An Interview with Therapist Claire Jack
Claire Jack, Ph.D. is an Anthropologist and Therapist based in Scotland. Dr. Jack specializes in working with women with Autism Spectrum Disorder and has published “Women with Autism: Accepting and Embracing Autism Spectrum Disorder as You Move Towards an Authentic Life”.
Jennifer Ghahari: Hey, thanks for joining us today for this installment of the Seattle Psychiatrist Interview Series. I'm Dr. Jennifer Ghahari, research director at Seattle Anxiety specialists. We are a Seattle-based psychiatry, psychology and psychotherapy practice specializing in anxiety disorders.
I'd like to welcome with us anthropologist and therapist, Claire Jack, who joins us from Scotland today. Dr. Jack received her Ph.D. in anthropology and has subsequently trained as a therapist over 10 years ago. In her late forties, she was diagnosed with autism spectrum disorder and has sought to help others understand more about this often challenging disorder. Before we get started today, can you let our listeners know a little bit more about you and what made you interested in becoming an anthropologist as well as a therapist?
Claire Jack: Okay. Yeah, actually, I suppose for me the two things link up really quite a long time ago. When I was 18, I started to train as a psychologist, I started to do my degree in psychology. For various reasons, it just wasn't really the right course for me. I shifted to archeology, so I've had a long route to get here, which led on to anthropology and history because, obviously, anthropology and archeology are quite closely related. I think there was just always that interest in how people work, how they communicate, so very much was studying that within anthropology.
I really got into therapy from my own personal experience. I had a really bad driving phobia and I had had hypnotherapy a long time ago, which was reasonably successful, but not fully successful. I had an incredible hypnotherapy session for my driving phobia and that just made me want to train. I trained in that, I did counseling, I did life coaching. That's it, really, I've been working as a therapist now I think for probably nearly 15 years and I've had a training school for 10 years, so I combined the two.
Jennifer Ghahari: Great. Can you explain to our listeners what autism spectrum disorder is?
Claire Jack: Okay. Autism spectrum disorder is a developmental disorder, so that means that you're born with the condition. When we're thinking about it, we can really think about three levels of autism, we've got level one, level two, level three. I think it's really important to remember, it's a huge spectrum, so very big spectrum of experience.
People with level one autism, that's what I've been diagnosed with, that's equivalent to what used to be called Asperger's syndrome. I think in 2013, you no longer have an official diagnosis of Asperger's. That is roughly equivalent to level one autism. People with level one lead independent lives on the whole; average or above average intelligence. They have symptoms, I think it's important not to downplay how difficult level one autism is, but most people can lead a certain completely independent life.
Level two autism, we're talking about people that maybe need some kind of assistance, might struggle to be lead independent lives.
Level three is often associated with learning difficulties; it might include people who non-verbal.
It seems like it's such a big spectrum that you almost think what have people, say like me, who's leading a completely independent life, with someone who has special needs and a lot of help, what have we got in common? It's really thinking about the traits. People with autism, we have sensory issues, difficulties processing sensory stimuli, communication and social difficulties. We might have difficulties with restricted interests. Emotional regulation difficulties are really common as well. Across the spectrum, people have these traits that they share in common.
Actually, I don't have anything visual that I can show this on, but I think when we think of a spectrum, we often think of a linear spectrum, from good to bad or difficult to easy, but actually, if you think of it as a pie chart and think of the symptoms and think, well, somebody might be much more affected in terms of communication difficulties, but maybe less affected in terms of restricted interests, or they might have difficulties with eye contact, but less emotional regulation difficulties. Instead of thinking of it a spectrum, we can think that people have really diverse experiences within autism as a whole.
Jennifer Ghahari: Wow, great. Thank you for explaining that and the different levels. Unfortunately, without more information known about autism among the general public, those without it can often feel frazzled or annoyed at some of the ways it may present in people. It's fairly common to hear notions like, "Why can't they stop doing that? Why don't they act normal?" Can you explain what it's actually like to experience autism? What does it feel like?
Claire Jack: Yeah. I suppose, first of all, there's not a choice in it. You are experiencing the world differently and you're processing the world differently, so you can't think yourself out of autism. I think that's the first thing for other people to remember. Actually, although I'm autistic myself, I come into contact with autistic people and we don't all necessarily get on together, so I can see it from both sides. An example might be, I do a lot of teaching, I teach students, and sometimes my autistic students need me to really explain things in a huge amount of detail, I need to spend an awful lot more time going over things, they might take things that I say very literally so I have to go over that, and just I end up spending a lot more time with them. I can understand that they need that time, but I can see that that could be frustrating for somebody else.
