Tag Archives: autism

Tools for navigating the world at large

By Laurie Meyers November 22, 2017

By the time children with autism spectrum disorder (ASD) are approaching elementary school age, they are already exhibiting symptoms that typically lead to lifelong social difficulties. Among these symptoms: impaired communication and interaction, an inability to self-regulate and modulate emotions, very narrow and specific interests, and sensory processing difficulties that make it difficult for them to connect with the world at large.

Many counselor practitioners may question whether they are even qualified to work with clients who have ASD. According to the individuals interviewed for this article, however, professional counselors possess a range of skills that can be particularly helpful to this client population.

Stephanie Smigiel, a licensed professional counselor (LPC) who does mobile counseling with ASD clients in the Pittsburgh area as part of the state of Pennsylvania’s behavioral health services, says clients with autism aren’t that different from other populations with which counselors work. She acknowledges that these clients often require a little extra accommodation and counselor ingenuity, but this call to be creative is one of the reasons that she particularly enjoys working with the population.

It is essential, however, that counselors understand clients with ASD and their needs, cautions Smigiel, a member of the American Counseling Association. “Ask yourself, ‘Do I have a bias? Is this a population I can see myself working with?” She notes that people with ASD can have problems controlling their aggression and says it is not uncommon for these clients, sometimes including adults, to pull her hair or scratch her arms.

Neurology tells us that the brains of those with ASD work differently. Those on the spectrum are often labeled as atypical (as opposed to neurotypical). However, those with ASD and many of the people who work with them have begun advocating for a different view: neurodiversity — or the idea that there is no single, correct neurology.

“The neurodiversity movement in the field seeks to apply a culturally competent view of people diagnosed with ASD or other neurological or neurodevelopmental diagnoses,” explains Ali Cunningham, a licensed mental health counselor (LMHC) who specializes in ASD. “As with most cultural groups who are trying to acculturate to the majority group, it is about achieving a balance of honoring individuality and uniqueness while striving to be successful in the majority.”

Cunningham says that many clients with autism struggle with wanting to maintain what makes them unique while still being able to connect with others and navigate the worlds of friendship, romance and work. Culturally sensitive treatment of clients with ASD involves helping them identify how their individuality or uniqueness is a resource while also exploring what new skills or techniques they are willing to integrate into their lives to strike that balance, she says.

“I always try to communicate the message that treatment is not intended to change who you are,” Cunningham says. “Treatment can help highlight the strengths you already have and add to them with skills or techniques that will enhance how you navigate the world and help you meet your goals.”

Boy (and girl) meets world

Because ASD presents early in life, experts in the field emphasize the importance of early intervention. One of the primary ways that professional counselors can help clients with ASD manage the challenges that come with the disorder is by targeting and teaching social skills.

Tami Sullivan, an LMHC and registered play therapist, maintains a private practice in Brockport, New York, that includes ASD as one of its specialties. She uses play therapy to connect with child clients who have autism.

“Children often make sense of their world and the people in it through play,” says Sullivan, a member of ACA. “Play can be used as an intervention [because] it is the native language of childhood. Counselors can understand children, the child’s world and his or her perspectives in the context of play therapy.”

Sullivan notes that children with autism play differently than do their peers without autism. “Children with autism have a low level of engagement in play. Their play is more concrete, private, ritualized … and restrictive,” she says.

She explains that young children with ASD possess limited imaginary or “pretend” play skills. Their tendency to engage exclusively in solo play and difficulty participating in imaginary worlds isolates these children and often precludes them from developing meaningful relationships or friendships with other children.

Sullivan uses a nondirective play therapy approach to engage children who have ASD. This means that rather than using a prescribed set of games or toys, she lets the child take the lead, exploring at his or her own pace.

“In this nondirective approach, the relationship is the key therapeutic medium [that] communicates acceptance of the child,” says Sullivan, an assistant professor in the Counseling and Psychological Services Department at the State University of New York at Oswego. “I aim to make the critical emotional connections that support a reciprocal relationship between us. I … encourage [the child’s] initiative and play with the goal of deepening engagement, lengthening mutual attention and regulating emotion and behavior.”

Once these children feel fully accepted, they begin to communicate and engage in reciprocal social interactions, Sullivan says.

When Sullivan wants to target a specific therapeutic goal, she uses more directive play, choosing activities that help build particular strengths in children with autism. For example, by creating something with the child, Sullivan strengthens the child’s ability to take turns, joint attention (the ability to focus on more than one thing at a time) and social perspective.

Sensory exploration can further increase the connection between Sullivan and the child. Many children with ASD use sensory toys to self-regulate, so in addition to baskets of sensory toys, Sullivan has sand trays, big bean bags and pillows, donut balls, a tunnel and a small ball pit in her office. “I am often invited by them to join in as they self-regulate,” Sullivan says. “This can be a time to connect deeper with the child and build our relationship.”

Sullivan collaborates with her clients’ parents or caregivers using two therapeutic approaches: skills-based/solution-focused therapy and filial therapy.

The first approach involves identifying goals and solutions for the child’s behavior and challenges that are causing stress on the family system. Sullivan then works with the parents to identify ways in which they can support and encourage the child as he or she develops new skills and abilities.

For example, children with autism often express anxiety through their behavior. Sullivan teaches parents how to identify this and how to help children recognize what they are feeling. The parents can then prompt their children to use coping skills they have learned with Sullivan, such as relaxing their bodies, distracting themselves or trying to change the way they feel about a situation.

With filial therapy, Sullivan says the work centers around strengthening the parent-child relationship in the counseling process. This is done in part by teaching parents play therapy relationship-building techniques such as reflecting the child’s feelings, empathic listening, imaginary play skills and limit setting.

Finding friends

During the elementary, middle school and high school years, social skills become even more critical, Sullivan says, particularly as they relate to the making and keeping of friends. “These children [her clients with ASD] desperately want to have friends, but they don’t know how,” she says.

Sullivan uses group therapy to help children with autism cultivate stronger social and relationship skills. She holds one group for children of elementary school age and another for clients of middle and young high school age.

When designing the groups, Sullivan decided the training for the elementary school-age children would be more effective if it featured an element of play. She chose to incorporate Lego-based therapy, a method pioneered by neuropsychologist Daniel LeGoff after he noticed that when children with ASD worked together to build things, they were more naturally inclined to socialize with each other. Sullivan pairs the Lego therapy with a structured lesson. She says the underlying play therapy lessens the children’s anxiety about the group while the building exercises aid in teaching social and friendship skills.

The group meets for 90 minutes once a week for 10 weeks. It is run by a professional counselor (either Sullivan or her colleague) and a relational coach who demonstrates social skills by engaging in role-play with the counselor.

Each session starts with a sensory warmup in which group members can play with sensory toys. After the warmup, the leaders and participants decide, as a group, what kind of Lego structure they want to build that day. The building process is collaborative and uses defined roles such as builder, supplier and engineer. From session to session, the children take turns playing each role. Once roles are assigned, the group must work together to decide how to go about building the structure.

As the group is building, the leaders introduce that session’s topic, such as learning how to have a conversation. The counselor talks about what the skill involves — in this case, trading information — and demonstrates it through role-play with the relational coach. This often consists of “good” role-play and “bad” role-play. For example, you don’t start a conversation by going up and introducing yourself, but you do hang back and wait until a topic comes up that interests you and then join the conversation.

Sessions end in free play, during which the children, over time, begin to interact with each other on their own, Sullivan says. The children’s parents or other family members receive a sheet after each session that outlines the skills the group worked on that week. As homework, parents are encouraged to help their children practice the skills they learned in group.

If possible, Sullivan also provides packets for the children’s teachers. She says that in some cases, teachers call her to collaborate, whereas in others, the parents work with the teachers. Many of the children in Sullivan’s groups are in mainstream classrooms. So, she recommends that their teachers identify peers to serve as social mentors and then provide time for the students with ASD to practice their skills at school.

The group also explores appropriate humor, a topic for which bad role-play is particularly suited, Sullivan says. The relational coach will display inappropriate humor — for instance, using potty language or imitating one kid making fun of another kid — and the counselor will react. Afterward, the coach and counselor ask the group members what they saw: “Did you notice that Tami didn’t laugh and that she actually looked kind of sad?” Then the coach demonstrates appropriate humor by telling a joke, and in response, Sullivan or her colleague will laugh. Sullivan also gives the children (and their parents) a list of appropriate topics to joke about and recommends joke books.

The group also discusses how to be a good sport. “We talk about a lot of things that you don’t do when you want to play a game with someone,” Sullivan says. For instance, “You don’t want to be a policeman or a referee — you don’t want to remind everyone what the rules are all the time.” The lesson teaches children to focus on what their role is in the game and how to participate in a sharing way. The topic also offers an excellent opportunity to talk with group members about additional skills such as dealing with frustration by walking away, taking a break or engaging in deep breathing, she says.

In later weeks, the group experience involves more discussion, such as talking about how to choose an appropriate friend. The children compile lists of qualities that are appealing to them in a friend and what makes a person a bad friend, Sullivan says. She also works with parents to help them brainstorm places, such as school clubs, where children can make positive connections.

Sullivan says the group leaders routinely look for opportunities to point out when children are demonstrating some of the skills they have learned in the group. Recently, during freestyle play, one boy, inspired by the monster structures they had been building, talked about wanting to have a Halloween party. His fellow group members then asked one another about their Halloween costumes and activities.

Teenage training

Sullivan’s group for clients of middle school and younger high school age runs for 14 weeks. It also focuses on conversational skills but covers additional topics such as how to handle rejection, how to handle rumors and gossip and how to be a good host. This group doesn’t incorporate Lego therapy. Instead of starting sessions with sensory play like the younger group, participants in the older group talk about their experiences trying to implement the skills they are learning. They also receive more homework to reinforce those skills.

Sullivan says the group spends a significant amount of time talking about bullying, rumors and gossip. “We teach a lot about how to reinvent yourself,” she says.

For instance, the group leaders emphasize that it is counterproductive to handle rumors or gossip by addressing them directly or denying them because those actions merely create more rumors and gossip, Sullivan says. Instead, they teach participants to redirect by using a sense of humor, walk away if someone is getting in their face and establish support figures in school and at home. They also talk about what to do about a damaged reputation, how to not take rumors and gossip personally, how to find other groups to hang out with and how to identify and connect with supporters within the school.

