Questions for Adults about Therapy

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I am thinking about seeing a therapist. I am now 50. It’s been > 25 years since I last saw a therapist. I suppose my goals are:
a) identify strategies for more effectively dealing with my ongoing anxiety and sadness and
b) improve my outlook on life going forward

So, I am one of those “lucky” people with an Obama Care plan (offered by Blue Cross). So far, I have called 7 Psychologists who are on the Blue Cross plan. 2 responded indicating that they are no longer taking new patients. 1 responded that she has helped people with anxiety and depression, but has not worked with people with Aspergers. The others never returned my call.

My question are as follows:
1. When going to therapy, how important is it that this person has experience with Aspergers? I know it’s critically important when seeking a diagnosis. Is the same true for general therapy? I can think of reasons why it would be important. Supposedly, someone who has worked with other Aspergers patients will better understand my processing impairments and not try to fix something that is not fixable.

2. When going to therapy, how often do you go and for how long? I am assuming that, for those who go to therapy, it’s not a one, two or three visit thing. But a series of weekly or bi-weekly visits over the course of at least 2-3 months. Is this correct?

3. Assuming that finding someone who has familiarity with Aspergers is important, what happens when the insurance plan you are on does not have such a specialist? I would assume that Aspergers specialists are very expensive. They seem to be in my area (SF Bay Area). And most of these people don’t take insurance.

4. For those of you who pay out-of-pocket, do you ever question the value? I certainly am interested in talking to someone who may understand me. But, I cannot imagine spending a lot of money on it. Unless it really, really helped.

Thanks for your advice and help.

My personal opinion is that it is very important that a therapist is familiar with Aspergers. This one therapist I went to before I was diagnosed wanted me to go to a local supermarket with him and try to meet women as he thought I was extremely shy. Needless to say, I did not go back to him. Then I went to a "legitimate" therapist who was very familiar with HFA. The one actual positive I took from seeing him was to accept myself as I was and to accept the limitations of having Aspergers.

Given where you are, I'd suggest first finding an adult-AS support group, then asking people there for recommendations. Otherwise you could be calling psychologists all day. Google "bay area adult aspergers" and see how you do.

My experience has been that it is essential my therapist have experience in working with Asperger's.

Save yourself the time, trouble and humiliation . . . buy some books on the subject and figure it out yourself. That's what you'll end up having to do anyway.
If you think you are suffering from depression, then see a psychiatrist, not a psychologist. Depression is an illness, not a time for reflection.

There are too many different types of therapy to generalize. I would say that it is important for the therapist to understand AS. Otherwise, they will not be able to treat you correctly. That is my experience. I have gotten nowhere with therapy until meeting my current therapist. He was the only one who knew anything about AS. He also had experience with my other issues. It is hard to underestimate the importance of finding someone who has experience treating the problem that you suffer from. Otherwise, it is so easy to make mistakes.

The most important thing, in my opinion, is that the therapist understands where you are coming from. If they cannot understand you, if they misinterpret what you say or discount what you have to say, then they can't help you. That's why experience is so important. If they are familiar with the problem you have, they will have an easier time understanding you and making recommendations.

Also, you need to feel comfortable with the person. What type of person would you feel most comfortable talking to? This isn't a rational thing. It's more of a personal preference. For example, I need a male therapist to feel comfortable. I also prefer to have someone with a Ph.D. in Psychology because I know they have had extensive training in order to get their license. It makes it easier for me to be honest with the therapist and hold nothing back.

About payments: I don't have insurance. My therapist sees me at a reduced rate. I also see him only once per month, because that is all I can afford. I was going to get ACA insurance from the online health insurance exchange specifically to cover therapy (I don't ever get sick). I tried to pick the insurance my therapist accepted. They don't accept what is available in my state, so I pay out-of-pocket. I think it is worth the money because I am getting positive results. I am happier and able to maintain my peace of mind.

Good luck. I think it will benefit you if you find someone who is the right fit for you.

I agree 100%. Most therapists are horribly misguided, and do more harm than good. Most often, they retraumatize their patients, by making them verbalize bad situations in detail, or worse, grilling them on how the situation made them feel. ("Umm, hello? If you don't know how it feels to be assaulted in the school hallways, then maybe you need a career change. Preferably to become a Walmart cashier.")

I much prefer to see a psychiatrist. They may ask me a series of clarifying questions, which may be hard to answer, but even then, there still a crystal clear solution in sight: medication to lift my spirits. It's a very cut and dried process. People who are suffering from anxiety or depression need something that provides them a noticeable fix right away. Without it, they risk sinking deeper into despair.

