Why Is it Good To Know How You Feel? Alexithymia Pt.2

 

Knowing your emotions helps you know yourself. Understanding that I sometimes had emotions that were too subtle to register, or that I had a swirl of emotions all at once, helped me see that just because I couldn't describe them, didn't mean the emotions weren't there.

A lot of autistic people I've known have a fear that they are psychopathic - that they really don't care and don't have feelings. But that is invariably far from the case. From their words and actions, it is clear that these people care deeply for others around them. I can include carers, nurses, aid workers and human rights activists in this group. And this is where 'cognitive processing' (as I call it) comes into its own: by examining their thought processes, often people uncover the subtle emotions they couldn't articulate. For example, I once asked an autistic human rights activist, who risked his life to help people, why he did it and he said, 'I can't see people suffer and do nothing about it'.

BBC mental health expert, Shahana Knight listed 5 reasons why recognising our emotions is helpful. Although addressing children, her 5 reasons work for everyone. They are:

1. Understanding the reason behind your emotion
2. Help you feel more in control
3. Negative emotions can lead to negative thoughts
4. It means you can ask for help
5. It makes you a better friend

Adapting this for adult Neurodivergents, I'd say we do things the other way around sometimes:

1. We tend to use reason to correctly identify the emotion, just as I did with my anxiety feeling. I knew that my body behaved a certain way when anxious, I then considered what I was anxious about (accidentally offending someone) and consequently was able to reduce the anxiety (by apologising next time I saw them).
2. Feeling in control (of our emotions) is something that helps everyone, especially Neurodivergents who are overloaded or have a lot of impulsivity.
3. Negative thoughts in neurodivergent people can often lead to negative emotions, as well as the other way around, so nipping catastrophising or self-deprecation in the bud is often helpful.
4. Not only can you ask for help more easily (because you are communicating to other people what the problem actually is), you are more likely to get the appropriate help. For example, if my anxiety is misread as anger, people will likely try to pacify me rather than actually deal with my anxiety triggers. For example, at the dentist, where what I really needed was to sit alone in a quiet room, but what I got was a nervous dentist trying to ask me what was wrong!
5. And lastly, understanding your own emotions (by whatever means) helps you understand the emotions of others, and maybe predict their behaviours a little more. As an autistic person, I am much more comfortable with people whose actions I can predict. It might improve your social skills, or at least help you avoid social 'danger' situations.

But the major reason why understanding your emotions is important is because your emotions are a big part of who you are and understanding ourselves is a vital element of wellbeing. To accept yourself without judgement, it is useful to understand yourself.

A note on emotional masking

Emotional masking, as I have discussed, is the habit of covering up how you really feel (or don't feel) by putting on a persona that seems more socially 'acceptable' than your real self. It's a way of keeping safe in a world which is not always as understanding as we'd hope. Neurodivergent people often mask for years without even realising we're doing it, but it can lead to confusion about what we really feel, and what we are just 'putting on' to fit in.

With the death of Queen Elizabeth II, a lot of Neurodivergent people may be in the situation of not feeling anything (that they can detect), having feelings they don't feel comfortable in disclosing, or having feelings which are in contradiction to those around them. They might be very sad - or not at all; They might have no idea how they feel or be overwhelmed with a mess of feelings. Sometimes the 'mask' is necessary to be safe or comfortable in social situations. I'm not saying just drop the mask and blurt out something that will get you into trouble. But if you can at least acknowledge, to yourself, what you feel - or possibly just what you think - that can help.

How Does It Make You Feel? Alexithymia Pt.1

 

One of the most irritating questions I find myself asking clients is that old standby: 'And how does that make you feel?'

The reason I hate it is I never know how to answer it myself!

Firstly, I have to work out what the question means in terms of physical sensation or emotional 'feeling'. Like many autistic people, it sometimes seems my senses and feelings aren't wired up right. My instant reaction is to tell the person how I feel physically - so I'll say, 'I'm cold' or 'I have hayfever'. But I quickly remind myself that that is probably not what they're asking (unless they're my doctor) so I scrabble about to think of plausible feelings to mention.