Sullivan says participants practice skills together during the group sessions, but group leaders also encourage them to set up short get-togethers with friends outside of group. In doing so, the leaders emphasize the need for the group members to practice sharing and exchanging ideas with others during these get-togethers. What group leaders don’t want is for group participants simply to get together for parallel play, such as two people playing video games separately, side by side, Sullivan says.

Group leaders review the process of getting together in great depth, even covering actions as simple as answering the door. “You don’t just open it,” Sullivan tells group members. “Invite the friend in and ask what they want to do.”

Next, the host should present the friend with two possible activities to choose from and let the friend decide which sounds more fun. Once they complete that activity, the host should talk with the friend about what else they could do, Sullivan coaches.

The sessions for Sullivan’s group incorporate ideas from the Program for the Education and Enrichment of Relational Skills (PEERS) for Adolescents model, an evidence-based social skills intervention developed by UCLA’s Semel Institute for Neuroscience and Human Behavior. PEERS focuses on the following topics:

  • How to use appropriate conversational skills
  • How to choose appropriate friends
  • How to appropriately use electronic forms of communication 
  • How to appropriately use humor and assess humor feedback
  • How to start, enter and exit conversations between peers
  • How to organize successful get-togethers with friends
  • How to be a good sport when playing games or sports with friends
  • How to handle arguments and disagreements with friends and in relationships
  • How to handle rejection, teasing, bullying, rumors/gossip and cyberbullying
  • How to change a bad reputation

Conversation starters

Cunningham, who practices at the Children’s Center for Psychiatry, Psychology and Related Services in Delray Beach, Florida, also uses the PEERS for Adolescents program with middle school- and high school-age youth. The groups last 16 weeks, and participants must be accompanied by a parent or someone else who functions as a social coach, she says. The “coach” requirement is in place so that the youth will have support not only for practicing their skills but also for finding opportunities for social engagement, Cunningham says. The clients with ASD meet in one group, while the parents/social coaches meet in a separate group to learn about the skills the youth are acquiring.

Cunningham, an assistant professor of counseling at Lynn University in Boca Raton, says that sessions start with role-play. Facilitators model some common errors related to that week’s skill lessons so that group members can learn what not to do. The facilitators then use role-play to demonstrate scenarios for using the skills effectively. The group participants then rehearse the skills and are given homework requiring them to go out and practice their skills in the outside world.

The group spends a substantial amount of time on conversational skills, beginning with how to start one, Cunningham says. Most people might say that the way to start a conversation is by introducing yourself, but few people actually do that, she notes, because it makes it seem like you’re selling something. Instead, group members learn how to find something that they have in common with the person and then make a comment or ask a question to continue the conversation, she explains.

People with ASD often have very particular, idiosyncratic interests, Cunningham says, so group participants learn about things that most people like to talk about, such as books, TV shows, movies, music or video games. She also tries to help clients understand steps they can take to expand their own interests or to make connections between their interests and the interests of others. For example, one of Cunningham’s clients with autism listens to a niche kind of electronic music. She has explained to him that he might not be able to find other people who listen to that exact music, but he can seek out people who like music that is similar.

After learning to start a conversation, the group moves on to how to maintain one, focusing on elements such as listening and having an equal exchange of information rather than doing all the talking or asking question after question. Participants also learn how to use humor in a conversation, how to pay attention to feedback and how to join a group conversation, Cunningham says.

Bullying is another important topic, but the focus isn’t so much on how to cope with it as how to prevent it from happening in the future, Cunningham says. One thing that group members learn is how to distinguish between actual bullying and straightforward feedback that they may get from someone who is annoyed by their behavior.

Cunningham also runs a PEERS group for adults with autism that includes four weeks focused on dating. (Cunningham doesn’t include the topic of dating in her younger groups but not because she thinks participants aren’t interested. Rather, it’s because parents of children with ASD often aren’t comfortable with their kids exploring romantic relationships, particularly when they still aren’t savvy about friendships.) The dating portion of the program focuses on topics such as appropriate ways to engage in flirting and assessing whether another person is interested.

It isn’t uncommon for men with ASD to be perceived as creepy, Cunningham notes, because they don’t typically understand how to read other people’s cues and might continue pursuing someone who is not interested in them romantically. Meanwhile, there are others with ASD who, despite their desire for a romantic relationship, won’t engage with anyone because they can’t tell if the other person is interested, she says.

Other topics the group discusses include how to handle peer pressure and sexual pressure.

Job hunting

Many people with ASD have trouble finding and keeping a job due to several factors, including a lack of social skills, difficulty understanding workplace culture and sensory difficulties that can cause them to become overwhelmed more easily. However, Smigiel believes that the most significant factor keeping those with ASD from career success is a lack of support.

In essence, Smigiel says, career counseling for those with ASD is similar in spirit to providing career counseling to any other client — it is a matter of finding out the client’s strengths and weaknesses. Smigiel did her internship at a vocational services agency that provided job counseling for those with ASD and intellectual disabilities. The agency helped clients practice their interviewing skills and assigned them a job coach who would try to connect them with positions that matched their skill levels.

Smigiel has worked with people on the high end of the autism spectrum who have found their niche in computer work, but at the vocational agency, they tried to match all clients, including those on the lower end of the autism spectrum, with jobs. “I’m a firm believer that anyone can have meaningful activity,” she says.

The key is to play on the focused nature of those with ASD. “What are they obsessed with?” Smigiel asks. “What can I do with that?”

For instance, Smigiel says the agency had many clients with ASD who loved to clean, so the vocational center helped them set up a car detailing program. The clients’ attention to detail produced “the cleanest cars you ever saw,” Smigiel says.

Counselors working with people with ASD have to think creatively and find that person’s niche, says Smigiel, who believes that everyone on the spectrum possesses strengths. For instance, some clients might be obsessed with organizing, which might make them a good fit for working in a clothing store and keeping all the displays in order.

Clients with ASD also often need help retaining their jobs because they don’t necessarily understand the social skills involved in working with others. As a result, they might ask too many questions, not understand what is and isn’t appropriate to say to a boss or have trouble interacting with co-workers, Smigiel says. In more severe cases, people with ASD might have poor personal hygiene, neglecting to brush their teeth or take a shower either because they don’t see it as a need or because it creates a disturbing sensory sensation for them.

At the vocational center, staff members would provide lessons on the importance of brushing teeth and taking showers, Smigiel says. When teaching these kinds of lessons, counselors should be aware that people with ASD are forthright and won’t want to do something “just because,” Smigiel says. Instead, the staff would say, “You need to take a shower because, otherwise, you’ll smell,” and, “You need to brush your teeth because, otherwise, you’ll get cavities.”

Emotional regulation

Clients with ASD also need help acquiring the self-regulation skills to cope with stress and frustration on the job, says Jamie Kulzer. An LPC in the Pittsburgh area, Kulzer helps clients with ASD and other cognitive disabilities as part of a multiweek vocational training program that teaches cognitive, self-management and vocational skills. The program includes internships with local businesses.

“We have found that emotional regulation is really important because if you’re escalated, [you] can’t access the other resources that you have to deal with problems.”

The program has participants envision an emotional thermometer, with green representing a calm, rational state and red representing a state of extreme sadness, anger or excitement. When individuals are in the red, they are unable to make good decisions, so Kulzer teaches clients to monitor their thoughts and behaviors and to be vigilant to when they are in the “yellow.” She also teaches clients to practice techniques such as deep breathing, visualization or standing up and stretching to help themselves avoid going from yellow to red.

Once clients have returned to a green state, they can approach a problem by asking for help or by using a divide-and-conquer strategy that breaks problems down into smaller, more manageable pieces. They can also express their problem by using “I” statements, such as “I need” or “I don’t understand,” explains Kulzer, an ACA member and assistant professor in the clinical rehabilitation and mental health counseling program at the University of Pittsburgh.

Program participants also learn about the physical and emotional gas tank, which is a measure of mental and emotional fatigue, Kulzer says. A full tank enables the client to be fully alert, present and ready to take in new information. An empty tank makes the client susceptible to aimless daydreaming, flooding emotions, racing thoughts and frustration.

Clients are taught that they can help keep their gas tanks full through self-care measures such as healthy eating, drinking water regularly and getting enough sleep. Kulzer also teaches program participants to approach their work or other projects by breaking them down and doing the easiest parts first and making sure to take frequent breaks.

It is critical for clients with ASD to monitor their physical and emotional gas tanks and to take action when they feel themselves getting to half full, Kulzer says. This means stopping and asking themselves, what’s draining the tank? For one person, it might be staying up too late to play video games, which requires better self-management. For another, it might be the result of being in an overly stimulating environment and needing to take a break by briefly leaving the area, Kulzer says.

In anticipation of the second half of the program, participants work on their vocational skills, which includes an emphasis on general communication. For instance, clients are taught to use “I” statements to talk about their feelings and encouraged to repeat back any request made to them to ensure that they are hearing it correctly and are aware of the nonverbal messages they are sending, Kulzer says.

People with ASD often have difficulty looking others in the eye, which can mistakenly give others the impression of disinterest. Kulzer’s program teaches these clients to say things like, “Eye contact is difficult for me, but I am listening.” Clients are also encouraged to indicate their attention and willingness to work by sitting up straight and taking out their earphones, Kulzer says.

The group also talks about social interaction. Subjects include what is appropriate to discuss in the office and how office friendships can have pros and cons. For instance, although it may be great to have someone you like and get along with, if you favor that person and don’t treat everyone equally while working, it can result in hurt feelings and misunderstandings.

Kulzer also talks with group members about issues such as scheduling and making decisions independently without telling a supervisor. She uses the example of someone with ASD who takes a bus that gets them to work 15 minutes early and then assumes this means that they can also leave 15 minutes early. Kulzer explains to group members that they can’t change their schedules (or make other similar decisions) without first discussing possible options with their boss.

The group participants receive feedback from Kulzer and other instructors as they work in their internships. Together, they tackle problems that come up in the workplace and implement suggestions for improvement. Kulzer says that many of the group’s members go on to pursue associate degrees or certificates in their internship field.

