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Using ACT in Thailand

I recently came back from a trip to Thailand where I was providing information to staff at an orphanage/school on how to be trauma informed. I have done international volunteer work in the past and have learned what to do and what not to do. Volunteer trips where you are focused on just hanging out in an orphanage or teaching English for three months in an orphanage can actually be harmful for them. People (and I used to) often go into these experiences thinking that just because they are showing love or having fun, the child is benefiting. What we are actually doing is showing love, but then taking it away again. Ultimately, we are abandoning children who have already experienced being abandoned.

Unfortunately, I have done many volunteering trips the wrong way. I know more now, so I am trying to do better. When I went to Thailand, the focus was not on simply playing games and having fun with the individuals in the orphanage, it was about training staff. The best way to help the children in the orphanage was to train the people that will be their constant caregivers. The Foundation for Children is an organization that cares for children (from birth to age 18) who have been abandoned or whose parents can’t take care of them. Because these children have been through trauma (even if they hadn’t been severely neglected or abused, a simple disruption in caregiving can be traumatic), we thought it was important for staff to be trauma informed. However, before we started, I thought it was important to figure out the staff’s motivation for working at the orphanage. What brought them there? What was important to them? What was hard about what they did? How did they cope? I did this using an ACT Matrix.

The ACT Matrix is a concept that was developed by Kevin Polk, Mark Webster and Jarold Hambright. We start by drawing a horizontal line and labeling the left side “away” and right side “towards”. We talk about how people are always moving either towards things or away from things. What you move away from and what you move towards is very individual, it will be different for each person. But the underly premise is “Are you living a life where you are focusing on moving away from unpleasant things, or are you living a life where you are moving toward what is important to you”.

It was amazing to see how people responded to this exercise. Some said that this exercise helped them clarify what was important to them. It is easy to get caught up in doing rote activities and being able to get in touch with your values can be very freeing and therapeutic. It was also good to see what things staff were moving away from, because this helped me see what ways I could support them. I wanted to make sure I wasn’t assuming what their needs were. The ACT Matrix helped me see what was important to staff and what staff valued. It also helped me see what was difficult for staff and what was making their job hard. Both of these things gave valuable insight into how to start teaching the staff about being trauma informed.

Stay tuned for Part 2 where I find out how Thai people are doing it right!

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Social Belonging and Social Media

How the need for social belonging can cause teens to engage in unsafe behaviors.

I have been leading some groups that teach social media safety skills to neurodivergent teens. (If you are interested in these groups go to the “Online Groups” page). At the beginning of groups individuals did not know what types of red flags to look for that would indicate someone was a predator. For instance, they were unaware that someone asking to talk with you on a more private social media platform was suspect or that someone giving you a gift online could indicate someone had malicious motives. Additionally, many neurodivergent participants were not aware that people lie online and they weren’t sure why someone would lie online. However, at the end of the groups individuals were able to identify red flags to look out for and were able to identify why people might lie online. Both of these skills will increase their ability to stay safe as they navigate social media.

Because of this I’ve been doing a lot of research in this area. I recently read a fantastic book by Emily Weinstein and Carrie James called, “Behind Their Screens: What Teens are Facing (And Adults Are Missing)” that goes over the research behind social media safety. The thing that I love about the book is that it looks at the research from the lense of a teenager. Teens were interviewed for this book and so the information is very pertinent to them. Adults (and I include myself in this) think that teens don’t know the dangers of social media, when in actuality many of them do. The thing is, teens are more susceptible to “peer validation and to the pain of feeling rejected or excluded” (E. Weinstein and C. James, p. 24). This means that they are more likely to do things that (even dangerous things) to get peer validation and belonging. What this means is that when we are looking at teaching social media safety skills we can’t just tell teens all the dangers that will happen. We need to address potential social isolation. This is especially important for neurodivergent individuals who already have a hard time finding belonging.

So, how do we do this?

