Creative Counselling for Autistic Clients by Lisa Cromar

Creative Counselling for Autistic Clients

What do you get if you cross Carl Rogers with an artist?

You get Helen Elliott Rogers (a talented artist) and Carl Rogers’ daughter Natalie Rogers; Natalie would grow up to develop Person-Centred Arts Therapy.

Okay, so that was a rubbish punchline, I shall stick to my counsellor day job! However, I wanted to make the point early on in this article that N Rogers (1993) viewed her work in the psychotherapeutic approach, as an evolution of her ‘father’s person-centred philosophy to include the expressive arts’ (p XV). As a person-centred counsellor, I feel this is important to know when sometimes, working creatively can be misinterpreted as working directively and in a ‘not very person-centred way.’ Nevertheless, Creative counselling goes back a lot further than Natalie Rogers.

History

N Rogers (1993) explains that ancient cultures ‘did not separate arts from healing’ (p96), and furthermore ‘the ancient Egyptians… encouraged the mentally ill to pursue artistic interests’ (p5). Gladding (2011) agrees that ‘almost all art forms have been used since ancient times to prevent distress and remediate internal and external strife’ (p4). Maybe we should take a step back from this fast-paced ‘cognitive’ favoured modern Western world to learn from our ancestors, and get back in touch with the healing powers of creativity. N Rogers (1993) worries that ‘this society has squeezed the tasty juice of the creative process right out of most of its citizens’ (p18).

Although I am focusing mainly on the Person-Centred Approach (PCA), as I would not be able to personally reflect on other modalities’ compatibility with creative working, it is worth noting that as Gladding (2011) explores, in Psychoanalysis, creativity is viewed as ‘a positive defence mechanism, known as sublimation’ and in Gestalt, it is seen as ‘an integrative process in which people become more congruent with themselves and their environments and thus try new behaviours’ (p4).

Now I have set the scene, for where creative counselling derived from and the known long-standing benefits, let us fast forward a few years. There seems to be a real appetite amongst many counsellors to offer creative counselling to clients, this desire is demonstrated by the success of ‘The Creative Counsellors Club’ (retrieved, 2019) founded by Tanja Sharpe, the club’s first mission is ‘to inspire and empower counsellors to feel more confident to integrate new and creative ways to support clients to express themselves’ (para 1). Furthermore, the club is ‘recognised by Facebook as one of the 115 most inspiring communities in the world’ (para 3).

Creative Counselling is gathering a louder voice within the profession, let’s really start listening to what makes it so beneficial and inclusive.

Why does it matter?

In a nutshell, N Rogers et al (2012) (on an autistic visual brain side note I cannot see ‘et al’ without seeing the image of all the food being eaten, but we will revisit cake later – and I’m back in the room) define expressive art as ‘using the emotional, intuitive aspect of ourselves in various media. It is a process of discovering ourselves through any art form that comes from an emotional fullness’ (p36) and they boldly ‘place creativity at the heart of what it is to be human: to be fully functioning is to be creative’ (p35-36).

To borrow a word from the art world, this seems a little abstract, let me get more creative in order to demonstrate an area of counselling that could benefit from non-verbal expression. Grief. The feelings an individual can experience when losing a loved one can feel almost impossible to put into words, it can be more of a physiological, frightening experience. People may describe it as gut-wrenching, a feeling in the pit of the stomach. Personally, I have found that clients have identified with a visual representation of grief, namely the Whirlpool of Grief as is shown in figure 1.

Figure 1. The Whirlpool of Grief by Dr Wilson

Clients often feel like they are going mad when in the grips of the grieving process. Images like this can help them to feel that what they’re going through is ‘normal,’ it can lessen helplessness and confusion. I discovered this task at a Creative Counsellors Club Conference, from a speaker named Sarah Watson. The client can use a cut-out boat to place where they feel they are in their process, they may go backwards and forwards, they might want to describe who is in their boat with them and who they would not like to be in their boat. The client directs this activity, but the ‘aid’ may help them access parts of their grief where words are failing. Beaulieu (2003) agrees that this ‘multisensory involvement’ recruits other senses that ‘can help break through to another level of involvement’ (p2).

Let us examine Carl Rogers’ descendants once again; Natalie expresses in her artwork in figure 2 how she felt when her father died. She describes the imagery as ‘in my grief, I felt overwhelmed. Painting the black tidal waves over and over expressed my sense of helplessness’ (p9).

