When I was younger I was dismissive of people who saw therapists. “What’s the use in that?” I used to think to myself. I didn’t get it at all; it made no sense.

But now I think I’d like to have somebody I could talk to about anything that was on my mind without worrying about being judged or that it might affect a relationship with a friend.

I need a confidante. Somebody to listen while I pour out a stream of thoughts from my turbulent mind. I’m not looking for answers or advice so much. But somebody who could prompt and guide the process would help.

I’m not seeking offers here; I don’t want to have to worry about how much I open up, about confidentiality. I need the reassurance of a relationship that is entirely professional and governed by professional standards.

I guess I’m in the market for a therapist. The younger me would be aghast.

The bottom line is that I need to open up about certain things. Keeping it all in is becoming harmful. It’s making me more vulnerable to depression.

There are some things from my past, some from my present. Things I’ve locked away, things I try to avoid. Things that worry me and others that absolutely terrify me. They’re not going to go away, but just maybe I can learn to live with them.

Therapy? Experiences of Cognitive Behavioral Therapy

Ok. Time to hold my hands up – I’m in therapy. I’m nearing the end of a course of Cognitive Behavioral Therapy to help me deal with anxiety. Up to now there were only three people who knew this: me, my wife and my closest friend.

Cognitive Behavioral Therapy (CBT) is a therapy that is designed to teach new ways of thinking, to provide the client with new ways of dealing with problems that they face in their lives. It is very important to bear in mind that it does not promise any cure: in my case it will not stop me feeling anxious in certain situations. What it will do (I believe and I’ve not yet experienced anything to contradict this) is give me tools to manage my anxiety.

One thing that has struck me throughout the course is how obvious it all seems. In short, the steps have been to identify the causes of anxiety and rank them in order of severity, start at the bottom and develop ways to handle them. It’s that simple! But there’s something significant about the fact that the advice comes from somebody who has no emotional connection, who is impartial and nonthreatening. I feel that they have no “hidden agenda”, that they are not trying to manipulate me (even though in fact they are – that is the purpose of the sessions). It comes down to trust: I feel that I can trust my therapist and consequently I am very accepting of her advice.

The thing about CBT is that it is a learning experience like any training course. If you are not engaged then you will not learn. Period. I believe that if you don’t want to learn something then you won’t. You can sit through lesson after lesson but if you don’t apply and practice what you are taught then you won’t learn. I think this is why CBT gets some negative reviews – people come into it expecting some silver bullet that will cure them of their problems, but it doesn’t work like that. The sessions with the therapist are just to provide the foundations. It is up to the client to build upon them by practicing the coping techniques learned. It’s difficult to begin with – you have to expose yourself to the challenging situation before you can try to apply the lessons.

I guess people fail because they don’t put the effort into this part. But as I said to my friend earlier tonight, I wouldn’t have brought this up with my GP if I didn’t want to try to fix my problem. And if that means I have to do “homework” then I’m going to put the effort in because the end result will be worth it.

I did some research about CBT before I started the course – that’s my way – and the key fact I learned about it is that it does not claim to be a cure. In may case it will not stop me feeling anxious. I believe it is important to go into this kind of therapy with realistic expectations of the outcome, and in my case it was that it would not stop me feeling anxious – it might not even make me less anxious – but it would provide me with ways to handle that anxiety, to function despite the feeling.

In many ways the success of the treatment depends on how much effort the client is willing to put in. The key to graduated exposure (which is the type of CBT I am receiving) is that you make the effort to expose yourself to the situations.

I’ve found that one of the hardest aspects of this for me has been to remember that I have to attempt to interact with people differently. Remembering this instead of falling back on ingrained habits has been very taxing mentally. I’ve discussed this with my therapist and she agrees that being on the autism spectrum poses particular problems for this type of therapy: resistance to change, ingrained habits (routines), co-morbid conditions such as social phobia and sensory hypo- or hyper-sensitivity, and difficulties interpreting non-verbal communication.

To this end I’ve been set tasks including listening to the radio (interpreting conversational voices) and summarizing what I’ve heard, observing other people’s conversations (which is one of the most difficult tasks – trying to derive rules for conversation based on observation, because it involves trying to interpret the non-verbal signals), and making phone calls (to my friends initially – it’s starting small but if that’s where I want to end up then I’ll have to build my way up to it.

I reckon I’ve made progress, even if it’s not easily quantifiable by the simplistic measures recorded by the questionnaire I complete before every session. And that’s the most important part – as long as I feel that I’ve progressed and I feel more able to tackle these anxiety-provoking situations then I think I’m gaining a benefit from the therapy.