 

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Additional resources

To learn more about the topics discussed in this article, take advantage of the following select resources offered by the American Counseling Association:

Counseling Today (ct.counseling.org)

Practice briefs (counseling.org/knowledge-center/practice-briefs)

  • “Autism Spectrum Disorder” by Carl J. Sheperis, Darrel Mohr and Rachael Ammons

 

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editor: ct@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Achieving a better understanding of adult autism

By Kenneth J. Smith September 11, 2017

Autism, Asperger’s and “nerd” personality features (to use a concept from Temple Grandin, a prominent author and speaker on both autism and animal behavior) seem to have something of an air of mystery and intimidation for many mental health professionals. Let’s face it, clients with autism/Asperger’s have very different ways of perceiving and thinking than most counselors do. For instance, talking about feelings in an unstructured way à la Carl Rogers is unlikely to be nearly as productive with these types of clients as with other clients. Barring extreme examples, I prefer to think of individuals with autism, Asperger’s or nerd characteristics as having a set of co-occurring personality features rather than a mental disorder. To that end, I refer to these kinds of clients as PFAANs (personality features of autism, Asperger’s and nerds). I refer to non-PFAANs (sometimes called neurotypical) as NONs.

When I became a licensed professional counselor, I had a decade of experience running pigs through mazes (animal behavior/animal welfare research) for my Master of Science and working as a humane handling consultant/reviewer in more than 350 slaughterhouses (basically, I did work similar to what Grandin does in slaughterhouses). During that time, I read all kinds of books by Grandin and others to see how autism might help me understand animal and human behavior and cognition to further my work and career. Coming from this background, I was rather surprised to learn that I was expert in counseling adults with PFAAN, and now a large part of my practice rotates around this. I provide a therapy group for developing social skills in adults with PFAAN, and I help NONs better understand and engage with spouses or loved ones with PFAAN. At least in my region, there are very few mental health colleagues I can refer to who have much expertise in adult PFAAN approaches and needs.

The lack of services for adults with PFAAN (and their loved ones) is striking. Many resources are available for childhood/adolescent autism, but these approaches do not seem well-suited for adults, and there is almost nothing for people over age 21. Although I have no hard statistics to back this up, I suspect that individuals with PFAAN make up at least 20 percent of the U.S. population. To quote Hans Asperger, “Once one has learned to pay attention to the characteristic manifestations of autism, one realizes that they are not at all rare.”

To illustrate how many clients you might be seeing without realizing that they have PFAAN, consider whether you could apply the ways of thinking presented in this article to many of your clients who work in science, technology, engineering and math careers. You will see clients with PFAAN in your practice, so it is important to have a way of understanding their thinking patterns.

A central issue for clients with PFAAN is their lack of ability to naturally recognize emotions and empathize with others. If you’re confused by how to help, it may be useful to conceptualize the different ways that emotions seem to work in these clients compared with most other clients. A common tool used in mental health therapy is the Feeling Wheel developed by Gloria Willcox. It is the one tool I have found that both PFAANs and NONs seem to comprehend, so it has served as a valuable tool in bridging the understanding gap between these two groups.

The Feeling Wheel is an excellent way of visually conceptualizing how emotions work differently for clients with PFAAN and NONs. Grandin has suggested that a good method for teaching cognitive flexibility to individuals with PFAAN is to describe people and their actions as a mixture of colors.

The Feeling Wheel (see above) is also in line with another of Grandin’s concepts in which she describes a difference between PFAANs and NONs. She says that many individuals with PFAAN tend to think in specific pictures, whereas NONs seem to think in words/emotions. How this pictures versus word concept works can be quite complicated, but the visual concepts in the Feeling Wheel simplify how to explain this difference. I have developed a list of concepts using the Feeling Wheel and its colors to help counselors and clients empathize with one another and to get to the clients’ goals and skill development.

Concepts

Concept A: People with PFAAN will intuitively get/understand only the innermost (core) feelings. If most people in the world had PFAAN, the Feeling Wheel would probably contain just an inner core (see image below).

The recognition of the detailed emotions (represented in the outer rings of the Feeling Wheel above) seem to develop naturally in NONs but not in individuals with PFAAN. The outer rings of the Feeling Wheel can be taught to clients with PFAAN, but this must be done in an inductive way, similar to the way that most NONs learn math. NONs start with 1+1=2; people with PFAAN need to draw a picture of what the more subjective feeling looks like in NONs so that they can relate the outer rings back to the inner core that they more readily understand. I’ll share more about this later.

Concept B: Emotional processing changes how the world is seen and experienced. NONs can have all kinds of emotions at the same time. For example, if a NON sees a cow, he or she might have several different emotions at different intensity levels about that cow at the same time:

a) Peaceful: “That cow chewing cud is so Zen.”

b) Anxious: “That cow might come and attack me.”

c) Sad: “That cow will be killed to be eaten.”

d) Angry: “I get angry about the ways cow are treated in bullfights.”

The NON’s emotions will also tend to make the picture of the cow less distinct when the person turns the cow into words and emotions. (I think this is somewhat similar in idea to Carl Jung’s archetypes. For example, you don’t remember one cow; you shove the individual cow you see into the archetype cow in your mind.) So, often, this will happen in NONs:

Individuals with PFAAN tend to have only one or a few emotions at a time. They seem prone to black-and-white thinking, rigidity to change and litigiousness (for example, they may ask what the hard rules are for social interaction). So, when a person with PFAAN sees a cow, and if he or she finds cows peaceful, conceptually, the emotional experience he or she will likely have is the picture of that cow overlaid with the emotion (see below).

The way that emotions work in people with PFAAN seems to more closely model the way that emotions work in social animals. For example, a dog either likes a person or is scared of a person, but the dog rarely seems to have both emotions at the same time.

Concept C1: Individuals with PFAAN tend to have one emotion at a time (AND versus OR emotions). NONs can often experience several emotions together. I refer to this as AND emotions (see below).

 

Clients with PFAAN may also have different emotions about something, but they can process only one at a time. I refer to this as OR emotions (see below).

Concept C2: NONs mix emotional colors to get completely novel feeling colors, whereas PFAANs flip between colors. Related to Concept C1, NONs use AND emotions to make new emotional colors (think of mixing paint). A NON might feel strongly peaceful yet a little afraid when seeing a cow (mix dark blue and light orange to get a teal emotional archetype cow).

Individuals with PFAAN won’t readily mix colors, although they might flip between emotions rapidly. The flipping is where they are analyzing what to do (“Should I cry or run away?”) if more than one emotion is present (for example, strong peaceful feelings and a little fear of a specific cow). Usually, the emotion expressed in the client with PFAAN is the most “vivid” color emotion.

Concept D: Individuals with PFAAN take more time to process and switch between emotions. OR emotions and emotional flipping appear to lengthen the time it takes to process the emotions. This lack of speed in emotional processing is often interpreted by NONs as not caring, being cold or being anti-social. The speed of emotional processing seems very important to most people, and many of my clients with PFAAN develop deep shame for their inability to rapidly process emotions. (See No. 5 under the “Counseling approach ideas” section below for more illustrations of this concept.)

Concept E: Individuals with PFAAN are prone to emotional and sensory overload, which may lead to a new emotional color that equals shutdown. What do you often get if you mix all the colors of the feelings together in individuals with PFAAN? Black. This is a good conceptualization of what happens in many people with PFAAN when they are confused or overloaded: shutdown.

Shutdown also happens in NONs (think about the shutdown of emotional controls in the animated movie Inside Out, where everything became gray and the emotions no longer worked). However, it usually takes much more time and intensity (think posttraumatic stress disorder) for NONs to get to black.

To extrapolate from the work of John Gottman in couples therapy, men are generally more prone to sensory/emotional shutdown than are women (see Gottman’s concepts of stonewalling and flooding for more information and illustrations). Based on my work with clients with PFAAN, I strongly suspect that men naturally have more features of PFAAN than women do. The Centers for Disease Control and Prevention reported that autism is 4.5 times more likely to be diagnosed in males. This means that many more men than women would have mild features of PFAAN. Grandin suggests that among girls, PFAAN is often labeled as being a “tomboy,” which doesn’t seem to receive the same level of focus or concern as the presence of autism in males. New research also suggests that females with PFAAN may generally be better than males are at social masking of these features. Or to quote Asperger, “The autistic personality is an extreme variant of male intelligence.”

An example from my experience is that giving too many food choices to a client with PFAAN can lead to shutdown. A large menu may be too hard for these individuals to process in a given amount of time because what they “feel” like having can often take much more time to figure out than it would for other individuals.

Concept F: The default emotion of most individuals with PFAAN is anxiety (if not shutdown). Anxiety appears to increase in those with PFAAN from adolescence on. I believe that increased anxiety proneness is a strong feature of being a person with PFAAN, although such a view is controversial. Novelty — good, bad or indifferent — almost always causes more fear in those with PFAAN than it does in NONs. Hence, rigidity in behavior, speech, routine or time management may often be an attempt to control fear.

Individuals with PFAAN and animals share the experience of novelty and sensory overstimulation producing anxiety and fear. An example from livestock science is the observation of flight zones in animals. The flight zone is how far an animal stays away from a person or experience. The less anxiety the animal feels, the smaller the flight zone. Novelty and sensory overload in animals produce fear or anxiety and lead to avoidance behavior. Thus, if this is the animal’s experience, the flight zone increases. Flight zones are reduced through exposure and positive (or at least neutral) experience. Being around strangers often produces great anxiety in animals and in clients with PFAAN. Thus, both will often avoid strangers whenever possible.

Counseling approach ideas

It is important to realize that counselors will likely need to be much more directive and teacherlike with clients who have PFAAN than with their other clients. Unconditional positive regard, reflection and talk therapy probably won’t be particularly useful because these clients are unlikely to get what these Rogerian-based interventions are working on or doing. What is most likely to be helpful to these clients is to remain focused on the skills that they need and then teaching them those skills. What follows are some approaches I have discovered that seem to help clients with PFAAN in the context of therapy.

