A Decisive Moment for an Asperger Child / Re-Post

imagesLUQ8KKG2My cousin Bette hated her hair because it was so curly that she shrieked and whimpered whenever my aunt yanked a comb through it. My mother loved Bette’s red hair, but regretted my fence-straight bob. The tone of voice she used when referring to my straight hair was an accusation – I made it grow that way.

The hair situation had nothing to do with an important event that happened during a visit to my mother’s sister in Pennsylvania, which happened to coincide with Vacation Bible School. I don’t recall the denomination my relatives supported (there are so many), but the audience didn’t stand, kneel, or sing much. Instead of real wine, grape juice was passed around in paper cups with a tray of white bread croutons.

This scandalized my mother. How could materials available at any grocery store be expected to turn into the blood and flesh of Jesus Christ? Before marrying, my mother had sung professionally in churches: based on those experiences, she had chosen to align our family with the Episcopalians, because not only the priests and acolytes got dressed up, so did the audience, and she still got to sing beautiful songs.

My mother (and the other Episcopalian women) took advantage of God’s demand that women wear hats to church to amass vast collections of seasonal head gear. Judging by the extravagant and expensive hats bobbing about in church, I suspected that it was mortal women who had actually made up the rule, not God.

“Wear the Donald Duck hat,” I would tell my mother whenever we were late for church and she couldn’t decide which hat to wear. The Donald Duck hat was woven from white straw with a blue bill that jutted out above her forehead.

Vacation Bible School had nothing to do with hats, and my attendance could not be prevented by a plea for exemption. Even humor failed. My mother had noticed a reluctant streak in her daughter whenever it came time to cooperate with formal institutions and she insisted that I join my cousin in one more attempt at forced religious indoctrination.

My red-haired cousin and I were dropped off outside the church, where we were seated at a picnic table with kids our age. Adults handed each of us a board covered with blue felt, plus pictures of Jesus and a few loose sheep. Paper cut-out Jesus had typical Sunday school eyes, the kind that look nowhere and everywhere, but which have the power to pry into the shallow secrets of the boring human brain. The sheep were suitably adorable and adoring.

The adults directed us to stick the paper figures to the felt board. No reason was given as to why we should do this. I looked to my cousin and the others, expecting one of them to ask the adults why we were doing this, but the rest were busy deciding whether Jesus should float above the flock near heaven, or to have the sheep crowd around his temporarily earth-bound feet.

I tilted my board for a better look and a breeze caught the pictures. Jesus floated onto the grass. Cousin Bette screamed: “Look what you did! You let Jesus touch the ground!”

Another girl shrieked, “Pick him up. Quick!” as if the three second rule applied to religious pictures as well as to gum.

“Stop shouting,” I told my cousin. “It’s just a piece of paper.”

“No-it-is-not! It’s Jesus, and you let him touch the ground: You are in big trouble!”

“God is gonna punish you,” the other girl gasped.

A feeling passed through me, as if I been removed to a foreign universe, where simple pieces of paper are possessed by invisible beings and small girls are punished by tyrants for trifles.

Of course, at that age, I didn’t think this out, but I surely sensed what had just happened, and it had nothing to do with standing and kneeling; with the squabble over wafers and Wonder Bread, real wine or Welch’s grape juice, or with a rule that said women’s hair had to be covered with shame. Bette and the other children had been taught to fear imaginary entities and to believe that pieces of paper have supernatural power. Did adults lie to children, or did they really believe such things? The unease that had pestered me when adults spoke about ‘God things’ was sharpened into Ah-ha! focus.

My father hedged when I asked him for an explanation. His avoidance told me that his mind was not united in his approach to the world; the engineer wanted to confirm my suspicions of sheer puffery, but deep inside a superstitious and primal fear haunts all people. Collusion in these matters is required by society regardless of personal belief.

A custom developed between us. “Well you know and I know, but keep it quiet around your mother.”

Cousin Bette was correct about being in big trouble, but not in the way she had imagined. Never again would I feel comfortable with people who let crazy ideas rule their minds. Although my questioning nature was sometimes rewarded in school, skepticism in matters of religion would need to be stifled in public, a Herculean task for an Asperger child. A tiny raft of reason and cunning that lay hidden in my brain would ever after have to support me on a journey that led away from my own kind.

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We don’t really know children as individual expressions of the human experiment, because we do our best as a society to never let that person emerge.

 

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Exciting Paper / Enhanced Perception (Autism)

Royal Society Publishing
Note: I think this “pattern-structure perception” applies also to Asperger individuals who are visual sensory thinkers, but proficient in verbal language. That is, it’s not an “either or” situation in actual brains. (This “either or” insistence is NT projection of their black and white, oppositional, competitive obsession). Specific brains can and do process and sensory info and utilize verbal language; these are not “matter-antimatter” interactions as NTs imagine.  

Enhanced perception in savant syndrome: patterns, structure and creativity

Laurent Mottron, Michelle Dawson, Isabelle Soulières / .

Full paper: http://rstb.royalsocietypublishing.org/content/364/1522/1385.long

5. Savant creativity: a different relationship to structure

Savant performance cannot be reduced to uniquely efficient rote memory skills (see Miller 1999, for a review), and encompasses not only the ability for strict recall, requiring pattern completion, but also the ability to produce creative, new material within the constraints of a previously integrated structure, i.e. the process of pattern generation. This creative, flexible, albeit structure-guided, aspect of savant productions has been clearly described (e.g. Pring 2008). It is analogous to what Miller (1999, p. 33) reported on error analyses in musical memory: ‘savants were more likely to impose structure in their renditions of musical fragments when it was absent in the original, producing renditions that, if anything, were less ‘literal’ than those of the comparison participants’. Pattern generation is also intrinsic to the account provided by Waterhouse (1988).

The question of how to produce creative results using perceptual mechanisms, including those considered low-level in non-autistics, is at the very centre of the debate on the relationship between the nature of the human factor referred to as intelligence and the specific cognitive and physiological mechanisms of savant syndrome (maths or memory, O’Connor & Hermelin 1984; rules or regularities, Hermelin & O’Connor 1986; implicit or explicit, O’Connor 1989; rhyme or reason, Nettlebeck 1999). It also echoes the questions raised by recent evidence of major discrepancies in the measurement of autistic intelligence according to the instruments used (Dawson et al. 2007).

A combination of multiple pattern completions at various scales could explain how a perceptual mechanism, apparently unable to produce novelty and abstraction in non-autistics, contributes in a unique way to autistic creativity. The atypically independent cognitive processes characteristic of autism allow for the parallel, non-strategic integration of patterns across multiple levels and scales, without information being lost owing to the automatic hierarchies governing information processing and limiting the role of perception in non-autistics. (Remember; in visual perception and memory the image is the content; therefore it is dense with detail and connections – “patterns”. NTs “fill-in” the gaps in their perception with “magical / supernatural” explanations for phenomena)

An interest in internal structure may also explain a specific, and new, interest for domains never before encountered. For example, a savant artist newly presented with the structure of visual tones learned this technique more rapidly and proficiently than typical students (Pring et al. 1997). In addition, the initial choice of domain of so-called restricted interest demonstrates the versatility of the autistic brain, in the sense that it represents spontaneous orientation towards, and mastering of, a new domain without external prompts or instruction. How many such domains are chosen would then depend on the free availability of the kinds, amounts and arrangements of information which define the structure of the domain, according to aspects of information that autistics process well. Generalization also occurs under these circumstances, for example, to materials that share with the initial material similar formal properties, i.e. those that allow ‘veridical mapping’ with the existing ability. In Pring & Hermelin (2002), a savant calendar calculator with absolute pitch displayed initial facility with basic number–letter associations, and was able to quickly learn new associations and provide novel manipulations of these letter–number correspondences.

The apparently ‘restricted’ aspects of restricted interests are at least partly related to pattern detection, in that there are positive emotions in the presence of material presenting a high level of internal structure, and a seeking out of material related in form and structure to what has already been encountered and memorized. Limitation of generalization may also be explained by the constraints inherent in the role of similarity in pattern detection, which would prevent an extension of isomorphisms to classes of elements that are excessively dissimilar to those composing the initial form. In any case, there is no reason why autistic perceptual experts would be any less firm, diligent or enthusiastic in their specific preferences for materials and domains than their non-autistic expert counterparts. However, it must also be acknowledged that the information autistics require in order to choose and generalize any given interest is likely to be atypical in many respects (in that this may not be the information that non-autistics would require), and may not be freely or at all available. In addition, the atypical ways in which autistics and savants learn well have attracted little interest and are as yet poorly studied and understood, such that we remain ignorant as to the best ways in which to teach these individuals (Dawson et al. 2008). Therefore, a failure to provide autistics or savants with the kinds of information and opportunities from which they can learn well must also be considered as explaining apparent limitations in the interests and abilities of savant and non-savant autistics (see also Heaton 2009).

6. Structure, emotion and expertise

While reliable information about the earliest development or manifestations of savant abilities in an individual is very sparse, biographies of some savants suggest a sequence starting with uninstructed, sometimes apparently passive, but intent and attentive (e.g. Horwitz et al. 1965; Selfe 1977; Sacks 1995) orientation to and study of their materials of interest. In keeping with our proposal about how savants perceive and integrate patterns, materials that spontaneously attract interest may be at any scale or level within a structure, including those that appear unsuitable for the individual’s apparent developmental level. For example, Paul, a 4-year-old autistic boy (with a presumed mental age of 17 months), who was found to have outstanding literacy, exceeding that of typical 9-year olds, intently studied newspapers starting before his second birthday (Atkin & Lorch 2006). It should not be surprising that in savants, the consistent or reliable availability of structured or formatted information and materials can influence the extent of the resulting ability. For example, the types of words easily memorized by NM, proper names, in addition to being redundant in Quebec, share a highly similar structural presentation in the context where NM learned them, including phone books, obituaries and grave markers (Mottron et al. 1996, 1998). However, a fuller account of why there is the initial attraction to and preference for materials with a high degree of intrinsic organization, and for specific kinds of such structured materials in any particular individual, is necessary.

Positive emotions are reported in connection with the performance of savant abilities (e.g. Selfe 1977; Sloboda et al. 1985; Miller 1989). Therefore, it is possible that a chance encounter with structured material gives birth to an autistic special interest, which then serves as the emotional anchor of the codes involved in savant abilities, associated with both positive emotions and a growing behavioural orientation towards similar patterns (Mercier et al. 2000). Brain structures involved in the processing of emotional content can be activated during attention to objects of special interest in autistics (Grelotti et al. 2005). So-called repetitive play in autism, associated with positive emotions, consists of grouping objects or information encompassing, as in the codes described above, series of similar or equivalent attributes. In addition, in our clinical experience, we observe that repetitive autistic movements are often associated with positive emotions.

One possibility worth further investigation would be that patterns in structured materials, in themselves, may trigger positive emotions in autism and that arbitrary alterations to these patterns may produce negative emotions (Yes! Stop f—ing with our interests!)—a cognitive account of the insistence on sameness with which autistics have been characterized from the outset (Kanner 1943). Individuals who excel in detecting, integrating and completing patterns at multiple levels and scales, as we propose is the case with savants, would have a commensurate sensitivity to anomalies within the full array of perceived similarities and regularities (e.g. O’Connell 1974). In Hermelin & O’Connor (1990), an autistic savant (with apparently very limited language skills) known for his numerical abilities, including factorization, but who had never been asked to identify prime numbers, instantly expressed—without words—his perfect understanding of this concept when first presented with a prime number. The superior ability of autistics to detect anomalies—departures from pattern or similarity—has accordingly been reported (e.g. Plaisted et al. 1998; Baron-Cohen 2005).

