The Art of Finding a Therapist

As always, names are changed-- in this case, abbreviations are used for my good therapists, and mischievous nicknames for some pretty bad therapists.

"Dr. L. would have some good advice for me on this," I often say to myself when I am having a difficult moment.

But then I remember that I am no longer working with Dr. L. 

An undisclosed medical condition forced Dr. L. into sudden retirement in June, and after six years of working with him-- the longest I have worked with any therapist-- I found myself having to find someone else.

I have been to several shrinks since age eleven. The past thirty years of on-and-off therapy have taught me some valuable lessons, not the least of which is that finding a good therapist is an art. In a sea of "just okay" and bad shrinks, I have had three terrific ones, including Dr. L. I started working with a new therapist, Dr. P., in June, but I'm considering looking for someone else if something doesn't click in the next couple months. She is nice and open-minded enough, and in the beginning I was feeling optimistic about her. However, I have since begun to feel that things aren't clicking as well as I hoped they would. For one thing, I am not convinced that she is intimately familiar with the nuances of autism, particularly in terms of what it generally looks like in cis women*. For another, I find that she often misses my point. Plus, she will often ask me a question right after I say something that contains the answer that she is looking for. For example, I might tell her that I have known somebody for twenty years, and two seconds later she will ask, "How long have you known this person?" It makes me feel like that she isn't listening, or at least isn't completely processing what I tell her, let alone appreciate where I'm coming from.

What was great about Dr. L. is that he knows what autism looks like, including in cis women*. Unlike an alarming number of the psychological community, he knows it is a varied, colorful, complex, and nuanced spectrum, well beyond the stereotype of train-spotting, hyperliteral, STEM-genius cis men. In fact, on the day that I first met him, he said that he knew after speaking to me for about a minute that I was neuroatypical-- he has that kind of radar for autism, picking up on more subtle, less stereotypical cases like mine. After talking to him for about ten minutes, he also commented, "What I am hearing is someone who has experienced a great deal of loss." These comments clearly reflected someone who is highly knowledgable about autism as well as someone who quickly picked up on a common denominator in the stories I related. 

Dr. L. was also good at validating my feelings while trying to help me sort through them. Sometimes I would tell him a story about a memory from my teenage years in the 1990s that had come back to haunt me, and I would say, "I feel like even among the autism community I have stories about traumatic interactions that are really unusual." He would tell me, "Believe me, this isn't anything I haven't heard before from an autistic person" and he would elaborate. You name the esoteric experience, he's heard about it at least once and often has some great insight into it. Sometimes, he would also ask me very disarming questions that would make me rethink my perspectives on certain issues. After getting to know me, it was also easier for him to contextualize any new information I gave him.

And finally-- and this is not a trivial issue-- Dr. L. laughed at my weird, gallows sense of humor. And that's important.

Aside from the importance of finding a therapist who understands your situation, it is important that this person is interested in little anecdotes about something fun you did over the weekend and appreciates your sense of humor. After all, if you're working with a therapist once a week, you are not going to have something "bad" to talk about every week-- sometimes not even for months at a time. Why should you? And being able to have everyday discussions with and laugh with your shrink is important. It helps them to see the whole person, and not just where things aren't working. Plus, it helps you feel more comfortable working with them. 

I have had only two therapists besides Dr. L. who I really clicked with. The first one was Dr. F., whom I saw during my senior year of high school. He was the second shrink I had been to, after my shrink that I saw in elementary school whom I have since dubbed Dr. Bonehead (more on him in a bit). After the first or second session together, he commented, "You're a very intense person." Just like Dr. L., he spotted a common denominator right away. The other one, Dr. G., was someone I saw in my late twenties when living in New York City. Like Dr. F. and Dr. L., she was able to appreciate where I was coming from and help me to understand my feelings. She helped me to come to terms with a painful personal loss of two friends who had recently ghosted me (this was in 2008, one of the worst years of my adult life).