1) Teach/discuss the Feeling Wheel concepts. I have found that simply teaching the Feeling Wheel concepts discussed in this article provides many clients who have PFAAN with the tools to move toward their goals and something constructive to do in the counseling context. These clients tend to be analytical and often like testing ideas. Interestingly, many clients with PFAAN are shocked when they find out that most people experience more than one emotion at a time. PFAANs and NONs speak a very different emotional language, so it is important to have a “Rosetta stone” to help facilitate emotional communication.

2) Teach the general behaviors that the emotions cause or are related to. For me, these are the main behaviors that go with the Feeling Wheel, and teaching these behaviors gives clients with PFAAN clues of what to look for in others. Behaviors are often easier to measure than are other ways of interpreting emotion. I relate the core emotions to the following broad behaviors (although there are many others):

Emotion Behavior

Powerful Having a choice/creating

Joyful Attraction/pursuit

Scared Avoidance/flight/urgency

Mad Aggression/flight

Sad Slowing down/reflecting

Peaceful Calm/unhurried/content

In my experience, the best emotional states in which to be empathic/thoughtful are sad, peaceful and powerful. Mad, scared and joyful appear to be more action oriented. Make sure that the client with PFAAN is in or near one of the thoughtful emotional states when practicing empathy training.

3a) Teach these clients to label the emotion they see in others so they can relate it back to the core emotions and choose an emotionally appropriate response. Practice what the emotions on the Feeling Wheel’s outer ring look like. For example, ask what the visual and auditory signs are of a person who is discouraged. The person may look down, exhibit less body movement, speak about being discouraged and so on. Once that emotion is labeled, trace it back to the core emotion (discouraged is a kind of “scared”) to help the client understand it better and have empathy.

3b) Teach clients with PFAAN phrases and actions that can be used once they empathize with the person’s emotion. Just because clients with PFAAN learn to empathize does not mean that they know how to respond appropriately. For example, a client with PFAAN might feel great anxiety at a funeral. To break the silence and sense of mourning that is causing his anxiety, he may start talking loudly to those around him about a new model airplane he is working on. This incorrect social response can have serious repercussions.

It can be helpful for these clients if counselors assign them a set response (at least in the beginning) for each core emotion. For example, you might instruct the client, “If you determine that a person is sad, a good response is to tell that person, ‘I am sorry that X happened’ in a calm voice.”

4) Teach one concept from the Feeling Wheel at a time. Remember, the emotional parts of the Feeling Wheel should be taught to clients with PFAAN in much the same way that you would teach children math: Start with the basics and work up. Clients may have no idea what scared looks like in themselves or others, so provide clear, visual, colored examples to illustrate the emotion. For instance, if the emotion is isolation, you might provide the visual of a person trapped in a purple box (because purple is the color for sad on the Feeling Wheel). A mirror might also be useful to show these clients what their facial expressions seem to be communicating to the counselor at any given time.

5) Teach clients to say “whoa.” Emotional processing takes longer in people with PFAAN, so it becomes very important for these clients to be able to communicate this to others. This is especially important in intimate relationships. I have noticed that many individuals with PFAAN are married to or have intimate relationships with NONs who are very emotional. To adapt a Catholic marriage concept, I think there might be great complementary benefit to such matches. He (usually) balances out her (usually) emotionality, whereas she provides him with an emotional vocabulary and a feeling of being needed. Sometimes this arrangement works well for many years, but then the more emotional partner begins to believe that the emotional avoidance and lack of emotionality/spontaneity on the other partner’s part indicate that he no longer loves her. Very often, this is not the case.

To offer a case example, if a wife asks a husband how he feels about her, she usually wants an answer that is specific and immediate. If the husband has PFAAN, it may take him some time to work out exactly what feelings he needs to communicate, no matter how much he loves her. This delay is often interpreted as the husband not caring, which can cause serious relationship issues. Either the client with PFAAN or the counselor needs to explain to the wife that it is hard for the husband to rapidly communicate his feelings but that, given time, he will tell her exactly how he feels.

You might also help clients with PFAAN “schedule” spontaneity into their relationships to improve them. I had a friend who decided that his wife liked being surprised with flowers, but he was not at all given to being spontaneous. So, he sat down, budgeted how many times he could afford to give his wife flowers (yes, he had a flower budget), and then randomly assigned different dates on his schedule for presenting the flowers. As a result, she got spontaneous (thus emotional) demonstrations of affection, and he still got to operate via a schedule and a budget. It worked great for them.

In a work example, a colleague wants to know everyone’s gut feelings about a new project. It may be important to teach the client with PFAAN how to tell this colleague that it will take time to understand what he or she feels about the project. If forced to communicate too quickly, deep anxiety or shutdown may occur. Clients with PFAAN typically have difficulty with “gut” feelings.

6) Use superhero/comic/sci-fi character modeling. Most of my clients with PFAAN like superheroes, fantasy and science fiction. Anime, a kind of film animation that originated in Japan, also seems very popular with these clients. I have noticed that almost every time an anime character has an emotion, the emotion is accompanied by an exaggerated facial expression or sound cue. You almost always know how an anime character feels, which may explain why anime is so popular among individuals with PFAAN. Many researchers seem to suggest that Asian cultures include more PFAAN by nature (e.g., saving face, defaulting to authority) than many other cultures do, which may explain why anime has these features.

I always ask my clients with PFAAN about their favorite superheroes or other favorite characters. This gives me insight into the clients and often provides a good picture that I can use to help them develop the emotional attributes exhibited by the characters they admire. I use this superhero therapy in a variety of ways, but one good technique that uses the Feeling Wheel is to make a color feelings diagram based on the client’s favorite superhero so that the client has some visual concept to reference.

For example, a client with PFAAN may really like and want to emulate Spider-Man. Spider-Man is a mix of powerful (he fights evil and has superpowers), joyful (optimism and hope) and scared (social anxiety caused by nerdiness) emotions. Aiming the client toward getting the emotions he or she needs to be more like the superhero provides structure for change. “I have plenty of scared. To be more like Spider-Man, I need to practice being more powerful.”

One warning: Make sure that clients choose characters who will move them toward healthy and effective goals. If a hero (or anti-hero) whom a client has chosen would be unhealthy to emulate emotionally or morally, don’t be afraid to speak up. I say this from personal experience. I had one client who really liked the character Deadpool, but under no account should this character be an emotional or moral model.

Conclusion

The concepts I have illustrated connected to the Feeling Wheel have been a revelation in helping my clients understand the difference between PFAANs and NONs and how to approach skill building and therapeutic effectiveness. It is the only tool I know of that explains and demystifies emotional responses in PFAANs and NONs (the group that most counselors fall into). These concepts and approaches have made a huge impact on my ability to help clients with PFAAN and their loved ones.

Adults with PFAAN will find their way into your practice. It is important to know how their emotions work and what may be effective and rewarding in therapy, both for them and for you.

 

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Kenneth J. Smith practices at Spirit of Peace Clinical Counseling in Ohio. He enjoys working with clients with PFAAN and clients with existential challenges, teaching and speaking. He holds a bachelor’s degree in animal science, a bachelor’s in history, a master’s degree focused on animal welfare/behavioral psychology and a master’s in clinical mental health counseling focused on the treatment of shame and guilt. Contact him at info@kentherapy.com or through his personal professional website at kentherapy.com.

Letters to the editor: ct@counseling.org

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, go to ct.counseling.org/feedback.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

The Social Adventures and Experiments of  Tommy Joe Peterson

By Brandon S. Ballantyne February 7, 2017

The idea of this therapeutic short story is to creatively illustrate the various dilemmas that occur from the perspective of a socially awkward young man, Tommy Joe Peterson. Through the story, the reader is able to gain perspective on the thought process and problem-solving skills of this uniquely talented 11-year-old boy.

Whether this fictional story is read by a child or read to a child by a teacher or counselor, the discussion questions included at the end are aimed at facilitating reflection and interpersonal growth. I believe that discussing the responses to the discussion questions will allow for improved awareness and insight into real-life dilemmas and help children to improve their problem-solving skills in a creative, narrative manner.

The target population for my therapeutic short story consists of teachers, parents, therapists and children of elementary through middle school age, particularly those with a mental health diagnosis similar to or consistent with autism spectrum disorder or social anxiety.

Friendship

Hello, my name is Tommy Joe. I am 11 years old. And in my mind, I am not just a boy. I am the world’s most coolest teenage superhero in my school. Well, at least I pretend to be.

Let me tell you about the time I almost saved my friend William from a flying plate of steaming hot lasagna in the cafeteria. Oh, and just so you know, William is only a few months younger than me. This is what happened …

The day started out just like any other day. I woke up at 6:37 a.m. I always wake up at that time to ensure that I get as many cartoons in as I can before I leave for school at exactly 8:02 a.m. I like the superhero cartoons. Batman is obviously the best, and I think I am like him in some ways. Although most adults say I am socially awkward, whatever that means. Clearly, they do not understand my abilities.

Anyway, after my cartoon time, my mother prompted me to participate in what she calls “activities of daily living.” She is a nurse, and I hear those types of phrases all the time. I have gotten used to it. This is the part of my morning routine during which I brush my teeth and comb through my brown wavy hair. I usually place some deodorant under each armpit, but not a lot. I typically do not like the texture, but I tolerate it enough to get at least a little bit of scent on me. Every good superhero needs a scent — at least that is what my mother tells me.

It was almost time to leave for school, so I slipped on my Velcro shoes and placed my bright red turtleneck on so it fit nice and snug, just the way I like it. I refuse to wear anything else but that red turtleneck. I feel most like a superhero in that shirt. Some people tease me for this. They clearly do not understand my abilities.

The bus ride to school is short. I live only four blocks from the school. And as a fifth-grader, riding the bus is the cool thing to do. On that day, the older kids were making fun of the way I was dressed. They always do. They also make fun of the way I only spray certain sections of my hair. You see, only some sections of my hair get messy, so there is no need to hairspray it all down. Only certain sections need a touch-up.

I do not think that the other kids understand my perspective. I don’t mind though. Life can be hard for a superhero like me. Clearly the other kids on the bus do not understand my abilities. And anything is better than riding to school with your parents, although my mother does listen to good music. But that is beside the point, and I do not want to ramble on, so let’s get back to the story of how I almost saved my friend William from an extremely steaming hot plate of lasagna.

