Co-Design as a Basic Methodology of ‘Reframing’ Autism

Co-Design as a Basic Methodology of ‘Reframing’ Autism

I recently revised work that I was commissioned to undertake for the Autism Association of Western Australia (AAWA), when invited to address the NDS State Conference in Melbourne, Victoria.

It was a reminder of the core principles of my approach to improving the lives of those with autism and their families.

The Autism Reframe Technique (A.R.T.) is a process and toolkit to realise and sustain positive outcomes. It is a series of simple, but progressively more sophisticated tools and techniques to restore a connection between the brain and nervous system. The exercises are graded to the capacity of the student and we go as fast or slow as we need to, to ensure interest and integrated learning.

When we work from this perspective and begin to restore connection between awareness, the brain and nervous system – we steadily progress to greater and greater levels of resilience and self-mastery.

Why is the concept of ‘Reframing’ hard for some professionals to grasp?

recent article in the Psychiatric Times made a great point: most people don’t know how to understand neuroanatomy and neuroscience. This makes it hard for professionals (and lay people) to grasp the potential of brain plasticity and the polyvagal theory so they often dismiss the approach without recognising the amazing benefits.

The article suggests that there are ten reasons why they find it so challenging:

  1. The language is obscure
  2. The terminology is confusing.
  3. The brain is extraordinarily complex and we are finding out each successive year just how complex it is (only last year did we understand the immune system is in the brain!)
  4. It is hard to visualise the brain in 3D and appreciate the structural features and then relate them to other structural features in the nervous system. People just can’t get their head around it.
  5. Looking at the brain is like looking at the Universe. The more you look at it the deeper you are drawn in, the greater the complexity. People get lost.
  6. All brains are different. Brains have common features but no two brains are the same. You have to be much more creative if you take each person individually.
  7. It requires intuition. Neuroanatomy is about spatial information and narratives. It is an unfolding story and requires a new way of thinking. Autistic people are much better at this; it’s why they are often so progressive.
  8. The material is often presented in first level organisation, maps and schematic information; this makes it hard to think and learn creatively.
  9. Practitioners are stuck in an old model of mass or ‘herd’ diagnosis; they have been taught by science to put people in groups. But we are finding out with neuroscience just how impractical that is when you are dealing with individual differences in the brain.
  10. Practitioners often lack the ability to understand, blend and form a therapeutic connection between the structural understanding of the brain processes to how behaviours manifests in things like Autism, Parkinson’s, Anxiety and Panic disorders.
Unblocking the blocks to a progressive approach
The upshot of all of this is that practitioners are often blocked from the potential of brain plasticity and healing by their inability to truly appreciate the underlying matrix of the brain. What we need is to learn to think in a different way. In a creative, open , fluid way. We need to appreciate individual differences; to understand that there is so much we don’t know, so that the person we are working with (the client) knows more about what is going on than we do thus enabling us to tap into this most amazing resource! A.R.T. program
Holly Bridges Book Review: Irish Journal of Counselling and Psychotherapy

Holly Bridges Book Review: Irish Journal of Counselling and Psychotherapy

How can we best understand autism? And how can we work more therapeutically with someone ‘on the spectrum’? These are the questions that Holly Bridges addresses in her recent book, Reframe Your Thinking Around Autism. She proposes that Stephen Porges’ polyvagal theory, along with Anat Baniel’s NeuroMovement approach, may offer novel ways to answer these important questions.

Stephen Porges has written a forward to the book and has given it his blessing. The polyvagal theory has been around for over 25 years now and is a well documented science. It has had a major impact on psychotherapy theory and practice, especially approaches that take the body more into account, notably somatic experiencing, Larry Heller’s NARM model, sensorimotor psychotherapy, and the work of Bessel Van Der Kolk. The gentle movements and felt sense style of working that Anat Baniel offers fits into a well-established tradition of body psychotherapy. Thus the background science and practice of these ideas will be familiar to many psychotherapists.

Reframe Your Thinking Around Autism is a manifesto for a new way to conceptualize and work with people on the autism spectrum and I certainly believe it deserves attention. Bridges maps out the polyvagal theory in a clear and pragmatic way and with this she does therapists of all orientations a real service. The author reports a growing base of case studies that have shown good outcomes. On the other hand, her approach is novel and there are undoubtedly processes and details that could be refined. Her approach would really benefit from some rigorous and impartial studies to better establish its’ scope and limitations. Personally, I feel this would really help move it into the mainstream of treatment, establish funding for it, and build confidence in using it.