Again, like many autistic and neurodivergent people, a feeling of anxiety is my constant companion, so I may mention that. Or if I'm trying to impress, I will guess what answer the person is expecting (an aspect of 'masking' ie autistic or ADHD people covering up their natural traits to be more acceptable to their audience). 

As I read on LinkedIn today, 'Neurodivergent people don't mask because they don't accept themselves, they mask because others don't accept them'

We Really DO think differently!

An autistic friend of mine volunteered for an experiment, a few years ago, where they put him in an fMRI machine to see what his brain did with various questions. As they were settling him in, they asked for his name (he answered, his brain was quiet) and his date of birth (easy answer; a little bit of brain activity around number processing), and then the nurse asked him how he was? Well, his brain lit up like a Christmas tree! This simple, socially polite question seemed to him to be like quantum physics, and his brain struggled to interpret it and work out the appropriate answer. He did eventually come out with a weak 'Fine', but only by looking at the fMRI could they tell how difficult that question had been for him.

So, what makes that question, 'How do you feel?' so difficult for many autistic people to answer? Partly the problem is that the answer is different in every context. If you are admitted to hospital with a heart attack, and the doctor asks how you feel, he's expecting an answer like 'I have an awful pain on the left side of my chest', not 'Fine' (which is ironically the answer many older people, as well as autistic people, tend to give).

Having disentangled the physical sensations from the emotional ones (not an easy task when you suffer sensory hypersensitivity, like myself) you are then left with a bundle of emotions, trying to decide which ones are expected in this context. To put it bluntly, and not very politically correct, I'm trying not to come across as nutcase. The last thing that occurs to me is just to say how I actually feel (emotionally) but even if it does, I can rarely verbalise what that feeling actually is.

Alexithymia

Psychologists call this emotion-identification problem 'Alexithymia' (literally 'unable to put feelings into words'). And if you're someone who gets your emotions muddled up, that's 'Dysthymia'. Neither of these terms denote a medical condition - they're more symptoms, or I'd say traits, that some people have.

As soon as I came across the term 'Alexithymia' I knew that described a problem I, and other Neurodivergent people, had. It is commonly found with autism, ADHD and dyslexia, but is extremely common with autistic people. My next question was, 'What causes it?'.

If you've met me, you know I have a problem with people blaming everything on neurology. A lot of research papers I've seen seemed to assume that alexithymia is caused by our unique, neurodivergent brain structures or brain chemistry. And they may be right. But I also notice that many Neurodivergent people had great difficulty learning anything as small kids, due to being permanently stressed-out.

Learning social-emotional skills as a Neurodivergent kid, especially if you are undiagnosed, like myself, was like trying to learn your Green Cross Code in Picadilly circus, in rush hour, while the Salvation Army band rehearses Christmas carols. And with people shouting contradictory instructions at you! I challenge anybody to learn anything with sensory and cognitive overload - the sort many autistic and ADHD kids experience every day in school. It isn't surprising, considering, that the basics of so-called 'Emotional intelligence' might have passed us by.

Overcoming Alexithymia

So, what did I fail to learn that could have helped? Firstly, I was well into my counselling training before I learned that human beings often have more than one emotion at one time. Maybe it's obvious to other people, but when I discovered that - a person who was angry, sad, resentful and optimistic all at the same time, for example, it blew my mind! So that sensation of a swirl of emotions - all mixing and colliding in a random pattern - is possibly 'normal'? (As in, found in both neurotypicals and neurodivergents).

This was my first lightbulb moment: Asking 'How does it make you feel?' is an extremely complex question, which confuses us because used socially, it is nothing more than a ritual that says, 'I care about you', and that is all. When a doctor uses the term, they are probably talking about your physicality (unless they're a psychiatrist). And when a counsellor or therapist uses it, maybe they are trying to look deeper... maybe my counsellor actually wanted me to explore the swirling mess of contradictory emotions? Or maybe, sometimes, just like myself when working with a client, it's the 'counsellory' thing to say?

