Julie Lloyd. Autism

Autism
Dialogical 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.”

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

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 track difficulties for therapists and people with autism

Dreaded state: overwhelmed
Desired state: familiar, safe, stress-free, know where I am
Pushed away carers then feel in the bottom part of this reciprocation

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.

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

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.