Being Autistic and Being a Therapist
In some people’s mind the title of this blog just describes an impossibility, a contradiction, like being tone deaf and being a singer, or like the proverbial fish on a bicycle. I was a bit worried for a while myself back in November 2012 when I (a practising therapist of many years standing) discovered that I was a full-strength, undiluted autistic, and always had been. What worried me, as you may have guessed, was that autistic people supposedly have NO EMPATHY. Whereas therapists are of course famed for their empathy (at least in theory – you could get one on a bad day).
So where did that leave me? Well, I resolved this problem the same way that I resolve many of my problems, by educating myself though judicious reading (well, I am autistic). It didn’t take me long to discover that the “autistics have little or no empathy” trope had begun to fall apart once people started to look a bit closer at it – and especially once autistic people started to look a bit closer at it…
To begin with, proponents of the Low Autistic Empathy theory, such as Simon Baron-Cohen, retreated slightly by clarifying that it’s only Cognitive Empathy that we are apparently deficient in – we have buckets of Emotional Empathy (this revised theory can be summarised by saying that we feel for other people’s feelings, but we have no idea why they feel that way). So that’s alright then? Well perhaps, or perhaps not…
It certainly makes us seem more “human”, and definitely matches the experience of high emotional empathy/sensitivity that many autistic people report (sometimes too high). Still, not understanding how other people see and process the world does make us sound very naïve (even if writers like Tony Attwood grudgingly acknowledge that we can eventually catch up to some extent as we get older, by painfully learning cognitive empathy like a second language).
And it still didn’t sound great for a therapist – we probably need both flavours of empathy. Also, rather puzzlingly, I felt I had a decent helping of both of them, and was pretty sure I was a reasonably good therapist (at least for some clients and some issues, which I think is as good as it gets in our complex, uncertain field).
Anyway, cue some intense autistic thinking. (Just to clarify for non-autistics, for an autistic person that means a good few hours a day for at least a few weeks, possibly months – anything less is just ordinary autistic thinking…)What became clear to me was not just how common high emotional empathy is amongst autistic people (sometimes so overwhelming as to oblige a person to shut down their empathy channels for a while, or even for the long-term depending on the nature of their emotional environment). I also began to see what I had always known was true in my own experience, that we autistics often see different, deeper, perhaps realer, interpersonal, social, psychological patterns than non-autistics do. This deeper level of the world is what we are interested in, not the superficial level that most of the social world operates on. So there is a mismatch between
- what we are responding to in non-autistic people in everyday situations, and
- the level at which they want to be responded to.
Hence they don’t feel empathised with.
This is part of what psychologist Damien Milton calls the Double Empathy Problem – autistic people can communicate with other autistic people with little mismatch, as can non-autistic people with other non-autistics. The big “empathy deficit” problems arise with attempts at communication between these two different communication cultures. And of course the deficit goes both ways – both sides can feel misunderstood and unheard.
Of course, I did refer to “everyday situations” above, and the interesting thing about the therapy setting is that it is about as far from an everyday situation as you can get, with its tight boundaries, clearly defined roles, deep level of discussion and probing, unusual communication style, goal-orientation, etc. Perhaps just right for an autistic person, in fact?
Thinking about all of this again more recently put me in mind of the Core Conditions that Carl Rogers, founder of Person-Centred Therapy, saw as necessary in the provision of a successful therapeutic relationship. One of these is our friend Empathy, but there are two others: “Congruence” (genuineness) and “Unconditional Positive Regard” (acceptance without judgement).
(For more details see https://www.simplypsychology.org/client-centred-therapy.html)
It occurred to me that, as we gradually shake off the old, deficit-based view of autism, some of the strengths that are becoming clearly associated with the autistic way of being are in fact qualities like authenticity/genuineness (what you see is what you get) and a naturally non-judgemental attitude to others (live and let live).
For instance, in the excerpt below from the “Discovery Criteria” outlined by Attwood & Gray, we can see exactly these kinds of themes standing out clearly.
A. A qualitative advantage in social interaction, as manifested by a majority of the following:
1. peer relationships characterized by absolute loyalty and impeccable dependability
2. free of sexist, ageist, or culturalist biases; ability to regard others at face value
3. speaking one’s mind irrespective of social context or adherence to personal beliefs
7. listening without continual judgement or assumption
8. interested primarily in significant contributions to conversation; preferring to avoid ritualistic small talk or socially trivial statements and superficial conversation.
9. seeking sincere, positive, genuine friends with an unassuming sense of humour
So I suppose I can keep on being a therapist, for now anyway…