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Abstract
Background:
Research in psychotherapy and counseling theory has shown the importance of a strong therapeutic relationship. However, in the context of working with autistic adults, the relationship appears to be de-emphasized, or "different approaches" are recommended without specifying these. Neglect of relationship building may contribute to autistic adults' negative experiences with health care professionals identified in previous studies.
Methods:
I interviewed 17 autistic adults about their relationship building experiences with a wide range of professionals primarily from mental and medical health backgrounds. I also interviewed two mental health counselors and one psychologist who had experience working with this client group and had been recommended by autistic participants. I elicited best practice recommendations from all participants. I analyzed the data in an interpretive-interactionist framework and present them through creative analytic practice.
Findings:
I address one major theme in this article: the importance of Rogerian/person-centered relationship conditions. All had to be practiced in an enhanced way: (1) Enhanced congruence could be demonstrated through therapist self-disclosure and refraining from phony relationship building "techniques" such as vocal adjustments. (2) Enhanced empathy could be demonstrated through genuine listening and accurate interpretation; however, interpretation needed to be phrased tentatively. (3) Enhanced unconditional positive regard could be demonstrated through explicit verbal expression, practical demonstration, and remembering.
Conclusions:
Results largely mirrored research with non-autistic populations: different approaches were not needed for relationship building. Participants emphasized the importance of Rogers' person-centered conditions and described pivotal relationship building moments associated with enhanced expression of these conditions.
... Previous research has described the importance of the therapeutic relationship for treatment outcomes (29, 30). According to Hume (2022), the relationship does not receive enough attention in the context of working with adults with ASD (31). However, the authors mention that the therapeutic relationship is just as important for adults with ASD as for adults with other psychiatric problems. ...
... Previous research has described the importance of the therapeutic relationship for treatment outcomes (29, 30). According to Hume (2022), the relationship does not receive enough attention in the context of working with adults with ASD (31). However, the authors mention that the therapeutic relationship is just as important for adults with ASD as for adults with other psychiatric problems. ...
... However, the authors mention that the therapeutic relationship is just as important for adults with ASD as for adults with other psychiatric problems. A change in perspective is needed to acknowledge that for adults with ASD relationships are important and that they should have the capacity for building relationships (31). Other studies also show that personalized care and a good therapeutic relationship for adults with ASD contribute to greater client satisfaction and better treatment results (32,33).Our findings confirm that a good working alliance is particularly important for adults with ASD. ...
Introduction
Although some adults with autism spectrum disorder (ASD) require intensive and specialized ASD treatment, there is little research on how these adults experience the recovery process. Recovery is defined as the significant improvement in general functioning compared to the situation prior to treatment.
Methods
This qualitative study describes the recovery process from the perspective of adults on the autism spectrum during intensive inpatient treatment. Semi-structured interviews (n = 15) were carried out and analyzed according to the principles of grounded theory.
Results
Our results indicate that, given the specific characteristics of autism, therapeutic interventions and goal-oriented work cannot be carried out successfully, and the recovery process cannot begin, if no good working relationship has been established, and if care is not organized in ways that a person on the autism spectrum finds clear and predictable.
... In total, there were 197 participants included across the 13 studies. The most frequently sampled profession was psychology, however, counsellors (Hume, 2022;Mitran, 2022), mental health nurses (Cooper et al., 2018;Kinnaird et al., 2017;Spain et al., 2017), social workers (Cooper et al., 2018), occupational therapists (Cooper et al., 2018;Kinnaird et al., 2017;Petty et al., 2021 and psychiatrists (Heijnen-Kohl et al., 2022;Spain et al., 2017) were also represented. ...
... The majority of the studies occurred in the UK (Ainsworth et al., 2020;Cooper et al., 2018;Kinnaird et al., 2017;Petty et al., 2021Russell et al., 2019;Siddell, 2022;Spain et al., 2017), two studies were from the USA (Maddox et al., 2020;Mitran, 2022), and there was one study each from New Zealand (Hume, 2022) Studies included in review (n = 13) ...
... Studies reported various attitudes towards the work of adapting MHI for use with autistic clients. Three studies, in particular, highlighted how professionals experience (4) Assistant psychologists (2) Occupational therapist (1) All clinicians delivering therapeutic interventions for autistic adults within a specialist autism services Autistic adults attending specialist autism service this work as rewarding (Hume, 2022;Mitran, 2022;Siddell, 2022). These professionals described a joy and passion for their work; Hume (2022, p.157) reports: "They all expressed love for working with their autistic clients…" There was also an acknowledgement that providing intervention for autistic clients can be emotionally affecting, sometimes due to an awareness of client's previous negative interactions with mental health professionals (Hume, 2022). ...
Autistic adults experience high rates of metal health difficulties and face significant barriers to accessing appropriate mental health care. Empirical research and recent professional guidelines emphasise the importance of modifying standard mental health interventions to best meet the needs of autistic adults. This systematic review explored mental health professionals’ experiences of adapting mental health interventions for autistic adults. A systematic search was conducted on CINAHL, PsychINFO, PubMed, Scopus, and Web of Science in July 2022. The findings from 13 identified studies were synthesised using thematic synthesis. Three major analytical themes were generated, the unique experience of adapting interventions for autistic clients, factors which facilitate successful adaptations, and challenges to adapting interventions. Each theme contained a number of subsequent sub-themes. Professionals view the process of adapting interventions to be a highly individualised process. A range of personal traits, professional experiences, and systemic, service-based issues were identified in facilitating or challenging this individualised process. Further research regarding adaptations with different intervention models and increased supportive resources are required to enable professionals to successfully adapt interventions for autistic adult clients.
... For Autistic adults, who might communicate differently to non-Autistic adults, have experiences of interpersonal rejection, and find new environments overwhelming, engagement in therapy is a big step. 2,3 Despite these barriers, Autistic adults tend to have high rates of health service utilization, 4,5 although do not necessarily find the care they receive meets their needs. 6 Autistic adults may also be less likely to benefit from standard psychological therapy than non-Autistic adults. ...
... 19 Although there is some evidence of adaptations to specific therapies as useful for Autistic adults (e.g., dialectical behavior therapy 22 and cognitive behavioral therapy 21,23 ), there is limited evidence-based information available on whether and how to adapt psychological practice to meet the needs of Autistic clients. 2 Being knowledgeable and experienced in working with Autistic clients has been identified as important, as has providing Autistic clients with clear communication, and individualized flexible support. 19 Although relationship building has been described as key in working with Autistic clients, 19 adaptations to the interpersonal aspects of therapy have largely been overlooked. ...
... Lei et al. (2024) echoed this sentiment, advocating for the integration of autistic identity and masking behaviours into holistic, person-centered frameworks that acknowledge the complexities of navigating neurodivergent and neurotypical contexts. Thus, according to Pantazakos and Vanaken (2023), Chapman and Botha (2023) invite epistemic humility on behalf of neurotypical researchers and clinicians, a stance that appears to be applauded by autistic individuals (Hume, 2022). ...
Background
Autism is characterised by unique patterns of social interaction, communication and repetitive behaviours, often accompanied by comorbid conditions such as mood disorders and anxiety. Standard psychological interventions, such as applied behaviour analysis (ABA) and social skill training (SST), are commonly used but remain controversial due to their focus on aligning autistic individuals with societal norms.
Aims
This paper critically evaluates standard approaches targeting core autistic traits and explores the therapeutic potential of prioritising comorbidities coherently with neurodiversity‐affirming strategies.
Materials and Methods
A critical analysis of clinical and empirical literature was conducted to evaluate the efficacy, ethical issues and broader implications of interventions such as ABA and SST. Particular emphasis was placed on synthesising findings relevant to mental health outcomes, autistic identity formation and the potential of neurodiversity‐affirming interventions to reduce distress and promote well‐being.
Results
Standard approaches often contribute to adverse effects, such as social camouflaging and increased mental health challenges. Conversely, interventions addressing comorbid conditions such as depression and anxiety, combined with neurodiversity‐affirming strategies that support autistic identity and adapt the environment, demonstrate improved mental health outcomes and greater self‐acceptance.