Dr. P. doesn't seem to be fitting all of these requirements. She enjoys listening to my anecdotes and laughs at my jokes but, as I've said, I'm not convinced she fully appreciates just what autism is and can be, and I feel her listening skills leave something to be desired. I don't think she's a "bad" therapist, but she might not be a good fit. I have had some "just okay" therapists as well as some awful ones, and I want to share a few stories to help my readers understand just how clueless and even inappropriate (nothing sexual in my case; don't worry) they can be, and that there's nothing wrong with looking for someone else if the shrink you're seeing doesn't seem to be helping. To make things easier to follow (and more amusing), I have given each of these therapists a mischievous nickname:

Dr. Bonehead: My first therapist, whom I saw between 1992-1995, ages 11-14. Nobody knew what autism was in the '90s beyond the Rainman stereotype, so I wasn't diagnosed. Dr. Bonehead meant well, but he didn't understand me at all. He told me I overreacted to the chronic bullying I experienced, he analyzed things that had no deep meaning, and he often expressed shock at my gallows sense of humor. And he seemed to think a good "cure" for my social deficits was to sit two feet away from me on the couch instead of sitting on the other side of the room. Hey, "normal" people would feel a little uncomfortable, but since I wasn't "normal," I guess he thought the answer was to throw me in the proverbial deep end and hope I'd swim. Oh, and he once told me my hair was sexy. While I don't think he "meant" anything by it (he had three years in which he could have touched me, and he never did-- not even a harmless pat on the shoulder), it was still inappropriate and, sadly, reflective of the culture back then when it was considered okay for thirty-something-year-old men to "compliment" adolescent girls like that. Again, I don't think he was trying to do something inappropriate; I think he was just clueless-- in many ways.

Dr. Uh-Huh: I saw this guy in my late twenties, in Brooklyn, for a few months before I started seeing Dr. G. I would tell him stories and he would just go, "Uh huh. Uh huh." I would ask him for some insight, and he would just shrug. Brilliant guy.

The Drama Queen: I saw her in Boston for a few months in 2014. She was inordinately convinced that I was harboring a repressed memory, which is just absurd because my episodic memory is better than most people's (Dr. L. said he has only worked with one other person in 45 years with a memory like mine). I have no trouble remembering traumatic experiences either, so I don't know where she was getting this. She also insisted that certain things in my life-- such as some drama in my extended family, which only came up because she actually had me make her a detailed family tree for some reason-- had a significant effect on me when I knew damn well it didn't. The family drama involved relatives I barely knew, and while I felt bad for my parents, who were at the receiving end of it, it had very little to do with me. These kinds of assertions felt like gaslighting. Additionally, The Drama Queen was Jewish, and she started asking personal questions to ascertain if I was "really" Jewish (that is, was my mother "born" Jewish? Nope, she converted-- I could see the wheels turning in her head when I revealed that). This is not just inappropriate, but irrelevant. Oh, and when I told her I was going to see cognitive psychologist Steven Pinker at an event to promote his new book, she said, "Maybe we can go together." Uhhh, that's a hard "no." Psychologists aren't supposed to interact with their patients outside of a professional setting. 

The bottom line is that finding a good therapist is an art. It takes time, and sometimes you need to try several before you find one that clicks. There is nothing wrong with that. Sometimes they aren't a good fit, and sometimes they are just bad. And if you, like me, are a woman on the autism spectrum-- which sadly isn't very well-understood in much of the psychological community-- it can be like finding a needle in a haystack. My father said it best-- finding a good doctor of any kind, but particularly a therapist, is like trying to find a good mechanic. You can take your car to several mechanics who say, "I don't know what to tell you." And then one day you take it to someone else who takes one look and says, "Oh, I know what's going on."

Sometimes, you just need to keep looking when your therapist isn't working out. And there's nothing wrong with that.

*This is a very in-depth topic, and well beyond the scope of this blog post. But let's just say that even a lot of the psychological community remains ignorant of the different presentations of autism.

Can We Stop Alienating Each Other?

I would like to make a request to the autism community: can we stop alienating each other?
 
Lately, I have grown very disheartened by the interactions in autism groups on Facebook. Many of us on the autism spectrum, particularly those who came of age in the final years of the twentieth century or earlier, have a lot of emotional baggage. We have experiences rife with interpersonal trauma that generally stem from misunderstandings by peers, teachers, camp counselors, and even our own parents. We have experienced a lot of loss: being kicked out of places, losing lifelong friends, being backstabbed by people we trusted and, overall, being condemned by one person after another. Often, we did not know what other people thought we did wrong, and any attempts to explain our actions were greeted with the message that perception and impact, rather than intent, was what mattered. It really hurts to go through life constantly at the receiving end of this dynamic. It also hurts that the people who thought they were supporting us, such as our parents, ended up invalidating our experiences and feelings on a regular basis.
 
