Advice on working with therapist

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Hi we have found a local autism therapist who we like and our son gets along with her very well, we've decided to go for at least a few sessions. We both think it could benefit our son, I think it could help him learn to deal with another person besides us at least and the cost is reasonable. He is four and non-verbal and the therapy is occurring in the therapists home.

One thing she wants to do is for both of us to leave during the first session since our son is attached to us, at least one of us must be in his eyesight at all times or he freaks out and is afraid. Sometimes he has become distracted playing at a park and forgot where I was sitting(although I could see him) and he starts screaming and crying and throws himself down on the ground. Also he can take off in a grocery store and get lost and can't find us and he does the same, basically outside the home he wants to know one of us is with him at all times, even in the home he has freaked out once when he woke and we were repairing something outside.

I am fully behind easing him into being ok with not being with us 24/7, and think it is something important to work on for therapy or entering school next year. What I'm concerned about is shocking or traumatizing him because if we are away from home he knows the only way to get back is to be with one of us.

I was non-verbal as a young child and I still remember the abject terror when my parents took me to a mental hospital for children and told me to go upstairs and play with all the Star Wars action figures they had and when I was done we'd go, well that was a lie and I found myself locked in and trapped. I can still remember the abject terror and fear I felt, it was very traumatizing and I believe set me back instead of helping.

The therapist said she had one child who screamed and even broke a window for an hour before calming down so don't worry about our son he will eventually get over it, my point isn't whether he will get over it I want to avoid traumatizing him. He has fairly good receptive speech(go get daddy the bag of chips, take these papers and give them to mommy) but I don't know if he can understand the concept of mommy and daddy are leaving for an hour and will be back to take you home.

I was just wondering what everyone thinks, or how we could go about easing him into this? My wife thinks I am being too soft and to just leave him, she says every kid experiences this but I told her he is not at the level of a NT four year old AND I have the memory of how traumatizing it was for me at age 6.

Thanks.

EDIT:Forgot to mention I don't think he has any concept of "the future" or of time really, so even if we tell him we're coming back in one hour he won't understand and will basically feel like we have left him. And I'm dead set against sneaking out, in the past such deceptions have only made him paranoid and I know from my own experience it is not a good idea.

I would not leave him, ESPECIALLY not in the FIRST session. How in the world does she expect to build trust and a relationship with him with that kind of experience early on?

I would suggest the first sessions with you in the room, then you gradually move to a corner, to the doorway, to outside the room but visible through the open door, to the door closed, to down the hall or in the lobby, etc. Since he's got good receptive language you can explain where you're going to be each time.

I 100% agree with Zette. Don't leave him the first time. You can build up to it, the same way you build up to an infant going to sleep on its own, and you can do it in a way that doesn't destroy trust or create debilitating anxiety. The only thing I would add is that once you make it to the step where you sit outside the door with it closed, you may want to add a step of coming back in in 15 min, then 30 min, and work your way up to staying outside for the full session. This may not be necessary, but is always an option if your child's sense of time really is better developed than you think. So glad to hear that you've found someone who may work for your family, though. That's huge!

I agree with Zette and pddtwinmom. I also wonder if you can also give him a visual timer when you do eventually leave, so that he can look and "see" when you are coming back.

I agree with everyone here that it's reasonable to not want to leave the first time and to transition out. With my son, we started with me in the room watching, then me further away, and then once I started leaving, I left for 30 seconds, then 1 minute, and so on. He adjusted really fast.

But I think it's important to note that THIS:

is NOT what you're doing.

What your son needs to learn is that it's okay if you leave, because you will come back. This is what you're trying to teach him. Obviously, if you don't come back, then he's not going to learn that. What you described sounds traumatizing for sure, but the difference here is that when you say you're coming back, you ARE coming back. If you never leave, he won't learn that (you can't "come back" if you never left), so it's important that you leave (as long as you do come back).

Totally agree. What happened to you was awful, but not at all like what your son will experience. Although he may initially feel abandoned, he will understand that he is not being abandoned because you will come back.

Sorry, I wasn't comparing the situations I mentioned it as an example as to why I think deception or the sink or swim approach is a bad idea, to my wife too. I told her it will be harder for him to just get over it. It isn't that I don't want to leave or are worried about it, I'm worried about sudden and unexplained in terms he can understand leaving.

I have been working with him lately on the concept of promises and he is slowly understanding that if we promise for instance that we will go back to the park later it will happen. But it is slow and has taken a while to build up that certainty, and I think we need to go slow and steady.

This is a good idea I didn't think of, now I am trying to figure out what I could use. Maybe a favorite video set at a point it will end when we will come back on a tablet.