Discussion
We highlight the importance of shifting the therapeutic focus from modifying core autistic traits to addressing comorbidities while fostering a coherent autistic identity. Such a dual approach aligns with the neurodiversity paradigm and emphasises the need for interventions that enhance well‐being by reducing distress caused by comorbid conditions without suppressing autistic characteristics.
Conclusion
Prioritising comorbid conditions while fostering autistic identity through neurodiversity‐affirming strategies offers a more ethical and effective approach to improving mental health and self‐acceptance in autistic individuals. This dual approach advocates for therapeutic practices that align with their well‐being and identity.
... The SPACE framework importantly shows how supportive, therapeutic relationships are viewed as realised between non-autistic professionals and Autistic persons through professional authenticity, active listening and the understanding of Autistic experience expressed via careful, accurate interpretation (Hume 2022). It also draws into relief the extent to which progress in ensuring neuro-inclusive practice in healthcare settings has been faltering, with considerable stigma around autism and stereotyping concerning diagnostic disclosures (Turnock, Langley, and Jones 2022;Walsh et al. 2020). ...
Social work has a vital role to play in supporting Autistic people of all ages. Whether in facilitating access to other services, such as housing, enhancing quality of life, or in a safeguarding capacity, social workers have a legal and moral responsibility to ensure their practice ensures full, equitable involvement of Autistic people. Regrettably, research evidence indicates practice is not always inclusive and can fall short in responding effectively to Autistic people’s needs. This article adds to recent UK practice guidance and social work scholarship concerning social work and autism. It does so by introducing a framework developed by Autistic doctors for meeting Autistic people’s needs in medical settings known as ‘Autistic SPACE’ and exploring how it could be used for social work contexts. The five core autistic needs recognised in the SPACE framework are addressed, i.e. Sensory, Predictability, Acceptance, Communication and Empathy. How a practice-near social work perspective may aid in developing the framework further is also considered, extending the acronym from SPACE to SPACES to highlight the significance of Social Safety and Support.
... Autistic adults may experience anxiety in developing therapeutic relationships 26 and may take longer to establish such relationships. 27 Therapeutic relationships are an important factor in psychological interventions both in autistic adults and in the general population, 28 including in safety planning, so that the autistic adult feels comfortable and able to communicate openly with their supporter. ...
... Others have discussed more concrete ways that the therapeutic relationship can be attended to, including matching clients' language (Anderson & Morris, 2006) and avoiding confronting clients about what is perceived as odd or eccentric behaviours (Gaus, 2011). Hume's (2022) qualitative research interviews with 17 autistic adults about relationship building experiences in therapy found that not only are Rogerian conditions such as empathy, non-judgement, unconditional positive regard, important relationship building conditions, but these factors may be even more important with autistic clients. ...
Purpose
A significant portion of autistic adults experience mental health challenges. Currently, the literature is incomplete when it comes to understanding the needs and preferences of autistic adults who receive therapy. This study elicited the perspectives of autistic adults, focusing on the facilitators, barriers and ways to enhance psychotherapy based on receiving this care for mental health problems.
Methods
Using the qualitative, exploratory approach of the Enhanced Critical Incident Technique, eight autistic adults took part in interviews.
Results
A total of 147 critical incidents were extracted from participant interviews and categories salient to therapeutic practice. The study identified key factors influencing therapy, such as trust and respect, practical approaches, client factors, structure of sessions, knowledge about autism, support for individualized needs, access to mental health services, and involvement of family/advocate. These factors were categorized into eight main areas relevant to therapeutic practice.
Conclusions
Findings from this research reveal that psychotherapy with autistic adults is analogous to performing this work with non-autistic adults, in the sense that this work too entails elements of individually tailored treatment and the reliance on common therapeutic factors. There are also differences in this work that necessitate providers having foundational knowledge about autism. Learning directly from autistic adults’ insights may help to improve upon the delivery of mental health care for autistic adults.
... Beyond shared decision making, standpoint epistemology proffers that clinical practitioners attempt to arrive at a critical consciousness about the methods and goals of the clinic, informed by the social position and own experiences of clients themselves. Chapman and Botha (2022) thus invite epistemic humility on behalf of neurotypical researchers and clinicians, a stance that appears to be applauded by autistic individuals (Hume, 2022). ...
The neurodiversity movement has introduced a new era for autism research. Yet, the neurodiversity paradigm and the autism clinic remain largely unconnected. With the present work, we aim to contribute to filling this lacuna by putting forward phenomenology as a foundation for developing neurodiversity-affirming clinical interventions for autism. In the first part of this paper, we highlight that autistic people face a severe mental health crisis. We argue that approaches focused on reducing autistic ‘symptoms’ are unlikely to solve the problem, as autistic mental health is positively correlated with autism acceptance and perceived quality of support provided, not necessarily with lack of ‘symptomatologic severity’. Therefore, the development and dissemination of neurodiversity-affirming clinical interventions is key for addressing the autism mental health crisis. However, therapists and researchers exploring such neurodiversity-affirming practices are faced with two significant challenges. First, they lack concrete methodological principles regarding the incorporation of neurodiversity into clinical work. Second, they need to find ways to acknowledge rightful calls to respect the ‘autistic self’ within the clinic, while also challenging certain beliefs and behaviors of autistic clients in a manner that is sine qua non for therapy, irrespective of neurotype. In the second part of the paper, we introduce phenomenological psychology as a potential resource for engaging with these challenges in neurodiversity-affirming approaches to psychotherapy. In this vein, we put forward specific directions for adapting cognitive behavioral and interpersonal psychotherapy for autism.
... Within clinical practice, we encourage providers to understand their client's whole and unique lived experiences, which requires humility, an awareness of intersectionality-that is, the unique experiences of those with multiple marginalized identities (47)-and a responsive style. A Rogerian person-centered approach may be helpful for promoting clinician authenticity, empathy, and positive regard (48). Within educational settings, valuing lived experiences includes training, hiring, and supporting Autistic educators, including Autistic co-facilitators and guest lecturers, involving Autistic people in curriculum development, and including written works by Autistic authors on course syllabi (49)(50)(51). ...
Autistic people often have poor outcomes over the life course, including in health, education, employment, and community inclusion. Many professionals working with Autistic adults in research, clinical, and educational settings devote their careers to trying to improve such outcomes. However, we maintain that real progress cannot happen without a fundamental mindshift. The status quo for professionals is to view autism as an illness. Instead, the neurodiversity movement encourages us to value and embrace autism as an aspect of human diversity and asks us to view Autistic people as a marginalized group that experiences significant disparities. While some professionals may be adopting language and concepts from the neurodiversity movement, we argue that making this mindshift fundamentally changes our practice across research, clinical, and educational settings. In this perspective, we call on professionals to embrace this mindshift to reduce discrimination and stigma, halt the spread of harmful ideologies, and help Autistic adults live fulfilling lives.
... Further, in a qualitative study of 17 autistic people discussing their experiences of therapy, participants appreciated and desired this form of epistemic humility from therapists including tentative interpretations of neurodivergence. 36 With such factors in mind-as Ho argues is the case when it comes to disability more generally-cultivation of epistemic humility on behalf of neurotypical therapists may help foster a two-way collaborative approach between practitioners and patients. 37 ...
The neurodiversity movement is a social movement that emerged among autistic self‐advocates. It has since spread and has been joined by many with diagnoses of attention‐deficit/hyperactivity disorder, dyslexia, and developmental coordination disorder among others. By reconceptualizing neurodiversity as part of biodiversity, neurodiversity proponents emphasize the need to develop an ‘ecological’ society that supports the conservation of neurological minorities through the construction of ecological niches—that is, making space for all. This is an alternative to the drive to eliminate diversity through attempts to ‘treat’ or ‘cure’ neurodivergence. So far, neurodiversity theory has not been formally adapted for psychotherapeutic frameworks, and it is not the role of the therapist to make systemic changes to societal organization. Still, there is room for fruitfully drawing on a neurodiversity perspective for therapists working with neurodivergent people in clinical settings. Here, we draw on the example of autism and synthesize three key themes to propose the concept of neurodivergence‐informed therapy. First, the reconceptualization of dysfunction as relational rather than individual. Second, the importance of neurodivergence acceptance and pride, and disability community and culture to emancipate neurodivergent people from neuro‐normativity. Third, the need for therapists to cultivate a relational epistemic humility regarding different experiences of neurodivergence and disablement.