Overexposure to material highly loaded with internal structure plausibly favours implicit learning and storage of information units based on their perceptual similarity, and more generally, of expertise effects. Savants benefit from expertise effects to the same extent as non-autistic experts (Miller 1999). Among expertise effects is the recognition of units at a more specific level compared with non-experts and the suppression of negative interference effects among members of the same category. Reduced interference has been demonstrated between lists of proper names in a savant memorizer (Mottron et al. 1998). Another expertise effect is the ‘frequency effect’, the relative ease with which memorization and manipulation of units, to which an individual has been massively exposed, can be accomplished (Segui et al. 1982). For example, Heavey et al. (1999) found that calendar calculators recalled more calendar-related items than controls matched for age, verbal IQ and diagnosis, but exhibited unremarkable short- or long-term recall of more general material unrelated to calendars. These two aspects of expertise would favour the emergence and the stabilization of macrounits (e.g. written code in a specific language, or set of pitches arranged by harmonic rules), which are perceptually the spatio-temporal conjunctions of recognizable patterns related by isomorphisms. Conversely, pattern detection may be unremarkable or even diminished in the case of arbitrarily presented unfamiliar material (Frith 1970).

Identifying savant syndrome as aptitude, material availability and expertise, combined with an autistic brain characterized by EPF, is also informative on the relationship between savant syndrome and peaks of ability in non-savant autistics. Perceptual peaks are largely measured using materials with which the participant has not been trained, whereas savant syndrome encompasses the effects of a life spent pursuing the processing of specific information and materials. We therefore forward the possibility that the range and extent of autistic abilities may be revealed only following access to specific kinds, quantities and arrangements of information. However, we do not expect savant abilities to differ from non-savant autistic peaks of ability in their basic mechanisms. According to this understanding of differences between savant and non-savant autistics, the fact that not all autistics are savants is no more surprising than the fact that not all non-autistics are experts.

NTs fill-in the gaps in their perception of the environment with magical beliefs; magical thinking is a developmental stage in young children.  

What psychologists say: Stage by Stage, age 3 – 4

  • Threes and fours often use magical thinking to explain causes of events.
  • Preschoolers sometimes assign their own thinking as a reason for occurrences that are actually out of their control.
  • Three- and 4-year-olds believe, with their powers of magical thinking, that they can change reality into anything they wish.

Every Asperger Needs to Read this Paper! / Symptoms of entrapment and captivity

Research that supports my challenge to contemporary (American) psychology that Asperger symptoms are the result of “captivity” and not “defective brains” 

From: Depression Research and Treatment

Depress Res Treat. 2010; 2010: 501782. Published online 2010 Nov 4. doi:  10.1155/2010/501782 PMCID: PMC2989705

Full Article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2989705/

Testing a German Adaption of the Entrapment Scale and Assessing the Relation to Depression

Manuel Trachsel, 1 ,* Tobias Krieger, 2 Paul Gilbert, 3 and Martin Grosse Holtforth 2 :

Abstract

The construct of entrapment is used in evolutionary theory to explain the etiology of depression. The perception of entrapment can emerge when defeated individuals want to escape but are incapable. Studies have shown relationships of entrapment to depression, and suicidal tendencies. The aim of this study was a psychometric evaluation and validation of the Entrapment Scale in German (ES-D). 540 normal subjects completed the ES-D along with other measures of depressive symptoms, hopelessness, and distress. Good reliability and validity of the ES-D was demonstrated. Further, whereas entrapment originally has been regarded as a two-dimensional construct, our analyses supported a single-factor model. Entrapment explained variance in depressive symptoms beyond that explained by stress and hopelessness supporting the relevance of the construct for depression research. These findings are discussed with regard to their theoretical implications as well as to the future use of the entrapment scale in clinical research and practice.

Being outnumbered by social humans, 99% to 1%, is de facto defeat and captivity

1. Introduction

Assuming a certain degree of adaptivity of behavior and emotion, evolutionary theorists have suggested various functions of moodiness and depression. Whereas adaptive mechanisms may become functionally maladaptive [1, 2], there have been many attempts to explain potentially adaptive functions of depression. For example, Price [3] suggested that depression evolved from the strategic importance of having a de-escalating or losing strategy. Social rank theory [4, 5] built on this and suggests that some aspects of depression, such as mood and drive variations, may have evolved as mechanisms for regulating behavior in contexts of conflicts and competition for resources and mates. Hence, subordinates are sensitive to down rank threats and are less confident than dominants, while those who are defeated will seek to avoid those who defeated them. Depression may also serve the function to help individuals disengage from unattainable goals and deal with losses [6]. 

Social rank theory (e.g., [4]) links defeat states to depression. Drawing on Dixon’s arrested defences model of mood variation [7, 8], this theory suggests that especially when stresses associated with social defeats and social threats arise, individuals are automatically orientated to fight, flight or both. Usually, either of those defensive behaviors will work. So, flight and escape remove the individual from the conditions in which stress is arising (e.g., threats from a dominant), or anger/aggression curtails the threat. These defensive behaviors typically work for nonhuman animals. However, for humans, such basic fight and flight strategies may be less effective facing the relatively novel problems of living in modern societies, perhaps explaining the prevalence of disorders such as depression [8]. Dixon suggested that in depression, defensive behaviors can be highly aroused but also blocked and arrested and in this situation depression ensues. Dixon et al. [8] called this arrested flight. For example, in lizards, being defeated but able to escape has proven to be less problematic than being defeated and being trapped. Those who are in caged conditions, where escape is impossible, are at risk of depression and even death [9]. Gilbert [4, 10] and Gilbert and Allan [5] noted that depressed individuals commonly verbalize strong escape wishes and that feelings of entrapment and desires to escape have also been strongly linked to suicide, according to O’Connor [11]. In addition they may also have strong feelings of anger or resentment that they find difficult to express or become frightening to them. (Or are NOT ALLOWED to express, without being punished) 

Gilbert [4] and Gilbert and Allan [5] proposed that a variety of situations (not just interpersonal conflicts) that produce feeling of defeat, or uncontrollable stress, which stimulate strong escape desires but also makes it impossible for an individual to escape, lead the individual to a perception of entrapment. They defined entrapment as a desire to escape from the current situation in combination with the perception that all possibilities to overcome a given situation are blocked. Thus, theoretically entrapment follows defeat if the individual is not able to escape. This inability may be due to a dominant subject who does not offer propitiatory gestures following antagonistic competition, or if the individual keeps being attacked. (Relentless social bullying) 

In contrast to individuals who feel helpless (cf. the concept of learned helplessness [12]), which focus on perceptions of control, the entrapped model focuses on the outputs of the threat system emanating from areas such as the amygdala [13]. In addition, depressed people are still highly motivated and would like to change their situation or mood state. It was also argued that, unlike helplessness, entrapment takes into account the social forces that lead to depressive symptoms, which is important for group-living species with dominance hierarchies such as human beings [14]. Empirical findings by Holden and Fekken [15] support this assumption. Gilbert [4] argued that the construct of entrapment may explain the etiology of depression better than learned helplessness, because according to the theory of learned helplessness, helpless individuals have already lost their flight motivation whereas entrapped individuals have not.

According to Gilbert [4], the perception of entrapment can be triggered, increased, and maintained by external factors but also internal processes such as intrusive, unwanted thoughts and ruminations can play an important role (e.g., [16, 17]). For example, ruminating on the sense of defeat or inferiority may act as an internal signal of down-rank attack that makes an individual feel increasingly inferior and defeated. Such rumination may occur despite the fact that an individual successfully escaped from an entrapping external situation because of feelings of failure, which may cause a feeling of internal entrapment. For example, Sturman and Mongrain [18] found that internal entrapment increased following an athletic defeat. Moreover, thoughts and feelings like “internal dominants” in self-critics may exist that can also activate defensive behaviors.

For the empirical assessment of entrapment, Gilbert and Allan [5] developed the self-report Entrapment Scale (ES) and demonstrated its reliability. Using the ES, several studies have shown that the perception of entrapment is strongly related to low mood, anhedonia, and depression [5, 1921]. Sturman and Mongrain [22] found that entrapment was a significant predictor of recurrence of major depression. Further, Allan and Gilbert [23] found that entrapment relates to increased feelings of anger and to a lower expression of these feelings. In a study by Martin et al. [24], the perception of entrapment was associated with feelings of shame, but not with feelings of guilt. Investigating the temporal connection between depression and entrapment, Goldstein and Willner [25, 26] concluded that the relation between depression and entrapment is equivocal and might be bilateral; that is, entrapment may lead to depression and vice versa.

Entrapment was further used as a construct explaining suicidal tendency. In their cry-of pain-model, Williams and Pollock [27, 28] argued that suicidal behavior should be seen as a cry of pain rather than as a cry for help. Consistent with the concept of arrested flight, they proposed that suicidal behavior is reactive. In their model, the response (the cry) to a situation is supposed to have the following three components: defeat, no escape potential, and no rescue. O’Connor [11] provided empirical support in a case control study by comparing suicidal patients and matched hospital controls on measures of affect, stress, and posttraumatic stress. The authors hypothesized that the copresence of all three cry-of-pain variables primes an individual for suicidal behavior. The suicidal patients, with respect to a recent stressful event, reported significantly higher levels of defeat, lower levels of escape potential, and lower levels of rescue than the controls. Furthermore, Rasmussen et al. [21] showed that entrapment strongly mediated the relationship between defeat and suicidal ideation in a sample of first-time and repeated self-harming patients. Nevertheless, there has also been some criticism of the concept of entrapment as it is derived from animal literature [29].

To our knowledge so far, there is no data on the retest reliability or the temporal stability of the Entrapment Scale. Because entrapment is seen as a state-like rather than a trait-like construct, its stability is likely dependent on the stability of its causes. (Remove the social terrorism, or remove yourself) Therefore, if the causes of entrapment are stable (e.g., a long-lasting abusive relationship), then also entrapment will remain stable over time. In contrast, for the Beck Hopelessness Scale (BHS), there are studies assessing temporal stability that have yielded stable trait-like components of hopelessness [30]. Young and coworkers [30] stated that the high stability of hopelessness is a crucial predictor of depressive relapses and suicidal attempts. For the Perceived Stress Questionnaire (PSQ), there are studies examining retest reliability. The PSQ has shown high retest reliability over 13 days (r = .80) in a Spanish sample [31]. It is to be expected that with longer retest intervals as in the present study (3 months), the stability of perceived stress will be substantially lower. We, therefore, expect the stability of entrapment to be higher than that of perceived stress as a state-like construct, but lower than that of hopelessness, which has been shown to be more trait-like [32].

Previous research is equivocal regarding the dimensionality of the entrapment construct. Internal and external entrapment were originally conceived as two separate constructs (cf. [5]) and were widely assessed using two subscales measuring entrapment caused by situations and other people (e.g., “I feel trapped by other people”) or by one’s own limitations (e.g., “I want to get away from myself”). The scores of the two subscales were averaged to result in a total entrapment score in many studies. However as Taylor et al. [33] have shown, entrapment may be best conceptualized as a unidimensional construct. This reasoning is supported by the observation that some of the items of the ES cannot easily be classified either as internal or external entrapment and because the corresponding subscales lack face validity (e.g., “I am in a situation I feel trapped in” or “I can see no way out of my current situation”).

