Why Talk Therapy Doesn't Always Work for Autistic/ADHD People [CC]

Talk therapy isn't effective for a lot of people with neurodevelopmental disorders. Why is that? And what can we do about it to make it better?

(Disclaimer - therapy may still work for you! Please don't use this video as justification to not even try! It's more of a "if it wasn't effective for you, you are not alone or weird" and a "what can the industry do to try and improve itself" than a "don't do therapy" thing)

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Hello my dears!
My name is Sydney and I’m an actress/singer-songwriter who writes music about my experiences being autistic, disabled, gay, and in general, a human. My goal is to fill musical gaps and write about things people often forget to make music about. I’m also a vintage enthusiast and disability advocate (among other things). I’ve now released 3 albums and, most importantly, my favorite color is buttercup yellow.
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[mikemacedo]

Sydney, as an Autistic therapist, I found your feedback to be very useful, I'm fortunate enough to have a large part of my client base to be Autistic, my niche demographic are adults, and being on the Spectrum myself, I feel I can translate and put words to some of the feelings my client's try to describe, that I have often had trouble describing, for me, using metaphors have always worked, but I'll try using less in my practice, which brings me to my next point, I think being a therapist can be an ideal career for Autistics, because it can be patternistic ie: seeing __ number of appointments today, etc), and growth-based- I believe in long-term therapy, so seeing and measuring progress is quite stimulating- I think we can be naturally detail-oriented, so I feel that definitely helps- I would love to connect and Learn more about how I can better bridge some of these gaps!

[RatsPicklesandMusic]

"what's the worst that could happen" is THE WORST thing to EVER ASK ME. 🤦‍♀️ My brain spirals down to depths way too dark and deep.

[KellyCDB]

CBT has definitely been very bad for me. It's like my problems are just. Entirely Different Problems than what CBT is addressing. CBT did make me unable to trust myself for years. I've worked really hard to get back in touch with myself and my instincts and emotions and ability to actually regulate myself rather than stuff everything down and tell myself it's all fine and dissociate.

[ryn]

Yeah... my CBT therapy basically went along a burnout cycle. Depression CBT basically meant 'go do things, and slowly that'll give you energy to do more things and you go into an upwards spiral.' I was there because I was extremely burnt out. I'd go up up up until I physically could function anymore, and then I'd crash even harder than before. And I didn't know why, so I blamed myself for failing at therapy. I tried so hard and I couldn't. If this worked for everyone else, why didn't it work for me? Why couldn't I just keep it up? I blamed myself for not 'gaining energy' from activities like seeing my friends and being able to use that energy for productive things like writing my thesis, even though that is literally just not possible for me.

And the CBT I had for anxiety, I remember sitting there and telling my therapist that my fears were not irrational because those things happened before and she just kept disbelieving me and minimizing my trauma. I told her I was aut!stic and she a, didn't believe me, and b, said it wasn't relevant because we were working on social anxiety now... Girl... Why do you think I have social anxiety?

She told me she could easily relate to what I was going through because she'd had a period of a couple of months where she felt kinda down, and it just felt like she was telling a person who was born without legs that she could relate because she'd twisted her ankle once. "Don't worry, it'll go away and feel like a blip in no time if you just try hard enough!' :)

But I do still need help to cope with life. I've been out of therapy for over a year now, because I finally got my diagnosis and decided I needed a therapist who knew how to deal with aut!stic people, but those don't exist, so I've been kinda Googling and losing hope and Googling and losing hope. Guess that's why I'm just shopping around YouTube channels by aut!stic people, because the science on therapy for aut!stic people keeps telling me 'hey we don't actually have any therapy that's proven to be effective, but peer support seems to help!' And like, great, it does help a little, but it kinda feels like I'm going to a doctor and they tell me 'uhh idk go ask your mom, she has the same genetics, she's probably dealt with whatever you're going through before.' That's just not what you want to hear from a professional.

[palomawoma]

Thank you for this video. I've just had to finish with a therapist (which made me feel guilty) because she just didn't get me and inadvertently made me feel worse. I am very loud. In everything I do, pretty much all the time. Whenever I kept getting emotional she would talk about "ways of showing healthy anger" and I would get so confused because after I would think, actually no, I was just really sad and it would just reinforce the experience of society viewing my sadness as anger which is really confusing and adds to my upset :(

[douglasman]

You mentioned watching things at 1.5 speed in another video, I used to do that and forgot it helped me. Left it on and opened this video LMAOOOO. You are already at 1.5x

[Chucanelli]

Sooo…my answer as a classical pianist would have been “The worst-case scenario is that I don’t place highly enough in this competition to move on to nationals and have a chance at placing highly enough there to play/“win” a concert with an orchestra, which could have an enormous impact on which schools I can get into.” Or it could just be an audition for anything along that chain of performances that gets you in with the best schools and therefore the best teachers and opportunities.