Figure 2. Black Wave by Natalie Rogers (N Rogers, 1993, p9)

Further down Carl’s hereditary line, may I introduce his granddaughter and Natalie’s daughter Frances Fuchs, an expressive art therapist. Fuchs (1995) describes using a creative activity to express her grief on a poignant anniversary for her late spouse, Gayle.

I went to a special pond that Gayle loved and made an altar of stones and special symbols in the sandy shore. I blew smoke to the four directions and cast a circle. I gathered a stone for each of the years we were together and placed them one by one in a circle, saying out loud memories of that year, both good and bad, setting the 16^th in the centre of the circle to represent that part of the year without her. I then threw a crystal heart out as far as I could into the pond. This ritual had a deep healing effect on my sorrow and I found that a tremendous depression lifted the next day (p3).

 Another incredible use for creative counselling is the reason I set out on my quest for knowledge, and a matter close to my heart, and that is the benefit for autistic clients.

Creative Counselling for Autistic Clients

Woods et al (2013) describe how autistic people ‘typically have problems with social communication, particularly conversation, non-verbal cues and reciprocal interaction’ (p34). Creative Counselling can offer an aid for autistic clients to express their feelings in a supportive environment where verbalising is not the only way.

My Literature Review

My literature review ‘Exploring the Efficacy of Person-Centred Counselling for Autistic People, was recently published in the Person Centred Quarterly (PCQ) (I will never tire of saying that). The key findings of the review were that ‘promising evidence was available to demonstrate Rogers’ (1951) Core Conditions of PCC; empathy, Unconditional Positive Regard (UPR) and congruence as being of therapeutic value to this group’ Cromar (2019), p10.

However, there was a caveat as to whether PCC was ‘enough’ for autistic clients, the evidence suggests that it is, but with some adaptations.

Adaptations

N Rogers (2012) knew the importance of the environment being offered to clients, believing ‘in the individual’s innate drive to become fully herself’ what’s more ‘individuals have a tremendous capacity for self-healing if given the proper environment’ (p13). A large focus of my review was examining what adaptations can be made to provide optimum opportunity for autistic clients to fully become themselves or, as C Rogers (1951) terms, ‘self-actualise.’

The review highlights, as Cromar (2019) explains, that it is vital ‘for the counsellor to be sensitive to sensory sensitivities in the client and differing communication styles’ (p27), differing personal and body language. Additionally, counsellor training needs to be made available as standard so counsellors have the knowledge and confidence to adapt appropriately. However, one of the most useful ways in which to make PCC accessible to autistic clients was found to be to add Creative Counselling.

Deficits in communication skills in autistic people has been found to hamper the ability for the counsellor and the client to develop psychological contact, which is as Cromar (2019) explains ‘deemed necessary to form C Rogers’ (1967) first condition of the relationship’ (p24). It has been well established that the relationship between counsellor and client is imperative for a successful therapeutic outcome. Creative Counselling can fulfil a role, similar to Prouty’s (1994), Pre-therapy to help form psychological contact, which aids in the building of the relationship.

Autistic people often have deficits in verbal communication, according to Aston (2011), additionally, up to 85% of autistic people will have a condition known as Alexithymia, which makes it almost impossible to find words to describe feelings. It is understandable that these struggles could have a negative impact on therapy. Creative Counselling can provide the key to helping clients overcome these barriers to counselling, especially as they are often visual learners. The review demonstrated that using tools including writing, drawing, sand-tray, small figure work and introducing clients’ ‘special interests’ can make a big difference in relaxing the client and aiding the therapeutic alliance.

My Experience

I have a strong belief in PC theory and its healing abilities, however, as an autistic person in my own personal PC therapy and when I was a fledgling counsellor, entering my placement at an autism charity, I found that classic PC did not have all that I needed. I am now going to break with stereotype and move into metaphor (although, on a serious note, some autistic people may struggle with metaphor and you should always check this out).