In conclusion, as a practicing psychotherapist I feel grateful to Bridges for making the polyvagal theory and the awareness movement approach more accessible and applicable to me in my work with a broad range of clients. What she emphasizes is that everyone is ‘on the spectrum’ insofar as ‘neurotypical’ is a construct. We all share similar nervous systems that can be prone to move out of balance into fight, flight and freeze states that can be chronic and debilitating across a wide spectrum. Her book will most likely help to make the polyvagal theory more accessible to the wider public and deepen our understanding of how embodied states operate, and for these reasons I feel that her book is a valuable resource.

Vincent is a Cork-based psychotherapist. He can be contacted at:

The Myth of Social Engagement

The Myth of Social Engagement

The Polyvagal Theory focuses on our ability to be socially engaged. In order to use our social capacity, we need to be in the right physical state. When we are in a flight/fight, or more immobilised state, our physical ability to use our social system – eyes, ears, voice, connection to heart – becomes reduced as our body has turned its attention to safety. The theory bases itself on the functions of the vagus nerve and the two tracks it runs on; the ventral vagus, which is our newest evolutionary function which allows us to use our social software; and the dorsal vagus, our ancient system that controls rest and digest, flight fight, immobilise and our capacity to be deeply connected to our inner world. The Polyvagal Theory, now over twenty years old, is used by a variety of therapeutic professions to model how we go offline when we are in a stressed state.

A worrying trend in the upcoming world of therapy based on the Polyvagal Theory is the emphasis on the superiority of the ventral vagal states. Like we do in the real world, we consciously and unconsciously give higher value to the ability to be able to smile; to smooth things over; to articulate our thoughts with clarity; to use soft eye contact to soothe and engage those around us. If we or our client cannot do this, it is assumed that we need to get them back into the mode where they can have this ability, this control, this self-mastery. It can seem a worthy goal and the quicker the better. Let’s all hack that vagal nerve and get back to work!

We feel safe when the social system, via the ventral vagus, is in play. People are easy to read, they don’t trigger our flight/fight system, and we can more easily get what we want; people like us more. So, we idealise this capacity and rightly so. It is our highest evolutionary function; it sets us apart from the beasts! But what are we missing when we all too often veer our therapeutic approach towards this end? Who are we serving and are we serving them well with our all too good intentions? Are we of any use to our autistic clients coming from this unquestioned psychological sanctuary?

In our therapeutic approach we psychologists and therapists all too often over prioritise the ventral vagal states (our capacity to socially engage). It’s not surprising since some of our best-known models for the PVT are ladders with the ventral states at the top that can only imply superiority of this function. We are encouraged to ‘climb the ladder’ up and out of the dorsal states, up into the lightness of the social engagement system! We honour the people who have met this challenge well, they are a success story for us as therapists and we also see ourselves as successful when we render our capacity to be just so.

It might look nice, but it’s dangerous territory. The danger is that if we are not careful this happy oversimplification of the polyvagal theory can all too easily lead to a ‘Poly-Anna’ like framework that is all too light on and cannot serve us well when we have to deal with complexity, contradiction and depth. There is more to life than being in a happy ventral state and the deep, dorsal states offer us wisdom, ancient knowledge and an adaptability that streams from the darkness of the dorsal states that we cannot begin to summon out of trained conscious thought.

In the world of autism, the goal posts are a little wider and deeper. People on the spectrum do not readily entertain the social system, often it costs them a lot; often they are held deep within the bowels of the dorsal vagus and they have little ability to move the ventral vagus at will. Often it costs them, in will, just to move from one room to the next or to ask their body to pick up a spoon to eat.

Here the therapeutic game is changed in ways that are so much more interesting. Here the general ways of moving into ventral states do not apply. The casual use of top-down, mind to body awareness do not work because the ability to know and operate the mind-body system are simply not there. Even if people can use their social system often the ability to know and master the physical is another realm. We cannot ask people to do breathing techniques, to still the body with mental gymnastics or ‘feel’ their way through something. Often this is simply not available.