I meet my friend William at the same spot every day before going into school. Every superhero needs a sidekick, and William is mine. William is shorter than me, and he refuses to be called Billy. He thinks that William is more formal, and he likes that. He has red curly hair and orange glasses. I do not really know where he got those glasses, but I like them. His glasses usually slip down to the end of his nose, and he has to spend most of the day adjusting and readjusting them. We have every class together. Every superhero needs a sidekick, and at least William understands my abilities.

The day was pretty boring until art class. It is like that every day. William and I count down the minutes leading up to our fourth-period art class. For us, it is more than just art class. It is a time for us to create new supercool superhero ideas. And on this day, the topic of class was “favorite transportation.” This was a perfect topic for superheroes like us.

William and I decided to create a spaceship. This was no ordinary spaceship. This was a supercool spaceship that William and I had imagined ourselves using to explore the outermost limits of our galaxy — beyond the black holes, red dwarfs, supernovas and solar flares.

By the way, space is my other supercool area of interest. William is mostly indifferent to the idea of space travel, but every superhero needs a sidekick, and because of that, I think he would come with me anyway. I guess the only problem would be if William gets motion sickness. I wonder if he gets sick in the car? To tell you the truth, I do not really know how William gets to school each day. I have never been in a car with him. Quite frankly, I only see him at school. Oh well, I do not want to ramble. Let’s get back to the story of how I almost saved William from an extremely overwhelming, steaming hot plate of lasagna in the school cafeteria.

Before describing the scene that would be about to take place in the cafeteria, it is important for me to be able to tell you how our art project turned out. William and I made a spaceship using cardboard, paint and a whole lot of glue. The spaceship was red, just like my turtleneck.

William is exceptionally good at folding cardboard, so I gave him the job of working on the wings. William attached long, narrow wings that seemed as if they would touch the ceiling. We carefully added glue to all the areas that needed to be held together, and then we added more glue, and then more glue, and then one last coating of glue to ensure that this spaceship could tolerate the astronomical elements that space travel would bring to the table. Every good astronaut needs a sidekick.

Our hands were sticky from the glue. It was hard for us to pull our fingers apart. But our spaceship was complete. William and I carefully placed the spaceship in our art closet to dry.

The bell rang for lunch. We hurried out of the classroom without cleaning up the rest of our materials. This was necessary because we need to get to lunch early so that we can sit at the table in the left corner — the one by the ice cream cooler. I like ice cream sandwiches, and it is important to be next to the cooler so that I can get two of them before they sell out. Every superhero needs his energy, and I just happen to get mine from ice cream sandwiches.

William prefers pizza, but they do not always have that. I once had the idea of putting my ice cream sandwiches on my pizza, but I have not been able to convince William to try it with me. And as a superhero, you need your sidekick to be on board before trying anything new. But that is for another story. Let’s get back to this one. I don’t want to ramble.

William and I entered the cafeteria and at a casual but fast pace assumed positions at our table by the ice cream cooler. The cafeteria was loud and chaotic as various students attempted to jockey for position in the lunch line. The teacher on duty was obviously struggling to keep order. I could tell by the look on her face. I did not have this teacher for class, but any good superhero can tell when another person is in obvious distress. I wish I could have helped her, but I needed to remain in position at my table.

This was partly due to the fact that the ice cream cooler is positioned just outside the kitchen, and as kids pass through the lunch line, they typically select their favorite ice cream product to complete their tray. William and I do it backward — we wait for a break in the line, and then we purchase our desserts first. Most kids do not think of going to the ice cream cooler first because it is positioned at the end of the line. Being the most supercool superhero that I am, I had developed this approach early last year. William agreed with me, although he typically does. William is a great sidekick.

The time was right. William and I stood up to go make our selection. I always purchase two ice cream sandwiches. William typically purchases the Italian ice. At least I think he does. Anyway, it was at that moment when we stood up that I began to notice an increase in chaos in the far right-hand side of the cafeteria. I quickly glanced over, and before picking out my ice cream, I noticed a food fight taking place. It was on the other side of the cafeteria, but it appeared as though it was escalating rapidly.

I needed to get my ice cream. I reached down and realized that I could not pull my fingers apart to grab it. Oh no, it was my worst nightmare. My fingers had been glued together from working on our spaceship in art class. It seemed that the harder I tried to pull them apart, the more they seemed to be glued together.

I had one dilemma with not being able to literally pick up my ice cream sandwich, and another dilemma with the rapidly growing food fight that was moving across the cafeteria like a tidal wave. I had to make a decision. I either needed to take cover and sacrifice my ice cream sandwich, or I needed to take the chance of being hit by food and attempt to grab my ice cream with my glued-together fingers. I had to think quickly.

At that moment, I noticed a red substance flying through the air toward William. I saw it out of the corner of my eye, so it was hard for me to tell what it was. But as it flew through the air, I realized that it was a piece of lasagna. It was hot. I could see the steam coming off of it as it whizzed past the heads of various students.

At this point, even the teachers were taking cover. Mr. Jones was under the table, and Ms. Sprockett was hiding behind the soda machine. The flying lasagna was coming our way, and based on my superhero calculations, it was heading directly toward William.

Everything was moving in slow motion. William was frozen in fear. He needed me. I quickly lunged in his direction and raised my hands in an attempt to take most of the blow from the flying lasagna. Every good superhero occasionally makes sacrifices for his sidekick — at least Batman did.

The only problem was that my fingers were still glued together. The lasagna not only hit my arms, covering me in sauce, but it also smothered William. He had sauce and cheese all over him. And the worst part of it was, I didn’t even get my ice cream sandwiches. The last thing I remember was William tasting the lasagna that was dripping off of his cheeks. William is always good at embracing chaos.

I guess even the best superheroes sometimes have trouble rescuing others. But William and I are still friends. He has forgiven me, and there are no hard feelings between us. I guess what I have learned from this situation is that every superhero needs a sidekick. I do not know what I would do without William. He is my best friend. But maybe next time, I won’t use so much glue.

 

Therapeutic discussion questions 

  • According to Tommy Joe, every superhero needs a sidekick. Who is the sidekick in your life? Who do you feel supported by? Who listens to you when you talk?
  • What makes someone a friend? What makes you a friend? What types of things do friends do for one another?
  • Discuss a difficult situation that a friend helped you with. What did they do to support you?
  • Discuss a difficult situation that you helped a friend with. What did you do to support them?
  • The glue on Tommy Joe’s fingers makes it difficult for him to rescue William and pick up his ice cream sandwiches. What should Tommy Joe have done prior to going into the cafeteria that would have made it easier for him to help William?
  • What is a goal you have in your life? What is an obstacle you face in your life? How can you plan ahead to make accomplishing your goal easier?
  • What can your sidekick do to help you reach your goal?
  • If you were Tommy Joe, what would you have done differently in the story? How would making different decisions have affected the outcome of the story?
  • Is there another way the story could have ended? If so, I would love to hear your version.

 

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Brandon S. Ballantyne, a licensed professional counselor and national certified counselor, has been practicing clinical counseling since 2007. He currently practices at Reading Health System in Reading, Pennsylvania, and Advanced Counseling and Research Services in Lancaster. He has experience working with both adolescent and adult clients struggling with moderate to severe depression and anxiety. He has facilitated many unique interventions and group modalities in the area of addressing relationship conflict and negative thought patterns. Contact him at ballantynebrandon@yahoo.com.

Letters to the editor: ct@counseling.org

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having your article accepted for publication, go to ct.counseling.org/feedback.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Gut health and healthy brain function in children with ADHD and ASD

By Michelle Harrell February 8, 2016

With the awareness being brought forward regarding gut health and neurocounseling, the future looks bright for our children with attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Although all the tools that are available for neurocounseling are excellent for improving cognitive, emotional and social skills, we now have additional research to support the addition of nutritional therapy to our toolboxes as counselors.

Although I am a new counselor, I have spent more than 25 years researching and applying nutritional therapy in my own life after being diagnosed with chronic fatigue syndrome in my early 20s. I have WatermelonTummyseen firsthand the benefits of nutritional therapy and how it affects emotional, mental and physical well-being, especially as I reversed the symptoms of ADHD with both of my two children. As a teacher, I have also witnessed the increase in children with ADHD, ASD, and other mood and anxiety disorders that could be greatly combatted with supportive counseling and nutritional therapy protocols. As I begin my journey as a counselor in the schools and private practice, I can’t imagine not grasping the opportunity to add nutritional therapy for my clients.

Improving gut health can have a dramatic effect upon mood and cognitive functioning because of its healing nature within the immune and nervous systems. The use of nutritional therapy to support gut health in children and adults builds resilience and supports the bottom-up aspect of neurocounseling that understands and recognizes the bidirectional connection between our gut and our brain, as discussed by Allen Ivey and Mary Bradford Ivey.

 

Current statistics

According to the Centers for Disease Control and Prevention (CDC), ADHD currently affects approximately 11 percent of children ages 4-17. ADHD is a chronic mental health and neurological condition that has been increasing at a rate of 5 percent per year since 2006.

ASD is also on the rise. According to the CDC, ASD affects approximately 1 in 68 children in the United States. That rate is expected to increase to an estimated 1 in 25 children by 2025. ASD is currently five times more likely to occur in boys than in girls.

The fact that both of these conditions are on the rise at these current rates in our children should be cause for serious concern. As a parent and a teacher, I have observed the increasing demand that these chronic health conditions are putting on caregivers and professionals. Many counselors are responding by offering neurocounseling and other proven therapies to assist with behavioral issues, emotional regulation and cognitive needs. Neurofeedback, along with cognitive behavior therapy, is also proving to offer improved brain function that is sustained after treatment ends. Because nutritional therapy supports brain function, the two work in synchronicity for a client’s well-being.

Much has been discussed and debated about the issue of diet with children who have ADHD or ASD. Many parents have noted that removing certain foods appears to reduce symptoms of the disorders, and there is general recognition that gluten, sugar and other allergens have had a negative effect on these children. Even though these irritants seem to cause increased symptoms in many children, the underlying gut health situation might be the actual culprit here.