Why, then, are we in autism groups doing it to each other? For example, there is a lot of controversy about the role of the term “Asperger’s”, and rarely a week goes by without some protracted, heated thread popping up in one of Facebook’s many autism groups. The controversy is due to its namesake, Hans Asperger, being a Nazi and that “Asperger’s” is used to describe people at a particular, “high functioning” end of the autism spectrum. People who object to the use of this term see it as ableist and endorsing a Nazi eugenicist. Whether the use of the term “Asperger’s” is still appropriate is a discussion worth having (and let’s not forget that many conditions are named after horrible people), but unfortunately a civil discussion never happens. Instead, those who object accuse its proponents of bigotry and internalized ableism. If the person does not admit that the other person was correct in their mindreading, then they are accused of being cold, callous, and not caring about others’ feelings. Often, moderators in these groups end up turning off comments after these threads turn into flame wars.
 
Another recent discussion in an autism Facebook group involved the topic of ghosting, a phenomenon where someone abruptly and without explanation halts contact with you. I assumed, perhaps erroneously, that the conversation was about being at the receiving end of this behavior—since many of us on the spectrum have repeatedly been in that position— rather than being the one engaging in it. I commented that I thought ghosting was cowardly, relating a painful memory about having been ghosted by my former best friend of fifteen years. Someone else told me that my feelings betrayed that I was a “toxic person.” This person—and others who backed her up—said that thinking a ghoster owed a ghostee an explanation was akin to someone saying that their partner owed them sex when they didn’t want it. Others in the thread commented that their own communication skills are not good and that sometimes they feel that ghosting is the only option for them. Again, these are points worth discussing, but instead I—and others who shared my viewpoint— was bombarded with accusations of ableism, callousness, and triggering other people. That was when I left the conversation and, admittedly, out of morbid curiosity, continued to watch it unfold without commenting. Ultimately, the thread was closed for further comments after more people accused each other of ableism and triggering comments.
 
Why can’t we even have civil discussions about these issues without accusations of triggering other people, of “coming from a place of privilege” if we feel a certain way about something? Why is reminding others in the group to please speak in a civil manner considered “tone policing” and “oppression?” We know how frustrating and painful it is to have someone assume the worst and treat us with intolerance. Can we at least make an effort to be more understanding and forgiving or at least civil with one another?
 
There seems to be something very insidious that happens in these threads: as soon as one person accuses another of triggering behavior, ableism, invalidation, and so forth, any attempt for the other person to defend their position only serves as further evidence that the accuser was right in their perception. Intent, after all, is meaningless, and apparently only impact matters. The last thing anybody wants is to be accused of ableism or bigotry of any kind, and it seems that the only option to keep the peace is to kill further thought, let alone further discussion, and ultimately agree with the accuser.
 
All this type of interaction ultimately does is further marginalize people within an already marginalized group. I would have thought that with the histories of gross misunderstanding we on the autism spectrum get from neurotypicals that we would want to refrain from this sort of mindreading behavior with each other. But sadly, I see an already frustrated, hurting population eating its own.
 
Can we please, please just stop alienating each other?

Growth vs. Change

As always, all names are pseudonyms...

Whoa, it's been 5 months since my last update! Well, a lot has been going on. For one thing, I'm almost finished the first draft of a novel that I hope to eventually publish. I am shooting for the end of the month (that is, in a week!) to have this draft finished. I've been trying on and off to write about this particular set of characters since the end of 1996, and it never got anywhere beyond a series of crappy and disjointed episodes. Well, this time it finally has, and I think I have a solid story in the works.

Now onto today's topic: growth vs. change. A couple weeks ago, I was talking on Zoom to Chuck, a counselor from my 1997 Israel trip with whom I reconnected last year. We have been chatting pretty regularly (usually once a month) since we reconnected at the beginning of the COVID-19 pandemic. I asked him if he remembered a particular time when the counselors led an "obscene sculpture contest" on the beach of a kibbutz we were staying at. He said he did, and I asked him whose idea it was. He admitted, "It might have been mine." Now that I think about it, I seem to recall that it might have been the idea of this other counselor who was a real smartass. But hardly the point. I laughed and said something like, "If only your kids knew. When you're a kid you like to think that your parents are these boring 'proper' people but you eventually learn that they did all the same ridiculous things that you did." Chuck laughed and said, "I really haven't changed since then. I'm still the same guy. It's just that now I'm a parent."