Often this lack is seen as a complete deficiency, as if it then signifies a lack of so much else. If you can’t operate your ventral vagus, if you can’t speak, or you take half an hour to say a sentence, you are inept, unintelligent. Although usually nothing could be farther from the truth, what happens if you can’t readily speak or move or articulate your thoughts, is that people feel obliged to fill in the gaps, to speak for you, to make decisions for you, to ‘move things along’ because things really do need to keep moving along! The pace of the session, the day, the week is then guided by the anxiety of others who need a certain momentum to feel safe. Then, however well meaning, we are playing the same old game.

As someone who aligns with being on the spectrum, I resonate deeply with the dorsal state. It is where I most often live, it is where my intelligence comes from, it is where I am informed. All the information that passes through my social systems, my eyes, my ears, my voice, all my senses pass through and are absorbed deep in my dorsal state and it is something I feel keenly and I am nothing without this presence; it is my presence. On the surface I can look animated or dull depending on the state of my physical prowess at any given time, but always the deep dorsal is in play. Here I know myself. It is secondary that I know myself through the ventral, the smiles, the eye contact, the speech, the outward physical; this is less to me. It has always been this way.

As a therapist, I watch my clients and their families grow in awe of the emerging self when we learn to resist the temptation to engage with behavioural outcomes and instead work softly, but potently with the dynamic tension of living within a highly immobilised system and the propensity to shut-down, versus a highly competent and informed mind. We see great gains when we work with close attention to the individual needs of the system while gently encouraging it to know more.

I often work with young men between 15 and 30 on the spectrum. They seem to find the approach useful and it is testimony to the work that they will chose to work with me. At present I am working with a young man in his mid-teens who is most enamoured with the Polyvagal Theory. He started working with me six months ago and after finding some ground sought a therapist who was able to work in person with him, as we were working online. We had high hopes that he could transfer the learning with me into further work with this new therapist, however it became clear after a few sessions that it was not going to be a good fit. He tried a few times but eventually left disappointed and dismayed and feeling misunderstood.

It is a common complaint that ‘people just don’t understand how hard it is’. If your body has always worked for you it is almost impossible to understand the effort it takes to override the inertia of the immobilised physical system. It is not a lack of will, but rather a burnt-out will that leaves you incapable of ‘following orders’ or being compliant, even if this just means engaging with the simplest activity like moving your head up and down. Sometimes you just can’t.

In our session today this kid found he could not speak at the beginning; he could not move his head in the simplest of actions and we were left waiting to see what would happen whilst not wanting to override him or fill in the gaps. Eventually I suggested that he might like either to ‘stay on the couch and try the head exercises or perhaps your body would prefer to start with the ball on the floor, and if that is the case just move down when you’re ready.’ This was the perfect solution as he then easily moved down to the floor and began the session.

It would have been easy to see that he had choice here, and was being obstinate, or disengaged, but in reality, until we got the choreography of the session just right, he simply could not mobilise himself. It takes time. It takes attention. It takes choice and autonomy and the therapist is merely a guide to an emerging process, but a guide all the same. By the end of the session this chap was talking in sentences and was using far less effort in his legs to move the ball. It is still a work in progress, but he is finding his way.

As a therapist you have to go slow. You have to go slow and you have to be attentive to the possible needs and wants of a person who is trying their very hardest, yet cannot ‘perform’ in a way that is satisfying if you want a ventral response to your enquiries and suggestions. There is much to attend to and anything you suggest if it is not done just so will easily engage a shutdown response.

There is a fine art to holding the dynamic tension between moving forward or staying still in a session. Sometimes you think you recognise that maybe, just maybe they have found this new point of stasis – between the ventral and dorsal states– and you need to let take a step back and leave the body to know and then stabilise this new information; or whether maybe it is time to press on and mobilise the body with a gentle exercise; or whether to invite the person’s opinion on this and how would that best be done; or whether this will be too much for them to manage at this point. Sometimes people are just fidgety and bored and they need an entirely different set of engagement to get them to find that quiet place inside them. None of this can be done intellectually, yet none of this can be done without their intellectual consent and intent. Like a Buddhist buried up to her head in snow, teaching her body how to melt ice; we are similarly playing in the land of deep dorsal states. It is not for the feint hearted.

They find they can manage the world better, that they have a mind and body that moves with more ease and agility. Then they learn to play in this newness, then we work some more, it is delicate, private work. Applying a behavioural program with times and duration and intensity and therapist driven, would quickly deaden this process.

