Autism & PTSD, with Sean Inderbitzen | EDB 254
Therapist and self-advocate Sean Inderbitzen discusses PTSD on the autism spectrum.
(VIDEO – 24 mins) Sean is a Behavioral Health Therapist, and lives with an Autism Spectrum Disorder. He has a caseload with 33% of his patients that live with ASD and varying co-morbid psychiatric conditions. Prior to being a mental health clinician, he was a Vocational Rehabilitation Specialist for Wisconsin Division of Vocational Rehabilitation for 3 years. He was also appointed by Governor Walker to the Statewide Independent Living Council of Wisconsin. He is an incoming member to the Motivational Interviewing Network of Trainers, and provides training on motivational interviewing, ASD and employment, and ASD and co-morbid psychiatric conditions.
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FULL TRANSCRIPTION
DR HACKIE REITMAN (HR):
Hi, I’m Dr. Hackie Reitman. Welcome to another episode of Exploring Different Brains. And today, we’re so lucky to have with us coming all the way from Wisconsin: Sean Inderbitzen, who is an author who is a coach, who is a therapist, who is so much more. Sean, welcome to Exploring Different Brains.
SEAN INDERBITZEN (SI):
Thanks for having me.
HR:
Introduce yourself properly, because you’ve done so much here. And I got two pages about you. But I want to hear from you. Yes, yes.
SI:
I mean, it’s kind of like that, right? Like, it’s, I’m a busy guy. Um, so I’m a motivational interviewing network of trainertrainer, or member. So there’s this organization called MINT, and I’m a member. And so
HR:
Say that again slowly, that whole name.
SI:
motivated motivational interviewing network of trainers, basically, in order to be a part of that you have to do a training with Bill Miller and Teresa Moyers about how to teach and so I did one of those trainings. So that’s really all that means. But like, I contract with engineers all over the country, right. So like, some of my clients have included the state of Oklahoma, or the Dan Marino foundation. So, I mean, it’s a pretty common thing, right? Like, I’ll teach him I some of the other stuff I’ve done. I’m doing my doctorate at Tulane in clinical social work, and I’m already done my dissertation. Um, so yeah, that’s…
HR:
You’re doing your doctorate now. Virtually?
SI:
Yeag, so I do it through Tulane School of Social Work. Um, virtually. And so we have classes one weekend a month. Um, so yeah, it’s really cool. So for mine, I did a big grants application for the state Oklahoma and one it. So that was half of my dissertation. And the other half was on a kid with autism and anxiety, I treated using physical exercise as an intervention. And that sort of a lens into my other part of my career, which is really autism and mental health and the intersection. So I do a combination of things in like speaking on mental health and autism. I do some research on autism and trauma, and specifically on EMDR, and autism, and now I’m doing some sensorimotor, psychotherapy, research on autism. And then I practice clinically with people with autism at about 30% of my caseload, and I work in a community mental health center.
HR:
And what are your own personal diagnoses? If you want to share with our audience?
SI:
Sure, I think there’s a pretty reasonable case for PTSD. Based on some of the stuff I’ve been through, I was diagnosed with Asperger’s at 18. And then at 12, I was diagnosed with ADHD, but I really believe that’s anxiety. And my current therapist would probably agree with you. Um, so yeah, so anxiety, autism, and probably PTSD.
HR:
Well, you know, one of the reasons we started different brains was I don’t think anything exists in isolation. So I think you will always have mental health issues. If you have a neurodiversity over here developmental Yeah, we have learning differences. If you have neurological issues, such as epilepsy, how are you going to have any of these things without anxiety with that little depression?
SI:
Right.
HR:
Throw in a little PTSD. You know, I mean, come on,
SI:
Can I can I share some symptoms that are common between both autism and PTSD?
HR:
I wish you would because I want to focus, I know it’s your big interest. That intersection you just spoke of their autism and PTSD.
SI:
Yeah. So why don’t we first start with some symptoms that are in both and then we can just drop into it however you like. Um, so symptoms that you would find in both diagnoses is include withdraw, lack of eye contact issues with trust, or in some others, no response to name reduce sharing of interest, frequent comorbid, anxiety and depression, difficulty with relationships, tantrums, self harming behaviors, frequent nightmares and sleep problems, changes in appetite or frequent eating problems, hyper or hypo sensitivity to sound, smell, touch, face, light disassociation, or lives in their own world of deficits and abstract reasoning and language development, or difficulty, rigid behavior. And so, Steven Porges has this really interesting idea that like, hey, people might not be either autistic or they have PTSD, they might just right, like have some symptoms, and that’s how we’ve named them.
