Autism Dialogical Self Conference August 2008

1. AutismDialogical Self Conference August 2008 Julie Lloyd Clinical Psychologist

2. Looking for Relational Intelligence: Using Cognitive Analytic Therapy to rethink the heroic efforts of therapists to make a relationship with autistic clients

3. 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

4. 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

5. 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.”

6. What is relational intelligence? Relational intelligence is the orchestration and integration of other intelligences Societal Intelligence Executive Intelligence Communal Intelligence • Emotional Intelligence = relational intelligence

7. 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.

8. Lorna Wing (1993) triad of neurological impairments; • Social interaction • Communication • Imagination

9. Baron-Cohen (1996) impaired Theory of Mind Blind to the “language of the eyes”

10. Hobson (1989, 2002) social affective model:Deficit in inborn capacity to form affective relationships

11. 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.

12. 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.

13. 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

14. CAT’s diagrammatic approach • The aim is to help us: • Recognise patterns • Reflect on the complex bigger picture • Revise our heroic attempts

15. Dreaded state: overwhelmed

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

17. 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.

18. Possible CAT diagram for working with autistic people in terms of relational intelligence From above • Societal Intelligence • Executive Intelligence Various gifts, talents special intelligences Lots of events, ideas and stimulation combined with demands, expectations, norms Do things my way under my control Gain control but lack knowledge of people and the world (Others & outside seems) over-whelming, impinging Restricting of others- go away From inside From outside Restrictively regulating me and my world Emotional Intelligence Communal Intelligence Caring, wanting to connect, wanting a response Familiar, safe, stress free, know where I am Attacking Rejected Therapist does heroic work or gives up want relief only by attacking impinging others Overwhelmed, Boxed-in, afraid From below

19. 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. Autistic Traps for out- of- dialogue therapists

20. 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.

21. 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 onesmore characteristic of empathic relating

22. 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).

23. 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

24. 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.

25. 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.