... Learning from the neurodiversity paradigm would include cultivating epistemic humility on the part of neurotypical researchers and clinicians. Further, in a qualitative study of 17 autistic people discussing their experiences of therapy, participants appreciated and desired this form of epistemic humility from therapists including tentative interpretations of neurodivergence (36). With such factors in mind -as Ho argues is the case when it comes to disability more generally -cultivation of epistemic humility on behalf of neurotypical therapists may help foster a two-way collaborative approach between practitioners and patients (37). ...
Abstract: The neurodiversity movement is a social movement that emerged among autistic self-advocates. It has since spread and has been joined by many with diagnoses of ADHD, bipolar, and dyspraxia among others. By reconceptualising neurodiversity as part of biodiversity, neurodiversity proponents emphasise the need to develop an 'ecological' society that supports the conservation of neurological minorities through the construction of ecological niches-that is, making space for all. This is an alternative to the drive to eliminate diversity through attempts to 'treat' or 'cure' neurodivergence. So far neurodiversity theory has not been formally adapted for psychotherapeutic frameworks, and it is not the role of the therapist to make systemic changes to societal organisation. Still, there is room for fruitfully drawing on a neurodiversity perspective for therapists working with neurodivergent people in clinical settings. Here we draw on the example of autism and synthesise three key themes to propose the concept of Neurodivergence-Informed Therapy. First, the reconceptualisation of dysfunction as relational rather than individual. Second, the importance of neurodivergence acceptance and pride, and disability community and culture to emancipate neurodivergent people from neuro-normativity. Third, the need for therapists to cultivate a relational epistemic humility regarding different experiences of neurodivergence and disablement.
Autistic people and those with attention deficit hyperactivity disorder are at a high risk of developing an eating disorder. While there is limited evidence on the relationship between other forms of neurodivergence and eating disorders, research suggests associations between giftedness, intellectual disability, obsessive–compulsive disorder, psychosis, Tourette’s syndrome, and disordered eating. Factors underlying disordered eating and/or eating disorder risk for neurodivergent people are multifaceted and complex, encompassing a wide range of intertwined psychosocial, environmental, and biological processes. Moreover, research shows that neurodivergent individuals experience poorer treatment outcomes compared to neurotypical individuals. However, there is a paucity of research in this area overall. More specifically, lived experience-led research remains rare, despite its critical role for improving individualised eating disorder care, as well as mental healthcare more broadly. Indeed, the importance of eating disorder care individuation is increasingly being recognised, particularly within the context of neurodivergence, given the heterogeneous experiences and support needs of neurodivergent people affected by disordered eating and/or eating disorders. Furthermore, despite documented overlaps between various forms of neurodivergence (e.g., co-occurring autism and attention deficit hyperactivity disorder), research looking at eating disorders in the context of neurodivergence through a transdiagnostic perspective is scarce. This lived experience-led narrative review aims to shed light on the intersectional factors underlying elevated disordered eating and/or eating disorder risk for neurodivergent individuals. First, an overview of prevalence data is provided, followed by a thematic framework identifying factors underlying disordered eating and/or eating disorder risk in relation to neurodivergence. A critical appraisal of current eating disorder research and care is then offered before suggestions for neurodiversity-affirming eating disorder care are made. In this view, this paper offers a foundation for future empirical work in this nascent field of inquiry by providing a lived experience-led, transdiagnostic, and intersectional account of eating disorders in the context of neurodivergence.
Introduction
Individuals with autism spectrum disorder (ASD) experience mental health concerns at a higher prevalence rate than the general population, yet mental health professionals have limited education, training and experience in counselling individuals with ASD.
Methods
To better understand the unique mental health concerns this population encounters, this qualitative study explored the experiences of 102 college students with ASD as they considered, attended and stopped counselling.
Results
Specifically, this study investigated the motives the participants reported for attending counselling, the reasons professionals indicated that the participants should attend counselling, the barriers the participants were confronted with in seeking counselling and the causes for terminating counselling.
Conclusion
Based on these findings, implications for counselling this population and future research are provided.
This chapter illustrates how an adapted version of Interpretive Interactionism, a qualitative methodology for insider researchers, can facilitate a neurodiversity-affirming interview study with multiply neurodivergent research participants. Influences from Access Intimacy, Crip Theory, and participatory autism research are synthetised to create a ‘cripped interactionism’. The chapter outlines, with concrete examples, how this methodology transformed research access from an act of logistics to a relational act, how it mitigated power dynamics and resisted epistemic injustice, and how it led to an ongoing dialogue with participants. Anticipating access needs as much as possible and being proactive in offering adaptations is central, rather than waiting for participants to request accommodations. Interviews are ‘cripped’ to become dialogues, reflecting a deep and genuine reciprocity rather than a mechanical extraction of community knowledge. ‘Found poetry’ alongside the lay summary is used to make the research findings accessible to readers with a range of communication preferences and engage the heart and as well as the mind.
The neurodiversity movement challenges the medical model of disability by framing neurodevelopmental disabilities as natural neurological variations rather than deficits. Consequently, as discourse on neurodiversity-affirming practices expands, there is a growing imperative for tailored implementation in school counselling. By emphasising client agency, strengths, and understanding, person-centred therapy arguably holds the potential to support neurodivergent student wellbeing within school counselling and across a multi-tiered system of support. The person-centred therapy modalities, including traditional person-centred therapy, pre-therapy, child-centred play therapy, school-based filial therapy, and collaborative and proactive solutions, offer the flexibility to accommodate diverse age groups, developmental stages, and communication styles. Overall, adopting a neurodiversity-affirming school counselling approach underscores a paradigm shift that supports the wellbeing and autonomy of neurodivergent students.
This case study outlines the sport psychology service delivery provided to a 17-year-old international-level competitive figure skater. The client had a diagnosis for autism spectrum disorder and reported experiencing low self-confidence, which hindered his performance in training and competition. An acceptance and commitment therapy intervention was implemented over 25 sessions across a 15-month period. The aim of the intervention was to develop self-confidence by encouraging acceptance of unhelpful thoughts, rather than changing or removing them, to move the client toward the athlete he wanted to be. This case offers a novel contribution to the wider literature by reporting an acceptance and commitment therapy intervention to develop self-confidence in sport. We report how psychological flexibility was achieved through exercises to “unhook” the client from his thoughts around perfection and self-imposed pressure. Reflections from the client and practitioner capture the evaluation of the service delivery process.
In this theoretical review and analysis, I examine the existing literature regarding social trauma in autism spectrum disorder (ASD) after proposing existential‐integrative adaptations of trauma‐specific interventions that account for many of the novel characteristics and features that manifest in ASD. Practitioners interested in reimagining how they enter trauma work with this population will find multiple descriptions by providing an overview of core challenges and how those challenges influence susceptibility to the experience of social trauma and general trauma in ASD.
Autistic adolescents and adults commonly experience mental health concerns; however, mental health clinicians may hold implicit stigmatizing views of autism that contribute to case conceptualization and treatment goal setting that align more with caregivers’ than clients’ goals. This impingement on client autonomy is concerning, problematic, and potentially harmful for autistic clients who are of an age to set their own treatment agenda regardless of co-occurring intellectual disability and/or language delays. An application of the shared decision-making framework, an evidence-based tool for promoting client autonomy, can help to avoid these challenges in treatment. In this perspective, we use a case vignette as an anchor for discussing the imperative of honoring autistic clients’ autonomy in mental health treatment and guiding shared decision-making to reduce stigma, promote autonomy, and increase collaborative care for autistic clients in mental health treatment.
