The EMDR Association UK’s regional East Anglia group were thrilled to welcome Consultant and Trainer colleague Caroline van Diest to take us through how, as EMDR therapists, to recognise and work with clients on the Autistic Spectrum and with ADHD.
Caroline is an EMDR Europe Approved Trainer/Consultant
A BABCP Cognitive Behaviour Therapist
A Registered Learning Disabilities Nurse (RNLD)
MSc in Applied Social Learning Theory & Counselling
‘EMDR with Autism Spectrum and ADHD’ 28.11.2020
Presented by Caroline van Diest, and reported by Ushma Patel
On Saturday 28th November, 232 delegates came together online for another extravaganza of stimulating information and enjoyable learning about ASD and ADHD and Aspergers from the comfort of our homes. Caroline had already sent us a plethora of handouts and information: with pen and paper ready and a hot cuppa we started the event at 930am.
For those who couldn’t attend on the day, the event was recorded and shared with everyone who signed up for the event, alongside handouts, slides and certificates with six EMDR UK Association CPD points.
Caroline is an EMDR Europe-Approved Trainer/Consultant, a BABCP Cognitive Behaviour Therapist, and a Registered Learning Disabilities Nurse (RNLD. She has an MSc in Applied Social Learning Theory & Counselling and is one of EMDR UK’s leading specialists on ASD.
Aims for the day were to introduce us to the history of clinical and social understandings around ASD and ADHD and considerations of the overlaps between them, as well as to outline how appropriate adaptations can be made in EMDR, working on the traumatic impact on relationships with self and the world using case examples and powerful personal stories.
Caroline also invited us to develop an understanding of what we need identify and tackle when working with clients incorporating functioning, diagnosis and insight.
At the outset, we learned about the challenges of language around this experience. The DSM has moved what used to be called Aspergers into the diagnosis of Autism, on the high-functioning end of what’s now widely understood as The Spectrum. And as Caroline emphasised, not everyone is happy with that switch, so she like many others in this field was happy to continue to use the term Aspergers as well as Autism.
Caroline shared thought-provoking videos to demonstrate what it’s like living with Autism and how communication is perceived by others.
Many myths were busted like: you can still process if a client doesn’t like eye contact, or if all these myths were true how do therapists who have Autism do their job?
The answer? A brilliant opportunity to hear from our own Mark Brayne who courageously spoke about his own experience with Aspergers, with a diagnosis confirmed very much later in life.
Listening to Mark’s account gave us a moving insight in to how, as he put it, “lying is very hard, almost impossible”, and with that the impact this has on a life informed by the often urgent desire to “whistle-blow” or speak out with frank honesty.
The struggle and loneliness of Mark’s journey with Aspergers resonated with everyone listening, including what he termed Grelief, as the bittersweet mixture of grief and relief upon having the diagnosis confirmed.
Mark discussed the upsides and the downsides of being Aspergers, which can bring a marked ability to learn different languages (with their reassuring grammar and rules), but also the challenge of emotional responses to different cultures.
It was with a touch of affectionate envy that we heard how well EMDR’s framework of protocols and focus meshes with Mark’s internal experience and appreciation of structure, supporting a sometimes surprisingly effective and rewarding implementation of EDMR in practice.
Mark also shared his experience of using an online self-assessment questionnaire, initially for himself and now with clients. The Autism-Spectrum Quotient Test was developed by Simon Baron-Cohen and his colleagues at the Cambridge Autism Research Centre, and is a 50-item questionnaire which helps identify if ASD might be part of a client’s story.
With a powerful and thought-provoking Guardian newspaper video called ‘The Party: a Virtual Experience of Autism’ e were then transported into the mind of a young teenager called Layla experiencing autism-typical overwhelm at a birthday party thrown for her by her parents, as yet unaware of how intensely distressing and confusing these events can be for someone on the spectrum.
After the break, we were fortunate again to be offered incredible insight to what it’s like living with Autism, through listening to the experiences of two more guest speakers: young Olivia and her mum Alexandra.
