What can I expect from Therapy?

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So, I just completed my first session of therapy, with a new Psychologist. I chose her, because she supposedly has experience working with people on the spectrum. She doesn’t specialize in this (to the exclusion of other patients), but she does have expertise. Her dissertation was in Autism.

Anyhow, I prepared for the session, by printing out a bunch of stuff that I thought could be relevant including:
- A 3-page document I wrote last year describing why I was seeking a diagnosis
- A 33-page document I wrote last year describing "stuff" that seemed to represent my symptoms of Aspergers
- A 6 page intake questionnaire, that I completed before getting my Aspergers diagnosis
- A 20 page diagnosis report, completed by the Psychologist who diagnosed me

My goals of seeing someone was (in order of priority):
#1. I wanted a second opinion on the original diagnosis
#2. I wanted to figure out how to better deal with anxiety and occasional depression
#3. I wanted to figure out to cope better, the next time I am out of work (which will probably happen within the next 4-9 months)
#4. I wanted to figure out how to make my life with my wife, daughters better

I had mentioned these goals to her, in a telephone call, prior to our first session.

During the 45 minute session, I gave her the full run-down of things. Well, honestly, how much can you cover in 45 minutes? But we did cover a lot. Everything from therapy history to childhood difficulties to work difficulties...

Near the end she indicated that she wasn’t that interested in providing a second opinion on the diagnosis. I think she said that that wasn’t that important. She asked me why having a label was so important.

Instead, she wanted to work on relationships. I pretty much said, I wasn’t interested in doing that. That I didn’t have that many relationships. She replied, that she wanted to focus on improving my relationship with my wife and kids. That anyone, even someone with Aspergers could improve their relationships if they are motivated to do so. Interestingly, up until that point in time, I had spent VERY little time talking about my family. Mostly, I talked about other stuff.

I am now wondering if this is all simply a waste of my time/money. That this person is not going to help me (with my top 3 goals).

Am I approaching this wrong?

Why is a second opinion so important to you? You already have a first opinion with a 20-page diagnostic report by a psychologist. Now, it's time to move on from the label and focus on the other three things on your list, which include improving your relationships with your family members.

btbnnyr - Thanks for your reply. So, I am not 100% certain why. But, it has been bugging me since I was first diagnosed. There are probably several driving factors:

- I am skeptical by nature. Usually, I do not like relying on any one person's opinion.
- Several family members (who are Doctor's in the mental health profession) have expressed surprise with the diagnosis and suggested second opinions.
- I am married, have 2 kids and have held a job (well, 15 of them, but who is counting) over 25 years.
- I don't experience the intense sensory issues that some people talk about on WP. I do have them, but not at the same level of severity.



That item (improving relationships), is at the bottom of my list (of concerns). As my relationship with my family members, while not fantastic is not awful. In other words, it could be improved, but it is not THAT bad.

I am almost thinking that the Psychologist skipped to #4 (the relationship thing) because she couldn't help me with the others.

So you just want to be more sure that you are on the spectrum? What if you get a second opinion in favor of the first opinion? You will still be married with kids and jobs, lack intense sensory issues, and other people will probably still be surprised that you are diagnosed with ASD.

You pritty much just diagnosed yourself. Someone else did too. Place those reports in a box, so you can read them in the very late future for recapitulation practices. If you gave them away, they may not be read. They are important to you, so you should keep them. I would guess that she believes you need to socialize more. If you talked for 40 minutes, and did not mention your family, that would be a good enough indication right there. Besides, it is on your list. If you know what you want to do, go after it. Involve yourself. Learn more. You are fortunate to have a loving family. As far as the short term employment goes. Pritty normal. average now days is under 5 years. It is not just you. If I had a family of my own, or a girlfriend/wife, and a job I could keep for more than three not so good years, maybe I could be more help. To myself as well.

That's a good question. The other equally good question would be, what if I get a second opinion that differs from the first opinion. You are probably right, that I am obsessing over nothing.



Yeah - I have already learned that lesson. I have no plans of sharing the diagnosis with others I know (as there simply is no benefit of doing so).

Thank you so much for your comments, they were quite helpful!

yournamehere - Thanks for your reply.



I suppose, after thinking about it, it is a bit odd that I didn't talk about my family. Probably because it's at the bottom of my list of concerns. By that, I mean, things are alright in that area (at least from my perspective).



This is true. I mentioned that I really don't desire to do that anymore. I did when I was younger. But now, I think that the effort isn't worth the benefit.

You are right, though. If this therapist can't help you sort out the bits about anxiety and depression, it will be a waste of your money and time.

I'm currently seeing a new therapist. He asked me what was my issues. I told him anxiety, depression and PTSD. He said okay. Those will be the things he'll focus on. #1? Depression.

