autism spectrum disorder

CEO RUTH STRONGE ON BUILDING RESILIENCE & REDUCING ANXIETY VIA DONKEY EXPOSURE THERAPY

An Interview with CEO Ruth Stronge

Ruth Stronge, MA is the CEO of Snowdonia Donkey Sanctuary. She has a master's degree in environmental and development education, and a master's degree in clinical and health psychology. She specializes in helping children, teens and adults build resilience and mitigate various anxiety disorders at her farm sanctuary.

Jennifer Smith:  Hi, thanks for joining us today for this installment of The Seattle Psychiatrist Interview series. I'm Dr. Jennifer Smith, 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 Ruth Stronge, CEO of Snowdonia Donkey Sanctuary, located in Bangor, Wales. She has a master's degree in environmental and development education, and a master's degree in clinical and health psychology. Ruth was a primary school teacher by training, and with the founding and development of Snowdonia Donkeys, she has been able to combine her passions. Before we get started today, Ruth, can you tell our listeners a little bit more about yourself, and how the rescue organization got started?

Ruth Stronge:  Hi. Well, thank you for inviting me. Yeah, I would say I have a passion for donkeys, and I have always loved donkeys. Maybe about 12 years ago now, there came an opportunity for me to get two donkeys, and I got two little donkeys. I kept them with my daughter who had a pony, and my children were older, my daughter had a pony, and our son was at the village, so we never rode our donkeys. We always took them for walks. And for me, spending time with those donkeys before work and after work were just the best time of the day. I would do it before I'd go to school where I was teaching, so then I was ready for school. And then on the way home, that would be my downtime of reflection. It went on from there and people, our friends that we knew said, "Please, can we come and walk the donkeys with you?"

And then we would bump into people with our donkeys, and they would say, "Oh, it's been ages since we've seen a donkey." And then, people just wanting to come and spend time with our little donkeys. It grew from there in as much as I wanted a donkey to ride, so I got another donkey. And then a group of friends, when we were out walking the donkeys, we were talking and decided if we could help any local donkeys, we would do that. We set up a small charity, and that was just 10 years ago now, a small charity to help local donkeys, and that's how we began, really.

Jennifer Smith:  Wow. That's great. Your website has a large banner that states, "Rescuing donkeys and changing people's lives," and I think that's a pretty moving statement, and I'd like to talk about some of the work that you do there. One of the first courses that you developed was for vulnerable adult learners, so that they could help build confidence by working with the donkeys. Can you tell us a little bit about that? How can caring for donkeys help someone?

Ruth Stronge:  It was a chance meeting with another organization, and telling them about the looking after the donkeys we do, and how volunteers were coming to help us, and how we were working with just giving people opportunities and time to spend time with the donkeys. And it was an organization in the center of Bangor who worked with adults, providing them with opportunities for support if they had mental health difficulties. And I invited their manager to come out and see the site that we worked on, and go through some of the activities that we did of how we managed our donkeys, which was following a simple routine in a quiet place, and basically just really being quiet around the donkeys, and being around each other, explaining to people how some of our donkeys are not used to people, and how we have to approach them, and how we read their body language so that we can support them in the best way.

And it was that opportunity and those conversations that allowed us to run a small program of one afternoon a week for people to come spend time outside with the donkeys. Initially, our volunteers and staff had done all what we would class as the "donkey work", so they'd done all the cleaning out, and the working out, and the feeding. But then just giving people time to brush a donkey and learning which brushes to use, how you would approach a donkey, basically reading body language, as well, of an animal, and giving them the story of the animal, and finding their character was the start of all that then, really. And for some of the people engaged with us, they became more and more interested, wanting to come more often, be more involved with what the animals needed for their welfare needs. And one of the really important things that we took from it was that it was a conversation piece for people. They had something to talk about with other people, what they had done.

Jennifer Smith:  Wow. Oh, that's great. And just for our audience to know, I actually met Ruth when I went for a tour of Snowdonia Donkeys, and it was really fabulous just getting to spend time with the donkeys, and I have to say there is something very soothing about it. Just brushing them, like you said, just petting them, just having that quiet moment, it really is nice. And going for a walk, and seeing beautiful scenery with them is a wonderful thing. I think you've stumbled upon, and definitely have built, a beautiful organization.