In classical music, a missed note basically means you either didn’t get the muscle memory down or you’re too flustered by performing to be a viable concert pianist (that’s the common belief, anyway).

Some of the most cathartic interactions I’ve had with therapists is when I lay something like that out, and they say, “Well shit, that does sound like the stakes are pretty high.” And then we can have a more nuanced, nitty-gritty conversation about the details and how they fit into the bigger picture.

[SchwarzesSchaefle]

Thank you so much for this video. I'm self-diagnosed and still trying to figure this out, but this has been a major issue in my past. When I was first referred to a therapist by my GP for depression and social anxiety following years of bullying, it felt like ...more bullying. It felt like I was being punished for "being weird" and further stigmatized, so I tried to be the "perfect" patient, tried to follow all the "rules" and basically just tried to convince the therapist that they have "caught the wrong person", so of course nothing much ever came out of it. I have been self-harm free for almost ten years now and haven't had a major depressive episode in just over 5 years and this has largely been due to the fact that I stopped trying to "fix" myself and focused on acceptance. I began by embracing my special interests, which I'd previously tried to suppress as that was a major thing the kids bullied me for and by generally allowing myself to be more authentic again.

Once I learnt about autism, I also realised that those "panic attacks" I would get during which the self-harm would usually happen, were actually meltdowns (which should've been obvious from the amount of stimming that goes on and the fact that I lose my ability to speak other than to repeat the same phrase over and over, but I just didn't know that was a thing), I also started handling them differently, by using the stims as tools and by reducing further sensory input - and finally was able to communicate to "helpful" bystanders that they should not try to "comfort" me by hugging me and should keep communication to a minimum and not ask me questions, because I won't be able to answer and it would further agitate me. I still struggle sometimes, but the autism community has given me a framework and tools to understand and manage my experience, that the world of mental health had not.

The main reason I haven't sought out formal diagnosis though, remains the fact that I am very much traumatized by some of my experiences with mental health professionals and just the thought of going for an "evaluation" by a "mental health professional" makes me really agitated. This is something I rarely talk about with my neurotypical friends, because therapy has such a positive reputation, it's like a sacred thing that is beyond critique and just mentioning the possibility that it could be anything other than helpful seems to make some people very angry, because you're seen as attacking something that might have saved their life at some point, so it's a very delicate issue and you've handled it exceptionally well, thank you so much for that.

[jemslost]

Thank you :) I just "finished" a DBT group therapy. I am in Canada and if you wait long enough or are unwell enough you are offered mental health services.

I spent a great deal of my one on one "therapy" sessions, debating with my DBT therapist. She kept insisting that I had to approach things in the "one size fits all" narrative. I was VERY upset to learn that I had been diagnosed as having borderline personality disorder. This was noted on my medical file and I discovered this at a clinic for Ehlers Danlos. I was diagnosed with severe predominantly hyperactive ADHD and "likely" ASD. An ASD diagnosis has a 6 year waitlist. I had a follow up with the psychiatrist who diagnosed me and she confirmed that I do not have BPD, that the shared traits are an overlap with ADHD and ASD. But the DBT program was designed for borderline and so no matter what I said I was being labelled with BPD and this was recorded on my medical file by my nurse/therapist.

How in the hell does any ND person trust the system? You're told to say how you feel but then some nurse with basic training has a personality disorder added to your medical file (it has been removed btw). So now I am waiting for CBT group therapy and although I do need help (can't work, COMPLETE burnout) I am so frustrated and know that I will probably wind up being told I am "doing this wrong" that accepting that things are the way they are is "resigning myself to being unhappy". I am almost done with all of this. We NEED therapy designed FOR US. Sadly therapy has become an additional trauma for me :( So thank you for validating my feelings, it will help when I have to go back. And I want to add this is just MY experience. I do think therapy can be helpful and trying it IS important. If anyone else is struggling please know that we need you. If we continue to speak out we have a chance of changing things for the better for all of us in the community <3

[nnylasoR]

Semi-unrelated side note: I just began meeting (remotely) with a new therapist, and I made my [many] diagnoses and struggles abundantly clear — including the traits of Pathological Demand Avoidance — and upon closing our first session, I found what feels like a mountain of homework waiting for me in my inbox. I am to watch some videos and answer questions, check in periodically, as well as complete journal entries, etc before our next session. I love researching, deep-diving and learning …. But I have always been “a poor student.” I do NOT handle being assigned / told what to do very well. And my anxiety increases with each new text reminder to “Complete the [fill in the blank]”
I thrive in the talking sessions — but did not anticipate this. 😩😩😩