  1. Virtual spaces aren’t always bad and we can find ones that are safe. I like the ones below.
  2. Look for places that correlate with your teens niche. If they are into Dungeons and Dragons, can you find a local group that does similar things? Are there specific groups at school/community that are neurodivergent affirming.
  3. Sometimes teens will find more connection in groups that are made of mostly of people who are neurodivergent. This doesn’t mean they can’t have neurotypical friends, but the research says that neurotypical people are not often as understanding/accepting of neurodivergent individuals.
  4. Model self-compassion. It is natural for us to think that we are not good enough. And this can happen even more if you are relying on the opinions of others to validate your self-worth. There are a lot of wonderful self-compassion exercises, but one of my favorites is the idea of “common humanity”. Often, when we feel lonely we caught up in how we are the only ones that feel that way. But loneliness is something that everyone feels. There are people right now who feel lonely, just like you. Knowing that you aren’t the only one working through these difficult feelings can make them easier to feel.
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Are their Pros to Sexting and What Teens Say They Want to Learn About Social Media Safety

I’ve been doing a lot of reading about teaching social media safety skills. I have some online groups coming up and I want to make sure I am addressing the real issue. I hate to say this cause I think it speaks to my age, but I need to educate myself in the CURRENT research and CURRENT views around sexting. The way that adults/parents view sexting is different from the way teens view it.

A study in 2016, “Sexting: Adolescent’s perceptions of the application used for, motives for, and consequences of sexting” (J. Ouytsel, E. Gool, et al.) in the Journal of Youth Studies found that sexting is actually a quite normal behavior for teens and should be seen as an activity that aids in their development. Sexting was used in romantic relationships to increase connection, to flirt or to experience sexual activity without actually engaging in physical sex.

According to “What Do We Know About Sexting, and When Did We Know it?” by Elizabeth Englander in the Journal of Adolescent Health, “sexting is not [always] strongly correlated with high-risk sexual behavior or poor self-image”. Now it can be, but often times these negative results comes when someone was coerced into sexting or harassed into sexting. Additionally, negative outcomes were more likely to be reported by pre-teens instead of older teens. Oftentimes, the stories we hear are the negative ones and so those are the ones that we pass along and use to scare teens. However, a study in 2018 interviewed teens and found that teens claimed that sexting also led to “enhanced self-confidence, positive self-image, and the strengthening of a romantic relationship”.

I am not saying that sexting is good or bad. But I think when teaching about how to be safe online, using shame and victim blaming (e.g. telling a victim of sexual harassment that it was their fault for sending the nude in the first place) isn’t going to work. Instead of using fear-based teaching we need to use a more normalizing approach. This type of approach would focus on:

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Executive Functioning Skills Impact Social Skills

I recently conducted a training about how to teach online safety skills to individuals with disabilities. Before I went there I looked into the pros and cons of online relationships. It is pretty easy to identify the risks (i.e. potential exploitation, bullying, etc). But as I did some research I thought it was interesting what the benefits are.

Many people (with and without disabilities) have executive functioning deficits. This means that they might lose things, not show up on time, fail to plan, lose things, lack emotional control, etc. I used to think that executive functioning skills were specific to school/work. But I realized that they are also paramount when it comes to social skills. See the table below for a breakdown of the executive functioning skills and how they related to social skills.

So, having online friends can actually help mitigate these executive functioning deficits. See below for how:

Some qualitative studies were done to see how neurodivergent individuals experienced online interactions. One participant said, ““With photos and names listed, I can keep track of my friends even when I have trouble with names and faces. All the background information of my friends are available for me to reference. Friends provide updates with which I can use as a context to re-establish contact with them where necessary.” Interesting….

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How I Teach Sex Ed

My focus has always been on working with neurodivergent individuals. Many of whom, have not had comprehensive sex education or have had a very limited sex education. Because sex education can protect against abuse and increase someone’s ability to have healthy relationships, I think this is incredibly important. So, here is what I do…

            The first step is to assess the individual’s knowledge. What do they know and what do they not know? What we work on next will largely depend on that.