Ruth Stronge:  Oh, well, thank you for that. But I would say it's how I want to spend time with my donkeys. I know it works for me. And sometimes when I'm talking to people, if we're explaining the kind of work we do, and with our young people as well, and I would have to say it isn't for everyone, and that's okay. If you are more interested in fast moving things, and you are boisterous, and you are running around, then we are actually not the right place for you to be, because you would frighten the donkeys. And it's a case of, okay, let's take a step back. And our donkeys and our organization is very good at supporting quiet, anxious people, because that's the way we look after our donkeys in a quiet way, building confidence, following routines. And partly that has just evolved, but also my training as a teacher, I was an early years teacher, so the routines and the structures that we put in place to take away too many decisions initially for people were simple things like which donkey you're going to work with.

Well, if you've got a pink brush in your hand, then you are going to be brushing the donkey that's wearing a pink head color. The one in the picture behind me is wearing a pink head color. So you would know, she would have pink brushes, a pink bucket for her feed, and if you were going for a walk with her, she would have a pink lead rope. It sounds simple things, but it takes away anxiety from people if they don't have to ask questions. Some things are just pointed out for them, and next time they come, that routine is built upon.

Jennifer Smith:  Wow, that's wonderful. Through a partnership with Adult Learning Wales, you run an accredited course on animal care, which focuses on supporting young adults. Can you speak about what that entails, and how can young adults psychologically, emotionally, and socially benefit from that course?

Ruth Stronge:  Again, you realize as you do these other, things happen by meeting and talking to people. Behind the scenes, the young people that we work with, or the adults, for them, they don't always know where the funding comes from as enablers to deliver sessions for them. So behind the scenes, it's a bit like a jigsaw puzzle so that they can have the best opportunities. And if they are interested, they can stay as long as they can if we can afford them to stay, and to progress their development. So Adult Learning Wales are a national organization here in Wales that fund accredited and non-accredited courses for people over 16, and we had been delivering some courses that it called engagement courses, which were non-accredited. But working with some of our other young people who had come through us from another grant program which allowed them to do one-to-one sessions with an adult and a donkey, basically just being in a nice quiet environment, having someone to talk to if they wanted to, or just spending time with a donkey.

We were looking for a next step for some of these young people when we identified that for a vast majority of them, they hadn't engaged with the education system at all. They had, whether it be anxiety built on after COVID, or for whatever reason that they had, not been in the education system, so there were no exams, and there was nothing on paper for them to take their next steps. With the program that we had delivering one-to-one sessions, we then built on that, offering them some small group sessions, which for us would be no more than four or five at the most for a few weeks. And then Adult Learning Wales, because myself as a trained teacher, I can be a tutor for them, I approached them and said, "I have this group of young people, who some would like to go to formal college in the future, but I want to be able to acknowledge the progress they've made. And also once the summer holidays comes for some of our other young people, what do they do for six weeks?"

And I wanted them to be able to come and work with us, but we didn't have any funding to enable that to happen. So Adult Learning Wales helped me find a couple of, we would call them entry level modules, so not too high, but requiring some academic input on animal care. We would do things like how to muck out, and how to brush an equine. And the young people that we had focused on having come for one time, one session a week as an individual, and then as a small group, were then asked to apply, we knowing that they would always get on the course, but to give them a formal leading to it, to apply us for a fortnight, coming every day to take part in practical activities and record those activities using photographs and written work so that they could then submit it for an accreditation from one of our organizations, Agored Cymru which accredits their work and then they can build on that.

That was a journey. We've been plotting a journey for some of those young people, and they themselves wouldn't know who had funded their journey, but behind the scenes, we were able to do that. And for our funders, that's interesting as well, because they like to see that it has an impact, which it certainly does.

Jennifer Smith:  Oh, that's really fantastic that you help people to transition in that way.

Ruth Stronge:  And one of the things you asked was about their anxiety and their social skills, so that because they had had those small steps before they got to something that we called education, but we often didn't use that term, then we were trying to look at adding one new thing every time they came. If they were all familiar with the setting, then one-to-one was their first step, be familiar with the setting. The next change would be to work with a small group of people, and then to come every day for a longer period, so trying to increase that confidence, and reduce the anxiety as they took on new things, then.

