Clair Cholajda Psychology
Clair is a clinical psychologist with thirty-five years of experience, who works with couples where one or both partners have autistic traits, or a diagnosis of Autism Spectrum Disorder (ASD). She also works with average to high-functioning adults with autism and other neurodivergent conditions (Asperger’s, a term no longer used, referred to high functioning autism).
WHAT IS AUTISM
Autism is a much more complex condition than the criteria used for official diagnosis in DSM-5-TR (Diagnostic and Statistical Manual of Mental Disorders – 5-TR). It is a neurodevelopmental condition that affects how a person’s brain develops and functions. The estimate used to be that 1 in 100 people had autism, now the estimate is 1 in 40. Considering it is frequently missed or mis-diagnosed it is likely that the prevalence is higher.
Autism is difficult to diagnose – it includes a vast range of traits. Some people will have a few and others will have many. Possibly they will have none in common, some in common or many in common. There can be contradictory qualities in the same person, which can be confusing to others. The qualities can also be extreme. Autism can be a very positive condition that people feel privileged to have and it can come with great suffering. Neuro-affirmation is important, but this can result in overlooking an individual’s struggles.
The Gifts
Autism can come with extraordinary gifts – it is not uncommon for people with autism to be extremely gifted in music or maths. Elon Musk and Bill Gates are said to have autism. Qualities such as high IQ, loyalty, a strong sense of justice, honesty, determination, extreme empathy, generosity, the gift of acting or being a comedian, often fits the autistic profile. Intense interests can lead to useful discoveries that may not have been made without autism. They will often have a deep appreciation of nature and an affinity with animals. Autism has been described as being both challenging and wonderful, “autism is the lock and autism is the key.”
The Challenges
Autism can have challenges such as deficits with theory of the mind (not understanding that others may have different thoughts and emotions), sensory sensitivities, lack of empathy, a tendency to perceive slight when none was intended, ego-centricity, alexithymia (no words for feelings), a struggle to understand the subtleties of communication such as tone or sarcasm, intense discomfort in social situations that requires social chit chat, difficulties in “holding other in their mind” (eg. remembering a birthday or anniversary), intense interests and passions that may exclude others and deficits in executive functioning (difficulties with planning and organisation, working memory, cognitive flexibility, inhibition and emotional regulation).
The Risks
Autism can come with co-occurring conditions such as Attention Deficit Disorder with or without hyperactivity (ADD/ADHD), extreme anxiety, depression, bi-polar disorder, post-traumatic disorder, pervasive demand avoidance and can come with a range of physical conditions. Studies show that people with mental health disorders are at considerably higher risk for suicide than those in the general population. Studies also show very high rates of suicide amongst those with autism, but it is impossible to extrapolate whether this is purely due to autism or a combination of other mental health conditions.
Risk factors, especially in the younger adult population can be a sense of not belonging, feeling that, “they are from Mars”, are bullied and socially isolated.
It is important for them to be diagnosed so that they can know that they are part of a huge tribe who share these difficulties, and who can lead rich lives. Sometimes, meeting just one other person who feels the same, can be a great relief. Chloe Hayden said, regarding her book Different not Less, “This book is for any human who has thought for far too long that they’re living on a planet that was not created for them. It’s for those who are ready to discover that they are different, but not less.”
COUPLE THERAPY
With couples, one of the partners may have read an article or heard a podcast about autism, or one or several of their children have been diagnosed with ASD, (there is a strong hereditary component) and they seek help, feeling that at last, there could be an explanation for the complex difficulties in their relationship. In some instances, one partner has given the other partner an ultimatum – to attend therapy or divorce. They have often seen several couple therapists, who do not specialise in autism, without success.
In couple therapy, there is a considerable amount of psychoeducation in most sessions. It involves two people recognising that they may have different perspectives of the same thing.
This is an illustration that the Association for Autism and Neurodiversity, (AANE) USA, uses to show that one person may see a duck, another a bunny. Neither perspective is right or wrong, just different.
Therapy requires a collaborative process between the two partners to understand each other and work towards shared goals. At no point is it an opportunity for one person to “dump” on another. Sessions are tailored to be productive and to script in detail how a change can be made before the next session. Sometimes it can be the way one partner greets the other at the end of the day, or the wish for one partner to book a holiday. Sessions often involve a considerable amount of role playing so that the couple, each know exactly what to do, and what they can expect, to avoid disappointment.
