Friday, April 10, 2009

Relational Therapy and an Incomplete Attachment: A New Look at the Etiology and Treatment of Autism Spectrum Disorders

Autism is like being trapped in an enclosed maze. Within this maze it is dark and scary. You can see out, but no one can see in. You are in a perpetual state of terror with no access to others or a way out. You feel the walls closing in and can do nothing about it. You are screaming inside, but nobody can hear your screams. You are frantic. You keep running in circles to no avail. Alas you run out of steam. It is futile, hopeless and depressing. It is no use. No one can see you. You have become a lost child forever. You have become forgotten. Lost in a never-never land. It is a never-ending hell on earth. The only thing you can do is wait and hope that you will be discovered.

Mystery and controversy surround the etiology and clinical work with children diagnosed with an Autism Spectrum Disorder. Although the etiology by many is considered to be unknown, the majority of professionals working in the field of autism and parents of autistic children consider autism to be a neurological disorder. From this perspective, the clinical work with this population focuses primarily on techniques such as Applied Behavioral Analysis, modeling and social skills development. The work done thus far with this population should be commended and not discounted. We are now ready to augment the present state-of-the-art work with this population by introducing Relational Therapy. This therapy is similar to Floortime in that it emphasizes the relationship between the child and the therapist or caregiver. The major difference is that Relational Therapy introduces a treatment process (plan) that at its core is based on understanding the etiology of autism. Once the etiology is understood, then the therapist or parent can understand how to engage with the child.

From this alternative perspective it is my belief that children on the spectrum have not had the advantage of a completed attachment. I call this perspective “Incomplete Attachment.” Thus it is my belief that what one sees when observing children on the spectrum is a child who is waiting for the attachment process to be completed. The child is doing the best he/she can to cope with this predicament. All the behaviors such as flapping arms, nonverbal communication, echolalia, lack of responsiveness to others or inability to communicate one’s needs, can all make sense when taken from this perspective.

These writings will go into detail about this perspective and how one works with children, adolescents and adults from this perspective. It is my belief that Autism Spectrum Disorders can also inform our understanding of psychological development in general and specifically Theory of Mind. Autism Spectrum Disorders can be viewed as a window into the understanding of how all “typical” individuals develop psychologically. It is my hope that these writings will lead to a beneficial dialogue within the autism community and beyond.

As a point of reference, I am presently working as a marriage and family therapist in West Los Angeles. I specialize in Autism Spectrum Disorders, depression, anger management, assertion training, anxiety and primitive states. I have worked for many years with children, adolescents and adults on the autism spectrum continuum. I have also provided trainings and support groups for parents of children with autism. I am now running groups for college age students with developmental disabilities. And finally I have made presentations on this subject at numerous conferences and meetings.

My next blog will discuss the Incomplete Attachment in more depth and begin to discuss the meaning of “autistic behaviors.”

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