Giving the researcher a voice: a conference presentation

Earlier this week, I presented a paper at York St John University's 6th Annual Research Methodologies Conference.  Please click the following link to view my Powerpoint slides and read a version of my verbal presentation .... http://www.box.com/s/ilj434q3a951eqo1oe86

The presentation is essentially about how the way in which I am carrying out my PhD research has progressed. As I have gotten more and more involved in my research, I have increasingly recognised that research does not always have to be positivist or objective.  Especially within the Social Sciences, where people are the subject of the research, objectivity is not so possible.  Also, because my research topic is one with which I have intimate connections, I have found it increasingly impossible to keep myself at the objective distance required of positivist research paradigms.

I discovered that my own history, knowledge, and experience (personal and professional) were yielding invaluable sources of data, and I want to find a way to incorporate all of this into my research ... hence the 'reflexivity' and 'autoethnography' which this presentation discusses.

Currently in my 4th year of a part-time PhD at York St John University, my research is entitled ... "Every body has a voice: the impact on the counsellor's embodied subjectivity when working with clients presenting with eating disorder symptomatology"

Anorexia as an autism spectrum disorder?

After writing my blog earlier this week about Asperger’s Syndrome, I was intrigued when I opened my newly delivered copy of the European Eating Disorders Review journal on Thursday (Vol. 19, Issue 6, Nov-Dec 2011) to see the first article entitled; “Is anorexia nervosa a version of autism spectrum disorders?”  The research essentially highlights similarities in cognitive functioning between people diagnosed with anorexia and those with an autism spectrum disorder.

Reading this article has led me to see what other research I could find about this link so I could think about the possibility for myself.  My earlier blog was inspired by my thinking about someone close to me and my struggle to understand them.  This new angle has now made me revisit some of my understandings about myself; as someone who was once diagnosed with anorexia.  In my earlier blog, I noted that I saw some traits of Asperger’s within myself … where does this new information leave me with my understanding of myself?  And of my relationship with this other person?

There isn’t a great deal of research to be easily found, but what I have found, I’ve written about, under the heading of ‘So what has the research out there told me?’ below.  For people not interested in reading the details of the research or my reactions to it, I’ve written ‘My Own Thoughts’ on the possible link immediately below …

My Own Thoughts

Reading the research was initially another ‘light bulb’ moment of enlightenment for me.  I thought; “Yes, I can see the links; makes a lot of sense to me!”  Anorexia definitely shares some of its traits with autism spectrum disorders, and more specifically the Asperger’s end of the spectrum (see bullet-point list below for comparative examples).  When I was ‘anorexic’ I would have satisfied a lot of the Asperger’s traits to quite a high degree … as would most anorexics.  Strange to think that at that time, I could probably have satisfied an Asperger’s diagnosis … and yet, that definitely wasn’t my experience; I was Anorexic.

And now, no longer anorexic, I can still see my tendency towards those traits (as I’m sure many people who haven’t experienced eating difficulties can!) but my increased self-acceptance and self awareness enable me to use those traits in a constructive and life-enhancing way.  With anorexia, there is a way forward … helping the individual work through their need to control food and / or their body and enabling them to gain weight.  The physiological effects of starvation create and / or exacerbate these same traits, so someone with anorexia whose weight drops significantly will display them, but once their weight rises out of the ‘danger zone’ the traits diminish.   The individual with a diagnosis on the autism spectrum disorder does not ‘recover’ … they might learn ways of managing their life effectively to compensate for their autistic / aspergic traits, but they can’t recover in the same way as many people with anorexia can, and do.

Seeing the similarities, has helped me understand how easily I related to, & connected so deeply with, someone in my life with Asperger’s … I was seeing parts of myself there.  I could understand that other person’s way of thinking, their way of being in the world … because I’d been there myself.  And although I’m no longer there to a significant extent, I do still have the understanding I gathered as a result of my time spent in that anorexic-aspergic world, making it so much easier for me to effectively relate to, and with, someone with Asperger’s.