Background: The therapeutic relationship is regarded as an important source of change in emotion-focused therapy (EFT) (Greenberg, 2014; Watson, 2018), but few qualitative studies have specifically investigated how clients experience the role of the relationship in EFT.
Aim: The purpose of the present study was to explore what clients experienced as helpful or hindering aspects of the therapeutic relationship when undergoing EFT for depression, anxiety, and severe self-criticism.
Methods: We interviewed 18 clients after a clinical trial of time-limited EFT, to explore their experiences of the relationship with their therapist during treatment. The interviews were analyzed using hermeneutic-phenomenological thematic analysis (Braun and Clarke, 2006; Binder et al., 2012).
Results: We identified four main themes: (1) Forming a trusting relationship or finding it hard to connect, (2) Collaborating and struggling to find new ways to relate to painful feelings, (3) Alliance ruptures and needs for repair when working with distressing emotions, and (4) The significance of new relational experiences.
Conclusion: Clients described therapists’ genuineness and the establishment of trust in the relationship as important preconditions to open up to vulnerability and painful feelings, and engaging fully in specific EFT interventions. The findings also indicate that the therapists need to be mindful of different client preferences and monitor potential alliance ruptures when working to change distressing emotions in therapy.
As interest in autism in adulthood grows, so does the need for methods to promote the inclusion of autistic adults in research. Our objective was to create practice-based guidelines for the inclusion of autistic adults, both as research team members and as study participants. We conducted an institutional ethnography of three closely related research partnerships that used participatory methods with autistic adults over the years 2006–2018. We used an iterative approach which combined discussions with community and academic partners and artifact review. Guidelines to promote the inclusion of autistic adults as co-researchers focus on being transparent about partnership goals, clearly defining roles and choosing partners, creating processes for effective communication and power-sharing, building and maintaining trust, disseminating findings, encouraging community capacitation, and fairly compensating partners. Guidelines to promote the inclusion of autistic adults as study participants focus on maximizing autonomy and inclusion, creating an accessible consent process, offering multiple modes of participation, adapting survey instruments for use with autistic adults, creating accessible qualitative interview guides, and handling data from proxy reporters. Although these practice-based guidelines may not apply to all research teams, we hope that other researchers can capitalize on these practical lessons when including autistic adults in research.
The term harassment is often used to refer two contexts, the workplace and school, but not the legal system itself. Long drawn-out litigation in the Family Law Courts often produces a surreptitious phenomenon of violence toward one of the litigating parties, who become victims of the legal system itself. The aim of this study was to determine whether legal harassment could be detected and measured in the Spanish Justice System using an innovative Legal Harassment Scale (LHS). This hypothesis was substantiated by the data obtained using a new 32-item psychometric instrument with a global index: the LHS, consisting of four factors: Direct Aggression, Procedural Harassment, Personal Contempt, and Manipulation of Reality. The estimated reliability and validity of the LHS was satisfactory, both in terms of the global score, and for each of the four factors distributed along the normal curve. The results of this study are discussed in terms of the limitations of the study and in relation to future lines of research aimed at ensuring that the legal system respects and safeguards the rights of the parties involved in litigation, and that no party falls victim to legal harassment.
This article introduces the journal issue devoted to the most recent iteration of evidence-based psychotherapy relationships and frames it within the work of the Third Interdivisional American Psychological Association Task Force on Evidence-Based Relationships and Responsiveness. The authors summarize the overarching purposes and processes of the Task Force and trace the devaluation of the therapy relationship in contemporary treatment guidelines and evidence-based practices. The article outlines the meta-analytic results of the subsequent 16 articles in the issue, each devoted to the link between a particular relationship element and treatment outcome. The expert consensus deemed 9 of the relationship elements as demonstrably effective, 7 as probably effective, and 1 as promising but with insufficient research to judge. What works-and what does not-in the therapy relationship is emphasized throughout. The limitations of the task force work are also addressed. The article closes with the Task Force's formal conclusions and 28 recommendations. The authors conclude that decades of research evidence and clinical experience converge: The psychotherapy relationship makes substantial and consistent contributions to outcome independent of the type of treatment.
Participatory research methods connect researchers with relevant communities to achieve shared goals. These methods can deliver results that are relevant to people’s lives and thus likely to have a positive impact. In the context of a large and growing body of autism research, with continued poor implementation, and some evidence of community dissatisfaction, there is a powerful case for participatory autism research. In order to develop a framework for such collaborative working, a UK seminar series was organised and co-produced by autistic and non-autistic people with academic, practitioner and lived expertise. This article reports on the outcomes from the series, identifying five topics relevant to building a community of practice in participatory research: Respect, Authenticity, Assumptions, Infrastructure and Empathy. Each topic is connected to a specific example from within and beyond research, to inspire new practices in the field. We call for the development of participatory research skills among the autism research community and the facilitation of greater autistic leadership of, and partnership in, research. Such work, if delivered to a high standard, is likely to lead to better translation into practice and improved outcomes for autistic people and those who support them.
Open access: http://psycnet.apa.org/fulltext/2018-23951-001.pdf Abstract: The alliance continues to be one of the most investigated variables related to success in psychotherapy irrespective of theoretical orientation. We define and illustrate the alliance (also conceptualized as therapeutic alliance, helping alliance or working alliance) and then present a meta-analysis of 295 independent studies that covered more than 30,000 patients (published between 1978 and 2017) for face-to-face psychotherapy as well as internet-based psychotherapy. The relation of the alliance and treatment outcome was investigated using three-level meta- analysis with random-effects restricted maximum-likelihood estimators. The overall alliance- outcome association for face-to-face psychotherapy was r = .278 (95% CIs [.256, .299], p < .0001; equivalent of d = .579). There was heterogeneity among the ESs, and 2% of the 295 ESs indicated negative correlations. The correlation for internet-based psychotherapy was approximately the same (viz., r = .275, k = 23). These results confirm the robustness of the positive relation between the alliance and outcome. This relation remains consistent across assessor perspectives, alliance and outcome measures, treatment approaches, patient characteristics, and countries. The article concludes with causality considerations, research limitations, diversity considerations, and therapeutic practices.
Keywords: therapeutic alliance, psychotherapy relationship, working alliance, meta-analysis, psychotherapy outcome, face-to-face therapy, internet-based therapy
It is both epistemologically as well as ethically problematic if the autistic voice is not heard in relation to social scientific research seeking to further develop knowledge of autism. Ever since autism first emerged, it has remained medicalised and almost exclusively the preserve of non-autistic researchers. More recently, autistic individuals have begun to contribute to autism research. However, the vast majority of research in autism is still undertaken on autistic people, rather than with them, and is often not concerned with improving the day-to-day lives of people with autism. We discuss the concepts of participatory research and emancipatory research before presenting a draft framework for what we regard as truly inclusive research in autism. Our proposals are firmly based on ideas developed by the members of a university-based group of autistic adults (the Asperger’s Consultation Group) as well as the knowledge and experience of the other contributors.
This article argues that psychotherapy practitioners and researchers should be informed by the substantive body of qualitative evidence that has been gathered to represent clients' own experiences of therapy. The current meta-analysis examined qualitative research studies analyzing clients' experiences within adult individual psychotherapy that appeared in English-language journals. This omnibus review integrates research from across psychotherapy approaches and qualitative methods, focusing on the cross-cutting question of how clients experience therapy. It utilized an innovative method in which 67 studies were subjected to a grounded theory meta-analysis in order to develop a hierarchy of data and then 42 additional studies were added into this hierarchy using a content meta-analytic method-summing to 109 studies in total. Findings highlight the critical psychotherapy experiences for clients, based upon robust findings across these research studies. Process-focused principles for practice are generated that can enrich therapists' understanding of their clients in key clinical decision-making moments. Based upon these findings, an agenda is suggested in which research is directed toward heightening therapists' understanding of clients and recognizing them as agents of change within sessions, supporting the client as self-healer paradigm. This research aims to improve therapists' sensitivity to clients' experiences and thus can expand therapists' attunement and intentionality in shaping interventions in accordance with whichever theoretical orientation is in use. The article advocates for the full integration of the qualitative literature in psychotherapy research in which variables are conceptualized in reference to an understanding of clients' experiences in sessions. (PsycINFO Database Record
The two-volume third edition of this book identifies effective elements of therapy relationships (what works in general) as well as effective methods of tailoring or adapting therapy to the individual patient (what works in particular). Each chapter features a specific therapist behavior (e.g., alliance, empathy, support, collecting feedback) that demonstrably improves treatment outcomes or a nondiagnostic patient characteristic (e.g., reactance, preferences, culture, attachment style) by which to effectively tailor psychotherapy. Each chapter presents operational definitions, clinical examples, comprehensive meta-analyses, moderator analyses, and research-supported therapeutic practices. New chapters in this book deal with the alliance with children and adolescents, the alliance in couples and family therapy, and collecting real-time feedback from clients; more ways to tailor treatment; and adapting treatments to patient preferences, culture, attachment style, and religion/spirituality.
