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Counseling Aspergers Adults: Musings from a Therapist

One of the more humbling things for therapists is realizing the cases where they missed the diagnosis of Aspergers in working with their clients (and perhaps came up with something else - like Narcissistic Personality Disorder) because they didn’t have adequate training at the time, or because the disorder hadn’t been adequately researched or named yet.

Although named by Hans Asperger in 1946, Aspergers didn’t get codified in the DSM until 1994. For many years thereafter, it was seen as a childhood disorder and not something to consider when working with troubled grown-ups. But more and more, therapists are finding – and diagnosing – Aspergers adults who fell through the cracks as a child (i.e., they would have been diagnosed earlier if we knew then what we know now).

Fortunately, training in the treatment of adult Aspergers is becoming more prevalent in graduate programs and professional in-service opportunities. The diagnosis has now become part of professional discourse and the popular culture. Also, books and materials are emerging to help the experienced therapist (as well as the novice) become familiar with diagnostic issues and treatment options.

While many therapies are appropriate for Aspergers adults, treatment really depends on the person’s response to the diagnosis (and responses can run the gamut from joy to anger and everything in between). Some people are overjoyed, because finally everything makes sense to them (e.g., why they can't hold a job, tolerate noisy children, stay in a relationship, etc.). They have blamed themselves - or others - all their lives. Now they have a framework in which to understand their weaknesses – and their strengths. For a lot of adult “Aspies,” it's a relief!

Of course, there is no obligation to do anything about an Aspergers diagnosis, and some adults simply stop the diagnostic process and walk away. Conversely, for those individuals who are interested in exploring their Aspergers further, the therapist does a debriefing and exploration focused on what the client feels now that he knows about the condition. The therapist (a) does a diagnostic “life mapping,” (b) explores the life map, (c) talks about how all Aspergers adults are different from one another, and (d) creates a treatment plan (e.g., “You came to therapy for a reason. Where would you like to go next?”).

Some of the issues that are explored in treatment include "quality of life" concerns (e.g., leisure interests, social activities, health, employment, family, etc.). The therapist will look at all the different areas that make up quality of life, see how the client is doing, and where the client wants to make some changes.

In addition to working on personal goals, “family work” is often indicated. For example, there are often rifts that have occurred where siblings are no longer talking. The therapist explores questions like, “What do you want to tell your family?” “How would you like to repair relationships?” Sometimes the family members come in to work on issues together.

Beyond cognitive-behavioral therapy, adults with an Aspergers diagnosis have a number of other treatment options. They can request that their therapist write a report that clearly outlines diagnostic issues, IQ, adaptive behaviors, etc. With that report, the Aspie can often qualify for services provided by state and/or federal agencies. Such services range from cognitive therapy to vocational training, job placement, health insurance, and, in some cases, housing.

Some of the therapies that are useful for children are also helpful for adults. For example, sensory integration therapy can be helpful in alleviating hypersensitivity to sound and light, and social skills therapy (often in the form of life-coaching or job-coaching) can improve job situations, friendships, marriages, etc.

Perhaps most important is a "do it yourself" therapy. Aspergers adults have access to books, support groups, conferences and other resources that provide insight, ideas and information on all aspects of life with Aspergers.

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