We went to a free first session she offered just to get a feel for both parties, so he has spent an hour with her already but he spent a lot of time avoiding her or coming to sit very close to either of us lol.

Our son is comfortable with being around and interacting with my wife's brother, and he once said he will take him with him to get out to the road to a convenience store. We were like well ok you can try if you think you can handle him and he was like yea he'll be fine, he came back with him looking worn out and said wow he screamed the whole way there and the whole way back, which is what we expected.

It was nice though since she is from Canada that she understands our position and how messed up services here are(the Caribbean) and she advised us not to bother paying for a local private diagnosis if we plan to go back to the US by the time my son is five. She said it is expensive and will probably be not accepted out there anyway so it will be a waste, and that school districts will offer it for free out there. I also liked that she "gets it" and isn't just believing autism is nonsense and he is just a brat etc which is a common attitude. She even mentioned that she knows there are speech therapists here charging outrageous amounts without even knowing what autism is(I posted about one of these before and I'm glad I decided against it with help from the board here thanks everyone).

I also liked that she said she has another child who is similar to my son in that praise and disapproval are basically useless, she said that is a tough nut to crack and I agreed.

If you have a smart phone, there's an inexpensive app called VisualTimer. Almost every therapist we've ever worked with has the original clock-like version in their office, called Time Timer.

So how much training and experience with non-verbal autistic kids does she actually have? Her suggestion to just leave him on the 2nd visit suggests to me she's mainly worked with typical kids. I'm not saying don't use her, just be sure to listen to your own instincts about her advice.

^^^^ This

Also, be aware that some people believe that autistic kids don't really care if their parents leave and it is wishful thinking on the parents part. if they are not accustomed to clingier aspies, they may not understand.

I do agree that your child has to get used to being out of your line of site, but am not sure on why it could not be something that is worked up to with gradually increasing amounts of time.

It sounds like she may be the best you can find, but knowing what I know now, I would not do it if at all possible. I apologize as I feel strongly and what I write may have no relevance to your situation, but here I go anyway

He is 4 with enough delays that right now, clinging to familiar people helps ensure he is safe. I don't see an advantage to leaving if you're uncomfortable doing so. A major disadvantage of leaving is that your comfort is something he likely depends on, so there's that. And at his stage of development, there must be work she could do with him that you could learn from watching and use with him at home.

Like you, I still as an adult feel abandoned though for different reasons and while your child is not you, I do not trust a therapist whose priorities for my child are that different from my own. I think you said he is nonverbal, my priority would be communication, which also would help behavioral issues and fears. Communication shouldn't require separation. Communication requires connection.

That said if she is the best you can find and you want to try, of course do that. I tried it, it was unhelpful to separate until we were all ready and providers who took care of me helped my kids. Those wanting to take my child away to fix her and interact with me as little as possible did nothing. Really, think about it. I think you're on the spectrum like I am? Two minutes of instruction at the end is useless. Like take playing games, a favorite for therapists when your child is ready. I can hardly bring myself to, I hate it, I played with the therapist and my child awhile and came to understand there really is a point, it helps the child engage, there's something to focus on that's positive, and now, when I need or want to, I can. Though it's still not easy. Maybe you don't need that kind of help, but take it as an example. I think a good therapist should be able to work with you present and even welcome you if that's your preference, for any reason. But especially as the reason is your son's discomfort. What I heard in what you wrote the therapist said I may have misunderstood, but it appeared she did not fundamentally understand your child is a person, with feelings that deserve to be heard and understood. Your son is apparently anxious in the world without mom and dad, how will he ever learn to communicate and understand feelings and the world without the help of people who understand him? And it kind of seems like she is operating on him like an object to be fixed. There may be short term gain from that, but he needs to be recognized and experience himself as a being who matters in the world and to others to truly grow. At least that is what I think.

If I were in your situation and I could, I would tell the therapist I would like to observe and learn from what she does if she could accept that. If she can't you may choose to go along, but understand that indicates her ability to implement change for your child will be limited by her narrow mindedness and lack of skill. This is for less than a year though. And many times even suboptimal providers can do some good. I hope she can

Thank you for this post, to give an update we have gone to one appointment so far but at my insistence we didn't leave him. Really it was originally our idea though, she asked us at the free evaluation what we wanted to work on and we said we'd mostly like to get him comfortable interacting with another person aside from us and a few close family, and get him comfortable not being so clingy to us. The therapist was the one who said she has had kids throw amazing meltdowns or even meltdown almost the entire session but it passes and eventually they come to work with her usually once the first appointment is over. I get the feeling she was at a bit of a loss with him after the eval so that is why she asked us what we wanted to work on, at the end of the first appointment she said she feels kind of useless.

