Beyond the Spoken Word: A Therapist’s Experiences in Autism

The lunatic, the lover and the poet… are of imagination all compact
And as imagination bodies forth the form of things unknown,
the poets pen turns them to shapes.” – Shakespeare

Creativity and eccentricity have a long and puzzling relationship. The image of the artist or philosopher flying too close to the sun, haunted by their own brilliance, is a common theme in the discussions of lives gifted with greatness. There is something of fascination in the notion that exceptional talent or creativity may render individuals more susceptible to bizarre behavior or even insanity.

As a developmental psychologist specializing in autism, I frequently encounter the murky parameters of what we refer to as “abnormal.” Even in this bold era of neuroscience, with its heralded pictured brain, definitive lines between what is considered normal or pathological remain elusive. What appears orderly or disordered is embedded in shared meanings, shared narratives. Psychiatric diagnosis is one such cultural construction.

I can thank the writings of Freud for first silencing the notion of any simple classification of mental illness during my early studies in Munich. The ideas presented in his Psychopathology of Everyday Life were a wonderful game changer, breaking the illusion of comfortable distinctions between normal and abnormal in the field of psychology.

Later, as I practiced psychology, I became aware that understanding the complex variations between people was not simply a philosophical or ideological debate but a theme of utmost import and substance. People did not fit into the rational systems that the social sciences had prepared me for. In years to follow, this issue became almost a daily challenge as I began to encounter clients with vastly unorthodox ways of perceiving the world. People with heightened senses, paranormal awareness and abilities that had no rational or psychological explanation within the scheme of scientific psychology. I remember one situation, where I was counseling a young man diagnosed with Asperger Syndrome, a high-functioning form of autism. In one of our first meetings together, he asked me if I had been reading a German author on the previous evening. I had to think for a second, and then before I could gather my thoughts, he responded, “It was Eckhart? Or Eckland?” Before bed that evening, I had indeed read from the German Mystic priest, Meister Eckhart. There is absolutely no way he could have known this. There would be several more such revelations in the weeks to follow, which certainly made for interesting counseling sessions.

Working with high-functioning autism and other forms of complex neuroatypicality, many of my patients, young and old, rarely had an initial “fluid” symptom or diagnosis such as depression or hyperactivity. If they did carry a conventional diagnosis, it was always accompanied by comments such as “Does not fully capture the difficulties of this individual.” They were sometimes described by their parents or spouses as odd, or unable to “get on with life,” or as “having no social life.” They were outsiders, and after framing them within a diagnosis, I was left to my own means, conjuring a role somewhere between a social trainer and an appreciative listener. To be clear, my studies and research had provided some basis, usually around aspects of autistic-skill training models. But it was in the relational domain, my place as a helping human being, that I felt most helpless. In a strange sense, the approaches and techniques themselves seemed autistic to me. They seemed detached from the being that sat in front of me. Unless I could open myself to this dimension, the space between us, my ideas fell like dead leaves on the office floor. Our heavily extraverted, Western society and its host of efficient psychologies rarely ask more of us than to adapt, to assume our position. Yet many of us sense something that remains lost in this conversation with life. Art perhaps touches this realm. Is it not the very expression of our attempt to stop and converse with this parallel reality of things unspoken?

I was finding that in treating high-functioning forms of autism such as Asperger Syndrome, the maps needed for individuals were far more expansive and mystical – yes, mystical – than the empirical techniques that were and are offered. I hold that, although teaching new behaviors and skills is a cornerstone in this work, making such interventions takes hold and requires close attention to this diverse and often irregular interpersonal realm.

Strangers and a Train

I typically begin a consultation or therapy in the role of “doctor,” but quickly change positions in order to establish a more genuine relationship with the patient. Over the years, I have been challenged by my experience with autism to become increasingly adept at using unconventional strategies, especially nonverbal ones, that may allow for connecting moments to occur more spontaneously. In those cases where autism is involved, a patient’s social interactions may be circumscribed by infrequent eye-contact, inhibited conversation, or hyper-focus. Forming a therapeutic relationship can be challenging, sometimes even arduous. It generally develops very gradually, as does a sense of a shared mission.