[Note: You can see from this how being autistic equates to chronic over-thinking about everything in my world!]

The second thing that helped me was recognising that I can overcome this 'deficit' in emotion-recognition by using reason and observation. For example, I don't know how I feel, but I have noticed my heart racing, my breathing has speeded up and I feel cold and clammy. This is a sensation I often associate with anxiety. Could I be anxious? If so, what is likely to have triggered the anxiety? Perhaps I've unintentionally upset a colleague?

Intellectualising?

When I was training as a counsellor, I sensed negativity around the idea that clients were 'intellectualising' their problems. I knew I did this, but since this was my major coping strategy, I kept quiet about it. When I started to work with neurodivergent clients, I found that most of them did the same as me - and many had been told by previous counsellors that it was unhealthy, and they were 'disconnected' from their emotions.

Through my own therapy (as a client) and my work with Neurodivergent people, I realised that this 'cognitive processing' did actually work pretty well. Just like my colleagues' Neurotypical clients, my clients made discoveries about the sources of their pain and learned to understand their emotions. I started to feel that just as people who've had a stroke have to learn to use a different part of the brain to walk, neurodivergent people had found a way round this 'alexithymia'.

As autistic people we are often incredibly observant about the people around us. It might not seem it - autistic special interests and ADHD hyperfocus don't seem to be all that suited to noticing those around you, but we're sneaky. I can be in full throttle, talking about my favourite subject (Neurodiversity usually) when someone walks past looking irritated. I notice. I probably don't know what to do about it, but I notice. Once a Neurodivergent person begins paying attention to emotions - their own and others, we often learn fast. It's a different way of learning, but it works.

So, if you were a fly on the wall for one of my sessions with my personal counsellor, or as I work with neurodivergent clients, it might seem that we are doing nothing more than having a philosophical debate about which emotion we are feeling at this moment, and if there are other emotions round it, and if we are repressing or denying some emotions because of masking and feeling they are 'inappropriate'... But you see, this is us using our brains to get round the alexithymic roadblock.

Thirdly, by dropping the 'mask', sometimes it's OK to say, 'I don't know how I feel', or 'I don't feel anything, but I have a lot of thoughts about this'. It doesn't make you callous, or a monster just because your emotions are not clear - 'Still waters run deep,' I like to say (meaning that for a thoughtful person, sometimes it isn't easy just to give a feeling a quick label and leave it at that). If you don't feel anything, allow yourself to be. As my supervisor always says, if we pay attention 'something will emerge'. Don't prejudge what your own mind will come up with - sometimes it will surprise you!

How Neurodiversity-Informed Counselling Can Help

 

My style of counselling draws mostly from the Person-Centred Approach, a way of counselling first invented by psychologist Carl Rogers in the 1960s. This is an approach which assumes you, the client, are the expert on your own life, and that inside you, you already have everything you need to be a fulfilled, self-accepting person. Underneath all of your difficulties and struggles, your true, authentic self and all of your potential is still there, waiting to be discovered. You just need the right environment for it to show itself.

• Difficulty identifying emotions (sometimes called Alexithymia)
• Disliking eye-contact
• Lack of facial expression (sometimes called 'blunt affect')
• Atypical body language e.g. looking angry when stressed, looking bored when concentrating, fidgeting even when not anxious etc
• Need for very detailed, precise instructions
• Very literal way of communicating
• Sensory overload and sensory distractions
• Cognitive 'inertia' - difficulty starting, stopping or changing direction on a task
• Low self-esteem (from having differences seen as faults)
• Social anxiety (making getting to know a counsellor quite scary)

So as your counsellor, I'm not going to tell you what to do. I'm sure you've already had plenty of advice: If it worked, you wouldn't feel the need to consider counselling. What I can do is listen - without judgement and work with you to figure out your thoughts and feelings and separate the 'shoulds' from the 'what is'.

Well so far, I've described Person-Centred counselling. How does that differ when you're an autistic person, Aspergers, ADHD or other Neurodivergences (ND)?

