Motley crew #1: Change that you and I don't understand

I see a 17-year-old Asperger’s Syndrome client who is very “high-functioning,” or at least high cerebral and high talky. He wants to work in nanotechnology or nanobiochemistry or some-such as his profession. He is unflappable: generally blinkless calm. I told him he must be on the alert when digging into these tiniest of quiddities. He might run into God, who can only be the smallest – the irreducible kernel of existence – not the largest. Nothing I’ve said, so far, to this young man has caused him to raise an eyebrow, skip a beat. It’s possible he knows everything.

“Watch out for Pee-wee!” No reaction.

There’s the thirty-three-year-old who needs to get a “drug assessment” several weeks out of prison. He is a lucky man to have elderly parents’ support, full family support. By a fortuitous network, he was offered a great job and career that most felons would never get. He’s clean and wants no more trouble in this new phase of his life. Question: Should I inform him that he has Antisocial Personality Disorder? That would kind of call his bluff and say “reliable future failure.” He might not like me after that.

And a different teen Asperger’s who, we have discovered, also has a full-fledged splitting “I hate you, don’t leave me” personality disorder. His autism “spectrum” kills access to a feeling place that might contain the seeds of solace – an eye within his hurricane. Some Borderlines can take their foundational childishness and, by desire and access to this eye, grow a fake decent adult upon it. I can’t see how he will ever do this.

And finally, the poor woman who, growing up, was forced by both parents to be so selfless and everyone else-centered that now, a debilitating flush of shame can prevent her from meaning, and saying, the word “I.” (I have asked her to read Ayn Rand’s novelette Anthem about a society so suppressive and collectivist that the word “I” is lost history and each person refers to him- or herself as “we.”) It took me two months (to my shame) to realize that she is not letting her feelings stir and move, to be discovered and worked with in sessions, but just sits and waits for my word.

Our work, as therapists, cannot fundamentally be to get people to “think healthy,” not fundamentally to introduce them to the “strength” that they should have, not even to have them cry their deep hurt. There are intermediate steps, pause points of mini-crises, startling truth, where they are presented with change, meaning not being themselves. How we work this must be idiosyncratic, must make the difference between individual therapists that has absolutely nothing to do with this or that therapy paradigm – cognitive, existential, behavioral, EFT, primal-related feeling-centered. How do we help someone not be herself, her original flawed structure? Become a major sea change of outlook, of internal feeling engine? If we see the client through these eyes, we will realize, with some deflation, that a few good insights or catharses are not this change. She will come back the next week the same, and the week after. And sometimes the month after, she may be her worst.

I don’t have the answer to this question, except that sometimes I have seen this change from one week to the next. Yet for no good reason, I suspect that mostly it’s going to be internal growth post-therapy. The stuff, the atmosphere in our room, and maybe in our peculiar personality, have given them the partially cooked seeds of evolution.