Adapting CBT for Autistic Clients with Prof Ailsa Russell

I think it's always helpful for us to start off mapping our territory and what it is exactly we're talking about.

So I wonder if you could define autism for us.

So, I mean, the diagnostic criteria for autism or autism spectrum disorder, which is what it's called in all of the systems, is this kind of difference in social communication and interaction and a restricted or repetitive pattern of behaviours, interests and activities.

And that we all know what kind of differences in social communication interaction might refer to, because I guess it's a such a part and parcel of everyday life that people are probably less familiar with the other domain of autism, the repetitive behaviors and interests domain, simply because it's such a very broad set of phenomena.

It can range from things like sensory difference to a preference for routine and sameness to circumscribed or very focused interests.

So it's, or might be stereotyped complex motor movements.

So Yeah, these two domains, differences in social communication and interaction, and a restricted or repetitive pattern of behaviours, interests and activities.

And these should be pervasive in the sense of impacting across important domains of function.

and have been present in the early developmental period, but they might not become apparent until a little bit.

People have moved through some of the developmental stages.

And you mentioned that we all know what the differences in social communication can be like.

How does that feel in the room with an autistic person, these differences in social communication? How does that present?

I sometimes say to therapists, don't worry if you've If you feel like you're not getting any feedback, or it feels clunky, or you're not sure if you can't read your client, it doesn't mean it's not going well.

It just means the social communication is different.

So I guess conversation might not build so easily.

You might ask a question, a very open question, and you might get a really short, factual answer rather than with Some other clients, you might get a life story.

So conversation might not build in the way that you're sort of used to.

And you might, as a therapist, also struggle to understand from somebody's nonverbal behavior, what's going on for them, how they might be feeling.

So some of those cues and clues might not be there to pick up on in the way that you're used to using.

And similarly, your client will be picking up on some of your cues and clues.

So I guess communication, social communication will Because, of course, therapy is a very socially communicative space to people really talking together.

It just will feel might feel a little less fluent, I guess, and less.

And the therapist might need to do a little bit more work in terms of.

really thinking, what do I need to know and how will I ask it?

So there's a kind of a fluency and a flow that feels different from the get-go often with autistic people.