Autism & Trauma: The Less Than Conscious Decision
By Sean Inderbitzen, LCSW
A Less Than Conscious Decision
Recently, an Autistic client of mine went to see John Mayer at the Xcel Energy Center in Minneapolis, Minnesota. Known for songs like “Why Georgia” and “Daughters”, John Mayer’s music career spans over twenty years and multiple Grammy awards. That stated, despite this amazing setting my client reported this overwhelming sense for the majority of his show of wanting to die and throw herself from the top ledge. All thanks to a less than conscious decision.
As my series frequently talks about trauma and autism’s intersection, I felt this story was an appropriate addition. My client, a victim of physical assault and severe neglect in child from a parent with dissociation and bi-polar, had recently undergone a break-up about two years prior. Her partner left rather suddenly and unannounced one day, in the middle of what would have been like any other. Engaged to be married the next summer, she bawled for months blaming herself until she discovered her ex had been cheating on her.
The last time however that my client had been to the Xcel Energy Center was for a Chainsmokers concert, in November of 2019 with that cheating ex. As they attended the concert they sat in the upper deck of the left hand side of the stadium. Which ironically was the same section she sat in for John Mayer.
Ironic or not, when she was reporting these feelings of suicidality to me, it was uncanny the resemblance of where she sat. Her “parts” (the varied elements of her brain), for better or worse, selected what they felt she deserved: to relive the pain, and the agony of that partner who was cheating all along. And while she did not realize it until she got there it was one of the few ways she could resurrect that ghost of a lover, in an effort to fill the hole.
The Reminders of Trauma
Triggering or flashbacks like my autistic client experienced, are responses to reminders of a traumatic incident from the past (like being cheated on, left, and blamed by a partner) that involve intensely discomforting feelings and reliving the past as if it is presently happening. My clients amygdala is akin to a dog who barks at both a mail man and a burglar. As a result it activated her sympathetic nervous system, and ultimately dorsal vagal system to bring on to my already unsafe feeling autistic client an intense desire to die. What was powerful about her experience however was that she was able to identify she was having a trigger.
She didn’t actually wish to die, but her body told her she did, all because of a choice she does not recall making. When I asked her why she picked the seats in our session this past week, she replied, “I just picked seats from a list”. However this to me as her clinician appears to ironic to be a coincident, no what is more likely is that one of her autistic dysregulated parts drove this decision making and picked what it felt would bring up the memory. As I allude to before my client was cheated on, left rather abruptly while engaged to be married. She in her last communications with her ex, when she asked him, “Why are you doing this?” Her ex replied, “Because you aren’t attractive to me. You’re too obsessed with work, and you don’t respect me enough”.
Regardless of if any of that were be true, it wasn’t until almost a month later she came to learn via social media that he had been cheating. However, while she cognitively knows this, not all of her “parts” have taken in this information. The information of about being left and accepting fault has a bit of a way of sticking, given how in her prior abuse she was blamed for the physical violence she endured from her father. That message of “these terrible things are happening to you because of you” is a deeply held belief, and so a flashback eliciting this desire to die makes complete sense. Her “parts” embrace the guilt of responsibility for something that is largely not her decision, but was rather imprinted on her from her father, and reminded to her by her ex.
Hence the desire to sit in the upper left side of the Xcel Energy Center. So what do we do when our less than conscious parts are making decisions we may or may not agree with? Therapy is likely a good starting point.
Seeking Trauma Therapy
While seeking mental health therapy is a good starting point, not all therapists are equal i. Trauma unlike other disorders actually does require some semblance of training beyond initial licensure for mental health professionals, as the work often involves re-exposure to the traumatic incident. Generally anyone offering trauma therapy will have some type of training in this modality before offering it publicly on their website or Psychology Today profile. An important note, that most of these trainings involve 30 more hours of additional training, and involve some type of certification body (emdria, sensorimotor psychotherapy institute, beck institute, etc.). This is distinctly more intensive than so-called, ‘trauma-informed’ trainings which are not the same thing, and do not qualify someone to work with trauma symptoms. So here we are going to give you a few ideas of the type of trauma interventions available to you:
Trauma Focused Cognitive Behavioral Therapy (TF-CBT) TF-CBT, developed by Dr. Aaron Beck, perhaps the most researched psychotherapy involves developing a narrative about trauma, presenting it to a family member, and then destroying the narrative. This therapy is great for those who want to talk about their trauma, and has a number of modified versions available out there for those with Autism. TF-CBT presents some challenges however for those who struggle to openly talk about their traumatic incident, and is not the best fit for all.
Eye Movement Desensitization and Reprocessing (EMDR) EMDR, developed by Dr. Francine Shapiro, involves the use of bilateral stimulation with either the movement of an index finger back and forth slowly, or the use of vibrating instruments called tappers or buzzies. Unlike its counterparts, EMDR involves relatively little talking about trauma, and involves an internal exposure to the traumatic incident while experiencing the bilateral stimulation of both sides of the brain to reduce the level of distress of the traumatic memory. This therapy, unlike TF-CBT has some case studies to demonstrate its efficacy with autistic patients. However to date there are no larger scale research studies on its effectiveness with those on the Autism Spectrum.
Sensorimotor Psychotherapy (SP) SP, developed by Dr. Pat Ogden, Dr. Kekuni Minton, and Dr. Janina Fisher, is a body based trauma therapy for treating single incident, and developmental traumatic wounds. This therapy operates on the premise that change occurs from the bottom-up, and begins by working with the body and then gradually involves working its way through traumatic memories by modulating the distress levels of the physical sensations associated with the traumatic memories. This therapy while great for resolving somatically held tension, can be challenging if a patient has difficulty focusing. While there are a number of randomized controlled trials which validate the efficacy of SP, there is only one presently being conducted on patients with autism.
This study involves researchers (myself included) studying 5 children on the Autism Spectrum who have comorbid PTSD, working with SP therapists to reduce trauma symptoms over 12 sessions. If you live in Arizona, Illinois, or Canada please feel free to reach out to me directly for a referral to a study clinician.
Internal Family Systems Therapy (IFS) Developed by Dr. Richard Schwartz initially, Internal Family Systems therapy involves working with the various parts of the human self. It involves working with different types of parts which make up the “self”, which from a freudian view is rather monolithic, departs from this view by helping patients work with their parts to foster communication between parts, and the adult self. While there are a number of randomized controlled trials on the effectiveness for IFS, there are none to date on its work with autism.
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 comorbid 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 comorbid psychiatric conditions. For more info, find him at Seaninderbitzen.com or on LinkedIn.