When Therapy is Counterproductive

Despite my strong desire to completely stop therapy sessions with my therapist, I have one more session scheduled this week. She wanted to give me a week to “think about my decision” and have one more appointment on the books to further flesh out my “self-directed plan.” When she rather adamantly urged we have this additional session, I felt myself begrudgingly agreeing, though it felt like the wind was knocked out of my sails a bit. I am still confident in my decision to stop for now and I can feel such a strong emotional pull that way, by that I mean I know that will make me much happier. I get that self-assuring feeling in my gut that it’s the right choice for me at the present time. I’ll keep my mind open to the fact that my circumstances may very well change, making professional psychotherapy an important tool to return to, but for now, I am certain it is more detrimental than beneficial. If I were to be stopping altogether, I’d have a much greater concern that I was “taking the easy way out.” However, I’m so self-disciplined and invested in working on my problems that I know I will hold myself accountable to do the self-directed work I’ve learned to do. In fact, rather than the mere one forty-five-minute block of time per week that has been dedicated to therapy, I’ll likely structure three similarly-lengthened sessions per week under my own direction. I like to be a leader so I feel excited, in a way, to be taking this on. I’m hoping the relatively small part of my personality that embodies rebel tendencies will more dominantly assert itself in an “I’ll show you how much progress I can do on my own” sort of way. I have such a competitive spirit, so I can absolutely imagine myself getting really into pushing myself and researching Cognitive Behavioral Therapy approaches and other techniques out there to really impact and encourage positive changes in my thinking and behavior. Of course, since I’m also impossibly hard on myself, I feel my concerns (that I’ll get too invested in ensuring my own therapy outperforms in-person sessions that I stubbornly cling to it even if it proves otherwise) assuaged. If I’m not doing a good job leading my own therapy work, I’ll quickly jump back into real sessions. I won’t necessarily be happy about that, but I will be compliant.

I wish that my therapist had more (or any!) experience with working with autistic patients. I can’t speak for all the many, many people on the spectrum, but it seems to me that our neurology is quite different, at least mine is. As such, it makes sense that the approaches taken in therapy might need to be different than those that are often effective for neurotypical patients. Again, as every patient, autistic or not, is highly individual, I’m not ignorant enough to think that there are “autistic approaches” and “non-autistic approaches” to therapy. Rather, each patient will have unique needs and ways of thinking, and certain therapeutic techniques and skills may be more or less appropriate or effective for that particular person. That said, I imagine that there may be trends in the effectiveness of these different modalities in the basic differences in neurology seen between autistic patients and neurotypical ones, especially when it comes to communication styles and abilities. Almost every therapy session becomes verbally exhaustive and overwhelming to me and I want to stop talking. More than that though, the stressful and often upsetting process of stirring up and describing difficult emotions naturally invokes selective mutism. I become too exposed or overwhelmed by the flood of painful feelings that I become tongue-tied and unable to speak. Precious, expensive minutes tick away in awkward, embarrassing silence while I try to coerce words to return to answer the posed questions and shatter the tension that’s built by my previously emotive words (and perhaps tears), but none come. I fiddle with my coat zipper or line up jolly ranchers from her candy dish in patterned rows, but talking ceases. I don’t intend for this to happen and find it rather mortifying, especially as she continually nudges me with words like, “Amber, tell me what you’re thinking,” “Amber, you seem upset. Tell me more about that,” and “Amber, did you hear my last question?” No, I can’t tell you what I’m thinking because I can’t seem to speak. No, I can’t tell you why I’m upset or what I’m feeling because words will not come out of my mouth. Yes, of course, I hear you in this quiet room. I feel so much pressure and distressingly self-conscious when she asks these questions and just stares at me silently fidgeting or staring at the rug while individual tear drops slowly spill over my eyelids and tumble onto my lap. I so desperately want to appease her and resume conversation if for no reason that to lessen the awkwardness and vulnerability I feel as her watchful eyes burn my face red. I’m not choosing to be mute. The mutism overrides any conscious ability to speak like a domineering tyrant. My will to talk or not talk is but a powerless pawn; it’s simply irrelevant because it’s impossible to control.

This is one instance where working with a therapist who better understands some of the unique challenges for autistic clients may be more productive or comfortable. I’ve tried to explain to my therapist that those periods of selective mutism don’t have to necessarily be squandered, mortifying minutes. It is true that I cannot speak but I can communicate. With an open mind and creativity, it’s possible to still express myself to her during these silent spells. For example, I’m able to and comfortable with drawing how I’m feeling or sketch what I’m thinking instead of vocalizing it. Though I’m no artist, my child-like cartoonish style of drawing is almost always correctly interpreted by other people. Even if she couldn’t make sense of them, I could make the sketches and then describe them once my ability to speak returned. Drawing can therefore be an effective non-verbal vehicle of communication; moreover, the process of creating it can be cathartic. It would also nearly eliminate the pressure to speak when I’m unable to. I don’t often draw as it’s not an activity I particularly enjoy, but it can be a helpful form of expression and easier for me than talking about some topics. In fact, when describing to my husband the events of the attack I suffered, I made sketches that we worked together to use to help me get the words out to explain the horrors.

I’ll try to keep a good attitude about going tomorrow to tie up loose ends for now and make more plans for how I’ll address the areas I’m working on without her help. I’ll give myself a few weeks of these self-directed sessions before evaluating their effectiveness. All I can say for certain is that it makes me way happier to envision a week free from attending sessions and with how difficult things are and how elusive happiness can be for me right now, that has to count for something.

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