What we are looking for is not broken, but waiting in the wings. If you truly appreciate the Polyvagal Theory and the knowledge that the body will shut down and make inaccessible states that are unnecessary in times of danger, then it is perfectly plausible that they can come back online. Even if they have never seen the light of day, they are there. I am seeing a woman in her thirties with strong intellectual disability and she is finding her voice, her taste buds, her independence in ways that are astonishing to her family and support workers in a few short weeks. It’s real, but it’s not a quick ‘whip it into shape’ vagus hack that we are talking about.

For the purists; yes, we are promoting ventral states. We are trying to remind and incorporate them into the system so, as one client described ‘I can have more gears on my bike’, but we do not do so at the cost of the dorsal. We bring it with us, it informs us all along the way. It is the body who makes the decisions, and we learn to listen and attend to its demands, we build relationship and then eventually learn to become to master of the ship – but never the boss. A good captain knows she is beholden to the sea and the state of the vessel and to the wind and the stars.

Very often classically trained therapists miss the wealth of the dorsal states and what they have to offer. If they would just take a step back from their training and their need to fix what is not broken but is waiting for the right conditions to emerge; they would not only get further quicker, they would learn something magical along the way. The people I work with are brilliant. They shine, they think things that others don’t even dream of. These people have much to offer the world, but we cannot make them fit into a shiny, shallow world. They bring something with them from the deep that the world needs. We must find ways to meet them where they are and then enhance their capacity to share their gifts.

This shared with permission from the two clients who are mentioned in the article.

The Boy From Outer Space

The Boy From Outer Space

A ten year old kid with Aspergers syndrome, has written a moving poem about his daily struggles.

This is a line from a poem by 10 year old Benjamin Giroux. There is something very beautiful about this poem, not because of the loneliness he shares, but because of the sheer beauty that he seems to witness – he touches the stars, he hears voices in the air, he is ‘new’.

He is lonely because he can’t share this, because nobody can see what he sees or hear what he hears.

We often think of Autism and Asperger’s as something to wish away, and we spend our clinical time ‘training’ it away with behavioural techniques to make things normal.

But maybe, just maybe, we have got the wrong idea.

Maybe instead of being lesser, people with autism and Aspergers are more? Maybe they know something we don’t; maybe they have something to teach us?

Leo Kanner wrote about this in the 1940’s and so did Hans Asberger. Both of them described ‘special abilities’ as the primary indicator of autism.

Yet we only define autism only in terms of deficit.

We can look at this poem and feel sorry for Benjamin, or we can look at it as an opportunity to begin to see something that we haven’t seen before. Who knows, maybe he can touch the stars and maybe he can teach us how. Benjamin doesn’t sound like he wants to be ‘normalized’, he sounds like he wants to be seen for who he is, right now.

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Today article (and picture of Benjamin)

The Physiology of Autism & Key Breakthroughs in Autism and Asperger Therapy

The Physiology of Autism & Key Breakthroughs in Autism and Asperger Therapy

Danny Raede, CEO and co-founder of Asperger Experts, discusses the physiology of autism and how an understanding of the polyvagal theory and brain plasticity may be a key breakthrough in autism and aspergers therapy.

About Danny Raede

Danny Raede is the CEO and co-founder of Asperger Experts and was diagnosed with Asperger’s at age 12 when his parents noticed him having difficulties staying focused in school. He didn’t think much of it at the time and spent most of his time in his room playing video games such as Neverwinter Nights and World of Warcraft. His parents would say that he was very much addicted to the computer. As he grew up in his hometown of Santa Barbara, California, homework became a constant battle. A simple assignment that should have taken 15 minutes to complete turned into a 5 hour power struggle.

In college, Danny decided he wanted to change his life, and became committed to the study of personal development, success, psychology and business. Once he got out of Defense Mode, life became a lot easier and he started to flourish and thrive. He started to make friends, and have a life outside of video games. He now runs Asperger Experts in Seattle, Washington with an awesome team of parents, life coaches, and people on the spectrum. When he isn’t working he enjoys boating, adventures with friends, travel and watching the Food Network on tv.

Through his work at Asperger Experts, he has been fortunate enough to reach millions of people and share his passion for a fuller, richer life experience. He is the winner of the Diana Vietz Award from the National Council on Independent Living.

Asperger Experts