What kind of therapist should I look for?
August 8, 2017 6:19 PM   Subscribe

Inspired by a similar question that was posted earlier today. I have social/behavioral and sensory issues I want to work on with a professional who has clinical training. Might be autism, not diagnosed. What type of professional should I look for?

Below I have included the symptoms I want help with. It ended up very lengthy, so please feel free to skip over if long list of symptoms is not actually useful. Ideally I want to find a practitioner who can help with all of them but I will understand if that isn't possible.


-I am always uncomfortable in social situations, especially situations where someone pushes my boundaries. I often get the sense that I am perceived as having poor boundaries because of my body language.
-One of many reasons I think I might have autism is that I have the feeling other people on the spectrum describe of "I feel like an alien trying to understand human language/behavior but I am missing the phrasebook everyone else has." I have other symptoms of autism but aren't germane to my question because I don't need help for them, but I want to note that I am not trying to take self-diagnosis lightly.
-I tend to interrupt a lot and talk over people. It's way, way worse when I'm happy and excited. I've gotten negative feedback from multiple supervisors at work along the lines of "you interrupt senior staff and clients, you talk over junior staff, you come across as combative in meetings even though I can tell you are just excited and feel strongly". I've been getting this feedback for my entire career but I feel like I can't change and it frustrates me deeply. I am female but I feel confident this is not about workplace sexism. Please assume this is true as you answer this question. And I know that no matter how much I caveat this, some of you will not be convinced, and that's fair, because I am intimately familiar with the context here.
-I also just have no brain-to-mouth filter and am constantly saying things I later regret. Things I would consider asshole-ish and rude coming from someone else.
-I struggle with friendships and making effort to keep in touch with people outside of regularly scheduled events. I also can't tell if my lack of filter and tendency to say off-putting things is driving people away or if I just have no idea how to do emotional labor. (A: both.)


-In my lowest moments, I hurt myself to punish myself for being "bad", usually by slapping myself. I've never seen myself in any description or narrative of self-harm, which unfortunately means that I don't find self-harm hotlines helpful.
-I have a lot of repetitive/"stimming"-type behaviors and unlike most people with autism, I HATE them and want to stop.
-I compulsively pick my skin to the point of bleeding.
-I have sensory sensitivities, including some that make romantic/sexual intimacy a problem.
-I have trouble with focus/concentration unless I'm multi-tasking and have multiple sensory inputs. At the same time, I'm fiendishly organized, I LOVE planning, and I always bowl over my supervisors with how quickly I complete work tasks. It's beginning to dawn on me that my seeming hyper-efficiency and Type A personality...might actually be...coping mechanisms?!
-I have trouble with self regulation. For example I am overweight because I am bad at being able to tell when I'm hungry or not so I always clean my plate.

I went to a mostly-DBT therapist before and she helped me a lot with past traumas, anxiety, intrusive thoughts, insomnia, and negative self-talk, but wasn't helpful for the above things. I also don't think "life coaching" will be helpful to me.
posted by robot cat to Health & Fitness (6 answers total) 5 users marked this as a favorite
You need a thorough assessment, so whoever you see needs to be able to perform a diagnostic assessment. That could be a PhD, LCSW, or LMHC for example. Take them this list.
posted by crunchy potato at 7:33 PM on August 8, 2017

A speech and language pathologist (SLP) can help you with communication (interrupting, etc) and body language. A lot of SLPs are attached to institutions (like schools and nursing homes) but if you could find a private clinic plus pay cash you would probably be good to go.

-Occupational therapists can help with sensory strategies. To me, the self-harm sounds almost like a sensory coping mechanism? Like, you feel anxious/guilty/uncomfortable so you are introducing a sensory input to distract yourself or regulate yourself? I'm not sure if I'm explaining that right, but it might help you to start thinking of it as a sensory strategy you want to replace with something more adaptive rather than a bad thing you do as punishment.
posted by Snarl Furillo at 7:41 PM on August 8, 2017 [2 favorites]

Also, I would suggest looking for a therapist of any modality who has experience with autism. That way they won't waste time trying to figure out what sad thing in your childhood makes you overeat instead of teaching you ways to quantify feeling full.
posted by Snarl Furillo at 7:45 PM on August 8, 2017 [1 favorite]

If it were me, I'd want to see a clinical psychologist (PhD), maybe a neuropsychologist (for initial assessment) - someone experienced in using statistically sound tests/assessments to exclude not only autism but e.g. ADHD or anxiety disorders (both of which can affect impulse control, and can mimic each other - not always easy to tell them apart. And, both of them are correlated with OCD spectrum behaviours like skin picking). I would not want someone relying just on the DSM (or vibes or what have you). (NB, where I live, neuropsych assessments covering ADHD run a couple of grand.)
posted by cotton dress sock at 8:01 PM on August 8, 2017

I compulsively pick my skin to the point of bleeding.

This is not an "instead of doing other stuff", but I am... very like you in a lot of ways and I'm still dealing with a lot of this stuff, but I saw a very noticeable improvement in my ability to not do this when I started taking an n-acetylcysteine supplement. Preliminary research that I've seen was supportive of it as a help for hair-pulling, which is on the same sort of axis of impulse control issues. Mine is also very sensitive to how much sleep I'm getting--I do it way, way more when tired. It's not like a miracle cure or anything, but it helped me cut way back and I'm able to snap back out of it faster when it happens when I'm taking the stuff. And it's cheap and OTC.

As far as other stuff goes: I had a relative as a kid who was an occupational therapist and was not officially treated but got a lot of help through that for my sensory crud. If you can't see an OT, you might do some reading on sensory diets. It takes a lot of experimentation to figure out what helps and what doesn't. I still am Very Not Good at anything that involves physical contact with other people but I can actually now manage to shower and tolerate general office noise, both of which I would have trouble with otherwise. This can also help with the stimming thing, if you can work out what it is you're indulging and find less objectionable ways of managing it.
posted by Sequence at 8:32 PM on August 8, 2017 [2 favorites]

To add on what Sequence said....Methofolate, B12 and the NAC that she describes above, helped my daughter a lot with picking. She has tested positive for two MTHFR genes. If you would like to know more about MTHFR, look up "Dr. Rawlins MTHFR". It is possible that the supplements that he suggest would be helpful for you in many ways.

I am also going to suggest that you get your eyes checked by a developmental optometrist who can check to see if both of your eyes are teaming together properly. It is quite possible that if your eyes are not working together right that you are missing social cues. When my son did vision therapy for it (physical therapy for the eyes) a lot of his sensory seeking issues went away...it was like his other senses were over compensating because his eyes weren't working right. This may be a kind of long shot, but worth checking out the next time you get your eyes checked. Be sure it is a developmental optometrist, the other eye doctors don't believe in vision therapy...but it made a huge difference for my son.
posted by 101cats at 9:27 PM on August 8, 2017

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