HR:
And you bring up an excellent point, because one of the things I want to try to do is — let me get in to this backwards, okay? The reason I wrote “Aspertools: the Practical Guide to Understanding embracing Asperger’s, autism, neurodiversity” was… and the publisher HCI books did Chicken Soup for the Soul, which has since been absorbed by Simon and Schuster. They weren’t too thrilled I wanted they had neurodiversity in this way you putting that in, make it just Asperger’s and autism. I said, because I now realize, coming into this with a fresh set of eyes, because I’m not a professional, that it’s all brains are different. We’re all on this giant spectrum. None of this occurs in isolation. So they gave it. And so what I’m finding if I go and reverse, the reason I wrote as per tools, and one thing, we’re very focused here at different brains is giving people tools they can use to help, whatever, whatever it is, I don’t care, we get God, I care. How can I help you? And so these tools help all of the above. Exercise a good diet having a full dance card? Yeah. And the big, big toughest one, I think that it’s common for all of them is socialization.
SI:
Right. I mean, that is basically right, like you’re trying to fit ventral vagus system, right. So there’s the ventral vagal system, which is responsible for socialization. And then there is the dorsal vagal system. And what Porges finds in his work on people with autism and people with trauma because he’s the originator of polyvagal theory. And what he finds is that there’s a lot of parallels between the way people with PTSD socialize and the way people with autism socialize because that that dorsal vagal system basically right like is or it’s either the it’s it’s like the fight flight freeze the that part of it the not the dorsal vagal system, the ventral amygdala, we Yeah, the amygdala basically is underdeveloped. It’s really what it kind of boils down to, right. So like the amygdala goes into fight flight freeze way easier, when it’s underdeveloped. Because when you’re exposed to trauma again and again and again and again, right? Like it basically fries your sense of normal, over and over and over again. So like the way I explain it, like with my brain to my clients is right, like right down here is the back here, the lower brain, right like the reptilian brain, the prehistoric react, what the previous start, right? The prehistoric brain is reacting to, like what it perceives as a threat, right? And so it’s called the limbic system. So it kind of like millions of years ago, when we had saber toothed Tigers story about that was a great thing. But now, right, like no saber toothed tigers, a lot of times that alarm system goes off when there’s no real threat, right, like and so when you have autism, right, like you enter into that much easier is sort of the belief.
HR:
Let me let me just shift gears a little bit. You recently shared some of your experiences with PTSD. Can you talk to us about that?
SI:
Yeah, yeah. What particularly would be helpful to illustrate? Would it be some of the intersections or more the… so I’ll just pull up the article here and we can kind of talk through some of what that be okay. Sure. Alright, so I start off by talking about right like, my loved one walks out of my life never turned back still hasn’t. And I thought this artist BlackBerry’s phenomenal if you’ve never heard him, give them a listen. But it’s the song me and your ghost and he’s like, I’m not alone. It’s just me and your ghost. This crippling depression I thought, my lesson. Right? And so one of the things about like, I was engaged to this gal and one of the things was she dissociated a year before Right? Like she actually has a diagnosis that supports this association. So when backfire says right, like, I’m not alone, it’s just in your ghost. crippling depression. I thought I learned my lesson that I really shouldn’t learn my lesson, but I did. Cuz, right love it. It’s this pickle thing. Um, and so it kind of hits just right at home. Because right like, I’ll like the other night for instance, right? Like, I’m, I have this sweater. This cardigan is beautiful. It’s cool. It’s brat or it’s not brown. It’s gray and blue. It’s kind of neat pattern and it’s from our grandparents. Like I literally just looked at it and that was enough right to bring back her goes to make me want to reach out be like, hey, hunt you to like, but like I know, right? Like when someone subjects with diction right like to quote Gaber Motzei um, gave you know gave her motto yes or no? Don’t um, so gave her Motzei wrote a book called in The realm of hungry ghosts. He talks a lot about the relationship between addiction and trauma and he talks about how passion gives an enriched and enriches addiction is a thief and kind of that idea right like me reaching out to my ex right like addictions a thief passion, right? Like other very similar addiction. Passion one generates and one robs right and like this whole experience, I was robbed of my loved one I was robbed of the person who’s gonna be a stepmother, to my kids, my kids were robbed of that experience. And so, um, so yeah, the flashbacks when I like so when I see a cardigan that right, like, shouldn’t have any memory or energy, this thing has all this memory and energy that like just has me ruminating about all the times we had. And the tricky part about it is right, like, My heart wants to believe like, Oh, I’ll, if I reach out, or I’ll get what I once got, which was that dopamine fix that, like, I had a loving relationship with this person…
HR:
“Come on and shoot the heroin, you’ll feel better.”
