Therapy? Experiences of Cognitive Behavioral Therapy

Ok. Time to hold my hands up - I'm in therapy. I'm nearing the end of a course of Cognitive Behavioral Therapy to help me deal with anxiety. Up to now there were only three people who knew this: me, my wife and my closest friend.

Cognitive Behavioral Therapy (CBT) is a therapy that is designed to teach new ways of thinking, to provide the client with new ways of dealing with problems that they face in their lives. It is very important to bear in mind that it does not promise any cure: in my case it will not stop me feeling anxious in certain situations. What it will do (I believe and I've not yet experienced anything to contradict this) is give me tools to manage my anxiety.

One thing that has struck me throughout the course is how obvious it all seems. In short, the steps have been to identify the causes of anxiety and rank them in order of severity, start at the bottom and develop ways to handle them. It's that simple! But there's something significant about the fact that the advice comes from somebody who has no emotional connection, who is impartial and nonthreatening. I feel that they have no "hidden agenda", that they are not trying to manipulate me (even though in fact they are - that is the purpose of the sessions). It comes down to trust: I feel that I can trust my therapist and consequently I am very accepting of her advice.

The thing about CBT is that it is a learning experience like any training course. If you are not engaged then you will not learn. Period. I believe that if you don't want to learn something then you won't. You can sit through lesson after lesson but if you don't apply and practice what you are taught then you won't learn. I think this is why CBT gets some negative reviews - people come into it expecting some silver bullet that will cure them of their problems, but it doesn't work like that. The sessions with the therapist are just to provide the foundations. It is up to the client to build upon them by practicing the coping techniques learned. It's difficult to begin with - you have to expose yourself to the challenging situation before you can try to apply the lessons.

I guess people fail because they don't put the effort into this part. But as I said to my friend earlier tonight, I wouldn't have brought this up with my GP if I didn't want to try to fix my problem. And if that means I have to do "homework" then I'm going to put the effort in because the end result will be worth it.

I did some research about CBT before I started the course - that's my way - and the key fact I learned about it is that it does not claim to be a cure. In may case it will not stop me feeling anxious. I believe it is important to go into this kind of therapy with realistic expectations of the outcome, and in my case it was that it would not stop me feeling anxious - it might not even make me less anxious - but it would provide me with ways to handle that anxiety, to function despite the feeling.

In many ways the success of the treatment depends on how much effort the client is willing to put in. The key to graduated exposure (which is the type of CBT I am receiving) is that you make the effort to expose yourself to the situations.

I've found that one of the hardest aspects of this for me has been to remember that I have to attempt to interact with people differently. Remembering this instead of falling back on ingrained habits has been very taxing mentally. I've discussed this with my therapist and she agrees that being on the autism spectrum poses particular problems for this type of therapy: resistance to change, ingrained habits (routines), co-morbid conditions such as social phobia and sensory hypo- or hyper-sensitivity, and difficulties interpreting non-verbal communication.

To this end I've been set tasks including listening to the radio (interpreting conversational voices) and summarizing what I've heard, observing other people's conversations (which is one of the most difficult tasks - trying to derive rules for conversation based on observation, because it involves trying to interpret the non-verbal signals), and making phone calls (to my friends initially - it's starting small but if that's where I want to end up then I'll have to build my way up to it.

I reckon I've made progress, even if it's not easily quantifiable by the simplistic measures recorded by the questionnaire I complete before every session. And that's the most important part - as long as I feel that I've progressed and I feel more able to tackle these anxiety-provoking situations then I think I'm gaining a benefit from the therapy.

So, in summary, I believe it's only effective if the client is prepared to put the effort in to practice the skills being imparted. If one doesn't have a realistic view of the aims and purposes of the therapy and isn't prepared to put in the work involved in learning the skills presented, then it simply won't work. In this type of therapy the therapist is the pilot guiding the course but the client is the engine room providing the momentum.

Bah Humbug!, or What Christmas Means To Me

I dread this time of year - the Christmas holiday. An endless all-you-can-eat buffet of bright, shiny, colorful, twinkly, saccharine, plastic, superficial, empty-hearted, compulsory frivolity and joy to all. The cracks of the rest of the year are papered over, temporary patches to support the pretense that we are all getting along famously and having a good time. It's all over the TV commercials - smiling families gather around the dinner table to share the feast, seasonal bonhomie ramped up to the max.

