Reflections on RO DBT as an autistic therapist

I had the thought that publishing a post about my experience of autism anonymously might smuggle to the reader that being autistic is something to be ashamed of, or that autism is a taboo subject that should be always kept private. When I thought about the issue more, I realised that I’m comfortable disclosing my experience of autism openly in close cherished relationships, as well as to other open audiences, but not in circles outside of those groups. Disclosure is a hot topic in the autism community – over or under disclosure about an autism diagnosis can lead to social problems. RO ‘categorises’ relationships in terms of closeness. We are more likely to be open about personal matters to people that we have close intimate relationships with. While I am comfortable talking about my experience of autism to friends and family, as well as to the RO-DBT community I am less comfortable talking openly about it to a faceless audience. As such I’ve decided to post this anonymously.

A common source of distress in the autistic community surrounds the notion of camouflaging or masking behaviour. Simply put, masking is where autistic people behave neurotypically (often under intense pressure) to fit in with a society that is not attuned to their needs. Masking is evaluated negatively by some in the autism community, as it is seen as disingenuous, acting against a person’s true, autistic sense of self. When autistic people first learn about RO-DBT, they can sometimes believe that the treatment is shoehorning them to behave in an inauthentically neurotypical way, as so many behavioural interventions for autism have done in the past. As someone who has been given the diagnosis of autism personally, and who has been involved in RO for several years, I can offer a different perspective.

In RO, there is an explicit emphasis on social signalling. A social signal is any behaviour conducted in the presence of another person. Social signals are interpreted by those around us, often in complete isolation to the intention of the signal held by the sender, and have a great impact on the dynamics of a relationship. A sigh could be interpreted as a sign of boredom, a stare a signal of hostility, and a flat expressionless face, as an indication of disapproval. This was all news to me. My own social signals became apparent when I started my training in RO. Following suggestion from the trainer, I asked for feedback from those around me about my own social signalling. Over time, I learnt from people who spoke with enormous sensitivity, that yes sometimes I was difficult to read, may seem disapproving, disinterested, or even hostile, when this was not what I intended. The process in which feedback is sought and given is carefully considered in RO, and it has always felt safe, sometimes fun, if not a little surprising, disappointing, and/or challenging.

Consciously trying to work on social signalling (including eye contact, flat expressions, monotonic voice, amongst other social signals that would not be considered typically ‘social’), whilst uncomfortable and difficult, has had a profoundly positive impact upon my relationships, work life, and have brought about numerous spontaneous and unplanned opportunities that have transformed my life for the better. The level of discomfort I have felt in social interactions has reduced, and I don’t feel particularly uncomfortable when trying new social signals. This being said, I still have autism – RO is not a cure for autism, and it doesn’t claim to be. As such I tend to return to social signalling patterns of old when my own vulnerability factors are present or if I am interacting with people privately.

RO contains skills such as loving kindness meditation and concepts including “kindness first and foremost”, which have been enormously helpful during the moments in which I have run out of steam with regards to social signalling practice. I have learnt that trying new behaviours is a learning process that I don’t need to get right immediately, and that it is OK to not behave perfectly all of the time. Interestingly, simply trying, although never perfect, is received positively by almost everyone around me who tend to rally to me (without any condescension), even if they aren’t consciously thinking about my difficulties.

Although the practical benefits to working on social signalling are enormous, it is the later RO skills (such as DEEP, PROVES, ALLOWs, ROCKsON, and HEART) taught in class that are transformative and unique to RO-DBT, as they rely on trying to work out what exactly a person values, and how they want to be in relationships. In my experience, a decision to work on a social signal has ultimately come down to what my personal values are in the relationship, and whether or not I have a valued goal that outweighs the sensory discomfort that I might experience from trying a new behaviour. Usually I do, and when I act in a way that accords with that goal, it goes well. Others may have a different experience. One helpful thing I was told in supervision was that an individual who looked at everything and decided that they have a different valued goal to me, may reasonably decide to continue to engage in social signals such as avoiding eye contact, though that may come with the cost of being socially isolated.

If you are in doubt about RO, I would say that despite the potential friction you are experiencing, stick with it. I was completely unaware of the sorts of behaviours I engaged in, and the impact they had on my own life and of those around me. I found it very useful for my colleagues and those close to me to be open about my social signalling.  I never got any constructive feedback in my personal or professional life about the social signals I engaged in at any point in my life, until I started asking for feedback directly, and being given it sensitively. Receiving examples of adaptive/maladaptive social signalling in the training, the books, supervision and personally has been hugely instructive.

Feedback relating to my own social signalling, given in both supervision and elicited from my close cherished relationships, has always been delivered with kindness first and foremost. I believe that without it I would never have been able to know exactly how my social signalling was affecting my personal and professional life. Without feedback, direct training and instruction I don’t think I would have been able to figure this out on my own. So although it can be a challenge, I would encourage autistic people embarking on their journey in RO, or people working with other autistic people in RO, to follow the model as intended and resist the urge to adapt or change it too much. This process of providing feedback isn’t rushed in the training, or in the treatment more generally, and so while reading this blog post may be overstimulating for other autistic readers, it is worth remembering that the process I have been through has taken place over a number of years. I have never felt bombarded or overstimulated by the training or the therapy itself, which has to me, even as a trainee in the model, felt gentle and sensitive to my needs.

Everyone with autism is different. Some people might not respond as I have done and may benefit from a different approach. This being said, I feel passionate that other people with similar sorts of difficulties to my own should have the chance to have the experience that I have had. I have never had RO-DBT as a treatment, but since starting the training several years ago to be an RO therapist, it has completely changed my life for the better.

I could talk at length as to the personal changes that RO has been responsible for, but that is one of the things I am trying to work on, so I won’t! However, one recent experience which may help illustrate the power of RO, comes to mind.

During my RO training I became a father (twice!). One of the skills in RO involves exaggerating facial expressions and bodily gestures – a behaviour that in recent years would have been unthinkable for me to engage in. I decided to practice with my son, and was greeted with a broad smile – the first I had ever seen from him. It’s impossible to know if my son would have smiled as broadly or as rapidly in response to me without RO – though I can say with some certainty that I wouldn’t have engaged in much social signalling with him other than a flat expression, despite my attachment to him. What I do know however, is that in that moment, the effort I had put into the process was worthwhile. My son, at only a few months old, was not concerned about social constructivism, RO-DBT, masking, or whether I was being authentic or not –  his experience was of his dad smiling broadly (and making some extremely goofy noises) staring down at him with loving kindness.

My experience was simple, an image of a 3-month-old baby smiling authentically, a melodic sound of laughter spontaneously expressed, dark eyes staring upwards, eye contact strongly maintained, and above all – a sense of warmth, felt deeply and strongly in the centre of my chest.