SI:
Right? Exactly. And it’s exactly the same parallel, right?
HR:
Interesting. I never thought of it like that.
SI:
Well, and Mochi talks about “why the pain” right like why the pain? And I think if you focus on the pain in PTSD, it gets a lot easier to move through because right like addiction, like giving myself that dopamine fix trying to text or thankfully, I didn’t want to do right, like, it would have given me a dopamine fix, that wouldn’t have given me any results, right? Like my life is moving forward. And it only moves forward as long as I don’t go backwards, right? Like there’s this quote, like depression, you’re looking back and staring, anxiety alert, you’re looking forward and staring. And then there’s just right now. And so the trick is to try and be in the right now. And so I feel like the depression part of PTSD very much is this idea that if I go back to that addiction, right, like that failed relationship, or that person is addicted to something right? Like, that robbed me of all this joy, right? Like, I’m not going to get through it.
HR:
Tell us about internal family systems therapy.
SI:
So I internal family systems, was created by Charles Schwartz, Dr. Charles Swartz. And basically it posits that the self is not just one being right. Like it’s this continuum of parts of self, right. So like, for me, I’m right, like I have some defender parts, I have some exile parts, Defender parts are the ones that try to protect us. And where his exile parts are really like the parts that are trying to be protected. Right. And so there are all these different parts. So like for me, and with my therapist, one of the things we work on is, I have this defender part that really is a chameleon, right? Like it will. It’s agile, like it’s weird to think that like metaphor can be such a useful way to access that, right? Like, when I access these parts, right? Like I have this one part, this defender part. It’s like a chameleon that changes shape, in order to actually right like, and so when I spend some time with it, right, like it shows up as a suit of armor. But then right like it’s avatar of the Airbender, and it’s a monk like fifth whirling ball of air. And I realized this sounds crazy, but it’s really neural pathways integrating right like, it might be metaphor, but right like this defender part of myself is very much my amygdala keeping up right, like, it’s like, this defender part is very much this amygdala, like gearing up grabbing for a fight. It’s like, are you going to hurt me, so you just kind of stick with it, you’ll be mindful, kind of like in boxing where you have to be then. Right? Like when you work with your parts, you have to be there and if not, right, like it won’t pass. And so a lot of it is learning how to make peace with those defender parts. So you can get at some of those exile parts, right? Because those exhale hurts are usually connected to a traumatic memory that hasn’t scored. And so what I mean by that is right, like this idea, right? Like that my ex left without reason, right? Like that memory can’t store properly because it doesn’t fit the logic of attachment theory, right. Like attachment theory posits that you spend time with one another right? Like it’s sort of like interlocking like, like a levee, right, like interlocks right, you shouldn’t be able to rip it apart. And so when she left it just completely rip that apart, like the memory can’t go.
HR:
It doesn’t compute.
SI:
Right? Right. And that’s the dysregulated part, right? Like my experience that That’s why the flashbacks that’s why when I look at the sweater, I’m like, I want to go back to her. And it’s like, no, hey, like, it’s this really, really dark, dark place. But now it doesn’t, doesn’t give us what we need. Right? Like it doesn’t create serotonin.
HR:
What advice would you have for our audience who are on the spectrum, about the type of therapists they should see?
SI:
I think the number one predictor of success for a person’s ability to heal in therapy, which is really articularly, argued by Bruce Lampold, is that the modality doesn’t matter so much is that you with autism have a relationship with your therapist, right? Like, over and over and over again, there have been studies to say this therapy is more effective than this one than that, wow. While there are a lot of those studies, it has like, two effects x versus like, treat, like your therapeutic alliance. It’s like a point 6.7 effect size. And while there are fewer studies on that, those ones yield the greatest impact in therapy. So if somebody with autism, so if you have trauma, I think finding a therapist you can connect with and have a relationship with is not like, Oh, you have autism, right? Like, because that’s a thing that is totally a thing when you have autism, right? Like, therapists will chew you out of your office just because you have that diagnosis.
HR:
It’s really a shame that I find that nobody gets, that’s an overstatement… psychologist and psychiatrist and MDs like myself, I’m an orthopedic surgeon by trade. Okay, get zero training, you know, and in in autism, and neurodiversity. In general, they get see, pediatricians don’t know about this stuff. They don’t get training in it, unless they took a special course in it. And, and then there’s so many things that are higher incidence in the autism community that are problems is the wrong word. digitus differences in issues like the transgender issue, okay. It’s just a much higher incidence in the Autistic community. So how can I coach somebody or be a psychologist to somebody if I don’t know anything about autism? If they also have what isn’t? And the wiring in their brain is such?