I was glad to hear somebody, anybody, say that. I reflexively cringe at phrases like, "People change" and "relationships change" especially when talking about someone who gets married and has kids. It's as if when someone gets married and has kids they're expected to be replaced by a pod person who has nothing to do with the person they once were. I associate these phrases with people having ditched me, sometimes inexplicably, including at least one time that involved ghosting. When I was a kid, my mom said "relationships change" and "people change" when I was in ninth grade and my "friends" caved into peer pressure and turned their backs on me. She said the same thing when I was 27 and Melanie, my best friend for more than half my life, ghosted me without explanation and didn't invite me to her wedding. Actually, she said it every single time a friendship came to a sudden end. These phrases carry horrible baggage for me, because the message I ended up getting was, "These people outgrew you. And their erratic actions were normal in response to someone like you."

Because the reality is that I haven't changed, and I told Chuck as much. And it's true: I still have the same interests as I did 23 1/2 years ago. I'm still irreverent. I'm still tomboyish/androgynous. Hell, I still think about a lot of things the same way as I did decades ago. Once, in 2015, I was telling someone a story about a conflict I had gotten into with my mother when I was in high school. Later, I found a school journal entry I had written right after the incident happened in 1998. The same points I made when defending my perspective in 2015 were all outlined in the journal entry, all with eerily similar wording. It didn't matter that 17 years had passed since the incident; I was still thinking about it in almost exactly the same way, right down to how I phrased things.

That isn't to say I haven't grown. I had a lot of issues in the summer of 1997 (and around then) but now they are largely under control. I had poor executive functioning in that I would say stupid things and regret them a nanosecond after they were out of my mouth (the "lacking a filter" issue common to people on the spectrum). I had extremely high anxiety and had a lot of meltdowns. Part of the issue was that back then autism was only used to describe people like the eponymous character in the 1988 film Rainman; I wasn't diagnosed until 2003. These issues have largely resolved with time, my growing understanding of the issues, and a whopping dose of SSRIs (which I've been on since 1999, the second half of my senior year of high school). I still have anxiety about certain things. I still have the occasional meltdown, but it's very rare and only in very specific circumstances. When it happens I am usually alone or dealing with my family. I have a good relationship with them, but the reality is we carry a lot of baggage and it sometimes comes to the surface and sets me off. As for the "filter", it usually does what it's supposed to, but I'm not perfect. I'd like to think that I've grown since then, and I believe I have.

"Oh, but see, isn't that change?" No, it isn't. Why? Because, my dear, what I described are adjustments, alterations to certain behaviors, not changes of who I am at my core. I'm still a smartass. I'm someone who will stand up on a chair in a restaurant and do the Pee-Wee dance when the song "Tequila" comes on. It's just that I'm more discriminating in terms of where I do these things; the "Tequila" incident was in a Manhattan restaurant with friends-- this sort of thing happens in public spaces in New York City quite a bit, so it's more acceptable there. I realize that I may be debating a semantic issue, but that doesn't mean that semantics are irrelevant. I'm older and wiser but, bottom line, I'm still me. 

So when should the word "change" be used instead of "growth"? I think when somebody's core persona changes. To use an extreme example, let's look at Frank Meeink, the former skinhead whose life loosely inspired the 1998 film, American History X. He was entrenched in an ideology that informed every aspect of his personality and his life. He even went to prison because he almost killed somebody. In prison, he found himself in sober reflection after interacting with black inmates on a regular basis. Today he is a changed man, and regularly educates people on the poison of racism and white supremacy.

I guess the word "change" also has more baggage with me, not just because of my mom's comments about people "changing" and relationships "changing", but also because over the years many people implored me to change, carrying the implication that there was something horribly defective about me: parents, teachers, peers, you name it. More then a few times when I had a social setback that was ultimately the result of an honest mistake and not rooted in maliciousness, someone said, "You could look at this as a positive opportunity to change."

"And my answer to that," to quote Bill Maher in one of his routines, "is fuck you."

And really, I was thinking about the issue of growth vs. change when I was in high school. My stance on it hasn't changed since then.

Why should it?