The gut ecosystem is a system that needs to be in balance. The gut is balanced when good bacteria and yeast exist in a healthy ratio within the digestive tract. When this balance is disturbed, food sensitivities and allergies can be noticed. According to Donna Gates (the author of The Body Ecology Diet) and Natasha Campbell-McBride (a medical doctor who wrote Gut and Psychology Syndrome), when gut health is restored, it results in a reduction in food allergens, allowing children to once again consume gluten and other supposed no-nos in a moderate amount.

Children with ADHD and ASD have shown remarkable improvement and overall symptom reversal by using food-healing protocols that increase healthy gut microbes, according to Gates and McBride. This can be a great relief and blessing for families that have been following a strict gluten- and casein-free diet. Imagine the joy of parents who can once again allow their child to attend birthday parties to enjoy cake and ice cream.

 

Basic knowledge

ADHD and ASD are just two of the many mental and developmental disorders that can benefit from the application of nutritional therapy to improve gut health. Gut health is important for brain health and directly affects mood and emotions. A growing number of researchers are interested in the relationship between gut microbes and brain function. According to the California Institute of Technology (Caltech), approximately 90 percent of serotonin is made in the gut. Researchers at Caltech are also studying the benefits of gut flora and its direct contribution to reducing autism symptoms in mice and humans.

According to Lisa E. Goehler, an expert in psychoneuroimmunology and faculty at the University of Virginia School of Nursing, gut microbes are responsible for creating most of our serotonin and numerous other neurotransmitters that are essential for healthy brain function. Serotonin is necessary for the brain to experience a positive mood and be resilient to stress. Microbes in the gut also have the essential task of supporting digestion by synthesizing vitamins, fermenting things we can’t digest and producing hormones that influence our immune, endocrine and nervous systems, according to Goehler.

Not just quantity, but diversity of gut microbes is important for overall health, Goehler says. She states that lean individuals have greater diversity in their gut microbes. But even a heavy person who has a diverse and abundant good microbe count is shown to be in better health than those with limited amounts of microbes, she says. According to Goehler, heavy individuals with a greater diversity of microbes experience fewer problems with metabolic syndrome and cardio and neurovascular disorders. This can even be a factor in the health of children who are overweight.

In general, Goehler reports, when good gut microbes are limited and displaced by toxins and yeast, digestion is impaired, resulting in leaky gut syndrome. In leaky-gut syndrome, yeast begins to take over when good bacteria have been reduced due to antibiotic use and unhealthy food choices. Yeast overgrowth causes leakage in the wall of the small intestine, allowing contaminants and undigested food into the bloodstream that would otherwise not have been able to cross the intestinal wall barrier. Yeast and other pathogens can then travel to the organs and cause additional health issues.

Nutritional therapy to restore balance begins with reintroducing additional healthy gut microbes back into the system. Probiotics and cultured foods seem to be a foundational piece to any effective gut-healing protocol. More of the science that goes with this essential piece of the puzzle is outlined in programs of leading practitioners. The results of restoring healthy flora back into the gut for healing has yielded many positive results for some families with ADHD and ASD.

I was pleased to find the work of two professionals who have been having similar results with the reversal of ADHD and ASD symptoms with a diet based on consuming probiotics and cultured foods. Gates’The Body Ecology Diet and Campbell-McBride’s Gut and Psychology Syndrome were remarkably similar, even though the two developed their works separately on opposite sides of the world. Gates, of California, and Campbell-McBride, of the United Kingdom, collaborated in a video to share the similarities between their results and the importance of balancing the body’s digestive ecosystem. I highly recommend their video as a source of valuable information for anyone seeking to learn more about the advantages of cultured foods (see https://youtu.be/nLP0Ijo2CK4).

Gates and Campbell-McBride both offer straightforward steps for balancing digestion, and they both have documented multiple cases of reversal or, in some cases, complete healing of ADHD and ASD in children when their methods are combined with additional holistic therapies. They both recommend the use of coconut kefir and fermented vegetables as foundational pieces of their plan. They both also mention that, historically, all cultures had some sort of cultured food that supported gut health, but during the latter half of the 20th century, this knowledge seemed to be disregarded for our current modern diet. Introducing these foods back into people’s diets has resulted in tremendous health restorative qualities for many of their clients. Having valuable resources that are in layman’s terms for clients to use can help support clients’ wellness plans.

 

Overcoming barriers

Counselors will come up against a variety of barriers if they choose to integrate food healing into their practice.

First is the issue of counselor training and understanding. Clearly we as counselors did not set out to be certified in nutrition, and many counselors may not want to pursue the additional certification. I have found it worth the time and energy to learn because I can apply it in my own life and experience improved personal health in addition to supporting my clients’ needs. Clients may also feel more inclined to see if food-healing protocols might work for them if their counselor is applying them as well. Regardless of whether you align yourself with another professional who possesses the credentials to offer nutritional therapy or you decide to jump in and educate yourself, your clients will benefit. But the choice is obviously the counselor’s to make.

As a recent counseling program graduate who wants to move forward into practice as a neurocounselor and offer nutritional therapies, it is important to educate myself on current research-based approaches that are demonstrating positive results. Current scientific research shared by Goehler in her workshop titled “Understanding the Gut Brain: Stress Appetite Digestion and Mood” offers one such professional learning opportunity for counselors. Of course, other researchers offer additional workshops. I make it a point to include these types of workshops in my professional development plan.

Although I am knowledgeable about food therapy and plan to constantly improve my skills, I also know my limits and will refer my clients as needed to those who are experienced experts in nutritional therapy. I also know that one size does not fit all. Clients require individualized plans that are suitable for their health needs.

Even if clients begin eating a healthier diet that is right for them, barriers such as cultural resistance at school, work or home can discourage them from continuing a positive habit. Counseling strategies might include encouraging clients to build healthy communication and confrontation skills when responding to those who question their dietary preferences. These skills can especially benefit teenagers who have to address their peers at a time when peer influence is of great importance in their lives.

Barriers of child taste preferences can be a serious problem for parents who have children with ADHD or ASD. Oftentimes, these children resist the foods that will restore their gut health. In his book Conquering Any Disease (2014), Jeff Primack shares the ingenious strategy of introducing delicious fruit smoothies into a child’s diet to restore gut health in children who have health issues. His research and books on food healing and smoothies have resulted in positive outcomes for Foodchildren with ASD and ADHD. These children were soon demanding more healthy smoothies as their tastes slowly changed toward a diet that would support their goal for improved health.

Within private practice, counselors can overcome barriers by educating clients through workshops and seminars. Clients can also benefit from support groups if they feel alone or don’t receive support from their immediate family or community system. Free online forums such as the one that Gates created (see bedrokcommunity.org) can offer testimonials and encouragement for parents who hope to help their children by integrating nutritional therapy along with other holistic protocols and counseling services.

School counselors might experience the most challenging barriers within a system that does not quite understand the role they play as mental health supporters. It would be interesting to see how administrators respond to data indicating that instances of ADHD and ASD are increasing and information about the current solutions available for parents and teachers to offer. The current demand to address the needs of ADHD and ASD students is enormous and requires a significant amount of time and resource planning for all school personnel. School counselors are being called on to assist with the increasing numbers of behavior issues and learning needs related to ADHD and ASD diagnoses. In addition to their current workloads that may include extra administrative duties that keep them from being available for these students’ counseling needs, school counselors are still trying to establish their identities as counselors in schools. This is where advocating for a comprehensive school counseling program as outlined by the American School Counselor Association, a division of the American Counseling Association, can be useful. Comprehensive school counseling programs encourage school counselors to be change agents, which could include mental health efforts that integrate nutritional support for these students.

School counselors can bring this information to light in a variety of ways, including offering a professional development class on mental health for school staff, administrators and school board representatives. As a teacher, I would have appreciated learning more about many of the diagnoses that I was designing 504 plans, individualized education programs and response to intervention frameworks around. Teachers are in the trenches daily dealing with stress and anxiety issues related to ADHD, ASD and other mental health disorders but don’t know the details behind these diagnoses. They will truly need the support of school counselors and administrators in the years ahead given the projected increases for ADHD and ASD.

There are many other creative ways that school counselors could address wellness. Counselors educated on nutritional research could advocate with their school boards and county nutritionists to suggest healthy food options that would be tasty for students. According to Luise Light, the former director of dietary guidance and nutrition education research for the Department of Agriculture, the food pyramid that emerged in the early 1990s was a product of business corporations and not true science. In 2006, Light stated that all of her research was overlooked in favor of corporate interests. In her book What to Eat, she explained how this development has directly affected our society’s health and particularly our most valuable natural resource — our children. Clarifying that the food pyramid is both outdated and not based on the best scientific data could help our society understand nutrition differently.

Another opportunity for counselor advocacy is to work collaboratively with health and science teachers to design lessons that align with current research. I knew of one health teacher who taught children in an impoverished neighborhood the benefits of micronutrients by bringing in a blender and creating fruit smoothies. This exposure to practical solutions that tasted good paid off. The students couldn’t stop talking about their lessons on food and nutrition from this progressive teacher, and I even heard them discussing how they were teaching their parents about healthier food options.

With food therapy and neurocounseling working together, the future looks hopeful for children and families dealing with ADHD and ASD. Obviously, each child is his or her own unique being and will require an individualized protocol that is specific to that child. Professional counselors have been trained to offer amazing tools for improved mental health, and I believe we now have a critical missing link to add to our toolbox. We are at an exciting time in our work, with science and counseling validating the relationship between the mind and body as never before.

 

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Michelle Harrell, an educator working in the Columbia County school system, lives in Evans, Georgia. She earned her bachelor’s degree from Georgia Tech and both a Master of Arts in Teaching MichelleHarrelland a Master of Education (school counseling) degree from Augusta University. She is currently working on her specialist degree in counseling education and supervision. Michelle is also a qigong and meditation teacher in her spare time. Contact her at michelleharrellneurocounseling@gmail.com.

Retaining family focus

By Laurie Meyers September 23, 2015

“Rose” and “Steve” came to American Counseling Association member Laura Marshak for couples counseling because they felt they had been growing further and further apart ever since their son, “Sammy,” who was now in elementary school, had been born with cerebral palsy. Out of necessity, Retaining-family-focusSteve had become the primary breadwinner for the family, while Rose left her job to provide the extensive care that Sammy required.