Jennifer Smith:  Oh, wow. Yeah, that's similar to exposure therapy, correct? And like you said, to lessen their anxiety, the social anxiety and such, that's wonderful.

Ruth Stronge: By the time they got to the accredited side, brushing a donkey was what they would do automatically, so it wasn't the new thing. The new thing may have been recording or talking about what you'd done. So yeah, it's those small steps, and just building on that was really important.

Jennifer Smith:  Ah, fantastic. You also offer one-on-one sessions for those with additional learning needs. What types of conditions is this specifically geared for, and who can benefit the most from these sessions? Would it be people with social anxiety like you mentioned, or general anxiety, or anything else?

Ruth Stronge:  A lot of people with either social anxiety or general anxiety, and we do quite a bit with people with autism as well, who have communication difficulties. Communication difficulties on the side of struggling to verbalize their needs, or anxiety, or shyness, or selective mutism. And again, through following those routines and building that confidence, we've worked with quite a number of young people in that way to increase their confidence. And again, hopefully moving from one-to-one sessions onto small groups. For some of the people that we work with, it isn't always appropriate to do that, but if we can, we can do that, or we would then change or build on the activities that they're doing, so they are being more engaged in different activities. Some of our work, we also work with young people who may have learning disabilities, and may have reduced cognitive abilities, and again, we would match the donkey to their needs.

Some of the autistic people we have worked with are very sensory, some of them like to throw things around, so sawdust moving around the place obviously isn't appropriate for all our donkeys. And so, we've got some donkeys who are very chilled, and don't mind those things happening. But I would say where I find most pleasure is working with people with anxieties, and shyness, and quietness, because to see them make that progress, and to be able to talk, even to their families, about the donkey that they've worked with is just amazing, really.

Jennifer Smith:  Wow, that's wonderful. In terms of the people who have the mutism, as you said, or if they're on the spectrum and not very, or nonverbal, have you noticed where they do become more verbal, or this therapy isn't really applicable for that? Have you noticed a change?

Ruth Stronge:  We do notice a change, yes. And for us, it's trying to not put them into situations where they become more anxious, or it's not putting them in those situations where it makes it more difficult for them to speak. Just by following those routines every time they come, and building a rapport with one of our support workers, and especially with the donkey, then we found almost that the donkey acts as that diversion, that there's someone else, so there's something else to talk about, to be involved with. And then our staff are very much aware of the sensitivities of some of the people we work with, and wouldn't then ask them direct questions. They are very good at supporting the people to shine, and to build on the skills they've got, so almost praising them in a positive manner, using the language of support, and making suggestions together to do things is the way that we tend to build on people's development.

Jennifer Smith:  That's fantastic. And this sounds so perfectly suited for you and your background. It's really wonderful that you've been able to develop this.

Ruth Stronge:  It has just been amazing. Yeah, I feel very privileged to be able to do that, and also then to look around at the other people that I work with and say, "Yeah, I couldn't do it all myself," because there's not enough hours in the day, but we have some lovely members of staff who themselves have maybe been through some of our systems as well, and are able to talk about how working with the donkeys, and following the routines, and just being out in the fields with them doing field work, and then having something to talk about to people. Because we have visitors coming to see the donkeys, and they've got something that they can talk about that they've achieved, they know about this donkey, in a supportive environment. There would always potentially be a member of staff or a key volunteer who would be around, if we saw them faltering or being more anxious, could then step in and support, so that they didn't have extra worries themselves then.

Jennifer Smith:  That's fantastic. Can you tell us about the program that you run with the BBC Children in Need? What is it, and who does it serve?

Ruth Stronge:  Okay. BBC Children in Need is a national charity, a national grant-giving charity here in the UK, and we've had funding for quite a few years from them. And our program for them has always been targeted at young people, so for them, that's under 18, who have social and communication difficulties. And that can be, from our point of view, I guess it started with shy people and quiet people with anxiousness, and that's how we've kept on going with that. We offer them one-to-one sessions for an eight-week period of an hour with an adult and a donkey, in a quiet period of our week. And then, if they are keen to carry on, then we offer them small group sessions for a longer period. So that, again, a bit linking what you were saying back to the exposure therapy, they are quite familiar with the donkeys and the donkey routine when they've done the one-to-one sessions for six to eight weeks, and wanted to come for longer.