Sometimes I create the space for this by introducing an art project, music or another special interest I might share in common with a patient, allowing for the possibility of a connection to form experientially, perhaps even without words. Other times, a connection may occur by respecting long periods of silence, or pausing to focus specifically on what a patient feels in his or her body as we engage in a discussion of his or her situation.

Occasionally these methods will yield extraordinary moments of understanding between myself and a patient which is what happened with Josh, a 12–year-old boy suspected of having Asperger Syndrome who was brought to my office for “diagnostic clarification.” Relieved to find a professional who actually specialized in this area, Josh’s parents had traveled a long distance to my office to bring him in for “diagnostic clarification.”

During our first meeting, Josh sat quietly and calmly in my office. He was considered intelligent, though he was hardly verbal. When he spoke, it was with a barely audible whisper. His parents had shared with me that along with other social oddities, he continually left his classroom without permission. After a long silence, Josh confirmed this behavior but didn’t know why he did it.

In our first meeting, I wanted to achieve a clearer picture of his developmental needs as well as establish some level of connection with this essentially non-communicative boy. Since words were not Josh’s first choice when expressing himself, I suggested he draw a picture. Like many male children diagnosed with Asperger Syndrome, Josh exhibited extremely delayed drawing ability, as his hands struggled to copy simple shapes and designs placed in front of him. Still, John began the task without any complaints. He drew an image of a train. Though he completed the drawing in silence, it felt like a positive start for two strangers.

Having been told that Josh had enormous passion for trains, I sat across from him and told him some brief anecdotes about my experiences with trains. Silence ensued. I waited a long minute, but he made no attempt to bridge my stories or respond to my gestures.

There are moments in therapy that seem almost mystical. This was one.

In our silence, a feeling came over me that, somehow, this quiet boy “knew me” – saw who I was. From this “zone” came my next question: “Josh, I understand you were born in _________. Do you know where I was born?”

Josh looked directly into my eyes and said in his soft, timid voice, “Hayes.”

Chills went up and down my spine as he identified the small west-London suburb where I was born. No one except my wife and family in England know this information, and on any of my biographies there is never any mention of Hayes. Only London. Appears.

I laughed in amazement and said something like, “How on earth did you know that?!”

He looked and smiled proudly.

In those few brief minutes, I knew we had made our connection.

The pioneering psychoanalyst Carl Jung might have described Josh as an “introverted intuitive” for whom atypical brain development had facilitated an extreme and unusual purity of intuitive abilities.

But there was more to the experience than just Josh’s intuition.

My best guess is that during our drawing project, an exchange of information took place, both subtle and profound, that guided me to ask the question about whether John knew where I was born and for Josh to intuit from the information he received and respond with such accuracy about my origins. The creativity involved in the process of making his train drawing and in me telling my anecdotes opened us both to an understanding and connection that transcended words.

With this interaction we silently acknowledged our mutual respect and appreciation, laying a secure foundation for the “therapeutic relationship” that would follow. While words remained only partially effective in our subsequent times together, the experience of our “seeing” and “knowing” each other sustained us.

I have come to refer to such ”mystical” occurrences in which a single exchange reflects the “wholeness” of an experience as “Blakean Moments,” named for the exceptionally intuitive artist, writer and divergent thinker, William Blake, who had a genius for expressing the totality of his experience in a single gesture.

Such moments deeply affect me and even change me in some way. I am reminded of what the existentialist Rollo May said: “In therapy, when there is any kind of growth, it always occurs in both client and therapist.”

My experience with Josh taught me that even in “talking therapy,” where words are the expected commerce, rational conversation doesn’t always suffice.


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