Olivia courageously articulated how her ‘mind works a lot faster than her mouth’, the impact on her mood and social interaction.
As well as stressors like tactile triggers or environmental triggers, she explained how others ‘don’t get me and then tell me I’m wrong’, further impairing her functioning and with the lack of validation and understanding leaving her feeling rejected.
Olivia spoke about how EMDR has been really helpful with her sensory issues, relationships and emotions, although not yet on trauma, given how being Autistic can leave people feeling intensely vulnerable.
Olivia stressed the importance of slowly working towards the trauma, and the need for a foundation of strong therapeutic alliance between the therapist and the client, working first on everyday stressors first.
Reiterating how validation and trust are key to helping a client feel safe, where ADHD is in the mix (Attention Deficit Hyperactivity Disorder), quite often a client can’t hold an image in their head for long time, because the mind is so busy with other distractions. It can at these times be helpful if the therapist checks in to see if the mind has wandered, so that focus can be brought back on to the target image.
We were so grateful for the opportunity to hear about Olivia’s experience and the difficulties she has to manage – inspiring to see such a passionate, bright and bubbly personality gain five million views on TikTok, raising awareness of ASD and ADHD.
Her mum Alexandra talked about the lack of support from core mental health providers and the impact on the family as well as on Olivia. The small things we take for granted, such as shopping in supermarkets, can become traumas in themselves, requiring parents to learn on the job, as it were, in supporting their child through these experiences.
It was clear to us that as a parent it’s not an easy situation to manage when you don’t have all the information, experience and support at your disposal. Naivety from schools and medical professionals can be hard and challenging, and Alexandra offered us words of wisdom when working with families, to “make sure your family members are doing lots of self-care, so they can cope with all the varied roles they have from parent to professional’.
Self-care is of course critical for all these varying stressors and crisis situations. We gained enormous insight from Alexandra, as she opened a window into the world of an ASD or ADHD child’s parent. Her patience and strength were most moving.
After lunch we discussed in smaller groups how our practice in EMDR’s eight- phase protocol would be influenced by what we had learned in the morning. Delegates were passionate and collaborative, sharing pdfs and links to information. It was inspiring to see us all come together and share our knowledge and experiences as well as resources on using EMDR with this client group.
In the afternoon we saw a video of a supervision session between Caroline and a therapist who discussed the assessment and formulation phases of working with an ASD client, as well as a video of a client who discussed her lived experience and EMDR therapy.
The latter gave us an understanding of not only the client’s account of living with ASD but also being able to see their body language, tone of voice and facial expressions while they described some highly emotive content. We could see the client’s window of tolerance (WoT) in response to a variety of open-ended questions that Caroline was asking, and the client’s perspective on the various phases of the protocol.
Caroline summarised the day by bringing us back to EMDR’s essential eight phases.
She reminded us that in history taking, the client might not get implicit memories, so a floatback might not help. It was therefore important to ask more direct questions.
In phase two, the safe place could be too abstract for some, so it could be helpful to focus on special interests instead.
Caroline emphasised the importance of identifying a client’s WoT, and their repertoire of resources, especially given that with this client group there may not be the verbal and nonverbal cues a therapist is used to noticing.
Caroline talked us through the complexities of identifying positive cognitions and of assessing SUDS with ASD and ADHD clients, who might be reluctant to choose the number ‘Zero’, preferring instead to use ‘Neutral’.
In phase five, installation of the PC, it could be useful to use visual descriptions instead of the VoC Likert scale.
Caroline stressed the importance in phase eight, re-evaluation, to be very clear with the client, what when we say image, we mean memory, so the therapist can check whether the whole memory has been processed.
Caroline’s overall message was to ‘test and tweak’ the aspects of the eight-phase protocol to suit the client’s needs, based on an awareness and understanding of ASD and ADHD.
Caroline’s hope for the day was that we leave with a fire in our belly to work with this client group, often get neglected and misunderstood.
I can honestly say that after a thought-provoking and inspiring day…we certainly did!