5. Discussion

The entrapment construct embeds depressiveness theoretically into an evolutionary context. The situation of arrested flight or blocked escape, in which a defeated individual is incapable of escaping despite a maintained motivation to escape, may lead to the perception of entrapment in affected individuals [8]. In this study, the Entrapment Scale (ES) was translated to German (ES-D), tested psychometrically, and validated by associations with other measures. This study provides evidence that the ES-D is a reliable self-report measure of entrapment demonstrating high internal consistency. The study also shows that the ES-D is a valid measure that relates to other similar constructs like hopelessness, depressive symptoms or perceived stress. Levels of entrapment as measured with the ES-D were associated with depressiveness, perceived stress, and hopelessness, showing moderate to high correlations. Results were consistent with those obtained by Gilbert and Allan [5]. Entrapment explained additional variance in depressiveness beyond that explained by stress and hopelessness. Taken together, the present data support the conception of entrapment as a relevant and distinct construct in the explanation of depression. (And much of Asperger behavior)

The results of our study confirm the findings of Taylor et al. [33], thereby showing that entrapment is only theoretically, but not empirically, separable into internal and external sources of entrapment. The authors even went further by showing that entrapment and defeat could represent a single construct. Although in this study the defeat scale [5] was not included, the results are in line with the assumption of Taylor et al. [33] and support other studies using entrapment a priori as a single construct. However, although this study supports the general idea that escape motivation affects both internal and external events and depression, clinically it can be very important to distinguish between them. For example, in studies of psychosis entrapment can be very focused on internal stimuli, particularly voices [47].

The state conceptualization of entrapment implies that the perception of entrapment may change over time. Therefore, we did not expect retest correlations as high as retest correlations for more trait-like constructs like hopelessness [32]. Since the correlation over time is generally a function of both the reliability of the measure and the stability of the construct, high reliability is a necessary condition for high stability [48]. In this study, we showed that the ES-D is a reliable scale, and we considered retest correlations as an indicator for stability. The intraclass correlation of .67 suggests that entrapment is more sensitive to change than hopelessness (r = .82). Furthermore, the state of entrapment seems to be more stable than perceived stress, which may be influenced to a greater extent by external factors. Given the confirmed reliability and validity of the ES-D in this study, we therefore cautiously conclude that entrapment lies between hopelessness and perceived stress regarding stability.

Whereas the high correlation between entrapment and depressive symptoms in this study may be interpreted as evidence of conceptual equivalence, an examination of the item wordings of two scales clearly suggest that these questionnaires assess distinct constructs. However, the causal direction of this bivariate relation is not clear. Theoretically, both directions are plausible. Entrapment may be a cause or a consequence of depressive symptoms, or even both. Unfortunately, studies examining the temporal precedence so far have yielded equivocal results and have methodological shortcomings (e.g., no clinical samples, only mild and transitory depression and entrapment scores with musical mood induction) in order to answer this question conclusively [25, 26]. It remains unclear whether entrapment only is depression specific. Entrapment might not only be associated with depression, but also with other psychological symptoms, or even psychopathology in general. This interpretation is supported by research showing a relation between distress arising from voices and entrapment in psychotic patients [49, 50]. Furthermore, other studies show the relation between entrapment and depressive symptoms [5153] and social anxiety and shame [54] in psychosis. The usefulness of entrapment as a construct for explaining psychopathologies in humans has been questioned [29]. Due to the present study, it is now possible to investigate entrapment in psychopathology in the German speaking area.

Modern social humans and the social hierarchy: Driving Asperger types crazy for thousands of years!

 

Adult Aspergers discuss bullies and manipulators / Re-Post

Adult AS discussion about Asperger individuals having a talent for setting off “typical” humans, specifically, becoming targets for bullies and the recipients of angry responses from “nice” people.

Edited and paraphrased to protect identities.

Topic: It seems that being Asperger’s means that I have SUCKER tattooed across my forehead. Anyone else agree? Any advice? 

Me too – since the day I was born and the result has been a very difficult life.

Aspies seem strange to other people: people fear what they don’t understand. The sad thing is, most Aspies are honest and sensitive and pay attention to other people and their needs. Guess this is what makes us so strange. The normal majority are not honest or sensitive to other people’s needs. We are strange because we love and care. We are hated because we are non violent; honesty and fairness make us unpredictable and that intimidates the average SOB. There is no way we can change ourselves to be as mean as most NTs.

It will be a long wait until society gets better and can make room for honest and intelligent people with good intentions. It could be a very long wait.

Asperger’s can put you at higher risk for this sort of thing (bullying, deception) but unfortunately (or I guess fortunately if it helps you feel better) anyone with low self esteem and poor social skills, and not Asperger’s, is at risk for all of those things. Also, I would bet that these so called “normal” people are only acting nice because society pushes them to be. Anyone who is a bully will bully lots of people, but they feel safe doing it to people like Asperger’s. Bullies aren’t nice people who are being mean, they are cowards being mean to people who won’t fight back.

Very true – “nice” people gave me hell most of my life. Nice normal people get angry at my very prescence in a room. It is hell to deal with our very complicated soul, while at the same time having to be confronted by unjustified cruelty in the  normal social environment. But is there a solution ?

I stay away from people as much as it is possible. it’s very hard, sad, and lonely but at least I’m alive and I don’t get beat up.

I do whatever “works”. I don’t care about being “socially appropriate”. Is there a reason to be ethical around unethical people, who create corrupt systems? Wouldn’t it be more unethical to allow them to get away with being unfair? Doing what is effective is only logical.

I also have never cared about what is considered to “socially appropriate” behavior because underhanded tactics are what is be socially appropriate. To play the game – to inspire fear or to manipulate people – is not something I’ll recommend to Aspies as it doesn’t fit our personality.

NTs are good at and like manipulating people because they seek power above anything else. Most Aspies don’t care about that stuff: power is for idiots

I don’t want power over people or social status. I want do as I please, as long as it’s fair, which isn’t always possible. My experience is that an Aspie must use strategic thinking to break free of the malevolent actions and unjust rules that NTs use to attack a person with ASD.

You know how hard it is to “read” NTs, and how their behaviour is so confusing? It’s the same for many NTs too, but we’re that lone nail that stands out from the masses. I don’t understand bullying, but I know it’s a survival thing, like an animal picking out the weakest in the litter and kicking it out. But, since humans don’t live in the forest and stuff, there’s nowhere for “one of us” to go – we become withdrawn, even die, or stay and try to take the blows.

Sounds sad and sombre, and it is.

I’d like to say that a common myth about Asperger people is that our lack of manipulation skills is because we’re weak or naive. Just the opposite is true – nothing terrifies NTs more than someone who expresses himself directly with no hidden agenda, or irony, or double meaning. With an Aspie, what you see is what you get. I think that assertiveness it is much better; use your natural strengths so you can be more creative and spontaneous.

I served in the military and everyone thought I was weird, but also very good at my job. And even though I was called “a freak of nature” they knew they could count on me no matter what.  An Aspie should count on his “native” strength and skills instead of wasting them on NT games. In short – be yourself

For me, Hell is the waste of time and energy that having to deal bullies takes. The bully demands my time … how dysfunctional is that? “

I don’t think there’s any doubt that we bring out the worst in some people. I assumed it was because there’s some “body language” thing that we’re doing or not doing. People  react as if we’re a threat or something. My attitude is to be extremely wary. I’ve become attuned to the signs that someone is getting annoyed or aggressive, and say something like … “it’s not necessary to get angry”. Of course, there’s a big risk saying that will cause some people to get even angrier.

Unfortunately, confronting people wears me out. Always warring with people leaves me more vulnerable to meltdowns – I end up being tired and over-stimulated.

Actually, I don’t really believe that normal nice people are bullies. Normal nice people do not do these things to people. It’s the bullies against everyone else. They hurt anyone that they think will let them get away with it.

What is the Asperger “Blank Stare” all about? / Re-Post

What is the Aspie blank stare and why is it a disturbing facet of Aspie behavior?

Complaint from an Aspie ‘Mum’ about her son, decoded:

MUM: In my experience, I would get a blank stare when I asked (my Asperger son) a question.  It could be, for example, what he would like for dinner? What happened at school? You know – normal sorts of ‘Mum’ questions!

Answer: Social typical questions tend to be vague and non-specific. A specific question would be: “Would you like pizza or hot dogs for dinner?” Or try, “We’re having hamburgers for dinner. I bought the kind of buns you like and you can add tomatoes or pickles or cheese, or whatever else you like.”  “What stories did you read in reading class today?”

MUM: How did I interpret the blank stare that I got?

At the time, I believed that ‘the blank stare’ was used by (SON) to avoid answering the questions I asked questions I thought were easy to answer! I realize now, that in my frustration over not getting an answer, I would pile on the questions one after another, and (SON) didn’t have time to process even the first one! I would get cross with him, frustrated that he seemed to refuse to respond to my requests for information, and I would give up.

Answer: One of the big mistakes that social typicals make is to attribute INTENT to Asperger behavior. This is because social typicals are “self-oriented” – everything is about THEM; any behavior on the part of a human, dog, cat, plant or lifeform in a distant galaxy, must be directed at THEM. Example: God, or Jesus, or whomever, is paying attention 24/7 to the most excruciatingly trivial moments in the lives of social typicals. We’re not as patient as God or Jesus.

The Asperger default mental state is a type of reverie, day-dreaming, trance or other “reflective” brain process; that is, we do “intuitive” thinking. The “blank face” is because we do not use our faces to do this type of thinking. 

Sorry – we’re just busy elsewhere! When you ask a question, it can take a few moments to “come out of” our “reverie” and reorient our attention. If you are asking a “general question” that is meant to elicit a “feeling” (social) response, it will land like a dead fish in front of us. Hence the continued “blankness”.  

MUM: What is the real cause of the blank stare?

I believe that SON uses the blank stare while he is processing a question. If give him enough time, he will think deeply, and consider his response, which is often unexpected.

Answer: The “blank stare” is due to our type of brain activity. We process questions; processing questions adds to response time. Some questions are so vague that we simply cannot answer them. Some questions aren’t questions at all, but are an attempt to get our attention and to get a “social” something from us. This is truly confusing. 

MUM: (I’m told that) at any given moment an Aspie is taking in lots of information from the world around them. They notice details that normal people ignore. These details can easily result in sensory overload. The blank stare is used by Aspies as a way to ‘zone out’, or ‘go into themselves’ as a coping mechanism for when their senses are overloaded.

Answer: Not correct (in my experience). Sensory overload is another matter entirely; sensory overload results in the desire to flee, and if we can’t “get away” we experience meltdown. Other Aspies may have a different take on this.

Aspie chat concerning “The Stare”

“I watched “Rain Man” again recently. There was a scene where Dusty was sitting on a park bench and just looking at the ground, and Tom Cruise started YELLING at him. I felt like, “Hey ! sometimes I just sit and think about things, and maybe I’m staring at the ground, so cool it Tom.” We tend to look off into the horizon while we’re talking, and really, it’s not a big deal …”

“At work I’ll be at my desk just working away and people will tell me to cheer up when I don’t feel at all down. Also, if I’m standing around somewhere, and not focusing on anything in particular – and feeling fine, someone will ask me if I’m OK or if I’m pissed off about something. Something about my neutral (not happy or sad, just contented) expression makes people think I’m depressed or angry.”