In a way, it doesn't. Every neurodivergent person is an individual, and we are all unique. But there are particular difficulties autistic and other ND people commonly experience. The most common of which is that we are different to most of the people around us. Yes, we are all different, but some of us are more different than others. And being different often means we are frequently misunderstood and may have a lot of negative experiences, leading to us trying to 'mask' or cover up our ND traits to better fit in. After many years, that masking becomes more and more automatic, and we can lose our sense of who we really are, underneath the mask.

In the old days of the Neurodiversity movement (as it's now called), autistic people used to gather on the internet (Usenet Newsgroups). We used to refer to one another as 'ACs', meaning 'Autistics and cousins'. The 'cousins' sometimes referred to other neurodivergent individuals (those with ADHD, Tourettes, dyslexia etc), but generally we referred to each other as 'cousins'. There was a kind of invisible bond between us. Not that we were the same, but like distant cousins in a real family, we had enough in common to recognise one another's struggles.

I still sense that bond to this day. It can be a joy when talking to a stranger at a conference or whatever, and you are both struggling with a similar problem e.g. the lack of literal language in the conference leaflet, sensory overload in the conference hall, embarrassment about fidgeting ('stimming' we call it in the ND world) or tics. Having a counsellor who is neurodivergent can be a great relief when you don't have to explain or justify why you find certain things hard. And even if I don't have that problem personally, you can bet your bottom dollar that I know someone who does, a friend or a relative!

So, here's a list of some of the common issues we have to adapt to, when counselling a neurodivergent person:

Some of this is because of autism and/or ADHD - but a lot of this is because people have a lot of trauma from how they've been treated, because of being ND and different. Sometimes that trauma is from people with the best of intentions - teachers, parents, previous therapists etc. So as your counsellor, I try to take all of this on board: not making assumptions but bearing in mind what sorts of things I might learn about you and being prepared to adapt my approach to meet your needs.

For example, a client might have a lot of difficulty knowing what sort of things to talk about in a counselling session. That's OK - my former tutor used to say, 'Something will emerge'. 

She's right - it usually does. And the thing you first think of is often a good place to begin. But it's hard when you're an ND person who is always careful to try to say the 'right' things and you are afraid of judgement. But I will occasionally adapt my approach by suggesting a place to start. Once we're off, we're off!

Another example is a very socially anxious client who may be scared to meet the counsellor (even over Zoom). So, adapting my practice to allow a trusted friend or relative to be there for the introduction can help.

As for things like facial expression and atypical body language - the key here is knowing that each individual may have different expressions and body language, but I just have to get to know you, and learn how you show your feelings, and we're fine.

Mostly, counselling ND individuals is about accepting difference and believing in my clients. Which, ironically, is how I work with everybody - ND or Neurotypical (ie Muggle). 

Not Like the Others - Origin Story

Not Like the Others started off life as a blog, as a place to vent about my experiences (good and bad) as an autistic student counsellor. I received a lot of feedback along the lines of 'Me too!' and 'That's my experience too!', so I knew I was on the right track.

About 6 years ago, I was at a National Autistic Society conference, when someone asked me what I did for a living. I explained that I had ambitions to 'Get a job that doesn't exist'. When asked what that job was, I answered 'A specialist counsellor to neurodivergent people, especially fellow autistics'.

Well since then, there have been many changes, not least of the fact that there are many 'neurodivergent counsellors' groups, and a ton of CPD courses and talks to help counsellors be more autism-aware. In fact I run such courses myself! (on the grounds that if you want a job doing, do it yourself).

I qualified as a counsellor, despite my many struggles. Along the way, I read a lot of books, went to a lot of courses, and best of all, worked with many autistic clients. In fact, my training placement was with a small autism charity called Autism Hub, part of A.L.A.G (the All London Asperger Group).

So now I am excited to be going into Private Practice, and of course, I had to call it Not Like the Others Counselling & Training, because I'm... well, not like the others. Or as a great autistic friend likes to say, 'Unique, like everyone else'.

And that is the philosophy of my practice: that you, whether you are autistic, ADHD or even 'neurotypical', you are a unique person, and you deserve counselling that celebrates that fact.