If there are links between anorexia and autism spectrum disorders, it opens a lot of questions as to how we currently help people with anorexia.  Most treatment currently focuses on challenging the anorexic thinking and behaviour, exploring reasons behind the behaviour to find what purpose it serves for the individual and either resolving those underlying issues or helping them find more effective coping strategies, and exploring their relationship with food and their bodies to encourage a healthier way of relating.  However, if it was the case that anorexia had a neurobiological component, like autism spectrum disorders, therapy wouldn’t improve the condition to any significant degree.

And like myself, many people who have been anorexic move into Bulimia, which encompasses many different personality traits.  The individual with bulimia loses some of their perfectionism, their ability to maintain control or to focus on the minutia.  They often feel at the mercy of their emotions whereas anorexics and those on the autism spectrum are less able to experience or recognise such swings in emotion.

I’m not sure … there may be links, but I’d like to see some more definitive research before I wholeheartedly endorse the idea.  Yes, I think the two ‘conditions’ display a number of similarities, but I’m not convinced they’re part of the same ‘disorder’ … I’d be happy to be proved wrong though!  

The research does seem to indicate a higher than normal prevalence of autism spectrum disorders within diagnosed anorexics than in the general population, but for me, this doesn’t prove the link.  Instead it makes sense to me that females on the  autism spectrum (diagnosed or not), because of the cultural imperative to be thin in modern Western society and hence control eating and body weight / shape, are probably more likely to turn to anorexic behaviour as a coping mechanism.

As someone currently working with people with anorexia, and with a past anorexic diagnosis, I think the recognition of these links is important in that it has helped me gain yet again, a deeper understanding of Anorexia and also of Asperger’s, which can only be a good thing…

So what has the research out there told me?

In previous research in 2007, Professor Janet Treasure (professor of psychiatry at the Institute of Psychiatry, King’s College, London, and a recognised ‘authority’ on eating disorders) suggested two aspects of the link between anorexia and autistic spectrum traits.  The first is that because of their propensity for black and white thinking, needing to feel in control and an obsession with rules and systematic thinking, girls on the autism spectrum are more likely to be drawn into the controlled world of anorexia.  Having rules to follow around eating affords them the safety and control they enjoy.  The second link comes from the physiological changes brought about as a result of the effects of starvation on the body, which echo and exaggerate the autistic traits.  The effects of starvation on the brain include impaired cognitive functioning, a tendency to think in black and white terms, a focus on themselves and an increasing difficulty in reading other people … all common traits of those on the autism spectrum.

There seems to be a higher prevalence of autism spectrum disorder in those diagnosed with Anorexia Nervosa than in the general public; a study reported by Janet Treasure in 2007 claimed 1 in 5 anorexics met the criteria for an autism spectrum disorder and Tony Atwood (a recognised ‘expert’ on Asperger’s), also in 2007, reported between 18% & 23% of anorexic teenage girls meeting some or all of the criteria for Asperger’s Syndrome.  The prevalence rate for all autistic spectrum disorders in the general population is estimated to be around 1%.  For me, as written above, this simply indicates that females with an autism spectrum disorder are more likely than the general population to use anorexia as a way of attempting to deal with their personality traits.  Or that girls who develop anorexia typically share many of the autism spectrum disorder traits and their anorexic behaviour and physiological changes it brings about exacerbates these same traits.

One area in which Janet Treasure links anorexia with autism spectrum disorders is from a neurobiological basis.  It has been established that autism spectrum disorders result from atypical neurological processing (the brain processing information in a different way from the person not on the autism spectrum) and Treasure has proposed that anorexia results in part from this neurobiological level.  This is an interesting concept as it impacts on the current understanding of eating disorders being more socio-culturally influenced.  It consequently has huge implications for how we work with people presenting with anorexia.  There appears to be, as yet, no definitive research to confirm or disprove this theory.