The second step is to tailor materials to meet the need of the individual. This might mean using visuals to portray difficult concepts, breaking complex skills into simple steps, modeling, repetition and feedback.

The third step is to train parents/staff (if this is determined to be appropriate and the individual requesting services gives consent). Parent and staff training might include how to support their child if they want to date or how to model concepts of consent at home.

Services can be provided in person or virtually, I have seen success in both areas. I can provide services individually or in a small group. As with all services I provide, participants are allowed to stop classes/intervention at any time. Consent is key!

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What is a Certified Sexuality Educator?

I recently completed my certification to be a Certified Sexuality Educator. I have had some people give me weird looks when I say this and so I thought it was worth a discussion. Firstly, when I talk about teaching Sex Ed I am not simply talking about anatomy. While that is a big part of a complete Sex Ed program it is only the tip of the iceberg. Sexual education also includes instruction on:

  • Developing healthy relationships
  • Setting boundaries
  • Advocating for yourself
  • Getting consent
  • Communication skills
  • Conflict resolution
  • Dealing with rejection
  • How to respond to sexually explicit material
  • Sexual Development
  • How hormones impact behaviors
  • Concepts of public/private
  • Hygiene skills
  • Gender identify/sexual identify

And that is not an inclusive list. What you should know about a Certified Sexuality Educator is that it is a credential through an accredited organization. I had to demonstrate competencies in a variety of areas before I could even quality for the certification.

One of the biggest things I learned in my program is that everyone has different values, especially around love/romance/sex. My values are not the same as your values and will not try to push my values onto you. If you want services from me, it revolves entirely around your personal goals and values.

To read the whole article by Rebekah Rollston click here: https://info.primarycare.hms.harvard.edu/review/sex-ed-isnt-about-sex

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Able-Bodied Tears

I have grown up with this idea that I need to be in the forefront. That my value is determined by my ability to be seen and noticed. Not only is this damaging for my mental health, but I also think it is against my new views and beliefs on disability justice.

            I work with neurodivergent individuals. I remember a time when I would talk about how “special” they were to me. I would cry and all of a sudden, the narrative shifted from one about disability to one about me. It seemed almost equivalent to white tears…maybe they were “abled tears” (Leah Lakshmi Piepzna-Samarasinha in “Care Work: Dreaming Disability Justice”). (For those not familiar with the term white tears, this is when white people start to cry when they are presented with information about racial injustice. While showing emotion isn’t bad, white people publicly crying about injustices done to BIPOC individuals shifts the attention to them and comforting them.) When I talked about the injustices done to my clients I would cry and the discussion was no longer about them and how to change systems/organizations- it was about me. It was about people comforting me and telling me how great I was and how patient I was. In addition to stopping the conversation, this also perpetuated the idea that I was this neurotypical savior, and I was sacrificing so much to help the poor disabled people.

            In an effort to change this mentally I have done a lot of reading in the area of disability justice and advocacy. I learned that if I want to be a disability advocate, that is not something that I get to decide. I don’t get to wear a disability justice shirt, throw some money at an organization and say “Look at me! I am a disability advocate”. No- the disabled people decide if I am an advocate. And if I am making the conversation about me and using them to make myself look better, then I am not being an advocate.

            One of the best ways for me to advocate for those with disabilities is to help lift their voices so that others can hear about their experiences. Specifically, this means that if I talk about what I learned from them I give them credit. I give them credit for talking about their lived experiences. I publicize what they have to say so that more people can be educated about the lived experiences of neurodivergent individuals.

            In order to be an advocate, I need to step back and get rid of this idea that my effectiveness and my worth is someone synonymous with how many people see me. Thus, I am going to start bringing attention to individuals with disabilities by quoting them, promoting their works and helping to increase their visibility.

