Philosophies and Therapy Approaches

If there is one single thing I wish I had known a lot sooner, it is this: there are wildly divergent philosophies regarding autism therapy.

Really, I had no idea.

Very broadly speaking, I have encountered two different approaches. The first view is that neurodiverse people are broken and need to be fixed, and to be trained using whatever means necessary to be "normal". The second, diametrically opposite ideology seeks to understand and appreciate the underlying differences of neurodiverse brains, and to help us understand and work with, not against, ourselves.

The first ideology could be labeled as conventional, traditional, behaviourism-based, or compliance-based. The most common example used to illustrate this approach is Applied Behaviour Analysis (ABA) therapy. ABA therapy undeniably has a dark history and I have no doubt that forms of it are traumatic, and even that does not seem like strong enough of a word. I frequently use the phrase "non-ABA practising" to convey the type of support and environments we are seeking.

However, I am going to shy away from that terminology here. My knowledge of therapy modalities is limited (I am just an orangutan, after all). I am vaguely aware that ABA is a very broad categorization, autism is a very broad spectrum, and I have heard claims that there are some forms of modern, respectful ABA therapy that are helpful to some. I am not going to pass judgment on that. Moreover, I struggle to label the worst of the compliance-based approaches that have been pushed on us at points as ABA therapy, for the simple reason that they weren't any sort of therapy at all, in any sense of the word. They were not part of any sort of structured plan supported by any sort of therapist. They were simply abandonment and abuse. So, I will tend to refer to these sorts of strategies as compliance-based instead.

The second approach is what, to me, defines a neurodiverse-affirming ideology. One of the most comprehensive websites I've encountered that lays out the ND-affirming philosophy is https://therapistndc.org/neurodiversity-affirming-therapy/ . Every time I peruse this website, I find another piece of validation of our experiences or have another epiphany. It feels like a call to arms, solidarity, a revolution ahead, hope for a better world. Heady stuff!

Why ND-Affirming Therapy Instead of Compliance-Based Therapy?

Alright, but why? Why exactly do I feel so strongly about this? Simply put, compliance-based approaches were, for us, ineffective and counterproductive at best, and traumatizing at worst. Unfortnately and, to me, inexplicably, we enountered compliance-based methods most often in a pediatric crisis care setting, where they were particularly and horrifyingly damaging.

Here are a just few reasons (and I'm sure I'll have more to say on the subject in the future). Compliance-based approaches:

• Do not address root causes.

• Encourage masking, which is known to fuel mental health struggles in autistic people.

• Push the individual to disregard their own feelings and needs, and only focus on what some authority figure wants. To me, this seems to invite abuse, which autistic females are already very prone to in their relationships. It is also the exact opposite of how a person with alexithymia needs to be supported. We need to learn to intercept and experience our feelings, not ignore them even more.

• Reinforce selective mutism (the type that is driven by anxiety and distrust). Why talk when nobody will care about helping you meet your needs anyway?

• Drive other expressions of distress. Compliance for compliance's sake only creates more distress, which then manifests in ways such as self-harm in its many various forms.

Compliance-based strategies come in many forms, from the outright abusive (e.g., involving the withholding of basic physical needs, and unsupported exposure therapy) to more gentle and supported. The latter seem superficially to be more palatable, but, qualitatively, they are no different.

Moreover, behaviourism has never actually worked for any member of our orangutan buffoonery,* indeed not even for our family dog. Perhaps we are a particularly self-possessed lot, who can't be swayed from running away on adventures or trying to eat little dogs by promises of liver treats or the like. Instead, we are a freedom-within-only-the-necessary-bounds family that relies on walking side-by-side with each other (quite literally on a leash in this example) and creative solutions (joyfully exhausting runs with a local athlete on the other end of the leash was one) that meet our needs and honour our individual way of doing things.

Oranguette, I am deeply sorry I did not understand this sooner.

* Dear Reader, I kid you not. The collective noun for a group of orangutans is indeed a "buffoonery", or so says the internet. I did not know this until I wrote this post. It is the most wonderfully apt tidbit I've discovered in a while.