[ren]

Thank you so much for this video. When you started talking about the "what's the worst thing that could happen" technique I was reminded of the many, many, many times a therapist asked me "What would you say to a friend who was going through this situation? How would you treat to a friend who was having a hard time?". And my answer to that, back then, would be -awkwardly try to say something comforting, escape from the room, avoid them for a while out of fear that I will make them feel worse and/or hate me because I suck. Also I've found that this kind of socratic dialogue/socratic questioning style makes me feel like I'm being manipulated into a corner where I have to agree with whatever answer therapist has already decided on.

[rileycollison]

Im autistic and did CBT before I knew I was autistic. I was masking so heavily during the sessions and the therapist told me to make eye contact (something which makes me feel SO uncomfortable) during the sessions. I thought it helped, but a few years on, I have realised that he just taught me to mask REALLY heavily. However, I found a really good counselor a few years later, and she suggested I might be autistic (i was already in the process of getting a diagnosis but it was nice to get that confirmed). I felt really comfortable and I now know that counselling helps me more than CBT. She also had dogs which came into the sessions which definitely helped.

[thegadflysnemesis]

...alexithymia explains so much about me. also the bit about needing time away from stimulus to process an emotion. by god that's exactly it! I spent most of today in a small dark enclosed space (small dark enclosed spaces my beloved) processing yesterday's emotions, which I was incapable of recognizing in the moment

[misspinkpunkykat]

I had a therapist at 14 tell me I wasn't autistic (I had been diagnosed since seven years old) that I was just a spoiled brat with ODD. She would sit really close to me and when I would scoot away from her, she'd scoot right back so she could intentionally be in my personal space.

[c.brackens]

This was so helpful and healing for me. (ND Female of Color 🙋🏾) I hope this presentation and others like it become required learning material for mental health professionals.

[ozmainthedark]

I swapped therapists until I found a good one. A lot of therapy is just me talking and self analyzing with input from the therapist when needed. Plus she's good at focusing on facts over feelings. Who told you you're bad? That sort of thing. 'Cause if I'm the one beating myself up and I haven't heard the bad thing I have to analyze why. I maybe also had a breakthrough type thing yesterday due to my assessing my fear of success. You know 'cause I could fall into the really bad stuff you mentioned. So I figured I'd make the worst less scary and acknowledge that I'm in a bad situation now. Also had a friend once not process that I had to leave when things were spiraling for me emotionally. I was like "I have to leave to calm down" and she kept going which maybe involved some of me screaming every time she started to talk.

Also I believe "I'll breathe when I want to" is my favorite response done by me to the "just breathe" comment.

[mikemacedo]

Sydney, as an Autistic therapist, I find your feedback extremely interesting, I currently have to tend to another task, and I can't come up with more words right now, so I'll get back to the video and ask more questions after, thanks

[ArtyAntics]

I could actually cry, you just described the last 10 years of my life with words I counldn't find. I wish I knew this 10 years ago, I could have saved myself a lot of pain and £15k.

[jaywalksabout]

Hi Sydney, I am a newly qualified CBT Therapist and can totally empathise with what you are saying. I understand how invalidating it must be to be told your thoughts are "irrational". I feel like the field is SLOWLY evolving as we begin to become more educated regarding Autism/ADHD. I personally take a different approach if I realise someone is on the spectrum (My partner and half my family are autistic so I can usually tell) and would take a more person centred approach. Thank you for your educational videos I really loved how you explained the best way to cope would be to remove self from situation - Have nice sensory input - Cool down and then process the situation and handle on your own - This information is VITAL that people like me learn and understand so we aren't making people worse when they are at their most vulnerable.

[wdlovesthee]

thanks so much for talking about this. for me the dynamics of therapy - with its own set of rules boundaries etc - i found very confusing & seemed to feel quite not inspired by them. i had times when talk therapy did not support my healing (i felt 'worse') & times when it was necessary. i actually went back & emailed a past therapist where it was really difficult & told them i discovered i am autistic & asked them to be aware of people who "present" like i did, like a "difficult case." (that's how i was described) social dynamics are confusing to me & how the relationship is supposed to be- like intimate yet not at all, that is really hard for me to feel comfortable in. also picking up on things i didn't understand in the therapist was difficult. we need more well informed people for autistic support, this is certainly true. i hope this comes to be for all those that need & want it. thanks for listening, thanks for being !