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Emotional Labor

            Have you heard the term “emotional labor”? (This was a new one for me.) Emotional labor is the “mental and emotional work we do to maintain relationships with other people, whether that relationship is an intimate one, or simply coexisting with strangers in a public place” (Ada Hoffman). Emotional labor can include initiating interactions with friends, setting up activities, listening to someone talk and showing concern, being friendly to people at your place of work, etc. For some people this type of emotional labor is effortless, but for some people (especially those who are neurodivergent), this can take a lot of effort.

Image made by Betterlyf Wellness

            What I think us neurotypicals sometimes forget is that autistic folx are doing emotional labor all the time! Below are things that are considered emotional labor and can be extremely difficult and extremely easy for autistic folk. I am getting the following information from Ada Hoffman, an autistic writer. You can find more of her writing here.

  • Trying desperately to figure out people’s facial expressions, when reading faces doesn’t come naturally to you. (This and other items on the list are still emotional labour, even when they are unsuccessful. Building a bridge is still labour, even if the bridge falls down.)
  • Trying to figure out how to respond appropriately to a social situation, when actually you are baffled or just want to go away.
  • Trying REALLY HARD to organize your shit even though you have executive function problems.
  • Enduring sensory discomfort, like lights and noise and other people, so that you can do an important thing that unavoidably involves them (and everything does).
  • Suppressing types of stims that you know will bother people around you or otherwise draw unwanted attention.
  • Trying to figure out the appropriate way to say a potentially hurtful thing instead of just blurting it out.
  • Asking people explicitly how they are feeling or what they need, because you know it’s important and you know you won’t figure it out on your own. Working up your courage and asking even though you know some people are offended by being asked.
  • Asking for accommodations, especially in an environment that you’re not sure will take you seriously.
  • Working up the courage to do social interactions that you know will be exhausting but necessary.
  • Trying to figure out ways to do basic things like make friends or express your emotions safely, when the NT way of doing them makes no sense to you.
  • Dealing with the ableist things people do and say all day.
  • Dealing with anxiety, depression, trauma, OCD, and the MANY OTHER very common comorbid conditions of autism.

I am hoping as we start to realize that seemingly effortless things for neurotypical people take effort for neurodivergent people we will have more compassion and understanding. Below are some ways that I am going to try to show that compassion as a clinician.

  1. Simply teaching my clients to advocate for themselves is putting all of the responsibility for accommodations on them. Job sites, schools and other professionals need to be educated on how to offer accommodations without waiting for them to be necessary. And society as a whole needs to be reframe the idea that “accommodations” make someone less then.
  2. Simply teaching my clients to read body language and interpret facial cues is putting all of the responsibility of smooth social interactions on them. Neurotypical individuals can just as easily learn to be more concise with what they want and explain how they are feeling in clear terms instead of being cryptic. This would take a great load off of neurodivergent folx.
  3. Normalize stimming. Interviews with autistic folx indicates that stimming can be very self-soothing. So, if we try to take that away or tell them to stop we are also taking away a coping mechanism. It seems silly to me that just because neurotypicals find a stim “annoying” the neurodivergent individual is responsible for stopping in order to make the neurotypicals more comfortable. Neurotypicals can learn to be flexible.
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Neurotypical Privilege: Getting out of your Comfort Zone

Neurodiversity is definitely the new buzz word. This could be a good thing because it shows more people are becoming educated/accepting of differences. But it could also be a bad thing as more and more people use the word without actually changing their behaviors.

Being a neurodiverse affirming therapist means that I am getting out of my comfort zone.  The first thing I learned when trying to become more neurodiverse affirming is that I needed to put myself in spaces where I was not seen as the expert. This meant going to groups led by neurodiverse individuals, listening, learning and correcting my behaviors and actions.

In my efforts to expand my knowledge I came across “The Checklist of Neurotypical Privilege”. The original list (found here) contains 50 items, but these are the ones that I really resonated with me.

