Cognitive Behavioural Therapy for Autism

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This is an article outlining reasons why traditional CBT psychotherapy doesn't work for autistics.
It can even be harmful.


This is something I've ranted about many times based on my own experience.
I'm glad to see CBT's poor efficacy is being researched and acknowledged.


It's a must-read for anyone struggling to find effective mental health support.







From Stimpunks.org

https://stimpunks.org/glossary/cognitiv ... and-autism

Yes, CBT is probably one of the worst therapy modalities for most Autistic people. It's great for the people that it works for but for most Autistic people, it's an absolute nightmare. Paul Micalef has a good video about this as well.

https://www.youtube.com/watch?v=YtalhGeKVNM

I think in the UK it gets prescribed a lot by mental health professionals (in the NHS at least) because its cheap and takes the pressure off mental health professionals. Where I am, if you get referred to the mental health team you get 6 half-hour talking therapy sessions. That's it. And that's after an 18 month wait because there's so many people needing that sort of help.

So if you can send people away with a worksheet for a bit while you try to clear the backlog, that's a win-win.

I guess you could argue that it's teaching people how to manage their own mental health issues but only if they engage with it and many people with mental health issues aren't in the right mental state to engage with it. I've certainly never been.

Yeah, I don't think CBT is very good.

20 years ago, long before I got a formal diagnosis for autism, I spent one year with weekly therapy sessions. The psychologist didn't strictly follow one method religiously. A lot of it was psychodynamic but it was also a portion of CBT in the mix. The psychologist said that I might be autistic but he didn't see any point in investigating that any further in order to give me a diagnosis. At that time I thought the idea that I could be autistic was nonsense. But maybe he had my autistic traits in mind when he adjusted how to use CBT with me. Anyway, I found the CBT part of the therapy useful. Before the therapy I had a life long history lot of social anxiety that I got rid of.

CBT isn't inherently client-centred, and I suspect that's something that enables a lot of the problems with it. I think the client-centred approach can be taken too far, but without a therapist who listens more than they talk, I don't see how any therapy can work.

I tried 3 therapists each 3 or 4 times when I was seeking therapy. Each time I was asked "how does that make you feel" or "how did that make you feel" I spent the entire time weeping and saying "I don't know". I cried on the way to therapy and on the way home. No ideas why, nor any understanding besides painful emotions. I am guessing that was failed CBT.

each attempt/ appointment was deeply upsetting with no explanations to help me understand a thing. I did not see how I was gaining skills or understanding, just wounding myself over and over with old trauma memories.
I was supposed to learn something from uncovering my feelings somehow???

I finally found somebody who could reach me and teach me. I needed explanations and examples, needed something different than those first 3 failed attempts.... thank goodness he was able to understand me and use other ways to help me. Getting therapy saved my life and my sanity, but first I had to find the right therapist.

My new psychologist (my previous one left which I was very sad about because she didn't keep to a certain therapy, she just let me vent) is sticking to CBT. And she's given me a load of homework that I still haven't done and my next appointment is next week. It's stressing me out and that's the last thing it should be doing.

Also, she has a very strong accent and last time didn't know what 'overwhelm' meant.

CBT is centered on correcting one's thought patterns and negative thoughts, which presupposes that there is something wrong with what one is thinking in the first place. I get the theory that for instance if someone is depressed they may see things as worse than they are, but they also may not and they may be right and seeing things correctly. And even if someone does have thoughts that are too negative, the whole premise that there is something wrong with one's thinking is insulting and I think unhelpful.

It also presupposes that the therapist knows your thoughts (or what you are seeing in your life that is causing you to have those thoughts) better than you do, which only works if the therapist assumption that everyone is alike and everyone should be thinking the same way and that their job is getting you to think that way is correct. Maybe it is sometimes, but not for me and not for many people.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a term for a set of psycho-therapeutic techniques and its various derivatives, including dialectic behavioral therapy (DBT) and Brief cognitive behavioral therapy (BCBT).  Rather than trying to repair the root causes of the patient's problem, CBT attempts to fix reactions to perceptions and the associated thought patterns -- it focuses on alleviating behavioral symptoms.

Uses

In the UK, CBT is the recommended treatment of choice for problems, including post-traumatic stress disorder, OCD, bulimia nervosa, and clinical depression.  Randomized controlled trials have even shown computer-based CBT to be beneficial.

Limitations

It is not effective for everyone; in particular, its form doesn't completely manage bipolar disorder or schizophrenia; they are best treated with psychoactive medication.  However, it can help some, but by no means all, bipolar patients as an add-on treatment with to prevent relapses in mood stability.

Criticism

It's getting criticism in the UK from non-CBT psychotherapists suspicious of the NHS and NICE having swooped upon it with great glee on account of it being relatively cheap and somewhat effective, because it is not in fact the answer to everything.

•  Link to Article 

•  Link to Abstract 

Hmmm...

There's the incomplete knowledge of psychology that favors how the autistic mind works, along with all the current or outdated biases as to what autism is...

... And then there's nationwide cheaper services widely recommended and provided.

Whether it's services that got default for being covered by insurance, or that many health care providers recommend -- that made some sort of demand and lowering quality.


The latter must be an opportunity to improve the former. Uncover more of the former.

While hurts many autistics in the past and present, due to the ignorance and mistakes by pushing these things out of assumptions over how autism works...

Such data had to be used for the future.


But I digress.

My own sped teacher tried to sneak in CBT and talk therapy. She knew me for nearly a decade now, since childhood.

Of course it's not effective; she wants me to mask as an NT, mimic NTs.

She must've known better that I do not want that -- yet she thinks this is some pride stuff, but it goes beyond that. Something pathological.

At least she has enough sense that autism is not my main problem.
That I do have thoughts and feelings that I know it's 'not me' and it's 'not right' -- it's not about anyone who judged me or what happened to me.

And she doesn't get it; she thinks it's all about owning it. I tried. It got worse. It's like enabling the shite.

I just want a real ability to disregard my thoughts and emotions.
That it stops dictating my behaviors and being this overreacting impulsive, affecting my perception, my cognition, and how much it gave me so much stress even if my life was fine is far from stressful...

I'm so tired with being this... 'Emotional person'.
This has been a struggle for me for most of my life so far.


But I no longer any of need that anymore it seems.
I already solved it myself.

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It's a widespread thing? I've been through CBT that was harmful for me roughly for the stated reasons. Plus encouraging repression. Nobody seems to believe therapy was harmful, not ineffective for me. Everyone says CBT is so scientific and evidence based. I ask - what kind of evidence do they have? Because it is clearly ineffective and harmful at least for some people, it encourages repression, teaches to sweep problems under the carpet and criticises your feelings. Therapy should be a place of acceptance and exploration of feelings, not shunning them.