So, in summary, I believe it’s only effective if the client is prepared to put the effort in to practice the skills being imparted. If one doesn’t have a realistic view of the aims and purposes of the therapy and isn’t prepared to put in the work involved in learning the skills presented, then it simply won’t work. In this type of therapy the therapist is the pilot guiding the course but the client is the engine room providing the momentum.

Anxiety: Learning to Cope

Nobody Home?

It’s the strangest feeling, or it would be if it weren’t so familiar. I catch myself playing the part, acting “normal”, carrying on without conscious intervention while all the time I’m there, watching. I feel like a spectator in my own body, a mere passenger.

I remain aware of everything around me, fully linked to my senses, but my mind is free-wheeling, pursuing lines of thought unrelated to what my body is doing. And every so often I notice that my body has been walking around, even talking to people, while I’ve been occupied with my thoughts.

Role Playing

I guess it’s a form of acting: I’m performing a role that I’ve rehearsed so thoroughly I don’t need to think about what I’m doing, leaving my mind free to wander. This is the state in which I’m most at ease: there is a comfortable familiarity as I run along the rails of routine.

Am I a Stereotype?

The trouble is… as I watch myself I wonder whether I am being myself or whether I am merely exhibiting a set of learned behaviors with the aim of fitting in. What makes me suspect this? I get little nudges from my conscience – a feeling that I should be, say, flapping my hands or talking at length and in detail about some topic of personal interest. Things I used to do as a child but have suppressed as I’ve grown.

Since discovering that I have Aspergers I have become more aware that a number of things I used to do instinctively were characteristic of the condition. I see my innate Aspie traits on one side of a balance with my acquired “normal” traits on the other, and as one side rises into prominence the other side sinks from view. I’ve been feeling more and more that I am out of balance and I need to take corrective action to restore the equilibrium.

I’ve found that whereas in the past I had been led into thinking of my differences as aberrant behaviors to be corrected, I now consider them to be natural aspects of the way I am. I have accepted that I’m different – and the reasons underlying that – and I try to be more myself rather than struggling to “act normal”. That said, there are some areas where my instinctive reactions are a hindrance to living independently: it’s not possible to go through life without interacting with strangers at some point.

Identity and Self-confidence

My sense of self – my identity – is moderately strong: I know who I am and my core values are well-established in my mind. I might not always have the strength or confidence to actively uphold them but I find that I am incapable of acting against them. My self-confidence on the other hand varies according to the situation from bulletproof to non-existent. And that’s where my anxiety creeps in.

The Sum of All Fears

First a bit of background: there is a psychological theory of learning usually referred to as “The Four Stages of Competence”. Briefly, the four stages are:

  1. Unconscious incompetence where you are not aware of your lack of a skill.
  2. Conscious incompetence in which you become aware that you do not understand or know the skill.
  3. Conscious competence which is having the knowledge but not grokking it: knowing a sequence of steps and able to follow the sequence but without fluency. One still has to think heavily about the task.
  4. Unconscious competence where practice – rehearsal – has made the skill so familiar that it has become habit and little or no conscious effort is required to perform it.

What I described at the start is stage 4: I’m doing things that are so familiar I don’t have to think about them and my conscious thoughts can drift off. Problems arise for me at stages 2 and 3 where I come face to face with the unknown.

When I am faced with a situation that is unfamiliar or where I can’t predict what turns events may take I become anxious. I lack self-confidence in my ability to perform the task, whether it is making a phone call or interacting with strangers. I know I can manage well-defined, structured interactions such as ordering a pizza or going to the doctor because I have become familiar with the routines involved: I am around stages 3-4 in those cases. But with something that is off-the-wall where I would have to react according to the context I find myself back at stage 2 where I am all too aware that I don’t really know what to do.

Breaking the Circle

At the moment I find myself trapped in a vicious circle where I have evolved strategies of avoidance when faced with anxiety-inducing situations. This prevents me gaining the experience to deal with similar situations in the future, and results in greater anxiety if I can’t avoid them. I recently raised this problem with my GP and I’ve started a course of therapy to try to manage my fears so that they don’t continue to be an obstacle to me doing things.

Square One

One of the first tasks has been to analyze the roots of my anxiety: what triggers it, what is it I am afraid of? Many people have a fear of judgement: what will the other person think of them? But that’s not it for me. My core fear is of failure, of not being able to complete the task. Fears of this kind in particular can affect people who grew up with a “gifted” label as I did. A lack of experience of failing makes any failure, however small, appear catastrophic. This leads to risk aversion, a strong drive to avoid the possibility of failure. Perhaps if I can learn to accept failure than I will be able to attempt things where I lack confidence. I can hope.