Aspies are their own unique case, when it comes to therapy. One, they may simply be too intelligent for conventional therapy, seeing right through its tactics. Two, conventional therapy is often reminiscent of taunting bullies use. For example, asking a patient how verbal abuse, that a therapist knows is horrible, made them feel. Since aspies are often victims of bullying, bully-like therapy is counterproductive.

yeah, no, worst thing I ever did in my life was get hooked up with a drug dealer, ruined me for years, seeing a therapist to solve the problems that are
actually causing me to feel bad about myself rather than just numb myself down,

my therapists may knot be experts in my AS but they help me deal with real life, it is what they do

Seroquel and Abilfy have saved my life. I feel lucky to have found them.

Aspie1, your comments reminded me of this scene from TBBT:
Penny and Leonard's Mother

Rocket, one book that really helped me was "Zen and the Martial Arts" by Joe Hyams. I don't do martial arts, but the thinking behind it is applicable to other situations. Do your own research. A therapist can be helpful if they can direct you to useful information, but more often than not they are stuck in some theory and don't actually engage their patients.

My therapist is a psychodynamic psychologist. I was saying why do we have to choose a philosophy? Why can't we see that parts of most philosophies are true? He said that kind of thinking has the advantage of not being dogmatic or inflexible but that picking a philosophy (or maybe in this case psychodynamic theory) protected him from being overwhelmed. Like Ann2011 said, "more often than not they are stuck in some theory". I have learned a lot from my therapy and consider it valuable. I believe he skips over ways of looking at the situation where I would like to view things from different perspectives.

No offense to Aspie1 or Ann2011, but your statements are generalizations.

To Aspie1, where is your proof that most therapists harm their patients? re-traumatize their patients? or that therapists are bullies? You don't know every therapist. You also don't know what "tactics" the therapist is using unless you've read some graduate-level textbooks on how to conduct therapy or went through the training yourself.

To Ann, where is your proof that most therapists are stuck in some theory? or don't engage their patients? You don't know every therapist.


I will grant you this. There are therapists who are not good at what they do. Also, a therapist can't be all things to all people (meaning a single therapist can't help everybody. Sometimes they need to refer out). Also, psychotropic medication is a good thing in many cases. For some disorders, it works better than psychotherapy. But it seems like to me that you are painting an overly negative picture based on limited evidence.

Just experience . . . I've seen four psychologists and two psychiatrists. All four were useless as was one on of the psychiatrists. The last diagnosed me, which has changed my life. Granted that's limited. But psychology is primarily an academic study as opposed to a medical one. I think psychology is fundamentally unsuitable in the treatment of mental disorders. The fact that this therapy still exists in light of modern medical findings is a function of familiarity and a hold-over from another era.



I really don't think it is overly negative, just pragmatic. Anything a psychologist can do, there's a book that you can do the same for yourself with.

I don't doubt that the psychologists you saw did not help you. I see how you would come to the conclusion that psychotherapy is non-sense based on your personal experience.

I just happen to have a different experience that leads me to believe that the skill of the psychologist, the problem being treated, and the match between patient and psychologist all determine whether or not treatment will be effective.

Also, there is so much research out there (literally thousands of outcome studies) that show psychotherapy in general helps and that specific therapies have helped people with specific problems.

I am not a psychotherapist. My experience is as a case manager (I see a problem and tell people where to go for help). From my personal experience, there are mental health problems that are physical (things a psychiatrist can treat) and there are mental health problems you need therapy for. A pill isn't going to fix every problem because not every problem is a physical disease. Complex emotional problems that result in problematic behavior take time to unravel and resolve, and that's what psychotherapy is about (in my opinion). And it is not just about somebody having a diagnosable mental disorder. Some life experiences are so unsettling, it helps to have support or someone to bounce ideas off of. There are no objective facts to be learned. Just support to better get through a rough time.

In fact, as a case manager, I did educational groups about mental health topics all the time, tried to teach clients life skills, and gave them information. That is not psychotherapy, and I don't think it had much of a lasting impact. That stuff is too dry for most people. Most people aren't into facts. They're interested in their specific situation and how working with a mental health professional is going to make it better. Therapy is about helping each individual person better understand his or her specific situation and react better to it. It is not about teaching. It is not an intellectual exercise. It is an emotional experience. That might be contrary to the philosophy of many psychotherapists (people with a behaviorist or cognitive/behaviorist background), but that is what I have found to be most effective.