“People are always doing one of the following: Ask me if I’m okay because I’m staring off into the distance; look behind their back to see what I’m staring at; or tell me to “SMILE!” because I don’t have any facial expression.”

Yes, social typicals are self-centered and demanding. They don’t want to “put up with” a blank face; it damages their perfect narcissistic universe, in which it is everyone’s job to make them feel important.

And then, there is the other “eye” problem:

“I dont get it…..my teacher tells me to look at her when she talks and when I look at other people they tell me to stop staring at them. What the…?”

“Apparently staring and looking are two different things, not that I know how to tell the difference.”

The teacher demands eye-contact because it indicates OBEDIENCE – SUBMISSION. Authoritarian adults demand instant obedience from children. But if you stare at a  “regular” person, that causes another problem. You are claiming higher status; predators stare down prey; you, dear Aspie, are unwittingly behaving like a predator.

“I stare because I get easily distracted by details and I want to see more; it’s just attention to detail. I’m doing better at straight eye contact, but open my eyes too wide because I’m trying hard to focus and pay attention.”

“If I am interested in what a person is saying – it’s new to me or important information, I will stare like a laser. Also if I am trying to recognize someone that looks vaguely familiar, or there is something interesting about how they look and I want to examine it. If I’m not interested, I won’t look at them. However, that does not mean I am not listening just because I am not looking at them.”

It seems to me, that Aspies use our senses as nature intended: We use our eyes to see and we use our ears to listen. 

 

 

 

Home / The place an Asperger will never know.

It’s not a summer or winter thing: it happens at odd moments. Instinct: Intuition. Intuition is instinct talking, taking me to an ancient place, to collective memories; to memories collected by our species, to ways of being that go to the beginning, to immortal chemistry that still blankets the earth.

Busy, busy, busy. That’s what life is. We humans are excruciatingly slow, not in our chemistry, but in awareness. There is a talent in our repertoire that is quite mysterious; we can stop time with our brain: hold the earth still, isolate everything around us, and abstract a new magnified world. See ourselves as if through a microscope; detect and dissect the objects around us, down to atoms and subatomic particles, and shadows of particles, eventually meeting the nothingness from which all the universe is made.

We don’t have to go far back in human instinct to come upon a rock solid concept of home. It’s where we all want to go, that is, if we’re not there now. It’s a principle we share with most living things. A plant is rooted; it’s offspring may grow around it and replace it, or the seeds may be carried a few, or hundreds, or thousands of miles away to new homes. Creatures on reefs, birds in the air that return to nest, migrating mammals and burrowing rodents: every living thing has a home, or two; some exact location embedded in their body as magnetic lines of force, or angles of sunlight, or distinctive molecules that point up river.

I used wear a glass pendant made with the figure of a snail, and a caption, “Always at Home.” This cheered me up, when as an undiagnosed Asperger, no place felt like home.  I had to be my home; a set of thinking and behaviors that aimed through the unfamiliar social world like headlights through the fog. This identity seemed to me to be a lucky and fortuitous “given” skill, because the world I encountered became increasingly chaotic, arbitrary and ruled by unattractive emotions: jealousy, revenge, exclusion, insincerity, false friendship and a motivating principle involving social utility: What can I get from Person X by pretending to be interested and “on the same wavelength?”

Even more confusing was that the personality of the average person did not seem to be composed of these scary intentions and tactics; the typical human is not really a jerk or a backstabber, but neither did individuals seem to see any alternative. “This is the way the world works,” was a consistent justification for unwarranted behavior.

I wandered around like a pinball ricocheting off bumpers: “There’s no place like home,” became, “Where the Hell is home?” Looking became a lifelong project, but after discovering my “Apergerness” home became ever more elusive.

Home is no place that I have ever been; no place will ever be home.

Long ago a fellow traveler and I were talking about looking for home: His advice was to “pick a place that’s safe, provides what you need, and settle down.” Twenty years ago that’s what I did. Small town Wyoming has been an excellent solution on those grounds, and my connection with the wide open land has proven to be highly significant. But that DEEP instinctive feeling of home is not satisfied; for an Asperger, home may be an impossible fiction.

Near the end of the poem Beowulf, (see yesterday’s post) when Old Beowulf faces his last task, that of slaying the dragon, a different spiritual concept of home as “completion of one’s fate” is presented. Fate is unknowable, but certain. A convergence of the threads of one’s life in an encounter with the dragon, which also must fulfill its fate.

Home is where I keep my cowboy boots.

Home is where I keep my cowboy boots.

Home is a pot of spring flowers.

Home is a pot of spring flowers.

Home is porch chairs that I never sit in.

Home is porch chairs that I never use.

Are these merely props on a stage meant to resemble home? 

 

DIY Transcranial Magnetic Stimulation / NTs are Novelty Magnets LOL

I shouldn’t have to say this, but,

DON’T F%#@ with your brain! 

If you want to stimulate your brain, try USING YOUR BRAIN.

 

Fees Therapists Charge / Business Model / It’s just like selling Tacos

http://www.thecounselorscoach.com/practice-business-building-ideas-counselor-blog/therapy-fees-counseling-fees

Welcome fellow clinicians and small business owners! My name is Mari and I love providing coaching support. The Counselor’s Coach Blog is a place to find free practical tips and solid tools for building and growing your practice – along with some authentic, keepin’ it real, no bullshit thoughts on business life. Please introduce yourself below, and take a moment to share about your journey as an entrepreneur, and…enjoy!

Therapist Fees: One Size Does Not Fit All

Important Note: Before you begin reading, it is important to share that this may stir up all kinds of feelings and thoughts, and some of those feelings and thoughts will likely be challenging. Though we therapists cannot have a public discussion of specific fees here in the United States as it violates antitrust laws, I do think it is an important topic to discuss without specifically sharing one’s exact fees.

Expanding the Dialog: One size does not fit all

While the subject of clinical fees and valuing one’s worth is not a new concept, I thought it would be helpful to blog on this topic because I find that it is typically not discussed from a comprehensive business point of view. I read and observe clinicians and coaches writing and sharing some pretty strong opinions on this subject, some of which do not take into consideration variables like client demographics, generational trauma with respect to money, personal preference, clinical experience, and societal influence.

Many business owners (especially women) have been taught not to discuss money and have been shamed into silence from an early age. Additionally, beyond the anti trust laws, there has been a veil of discouragement on having open and supportive conversations about money in the clinical community. Conversations that take into consideration many points of view.

Please Don’t Shoot the Messenger

As an aside, I have also felt subtle pressure from a handful of colleagues, even those that I respect and adore, to keep my thoughts on my business philosophy to myself because it differs somewhat from the current popular group think. I have experienced a reverse sort of shaming that sometimes feels to me like, “Mari, your thoughts on this topic of fees feels different than my thoughts. Your business model is now stirring up emotional stuff for me that I don’t like. I’d like you to please just hush up because what I am reading is activating challenging emotions.” I try hard not to personalize the push back, or in some cases the sudden with drawl or silence, but it does get a bit perplexing and draining at times. If we as therapists are all about people having a voice, does that apply only if the person sharing their voice agrees with your point of view?

Comment: Hmmm, some rather touchy therapists out there? Not so “grown up” themselves, needing all this apologetic “blah, blah, blah” because their “feelings” might get hurt? OUCH! 

I sincerely understand and accept that some colleagues will not pick up what I am putting down. My way is not the end all be all. It is my (key word my) fee structure model and heart centered way of doing business for over 30 years. I honor and value that you are working hard in your corner of the world. And, I appreciate that you will have your own thoughts, feelings, and perspectives on money management, business practices, and fee setting.

Are Therapists a bunch of Crybabies? 

If you have read my other blogs or worked with me as a coach, you know I am a generous and kind straight shooter, so here is the real deal-io: If you choose to move forward in reading this blog, I hope that you will not personalize anything that I am sharing. But, if you do, please understand that I will not take responsibility on how my sharing about my business philosophy regarding fees impacts your delicate sensitivities. We have all gone through healing work around financial fears and inadequacies, no one is exempt. However, like it or not, I am going to weigh in on this topic respectfully, compassionately, and without assumption or apology. 

Up to this point, the blog post is nothing but an apology!

My sincerest hope is that by offering a different perspective, and inviting other clinicians to share their own perspectives, we can begin to change the discourse on how we “should” be discussing money, fees, and so forth in the clinical community.  If you feel triggered in reading through this, I hope you will hold this gentle reminder close to your heart, and do what you need to do to take care of yourself.

If anyone is still reading along, let’s move forward and take a closer look…

Charging One’s Worth: What the heck does that really mean?

A tired old chestnut that is being tossed around is this strongly held notion that therapists must charge between $200-$300 per session or they are devaluing their work and the therapy community. The other rant I hear is that we should never, ever use sliding scales or accept insurance and, if we do, somehow we are not honoring our worth. What is not being discussed is how this big message sometimes pushes out other voices, and by doing so, is creating trauma and shame for some in our community.

YIKES! TRAUMA AND SHAME IN THE THERAPY COMMUNITY!

The backlash pouring into my coaching sessions, my email, and face book messages are from therapists who are now sharing feelings of shame, envy and upset stating, “What does having a fee over $200 a session and not accepting insurance have anything to do with my worth and value as therapist or business owner?” Part of the coaching work I am doing these days is to have healing conversations about this topic. Conversations that support inclusiveness vs. exclusiveness. Conversations that look into what fears that therapist may have that is blocking abundance. And conversations to balance the idea that some therapists who have a higher fee must have it all figured out, while others who don’t are just failing miserably.

For example, without going into my specific clinical fees (in order to honor the US law), it is no secret to my clients or colleagues that I have always had a fee for service practice and have never worked with insurance panels. I have increased my fee judiciously only 3 times over the last decade for my individual sessions as my experience grows and evolves. My fee is now the highest in my area, as well as being at the high end of the average therapy fee nationally. I have had other colleagues tell me that given my level of expertise and experience, I “should” raise my therapy fee well over the $200 range, especially since I work with clients from the entertainment and sports industries.

My response to this unsolicited advise: “Thank you, I appreciate your feedback and confidence in my expertise. However, I will not be charging that amount for my clinical clients, no matter how wealthy my client is. I am happy with my current fee. It respects my business model and supports my clients. Perhaps I will raise it in the future, or perhaps not.”

And, I have had my own coaching clients share that, “Your fee is way too low Mari. I get more out my coaching with you than I have in spending twice that with other coaches.” My response? See above. (More than a bit NT narcissistic?)

And no, this does not impact my value or worth one iota. And, yes, I have done the work on my relationship with money and worth as a female business owner. My position is not to side with either camp based on my model. My position is to offer another perspective.

SO THERE! 

Sliding Scale? It’s Whats for Dinner

It is also no secret that I provide a sliding scale for clinical clients who really need this. I don’t mind offering a modest slide at all, not even a little bit, it has served me and my therapy clients well over the years, and is still within a very respectable fee structure. I refer out about 15-20 clients a month who cannot afford my fee even with the slide to clinicians I trust and respect. This is an ethical support to the client in need, as well as a nice support to my colleagues who are wonderful clinicians, but are still growing their clinical skills and practices. As colleagues will tell you, I have populated more than a practice or two (or ten) in my clinical career.