Amid the repeated-ad-nauseam Christmas songs, the wall-to-wall sparkling lights and baubles and the commercial brands lashed tightly to old traditional symbols I can't help feeling that the whole experience is empty, devoid of meaning. Christmas has become its own parody, a cheap, mass-produced knock-off that has smothered the original beneath its glittering red and white, snow-carpeted facade.

Christmas died long ago: its dried husk is buried deep beneath strata of tinsel and fairy gold. With a wonky plastic angel stuck on top.

For me this time of year is not about giving or receiving gifts. It is not about parties and feasting. It is not about excessive consumption - gluttony if you will - of any kind. It is not about decorated trees, homes or streets. It is not even about the Christian religious festival.

For me it is the time of year when the darkness is closest at hand. When the long, cold nights harbor age-old fears of loneliness and hunger. When people used to gather round their fires to share warmth and protection, and to pray that the winter would end; that the sun would soon return to warm the land.

For me it is a time for thinking of the people I care about, those I love. This has become a season of unrealistic expectations, unattainable goals, impossible dreams. A season when so many people will fall short of the targets they set themselves, whether they didn't manage to lose that weight to fit into the new party dress, or they saw Dad get drunk Christmas Day and fight with Mum, or they didn't get that one special present they'd set their heart on. A season when people feel disappointed, hurt, alone.

I will not buy presents; I will not send cards. I will find my pleasure in what I can do for those I am close to. If I can make somebody smile, or help them feel that they are not alone, help them feel that they are appreciated and valued... then I believe that would be a worthwhile gift.

With a Little Help

If happiness in life dependsOn finding comfort where you may,
Then most of all you need good friends
To brighten up your darkest day.

If loneliness should reappear
And threaten to extinguish hope,
Don't ever give in to your fear:
Your friends can give you strength to cope.

The Support of Friendship

I fear that this Diamond Jubilee weekend just gone has left me sadly out of sorts with the upheaval and disruption to my regular routines. I accompanied a group of friends to London on Saturday, a lads' day out. I will admit to having reservations in the run up to the day itself - I don't generally enjoy the crowds and hectic work-day pace of the city - but I had not been there on a Saturday for many years and never in the company of a group of friends. As it turned out I ended up in a smaller group of three or four for most of the day and by focusing on just this group I was able to insulate myself sufficiently from the many thousands of people all around us - it felt to me as if we were in our own protective bubble.

The day passed so quickly and I had a wonderful time - my companions were good company and all the strangers around barely registered in my mind - I was relaxed and happy, and had one of the best days out ever. The next day, Sunday, was quiet and flat by comparison - I have no clear recollection of it - but Monday brought another social gathering. This time it was a barbecue hosted by another friend, and again I started out with some trepidation because of the number attending: over thirty people, but nearly all of them people I know well.

I needn't have worried. They were welcoming and genuinely pleased that I had come along and my anxious insecurity was soon forgotten as I joined in the fun. I ended up not going home that night, spending the night at the home of yet another friend where I slept on the sofa - I can scarcely believe that people not only appear not to object to having me around, but even invite me over.

That long weekend is over. But despite my lingering tiredness I have memories of some very enjoyable times, thanks in such a large part to my friends. I cannot overstate the importance that such acceptance has to me - it gives me such a sense of support.

Playing it Safe

Social situations are a minefield in which the slightest misstep can result in things blowing up in your face. I picture the situation as a narrow path - the "safe" area in terms of what I can say or do - with increasing danger of stepping on a mine - upsetting somebody - the farther I venture from the path.

Since I am risk-averse I do not often test the boundaries of what people find to be acceptable behavior - mapping out the danger area - and when I do, I tend to do so carefully and deliberately in the hope that any negative reaction will be small enough for me to handle.

I find it difficult because different people have wildly different standards of what they deem to be acceptable. Not only that, but the boundaries move depending on context. There is only a small patch of common ground on which the majority of people I encounter socially can agree.

My starting position with somebody I have not met before is to play it very safe - speak when spoken to, no slang or swearing, no physical contact. Over time I will observe how they act towards me and others, and slowly begin to introduce those behaviors that they demonstrate - the assumption here is that they are less likely to be offended by something that they do themselves.

