Facilitated Mirroring: Building Perspective in Clients with Asperger Syndrome

Nan Gray Lester, M.S.

Brief Clinical Vignette

Anne is a 41 year-old unmarried woman with Asperger Syndrome, who is an undergraduate student studying Human Services. Although the university she attends is relatively large, the program is a smaller, cohort model that places tremendous emphasis on teamwork and respectful relationships among group members. Anne shared a story in group where the topic was “social confusion”. A recent class assignment in her school program required breaking up into self-organized groups to develop a project and make a presentation. Joining informally organized groups causes Anne a tremendous amount of anxiety, and she was not primed for the assignment, as it had not been indicated on the syllabus. The crowded, poorly lit and acoustically vibrant classroom, which had been a difficult environment for her all term, became even noisier and chaotic as people moved their chairs to connect into groups with their preferred classmates. Anne felt overwhelmed and disoriented. By the time she had mustered the courage to ask to join a team that included anyone she felt comfortable with, there was no space for her. She finally found a group to join, but she wasn’t familiar with any of the members. She was still dragging her chair across the room when the instructor began giving the directions.

From the beginning, Anne had difficulty understanding the instructions of the project. She was reluctant to ask for more information from the instructor, whom she perceived as “brusque.” The group decided not to meet again before the presentation, and to conduct all further communication by e-mail. Anne was too nervous to provide input on the decision, yet she felt terrified by its ramifications. All of the students in the group were much younger than Anne and very comfortable with technology; she had difficulty communicating by e-mail, because she was intimidated by the technology and unsure of her ability to communicate her ideas with clarity. The other students seemed impatient and even unwilling to help her; she felt intimidated.

On the day of the presentation her anxiety was high, but she had completed her portion of the work and felt good about its content. Shortly after beginning her presentation, she sensed a hushed and hostile silence around her. A member of her group called out to her in a voice loud enough for all to hear to “watch out for political correctness!” Anne turned to her, startled. She had heard this term repeatedly in her studies, but it had never been defined for her and she had never full grasped its meaning. At this point her mind went blank, and she panicked. The same group member came over and told her “don’t say negro!” while presenting her categorical statistics. Anne tried desperately to track where she was in the presentation, fighting her instinct to start from the beginning. She decided to pick up at the word that was apparently the issue, and tried the word “Black” this time in describing her statistics. Both Negro and Black had been acceptable terms where she grew up. Anne sensed a growing discomfort in the crowded room, but forced herself to complete her presentation. As soon as she finished, a member of her group stepped up to the podium and profusely apologized for Anne’s “offensive” remarks.

Anne was deeply humiliated and horrified, but had no idea of what was so offensive about what she said or done. She wanted to bolt from the room, but forced herself to go up to the group and ask what she had done wrong. They looked at her incredulously, and told her that the politically-correct terminology is “African-American!” Anne had thought this term referred to people who had recently migrated to the United States from Africa. At this point, the instructor came forward and said she wanted to meet with the whole group after class to discuss what had happened. At the very least, the instructor explained, the group needed to meet with the higher faculty and make a formal apology over e-mail to the entire cohort. In the end, none of this actually took place, as the incident occurred during the last days of the term. Anne never understood or felt closure about the incident.

Anne reported feeling extremely depressed and anxious after this experience. She had even seriously considered suicide. Her roommate talked her out of it, and, upon Anne’s request, supported Anne by accompanying her to the first class the following term. Anne was extremely nervous about facing her fellow students and the faculty upon her return to school. One of the African-American students who had taken the most offense approached her and they talked. Anne explained her limited understanding of “politically correct” terminology and apologized. They embraced, and even ended up going to lunch together. This meant a tremendous amount to Anne, even though she still didn’t fully understand everything that had occurred.

The group members had no difficulty using the Facilitated Mirroring process to relate to this incident. As a group they readily identified the Key III elements at play in Anne’s experience. In order to concisely illustrate their comprehension, I’ll focus on what, to a neurotypical observer, may seem to be a minute aspect of the incident, but to individuals with AS a functional nightmare within the context of the Key III. They understood how Anne felt when faced with the unstructured group selection process (executive function and social cognitive). In visceral terms, they deeply empathized with the process Anne went through as she dragged her chair across the noisy, crowded room to join the group (sensory overload) of students she didn’t know or feel comfortable with (social-cognitive). They described the panic she must have experienced as the instructor began giving the directions while Anne was still enroute across the noisy room (executive function, sensory). This seemingly trivial sequence of the larger story occurred within a matter of minutes, but the implications of the Key III for the individual with AS are glaring.

After providing a Key III assessment of the incident, including the group members’ perspective on Anne’s emotions, the group shared similar experiences. Anne’s confusion over the term “political correctness” and her misunderstanding of the African-American ethnic label offer an outstanding illustration of the ensuing social predicaments associated with adherence to literal meaning. Each client was able to attribute a similar experience including the emotional devastation that occurred as a result of their faux pas. The outcomes of these stories ranged from embarrassment, to social exclusion, to criminal arrest.

Suggestions for follow-up

Each session should end with a discussion of solution-focused strategies. In the above case, Anne was given much positive feedback for the support she sought from her roommate regarding her anxiety, depression and suicidal thoughts. It is advisable to check in with the individual after he or she relates the dominant story used in the Facilitated Mirroring process. It is my recommendation that this take place informally within the group at the close of the session, and be followed up by a private conversation with the individual. The individual may benefit from further processing of the incident discussed, or by a continued discussion about perspective building and self-regulation strategies.

Contraindications for Use

After starting my group, I found it necessary to develop a policy of inclusion based on client profile. As mentioned earlier, the prevalence of co-morbid psychiatric conditions is extremely high for individuals with Asperger Syndrome. I have experienced difficulty maintaining the focus of the group when it is being affected by individuals who are not following medical treatment for mood disorders. Another area of difficulty arises when including others who are lower functioning on the autism spectrum, or have pervasive developmental disabilities not otherwise specified (PDD-NOS). A lower level of cognitive function may interfere with the ability of such individuals to participate.

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