AutismDialogical Self Conference August 2008

Julie Lloyd

Clinical Psychologist

Looking for Relational Intelligence:

Using Cognitive Analytic Therapy to

rethink the heroic efforts of therapists to

make a relationship with autistic clients

Introduction

• Faced with a person behaving autistically we want to get a more normal relationship

• We either go to heroic lengths

• Or abandon the attempt perhaps

dismissively

• This situation applies with other ‘hard to reach’ people

Plan

• What is autism?

• Describing longing to break through into dialogue

• How does the Relational Intelligence model describe autism?

• What would a Relational Intelligent approach to autism look like?

• Case example

What is autism?

• Autism is on a continuum and we are all a bit autistic at times

• Leo Kanner (1943) “autistic aloneness” and an “innate disturbance of affective contact.”

Societal Intelligence

Emotional Intelligence

Communal Intelligence

Executive Intelligence

Relational intelligence is the orchestration and integration of other intelligences

= relational intelligence

What is relational intelligence?

Only my steps

• If being relationally intelligent is the ability to dance different steps with different partners, to multiple and changing tunes and instruments

• In autism there is only one dance. A partner is required to dance only the same steps.

Lorna Wing (1993) triad of neurological impairments;

– Social interaction– Communication– Imagination

Baron-Cohen (1996) impaired

Theory of Mind

Blind to the “language of the

eyes”

Hobson (1989, 2002) social affective model:

Deficit in inborn capacity to form affective relationships

Daily Life Therapy

• Kayo Kithara’s Higashi schools uses principle of teaching imitation in groups via physical and artistic tasks as well as activities of daily living.

• The aim is to improving social integration.

A lack of relational intelligence

These overlapping descriptions of autism point to how deficits in

communal and emotional intelligence

and narrowing of social intelligence in

autism means executive intelligence is used to constrain.

Adapting CAT’s diagrammatic approach to highlight Autism and

Relational Intelligence

This approach aims to map and This approach aims to map and track difficulties for therapists and track difficulties for therapists and people with autismpeople with autism

CAT’s diagrammatic approach

The aim is to help us:

• Recognise patterns

• Reflect on the complex bigger picture

• Revise our heroic attempts

Dreaded state: overwhelmed

(Others & Outside seems) over-whelming, impinging

OverwhelmedBoxed-In, Afraid

(Others & Outside seems) over-whelming,

impinging

OverwhelmedBoxed-In, Afraid

Desired state: familiar, safe, stress-free, know where I am

Restrictively regulating me and

my world

Familiar, safe, stress free knowing

where I am

Pushed away carers then feel in the bottom part of this reciprocation

They will feel dismissed, controlled and / or possibly hurt and rejected depending on the pattern of their own normal expectations of relating.

Restricting of others,

sometimes attacking

Dismissed, rejected, hurt

Societal Intelligence

Emotional IntelligenceCommunal Intelligence

Executive Intelligence

From outside

From inside

From above

From below

(Others & outside seems)

over-whelming, impinging

Overwhelmed, Boxed-in, afraid

Attacking

Rejected

Familiar, safe, stress free, know where I am

Restrictively regulating me and my world

Caring, wanting to connect, wanting a response

Restricting of others- go away

Do things my way under

my control

Lots of events, ideas and stimulation combined with demands, expectations, norms

Gain control but lack knowledge of people and the world

want relief only by attacking impinging others

Various gifts, talents special

intelligences

Possible CAT diagram for working with autistic people in terms of relational intelligence

Therapist does heroic work or gives up

Autistic Traps for out- of- dialogue therapists

Heroics• Feeling captured by

mind-numbing tedium • The therapists strives to

break through into a rich relationship

• Each disappointment is met by renewed search and effort and the staff team offered exhortations and psycho-education.

Abandoning• The therapist wants to get

away from their failed relational hopes

• They say there is very little we can do about autism

• They avoid the person and leave the staff team to get on with it.

A relationally intelligent approach to autism

• The ‘client’ of therapy in autism is the whole system within and around them. The aim is a well attuned relationally intelligent system of support; joined up, realistic, responsive and collaborative.

• Participants in the client’s care needs all their emotional, communal, executive and social intelligence to make relationally intelligent plans to assist the client to be at the centre of the well-attuned compensatory environment.

How the team can use their relational intelligence

• It allows the workers space to think about the patterns they may be falling into

• It can help formulate a plan of support, which is more relationally intelligent

• It can soften and help adjust those tendencies to want to recast the autistic person’s particular patterns of relational intelligence into ones more characteristic of empathic relating

Case example

• A consultant to the team advised a care team following an outburst of challenging behaviour from a woman with severe autism who screamed at a bus driver and passengers because the bus was unexpectedly late (impinging, overwhelming). The client was initially given a brief break from going on buses, (perhaps a communally and emotionally intelligent response- familiar safe but limited) whilst a letter explaining autism was sent by the home manager to the bus company (socially intelligent).

Using executive and communal intelligence

The client rehearsed a Social Story script with the consultant to the team about why buses may be late and how to handle this tension and staff now practice this with her whilst waiting together at the bus stop until the bus arrives

The home manager also boarded the bus at the time the client normally went on it in order to talk to a passenger who had burst into tears when the client had screamed abuse at her.

Functioning surrounded by a relationally intelligent

environment

• On her first return to the bus, the client gave a card to the passenger whom she had particularly upset, by way of an apology and later described how she and the passenger were now friends again.

• She now boards the bus by herself. Staff collect her by car for the return journey in order not to expose her to too much stress.