In recent studies it has been suggested that Cognitive Behavior Therapy (CBT) is beneficial to people with Autism Spectrum Disorder (ASD) but that the method needs to be modified in relation to their cognitive profile. The aim of this study is to measure the effect of modified CBT, that is, using visualized language throughout the entire session for clients with ASD and anxiety and avoidance behavior. The modification of CBT in this study consists of focusing on CBT protocols for anxiety disorders and depression, while visualizing and systematizing "the invisible" in the conversation, in order for the clients to understand the social, cognitive and emotional context of self and others and how they should interact to avoid misunderstandings. ASD clients may need help to detect the invisible code of social interaction and communication. The level of anxiety and the frequency of target behavior were measured. Four assessments were made, two at the pre-assessment, and one in mid-therapy and end of therapy respectively. Generally, results suggest no improvement during pre-treatment period but a significant improvement during treatment. The values of the clients' psychological, social and occupational ability to function improved on the Global Function Rating scale. The preliminary conclusion of this pilot study indicates that the use of visualized language throughout the CBT therapy sessions is a promising modification of current CBT protocols for individuals with ASD. After manualization, larger studies with randomized controlled study designs can replicate or challenge these results.
There is limited large-scale research into the lived experiences of female adults who have an autism spectrum disorder with no co-occurring intellectual disability. Drawing on the findings of an Australia-wide survey, this report presents self-report data from n = 82 women with high-functioning autism spectrum disorder in the areas of health, education, employment, social and community activities. Where relevant, comparisons are provided with the male subset of the same study population; however, in the majority of analyses, no discernible gender differences emerged. The findings highlight the diverse and complex challenges faced by women with high-functioning autism spectrum disorder, including high levels of mental health disorder, unmet support needs in education settings and the workplace, and social exclusion and isolation.
© The Author(s) 2015.
Our objective was to obtain an in-depth understanding of autistic adults' experiences with healthcare and their recommendations for improving care. Our academic-community partnership used a community-based participatory research approach to conduct semi-structured, open-ended interviews with 39 autistic adults and 16 people who had experience supporting autistic adults in healthcare settings. Participants identified patient-level, autism-related factors that impact healthcare interactions, including verbal communication skills, sensory sensitivities, challenges with body awareness, slow processing speed, atypical non-verbal communication, and challenges with organization. However, the success of healthcare interactions largely depended on the interplay between patient- and provider-level factors, as well as the larger context in which patients were receiving care. Provider-level factors included providers' knowledge about autism in adults, incorrect assumptions about individual patients, willingness to allow written communication, use of accessible language, openness to providing other accommodations, and skill in appropriately incorporating supporters. System-level factors included the availability of supporters, complexity of the healthcare system, accessibility of healthcare facilities, and stigma about autism. Further efforts are needed to empower patients, adequately train providers, increase the accessibility of the healthcare system, and decrease discrimination.
© The Author(s) 2015.
Many youth with autism spectrum disorder participate in school-based, peer-mediated intervention programs designed to improve their social experiences. However, there is little research discerning how these youth view intervention practices currently represented in the literature, information which could improve the social validity of intervention programming. In this mixed-methods study, we interviewed 33 youth with autism spectrum disorder about seven social-focused, peer-mediated intervention components. We asked participants to rate the favorability of each component to determine their degree of liking. Subsequently, we asked participants to give a rationale for their rating, in order to explore influencing factors. Chi-square tests indicated that high ratings were most prevalent for recruiting peers and family involvement and medium ratings were most prevalent for meeting with peers. Analyses of variance also indicated that preferences in the specific format intervention components were delivered. Several themes emerged from our qualitative analysis of open-ended responses, including the ramifications of adults in adolescent social life, the advantages of learning through shared activities with peers, and the effects of disclosing disability status. Our findings will offer guidance for researchers and practitioners interested in individualizing interventions to reflect student preferences. Furthermore, we document areas of concern for youth with autism spectrum disorder as they access school-based interventions.
© The Author(s) 2015.
A total of 128 adults with high-functioning autism spectrum disorders were surveyed concerning the process they went through to obtain their diagnosis and the subsequent support they received. Results suggested that routes to diagnosis were quite heterogeneous and overall levels of satisfaction with the diagnostic process were mixed; 40 % of respondents were 'very/quite' dissatisfied, whilst 47 % were 'very/quite' satisfied. The extent of delays, number of professionals seen, quality of information given at diagnosis and levels of post-diagnostic support predicted overall satisfaction with the diagnostic process. Important areas and suggestions for improvement were noted for all stages of the diagnostic pathway. Respondents also displayed above average levels of depressed mood and anxiety, with greater support being requested in this area.
In an attempt to make sense of contradictory findings, meta-analysis was used to review 53 studies that examined counselor self-disclosure (CSD) vs. nondisclosure. CSD, overall, was found to have a favorable impact on clients/participants, with clients/participants having favorable perceptions of disclosing counselors and rating themselves more likely to disclose to counselors who had self-disclosed. Specifically, CSD that (a) revealed similarity between client and counselor; (b) was of negative content valence; or (c) was related to intra- or, especially, extratherapy experiences, had favorable impacts on clients/participants compared with nondisclosure. These types of disclosure resulted in more favorable perceptions of the counselor, especially in the area of professional attractiveness. CSD that revealed similarity between client and counselor also had a favorable impact on clients'/participants' allegiance-specifically, on their willingness to return-to disclosing counselors. Significant moderators of the impact of CSD on clients included researcher bias for or against CSD, type of "session" (e.g., written transcript, interview, real session), timing of CSD (whether before or after client self-disclosure), verb tense of extratherapy CSD, experimental setting, type of control group, and the number of CSDs in the experiment. Clinical implications include that CSD may be beneficial for building rapport, strengthening alliance, and eliciting client disclosure, with similar CSD being especially beneficial. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
Background:
Autistic adults have complex physical and mental healthcare needs that necessitate specialized approaches to healthcare. One promising approach is to embed providers with specialized training or specialty clinics for autistic adults within general primary care facilities. We previously found that autistic adults who received their healthcare through one specialty clinic designed with and for autistic adults had better continuity of care and more preventive service utilization than national samples of autistic adults.
Objective:
To characterize factors that increased or decreased satisfaction with healthcare received through a specialty clinic for autistic adults.
Methods:
We conducted 30-60-minute semi-structured interviews with autistic adults (N=9) and parents of autistic adults (N=12). We conducted an inductive thematic analysis, using a phenomenological approach.
Results:
Factors that increased participants' satisfaction included: (1) receiving personalized care from the provider; (2) spending quality time with the provider; and (3) having strong, positive patient-provider relationships. Factors that decreased participants' satisfaction included: (1) lack of access to services due to scarcity of trained providers; (2) difficulty at times communicating with the provider; and (3) system-level barriers such as policies, practices, or procedures.
Conclusion:
Our findings highlight the importance of providers using personalized approaches to care that meet patients' sensory and communication needs and spending quality time with patients to establish strong, positive patient-provider relationships. Our findings also underscore the critical scarcity of healthcare providers who are trained to deliver care for the growing population of autistic adults.
