HOW NOT TO START A
THERAPEUTIC RELATIONSHIP
Copyright © 2000 Roger N. Meyer
All Rights Reserved
The following Email exchange
illustrates the typical problem an adult with AS has when encountering a
counseling professional. The therapist holds a Ph.D. and an MSW. Knowing
that he would benefit from cognitive behavioral work, he sought her out
based upon her representations and experience as a CBT specialist.
The therapist charges $145.00 per hour. This exchange followed the client's
confusing intake visit costing $212.50. Throughout the session, the
therapist insisted on deference to her expertise in a struggle for power
inappropriate for any counseling professional in an introductory session. As
you will note below, outside the session she continues to demand it.
The client was confused by the "homework" assigned by the therapist. After
struggling to understand for three days, he sought clarification. She had a
72 hour cancellation notice requirement, and he was up against her deadline.
In a telephone call, he left a message asking her to explain the work he was
to do. Not having heard from her despite his early morning call, he wrote an
email at noon. He left a second telephone message later in the afternoon.
The following material is actual email text, unedited.
His first Email message:
K: I can't make sense of the
assignment. I've left a message for you on your voice mail. I first called
about eight or so in the morning.
R: Her First Response:
Subject: Re: "Second Call"
Date: Tue, 25 Apr 2000
Hi R,
You are probably being too concrete. Allow yourself to acknowledge little
R.. Take out his picture and love him. I know that you cut off those
feelings a long time ago, so this is why it is hard to connect with the
assignment. However, the unconscious understands everything and will comply
with your request, even if your conscious mind balks. Leave it at that and
we will follow through with more intense work at our session.
KM: Her Second Response
Subject: Re: "Second Call"
Date: Tue, 25 Apr 2000
Dear R,
I understand your worries. But I must insist that we do therapy in the
office, not over the phone or e-mail. I will lead you into the techniques
you need to handle your feelings and those of others. Part of the problem
with your disorder is trust. You have none and will have none with anybody.
Unfortunately you will have to trust somewhere to get your goal
accomplished. Your verbal skills are impressive, but they are not a
disguise. If anything, the excessiveness of your analysis gives you away.
We will work on this too.
I do not have a specialty in treating clients with Asperger Syndrome.
However, I have a great deal of experience with cognitive behavioral
therapies and I have worked with autistic children. My daughter has a
classmate with AS that causes my daughter no end of consternation so we
frequently discuss strategies to deal with this girl.
If you still need to be sold, I suggest you cancel your appointment and
continue your search for the ideal therapist. If you are willing to knuckle
down and work at something that frightens the heck out of you, then I am
game. Please call to confirm by Wednesday.
KM: His Second Email
Subject: Re: "Second Call"
K,
Concrete thinking is a bell-ringing diagnostic criterion for Asperger
Syndrome. Just telling the client not to think in a certain way or to put
that paradigm aside to get at emotions is not effective. That's why I know
that CBT will work. Theory of mind issues are an impediment with me. They
can be addressed through specific, programmed behavioral scripting. From my
past experience with many kinds of psychodynamic therapy, I know that my
receptive challenges in identifying general feeling states has been the
barrier. Do not mistake my facility in verbal expression as indicative of an
equally well-developed skill at perceiving emotions, which first means
recognizing that I know how to look for them. Maybe some infants can swim by
being thrown into the swimming pool and paddling naturally. Not me. My
process for receiving emotional messages first requires that I either use
the tools I have to perceive my emotions--and I really have to know I have
them--or get them and learn how to use them.
You are going to find that many of your tools don't work for a person with
AS. If there is to be a working relationship, you must first understand my
vocabulary and my logic to determine whether we are on the same page. At
this point we aren't. I know what you "say;" I simply don't understand.
There is no third party payment scheme that allows me to ignore the fact
that your time is "worth" over twenty times per hour more than what I earn
when I am working in the employ of others.
I don't have the time or the money to bring you up to speed about the
disability if you've had little experience with it.
I didn't really ask you about whether you've worked with persons with AS,
and what the results have been.
Now is "your time" to sell yourself and convince me that you "get it." At
this point I'm not feeling good about your response, and wonder whether it
would be worth while to even keep the second appointment.
Please respond.
Here's my pager number if I'm not immediately available by phone:
503-XXX-XXXX
R: She did call. R felt patronized, belittled, and bullied by her tone
of voice and repetition, almost verbatim, of what she said in her Email.
The client cancelled.
This short article was prepared as part
of a set of initial instructional materials used by clinical counselors
from all disciplines who meet in the Portland, OR metropolitan region as a
monthly study group dedicated to developing best practices in counseling
individuals and family members in he presence of Autistic Spectrum
Disorder (ASD). When the author
discovered that the psychologist who was
previously anonymously referred to in the Emails was hawking her wares and
claiming competence as an AS specialist, he felt an obligation to "out
her" as the type of person she really is. When the author first saw her
for personal counseling, he had no inkling that she had formed such a
destructive, negative impression of AS individuals.
Professionals such as this person should
be avoided, at all costs, by anyone wishing to gain a better understanding
of themselves and their relationships with persons on spectrum, or, for
that matter, off the spectrum. It is clear in the freely available first
chapter to her book that she carries huge unresolved personal baggage that
seeps and leaks into her approach towards individuals on the
spectrum. It's also apparent that the many individual accounts of persons
on the autistic spectrum written over the past decade have done little to
enlighten her. In fact, she appears to have vacuumed negative
characterizations and details in a selective list of 'hopeless"
manifestations that can't be altered by either party to a relationship
where ASD is present. In this regard, she joins the ranks of Bruno
Bettelheim with explanation of the etiology of autism as due to
refrigerator mothers, as well as Freud, both of whom were out and out
frauds.
ENTREPRENEURIAL
COUPLES
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Author, Kathy J. Marshack, Ph.D., P.S.
Davies-Black Publisher, 1998
Chapter 1: Entrepreneurial Couples -- Who
Are They?
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