This is how I see it, as a case manager:

You refer to a psychiatrist if a person has a physical problem that is causing negative behavior (severe depression, anxiety, bipolar, schizophrenia or some other form of psychosis, etc.).

You refer to a psychologist if the person needs to work through some feelings (has a relationship problem, life problem, history of abuse, mild to moderate depression, basically any problem that is not organic in nature and is too in-depth for non-professionals to handle). Do your research when referring to a psychologist, because different psychologists specialize in different things. For example, you can really mess somebody up if you do trauma therapy wrong. I don't want unqualified people working with a survivor of rape or combat or domestic violence. Also, licensed clinical social workers can be just as good as psychologists.

You give people self-help books to read if their problem can be solved by learning some kind of skill, and they can learn to apply that skill without the assistance of a professional.

You refer to support groups if there is a support group for that person's particular problem because it is cheaper than therapy and people can share ideas based off life experience and motivate each other.

You refer to social service agencies if it is a practical problem like getting into school, finding a job, needing gov't assistance.

So basically, there are different people you go to for different problems. Sometimes more than one approach is needed. It depends on the individual. Psychologists are useful in some situations, and in some situations, you probably don't need one. Also some psychologists are not good or they don't fit your needs. That is why it is important to do the research and to work with the person you feel is the most beneficial for you.

I know I put a lot of stuff in this post. It is not just to address your comment but for the original poster or anybody else thinking about seeking psychotherapy.

Well a supportive listener is valuable. My therapists always seemed to think the purpose was to make me feel as bad about myself as possible.

Proof? <raises hand> Over here! Over here!

Tactics are fairly easy to figure out. You don't need graduate-level textbook. A psychology textbook from a good high school will do just fine. (I kind of wish I kept my high school psychology textbook, and just paid the fine; it was a damn nice book.) Every methodology has its own unique phrases and word usage, which is easy as hell to figure out once you know what to look for. Let me show a few examples:
Rogerian therapy is the one aspies almost universally hate. Its signature phrase is "how did that make you feel?". It's asked in response to all kinds of experiences: from witnessing 9/11 (sorry) with your own eyes, to having a root canal, to losing a job. If the patient can't answer or answers incorrectly (e.g. "that's a thought, not a feeling"), he's grilled about his feeling over and over, until he gives in and spews out an emotional-sounding platitude just to get the therapist off his back.
Client-centered therapy is also aspie-hostile. The therapist does very little talking, asking only minimal questions, saying only brief comments, and never answering questions directly, to allow the patient to discover a solution through rambling. In the most extreme cases, the therapist sits and stares silently at the patient for the entire hour. The best way to fight back against this is to ramble about your special interests. That's a piece of cake for most aspies.
Psychoanalytic therapy was originally developed by Freud, and can be kind of cool at times. You're asked to talk about your early memories. However, if there aren't any to speak of, you will be accused of repressing them, and psychological manipulation will be used to get those memories out of you. Many a time, kids were brainwashed into believing things that never happened to them. What's really ironic is that it resembles past life analysis in Scientology; and Scientologists rabidly hate all forms of psychology.
Cognitive-Behavioral therapy is more aspie-friendly. It's focus are thoughts, not feelings, which helps many aspies. Its underlying principle is that thought are connected to emotions, emotions are connected to actions, actions are connected to one's life. It's designed to change your way of thinking, to give you a better life in the end. Its downside, however, is that your may be told that your emotions are "wrong", because they're triggered by wrong thoughts.

Rogerian therapy was done on me when I was a teenager. I was constantly accused of lying or hiding things when I gave the therapist true answers about my feelings. It was SO FRUSTRATING! She made me cry many times by doing this. It wasn't until I started actually lying about how things made me feel, when she started praising me for being open with her and being in touch with my feelings. I checked out a psych book from a public library, read it cover to cover, memorized a bunch of mushy emotion words, and spewed them right out.

I also tried Cognitive-Behavioral therapy two years ago, as an adult. It was somewhat helpful, but the suggestions the guy gave me just sounded way out in the left field: meditation and starting a long-term relationship are the most notable examples. Last time I tried meditating, I felt intense anger afterwards. And the relationship one, hello! I didn't go on my first date until I was 18, with a girl I could barely stand to look at! However, being an adult, I could easily say "hey listen, I appreciate your work, but it ain't helping", which I did.