For myself, the following similarities when they were first highlighted to me were what excited me and made me think that maybe a link between the two ‘conditions could be possible. Common symptoms shared between people with a diagnosis of anorexia and those on the autism spectrum include…

• Obsessive or compulsive behaviour
• A tendency towards perfectionism with the individual having a need to do things perfectly or completely
• Reduced ability to see, and think about, self-identity and connections with others
• Difficult empathising
• A tendency towards focusing on minute details, and therefore, an inability to see the bigger picture 
• Difficulty with multi-tasking or switching between ideas and tasks
• A lack of flexibility in their thinking, which makes coping with changes in plans or routines very difficult and stressful
• A like of routine
• Difficulty in negotiating, and coping with, life changes
• Ritualised eating, food preparation, or exercise routines
• Increased incidence of anxiety and depression

However, as discussed above, people diagnosed with anorexia are able to move away from these rigid patterns as they ‘recover’ … unlike those with an autism spectrum diagnosis … unless, the individual experiencing anorexia actually has a co-morbid autism spectrum diagnosis.

Another similarity which intrigued me, because I wasn’t aware of it, and which again, highlights a physiological element to anorexia is that both individuals diagnosed with anorexia and those on the autism spectrum have lower levels of Oxytocin. Oxytocin is a hormone involved in social recognition, the ability to empathise, bonding and sexual arousal; all of which may be impaired in these two categories of people. 

Anorexia has been called the female Asperger’s … Professor Christopher Gillberg, writing in 2005 suggested that autism spectrum disorders may be overlooked in girls as they present in different ways than with males; for example, anorexia, and it may be easy to overlook the possibility of an autism spectrum diagnosis when the presenting symptoms are indicating anorexia.  As I wrote above, for me it seems likely that females on the  autism spectrum (diagnosed or not), because of the cultural imperative to be thin in modern Western society and hence control eating and body weight / shape, are probably more likely to turn to anorexic behaviour as a coping mechanism.

I’m always happy to have my current ways of thinking challenged (doesn’t that statement itself ‘prove’ how far I’ve moved away from an anorexic / aspergic way of thinking!?!) and for me, challenging my beliefs, allows me to question them and to look around them and decide if I really do still believe them as they stand.  It allows me to adapt and expand my understandings and ways of thinking about things and to see a bigger picture as more relevant research emerges. I suspect that this will be an area of research I keep a close eye on …

What is this thing we call 'counselling'?

I've just rediscovered this 'information sheet' I wrote earlier this year, & thought I'd share it on here. It gives a very brief overview of counselling & some of the different approaches available ...

Counselling

When might counselling help?

If anything is troubling you in your life, counselling can provide a safe, accepting, confidential place in which you can talk about your concerns. People talk about a wide range of things in counselling, including; drug use, eating problems, bereavement, family issues, relationship problems, sexual assault or childhood sexual abuse, other forms of childhood abuse, work related concerns, sexuality and much more.

What is counselling and how does it work?

Counselling allows you the opportunity to sit down with a trained professional and explore your thoughts, feelings and emotions about the situation you find yourself in. The counsellor will offer a safe and accepting place in which you can talk about yourself and any concerns you may have. The counsellor will not judge you, or anything you say, but will instead allow you to explore the thoughts and feelings you may be having which you maybe don’t want to share with friends or family.

By talking about yourself and your experiences in a safe place and having what you say heard and listened to carefully you may find that the influence of those experiences on your life begins to lessen. The process of sharing your thoughts and feelings can be very helpful in enabling you to make sense of yourself and your life. Sharing things with a counsellor who you can trust not to judge you and who isn’t part of your usual circle of friends can be a healing experience in itself.

We don’t often get the opportunity to sit down and talk about ourselves in such a focussed way. Having your experiences and yourself listened to in such an accepting way by someone else can help you begin to feel better about yourself. And this in turn can help you begin to like and accept yourself more, which leads to improved self-esteem and self-confidence.

Counsellors tend not to give advice or tell you what to do, and will instead enable you to make your own decisions about what you need to do. In this way, you learn to trust yourself more and learn how to empower yourself to live your life more effectively.

Counsellors will reflect back to you some of the things they hear you say; hearing your words reflected back by someone else can sometimes help you hear them in a different way which can change the way you understand them or think and feel about yourself. Sometimes too, just hearing yourself tell your story out-loud and the process of having to think about it clearly in order to tell it to someone else can help you make clearer sense of it for yourself.