I am going to compare PCC to a cake, specifically the Victoria Sponge as (full disclosure) that is the only cake I know how to bake. I have learnt the hard way (you may be guessing that I am no Nigella Lawson) that if a Victoria Sponge does not have baking powder included in its ingredients, it will not rise to be a splendid and fully-functioning cake. Baking powder, also known as sodium bicarbonate, is, as Wilson (retrieved 2019) states, ‘the gas that gives rise to our favourite cakes’ (para 7). All of the ingredients for the delectable Victoria Sponge are important, but without this scientific wonder, you get a very flat cake. Creative Counselling is the baking powder of C Rogers’ (1951) PC theory when helping some autistic clients, when mixed with all the other ingredients, it makes PC counselling more effective and accessible.

My PC Angst

In the early days of me feeling it necessary to branch away from classic PC training, I experienced so much doubt that I was practising in a PC way that I gave the feeling (or my newest condition of worth) a name, my PC Angst. Additionally, I have met with some opinions that I am not being ‘very PC.’ It pleases me that a great like N Rogers (2012) met with similar scrutiny, she was told ‘well you’re not doing it Carl’s way.’ She didn’t pull any punches when she said ‘well, so what?… what I think he would want us to talk about is “is this helping people to become their full potential? Is this helping people grow?”’ Furthermore, she makes an incredibly significant point ‘we know things now he didn’t know and the world is a very different place’ (p40). If that belief is good enough for Carl’s flesh and blood, then it’s good enough for me.

We have made great strides in, not only our knowledge of autism, but also our acceptance of autistic people and how to best meet their needs since C Rogers developed this theory, why would we exclude this knowledge from the PCA? If we do, we knowingly exclude many autistic clients.

In Practice

I need to make it clear that Creative Counselling does not automatically mean being directive. For my clients, I follow N Rogers (1993) lead to ‘create the climate for self-direction… preparing the ground for their self-empowerment’ (p99). I have a collection of creative tools which I like to think of as keys, I don’t mean this like I am the expert and have all the keys. I aim to help my clients access their own keys, to help unlock their feelings or to unlock their ‘voice.’ Different keys work for different clients and if none of the keys work, I help the client find more keys, all whilst offering a safe environment with congruence, empathy and UPR.

My key in my counselling with a PC counsellor was a set of buttons, each with a feeling word on. I am one of the 85% of autistic people who has Alexithymia, I could tell you the narrative to my difficult experiences over and over again, but name the feelings inside of me, I could not. I was stuck, I was frustrated and I felt broken. My counsellor set up a piece of paper and gave me some basic guidelines for the task. I was to draw a timeline, we would start at the beginning of my life (it is important for me to note here that I had previously told my counsellor that I wanted to work through all of the events in my life methodically), when I reached a significant event, good or bad, I was to mark it on the line, including the age I was at the time. Then I would explore the event and pick the appropriate feeling words from the buttons and place them next to the event. These words opened me up to feel – it was life changing, I was given access to a key which enabled me to self-direct and work towards self-actualisation.

I have a Jenga set which some of my clients will choose. Each Jenga piece has a prompt written on it, which we take turns to answer. This is useful not only for when clients are finding it hard to access their thoughts but also as I mention in my review, Cromar (2019), self-disclosure can be enormously helpful in building the therapeutic relationship. Autistic people can often feel marginalised, and trust is frequently broken in their lives, self-disclosure can be vital in the building of trust. What is most interesting about this tool, however, is that self-actualisation almost always kicks in, what the client ends up sharing or exploring often bears no resemblance to the prompt on the Jenga piece.

I cannot share my client work with you, however, my son Harry, 13 with autism, has created an art-piece with accompanying text which he has written for this article and which he has given me permission to share. I feel this piece demonstrates better than the previous 2447 words of this article, how Creative Counselling could be utilised to help clients.

The artwork in figure 3 is a visual representation of how Harry views his autism. This picture enabled him to put his feelings into words, with the beautiful, the heartbreaking and heartwarming description which follows (verbatim). Harry would not be able to verbalise these feelings without such a prompt.