Just food for thought...but have you considered that maybe she feels that your other struggles such as depression may be rooted in troubled relationships (or lack thereof)? Maybe she is just family or relationship focused and thinks, even though you are not concerned about them, that addressing and improving them will help you overall. I could be wrong but just an idea.

This is my opinion. I can't jump into the psychotherapist's head. With that being said, I think she jumped to #4 because that is the only problem she can work with you on right now.

She skipped over #1 because, on a practical level, there it doesn't make much difference either way. If you don't have AS, you still have whatever symptoms that made you think you might have AS. If you do have AS, there is nothing she can do about it. It is a neurological problem, like ADHD. She can't rewire your brain.

Anxiety and depression are extremely common as far as things that people seek therapy for, and the treatments are pretty standard. It would be comparable to going to a doctor for the flu. I'm sure she knows how to deal with anxiety and depression.

Anxiety and depression do not exist in a vacuum. They are connected to specific life events. We worry about specific situations. We obsess about specific negative things. Furthermore, we have to deal with anxiety and depression while living in specific life situations. In the mind of a therapist, your anxiety, depression, and current life situation are inseparable. The therapist's goal, in your case, is to help you deal with whatever life situation you are currently in without being too negatively affected by anxiety or depression or the specific AS-symptoms you suffer from.

Out of the two things you mentioned that can cause anxiety or depression (unemployment and family relationships), the relationships thing is the thing that would seem most pressing to a therapist because it is going on right now, so that is the thing she wants to start with. She will work with you on how to cope with employment problems when they occur. The AS symptoms are going to be a part of the picture no matter what situation you find yourself in so she will keep that in mind at all times.

Perhaps talk to her some more the next time you see her about what you see as the major problem right now. If your primary concern is getting a second opinion about your AS diagnosis, she can probably help you with that. She can refer you to somebody who does assessments. The assessment is a one-time event, no psychotherapy needed. (You won't get another AS diagnosis though. AS doesn't exist anymore in the US. They lumped everything together into Autism Spectrum Disorder).

If employment is a bigger issue for you than family relationships, tell her you want to focus on employment. I'm guessing she is on the same page as you when it comes to relationships. She is just going to focus on the relationships with your wife and daughters. I don't think she will try to do social skills training or treat you for social anxiety. If she does, tell her you are not interested and find someone else.

banana247 - You may be onto something. During the session, we talked about the nature of friendship. I told her that I have a couple of people I consider friends. One person I have been friends with since I was 5. We hang out together. However, she then suggested a definition of friendship. Where friendship was more than simply hanging out with someone and doing something together (such as playing cards). That when friends get together, they share personal things like worries, fears, concerns, successes, etc. I cannot recall everything she said. But, I do know this is not something my "friends" frequently share with me. And, I seldom share it with them. And, I told her that. I explained to her that the only person I talk about that type of stuff with is my wife.

So, you are probably correct. That she sees my problems rooted in troubled relationships. Perhaps she will start with the immediate family and then branch out.

Though, now I am wondering if she is simply trying to impose neurotypical standards on me. And, maybe, just maybe I just wasn't wired to have close relationships with other human beings.

em_tsuj – Thanks for the reply. What you say makes a lot of sense.

It’s funny (well, not that funny). I have a history of anxiety and worry. From when I was small. My anxiety and worry seem more tied to simply being rather than a specific “life situation”. Essentially, I pretty much always worry. There are some benefits of this. As the worry drives me to action. The issue is that the worry is exhausting, as it is a constant low-grade worry.



It was odd that she wanted to focus on the relationship thing. As it’s the one thing that is not causing anxiety or depression (at least that I am aware of). Well, check that. I do have some worries about my daughters. I have one in college. I worry about whether she will do well in school. I worry about whether she is adjusting well. I have another in high school. I worry about whether she will do well on her college entrance exams. I worry about whether she will get into college that she wants to. But…these worries are not related to my relationship with them. And, I had not mentioned them during our session. Rather, it is one of “life’s things” that I worry about. I suspect things will end up well (as they usually do). And, then I will find something new to worry about. Unfortunately, this worry thing has been a pattern in my life.



That makes sense to me. Thanks again.

My mother seems to have this constant low grade worry. She is always finding something to worry about. She thinks that in eberry parking garage, there are several people on each floor waiting to murder me when I walk to my car, and constantly warns me about not parking in the parking garage at night.

Maybe the second opinion is part of your constant worrying. I seem to recall you starting a thread in which you outline your diagnostic process, and it seemed quite thorough.