Over time, Steve buried himself in his work, while Rose handled Sammy’s daily needs. She shuttled Sammy to his appointments for speech therapy, physical therapy and other specialized services and also took on the task of petitioning Sammy’s school for an Individualized Education Program. Rose felt she was doing all the heavy lifting and resented Steve because she thought he wasn’t helping enough with Sammy’s care. Steve, on the other hand, thought Rose didn’t appreciate how hard he was working to secure their financial future. Angry and resentful, they rarely spent time together as a couple, says Marshak, whose specialties include counseling parents of children with special needs as part of a group practice in Pittsburgh.

“They said it was too hard to find a qualified baby sitter who could handle their son’s medical complications,” recounts Marshak, who is also a counseling professor at Indiana University of Pennsylvania. “In reality, they did not have much to say to each other anymore and had lost an intimate connection.”

According to Marshak, the author of the recently published book Going Solo While Raising Children With Disabilities, Rose and Steve’s story is not unusual. Instead, it is an all-too-common experience shared by many other couples who have children with special needs.

As loved and wanted as these children may be, the unavoidable extra care they require can take a toll not just on parents but also on siblings and the family as a whole. When a child has special needs — whether physical, medical, intellectual, emotional or educational — parents may find it necessary to alter virtually every facet of family life. For these families, it can sometimes seem as if every resource, from time to money to even patience, are continually at risk of being exhausted. Depending on the severity of the child’s disability or special circumstance, the family may need access to intensive medical, health or other services such as occupational or speech therapy; specialized education and possibly job training; and help with daily tasks that other families may take for granted, from basic hygiene to learning and applying social skills.

Because efforts are understandably focused on navigating the day-to-day and moment-to-moment challenges of addressing their child’s special needs, another very important need can often get pushed to the side: maintaining the overall health and well-being of the individual family members and the family unit as a whole. Parents can struggle to take time for themselves while caring for their children. Marriages and partnerships can be tested or neglected. Siblings might struggle to cope with disparate levels of parental attention, feeling they have been left to face life’s challenges on their own. That’s why counselors can play such an important role in helping these families not just meet the special needs of their children, but also attain a better sense of equilibrium.

Addressing behavioral issues

Charmaine Solomon, a licensed professional counselor (LPC) and sole practitioner in Plano, Texas, says that when families of children with special needs come to see her, they are generally looking for help with the day-to-day issues. One issue that comes up frequently is discipline.

“Families with special needs children struggle to discipline in an appropriate manner,” Solomon says. “Because the child has special needs, they [the families] feel like they can’t hold them accountable.”

Solomon, a member of the Texas Counseling Association, a branch of ACA, has a now-grown son who suffered a traumatic brain injury as a child that left him disabled. This personal experience has informed her counseling practice. One of Solomon’s areas of focus is working with children and adults who have special needs such as autism and intellectual disabilities. She is also one of the founding members of My Possibilities, a continuing education day program for adults with special needs located in Plano.

Considering everything else that the parents may be struggling to manage, a child’s acting-out behaviors may seem like a relatively minor problem, particularly when the child is young, Solomon says. However, as the child gets older, this lack of discipline may become virtually unmanageable or, in some cases, even lead to violence, she notes.

Parents who focus on punishment when their child with special needs is acting out or showing aggression may find themselves locked in an escalating punishment cycle until seemingly the only solution left is to ground the child for life, says Erik Young, an LPC in West Chester, Pennsylvania. He has worked with individuals with special needs and their families for the past 20 years, including in a rehabilitation center, a life-skills training organization, a behavioral health care organization and, for the past four years, as a private practitioner. Young and his wife have also provided foster care for several children with special needs.

When parents come to Young for assistance with their children’s behavioral problems, he helps them develop a behavioral plan, which will vary according to the child’s problem behavior and capabilities. For example, many children with intellectual disabilities possess poor verbal communication skills, and their inability to communicate effectively may be part of the behavior problem, he says. Young frequently works on communication skills with the child and parents, giving the child a book or tablet device with pictures that the child can use to indicate what he or she wants.

Discipline strategies will vary from child to child, says Solomon, but should typically focus on reward and reinforcement rather than exclusively punitive measures. For example, parents should focus on what the child really enjoys, such as spending time on an iPad, and start by setting a time limit on the activity, Solomon explains. If the child displays the desired behavior, the limit will be increased, but problematic behavior will result in decreased time with the pleasurable activity, she says.

When appropriate, Young likes to use cognitive behavior therapy (CBT) to uncover what the trigger or cause of the child’s behavior problem might be. Conversely, it may be that a child’s behavior is not truly problematic but is simply angering or frustrating to the parent for some reason, so he will also use CBT to help the parent understand why. Young will then develop a behavioral plan that may include teaching the child and parents strategies for anger management, emotional regulation and so on.

Robert Jason Grant, an LPC and sole practitioner in Nixa, Missouri, also works with both the child (mainly children who are on the autism spectrum) and the child’s parents to explore factors that contribute to behavioral issues. For instance, he explains, punishment for certain behaviors isn’t successful with children who have autism because these children engage in impulsive behavior.

“[The behavior] is not thought out and may even be a surprise to the child,” says Grant, a member of ACA. “They may not even have time to think about consequences.”

Instead, Grant says, behavioral work should focus on what is causing or contributing to the problem. Because children with autism typically possess little or no ability to regulate emotions or process sensory input, emotional and sensory dysregulation are often the main contributing factors to these children’s discipline problems, he says.

“What tends to create dysregulation, and how do we change that?” Grant asks. “Is it environmental? Do we need to provide sensory breaks? … A sensory break could be something as simple and basic as a private quiet room, let’s say in school, where the child can go to be by [himself or herself], with no other people and no one coming to talk.”

Sometimes, all these children need is to “reset,” Grant says, and that can take as little as 10 minutes.

Grant also works with children and parents to tackle the dysfunction head on. He has designed a specific approach that he calls AutPlay, which is a combination of behavior and play therapy for children who have autism. The play therapy tools he uses include objects such as weighted vests, weighted balls and other sensory toys because children who are on the autism spectrum find these items soothing, he says. Parents can use these toys at home to continue the therapy, and that is important because dysregulation requires constant maintenance, he says.

The benefits of effective discipline go beyond managing specific behavioral issues, Solomon says. When parents discipline a child who has special needs, they are teaching him or her how to tell right from wrong and also how to accept instruction, she asserts. Knowing how to make decisions and how to follow instructions contribute to a child’s sense of independence, adds Solomon, who believes that parents should always be working toward increasing the child’s level of independence.

For instance, some children with special needs may require help feeding or dressing themselves beyond the age that is typical for completing those activities independently, Solomon says. Although it is often easier to continue to dress and feed a child who has difficulties, parents should keep working toward teaching the child to do these things on his or her own, she asserts. Solomon acknowledges that this process can take a little — or a lot — longer, but in many cases, she says, the child will eventually have the capability to do it. The same holds true for many other self-care and independent activities that will ultimately benefit the child, she says.

Letting children with special needs do everything they are able to do can also bolster their self-image, says Susan Stuntzner, an assistant professor in the School of Rehabilitation Services and Counseling at the University of Texas, Rio Grande Valley. On the flip side, automatically doing everything for a child who has a disability can send negative messages about his or her capabilities and value and also create a sense of learned helplessness, she says.

Family needs

As children become more self-sufficient, this generally eases the pressure on parents. But parents of children with special needs sometimes come to believe that they are the only ones who can — or should — provide adequate care for their child, Solomon says. Unfortunately, being constantly on call, and with no relief in sight, tends to only cause more problems, she says.

Young says that although families may initially come to counseling for help with a specific problem such as discipline, he also probes for any other stressors with which the family is having difficulty coping, either as a group or individually.

There really is no way to fully prepare for the needs of a child with a disability until you have to do it, he says. Families are suddenly faced with the need to obtain — among other things — health, medical and disability services, Young explains. Further complicating matters is the fact that there is no one central place to obtain services. Disability and educational assistance vary from state to state, and health and medical services are usually secured through insurance plans with varying levels of benefits, Young and Solomon point out.

In addition to coordinating outside services, parents must come up with a plan for meeting the child’s daily needs, Young says. Children with special needs may require additional help with daily activities such as getting dressed or even eating. Children with disabilities may need constant care, meaning someone has to be watching them at all times, Young adds. This means spouses and families may have to engage in tough discussions and make significant compromises. For instance, who stays home to provide care to the child? Who will be on call to take the child to any therapy that he or she might require? To address these needs, one parent will often stop working, which can creates an additional source of stress: money and finances.

Caring for a child with special needs can be a 24-hour job that many families assume they can and should engage in alone, Solomon says. But if all of the family’s time and attention is spent on taking care of the child, who is taking care of the family?

“Oftentimes, families are trying to figure out how to tend to their family member’s needs and concerns to the point that they forget they have their own set of needs,” says Stuntzner, an ACA member who also writes and speaks about living with a disability. “As a result, families … may experience personal or caregiver burnout.” In fact, if parents consistently ignore their own needs, they may eventually grow resentful of how much help their child requires, she warns.

Young works with families who are dealing with a child’s special needs or circumstances to help them recognize that they don’t have to do it alone and that resources are available to them. He points out that he, or any other counselor, can offer the family a neutral source of support — someone to talk to who doesn’t have any kind of emotional attachment or agenda but understands what the family is going through. Because Young also has connections (from his time working in a rehabilitation center and a behavioral health care organization) to state and local agencies that help provide services, he can point these families in the right direction. He even keeps a binder of business cards that he has gathered over time, based on personal or client experience, for tradespeople such as plumbers and handymen who are used to coming to homes with children with special needs and who won’t be disturbed by outbursts or other behaviors that might be regarded as outside the norm.

A system of support

When Grant works with parents of children with autism or other special needs, he always emphasizes the importance of self-care. He teaches parents how to conduct a self-care inventory so they will start actively thinking about caring for themselves.

Encouraging family members to engage in self-care sometimes requires a shift in perspective. For instance, self-care can mean something as small as taking a few moments during the day to indulge in something the individual really enjoys, Young notes. “Instead of a week on the beach — because that’s probably not going to happen — what can they do during the day? [It’s] just little moments that can be refreshing,” he says.