YIKES!

Over the years I’ve heard it all when it comes to the rhetoric and outrage with providing a sliding scale. And, yep, a few years ago as a new therapist, I espoused this same message with the other vocal zealots. I adamantly expressed my own outrage over the sliding scale. Fist in the air, NO more sliding scale was my loud mantra!And then, one day, I realized what a dumb ass I was being. When I slowed down for a minute and took into consideration my past business ownership experience, this was my a-ha moment and my evolution in turning the corner with respect to the infamous sliding scale…My first career was over 30 years ago as a 21 year old hair stylist and make up artist where I offered coupons to clients in order to build my client base. Eventually I founded a very profitable business in this industry. During those early first years in business ownership, I kept my fees comparable, more than the less experienced stylists, but in line with my expertise as I grew my skills (i.e. I raised my fees as my expertise grew).

I guess therapists ought to make at least as much as a hairstylist!!!

I sold that business a few years later, with a long client list, and for a very nice tidy sum while some of my more flashy and high priced colleagues (“I don’t get out of bed for less than $300 a cut) slowly saw their businesses dwindle, or were always on the hustle for the highest paying clients.Over those years, more than a few of their clients ended coming my way because they could receive the same beautiful beauty service, like hair and make up for their wedding day at $350 vs. hair and make up at $800. We also did a homeless hair day 2x a year where we offered cuts and shampoos (there are some hilarious, gag worthy, and heart warming and heartbreaking stories as you can well imagine). And, though media attention was not the motivating reason in providing this to the homeless, to my surprise, and as word got out, the media tuned in and also supported my business.This was the model that just worked for me as a hair stylist and business owner. I kind of made it up as I went along in my early 20s, and learned just as much from my mistakes (and there were many) as I did from the successes. My second business in my 30s was as an interior designer and founder of Eden Designs and Interiors. And once again, I offered discounts and created client packages as part of my business model. I refined this business model by using what I had learned in my first business. I had a long wait list, and my fees were much higher than some designers (again, in line with my evolving design skills), yet lower than less skilled designers in Brentwood or Beverly Hills because that client demographic was different than my client demographic when I first began in that industry.Over the years, as my reputation grew, those clients from Beverly Hills reached out to me.  While I did not raise my rates based on their zip codes, I also did not offer discounts for those design clients because they could afford my full design rate. Instead, I built in a travel fee that I openly shared with the client (I am one hour east of Beverly Hills and with Los Angeles traffic, that can add up to 2 hours in each direction).You know what that is called in my world? Ethical business practices.No sliding scale as a therapist? What freaking cool aid did I drink? Once I stopped bleating and braying along with the rest of the herd, and got very still, I realized that not offering a sliding scale simply did not make sense to me as a business woman (again, key words here: make sense to me). So, like the proverbial black sheep, I walked down a different path of my own making. I re-thought the concept of valuing my time and fees as a therapist, what that meant to me, examined any fears, and then added a sliding scale to my private practice business fee structure.No matter what direction our business compass points us in, I believe we can stand together and agree that we are NOT the only industry that offers discounts (and by the way, that tired old saggy jeans argument needs to be taken to the Goodwill already). We can get all sensitive and pouty when someone provides another point of view, we can personalize, and Facebook message our colleagues who also feel butt hurt and upset, or we can keep our chin up and keep on truckin’ like professionals. I find that when I am feeling all itchy and upset in my spirit, then that is a message for me to sit with. Growing pains, like ’em or lump ’em…we all will have them when creating and refining a business model.

YIKES! Who knew that therapists are raging drama queens under that “creepy soothing exterior”? 

Why is it so hard in our community of healers to simply give an atta’ girl or atta’ boy for another therapist’s good work, even if it differs from the work we are doing? Why does reading another point of view trigger such feelings of shame, anger, or competitiveness? Not one therapist, coach or organization has it all perfectly figured out. How about we all learn from each other instead of punishing or withdrawing from one another.

It’s a BOGO World After All

From time-to-time I observe therapists adamantly stating that, “No other industry offers a sliding scale or discounts so why should therapists?” I used to march to that message as well, but these days I respectfully disagree. Think about Taco Tuesdays, or Early Bird Specials, or BOGO, or any number of ways consumers save. What about groupon for accountants or attorneys, or discounted airfare, vacations, early sign ups for retreats or conferences, or spa discounts, or yoga, or medical procedures, and coupons, and you-name it- ons.

You betcha! In the Good “ol usa, a bucks a buck!!!

While I fully get that therapy is more sacred and important than Taco Tuesdays (well for some that is), my point is that we are a nation accustomed to bargaining and looking for a sale. I understand that what we offer is more valuable than buy two shoes for the price of one (as a shoe lover, I might have to re-think that). My point here is that our client may not understand the value of investing in clinical support, especially if they are new to therapy, on a budget, have their own money shame, etc. Like us, some of our client’s will have been socialized to think about how to save money. We need to know what our client’s mindset is. And part of that knowing includes considering ethnicity, poverty, institutionalized living and so on. We as therapists must do the education within our communities on the value of what we provide. Yet, even after all of our hard work, beating the drum on the value of therapy, providing a service of excellence, this may still not change deeply ingrained beliefs that our clients (yes, even our “ideal” clients) hold.

A CON ARTIST ALWAYS KNOWS Her MARK’S vulnerabilities; WHO BETTER THAN A THERAPIST TO KNOW how to manipulate her “sucker Clients”? 

You say Insurance, I say hell no!

Now, on to the much debated topic of insurance, for those who have heard it is not smart or cool or wise or whatever to work with insurance clients, let me state here clearly that there is not a single thing wrong with being on insurance panels. Though I have never worked with managed care (made that choice from day one given my specialization and other reasons that would fall into a whole other blog), I support colleagues who feel good with this business model. For me, a small slide and a comparable fee that takes into consideration my expertise, years of experience, my diverse client demographic, and so forth simply made sense for me.

This combo has worked like a dream for my business model for many years. Let’s stop here to take a deep breath. In for seven out, for seven. Ahhhhhh. If this information that I am sharing is stirring up some feelings in you regarding your business model, a model that does not include a sliding scale or insurance, then I stand in support of what feels best for you. I celebrate how you choose to structure your fees. I don’t use insurance because it doesn’t feel good for my model. I use a sliding scale because it does. Chin up buttercup, I am not writing this to anyone person in particular. I am writing this to the community as a whole. Bottom line: If we want a consistently full practice, in addition to being clinicians of excellence, we might need to be creative and a bit more flexible (and always ethical) about how we manage our fees. And that may include offering a small sliding scale at times. Or it may include accepting insurance. Or not.

Keepin’ it 100: What’s your Model Mari?

Who knew that your therapist could be a financial dominatrix?

For transparency and full ownership: I have a modest slide for my clinical clients, and I also have a slide fee for group therapy as well. If a client works with me and pays my full fee for weekly individual therapy they will be paying several hundred a month. If they are in my group therapy, then they will be paying an additional several hundred per month. Some of my clients can easily afford this without a second thought. However, some of my clients struggle to make this work. As a support for my clients who see me for individual and group, and work hard to budget in that money each month, I extend a lower fee in group by $25, and a lower fee for individual by $25. (How magnanimous!)

If this is still a challenge, then I offer to see them every other week. (OMG!) For clients who have received the slide for weekly sessions, and are ready to reduce meeting to every other week (e.g. they no longer need weekly), I ask that they pay full fee. And for clients who do occasional check ins, even if they were on the slide, I ask for full fee. I also keep one pro bono spot open in my groups (I close at 7 members, 6 are paid) for women and men in need of support who cannot afford therapy at all. Each year in January I increase fees for those clients who have been on the slide for the year prior to make room to support other clients who made need this support, and/or are doing much better financially. If a client is going to be working with me, healing issues around money is important and many of my clients begin to experience more financial freedom as they move through their healing work. If they are still in dire straights, well guess what my esteemed colleague, they get to keep their lower fee. And I don’t think that de-values my worth as a therapists by one red cent.

I’m sorry: I’ve reached my, “For the Love of god, please shut up” puke-level disgust limit. Read on, if you can. 

Fees and Fears and Frustrations…Oh My!

Could I demand a higher fee at this stage of my career? Sure I could. Is the reason I don’t because of fear or low self worth? Nope, not by a long shot. I’ve done my work in healing those old money demons.That said, it is a great question and one that I help clients examine in my coaching work. In fact, let’s move a bit deeper into this topic of fees and fears and frustrations to see what is really going on with some therapists. We will start with the ever popular topic, “Charging a Full/Higher Fee.”Every therapist needs to figure out their average client fee on a regular basis. If you have a fee for $185, do you actually get that for every single client? If so, hurray! If not, then that is not your accurate fee. Thus, this is not an honest portrayal of your fee structure. An ethical assessment includes your average client fee.For example, each quarter I meet with my CPA. We go over my PNL statements, set some quarterly goals, look at any potential red flags, and take a look at what I am grossing for an average hourly fee compared to the number of clients I see.For those of you who glaze over with numbers, this is a very, very easy formula, so stay with me. If we are true boss babes and bros we do not shy away from this kind of information.How this works:Add up your clients fees for one week like this (I’m using these numbers as a hypothetical example as a way of demonstrating this simple tool without pissing the law makers off):We will name our therapist Ima McCounselor. Ima sees 10 clients a week at $185 a session, with a sliding scale to $150, like this:Client 1: $185
Client 2: $185
Client 3: $185
Client 4: $150
Client 5: $165
Client 6: $150
Client 7: $150
Client 8: $160
Client 9: $160
Client 10: $185Ima’s total weekly therapy client fees = $1,675$1,675 divided by 10 week clients = $ 167.50Thus, Ima’s actual average hourly fee is not $185, it is $167.50. So Ima is unintentionally being dishonest when she proclaims from the rooftops that she is making $185. Ima needs to do her math.For those clinicians who share that they charge $225/per clinical session, fantastic! If they can do this without insurance, even better. If you are using insurance, then you must take into consideration the time involved outside of session to work with insurance billing and calculate that into your average. If you do not, then again, this is not an accurate portrayal of your fee. If a therapist can keep their practice consistently filled to their liking (as a “full” practice means different things to different therapists) at $225 or higher a session, without using managed care or a sliding scale, without having a niche, and has the expertise, reputation, public recognition, and experience to back up the fee, wonderful!(Side Note: Yes, we all know that the client relationship trumps the letters behind one’s name or the years under one’s belt. But please read on for a more nuanced look at other factors that influence a client…)However, what I have found is when you pull back the curtain and do the numbers to find your average fee, most therapists find that they are making at least $30-$40 less than their stated highest fee and, at the end of the day, are actually fairly in line with other clinicians in their area. Not all, but many. So, Ima is not the only one who is not actually making their claimed “high fee.”Another popular notion is to work with less clients for a higher fee. This is not a new idea. This is an idea that has been around for-ev-er. It’s called working smarter not harder. While some therapists are financially able to do this because of a second income in the home, many are not. So, working with 4 clients a week at $225 (or about $650 net per week) may be the sweet spot for some, it is not the sweet spot for all. I need and want more than $2,500 a month of net income. Just because a colleague shares they are making a certain high fee, doesn’t mean that they are meeting their income goals.

