Goal III - Development of a Repertoire of Practical Techniques - Part I

This blog is a continuation of the goals of Relational Therapy. In this discussion I will emphasize how the caregiver or therapist can set out to develop a repertoire of practical techniques while utilizing Relational Therapy with individuals with Autism Spectrum Disorders. Part II of this blog will be a continuation of a discussion of practical techniques that one might use in working with those with autism.

Goal III: The development of a repertoire of practical techniques (Techniques to be used when working with a person who does not have access to use herself in relationship to an other – lacks self-agency)

A. Do not try to extinguish the “behaviors” that the child uses to communicate. This is their only means of communication. This is important for the following reasons: 1) Without the use of oneself, the child exists at the mercy of the other, 2) Without the use of oneself, the child’s body responds to the ‘other’ as if the other controls them, 3) The child is inseparable from the ‘other’ – if the mother says something, the child feels they now have been given permission to exist. This is a very fleeting experience. The child does not have a mind to use with the other. The only thing the child can do is exist as the other. 4) If you do not have any use of yourself in relationship to others, you forget yourself when you are in relationship with an ‘other’. The other ‘other’ becomes like the boss of ‘you’. You cannot make a move unless the other moves first. Your body will not let you move on your own. You are at the will of the other. This is a very good example of being in the waiting position – waiting to attach. 5) Everybody on the outside becomes that “hoped for person” to attach to. Your body acts as if this is the person to attach to and 6) It is important to understand that the child does not have any control over these behaviors or their bodies.

B. Do not force eye contact. As the child can use “I”, the child will use “eye” contact.

C. Interpret the behaviors the best you can back to the child. In doing this, you are letting the child know that you understand what is going on.

D. Understand that the “autistic behaviors” are communications of an unconscious child who uses his body as a means of communication.

E. This type of communication is not nonsensical. It just needs to be understood as one might understand a dream. Also the child talks in metaphor that is like a mystery that needs to be understood

F. It is your job to make meaning of the communication by using words that symbolize the autistic child’s/adolescent’s behavior and or communication. The child does not have the ability to symbolize words and use them as a typical child might. Thus we need to be the intermediary in helping to put words to their actions.

G. All the behaviors of an autistic child are important and need to be understood by the therapist or caregiver so the child can feel understood and recognized.

H. In whatever way you can, let the client know that you see and understand him.

I. The child may or may not let you know that they feel understood.

Next week we will continue this discussion which will include more techniques you can use when working with your autistic child.

Relational Therapy with Autism Spectrum Disorders: Beliefs, Behaviors, Assumptions and Goals

Relational therapy is based on understanding autism from an incomplete attachment. It is a therapy that utilizes the relationship as the basis of growth of the autistic child. It is a therapy that utilizes assumptions that the parent/professional believes when interacting with the child. These beliefs/assumptions form the basis of the actual therapy. It emphasizes working with the emotional development of the individual by developing the ability of the child to feel, think about and verbalize their emotions and recognize the emotional states of others (theory of mind). Relational therapy cannot be practiced unless the parent/professional can first accept and adopt important beliefs, behaviors, assumptions and goals. These core four (beliefs, behaviors, assumptions and goals) help form the basis of the worldview the parent or therapist develops in order to work with this population.

This blog will address the first two elements of the core four which are beliefs and behaviors and the next blog will comment on assumptions and goals.

Relational Therapy is based on the following beliefs: a) Acceptance of Relational Therapy assumptions, b) Belief that by accepting these assumptions that one can form a meaningful relationship and attachment with the child, c) Through the relationship change can occur and d) That this change may not only occur within the child but may also occur within the parent/professional (reciprocal).

Relational therapy depends on the following behaviors of the parent/professional:
a) Certain beliefs that must first be incorporated within the parent/professional, b) The development of an emotional attachment between the child and parent/professional, c) The utilization of specific techniques that promote an attachment, d) The desire to experiment with techniques that have never been tried before, e) The acknowledgement that this is a time consuming process, f) The desire to persevere especially when resistance within either of the members of the dyad is very strong, g) The ability to live within the unknown and with ambiguity, h) The ability to not blame the child for the behaviors that they are using because of their lack of attachment (the ability to move from blame to understanding the behaviors as a means of communication), i) The ability to understand that “autistic behaviors” are communications from the unconscious, j) The ability to use one’s countertransference to inform one’s self about the child and the relationship and k) The ability to hold on to hope for an attachment and the forming of a relationship.

An Incomplete Attachment and Understanding Autistic Behaviors

What does an incomplete attachment look like? One only needs to look at any child, adolescent or adult on the autism spectrum continuum to answer this question. The behaviors one sees with such individuals seem to be confusing and do not make sense. No two individuals with autism seem similar or manifest the same behaviors. If one thinks about autism from the perspective of an incomplete attachment then the developmental delays and the children will make sense.

From this perspective, the child has not had the benefit of a completed attachment. As all infants, she is born into the unconscious ready to be brought out in relationship to the caregiver, but this does not happen. The child is in a waiting state. He or she is waiting for a completed attachment. Thus the behaviors that one sees in the autistic child are the result of not having had a completed attachment. The behaviors are what can be called “coping” and “state of existence” behaviors. Each child will cope differently to the circumstance and thus will have different behaviors as compared to another child. A key point to mention is that because of the incomplete attachment the child is left without the ability to use herself both in body (lacks self-agency) and mind (lacks theory of mind). The ability to use one’s self will vary from child to child. Some children will be more conscious of him/herself and thus have more access to use themselves in relationship to others. Thus we have a continuum of ability, which is typically known as the functioning level of the individual on the spectrum (low functioning, high functioning and Aspergers).

To explain it in a little more depth, the behaviors one sees in autistic individuals are unconscious behaviors that have been dissociated or separated within the child. It is like the child is of two minds, the conscious mind and the unconscious mind. This is true of all human beings. Within the autistic child they are more dissociated and split from their emotions than others who appear to develop “typically.” Dissociation does not give us the complete picture. From a broader perspective, one can say that the child on the autism continuum has a lack of a completed attachment, has a dissociated sense of self, has developed coping mechanisms to manage the situation, is unable to use one’s self in relationship to others, seems to lack the knowledge of their own emotions and is unable to access those dissociated emotions and finally uses indirect mechanisms to grow in relationship to others. The treatments that seem to help this population are actually helping the child to become more and more conscious and integrated as a human being. Below I have compared the developing autistic child to the developing “typical” child.

“Typical” Child
1. On a continuum – from partial sense of self to a well integrated sense of self
2. Attachment has occurred
3. Ability to use oneself to get needs met. The degree that the individual can do this will vary widely
4. Knowledge and ability to know one’s emotional feelings
5. On a continuum has access to use one’s emotions in response to the other
6. Transference occurs in the relationship in a way that is typically understood
7. Can use the relationship to grow

Autistic Child
1. Varying degrees of dissociated sense of self
2. Lack of a completed attachment
3. On a continuum - from no ability to use oneself in relationship to another to ability to use oneself on a limited basis
4. Lacks knowledge of one's emotional feelings
5. Does not have access or ability to use dissociated emotions
6. Transference expressed in ways unfamiliar to most (indirect). Transference is fragile
7. Does not directly use the relationship to grow (indirect usage)

In my next blog, I will take the behaviors of the individual on the autism spectrum and make sense of them.