Counsellors may also ask you questions or offer you exercises and activities to help you explore your thoughts and feelings in a different way. Sometimes we can get stuck in unhelpful ways of thinking which leave us feeling unhappy or unfulfilled. The counsellor’s questions can help you challenge these ways of thinking and find more effective ways of viewing yourself and your situation which will enable you to make changes in your life.

Working together with you like this, the counsellor is aiming to help you develop a clearer understanding of yourself and your life and to help you decide upon any changes you wish to make to help you live more happily.

The counselling process

Counselling sessions tend to last between 50 minutes and one hour, depending on how the counsellor works. They usually happen on a weekly or fortnightly basis because counselling is a process which you need to engage in regularly in order to get best results. Once you’ve talked about something in a session, it’s helpful if you think about the things you’ve talked about in the time between sessions. In this way, you are beginning to make changes to yourself and your life which you can discuss with your counsellor at your next appointment.

At the first session, the counsellor will discuss the “counselling contract” or “counselling agreement” with you. This will set out what you can expect from your counselling and will include things like the counsellor’s confidentiality policy, how often you will be seen, how many sessions you are entitled to, what happens if you miss sessions, etc. In the first session, the counsellor will give you the opportunity to tell your story and talk about your hopes or what you wish to achieve from counselling. They may also carry out a formal assessment, looking at things including your history, your support systems, your current life situation and any risk factors (things like excessive alcohol use, drug use, self-harm or suicidal intent). This first session gives both you and the counsellor the opportunity to decide if counselling is the most appropriate service for you.

The first session also gives you the opportunity to find out if you feel comfortable with the counsellor. The relationship which you develop with them is an important part of the process and you need to feel comfortable with the person you are choosing to work with; after all, you're going to talking to them about personal, precious, private, and sometimes painful things.

Accessing counselling

Counselling is offered by a number of organisations, depending upon which services you are accessing. This counselling is very often free, although some organisations may charge a fee. You can also be referred to counselling within your GP surgery, which is free. Private counsellors also offer counselling, although you will need to pay for this.


Different styles of counselling

There a number of different approaches to counselling and different counsellors work in different ways. Below are details of four of the most common approaches used. Some counsellors work purely from one particular model, whilst others may integrate skills and techniques from a number of approaches, and call themselves ‘Integrative’ or ‘Eclectic.’ It can be useful to talk to your counsellor about how they work so that you can understand a little bit about their approach and how you will be working together.

Person Centred

Person Centred counsellors work from the belief that clients are the experts in their own life and have all of their own answers inside. The approach is non-directive which means that the counsellor will not give you advice or tell you what to do in any way. They will follow your lead, believing that you, as the client will bring to counselling those things which are most pressing for you to explore. This also encourages you to learn to take responsibility for yourself, by teaching you to decide what is most important to you. The counsellor will help you explore the issues you take to counselling to help you find more effective ways of understanding your situation or living your life.

CBT (Cognitive Behavioural Therapy)

The underlying belief of CBT is that the thoughts we have influence our behaviour and how we act. By helping you to take more notice of the thoughts you are having, the therapist will help you find ways of challenging and changing your unhelpful thoughts to more helpful ones. With these more effective ways of thinking in place, you can then choose to change your behaviours to help you live more effectively.

Psychodynamic

Psychodynamic counsellors will help you explore the impact your unconscious and your past experience is having on your current life situation. As children, we learn beliefs, values and behaviours from the adults around us and how they treat us and other people. Sometimes when we grow up the things we learned in childhood prevent us from being happy or living our lives effectively. By exploring where our beliefs originate from, we can then find ways to challenge and change them to more effective beliefs which fit more easily with the adult we have become. Psychodynamic therapists also believe that we often respond to people and situations in our current lives in ways which remind us of past experiences and relationships. This may occur in the counselling relationship and the therapist will observe how you interact with them, with the aim of assisting you to find more effective ways of relating to people in the present.