Figure 3. The Goat on the Mountain by Harry Cromar

Harry’s Goat on the Mountain

This picture is to represent that when people are being mean to you and bullying you, they are either doing it because they feel jealous of you or because they feel all of the bad things they tell you but they are too afraid of sharing that with others. And all of their emotions build up causing them to be sick and cruel people. But, they also have another name – Sheeple – which means that they follow others just so they can fit in and sometimes that means that they do not trust anyone else and never be nice to people. But you can be the great goat that leaps ahead, away from the Sheeple and climbs the mountain of life, leaving all of the bullies behind. I personally have experienced much bullying throughout school and so far it has continued for six years in total. And the first few years of primary school is where it all started, due to me having a very cruel teacher in year two of primary school. She would often tell me I was doing everything wrong and yelled at me, calling me an idiot and stupid due to the fact that I have autism and didn’t understand what she meant very well. And as we were all very young, her actions towards me made everyone think that they had to do the same thing. And so that was what sparked the flames in the first place. And throughout the years I didn’t trust anyone that well, as I was afraid of talking to anyone. But now I have built up my courage and shown that having autism or other issues do not matter in life, and it allows us to become the goat on top of the mountain and succeed, where the Sheeple fail. And so this is a message to all who read this and have autism. If you ever get bullied or treated unfairly, never be afraid to tell someone, as telling others of your real feelings can always help, and if you are picked on by people, just ignore and walk away, and show them that they have no effect on you or anyone else. Harry Cromar (2019)

Art was my son’s key. I hope that I have (with a great deal of help from Harry) been able to demonstrate what an asset Creative counselling can be to PC counselling, as it is difficult to put into words, as N Rogers (1993) states, attempting to ‘is like trying to tell a woman from Mars what an orange tastes like. Really, you must taste it to understand it’ (pXVI). So I urge you to give it a try.

Education

My review also highlighted alarming rates of poor mental health in autistic people, significantly higher than neurotypical people. Add to this another finding of a chronic lack of counsellors trained in autism and how to adapt services appropriately to make counselling accessible. This was partly the motivation for me to firstly provide training workshops for counsellors. My next workshop is for The Person Centred Association (TPCA), who I am proud to be a co-opted trustee for. This is a train the trainer’s conference hosted by Janet Tolan; I will have the honour of presenting alongside some inspirational speakers, including Janet, Pete Sanders and Mick Cooper. My other venture has been to co-found ‘Counsellors Working With Neurodiversity’; our mission is to improve awareness for counsellors and to build confidence in them working with neurodiverse clients. It is my personal hope that members of the group will incorporate Creative Counselling into their personal way of working, as it can be a game changer in the successful outcome of therapy for autistic clients.

References

Aston, M. (2011). Understanding Asperger syndrome. Retrieved from https://www.bacp.co.uk/bacp-journals/therapy-today/september-2011/understanding-asperger-syndrome/

Beaulieu, D. (2019). Beyond Just Words: When words are simply not enough, go for Impact!. Retrieved from http://www.academieimpact.com/en/pdf/beyond_words.pdf

Cromar, L. (2019). A Literature Review Exploring the Efficacy of Person-Centred Counselling for Autistic People. Person Centred Quarterly. Retrieved from https://www.academia.edu/39297198/A_Literature_Review_Exploring_the_Efficacy_of_Person-Centred_Counselling_for_Autistic_People

Fuchs, F. (1995). Retrieved from http://www.francesfuchsphd.com/Practicing_Grief.pdf

Gladding, S. (2011). The Creative Arts in Counseling. Hoboken: Wiley.

Prouty, G. (1994). Theoretical evolutions in person-centered/experiential therapy. Westport, Conn.: Praeger.

Rogers, C. (1951). Client-centered therapy. London: Constable.

Rogers, C. (1967). On Becoming a Person. London: Constable.

Rogers, N. (1993). The creative connection. Palo Alto (Calif.): Science and Behavior Books.

Rogers, N., Tudor, K., Tudor, L., & Keemar, K. (2012). Person-centered expressive arts therapy: A theoretical encounter. Person-Centered & Experiential Psychotherapies, 11(1), 31-47. doi: 10.1080/14779757.2012.656407

The Creative Counsellors Club. (2019). Retrieved from http://thecreativecounsellorsclub.com/

Wilson, J. (2019). Baking 101: The Difference Between Baking Soda and Baking Powder. Retrieved from https://joythebaker.com/2013/10/baking-101-the-difference-between-baking-soda-and-baking-powder/

Woods, A., Mahdavi, E., & Ryan, J. (2013). Treating clients with Asperger’s syndrome and autism. Child And Adolescent Psychiatry And Mental Health, 7(1), 32. doi: 10.1186/1753-2000-7-32