This is not an infallible method. That's people for you - they're not always rational, logical or consistent. It can be a case of "do as I say, not as I do" - how confusing! But slowly, gingerly, I can explore the envelope and work out just how far I am able to take things with those I know reasonably well.

2011 Retrospective

Goodbye 2011, you were a year of new experiences, happiness and sadness.

Last year started cold. We were snowed in for a week - too icy to drive - and I had to walk to the local stores, hoping their deliveries had got through. Bread was in short supply. But it was so enjoyable walking through the snow, the absence of traffic on the roads, everybody on foot. Parents towing their children on sleds. A peaceful, happy time.

I started working part-time as a barman at the local pub, just to help out at first. I took to it like a duck to water and now, almost a whole year later, I'm still there. It's been a great help as it gave me a way to talk to people, initially within the boundaries of the job and then, as I got to know the regular customers better, beyond it. By now I think of the people there as a kind of extended family - I feel accepted and wonderfully comfortable among them.

My main job as a software developer continued to be a source of great pleasure - interesting, challenging projects and opportunities to learn new skills and technologies. I'm incredibly lucky to get paid for doing something I enjoy so much. I'm not financially motivated - the work is its own reward for me, but obviously I need to earn money to live.

I started this blog in July, initially just to write about my day-to-day experiences through the lens of Aspergers Syndrome but soon expanded to become a means to express my feelings, whether through my attempts at poetry or through prose. One unexpected result was that I've connected through blogging with other people on the autism spectrum which has helped me both to understand myself better and to feel less isolated by my differences - I now know I'm not the only one whose brain functions in this special way.

The past few months has seen times of great strain in the relationship between my wife and me. Various events, my Aspergers and her deteriorating health have combined at times to set us at loggerheads. When communication breaks down everything else starts to tumble after it in an avalanche of self-destructive behavior. But through our mutual love we have found the will and the strength to keep working on our marriage and, although I cannot say with all honesty that everything is fine right now, we are past the lowest point and building up again.

I saw the year out with a New Year's Eve shift in the pub - 6pm to 3:30am. It was physically tiring but emotionally exhilarating. I can recall noticing the clock around 8pm and the next time I looked it was well past 11! It truly felt as if only minutes had passed, yet it was more than three hours later. An enjoyable busy night.

Overall despite the lows it was a good year and seems to have passed so quickly. Hello 2012, I wonder what you'll bring. Interesting times, I'm sure.

Getting Through

I have times when I feel such utter frustration and helplessness, times when I feel buried under a growing mountain of pending tasks, times when almost everything I touch seems to go wrong or fall apart and I don't know what to do to fix it, times when I just feel trapped by the flow of events - pulled in so many different directions that I feel dizzy and overwhelmed: adrift.

At times like these there are some things that help me get through, none more so than the support of kind words from friends. That gives me just enough of a boost - a positive feeling of hope and self-worth - that I can face the situation and start to deal with it instead of feeling dwarfed and powerless by the terrific enormity of what is facing me. I need to have my mind at peace to handle difficult, stressful situations - this is a great challenge to achieve and I often need help. That little bit of support, telling me that I'm doing OK and I've got somebody behind me who can catch me if I fall.

That's all I need to reduce my anxiety and insecurity to a level I can manage, a level at which I can think straight. Because when my mind's thrashing about, floundering, wasting energy in an attempt to keep afloat, it can escape my notice that I'm not really out of my depth - I'm just so flustered and panicky that I don't realise I can touch the bottom and instead feel as if I'm drowning. That's such an unpleasant sensation. The relief I feel when somebody helps me find my feet and steady myself is immense.

The Best Card Ever

I've been meaning to put this picture up since my birthday last month. It's the card I got from a couple of good friends. I loved it when I opened the envelope and read the front: "I like having a friend like you. You're different..."

It might sound silly but I felt really happy - not just accepted but liked for who I was. I think it was the perfect card for me. I don't usually pay much attention to cards beyond reading who sent them but in this case I made an exception - this one really means something to me and I'm going to hold on to it.

I was in one of my low phases at the time when I got this card and it comforted and cheered me immensely. So a big thank you and lots of love to "B" & "M" who sent me this card - you know who you are...