Fly on the Wall: A Coaching Call

So, how does one stand firmly in valuing worth while using wise assessment in setting a solid fee with fee increases? I thought it would be best to answer this question by taking you into a hypothetical (though not all that unusual) coaching call. Again, this is a hypothetical conversation role playing what usually transpires around managing expectations, valuing one’s clinical skills, honoring clients, while setting fair fees.In this example below, I am the one asking the questions with a new coaching client that we will call, Hope. Hope is my “avatar” client, she is someone who very realistically would reach out to me. So, let’s see what is happening with Hope:Mari: “Hi Hope! I am so glad we are meeting today. I reviewed your 360 form, and see that your top goal is to figure out the ebbs and flows of why your practice is not staying as full as you would like. Let’s start there today and roll up our sleeves.I see that you are 2 years into private practice, congratulations! And that you are a solo practitioner, 36 years old, married, one child, no employees, and that you charge $225 per individual session, and that you do not work with insurance. Is that correct? Yes? OK good, thanks.Also, please tell me what the average therapy fee is in your area, and the average percentage of clinicians in your area working with insurance, and what is the median household income in your area/for your client?”Hope: “Thanks Mari! Yes, that’s correct. Hmmm about $150 is the average fee in my area. And I’d say about 50% of the therapists work on insurance panels. BUT don’t even go there with me, I WILL NOT do that. I have no idea what the average income is around here, is that important?”M: “OK sounds good, no worries Hope, I’m not here to try and force you to do anything you are not comfortable with, but I will ask you to lean into some challenging parts of your business during our coaching call today, so hang with me and breathe. I just googled and it looks like your area is upper middle class income, and that your client, if they live in your city, will be making about $75,000 annually, so that is good for us to know.Also, your fee is $225, which is $75 more per session than the other clinicians in your area. Will you please share with me what informed your business decision to charge this fee?”H: “I offer EMDR and I believe in charging my worth, I need to value my time. NO bargaining or sliding scales! I think a client in my area can afford to pay that. I was told to decide on how much I want to make each year and then to raise my fee so that I could make that number.”M: “Yes, charging one’s worth is so important, I truly agree! So, let’s do the math here, if a client is seeing you weekly, they would be paying $900/month. If they are making $75K a year, they are taking home about $4,000 a month, so that is about 25% of their income that they would be spending on therapy with you.Are you the only EMDR therapist is your area?H: “Wow….25% is a lot when you put it like that, but I guess numbers don’t lie, right. No, I’m not the only EMDR therapist, in fact, there are several of us who provide EMDR in my area.”M: “OK, good to know this Hope! And are you the most experienced EMDR therapist in your area, or do you provide a higher quality of EMDR or therapy, do other’s provide EMDR though insurance?”

H: “I’m not sure, I think there are a couple who have been doing this for a few years, in fact one of them has a consulting group for EMDR therapists in the area, I really respect her work a lot! Yes, some use insurance, but that won’t be me.”

M: “I love that you have a colleague in the area that you trust and respect! Let’s hold good boundaries around the laws on fee setting, if you had to give an educated guess, do you know what her fee is?”

H: “$175 is what she has listed on her website, and she offers a small sliding scale, but I don’t want to do offer a sliding scale. It is old school thinking and cheapens our industry.”

M: “OK got it, and is she brand new to this work too?”

H: “No, I think she’s been doing this work for about 8 or 10 years. And she is ONLY fee for service like me.”

M: “Thanks, OK that is helpful to know. So then we can see that you are charging $50 more than her and she has been doing this work 9 years longer and is considered an expert in the area, is that right?”

H: “Yes, people really respect her – she is very good. I learn a lot from her too!”

M: “Wonderful! OK, let’s keep moving along here and figure out these gaps in your client schedule and income. Are there other therapists or organizations that hire you as a consultant and expert in this modality or method?”

H: “No, but one day!”

M: “Yes, definitely one day for sure! OK, hmmmm…are you hired to speak as an expert on the topic of EMDR anywhere?”

H: “No, not yet, but I would like to get paid to do this! How can I start lining up paid gigs like you do Mari for $5,000 a gig?”

M: “Let’s hold a good space for you getting paid for your EMDR expertise one day soon! For now we will book mark on that topic and let’s stay focused on filling these gaps as this is your stated goal for today.” OK, hmmm..do you have a book that you have written? The reason I am asking all of these questions is because I am gently assessing so that we can team up and figure out what sets you as a higher fee therapist in your area and add that to your marketing information.”

H: “Well, I believe I am just as good as most, and probably better than others. But no, I’m not hired as a consultant, nor do I speak as an expert, and I want to write a book…but haven’t found the time. Can we talk about a book today?”

M: “I think it would be a great idea to get that book started one day! But for our purposes today, let’s stay focused on your stated goal. I know this can be a challenging topic and it makes sense that you might want to discuss other more fun topics. But, part of my work is to support what you wanted to get done today. I hear that you have already set your mind to $225 per session. So, is the higher fee because of your years of working with clients, or other businesses you have owned, or some other work I am not aware of, and this is why you have the highest fee?”

H: “Well, like I shared, I’ve been doing this work for about 2 years. I feel like I do a great job, my clients tell me I do, and I deserve to charge a fee I am worth. But no, this is my first business and this is my first therapy role. BUT I have a lot of life experience. ”

M: “I agree 100%. Charging one’s worth is so important. And having life experiences to draw on as a clinician is truly so valuable. And listen, there are plenty of therapists out there who have been doing this work for 20 years and are burned out or just not really all that skilled. But help me better understand as a fairly new therapist with less than 5 years of experience, how did you decide to set your fee at $225? The reason I ask is, as an example, I really like my OB GYN, I really love that she is an expert and has many years of experience, and has a holistic point of view, and I am happy she has a vagina and understands first hand about women’s health because she is a woman, but….I don’t care too much beyond that in terms of her life experience, only as it relates directly to my specific care. Make sense?”

H: “Yes, makes a lot of sense actually. Well, how I came up with my fee. Um. Hmmm..I’m not sure, LOL! I guess because I worked with a coach, then joined a coaching group, listened to a couple of podcast interviews, and I read a blog that said I should be charging that amount! And a bunch of therapists on Facebook all say that we should be charging a lot more money. And when I broached the topic of moving my fee down a bit, they all lectured me on why I should never do that. And most of them are new too!”

M: “OK, makes total sense, we don’t know what we don’t know when we are new in business. I agree that historically therapists have undervalued themselves. The great news is that this has changed quite a bit in the last few years. You contacted me because you are having a hard time attracting and keeping clients. On the other hand, you share with me that clients don’t stay in your practice even though you receive great feedback for the work that you do. This is really good news in a very real sense because no matter how skilled a person is with marketing or fee setting, if they are not skilled as a clinician and cannot connect with the client, then clients won’t stay. Clearly that is not the concern here with you. So, let me ask you this, what is the first thing that clients say when you share your fee?”

H: “That they can’t afford it. But I am determined to charge my worth. No sliding scales!”

M: “Yes, I absolutely agree it is so important to value self. You know Hope, I think it may be helpful to share my perspective on fees and worth: since that is a topic you are coming back to again and again today. I believe that the support that we therapists give is priceless because we help people to step away from suicide, we help people recovery from addiction, and we help people heal relationships, to reduce anxiety and depression, to create lives they are proud of, to reach dreams and goals, and so much more. Providing skilled therapy to help hurting people grow and heal is priceless work as far as I’m concerned. But, in the real world people have budgets, and services have prices, and not many people can give a quarter of their monthly earnings to a therapist, some can, but not every one. And, I would imagine that might even be hard for you to give 1/4 of your income to your therapist. So, here is the thing…why do you think your clients don’t book a first session or stay on for more sessions with you?

H: “No, I could never afford to pay my therapist a quarter of my income. Well….I think clients don’t book or stay because they can’t afford my fee. BUT, I really am going to stand my ground on this. I DESERVE to value my service, no discounts, no other industry offers discounts but us. Like you said, the work is priceless [long pause]. But, yeah, I can see what you mean…I guess.

M: “I am with you 100% on this. However, it is good to remember that pricing services is about a business model and system. We cannot do that without taking into consideration a number of factors including the larger social system. What I mean by this is that we live in a culture where people are socialized to price shop and compare. Many people base their choice on where to spend their discretionary income on word of mouth, or if the product they are buying comes with great feedback (think about our Amazon review culture we live in), or the service they are investing in (be it a hair stylist, a mechanic, an attorney, a doctor, or a personal trainer) comes with either A) Great references or B) A high level of experience and expertise. And some people just want to get the cheapest. And some people don’t have it in their budget. Make sense?”

H: Silence.

M: “You still there Hope?”

H: “Yeah.”

M: “You OK?”

H: “Yeah. I’m just feeling a little shaken up and angry, but it is not fair of me to “kill the messenger” when what you are saying makes so much sense. I guess I am pissed off at myself because deep inside I was never comfortable with my $250 fee. I sort of felt peer pressured into it. I felt all pumped up at the coaching event, but then when I got home, and I followed their advise, it was just crickets. No clients were calling. And even though I already have 5 clients and all of them are willing to pay full fee, I sense that two of them are a little resentful, and one has started canceling session after I raised my fees.

M: “Thank you for the trust in sharing that with me Hope. That must feel pretty scary and frustrating. Did you talk to your coaching group? They can’t read your mind after all, you need to let them know this.

H: “Mari, I did! But one of the coaches publicly shut me down and shared that they built a full practice in the middle of the recession a few years ago, and if they can do it so can I. No excuses were allowed. I felt a lot of shame. Plus I spent a boat load of money to learn the marketing system they were selling, so I felt like I had to do what they were saying. They told me I needed to build a bigger list, or blog more, or attend a conference, or start giving out freebies, or put together all kinds of different income funnels that were incredibly exhausting and time consuming. So, I guess I feel some shame that even though I have jumped through all of their hoops, it’s not happening for me.”

M: “I know it can feel a discouraging, but here is the thing Hope, let’s look shame in the eye and ask it to pack its bags. You are the person paying your bills. Not me, not the other coaches, not your Facebook buddies. You. And when we really pull back the curtain, there are some coaches and other colleagues who do many other things to make money beyond a private practice when they are first getting started.

When someone says, “I built a practice in the middle of the recession in the middle of nowhere walking through 10 foot snow banks and so can you!” I’d be curious to know if they were also working another job, or taking on side projects like writing, or website building, or supervision, or agency work, etc. And, I’d also want to know what a “thriving practice” meant to them. How many clients did they consistently have on average? How long were they in practice? What was their actual average therapy fee, not just what they were advertising on their website, and what was their net annual income strictly from their clinical fees? Do they share those things with you Hope?”

H: “No. Sigh. I have no idea what the answers are to any of that. But, now that I think about it, I do believe that the coach was working at an agency part time, and had a part time business doing copy editing or website design, or teaching, or something when he first started his practice. And I think his fee was like $100 or $125 when he first started. I never really thought of it that way. I just figured I had to set my fee pretty high in order to value my worth. But you know what Mari, when I tell my colleagues in my area what my fee is, I can see them sort of looking confused because I am so much higher than they are, but can’t really back up my reason for being that much higher. Other than what I keep repeating which is, “I totally deserve to charge my worth!” I wonder if this is why they don’t refer to me?”

