self-esteem resulting from countless episodes of these types of social blunders. Imagine the feeling of loneliness and depression, despite your best attempts at engaging others. Is it any wonder why someone with Asperger syndrome/High Functioning Autism (AS/HFA) may want to seclude themselves from others and prefer to play video games in the confines of their bedroom?
Anxiety and stress are extremely common comorbid features associated with AS/HFA In fact, I believe they are a given. How can repeated episodes of the above situations not produce anxiety? But what can we do to help these individuals improve upon their situation? How do we decrease the feeling of walking on eggshells anticipating the next social blunder?
In the field of counseling, a variety of techniques are used to help individuals perceive the world with greater accuracy. Many reactions are self-induced and rapidly spiral out of control. When speaking to the counseling professions, I regularly hear of their frustration in that their clients will utilize the techniques taught in their office but frequently fail to spontaneously use them in real-life situations. How, then do we increase this transference of new information into daily activities?
Use visuals. It is amazing how flow charts, diagrams, pictures, etc. will increase the use of these skills. Most people think using language. We internally self-talk and guide ourselves through new and difficult situations thereby helping to reduce the stress associated with the unknown. But what if you don’t think in words? Temple Grandin’s book Thinking in Pictures describes the workings of her brain in visual pictures rather than in language. She guides herself using pictures, not words. Do the same with your clients. It doesn’t matter how brilliant they are or how verbally accurate they are. If you want them to carryover your ideas, then use visuals.
Use clear language. In short, be blunt. As a therapist you need to change the way you view things. We regard bluntness as rude. That’s because we manipulate others using nonverbal means. Body language, facial expression, eye gaze, and gestures all lend important information in helping you communicate displeasure to others. Think about it, you likely never say “I find your conversation dull and boring and I don’t want to continue with it.” Instead you use nonverbal communication to “say” to your conversational partner “Enough already!” But what happens if the person doesn’t read nonverbal communication as in the case with many people diagnosed with AS/HFA? They are waiting for you to tell them exactly what you want. As therapists we have to realize that these clients require a different strategy than those without the diagnosis. Doing so will not be considered rude. It is a technique to meet their unique needs.
The field of counseling is much more familiar with the following techniques to help reduce stress. If you want to be more effective with this population, it would be beneficial to incorporate them into your therapeutic toolbox.
Mindfulness – Based on Dharma Buddhist meditation, it increases awareness of emotions from within. It helps individuals discover what external triggers make them feel better or worse and how to incorporate these into their daily life. In my practice I refer to this concept as “Be one with the dog” as I have a Zen dog in my office.
Systematic Desensitization – As the name implies, it is based on establishing a hierarchy of fears or activities that create anxiety. It helps the individual to identify coping mechanisms such as breathing, relaxation, and or cognitive reappraisal, to deal with the increase in anxiety. It links these strategies to specific situations and exposure through structured practice while advancing through the hierarchy.
Social Cognitive Learning Theory – The concept behind SCLT is simple, behavior is learned through observation. That’s why I constantly stress social skills are learned by being shamed. A 3-year old will simply reach back and scratch his butt if it itches. A change to this behavior happens when he realizes he will be ridiculed and embarrassed if he continues to do so. This realization that people can, do, and will make judgments about you based on what you do or don’t do is the basis for social awareness and a core fundamental of SCLT. Personal changes can be made without changes in the environment. But think of the individual with AS/HFA’s response – “But my butt was itchy and you shouldn’t make fun of me!” He doesn’t correlate a cause-effect and expects the environment to change for him. Reality check. It won’t. When using SCLT, stress appropriate goal setting and self-regulation. Without these two components, change will be difficult.
Cognitive Behavioral Therapy – Change your thinking and you change your feeling. If you focus on the distressing part, you will continue a downward spiral. I use the concept of swirling around the toilet bowl. Why do that? Climb out as quickly as you can. I also ask what you do when watching a television show that you don’t enjoy. Everyone’s response is “Change the channel.” I then toss out a TV remote and tell him to change the channel in his brain. (Remember Thinking in Pictures?) Be aware of cognitive distortion in which dysfunctional thinking and incorrect assumptions interfere with appropriate decision making. These individuals have countless situations in which they have been accused of doing something that they weren’t (e.g. The child accused of hitting a girl and responding to the teacher with a simple “No,” causing the teacher to think of him as oppositional when in reality he was thinking “No, I was playing tag.”). As a result, they often can’t differentiate if a situation was an accident or a deliberate attack. This leads to retaliation for equality of pain. Try using Comic Strip Conversations to help develop a more appropriate thought process.
Dialectical Behavior Therapy – DBT is cognitive behavioral treatment that was originally developed to treat chronically suicidal individuals diagnosed with borderline personality disorder. It is support oriented. It helps a person identify strengths and builds on them so that the person can feel better about him/herself.
It is cognitive-based. It helps identify thoughts, beliefs, and assumptions that make life harder: “I have to be perfect at everything.” “If I get angry, I’m a terrible person” and helps people to learn different ways of thinking that will make life more bearable: “I don’t need to be perfect at things for people to care about me”, “Everyone gets angry, it’s a normal emotion. It is collaborative. It requires constant attention to relationships between clients and staff. In DBT people are encouraged to work out problems in their relationships with their therapist and the therapists to do the same with them. DBT asks people to complete homework assignments, to role-play new ways of interacting with others, and to practice skills such as soothing yourself when upset. These skills, a crucial part of DBT, are taught in weekly lectures, reviewed in weekly homework groups, and referred to in nearly every group. The individual therapist helps the person to learn, apply and master the DBT skills.
Other techniques helpful may include breathing exercises, progressive relaxation, body awareness, safe zones, quiet spaces, visualization, and lifestyle choices.
Whatever technique you use, it is critical you develop your client’s ability to increase his emotional intelligence. He has to understand what his body is telling him as well as read what other people are telling him. Not doing so assures a continuation of the cycle and doesn’t help anyone.
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