Unlabelled:
Academic literature has long associated autism with empathy deficits. Although this view has been attenuated over time to include only cognitive empathy, earlier perceptions continue to influence popular representations of autism and screening/diagnostic tools. As a result, empathetic autistics may be prevented from accessing diagnosis, and those with a diagnosis may experience internalized stigma or violence under the guise of therapy. There are, however, some autistics who do self-identify as having empathy difficulties. The purpose of this perspective piece was to first trouble the view of empathy "deficit" as intrinsic within autism and consider alternative explanations and, second, to more deeply consider post-traumatic stress disorder (PTSD) as a factor for autistic people who self-identify as having empathy difficulties. Using both literature and author narrative, we argue that autistics are more likely to experience trauma and more vulnerable to developing PTSD, but less likely to receive a diagnosis of PTSD than nonautistics, as their PTSD-related symptoms, such as a lack of affective empathy, may be conflated with autism traits. Our main recommendations are: (1) future studies should investigate the possible interactions between autism, trauma, PTSD, and affective empathy, determining whether autistic adults with PTSD may recover affective empathy following therapy; (2) clinicians should look beyond autism if their client identifies a lack of affective empathy as part of their challenges; (3) and clinicians should adapt diagnostic procedures for PTSD in autistic adults to accommodate those with alexithymia, and exercise caution when using screening tools for autism, allowing empathic autistic adults to access diagnosis.
Lay summary:
What is the topic of this article and why is it important?: Many people believe that autism causes a lack of empathy. This belief is a problem because it denies the lived experience of autistic adults and makes them appear as less than human. It can also lead to violence against autistics, and it can mean that empathic autistic adults miss out on an autism diagnosis. As a result, they may not be able to access necessary supports. This situation may cause suffering for autistic adults.What is the perspective of the authors?: R.H. is an autistic woman diagnosed in adulthood, who is often overwhelmed by too much empathy. She worked as an employment mentor for autistics and is now a PhD candidate researching relationship-building between autistic service users and their support professionals. H.B. is an autistic man diagnosed in childhood. As a teenager, he was also diagnosed with post-traumatic stress disorder (PTSD), a mental disorder caused by trauma. He did not feel any empathy for most of his life and felt very distressed by this, as he thought that it was a permanent trait of his autism. However, he started feeling empathy after trauma therapy and falling in love. Both authors believe that autistic adults can experience all forms of empathy.What arguments do the authors make?: The authors cite research that shows other reasons which may explain the autism-empathy myth: (1) nonautistics may not recognize empathy in autistics because of mutual differences, (2) nonautistics may not believe autistics who say they have empathy because old research suggested that this is impossible, and (3) empathy research on autistics may not be correct because it uses inappropriate methods. The authors then suggest that unrecognized PTSD may be the reason why some autistics have difficulties in this area. They think so because PTSD can shut down emotional empathy. Autistics are more likely to experience trauma, more vulnerable to developing PTSD, and less likely to receive a diagnosis of PTSD than nonautistics.What do the authors recommend?: 1.Researchers should work with autistic adults who report difficulty in feeling empathy to determine whether they may have PTSD and/or recover empathy after trauma therapy.2.Professionals who support autistic adults should look beyond autism if their client identifies a lack of empathy as part of their challenges.3.Clinicians should treat questions relating to empathy with caution when using autism screening/diagnostic tools, allowing empathic autistic adults to access diagnosis and appropriate supports.How will these recommendations help autistic adults now or in the future?: We hope that this will lead to better support for autistics who have PTSD, and less biased referral and diagnostic procedures for those who do not. We also hope that autistic adults might feel less stigma by suggesting PTSD, not autism, as the underlying cause if they have difficulties feeling empathy.
Lay abstract:
Participatory research means working together (engaging) with the community that is affected by research to make decisions about that research. Participatory research is common in some fields, but it is still rare in autism research. In this study, we wanted to find out how Australian autism researchers and community members feel about participatory research. We worked with an Autistic Advisory Group to design this study, understand the results and write this article. We asked 127 people, all working on research from the Cooperative Research Centre for Living with Autism, to complete an online survey about participatory research. The survey included some questions that were answered on rating scales, and some where participants wrote their own answers. Seventy-nine people (64 researchers and 15 community members) completed most or all of the survey. The rating scales showed that most participants (82%) supported moderate or extensive community engagement in research, and most participants (72%) thought there should be more community engagement in autism research. In general, the participants rated their experiences of participatory research positively. Using the participants' own written answers, we found four main ideas: (1) participatory research is important, but difficult; (2) many people do not fully understand what participatory research is; (3) academics and community members do not work together as = and (4) research systems are not designed for participatory research. Our results suggest that autism researchers and community members want to do more participatory research, but they might need training, support and funding to do participatory research well.
Lay abstract:
Research ethics means issues that concern the welfare and wellbeing of people who take part in research. It is important in all scientific studies. Ethics helps people who do research treat people who take part in research fairly and with respect. This article is about day-to-day ethics when autistic people take part in research. We present tips for researchers who want to do this type of study. We used two methods to create these tips. First, we wanted to know what other people said about this topic. We used a literature review to find out. Second, we wanted to know what autistic people, parents, and professionals thought, and had a working group meet to discuss it. The working group provided advice that researchers could consider around day-to-day ethics in research. This article talks about these methods and advice. The advice fits into five big groups: Tailor the research process for the unique needs of each person. Think about the world in which people who take part in research live. Make it easier for people to make their own choices. Value what people who take part in research have to share and consider their needs and strengths. Think about how researchers and people who take part in research work together. This project shows why it is useful for researchers and communities to talk about research ethics together.
This volume highlights the contributions of tutors and their pedagogies to the field of education, focusing on the lived-experiences of tutors in alternative education programs in New Zealand. Tutors' voices were largely absent from education literature, yet, they are charged with providing a holistic education to disenfranchised young people, and they have artfully re-engaged many of their students into learning.
This monograph presents the author’s poetic inquiry methodology and methods that are intended to inspire others to take risks using arts-based educational research. Based on in-depth interviews, field work, and a performative workshop with tutor participants, the author created more than 200 poems. Drawing on these poetic findings, 21 constellations of tutor essences were created. From these, the tutor emerges as an holistic educator, whose pedagogies offer a conceptual foundation on which future training and development of tutors can build, and from which conventional schools can learn inclusive ways of working with all students.
The alliance continues to be one of the most investigated variables related to success in psychotherapy irrespective of theoretical orientation. We define and illustrate the alliance (also conceptualized as therapeutic alliance, helping alliance, or working alliance) and then present a meta-analysis of 295 independent studies that covered more than 30,000 patients (published between 1978 and 2017) for face-to-face and Internet-based psychotherapy. The relation of the alliance and treatment outcome was investigated using a three-level meta-analysis with random-effects restricted maximum-likelihood estimators. The overall alliance-outcome association for face-to-face psychotherapy was r = .278 (95% confidence intervals [.256, .299], p < .0001; equivalent of d = .579). There was heterogeneity among the effect sizes, and 2% of the 295 effect sizes indicated negative correlations. The correlation for Internet-based psychotherapy was approximately the same (viz., r = .275, k = 23). These results confirm the robustness of the positive relation between the alliance and outcome. This relation remains consistent across assessor perspectives, alliance and outcome measures, treatment approaches, patient characteristics, and countries. The article concludes with causality considerations, research limitations, diversity considerations, and therapeutic practices. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
Progress in psychological science can be limited by a number of factors, not least of which are the starting assumptions of scientists themselves. We believe that some influential accounts of autism rest on a questionable assumption that many of its behavioral characteristics indicate a lack of social interest—an assumption that is flatly contradicted by the testimony of many autistic people themselves. In this paper, we challenge this assumption by describing alternative explanations for four such behaviors: (a) low levels of eye contact, (b) infrequent pointing, (c) motor stereotypies, and (d) echolalia. The assumption that autistic people's unusual behaviors indicate diminished social motivation has had profound and often negative effects on the ways they are studied and treated. We argue that understanding and supporting autistic individuals will require interrogating this assumption, taking autistic testimony seriously, considering alternative explanations for unusual behaviors, and investigating unconventional—even idiosyncratic—ways that autistic individuals may express their social interest. These steps are crucial, we believe, for creating a more accurate, humane, and useful science of autism.