M: “Well, I think that is really courageous and I appreciate your transparency. I think it is perfectly wonderful to command a higher fee if that works well for one’s practice, aligns with one’s experience, and supports one’s business model. That said, I don’t know that any fee, no matter how high, will ever really be a statement about my worth as professional. And yes, we should get to make a great living doing this complex and challenging work. And we should only work with the clients that we want to work with.

I would imagine that some of your colleagues either feel your fee is too high given your experience, and/or are not therapists who refer often, and/or are ashamed because perhaps they have a very low fee, or are insecure, or who knows why. Let’s not get too wrapped up in worrying what other people are doing. Best not to compare. Are you open to my suggestions on how we might find that sweet spot between valuing your worth and keeping your practice filled with the number of clients you would like to see each week?”

H: ‘Yes, yes, yes please! That is why I reached out to you.”

M: “Great! So, this is going to require you to dig deep, and look through another lens, and think about worth and value a bit differently. Are you up for that?”

H: “I am so freaking up for that I need a new word for up for that!”

M: “I love your energy shift Hope! You have learned some great tools from your previous coaching so your investment in not wasted. There are some things we will dive into in our next coaching session to tighten up and refine your voice and website, your niche, and especially your blog. There are ways we can start branding you as an expert in your community while you grow your experience. There are ways we can build the relationships with other clinicians. And none of this is fancy, or a bright shiny new anything. And it won’t require a bunch of coaching sessions or big money investment.

But, for the sake of staying focused on today’s goals, and in order to get this train back on track, first thing we need to do is create a fee that is in line with what you bring to the table and so you have clients and income. What you bring to your clients is a lot! And is valuable! But…maybe not at $250/hour just yet – as your practice is showing you currently. Especially when we consider your current demographic and the other factors we discussed today. When you get very still in your heart, what is the fee that really works for you?”

H: “Hmmmmm….well….$165 has always felt like my number but I was told that was too low.”

M: “Why this number? Let’s really assess why this fee feels right for you. I want you to know in your business bones why this is your ideal fee for now.”

H: “Because it is just above the standard in my area which also keeps it marketable and fair for clients, and still honors my certification as an EMDR therapist. And it is just below the more skilled and experienced EMDR therapists in my area.”

M: “I like that Hope, that feels like a good solid fair fee and great insight. A fee that you are setting by using good business skills in assessing why this is the right fee for you. And a fee that respects your additional certification.

Now, what would need to happen for you to feel more comfy moving this up to say, $185 at a future date, maybe a year or two from now.”

H: “I’d want to get a couple’s counseling certification, and I’d want to get some consulting/coaching on how to facilitate therapy groups and workshops, and then start offering those and getting skilled in that area. And I guess, well, even though a part of me hates to admit this, it would be wise to have 2-3 more years under my belt to grow my experience so that I have more credibility with clients and colleagues in charging a much higher rate.”

M: “OK, I love that! Such clarity here. Now, what would need to be in place, let’s say 3-5 years from now to go from your current new fee of $165, to your future fee of $250?”

H: “I’d want to start speaking and teaching as an expert. Getting paid for consultations, be respected in my area and within my niche. And speaking of a niche, I thought it was working with women in transition, but after reading your blog on niching down your niche, I see that that is way too vague. And, I’d like to be paid for speaking, and write a book that would support my clients and possibility create materials like you have done on your therapist tool box store, and training that would support other colleagues.”

M: “You know what I call that?”

H: “What?!!”

M: “A very wise on ramp and ethical foundation to create a thriving practice with multiple income streams that will bring you abundance for many, many years ahead.”

Fast forward 10 months later…email from Hope to Mari:

“Hi Mari,

I wanted to take a moment to first of all wish you a happy holiday season. And to let you know that after meeting with you for 4 coaching sessions earlier this year, I refined my practice and fee structure based on our work. I am happy to report that I have had a full practice of 17 clients. While my fee is $165, I also added a small sliding scale and my average client fee is $155.

I also implemented our work and what you taught me about leveraged income and group therapy, and I now have a women’s weekly trauma group. I charge $85 a week per client, and I already have a wait list for next module! I even started a small mentors group that meets weekly via SKYPE and I charge $10 a person to facilitate this and we have 8 people. I went from less than 1,000 a week to over $3,200 a week in the last 8 months! I am taking home $9,030! This has given me such a boost of confidence. I stopped racing around for the easy shiny carrot (using a Mari-ism) and I started speaking at local businesses for free to increase my visibility in my community.

And guess what? I just got booked to speak at a woman’s group for guess how much? $1,500!!!! I am so so so happy, and so so so grateful. I work 4 days a week, and see on average 4 clients a day. It really is a dream come true. Thank you Mari! I know you are going to say it is my hard work that made it happen, and I agree, but I am grateful for our time together and all of the practical tools and good information that I learned from you and I wanted to share my progress! Once I stopped being so mad at you for telling me the truth, and I got out of my own way, and trusted my own business compass, I made it work!”

Warmly,
Hope

Final Thoughts

So, there you have it my fellow healers and colleagues, “Live” from the Counselor’s Coach. I realize this may not be the popular current group think that is resurfacing of late on fees and valuing worth. And I fully respect that you may have a very different way of approaching fees and business building, and that is 100% OK! Different strokes for different folks.

In closing, this is what I know from 30+ years of business ownership:

1. You can’t build a reputation over night;
2. Clients do their research, they compare fees, and they compare expertise and experience;
3. Not every therapist or every coach can be an expert right out of the gate;
4. You grow a business over 3 years – not 3 months;
5. The word “thriving” means different things to different people;
6. Not everyone tells the truth about their fees;
7. People/Coaches sometimes have an agenda on the whole “charge what you are worth” that has nothing to do with your success, and everything to do with their own agenda (i.e. if they charge a really high fee for coaching for example, then why would they not lead loud and proud with this message for you to charge a high fee too?);
8. Anyone, not just me, or you, or the man on the moon, can build a successful business with the following: Experience, and sometimes education and certifications, guidance, integrity, professionalism, flexibility, hard ass work, focus, dedication, gratitude, kindness, balance, reputation and trust (and for me prayer);
9. You can start making money over a short period of time as long as you have a business model that is realistic and consistent;
10. Always, always, listen to your heart and guts and not the roar of the crowd. Or the convincing of a coach, or a blog (even this blog). Trust and honor your own internal compass.

I would love to hear your thoughts on this topic as well in the comment section below (please keep in mind our anti trust laws on sharing your fees).  How did you assess and decide on your fee, and why did you choose that specific number? Gentle hint: Responding with, “I decided to charge my worth because my colleagues and coaches said so, and clients just paid what I told them to pay” is not a skilled or insightful answer.

Yes, I went there. And remember lovely reader, please don’t kill the messenger.

Kindly and in support,
Mari A. Lee, LMFT, CSAT-S

 

 

The Experiences of Late-diagnosed Women / Female Autism Phenotype

I’ve excerpted a section of quotes by ASD females: for the full “poobah” go to the article. 

An Investigation of the Female Autism Phenotype

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5040731/

“You’re not autistic”

This theme included reported experiences of autistic difficulties being ignored and misunderstood, perceived reasons for this, and beliefs about the implications of having received a late diagnosis. Almost all the young women reported having experienced one or more mental health difficulty, with anxiety, depression and eating disorder being the most commonly reported. Most participants commented that health professionals treating them had not noticed their symptoms might be related to ASC:

“Four to five years of depression and anxiety treatment…years of talking therapy…and not once did anyone suggest I had anything other than depression”. (P05)

Even when participants had begun to suspect that they might have ASC, for example after suggestions from friends or family members, when they approached health professionals, their concerns were often dismissed. After having researched ASC and decided to pursue a diagnosis from their family doctor (in the UK called a ‘general practitioner’ [GP]), five participants reported that their GPs had dismissed their concerns and did not offer further assessment. Others reported being misdiagnosed:

“You go to your doctor…and you get diagnosed with multiple personality disorder which is completely opposite to what you are.” (P07)

In contrast, there were two exceptional cases of a speedy diagnosis: both young women had been immediately referred for assessment after presenting to their GPs who had recognised signs of autism in their behaviours. In most cases, young women thought that their delay in receiving a diagnosis was partially due to a lack of professional knowledge of how autism presents specifically in females:

“When I mentioned the possibility to my psychiatric nurse she actually laughed at me…I asked my mum, who was a GP at the time…if she thought I was autistic. She said, ‘Of course not’. At the time, a good 10 years ago now, there just wasn’t much information about how girls presented, and from what she knew, I was nothing of the sort.” (P05)

Participants also suggested that a stereotype that people with ASC all have very severe and overt social and communication problems added to professionals’ reluctance to diagnose females who showed some capacity, albeit superficial, to socialise with others. Young women also felt that ‘Rain Man’ (P03) stereotypes, which incorrectly assume that ASC is always associated with savant skills and with an interest in mathematics and science, had delayed their diagnoses.

“I’ll always remember my special needs teacher saying I’m too poor at maths to be autistic.” (P04)

Teachers were the other significant professionals who young women had experienced as having had little knowledge of female ASC. When reflecting on their school years, young women reported that their passive and compliant behaviours had often been misinterpreted as being ‘shy’ or ‘good’. Several recalled being regarded as the “teacher’s pet” (P04) or the ‘model pupil’. In contrast to their good behaviour in school, these women recalled having had regular emotional ‘meltdowns’ at home after school:

“I was unbearable with my mother, but at school I was perfect” (P09).

Some young women suggested that as their quiet and passive behaviours were seen as socially acceptable for girls, they had gone unnoticed, and proposed that had they been more disruptive they might have been noticed sooner.

“The reward for trying hard to be normal was to be ignored because you were acting normal and I look at stories online of kids who were going off the rails and I think, I should have just burnt more cars” (P09)

Interview data suggested that during secondary school, teachers’ misinterpretations of autistic girls’ behaviours changed. A number of young women said that they had been told they were ‘rude’ or ‘lazy’ after they had made social faux pas, due to their misunderstanding of social rules:

“I was often accused of being rude when I had absolutely no intention of being so…he [a teacher] started saying I wasn’t trying and that I was a waste of his time.” (P04)

Other poignant examples of being misunderstood came from young women who had been bullied. Upon complaining to their teachers, they recalled that they were blamed and been told to try and ‘act more normal’.

“When I was being bullied, I was told not to antagonise these girls and actually I was only antagonising them by being myself.” (P03) (YES!)

Most of the interviewed young women were diagnosed between the ages of 20 and 30, and many shared how they thought a delayed diagnosis had been detrimental to their wellbeing and education:

“I think women tend to be diagnosed later in life when they actually push for it themselves…when you’re a child, you don’t realise that you’re anxious and depressed… [that] your education is going to suffer because of that and I think that if I had known, and if people had helped me from earlier on, then life would’ve been a whole lot easier.” (P07)

Women also talked about their emotional reactions to having a late diagnosis, and shared their regret and anger at having “tried to be good” (P09) for so long, and as a result, been missed. One young woman felt that knowing about her diagnosis could have protected her in risky social situations:

“Had I known about Asperger’s, I think I’d have known that I’m more suggestible…and I might not have ended up in the situations that I did.” (P14)

Pretending to be Normal

Interestingly, most women reported that, whilst in childhood teachers did not notice their difficulties, other children were very sensitive to their differences. This theme includes such experiences as being seen by peers as ‘different’ and subsequent attempts to ‘fit in’. The subthemes describe the strategies that women learnt from various media and other people and young women’s reflections on the costs of pretending to be someone else.