When a child is born with special needs, becomes disabled or is diagnosed with a disorder, Young says, it is common for extended family members and friends to draw back at first, often because they feel like outsiders and aren’t sure what they can do to help. So Young encourages families who have a child with special needs to actively reach out to others, explaining that maintaining a solid social network is crucial for both emotional and practical support.

“I often take my clients through the process of listing all potential resource people — no matter how disconnected — and talk about what they might be able to contribute,” he explains. “Then we go about ‘recruiting’ them so to speak. Find ways to utilize their talents and, thus, spread the stress. People generally want to help when they can. They may just need guidance.”

That’s why Young tells these families to let their networks know what they need specifically. “Take an executive role. You are president,” Young urges his clients. “These people are your Cabinet, your advisers. Make sure you’re getting them to do what you want.”

With a support network, parents can also build a system of respite care. Once a child is used to being with a caregiver, the parents can take breaks, possibly even getting away for a day trip or weekend vacation, Solomon says.

Sometimes families won’t seek any kind of support because they feel ashamed of their struggles, Solomon says. Rather than isolate themselves further, she encourages these clients to seek out others families of children with special needs. She suggests that parents contact local mental health agencies to find support networks.

Young says that lately he has been providing more couples counseling than family counseling because the primary issue for many of his families who are dealing with special needs is actually a problem with the parents’ marriage or partnership. The stress of caring for a child with special needs can take a particular toll on a couple’s relationship, he points out.

Solomon agrees, noting that respite care isn’t just important for parents as individuals but also as a couple. When providing focused care to a child with special needs, it can be particularly challenging to find the time or the energy to just be a couple, she says. Identifying someone who can provide caregiver support can allow couples to take much-needed time for date nights or even a short trip, she adds.

Parenting styles can also drive a wedge between couples who are caring for a child with special needs, says Young, who uses talk therapy with couples. If parents can’t agree on how best to care for or discipline their child, it creates a continual source of conflict, he says. Young helps couples learn to communicate with each other about what they want and need and how best to compromise, if needed.

“I like to use a variety of techniques that hone active listening and clear communication skills and trust,” he says. “One favorite technique I learned at an attachment therapy conference is to have the couple sit in chairs facing each other. One person communicates a brief statement, then the other person has to repeat it back. Then they switch roles. Even this simple exercise can highlight when assumptions are being made and communication is being blocked.”

Young also specifically addresses differing parenting styles with couples, such as when one partner is more authoritarian and the other is more nurturing. He works with these couples to develop a joint parenting style that is balanced — both authoritative and nurturing.

Young also works with the parents in session to practice planning for specific concerns. He asks them to think about how they were raised and how that influences the way they parent today. This exercise helps to spur conversations that can uncover differences in the way they view parenting, he says. Young then helps the couple to negotiate these differences.

Sometimes it’s not parenting style — but substance — that causes the problem. Solomon says disparate distribution of parental responsibility is often a source of tension in families managing special needs. She regularly sees mothers who take all the responsibility for caregiving — either by choice or necessity — which leaves little time for other relationships. Solomon tells her clients that parents need to share responsibility. For example, when possible, fathers should take a turn accompanying the child to therapy. If the mother is the sole caregiver during the day, the father should give her a break by taking on extra duties at night.

Marshak’s couple, Rose and Steve, offered an example of disparate responsibilities — or at least that was how it appeared to Rose. With Marshak’s help, the couple began to discuss the underlying tensions and motivations that had led them to their crisis point.

When Sammy was first born, Rose was deeply depressed and wanted to talk about her grief with Steve, explains Marshak, who co-authored the 2007 book Married With Special Needs Children: A Couple’s Guide to Keeping Connected with Fran Prezant, a speech and language pathologist and researcher on disability issues. Steve, however, preferred to avoid discussion and bury himself in his work. Rose thought Steve’s silence meant that he didn’t care about her or Sammy, but focusing on work and providing for his family was actually Steve’s coping mechanism to deal with his grief. As time passed, Rose spent her time learning as much as she could about cerebral palsy and seeking support through a network of other mothers who had children with the disease. Steve worried constantly about how to financially support his family in the present and how to make sure there would be money for his son in the future in case Sammy couldn’t support himself. So Steve worked even harder.

Guided by Marshak, the couple discussed all of these issues in counseling. Rose began to understand that work was Steve’s way of coping with his feelings of grief and worry and that even though he wasn’t sharing his grief verbally, that didn’t mean he wasn’t hurting. Steve learned to become more expressive with his feelings.

Rose and Steve also worked to re-establish their romantic connection by going out as a couple again and trying to view each other as the individuals with whom they had fallen in love — not just as Sammy’s parents, Marshak says. Over time, as they re-established their bond as a couple, they also started to adjust their roles, including sharing more of the responsibilities related to Sammy’s educational and medical needs. Rose even resumed some of the leisure activities she had given up when she felt she was solely responsible for Sammy’s care.

Speaking to siblings

When working with a family who has a child with special needs, it is also important for counselors to take time to focus on the needs of family members who may get overlooked, or at least feel like they are overlooked — siblings.

Grant sometimes works with siblings on their own so they will know they have an outlet for their struggles and frustrations. “One of the biggest challenges [for siblings of a child with special needs] is the feeling of having to take a step back, of giving up things for their sibling,” he says.

Out of necessity, the child with special needs is the family’s biggest area of focus. To the child’s siblings, this circumstance can seem not only unfair but also as if the parents are choosing to favor the child with the disability or special needs, Grant adds.

When Solomon’s son who is disabled was a child, his siblings struggled with feeling forgotten. “I had to teach my [other] sons the difference between ‘have to’ and ‘want to,’” she recalls. Solomon sat down with her sons and explained that it wasn’t a matter of wanting to spend less time with them but rather that their brother needed more of her time.

As the siblings of a child with special needs get older, they may also start to worry about or feel responsible for their brother or sister, Grant says. He regularly teaches siblings games that they can play with their brother or sister who has special needs that will help the child to cultivate specific skills. One such game is called Social Skills Fortune Tellers.

Grant teaches the “neurotypical” sibling — the fortune teller — how to make an origami structure with tented triangles that can be manipulated with the fingers so that different sides or flaps of the triangle show. Each flap holds a social skill to practice. The fortune teller manipulates the origami and reveals a skill, which the siblings then practice, Grant explains. As an alternative, the origami can also be used for emotions, he says. When a particular emotion is revealed, both the neurotypical sibling and the sibling with special needs can share a time when they felt that particular emotion or make a face that demonstrates that feeling.

Grant also uses family play therapy techniques to allow siblings — and all family members — to express how they are feeling or what they are thinking about issues such as how autism is affecting the family or how the parents are parenting. One technique is called “color my feelings.” Each family member uses a white piece of paper with a heart drawn on it. The family members color the hearts with whatever color best represents their feelings, he explains. The family members then share their hearts, allowing everyone an opportunity to talk about the feelings they are having and why they are experiencing those feelings.

Lifelong support

It is painful to contemplate, but there will come a time when the parents are no longer there to help their child with special needs, Solomon says. That is why she is adamant about encouraging her clients to plan for that future now.

Solomon tells parents that they need to consider questions such as: Who will take care of the child? What services will the child need? Where will the child live? Where will the money to pay for the child’s needs come from?

She helps parents learn what guardianship is and urges them to start planning immediately for the lifelong financial needs related to providing for someone with a disability. Solomon also notes that it is important for parents to apply for disability services well ahead of time. Once a child graduates, he or she loses any benefits, such as ongoing speech therapy, that the child’s school provides, she points out. Solomon adds that in Texas, there is currently a 12-year waiting list for state services.

Young also helps families come to grips with the reality of planning for a child’s ongoing support once the parents are gone or are no longer able, for health or other reasons, to continue providing care. Although he acknowledges it is a difficult conversation to have, he sits down with families and helps them develop a long-term plan by investigating options such as sheltered workshops and group homes. Young also emphasizes the wisdom of financial planning with insurance agencies that specialize in estate planning and special needs trusts.

From Solomon’s perspective, this planning process also comes back to encouraging children with special needs to develop as much independence as possible and teaching them skills to help prepare them for the future, just as parents do with any child.

“Just like with another child [without special needs], you ask, ‘Have you done your homework? Practiced your instrument?’ With the child with special needs it’s, ‘Did you practice doing your buttons? Did you take a shower?’” she says. It’s still homework, she adds, but homework of a different sort.

Young says it is important for counselors to empathize with parents about the challenges of raising a child with special needs. At the same time, he encourages parents to let go of the idea of what “could have been” and instead embrace the child that they have because each child with special needs also has his or her own beautiful gifts.

Stuntzner, who is also a member of the American Rehabilitation Counseling Association, agrees. “Coping well does not mean the family has not felt or experienced negatives or difficulties,” she says. “Rather, it is an indication that through the experience of a loved one’s disability, they have found a way to work with the situation so that it brings the family together instead of pulling it apart.”

 

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Additional resources

The American Rehabilitation Counseling Association, a division of the American Counseling Association, is an organization of rehabilitation counseling practitioners, educators and students who are concerned with enhancing the development of people with disabilities throughout their life span and in promoting excellence in the rehabilitation counseling profession’s practice, research, consultation and professional development. To learn more, go to the ARCA website at arcaweb.org.

The International Association of Marriage and Family Counselors, also a division of ACA, is an organization whose members help develop healthy family systems through prevention, education and therapy. For more information, visit iamfconline.org.

Other resources include:

  • “Disability Awareness,” an ACA podcast presented by Robbin Miller. To access the podcast, go to the Knowledge Center section of ACA’s website (counseling.org) and click on “Podcasts.”
  • Yes You Can!: Art-Centered Therapy for People With Disabilities, an ACA DVD presented by Judith A. Rubin. To purchase the DVD, go to the ACA bookstore (counseling.org/publications/bookstore).
  • “Autism Spectrum Disorder,” an ACA Practice Brief written by Carl J. Sheperis, Darrel Mohr and Rachael Ammons. To access this brief, go to the Knowledge Center section of ACA’s website (counseling.org), click on the “Center for Counseling Practice, Policy and Research” and then “Practice Briefs.”

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To contact the individuals interviewed for this article, email:

 

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editor: ct@counseling.org