AUTISM

A Young Boy Who Could Not Play

“How did you get to work today?” Ben, an adorable 4-year-old boy entered the playroom, came right up close, and asked. I told him that I took the train. “You must have taken the local 1 train, because the express does not stop on 86th street,” he said with noticeable confidence. “Where did you change for the local?” As it turned out, Ben knew not only all the subway stops and where to transfer from express to local, he also knew the names of every single stop in the New York City Subway system. His parents, who were observing our exchange, seemed both pleased and exasperated. “Transportation is his passion,” Mom said. “When I try to play with him with anything else he will have a huge tantrum or check out,” said Dad with visible frustration. Ben proceeded to discuss trains and transportation with me. When I felt that he was calm enough, I asked him to use my train set to show me how it works when one wants to change from the express to the local on the way to my office.

Quiet. It was as if, for the first time in his short life, he had to show rather than to tell, a whole new domain and way of being with another. There was a long silence in the room as the two trains came to an abrupt stop on the local and express tracks. I said to him, “The little people here (pointing to the express) want to get to the local train to go to Ron’s office.” He stared at me blankly and began to fidget. He turned to his mom and said to her pleadingly, “I want to go home now.” He was gathering some air for a major fit. It felt like I had only a second or two before we might see one of these spectacular tantrums that his dad described earlier. I quickly took three Post-It notes and wrote on them ‘Express’, ‘Local’, and ‘96th Street’, all the while repeating to him in a soothing, reassuring voice, “I know what these people need in order to find where they are going. We need to help them!” Ben watched me as he approached the door–about to grab the handle and run out to the street, which he does at home. Something made him stop and watch. Suddenly, he smiled. His face completely changed, his shoulders dropped down from his ears, and he said, “This is the 96th Street Station.” He immediately came back, sat down and carefully moved each character–“Mom,” “Dad,” and “Ben”–from the express train to the local. He looked at me with approval.

 

“So you know the station.” Ben was so fascinated by his ability to create what he saw in his mind with the trains that he did not notice when it was time to go. “I can make people move! Next time I will show you how they swipe their Metrocard!” he said on his way out.

 

Mom and Dad reported on our next appointment that Ben has taken all his old toys that had little people in them and, for the first time, began animating them, having them speak to each other. There was even one family which sat at the dinner table discussing, of course, which mode of transportation each one of them took to work and to school. The path was now open for Ben to share his fears and hopes with his parents and people closest to him through representation and play. His mind, filled with ideas, could now connect to his fingers and make these little people feel and think and let us know his inner world.

 

IMPORTANT: In order to preserve clients’ privacy, case material is based on composites with biographical information altered.

 

AUTISM & SENSORY PROCESSING

“What Were They Thinking?!”:  A Tween with Asperger

Jonah, a twelve-year-old, lanky tween, who has grown about eight inches during the last year, was again suspended from school for fighting with his peers during recess and after school.

As he sprawls out on a large bean bag in my office, he tries to describe the incidents that got him into trouble: “So, as I walk past the guard in the lobby at school, I see my friends Joe and Nick getting out of school. They look back towards me and start laughing. I got really mad, approached Nick, who was not looking at me, and punched him in the arm and told him to stop making fun of me.” A fight ensued, and the principal suspended Jonah for a week for instigating the fight. Jonah was ready to move on to another topic of conversation, as if the issue had been clarified. I did not understand what really took place between him and these two boys, whom I found out, he considers his best friends. Jonah, who is an otherwise very polite and friendly kid, did not mind indulging me and explaining what had happened. He said that earlier in the day, he sat with Joseph and Nick at the lunch table, and they were discussing the relative merit of Jordan versus Converse sneakers. Jonah was wearing his brand new Jordans, and with some pride he showed off how bouncy they are and how much higher he can jump with them.

 

Joseph and Nick commented, “Well, with these Jordans you will for sure get your starter position on the junior varsity team!!!” Jonah turned around to the assistant coach who sat nearby and told him that he wanted to be a starter on the team showing him how well he can jump. So far, he has only been on the bench and has never gotten any play time. The coach looked at him surprised, and Jonah noticed that Joseph and Nick were rolling on the floor with laughter, sporadically imitating his jump. Only at this moment did it dawn on him that they were pulling his leg. How is he supposed to make sense of this moment? Here are his best friends – obviously setting him up for a public humiliation. He ran out of the lunch room burning with shame and rage, and hid in the bathroom until classes resumed.

 

It took about three sessions to piece together the situation that preceded Jonah’s fight with these boys. When he saw them looking back at him and laughing, he had no doubt in his mind that they were again trying to humiliate him. The lunchroom incident instantly flashed in his mind. Later on, when Nick and Joseph were questioned by the principal, they said that they were inviting Jonah to join them for after school snack, and that their smiles were friendly and inviting. For them the lunchroom incident was long gone, yet it remained in the forefront of Jonah’s mind.