Socialising as part of large groups was reported as challenging by all the young women interviewed. To cope, many described ‘wearing a mask’ or taking on a certain ‘persona’, when in specific social situations:

“I honed something of a persona which was kind of bubbly and vivacious, and maybe a bit dim, because I had nothing to say other than adult novels. So I cultivated an image, I suppose, that I brought out to social situations as my partner’s girlfriend, that was not ‘me’.” (P09)

Masking was also used to hide autistic traits in order to appear ‘normal’. One woman described using her ‘mask’ as a ‘double-bluff’ technique to openly joke about an aspect of her behaviour that her peers might have labelled as autistic:

“I’ll mask if I act weird which is typical of ASC, I’ll make a joke about it.” (P02)

Another woman described using alcohol (I worked in advertising, an industry in which alcohol abuse was epidemic; it was an acceptable way to cope) as a way to “free me up to maintain my neurotypical mask” (P03) in situations where she needed to pretend to be interested in conversation topics, such as television programmes that she did not like. Many women described actively learning how to ‘mask’ from different media sources including characters on television, magazines, books on body language and novels:

“They’d have the right behaviour for certain things, so ‘If you want this, you should do this’.” (P02)

Another woman learnt phrases and facial expressions from fictional literature in order to manage more unpleasant situations, such as bullying.

“When I was being bullied, there’s this book by Ellen Montgomery and the character Emily, whenever somebody is horrible to her…she just looks at them, and because of her expression they go away.” (P04)

Social mimicry was another strategy used in social situations. However, young women reported that mimicry was automatic and unconscious, in contrast to their willed and conscious masking behaviours.

“I honestly didn’t know I was doing it [social mimicry] until I was diagnosed, but when I read about it, it made perfect sense. I copy speech patterns and certain body language.” (P05)

Some young women had noticed that they would quickly pick up accents from other people and suggested that this may have been an unconscious attempt to create an increased sense of familiarity when socialising with new people:

“I automatically mimic what other people are doing, what people are saying, how people say things, I went on [Girl Guide] camps…and I would come back with strong accents. But I can’t consciously put on an accent…my way of coping is that I mimic.” (P06)

Despite having acquired superficially adaptive strategies for coping in social situations, young women also identified some significant costs related to ‘masking’ and ‘mimicking’. Many had found that the effort required to process consciously people’s behaviours and later act them out, was exhausting:

“It’s very draining trying to figure out everything all the time, everything is more like on a manual, you’ve got to use one of those computers where you have to type every command in.” (P01)

Others reported having felt confused about their identity as a result of pretending to be someone else, indeed some had “acted neurotypical” (P07) so convincingly that at times they had doubted whether they had ASC.

Passive to Assertive

I have to say that the following section seems to describe PAN FEMALE experience with sexual aggression; NT women and girls are obviously not as assertive and self-protective as they need to be! 

Many participants described experiences of victimisation, and related this to their autistic difficulties. When participants considered their experiences of victimisation, their accounts often included narratives of passivity and assertiveness. They described how their perceived passivity, which they linked to their ASC, had led to unhealthy relationships and high-risk situations. One participant described feeling the need to “please, appease and apologise – do what you’re told” (P03) in order to feel accepted and receive affection. When describing her response to unwanted requests for sex within a relationship another said:

“I almost feel pressured by society to do it because you get told this is what is expected of you to make to be a good girlfriend and you think, if I don’t do it, then I am not fulfilling my duties (P08).”

Many participants also described going to great lengths to avoid conflict. One woman reflected that for many years she had considered any form of verbal disagreement as ‘having a fight’ (P03). In other cases, women who had previously avoided conflict talked about having over-asserted themselves at times, resulting in lasting damage to friendships: “When it finally comes out I can be a bit too blunt” (P10). However, there were two exceptions to women seeing themselves as being passive. One woman in particular made it clear that she had never appeased if she knew something was wrong.

There was a shockingly high incidence (9 of 14 participants) of sexual abuse reported in this sample. Half of the accounts of sexual abuse were reported to have happened in relationships. These young women spoke about feeling obliged or “gradually being pestered’” (P14) into having sex, as something they felt was expected of them in a girlfriend role. Another commented that arguments would “end up in us having sex even if I didn’t want to” (P11). Three young women reported being raped by people they did not know. In one particularly distressing case a young woman was groomed by a peer at the bidding of three older men. The data yielded a number of interlinked reasons as to how young women had become entrapped in situations where their safety and rights were compromised. First, the role of social mimicry was considered:

“There’s potential for you copying a guy’s flirtatious behaviour without realising that’s what you’re doing (P05).”

Second, many women reported finding it difficult to ‘read’ other people’s intentions, and so struggled to understand if a man was just being friendly or was sexually attracted to them. Third, in contrast to their neurotypical female peers who could share skills to keep themselves safe, young women with ASC reported feeling isolated as teenagers and so lacking a point of reference from which to develop strategies for staying safe. Fourth, some women reported that their experiences of peer rejection left them ‘desperate’ for acceptance, which in turn made them more vulnerable to exploitation:

“Because we don’t sense danger and can’t. That’s one reason, I think you not reading people to be able to tell if they’re being creepy, you’re that desperate for friends and relationships that if someone is showing an interest in you, you kind of go with it and tend not to learn from others’ safety skills.” (P07)

Fifth, young women’s uncertainty regarding social rules was also mentioned as contributing to risk of abuse. For example, some had not known that they could say ‘no’ when they had wanted to refuse sex or other people’s advances. At times when they had known they could refuse, young women reported that they had not known how to say ‘no’ or how to leave a situation until it was too late. Others talked about being trapped in unhealthy relationships:

“I kept trying to break up with him and whenever I did he would say I didn’t know my own feelings…I was at my wit’s end I felt so trapped (P04).”

Despite narratives of passivity and accounts of abuse, a number of women also talked about an increase over time in their ability to be assertive. Young women who had reported difficult interpersonal experiences were able to later reflect on and describe how they had been manipulated. As a result, many described having learnt to read others’ intentions better and used this knowledge to leave situations where they felt uncomfortable: “[there were] times when guys pushed for it, so I just walked away” (P05). Other women used skills they had actively learnt, such as “a guide to being assertive” (P02) provided by a counsellor and skills learnt in their jobs.

Four women explained how they had used their diagnosis of Asperger’s as a tool to give them more confidence asserting their opinion. Women commented that before having a diagnosis they would have “just kept quiet” (P10) but now they were able to ask people for clarification or explanations when they were unsure of a situation. One participant who had previously used her diagnosis as a means of explaining difficulties, now no longer felt obliged to provide an explanation and felt confident enough to simply say ‘no’.

Forging an Identity as a Woman with ASD

The final theme concerns young women’s perceptions of social gender stereotypes that they had felt pressured to, struggled to, and at times, refused to fulfil. Related to this, their experiences of navigating and negotiating friendships are also explored.

Young women’s opinions varied regarding gender-stereotypical roles. Whilst some openly rejected gender-based theories of behaviour: “[I don’t] really accept the validity of gender stereotypes” (P04) or ‘status quo’ behaviours, for example, dating someone their own age: “He’s 50, err so what, such conventions never bothered me before” (P07), other women were more tentative. Indeed, some young women described having tried to fulfil socially expected roles: “caring, nurturing, ‘looking out for everyone’, kind of role” (P08), and many had experienced a sense of lost identity, where they felt “I knew that I wasn’t being me” (P10) when trying to play ‘the wife’ or ‘girlfriend’.

Young women discussed how ASC affected their ability to form friendships. One difficulty raised by three women was ‘defining a friend’. All three had to think consciously of situations in order to decipher if someone was a friend:

“this person sort of dealt with this and was still my friend afterwards, [so] they must be good friends (P11)”

Another challenge young women experienced was not knowing how to navigate the nuances of friendly interactions:

“Not knowing what was expected of me, not being able to pick up on when to provide support or how often to get in touch (P09).”

When reflecting on previous school friendships, a number of young women commented that the main areas of conflict had often been related to wanting the exclusive attention of a particular (and often, only) friend.

“A lot of my problems came about with them having other friends that I didn’t like or I didn’t get on with…I didn’t really want to share them.” (P10)

Young women also reflected on people who they found it easier, and more difficult, to be friends with. Eight participants reflected on their experiences of trying to form friendships with neurotypical women and had often found it hard to manage what they perceived were socially expected skills of a woman. During teenage years, many of their female peers were noticeably more sophisticated in their social abilities: “girls…socially are a lot quicker” (P02). The young women had also found gossip and competition amongst females difficult to navigate. (And painfully irritating…LOL)

“The gossip…in women that can be quite hard…if they’re talking about someone sometimes it’s hard to know whether they are… [being] mean…you know you worry that if you say the wrong thing with other women that you’re going to be talked about behind your back.” (P10)

One woman commented that at times, girls would notice someone who was vulnerable and “they’ll generally put her down” (P02). Another remembered feeling intimidated by neurotypical teenage girls and had experienced rejection for being seen as “one iota different from them”. (P03). In contrast, a number of young women said they felt more at ease in their friendships with males. This was not thought to be related to biological sex, but to society ‘allowing’ men to be more straightforward, and this being a communication style that suited women with ASC better:

“I just feel so much more comfortable with men because they’re more, you can take them at face value and its not that fear of them judging you or having alternative motives and thoughts and they kind of say things straight.” (P07)

Several women spoke of the importance of friendships that they had made or maintained using online media. Friendships with other ‘Aspie’ women from online forums were particularly important. One woman described her friends as a: “gang of fellow Aspie women who I think of as my family” (P10). Some had found that their visits to online forums had increased their pride and confidence in having a diagnosis:

“It’s a difference not a disorder…it was really helpful because it made me feel good about myself (P02).”

Other women used blogs as a way of hearing other women’s stories and sharing their own, and as a result felt accepted and understood by others who have been through similar experiences.

“Something that I really appreciate about having the diagnosis is actually being in this club now where people talk about their experiences and having so many echoes of my own.” (P03)

The use of an online platform had made communication easier for some young women. For example, in normal face-to-face communication, one would be expected to ‘read’ body language, tone of voice and facial expression, so “If all we have is typing for each other, then it’s completely equal” (P10). Women talked about being able to express themselves more clearly when they didn’t have the pressure and anxiety to respond immediately, as with a face-to-face conversation. Further, use of messaging was also an easier and less awkward medium to express difficult emotions and access support from their friends. Despite the previously mentioned challenges with establishing friendships, it is notable that most of the young women had a small number of consistent friends from school or university. Finally, young women’s interests appeared to be a defining feature of their identities and an important part of their raison d’etre. Indeed, for those whose interest was their full-time occupation it defined them as people, gave them a focus in life and provided a sense of personal well-being: (YES!)

“I was very obsessed, and still am, with creative writing and that kind of provides the entire focus of my life…I would say I forge most of my identity on that and the degree…they allow me to express myself in different ways, they form the basis of my identity.” (P09)

Reported interests varied enormously, from animals to international boat racing, from sexuality, physics and The Middle East to autism and events organising and provided them with structure and a sense of achievement:

“It’s very good…for my self-belief, to see that that I can do something that’s recognised by other people as beneficial and productive (P04).”

Therefore, instead of relying on common social norms, such as sociability or motherhood, to define themselves, young women formed their identities through their special interests.