Background
Psychological interventions informed by cognitive behavioural theory have proven efficacy in treating mild-moderate anxiety and depression. They have been successfully adapted for autistic children and adults who experience disproportionately high rates of co-occurring emotional problems. There has been little research into the perspectives and experience of psychological therapists adapting cognitive behavioural therapy (CBT) as part of routine clinical practice. We surveyed therapist skills, experience and confidence in working psychologically with autistic people, in order to highlight gaps and needs, as well as strengths in terms of therapist skills when working with this group.
Method
Fifty therapists attending a training event completed a survey about their experience of adapting CBT for autistic clients, alongside a measure of therapist confidence.
Results
Almost all therapists reported making adaptations to CBT practice when working with autistic clients. Key challenges identified were rigidity in thinking and pacing sessions appropriately. Therapists were relatively confident about core engagement and assessment skills but reported less confidence in using their knowledge to help this group. Therapist confidence was not associated with years of practice or number of adaptations made, but was positively associated with level of therapy training received.
Conclusions
This study highlights a need for training and ongoing supervision to increase therapist confidence in and ability to make appropriate adaptations to CBT treatment protocols for autistic people.
It is both epistemologically, as well as ethically, problematic if the autistic voice is not heard in relation to social scientific research seeking to further develop knowledge of autism. Ever since autism first emerged, it has remained medicalised and almost exclusively the preserve of non-autistic researchers. More recently autistic individuals have begun to contribute to autism research. However, the vast majority of research in autism is still undertaken on autistic people, rather than with them, and is often not concerned with improving the day-to-day lives of people with autism. We discuss the concepts of participatory research and emancipatory research before presenting a draft framework for what we regard as truly inclusive research in autism. Our proposals are firmly based on ideas developed by the members of a university-based group of autistic adults (the Asperger’s Consultation Group) as well as the knowledge and experience of the other contributors.
Background:
Individuals who have autism spectrum disorders (ASD) commonly experience social anxiety (SA). Disentangling SA symptoms from core ASD characteristics is complex, partly due to diagnostic overshadowing and co-occurring alexithymia. Causal and maintaining mechanisms for SA in ASD are underexplored, but it is feasible that there is an ASD specificity to the clinical presentation, with implications for the development of targeted treatments.
Methods:
Five focus groups were conducted with multidisciplinary professionals to investigate their perspectives about, and approaches to, working with individuals with ASD and SA. Data were analysed thematically.
Results:
Data analysis revealed two overarching themes: conceptualizing SA in ASD and service provision. Our results suggest that adaptations to service provision are pertinent, so as to accommodate inherent impairments that can mediate assessment and intervention.
Conclusions:
Future studies should establish how aspects of the care pathway can be improved for individuals with ASD and SA.
In this article, written in a combination of collaborative and singular voices, we tell the stories of shaping an interdependent crip methodology while conducting a qualitative interview study with 33 disabled faculty members. Our central argument is that disability crips methodology. In other words, centering disability from the beginning of a research project, and committing to collective access, reveal specific ways that disability changes the assumptions and outcomes that ordinarily characterize—or are assumed to characterize—research situations. To illuminate those specific ways, we focus on three dimensions of qualitative research that emerged as particularly important to our interdependent methodology: time, gaze, and emotion.
Objective:
This review aimed to synthesize qualitative research exploring clients' perspectives of forming a therapeutic relationship with their therapist or counsellor.
Method:
Noblit and Hare's meta-ethnographic approach was used to guide the synthesis of 13 studies meeting inclusion criteria. The quality of each study was rated using the Critical Appraisal Skills Programme quality rating checklist.
Results:
Findings demonstrated that clients create a hierarchy of desired therapist characteristics to assess how well the therapy can meet their needs (theme 1: assessing client-therapist match). The formation of the therapeutic relationship is facilitated by an openness from both the therapist and client (theme 2: facilitating openness) and helps to develop a connection through which the client can be fundamentally understood (theme 3: connecting on a deeper level). Displays of disrespectful or disempowering behaviour generate barriers in the formation of a therapeutic relationship (theme 4: empowerment through respect).
Conclusions:
The meta-ethnographic approach extended the findings from each individual study to highlight some significant discoveries, including that clients across different settings created a hierarchy of therapist characteristics which were of varying importance to them depending on their perceived needs. Additionally, clients reported that they preferred their therapists to disclose information in order to facilitate the therapeutic relationship.
This small-scale exploratory study sought to develop an understanding of the meaning of well-being and social belonging as represented within the narratives of adults on the autism spectrum. Employing an interpretivist approach facilitated the investigation of potential contributory factors to these lived experiences in order to inform further research regarding both this topic, and service provision for adults on the autism spectrum. The project involved a thematic analysis of issues of the magazine Asperger United (AU). Four broad main themes were identified: meeting personal needs, living with the consequences of an ‘othered’ identity, connection and recognition, and relationships and advocacy. Autistic adults reported many barriers to feeling that they belonged in a number of social spaces and the detrimental effect this had on their wellbeing. Fundamental to positive narratives of wellbeing, were feelings of connection and recognition from others and positive accepting relationships, with autistic-led spaces, particularly the Autscape conference, being frequently cited as of central significance in increasing feelings of wellbeing and belonging. This study has demonstrated a need for less focus on remediation and more on limiting the social isolation of autistic people.
This article uses an evocative autoethnographic approach to explore the experience of being an insider-researcher in a community-based participatory research setting. Taking a holistic perspective and using the form of narrative story-telling, I examine the dynamics between the typically marginalizing (but sometimes empowering) experience of being an autistic woman and the typically privileging (but sometimes oppressive) experience of being an engineering professional, during a time of career upheaval. Themes of motivations and mentors, adversity from social services and the academy, belonging, the slipperiness of intersectional positioning, feedback cycles of opportunity, dichotomies of competence and inadequacy, heightened stakes, and power and resistance are explored through the narrative. While primarily leaving the narrative to speak for itself per the qualitative approach taken, the article concludes with a discussion of how the personal experiences described relate both to the broader work of insider-researchers within disability-related fields, and to misconceptions about self-reflection and capacity for story-telling in individuals on the autism spectrum.
p>The purpose of this article is to consider the implications to reflexivity in disability research. The author begins by positioning herself in the field of disability studies, disclosing her own experiences. She goes on to trouble the expectation to disclose. The call to confess may be grounded in historical developments within feminist scholarship, including standpoint theory and research reflexivity—methodological tools that are certainly valuable in the pursuit of knowledge, but that are not without criticism. The author explores some key critiques, and considers the implications, specifically regarding her own responsibility to give account. She demonstrates that the sharing of personal experience and the disclosure of identity is not only difficult, uncomfortable, and invasive, but is sometimes useless, for even our confessions may be subject to thematic interpretation.
Keywords: disclosure, standpoint theory, reflexivity, narrative, invisible disability</p
Purpose
– Empirical research indicates that adults who have autism spectrum disorders (ASD) can derive clinically and statistically meaningful benefits from individual and group-based psychological interventions, specifically those which employ skills-based, behavioural, and cognitive techniques. Given the inherent socio-communication, executive functioning, and theory of mind impairments that individuals with ASD can experience, it is deemed necessary to modify the design and delivery of interventions so as to enhance engagement and outcomes. The paper aims to discuss these issues.
Design/methodology/approach
– This general review provides a summary of the extant literature and clinical guidelines for the provision of psychological interventions for adults with ASD.
Findings
– Adaptations to the structure, process, content, and outcome measurement are outlined. It is likely that optimal treatment gains for adults with ASD are contingent on a prolonged assessment phase, pre-therapy interventions including psycho-education and skills-based interventions, thoughtful regard to the formulation of presenting difficulties, and consideration of, and methods to overcome, the difficulties that may arise when seeking to implement change, identify goals, and manage endings.