Yeah, and to come back to your question, it's important to know that when something is happening for somebody autistic, it tends to be happening in a really extreme way and there is nothing that they can do about that. For instance, when I was a child, because I think a lot of people learn about autism because they've got maybe autistic children, when I was a child, I was very well behaved; never, ever misbehaved. That was what I wanted to be like, I just wanted to be a really well-behaved kid. But if I was triggered, I was a monster; absolutely, I was horrific.
One time in the hospital, I was there for an operation, I attacked all the nurses, I got all the medical equipment, I threw everything everywhere. I scratched my mum so badly that she still has the scars. I was five, but there was no controlling me. It wasn't a choice; I never would've attacked like that. I think that's just really important to think, because autistic people have to process things in a different way, you have to understand it is different. It's not the same, no matter how they might present most of the time to somebody.
Jennifer Ghahari: Great. You mentioned triggers, could that be something like lights or smells or sounds?
Claire Jack: Absolutely. I think when I'm thinking about triggers, I'm usually thinking about emotional triggers and sensory triggers. What you're talking about is more in terms of sensory processing. An example might be going to the supermarket and dumping your bags because you can't be there any longer, or a huge one for me is people scraping their plates. As a kid, I couldn't stand, especially if we had unglazed plates in the house, that noise, I just couldn't be in the room. Even as an adult, I've learned to cover it a bit, but that kind of thing, I experience it very, very deeply. It's like a physical, horrific pain. Both my sons have that sensory thing as well, they're exactly the same.
Emotional triggers can also be a huge thing as well. I think often, if you're not being understood or you're not being listened to, maybe somebody's given you too much information. I had a client recently, a student, and she was just getting too much information that she wasn't able to take in and had a complete meltdown. I think those are two really big triggering things for autistic people.
Jennifer Ghahari: Great, thank you. On your website, you mentioned that males and females with autism actually present differently. Can you explain the differences?
Claire Jack: Okay. Well, I think there are a lot of similarities, in terms of the traits, there are really big similarities, but women tend to camouflage or mask their autism. We know from a really early age, girls tend to be driven to be more social than boys. That goes from neurotypical girls and autistic girls, but there is this drive. They want to engage a bit more, little autistic girls than little autistic boys, so they find ways of trying to appear "normal" so that they pass. For that reason, girls tend to be awful lot better at making eye contact, at having conversations, at just blending in.
Also, in terms of things like interests, there seems to be a difference. The classic, what we might think of, collecting Star Wars toys or little trains or something that boys might do, collecting things, girls often become really obsessed with other people. It could be crushes, it could be bands, film stars, even a best friend.
Again, they tend to go under the radar because they're presenting very differently to boys. They still have the restricted interests, still have the social difficulties, still have all of it going on, but it tends to look really different in girls and boys.
Jennifer Ghahari: In terms of comorbid mental health conditions, what do those with autism tend to experience? Is it anxiety, depression, things like that, or any other?
Claire Jack: Yeah, absolutely. They tend to have really high levels of anxiety and depression. What the research shows is that that tends to be linked to the degree of camouflaging. It's not necessarily linked to how autistic you are, how severe your autism is, but how much you try and cover that. Again, women tend to maybe have worse mental health than men and that tends to be linked to how much they mask it, because when you're masking all the time, it's absolutely exhausting. It's a strange just doing anything because you're putting on such a constant act. That's a big reason for the certain mental health issues.
Suicidality is also a really big problem with autistic people, higher levels of suicidality and also more of a likelihood that it's followed through on as well. A lot of autistic, well, I don't know a lot, I'm possibly using the wrong term, but certainly some autistic people are misdiagnosed with things like bipolar disorder as well, because meltdowns can seem horrific, it can seem like a bipolar episode. Some of the extreme behavior that autistic people present with as well can sometimes be misdiagnosed as bipolar. Some people do have autism and bipolar, but the misdiagnosis is something that comes to light quite often as well.
Jennifer Ghahari: When we diagnosis this, is it a psychiatrist, a therapist?
Claire Jack: It's usually a psychiatrist, sometimes clinical psychologist will diagnose, for a full clinical diagnosis. Therapists, such as myself, might offer a nonclinical diagnosis. I suppose one of the reasons certainly that I offer that is just the problems that people have getting a full clinical diagnosis. The wait times can be huge, the expense can be really extreme, and so sometimes people might go to someone like myself, even as a stop-gap, so that they have something to work with whilst they're waiting a couple of years for a diagnosis.