  • I can assume that police officers will not become alarmed at my natural body language and find it necessary to subdue me in advance of any wrongdoing.
  • I do not have to carry a special card or bracelet with me to explain my natural body movements or the sounds I naturally make.
  • I do not have to fear that important decisions about my life will be made by others who are considered more qualified based on their neurology.
  • People do not constantly tell me that I need to work on the things which I am very bad at, at the expense of things which I am good at and enjoy doing.
  • If I have a particular talent or ability, I can demonstrate that talent without being called an “idiot savant” or my talent being called a “splinter skill” or some other demeaning word.

For each of the bullets above I have had a client who has experienced this exact thing. I have clients who have had the cops called on them because they were pacing back and forth in a grocery store. (Needless to say, this was extremely traumatizing for my client). Unfortunately, I often recommend having a special card or bracelet for just this reason. If the police show up, my client is stressed and is not able to explain themselves well. A card is a simple way to help with that. But, at the same time, a little demeaning.

I was reading an article about ADHD and the article talked about how some individuals with ADHD can become hyper-focused on things that really interest them. All too often, we see this is a detriment for the neurodiverse individual when we would see it as a benefit for a neurotypical person. For instance, if a neurosurgeon spends hours a day reading about the brain and practicing movements needed in surgery we would applaud that individual for being so dedicated. If an author locked themselves in their room until they finished writing a chapter we would admire their commitment. Do we offer neurodiverse individuals that same acceptance? I know that in the past I haven’t. My personal goal is to change the way I view interests and “obsessions”.

References: Neurotypical Privilege Checklist

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Should IQ tests Determine your Right to Marry?

Photo Credit: Dominick Evans, “The Crip Crusader”

When you wanted to get married, what did you have to do? Did you take a test? Did someone observe your cooking or budgeting skills? Were you quizzed on your emotional IQ? I am guessing you said “no”. Did you know that this is not the case for individuals with disabilities?

Photo Credit: history101.com

Marissa Debellis talks about these restrictions and how to increase sexual rights for disable individuals in her article “A Group Home Exclusively for Married Couples with Developmental Disabilities: A Natural Next Step”. Individuals with developmental disabilities who wish to marry are often required to prove that they have the skills necessary to do so. According to… “The law does not require you to prove that you can iron and wash clothes, and cook dinners, and balance a budget and wash the floor before you can get married. You don’t have to prove that you’re competent in any of those areas, and yet that’s what we’re telling them [disabled individuals]. So, we’re not treating them live everyone else. We’re singling them out and we’re denying them their rights based on criteria that have nothing to do with marriage”.

How did we get to the point where your ability to love/express love is based on pre-requisite skills? A lot of it goes back to the fact that individuals with disabilities still experience a lot of discrimination, despite laws attempting to curb this. In an attempt to protect disabled individuals, states make their own laws about what a legal marriage looks like. Some states require that an individual be able to “concentrate, understand, communicate, reason and recognize objects and people”. How is this measured? What does communicate mean? Are we denying rights to individuals simply because we cannot understand their communication (it seems like the fault is on us in that instance). How many objects/people do you have to recognize? And how in the world does concentration equal a happy marriage? If concentration is our golden standard then we just voided a whole bunch of marriages!

People are trying to protect individuals with disabilities. I get it and there are times when I agree with that being the goal. But in trying to protect individuals we are denying basic freedoms. I also think that we are trying to protect ourselves. Sexuality is often seen as an uncomfortable subject; even more so when we discuss the sexuality of individuals with disabilities. I feel like we are trying to relieve our anxiety and discomfort by requiring individuals to act in a way that makes us feel comfortable. So, while there is still so much to work through and unpack in the area of sexuality and disability I think that the first thing that people need to do is self-evaluate. We need to pause and ask ourselves:

  • “Is this topic/person/action making me uncomfortable?”
  • “Why is it making me uncomfortable”
  • “Am I putting restrictions in place so that I will feel better?”
  • “Are my assumptions minimizing this individual’s humanity?”.

Resources:

“A Group Home Exclusively for Married Couples with Developmental Disabilities: A Natural Next Step” by Marissa Debellis