To clarify a little it wasn't her original idea for us to try leaving, it was ours. She only raised the issue because he clings to us so much she can't interact with him really at times, or becomes totally focused on wanting us to leave with him.

She is fine with observing but even during the eval he spent more than half the time when she tries to interact hiding by us, he will grab a toy and bring it by us. Even when I sit next to the two of them he sometimes gets up and grabs my hand and tries to drag me out the door. He isn't afraid of her, he just doesn't want to interact with anyone. So that was another reason she suggested us leaving, she said maybe if we aren't there to run to he will eventually realize he can interact with her or do nothing and all kids she has worked with eventually choose interact. So those are the reasons she suggested it.

I stood outside and just listened when I got there after calling my wife, I heard him having a mild meltdown for a few minutes from outside right before I went in close to the end. My wife said she had to use the toilet so she left him outside with the therapist just to see what would happen instead of letting him come in the toilet. The first thing he did when I came in was to take my hand and lead me to the restroom and open the door and he went inside and looked all around, moving the shower curtain and looking behind the wall blocking the toilet and another wall. I realized he was checking to see if that room had an exit! When we came back out they asked if he wanted to use the toilet, I said no did you show him the room before hand and they both said no, I said he was checking to make sure my wife could not leave and they said they did not think of that at all. I said you should have shown him the room so he would have known you couldn't leave. I have mentioned before being a non-verbal kid myself I often "get" things from my son's perspective, but I don't blame my wife for not thinking of it. They assumed he would know what a restroom was but he didn't.

My wife wanted to try seeing how he would behave with her there alone with him, and I said ok I'll meet you there half way into the appointment but promise me you won't just leave and she said ok and she didn't, even she said she has second thoughts on once she was there. She said my son entered and climbed the stairs first even and went to look at the toys and play equipment, but once the therapist started trying to engage him in mutual play and wouldn't let up easy he just spent nearly the whole time sitting next to his mom and wanting to go. He actually tried to make a break for it, so they locked the door and he saw where she put the keys so then he was just focused on getting the keys. My wife had to hide her purse lol, because he kept putting it in her hand.

One bad thing was he was just off that day I noticed, I don't know if he was tired or hungry but I could tell he was not in a good mood as the eval went much smoother and he even interacted with her more. It is hard to call and cancel and reschedule so close though(she is pretty booked and it isn't just her saying it, we saw other kids being picked up and dropped off).

Mostly what we want to get out of it is our son being comfortable interacting with someone else, eventually with us not present. I'm not looking for a miracle just some improvement. And we're comfortable with her versus a preschool or baby sitter because we know she has dealt with non-verbal kids and won't just get angry or hit him or punish him. Otherwise we could just use a more common option but as I said before local attitudes are very much in favor of corporal punishment, especially on a "spoiled brat"(this is how they will view him). It is just like a different world, and I've seen how people just assume he is rude and in need of spanking when they interact with him if they don't have exposure to autism. Or they just try to use time out corner or whatever and it just goes downhill in meltdown. My son has never been violent but if someone tries to keep him in a timeout he will struggle against them which just makes them angrier, they don't understand the different approach needed.

Oh and as an aside my wife said when she left the toilet which was only a few minutes, he had thrown down all the boxes of games and puzzles and thrown toys everywhere. The door to her place is glass and there is a glass table near where she has parents sit. I am really concerned my son will attempt to break the glass sliding door is he sees us leave. He doesn't normally trash things during meltdowns either or break things, but he can be pushed to it.

I've had the idea of us sitting outside on the patio with him inside, but I know he will just focus on us and be screaming the whole time.

Oh and we would be outside listening when we leave, and in case his meltdown gets too bad she said. So we would not be gone sorry my OP was vague. We would not be going off the property just where he cannot see us, at least the first few sessions.

Hi,

If the whole and sole point of this is to help your child socialize with an individual aside from you, then why not have these sessions in the comfort of your own home (a known / safe / familiar environment for your boy) ? How about having friends or relatives visiting your home for about an hour or so, solely to interact with him, when you are around ?

For instance, you mentioned his uncle's difficulty in taking him to a local store - well, how about having his uncle come to your house and play with him in the backyard, (an example) ? I would have thought it would be best to have him interact with a stranger in his own home - why introduce multiple unknowns at the same time ?

A stranger (even if a family member or a close friend to you) in a strange place is probably really overwhelming for him, right now ? So keep one variable - the location of the interaction - a constant and see if that makes a difference ?

Good luck (he sounds like a really smart kid, btw) !