My Twitter bio currently reads “Mentally interesting queer with awkward career”. I last edited it a couple of years ago during the general horror of my last episode of depression, referencing the irony of a therapist who couldn’t seem to stabilise their own mental health. But my mood has been much better for a year now: the bio might have appeared during the depression, but it stayed for the social awkwardness, and the emerging suspicion that my long and colourful history might not actually have been entirely caused by psychological factors.
A few months ago, having a slight dip in professional confidence, I tried googling variations on a theme of “counsellor with autism”. All I came up with was a reddit thread of laughably inappropriate jobs: autistic counsellor had the honour of being top of the list. With my new diagnosis, I am even more of a punchline than ever before.
I see why, and I find it kind of entertaining myself. Autism is defined, diagnostically, by social and communication impairments. I have these impairments alongside a degree and a business based on communication skills. People also find it funny because of the idea that people with autism don’t have the ability to empathise, and empathy is the very foundation of counselling.
From my academic studies, I know this is largely a myth perpetrated by poor communication (haha) of research findings by the media. While reading research on central coherence (i.e. super attention to detail, possibly also coupled with difficulties seeing the bigger picture) in autism and anorexia for my thesis last year, I also ended up indirectly learning more about empathy in autism, since a lot of studies research several cognitive traits associated with autism in one go. I eventually came to an understanding on the subject that I shared with someone asking questions on Twitter a couple of weeks ago, which I’ll mostly copy and paste here due to laziness😉
Given that empathy wasn’t my main research subject, I should make a disclaimer that my understanding might still have some holes I’m unaware of. Having said that, it seems fairly well accepted that empathy in autism is a lot more complex than what is portrayed in the media (well, isn’t everything?!).
Firstly, theory of mind is the concept used to describe the ability to understand that other people also have thoughts. Secondary to this is that those thoughts may be the same or different to your own. This is something most children start picking up as toddlers, but seems to be developmentally delayed in children with autism. I’ve seen a review which suggests it is largely developed in typical kids by age 5, whereas children with autism typically get to the same point by around age 10, although in children with additional learning disabilities or those who are largely non-verbal it can be hard to assess.
Affective empathy is the automatic reactions people have to seeing emotions and pain in others. This seems to potentially be intact in autism. So if someone is crying, I feel pained that they are hurting and my eyes water, which can be a real pain in the arse when I’m working! Anyway, this reaction is what the general public tend to imagine is impaired in autism – the equivalent of not caring if someone is in pain.
Cognitive empathy is what seems to be affected in autism. This is the ability to quickly, instinctively understand why someone thinks or feels the way they do. People with high functioning autism often do develop cognitive empathy, but it tends to be the product of logical deduction rather than the more automatic process in neurotypicals. Logical deduction is a lot slower and more energy consuming, so this leads to slower performance on cognitive empathy tasks, and outside of a lab, lots of going quiet or blurting out something inappropriate in a heated/emotional moment. So, for example, if I’ve upset someone, the reason for their reaction only tends to occur to me later, or after someone else has helped me figure it out. But that’s not the same thing as not caring, or not being upset that I’ve upset someone because I know how that emotion feels and don’t want other people to feel like that because of me, which is more what people tend to think happens with autistic people.
Finally, this is all complicated by alexythymia, which is common in autism. This is a neurological difficulty in understanding what you yourself are feeling, and in explaining this to others. This means that sometimes people with autism might not know that they are feeling bad for someone else, even if fMRI shows the expected pattern of activation for empathic pain in response to someone hurting emotionally. I think I’m alexythymic too, although 15 years in and out of therapy has helped with this quite a bit.
(/end of technical bit)
I knew before my diagnosis that I have strengths and weaknesses as a counsellor. Judging by my long term clients, I work best with people who have eating disorders, people with high levels of autistic traits, and those who have chronic problems with anxiety or depression who want someone to talk to every few weeks rather than a third or fourth stint with IAPT involving someone trying to “fix” them in six weeks and discharge them without support when it doesn’t work again (n.b.: IAPT have their uses, but I get a lot of people who have been through the system repeatedly and have a number of very similar complaints about the process. However, I also recognise that I’m bound to end up with a poor opinion of the service because obviously I never see the successes – they don’t need a counsellor anymore!). On the other hand, I don’t consider myself to be competent, skilled, or experienced enough for trauma work, I get too frustrated on behalf of clients experiencing work-related stress, and I am uneasy working with relationship difficulties. I know my limits and I am comfortable referring people elsewhere if I don’t feel I’m the right person for them.
I am not the therapist for everyone, by a long stretch. But my longer term clients consistently tell me that I “get it”, when no one else ever has. This, to me, suggests ableism at play in my profession. An autistic counsellor is a joke: but then, does everyone really relate best to and feel most comfortable with a neurotypical therapist? As a client, I’ve felt with virtually every therapist I’ve ever seen that I’m continually having to fight against their basic assumptions about what the human experience is: every session is a variation on the theme of BUT IT’S NOT LIKE THAT FOR ME. This is often read as me being defensive, arrogant, in denial, over-intellectualising, and so on – and so the divide widens. Until my diagnosis I had no words with which to back up the basic experience – like my clients – that people just didn’t get me or me them. While I tried hard to figure out what I was doing to make everyone misunderstand me, a small voice in the back of my head complained that actually, people in the caring professions seemed to lack empathy. They just couldn’t put themselves in my shoes.
(Understandably, since my feet are only size 3.5. Which is a very literal interpretation of the phrase. Which is in itself unnecessary to say, since most of you would have got the joke. I’ll stop there before I accidentally use another metaphor and have to deconstruct it. Oh dear.)
So, the world might not be ready to understand how autistic counsellors could possibly exist. However, given personal experience as a client, and professional experience of the people I work best with, and the consistency of what the non-neurotypical minority say to me about their experiences with neurotypical professionals, I put forward the suggestion that maybe the world needs a few more autistic counsellors.