Originality/value
– This is one of the first reviews to condense the clinical implications for providing psychological interventions for adults with ASD.
Justice is one of the oldest and most central themes of philosophy, but sometimes we would do well to focus instead on injustice. In epistemology, the very idea that there is a first-order ethical dimension to our epistemic practices - the idea that there is such a thing as epistemic justice - remains obscure until we adjust the philosophical lens so that we see through to the negative space that is epistemic injustice. This book argues that there is a distinctively epistemic genus of injustice, in which someone is wronged specifically in their capacity as a knower, wronged therefore in a capacity essential to human value. The book identifies two forms of epistemic injustice: testimonial injustice and hermeneutical injustice. In doing so, it charts the ethical dimension of two fundamental epistemic practices: gaining knowledge by being told and making sense of our social experiences. As the account unfolds, the book travels through a range of philosophical problems. Thus, the book finds an analysis of social power; an account of prejudicial stereotypes; a characterization of two hybrid intellectual-ethical virtues; a revised account of the State of Nature used in genealogical explanations of the concept of knowledge; a discussion of objectification and 'silencing'; and a framework for a virtue epistemological account of testimony. The book reveals epistemic injustice as a potent yet largely silent dimension of discrimination, analyses the wrong it perpetrates, and constructs two hybrid ethical-intellectual virtues of epistemic justice which aim to forestall it.
A very important study that will appeal to a disability studies audience as well as scholars in social movements, social justice, critical pedagogy, literacy education, professional development for disability and learning specialists in access centers and student counseling centers, as well as the broader domains of sociology and education. -Melanie Panitch, Ryerson University "Ableism is alive and well in higher education. We do not know how to abandon the myth of the 'pure (ivory) tower that props up and is propped up by ableist ideology.' . . . Mad at School is thoroughly researched and pathbreaking. . . . The author's presentation of her own experience with mental illness is woven throughout the text with candor and eloquence." -Linda Ware, State University of New York at Geneseo Mad at School explores the contested boundaries between disability, illness, and mental illness in the setting of U.S. higher education. Much of the research and teaching within disability studies assumes a disabled body but a rational and energetic (an "agile") mind. In Mad at School, scholar and disabilities activist Margaret Price asks: How might our education practices change if we understood disability to incorporate the disabled mind? Mental disability (more often called "mental illness") is a topic of fast-growing interest in all spheres of American culture, including popular, governmental, aesthetic, and academic. Mad at School is a close study of the ways that mental disabilities impact academic culture. Investigating spaces including classrooms, faculty meeting rooms, and job searches, Price challenges her readers to reconsider long-held values of academic life, including productivity, participation, security, and independence. Ultimately, she argues that academic discourse both produces and is produced by a tacitly privileged "able mind," and that U.S. higher education would benefit from practices that create a more accessible academic world. Mad at School is the first book to use a disability-studies perspective to focus specifically on the ways that mental disabilities impact academic culture at institutions of higher education. Individual chapters examine the language used to denote mental disability; the role of "participation" and "presence" in student learning; the role of "collegiality" in faculty work; the controversy over "security" and free speech that has arisen in the wake of recent school shootings; and the marginalized status of independent scholars with mental disabilities. Margaret Price is Associate Professor of English at Spelman College.
Over the last thirty years, the field of disability studies has emerged from the political activism of disabled people. In this challenging review of the field, leading disability academic and activist Tom Shakespeare argues that the social model theory has reached a dead end. Drawing on a critical realist perspective, Shakespeare promotes a pluralist, engaged and nuanced approach to disability. Key topics discussed include: dichotomies - the dangerous polarizations of medical model versus social model, impairment versus disability and disabled people versus non-disabled people, identity - the drawbacks of the disability movement's emphasis on identity politics, bioethics in disability - choices at the beginning and end of life and in the field of genetic and stem cell therapies, care and social relationships - questions of intimacy and friendship. This stimulating and accessible book challenges orthodoxies in British disability studies, promoting a new conceptualization of disability and fresh research agenda. It is an invaluable resource for researchers and students in disability studies and sociology, as well as professionals, policy makers and activists.
Praise for Doing Therapy with Children and Adolescents with Asperger Syndrome. "Providing an explanation of Asperger's based on a review of scientific research, Richard Bromfield describes how the characteristics of the syndrome affect the person's thoughts and experiences throughout childhood. Psychotherapy based on the practices described in this book will change the destiny of children and adults with Asperger Syndrome to one of greater connectivity to themselves and others. This should become the primary text for pshchotherapists working with children and adolescents with Asperger's." -Tony Attwood, PhD, author of The Complete Guide to Asperger's Syndrome. "Dr. Blomfield generously shares his wisdom and experience in this very accessible, honest, and often moving book. Any clinician who reads it in its entirely-or even selects a chapter or two at random-will no doubt discover new paths to take their most complex and challenging clients and gain a greater appreciation for those with Asperger Syndrome. Bromfield gives us all a window into a world that is hard to describe, impossible to imagine, but needs and deserves to be understood." -Naomi Angoff Chedd, LMHC, Autism Specialist and coauthor of Replays. Cutting-edge guidance for effective treatment of children and adolescents with Asperger Syndrome. Diagnoses of Asperger Syndrome in children and adolescents are on the rise, and while some clinicians have training and experience in this area, most do not. Using vivid case material, Doing Therapy with Children and Adolescent with Asperger Syndrome offers clinicians the guidance they need to treat the young people they endeavor to help.
New writing practices in qualitative research include evocative writing - a research practice through which we can investigate how we construct the world, ourselves, and others, and how standard objectifying practices of social science unnecessarily limit us and social science. Evocative representations do not take writing for granted but offer multiple ways of thinking about a topic, reaching diverse audiences, and nurturing the writer. They also offer an opportunity for rethinking criteria used to judge research and reconsidering institutional practices and their effects on community. Language is a constitutive force, creating a particular view of reality and the Self. No textual staging is ever innocent (including this one). Styles of writing are neither fixed nor neutral but reflect the historically shifting domination of particular schools or paradigms. Social scientific writing, like all other forms of writing, is a sociohistorical construction, and, therefore, mutable.
Purpose
– Adults who have autism spectrum disorders (ASD) experience a range of core and co-morbid characteristics which impede daily functioning and quality of life. Children and adolescents with ASD derive clinically meaningful benefits from psychological interventions, including those designed to reduce socio-communication deficits and mental health conditions. Relatively little is known about the effectiveness of these interventions for the adult ASD population. The paper aims to discuss this issue.
Design/methodology/approach
– A selective search of English language, peer-reviewed publications was undertaken, in order to summarise the empirical data pertaining to psychological interventions for adults with high-functioning ASD (HF-ASD).
Findings
– Thus far, social skills interventions, cognitive behaviour therapy techniques, and mindfulness-based approaches have been researched most extensively. Interventions have primarily sought to: reduce the impact of core ASD characteristics; enhance skills; and improve co-morbid mental health symptoms. Methodological and clinical heterogeneity render it difficult to generalise study findings across population samples, but overall, interventions appear to be associated with reductions in co-morbid symptom severity, and improved functioning.
Research limitations/implications
– Further studies that seek to improve functioning, reduce co-morbid characteristics, and enhance the propensity for attaining and maintaining independence are now needed.
Practical implications
– Adaptations to standard treatment protocols are likely required in order to enhance engagement and optimise treatment gains.
Originality/value
– This is one of the first reviews to focus specifically on psychological interventions for adults with HF-ASD.
The purpose of this paper is to explain what clinicians need to know and understand when treating individuals with Asperger's syndrome (AS). This paper addresses the presentation of AS and what clinicians need to focus on during intake, while establishing a therapeutic relationship, and the range and severity of co-morbid issues within this population. The paper also discusses diagnosis of AS and the effectiveness of cognitive-behavioral therapy in the treatment of symptoms of AS and explains the use of medication and psychosocial support.