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Facilitated Mirroring: Building Perspective in Clients with Asperger Syndrome

Nan Gray Lester, M.S.

Introduction

Odd, quirky, uniquely intelligent…rigid, “difficult” and terminally uncomfortable in their own skin; these are some of the adjectives routinely used in describing individuals with Asperger Syndrome (AS). In my experience as an advocate, university educator, psychological consultant, and parent of a child with Asperger Syndrome, a clear understanding of this emerging diagnosis is best realized when one makes a personal connection to someone they have known. When lecturing on the subject, I often begin with a painful description of “that kid from school,” the weirdo with no friends, who tripped over his own feet, wore the same ill-fitting clothes day after day, and seemed to connect only with the science teacher. Unstructured times such as recess, lunch and study hall proved a social nightmare for this poor soul, while his attempts to make social connections often involved inappropriate bursts into the conversations of others, only to be met with odd stares and fits of giggles. The opening of his locker promised an avalanche of homework that had been brilliantly completed but never turned in. His annoying, even repulsive, habits ran the gamut from jiggling knees, endless rocking and knuckle-crunching to chewing the sleeves of his well-worn shirt into sopping shreds. My description never fails to bring flickers of recognition in the eyes of my audience members, which is why I resort to such obvious generalizations. My next question is what became of this child? Did he or she find a way to channel their talents into a meaningful career? What about relationships?

Given that one in 250 to 500 people meet the diagnostic criteria for Asperger Syndrome (Myles, 2000), you most likely have encountered clients affected by AS in your clinical practice. Given the genetic predisposition for developing the disorder (Volkmar, 2000), it is highly likely that your work with this client most likely will involve multiple family members within his or her family system who meet the criteria for AS, or were raised by, or with, someone on the spectrum.

The brevity of the format given here does not allow for an extensive clinical overview of this perplexing Pervasive Developmental Disability. Nor does it allow me to reflect anecdotally on the many reasons why I love working with children and adults affected by Asperger Syndrome: the talent, intelligence, humor, sensitivity, honesty, loyalty, insightfulness…the list goes on. Within this brief framework, my goal is to describe a method of working with this population that I have found to be effective in building self-awareness and positive relationships. Over the past two years, I have developed the intradiagnostic-intergenerational peer mentoring model, and since then have successfully implemented it in a group therapy setting.

Objective

Functional perspective of self and others is often the greatest barrier to success for individuals affected by Asperger Syndrome. Facilitated Mirroring is a method of building self-awareness through a triangulated process involving others with AS and a neurotypical translator (the therapist). It is a systematic, literal breakdown of life experiences as described by one individual with Asperger Syndrome, and, in turn, reflected upon by others with AS. It is the therapist’s role to contain and facilitate the mirroring process, and to provide the framework for teaching self-awareness and self-regulation through a contextual understanding of the diagnosis. It is a rigorous exercise for the client(s) that combines a visceral experience with an intellectual one. Ideally, this merges the disjointed perceptions, reactivity, and literal adherence associated with AS into a revelatory and empowering process that is aided by others with the same challenges.

Rationale for Use

Traditional psychotherapy techniques are generally ineffective for individuals with AS. There are many reasons for this, and I have included books in my bibliography that go into much greater detail, particularly with regard to Theory of Mind. However, I have observed that traditional therapies fail on two levels: 1) a lack of understanding on the part of the clinician regarding the complexities of the diagnosis, and 2) a failure to adhere to literal meaning in all things said and done, no matter how trivial they may seem.

Before describing the Facilitated Mirroring process, there are two misconceptions regarding AS that I feel must be addressed. Unfortunately, the first is also a current descriptive within DSM IV-TR diagnostic criteria. The idea that individuals affected by AS lack empathy is semantically inappropriate. At best, a lack of empathy can be described as a casual disregard for the feelings of others or, at its most extreme, descriptive of sociopathology. What people with Asperger Syndrome lack is perspective, not empathy. Perspective is defined as having a mental view of aspects of a subject as they relate to one another, an understanding of the relative importance of things. This distinction will become more apparent as I explain the Facilitated Mirroring intervention technique and how it relates specifically to the hallmark features of Asperger Syndrome.

Secondly, Asperger Syndrome is not mild autism. There is nothing mild about having a Pervasive Developmental Disability with lifespan implications. Over the course of my work, I have witnessed tremendous strides in childhood diagnosis and corresponding educational and psychosocial services regarding Asperger Syndrome. However, my current focus has turned toward adults, the majority of whom have never received educational or social support services of any type. In fact, obtaining a diagnosis is highly problematic for adults, with services all but non-existent for a condition that is still considered a “childhood disorder” and therefore confined to pediatric and behavioral/developmental domains. Adding further complexity to the diagnostic picture is the prevalence of co-morbid psychiatric conditions. It is estimated that upward to 60% of individuals with AS meet the criteria for other Axis I diagnoses (Myles, 2002), including anxiety, depression, ADHD, bipolar disorder, and, to a lesser degree, schizophrenia. I continually speculate with my adult clients as to the origin of these co-morbid conditions. Perhaps they are symptomatic of living life as an undiagnosed autistic, with all of the residual trauma that implies.

The most important aspect of Facilitated Mirroring is the inclusion of more than one individual with AS in the process. Authentic validation of the difficulties that one encounters living with Asperger Syndrome is a core rationale for the use of Facilitated Mirroring. The difficulties of coping with what I refer to as the “Key Three” (Key III) deficits defining the disorder–Executive Function, Sensory Integration, and Social-Cognitive–are most effectively validated by another person with the same functional challenges.

The analogy to any support group model is obvious; however, as with “all things Aspergers” the process is more complex. The desired outcome here is building perspective of self and others while developing an understanding of the how the disorder affects one’s behavior and how one is perceived by others. The role of the facilitator is crucial, but not central, to the process. The model of Facilitated Mirroring is that of an inverted triangle, with the neurotypical facilitator (you) at the bottom (see Figure 1). Part of the experience for the client(s) is that they outnumber the neurotypicals in the equation, for perhaps the first time in their lives. My clients report that this is deeply liberating.

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