SI:
I mean, maybe I fall with Bruce Lampold but Right, like, as a therapist, my ability to help someone doesn’t like wow, right, like somebody with dissociative identity disorder, right. Like, that’s a very special set of issues. Like, that’s a very particular way of working with someone but autism, right? Like, these are people like I have this conversation with Valerie Gauss, sometimes she’s like, if you had cancer and went to the doctor, they wouldn’t say, we’re not going to treat you because you have cancer, right? Like, that’d be insane. It’s the same thing with autism. But like, for whatever reason…
HR:
The analogy you just gave, okay, if I’m a cardiologist, and I’m treating somebody for their heart condition, and they also have cancer, all right, I have to know a little bit about cancer in order to treat that patient properly. If I’m a psychologist, and the patient has cancer, I have to have read a little bit about specific mental health issues with people with cancer. So I would push back a little bit on that, because there are certain certain things unique to autism. That don’t mean you shouldn’t treat that it just means wouldn’t it be helpful if I had some training in it?
SI:
Yeah, absolutely. I mean, they absolutely should get more training. That’s not my argument. My argument is more about access, right? Like if I have autism, and I’m a mom of a kid, who is just like ending up in the emergency room, and every time I go to a therapist, right, like, they’re like, Oh, you have autism? I can’t treat you right. Like…
HR:
No, that’s not right. All right,
SI:
Is so not right. And that’s my point. Right? Like, it’s that there are trainings out there. Like I can think of three right like I have one Wisconsin Autism Society as another and then there’s this lady named Tasha Rollins who has another right like, and we work with clinicians to improve confidence, right? Like that’s the outcome we measure, like mine is statistically significant with my program, like it has a large effect size. And so I mean, mine specifically geared towards mental health but right like there are only five MSW programs in the country master’s in social work programs that teach about developmental delays in autism, right like this is a problem at a systemic educational level, right? Like this is a big freaking problem because if you had cancer and you go to the doctor, right Like, you’re not gonna, like get sent away because you have cancer, you’re going to, like, get sent to an oncologist. Right? Like if you’re a cardiothoracic surgeon, right? Like, and you have a case patient with cancer, you’re going to defer your expertise to the oncologist. But it’s not like, right, like, we’re not gonna do something to help the person because that’s what happens, right? Like the patients and come to see me, right, like, they end up going to higher and higher levels of treatment, because they end up in inpatient. And then, like, there’s a local inpatient unit, and I won’t say which for like, my own liabilities, right? But, um, right, like, they honest to God, right? Like, they’ll send people down to the state mental institute, right. And these kids come out with trauma, because they don’t know what they’re doing. And they make it worse, when they very much went to the hospital to get help. Right. So if our systems of care are harming people, I sort of wonder if we have bigger problems.
HR:
Tell us about the course you have coming up for the University of Wisconsin.
SI:
Sure. So my course is really addressed to meet this need of lack of confidence, and lack of ability, right, like so I kind of go back to that research by Bruce Lampold and say: biggest predictor of success in therapy or psychology, right? Like, isn’t whether or not you have some specialized knowledge. Like what we know from the research is that as a point to effect size, right, but the point six effect size is your ability to form a relationship with a person. And so really, what my course does is it works with clinicians to like figure out what do you already know, that you can use to create a relationship with this client? Who has autism. And so the way it’s structured is it’s two hours of lecture. And then it’s five half hour consultations with me and other members of the cohort. So it’s coming up in February, it’s the 16th, or the 17th. We’d love to have you join us,
HR:
Tell our audience how they can learn more about you and follow you.
SI:
Yes, so they can go on LinkedIn. I have SeanInderbitzen.com. And you can look up Shawn into bits and calm on LinkedIn. And I have a profile there. I’m on different brains, too. So I blog with you guys so they can follow me there. Um, you can go to Pesi and look for me, I’m a training on motivational interviewing and autism there that you can take if you’re interested. There’s some recordings there. Or you can go to my website to contact me directly at SeanInderbitzen.com.
HR:
SeanInderbitzen.com. That’s the place to go, great.
SI:
Yeah. A lot of goodies there.
HR:
Sean, what is one piece of advice you have for someone with autism that has experienced a trauma?
SI:
One piece of advice that I have for somebody who has autism and has experienced trauma is find a therapist you trust, right? Like there’s nothing more important than that. Finding someone you trust.
HR:
Well, Sean Inderbitzen, and it’s been such a pleasure to have you here. Thanks for enlightening us. And I got to say the intersection of PTSD and autism is a fascinating one, as well as all the other things you’re doing. Thank you so much for everything you’re doing.
SI:
My pleasure. Thanks for having me.