Gestalt

Gestalt therapists focus on the whole of the client’s experience. They will encourage you to gain self awareness and understanding of your behaviours by encouraging you to talk about yourself. They will focus on your body language (the unconscious movements you make as you talk), which can often give clues as to how you are thinking or feeling. The Gestalt therapist may encourage you to act out scenarios or explore your dreams in order to enable you to become more aware of your unconscious thought processes. Bringing your unconscious gestures and thoughts to awareness allows you to make more effective choices about your beliefs, behaviours and ways of living.

All Cats (& Humans) Have Asperger Syndrome

I’ve ‘stolen’, and adapted, this blog title from a wonderful book by Kathy Hoopmann called “all cats have asperger syndrome” (published by Jessica Kingsley Publishers). In it, she illustrates many of the typical asperger’s traits with wonderful pictures of cats; some sweet, some amusing, some sad, many thoughtful, but all of which highlight the experiences of many people with Asperger Syndrome.


Asperger’s Syndrome is something I’ve become interested in recently. To help me better understand someone I suspected was affected by it, I began researching the subject, and as I’ve read more and more about the syndrome, it has continued to fascinate me. Although I know I don’t have Asperger’s myself, I do recognise a number of so-called Asperger’s traits in my own thinking and behaviour; as I’m sure many of us would! And to my mind, that’s no bad thing, as some of the traits are highly positive.

So often, once someone is given a label (‘Asperger’s’ in this case), it immediately makes other people think differently about them, and to begin to see them as someone odd, or someone to be pitied or avoided, ridiculed or seen as a victim. And yes, some conditions bring their own problems, but what gets forgotten about is that there is still a person inside; a person who deserves to be treated and viewed in the same way as ‘neurotypical’ people (ie: people without Asperger’s / Autism) or as they were before being given the diagnosis.

Asperger’s is on the high end of the Autism spectrum and people with Asperger’s are often highly intelligent people. They often struggle with human interactions and communication, not being able to empathise with other people as easily as ‘neurotypical’ people. And this can cause problems in relationships and friendships … especially if either party is not aware of the possibility of Asperger’s. They can be very honest; telling things exactly as they are … which can be quite difficult to be on the receiving end of, if you’re not used to that level of brutal honesty. They are often very black & white in their thinking and are unable to see any shades of grey. They often have very high morals and standards and may find it difficult to appreciate that not everyone else lives up to their standards. They sometimes find intimacy difficult, although some people with Asperger’s can be extremely affectionate. They also often experience high levels of sensory awareness, which can make it difficult for them to cope in some situations. There are a whole host of traits linked to Asperger’s and, just like neurotypical people, every person with Asperger’s is unique and will have their own mix of traits and level to which they are impacted.

Quite often, those people with Asperger’s aren’t aware that they are experiencing it. It wasn’t fully recognised until the mid 1980’s and so a lot of adults today have grown up experiencing Asperger’s without it ever being recognised or diagnosed, as it increasingly is in childhood today. They’ve maybe had a sense of feeling ‘different’ or ‘apart’ from others, or maybe they’ve felt misunderstood, or have struggled to understand why other people have not understood them … these can all be common experiences of Asperger’s.

… and may be what initially brings the person with Asperger’s into counselling. This is where I think an awareness of Asperger’s is essential for counsellors, because someone with the syndrome may not necessarily be able to engage in counselling in the way that we would expect. As a counsellor, my research has made me even more aware of how I may need to adapt my communication and language patterns if I was working with someone with Asperger’s. And it may be that some clients who have proven difficult to work with, or who have struggled with the concept of counselling, may have had some level of Asperger’s. It’s certainly something which I bear in mind now.

Asperger’s is a neurological developmental disorder, which essentially means the individual’s brain works differently from those of us who are neurotypical. It is often confused as being a ‘mental illness’, which it very much isn’t. Therapy or medication will not ‘cure’ Asperger’s … it’s simply a description of how their brain works. Therapy can however, still be useful as a venue for the individual to explore their experiences in the same way as any other person.

I love the diversity of human beings, and for me, those with Asperger’s traits can be unique and interesting people … as can we all.