You should tell her what you told us....that you are skeptical and want to be sure. She may be doing you a favor as if she sees no reason to disagree with the first Dx as she'd have to do a whole new workup to give a proper 2nd opinion. A medical doctor doesn't just take your lab results from the first doctor to give a second opinion. They should run their own tests...that takes time and costs YOU (and your insurance company) money. You could make it easier for her if you could ask her opinion on if she felt the evaluation done by the first doctor is spot on or if she has reason to disagree with it. Then, she's just reviewing the first doctor's evaluation for possible flaws/oversights.

When I needed teeth pulled. The oral surgeon I went to had two people look at me. One wanted to pull the secondary molars and let my wisdom teeth come forward to replace them. The other wanted to surgically remove the forming wisdom teeth. Removing the secondary molars was straightforward and easier to do, but if the wisdom teeth didn't come in right, it could be a complication. Removing the wisdom teeth before they fully formed was more work with more recovery, but no chance of complications because the teeth didn't shift forward as planned. Two docs...two opinions on how to approach a problem.



To some degree, she is correct. You probably DO need to work on it, but it should not be a higher priority that your concerns over your coping skills.

In therapy, YOU are supposed to be in control. She should respect that. Be open to working on social skills, but insist that she focus on helping you on areas you believe are more important. If she keeps shifting away from what you feel you need without a good reason, she's not listening to you.

I don't know anyone who will stick with a doctor that doesn't listen to their patients.

It is really disturbing to me that she said that.

Yes it's true as others said, that you will be treating the same symptoms no matter what the label is, BUT the approach you take to understand and treat those symptoms may vary quite a bit depending on the diagnosis. If she does not think it would make any difference, that most likely means that she plans to treat any symptoms you present with in the same way, regardless of what condition you may have. I think that is a mistake. If you actually had another condition, the approach might need to be different.

Of course it is important to have the right diagnosis! If therapists only treated "symptoms" and treated all symptoms the same way there would be no need for any labels at all. There would be no need to diagnose anything. The diagnosis is important because it changes the approach for treatment. Duh! What is she thinking? This is so absurd to me it makes me angry on your behalf.

Even if she is certain that your diagnosis is correct - which she shouldn't be sure of after only seeing you ONCE - she should explain that to you and address whatever questions or doubts you have about it.

This also throws up a red flag to me: "That anyone, even someone with Aspergers could improve their relationships if they are motivated to do so." Even someone with Aspergers? if they are motivated to do so? It sounds almost like she has already made some kind of judgment on you, that you should be more motivated.

A first session should establish pretty clearly what you are going to work on together, and whether or not you feel comfortable enough with the therapist to continue. It should NOT leave a lot of doubts in your mind as to whether you will be wasting your time/money. Having some doubts and hesitations would be normal, but not to the extent of thinking that it will be a complete waste and she won't help you at all.

How did it go at the end? Did she outline a plan on how she wanted to proceed? Did you she ask what YOU think about her suggestions and how you feel about proceeding? Did you get all your questions answered? Did the two of you settle things at all?

To me it sounds like, at the very least, she did not communicate very well with you, if she left you with the impression that she is not going to help you with your primary concerns. Even if she somehow miscommunicated, and/or you somehow misinterpreted things, that does not bode well for future visits. Even if she does actually has some good ideas about how to treat you, she did not convey that to you very clearly.

At worst, it sounds like she has a dismissive attitude. You told her exactly what you are looking for and what you want to work on, and she redirected you to something that is a lesser priority. Also I don't think it is valid to assume that improving your relationships is going to help with your anxiety and depression. It is more likely the other way around, your relationships will improve as a by-product of treating your anxiety and depression and coping better with being out of work.

btbnnyr - Thanks for the reply.

My constant low grade worry is not that severe (i.e. I don't worry about things that have a VERY low probability of occurrence).

Sometimes my worry is related to sensory things. For example, I hate when my clothes are near their end of life as it's difficult to find things that are comfortable. So, I worry and stress until I find a replacement. This may take multiple trips to the store over multiple weeks. It may include multiple purchases, returns and more purchases. To, say, find a single pair of pants. So, I worry.

Sometimes it is related to my lack of social connections. For example, I know when my current contract expires that finding a new one will be very difficult as I am not good at networking or selling myself (I have this bad habit of being overly honest). So, I worry.

Sometimes, I just worry about the next thing that will likely happen. In any event, I always have something to worry about.



It was thorough (and, thanks for remembering my prior post).

I suppose I have a general distrust of people. At least, that is what my wife says. And, it is certainly true.

As an example, whenever we have something done on the house (such as replacing the fence or installing a drainage system or fixing a major plumbing problem - which isn't that frequently) I usually have multiple people (sometimes 4 or 5) come out to give their opinions. Because, I suppose, I lack confidence in my ability to judge whether or not they are bull-sh*tting me.

So, I always seek a second opinion. Just to be certain. I suppose it's part of my obsessive nature. Sigh.