Jennifer Ghahari: Oh wow; years.
Claire Jack: Yeah, absolutely. Yeah, I don't know about every country, and obviously in the UK we have the NHS, so it's a free diagnosis, but that can certainly be up to a couple of years waiting. It's a massive wait.
Jennifer Ghahari: Which could lead, as you said, to the anxiety and depression.
Claire Jack: Absolutely, yeah.
Jennifer Ghahari: Wow. In terms of treatment, how would autism spectrum disorder typically be treated, from a therapeutic standpoint?
Claire Jack: I think this is a really interesting question. The recognized treatment for autism is applied behavioral analysis, ABA. To be honest, it's not something that I've had and it's not something that I'm trained in, I'm no expert in ABA, but basically, it's... I'm trying to think of the best way to describe this. It's aimed towards people maybe having a more productive, and again, inverted commas, “normal” life. It's quite a rewards- and punishment-based therapy, as far as I know. It's not particularly popular within the autistic community, because the autistic community are of really working towards accepting autism and accepting yourself. But certainly, I think it's very common amongst autistic children, trying to almost train them to be less autistic. Like I say, it's not a very popular approach within the autistic community.
CBT can be effective, but I think what's really important is you need to go to somebody who understands autism. I've been trained in CBT and I do work with CBT, but it doesn't necessarily work with autistic people unless you really recognize the limitations, because trying to push yourself and change your beliefs and come up with new behaviors can be really impossible for people with autism. What I find is that a lot of people who have been down traditional therapy routes just haven't got the help that they need at all. A lot of them have talked about therapists, and actually I've had this experience looking for past trauma to explain what I'm experiencing, because it can present in a very similar way, and actually there's maybe nothing particular in the past that can explain what you're experiencing now.
There are autistic therapists out there. I think just having that level of understanding from a personal perspective and being able to educate your clients, I find with autistic clients, I'm educating them a lot more than I would with other clients and that's a hugely important part of therapy. But to me, therapy is all about accepting yourself, it's accepting you're autistic beginning to work to take the pressures off and work with, I don't like to call it limitations, differences. Just think, yeah, I'm different in this way, but this is a solution for it. It's all about acceptance.
Jennifer Ghahari: Oh, that's fantastic, thank you. In terms of self-care tips, are there any that you can recommend that people can try at home or just on their own without any therapy?
Claire Jack: Yeah. I think one of the big problems people with autism have is emotional regulation. The worst effect of that is when people have meltdowns, which can be absolutely horrific. It can involve leaving your house, putting yourself in danger, breaking things, putting other people in danger, they can be horrendous. But there are signs at some point that you are probably heading from meltdown, so it's really important to begin to recognize your own signs. They don't come out of nowhere.
You might just recognize you're a bit tired, some people might stim, so it could be touching their face or rocking backwards and forwards or pacing, or even talking a bit loud, there will be something. If you can think about it as an emotional regulation timeline, you can begin to recognize that actually you need to stop and don't go to the supermarket. I'm mentioning supermarkets because I hate them, but don't go to the supermarket if you're starting to talk a bit quickly. At that point, you start to rest. I think that's a huge tip, start to think about a timeline and what you need.
Also, you need a recovery time. I think this is, again, autistic people are different. They take ages to recover from a meltdown. It might be hours, it could even be days. You need to think, “Do I need to rest here, do I need to avoid something?” There's a theory that lot of people use, called “spoons theory”, and it was actually developed by somebody with I think it was chronic fatigue, it was some kind of chronic illness. It's a great way to think about self-care. You need to think, “I have X amount of spoons this morning, so I've got 10 spoons. I'm not going to get anymore, when they're gone, they're gone.” I can think, “Right, I've got a meeting, that's two spoons, I've got the school run, that's going to be three, but I don't get any more at the end of the day.” You might actually only be starting with six. It's a real check in with yourself and thinking, I don't have limitless capacity, because fatigue is a huge thing as well.
I like to think of it in terms of pebbles, because I live by the coast. Literally, you have your pebbles. You can even take a pebble out with you, but you just don't get anymore. Again, without being negative or trying to think about limitations, it is a reality check, that you do need to look after yourself or you could end up being exhausted and frazzled and have a meltdown and all of these other things.