 

It is evident that Jonah is completely out of the loop when it comes to “Teenagerese,” that particular dialect or vernacular typical of young teens when they practice sarcasm, irony, and flex their newly acquired capacities for hyperbole and pretense. Children who have had struggles with Asperger’s disorder as Jonah had for many years have a difficult time picking up the subtle cues, often meta-cues, that indicate the nature of the message being communicated. So that the message, “Your sneakers are hot and will get you on the varsity team!” is accompanied by a more subtle meta message, like further decoding instructions, “This is meant in jest, do not take it literally!” which Jonah, of course, missed completely. He had much to catch up on. Our best training ground was our real-time interactions during our sessions

 

In my office, where he felt relatively safe from humiliation by peers, he could better identify times when I was ironic, sarcastic, or when I did not mean what I said. At some point we were discussing politics, and I communicated to him that next elections I will vote for the Republicans, as I was disappointed with some environmental policy of this administration. Jonah looked at me and, for the first time on his own, said, “No you are not!” I confirmed that I meant it only in jest, and asked him how he knew that I would not vote Republican. He said, “Because you care about poor kids and people who have problems, and you are a psychologist, and no real psychologist votes Republican!” Jonah has shown us that he is now able to hold two concepts in mind: “Ron is sensitive to social policy” and “Ron says he will vote Republican.” He is now able to identify apparent contradictions and resolve them by properly recognizing that the more stable and broader traits carry more weight than the transient ones. More importantly, he could begin to “read minds” which is a capacity that is often compromised in youth with Asperger’s. Also he could tell me that sometimes I say things that I don’t really mean, quite spontaneously and naturally. When I told him that I had a terrible time with a rude cab driver on the way to the office and I fired him he said, “Ron, I can tell that you are making it up because it does not make any sense; he does not work for you, you were just mad!”

 

Jonah has clearly come a long way. At our initial consultation, when I told Jonah that his parents know him like the back of their hands, he stared at me blankly and proceeded to intensely examine his own hands trying to make sense of the metaphor I had just used. He is now better prepared to meet his peers and begin to read their intentions.

 

IMPORTANT: In order to preserve clients’ privacy, case material is based on composites with biographical information altered.

 

ADULT TRAUMA

Trauma: Finding One's Resilience

Ms. J came to see me after surviving a terrifying auto accident that occurred while she was asleep in the backseat. She and the driver have survived more or less unscathed, but the friend sitting next to the driver had died in the crash. She needed a space to process this near-death experience: the residual fear–which was filling her with intense, persistent dread–as well as a great urgency to reevaluate her life with a new awareness of how ephemeral and fragile it can be. It seemed that nothing that made up her busy life – work, relationships, friendships – seemed to stand up to this new scrutiny. She became depressed and pulled away from life. She could no longer stomach her grueling job, “Where I have to make my boss look good,” nor “The way my father has been treating my mother all my life. I cannot bear it anymore, I have to get away!”

With a new lease on life, she set about making changes. Within just a few weeks, she gave notice at work, telling her boss with an assertiveness she never suspected she possessed. When the boss implied that she was not happy with recent changes in job title, she responded by saying, “You and you alone are the reason for my leaving!” Observing her aging parents’ dysfunctional marriage and her attempts to fix it with the new eyes, she lost patience with her depressed mother and strongly encouraged her to leave her emotionally abusive father. “You can still have a happy life ahead of you, it’s not over yet!” She heard herself say to her mother who had just marked her 75th birthday.

As I listened to her, this new lease on life appeared compelling, exciting, and filled with new promises. Something was not right but neither she nor I could be clear about it till we started to address the trauma that she had just survived. Using Somatic Experiencing as well as other mindfulness and hypnotic tools, we could allow her first to settle, and to slow down the frenzied pace with which she was approaching her life. Somatic Experiencing,  a body based approach developed by Peter Levine, is addressing the need to re-establish safety and a healing environment in the aftermath of trauma which remains otherwise lodged in the survivors nervous system.

 

Ms. J and I began the process of “resourcing,” a term often used in SE circles to describe how we allow the client to tap into their available skills, relationships and innate intelligence in order  to mobilize themselves against impact of the trauma. Through this process, a much more complex picture of Ms. J’s experience has emerged. While she was able to soldier on, brace herself, and make herself do all that she felt compelled to do following the trauma, she did not feel any compassion or love for herself. She was administering to herself “the medicine” that  she thought was necessary, like a doctor performing surgery on a stranger. She realized that she was profoundly lonely, a feeling that is often triggered by trauma, but for her it had been a life-long experience which she had always been pushing away from her awareness. She realized she was suddenly incredibly lonely.  The trauma has confronted her with her inability to have a loving, compassionate connection with herself. She could take care of herself – she could even be quite successful, but all in the name of “managing her life,” “Doing the right thing,” etc. Any compassion and soft feeling towards herself felt like a huge indulgence.  No one around her had that soft and compassionate touch that she felt in coming to therapy with me, and she was struggling to make sense of it.  Paying close attention to he felt senses of her body, gradually allowing her to stay with her lived sensation of her breath, her feet on the floor, she was able to enjoy simply being alive – not doing anything other than being for a few seconds at a time. Allowing the experience of her aliveness just to be there, and to begin feeling the love and care for her life and the wish to nurture it allowed her to continue to examine and make changes, but now with an entirely new feeling of gratitude for having survived and being given her life back.

The experience of witnessing death at close quarters opened up a new and vital perspective on her lifelong struggle.  Discovering the mystery and the wonder of her own existence,  she was no longer propelled to force her life to change out of dread and self-hatred. Now she found herself worthwhile, lovable, and compassionate, affirming the preciousness of her newly discovered possibilities.

 

IMPORTANT: In order to preserve clients’ privacy, case material is based on composites with biographical information altered.

© 2018 by Ron Balamuth