Use of a diary to record significant events such as anniversaries, with many reminders is important, along with clarity about what would be pleasing to the person who is having the significant event. This way couples feel they are moving forward, making changes and enabling the relationship to function more effectively, but also with joy.
Here are a few examples of the types of difficulties couples may experience:
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feeling that the partner is not responsive and subjects of importance cannot be discussed.
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that the relationship feels empty and lonely.
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that the partner is unrecognisable at a party, becoming an extrovert, as if wearing a mask, and then goes home to sleep for hours, from the exhaustion of the social interaction.
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the partner presents obstacles to suggestions, like going on a holiday or doing a domestic chore.
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that the role of parenthood is misunderstood. The partner thinks of themself as a friend to their children.
INDIVIDUAL THERAPY
Individuals may seek therapy for a range of reasons – they are depressed and have extreme anxiety, their doctor has referred them, when one or several of their children have been diagnosed with autism, when they’ve read an article or heard a podcast that makes them wonder if they have autism or they cannot understand who they are and believe something is wrong with them. They may or may not have a formal diagnosis.
These are a few illustrations (not based on any single individual) about how therapy can work,
A client was at risk of losing her job as she was considered extremely rude to her work colleagues. In her mind, she believed she should only say what was needed and only tell the truth. Helping her to understand the concept of “social niceties” was difficult for her. She would say she didn’t care how someone’s holiday was or had no interest in a new baby, so why should she ask, as this would be a lie. With considerable role-playing and psycho-education, she gradually became a much more pleasant colleague and retained her job.
A young man was having difficulty living with his house-mates. One of his jobs was to do half of the vacuuming of the house. He would do exactly that – to vacuum 50% of the house, never offering to help his house-mate out by doing more. With psychoeducation he understood that due to his rigidity and sense of justice, he followed a 50:50 rule which was not always helpful and it would be fine, if at times, he did more or even offered to vacuum the whole house. He found this elucidating and said that in fact, he didn’t mind doing more of the vacuuming. He had just been guided by his rule and thought that this was the only option.
A young autistic university student with some executive function deficits had difficulty organising her life. She was untidy and was seldom on time because she couldn’t find what she needed. She was late handing in assignments and struggled to plan her life. She felt overwhelmed and anxious,and was described as “chaotic” by her family. Again, psychoeducation and planning strategies made a significant difference to her life. The use of Mindfulness-integrated Cognitive Therapy (MiCBT) helped reduce her anxiety significantly. It seemed as though a contributing factor to her executive functioning deficits was ADD, so she was referred to a psychiatrist, who confirmed this and prescribed stimulant medication, which was of enormous benefit.
It is important for a person who is struggling, to get the help that is needed from someone who has a special interest in autism. When clients are diagnosed late in life, they can have a sense of loss over past years where they were given multiple diagnoses, none of which were helpful. An accurate diagnosis can be life changing, resulting in a sense that their lives can truly begin.
ABOUT CLAIR
B.A. Hons; M.A., (Clinical Psychologist)
Clair is registered with the Australian Health Practitioner Regulation Agency (AHPRA) and the Australian College of Clinical Psychologists (ACPA).
Clair grew up in southern Africa and qualified as a clinical psychologist at the University of Natal. She went on to do further study at the Tavistock Clinic and the Institute of Family Therapy in London. She has completed Training 101 in Couple Therapy through the (AANE) USA, and meets with them regularly via zoom.
Clair has worked in a wide range of settings, including mental health care centres, GP practices, acute and chronic wards in psychiatric hospitals, general hospitals, and outpatient centres on three different continents. For the past twenty years, Clair has had a special interest in neurodivergence, especially therapy for individuals with Autism Spectrum Disorder and couple therapy, where one of both partners have ASD.
Solution Focused Therapy, Acceptance and Commitment Therapy (ACT) and Mindfulness-integrated Cognitive Therapy (MiCBT) are the predominant modalities she uses. MiCBT is especially effective for extreme anxiety which is a common symptom in ASD.
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