Jennifer Ghahari: Yeah, I think you bring up a good point. I think a lot of people without autism don't realize how bad a meltdown can be, number one. Yes, people can witness it, but then, like you said, the recovery can be hours or days. Autistic people really need to do self-care. If they can't go to an event or if they're wearing noise-canceling headphones, it's not because they want to look stylish or interesting, it's because they actually need to do this for their own health.
Claire Jack: Yep, yep, absolutely. I know a lot of my clients love noise canceling headphones and some will wear them in the house. I was talking to someone recently, big family, including stepchildren, and just the noise at dinner time was just too much to cope with, and she started to wear these. Her family thought it was amusing at first then they accepted it. It just made such a difference. Yeah, but yeah, it's not about trying to look for attention or anything else, it is about trying to keep yourself safe.
Jennifer Ghahari: That's great. I'm glad that client found that way to do it.
Claire Jack: Yeah, it's amazing. I think once you accept it, the solutions you come up with are really inventive.
Jennifer Ghahari: This has gone by pretty quickly. I always think that's a good sign of a good interview. Usually, we wrap up our interviews by asking if you have any parting words of advice. I'm actually going to ask you that twice. First, do you have any parting words of advice that you'd like to offer for those diagnosed with autism disorder?
Claire Jack: I think it's a really difficult thing at the beginning to come to terms with, particularly for adults. I think it's different if you've maybe known since you were younger, and certainly the way parents impart that knowledge to their children is really important. But I think just if you find out a bit later in life, as most of my clients have, you've got to be really patient with yourself. It can be scary, you can think, “My life's going to be limited, I can't have the career I want, can I have a family?” Yes, you can do all of these things, but you maybe need to just find different ways of managing it, but it really doesn't have to limit your life in any way.
To me, it's something that it can really open up doors and it can open up new ways of thinking and being once you've begun to accept it. I think that's the really important thing. If you keep battling against, it's always going to appear like this terrible thing that's going to hold you back, but if you can accept it... Autistic people tend to have different ways of viewing the world, they maybe have different talents, they might be particularly good in some areas, so once you can accept all of that, then you can lead this incredible, rich life. It might be slightly different or it might work in slightly different ways, and that's completely fine. I think it's accepting that that's completely fine.
Jennifer Ghahari: Do you have any words of advice for those without autism that you want them to be aware and cognizant of?
Claire Jack: Well, I think first of all, the client base that I work with, you wouldn't know they're autistic. I think some people think they're giving a compliment by saying that, “You don't look autistic at all,” which is actually really frustrating because they don't see what's happening in the background. When I went to my GP initially to ask for a referral to a psychiatrist, I was just completely knocked back on the basis that I can have a conversation, I can smile, I can look somebody in the eyes. I'd done tons of research and I really tried to explain why and what was going on for me, and it was, "You don't look autistic." I think it's terribly important, if you're not autistic, don't judge somebody, because you don't know how much effort they are putting into something.
It's also, I think, really important to recognize it's real. Most of the people that I work with tend to be really lucky in terms of their partners. I think autistic people are often drawn together anyway, but even if there is a non-autistic partner, most of my clients have had a lot of support, but I have had some clients who've had a really horrible experience from husbands and partners who will not believe that they're autistic and it doesn't seem to matter what they say. Even when they get a full diagnosis, they will not believe it.
I think if somebody has a diagnosis, even if they haven't, even if they're self-diagnosing and have done the research, what they're experiencing is very real. Just because you don't understand it doesn't mean it's not real. Again, just thinking about autistic people having to be inventive with some of their solutions is a great opportunity for partners, children, parents, to be inventive with the autistic person as well, be open to it. Accept if they don't want to do something, they don't have to do that thing. You can probably work around it, you can come up with a different solution. If they don't want to come to your family party, fine. Do they have to go? Probably not.
It's about, I guess, looking at societal norms, which very much are made to fit neurotypical people. This is where I'm going into my anthropology bit here, and I'm thinking, well, do we have to adhere to these norms, and why would we? I think, again, it's a great opportunity, but people have to be really open to accepting their loved one or colleagues or whoever has autism and thinking I can either treat this in a way that's going to stress this person or I can support them, because this is absolutely real for them.
Jennifer Ghahari: That's really great. Thank you so much. Dr. Jack, it's been wonderful talking with you today and we really appreciate your contributions to our interview series.
Claire Jack: Thank you.
Jennifer Ghahari: Have a good day.
Please note: The views expressed by the interviewee are for educational and informational purposes only, are not meant to diagnose or treat any condition, and do not necessarily reflect the views of Seattle Anxiety Specialists, PLLC.
Editor: Jennifer (Ghahari) Smith, Ph.D.