The only thing that is different then is there may be more people around. The staff tend to be the same, so they've got familiar people to support them. They know the donkeys. It's just extra new people, then, and that seems to work quite well. And those groups then go on as they get older, and we've had some people with us for quite some time now, so we've moved to being volunteers, or we call them supportive volunteers. Again, they are supported by key staff, funded by Children in Need, familiar adults who know or are aware of their own personal needs. But the older young people then, one of the targets is to take our donkeys to a local agricultural show, and show the donkeys to be part of something bigger, and that works really well. We do that as a day out, so they take the donkeys out for the day.

The show is a four-mile walk to get to, so they have to come the day before and get the donkey ready for the show. Then they have to come early on the day it's happening, walk the donkey to the show, be in the show ring. They will have spent quite a few months actually preparing for all this, but that is on those following through, and that's what we aim for them to be part of, so that then, again, following the journey with Children in Need, then they can be active volunteers then, in some respects giving something back to us, as well as their own lives then.

Jennifer Smith:  Wow, that's a fantastic cycle. Like you said, people get help, and then they help others, and it's just a wonderful thing.

Ruth Stronge:  It's really important for me behind the scenes, to provide that route for people. And I guess that's not just my teacher background, but also the psychology side of it is where do you go? Where is your journey on it? And I would say that I actually do that for all the donkeys as well. They all have a learning journey, too, and targets that I need them to achieve, and things that they can be good at, and stuff like that. But if the young people or the adults coming to us on the one-to-ones are making progress and want to stay with us, then we discuss with them those journeys we would like them to be able to take, if that's what they want, and how we can best support them on that.

Jennifer Smith:  Wow, that's wonderful to have those specific goals to try to reach for, if they're able and want to. One thing I saw on your website was that there was a video showcasing the experience of Zoe, who is 16 years old. Can you tell our listeners a little bit about what she experienced in life, and why time at the sanctuary has been essential to her mental health? And this is just one story, but I think it really signifies what your sanctuary can do to help people.

Ruth Stronge:  Yeah. Zoe has been with us for quite a few years now, and when she first joined us, as with all our children funded through BBC Children in Need, we asked them to be referred to us by a professional working with them. That could be a school nurse, it could be a teacher. We have something we call CAMHS over here, which is Children and Adolescent Mental Health Services so that we had some kind of filtering system, and we'd sent information to our school nurses and CAMHS, and also I often will give talks to the local authority, and give them some examples so that we work with the right people, so that we can have those best outcomes for ourselves, and for the people we work with. And Zoe was referred to us by CAMHS. She had moved to Wales just before COVID time, it was. She'd moved to Wales with her mother.

It was a one-parent family, and moved to quite an isolated place in Wales, as well. Quite in the countryside, quite remote, but didn't go to school, so was homeschooled as well as moving to a new place with one parent. And so Zoe came to us doing one-to-one sessions for her eight weeks. We had to let Zoe know before she came which donkey she would be working with, which adult would be there, reassure her that the adult would be waiting for her when she got there, again, to remove all those anxieties. And we actually sent her, before she came to us, a picture of the donkey she would be working with, so that she had some knowledge of what she was going to be doing. We knew that Zoe liked animals, and this was a good opportunity for her.

After her one-to-one sessions, she wanted to carry on coming, which was wonderful. And so, she joined a group that stayed for more, so she came from morning session again, five or six children at the most, with adults that she had met. But again, those preparation time and the information, so she knew what was coming, who she would be working with. Zoe had quite a lot of anxiety, as it sounds like, obviously when I'm presenting that to you, quite a lot of anxiety. And her anxiety would not only manifest before she came, but also during sessions, as well. If there was going to be something new happening, we would tell her beforehand.

There would be a lot of demonstrations. If it was maybe learning how to tie the donkey up, then a lot of demonstrations, let her do it without being watched, because she found that very anxious to be watched, or if she felt she wasn't achieving it, or couldn't get it right. A lot of support for Zoe in that way, repeating, and again, positive reinforcement, the things that she had done right, and then taking those small steps.

Zoe came when we were talking before about the two-week course. Last summer, Zoe came on that course for two solid weeks and she had never been... She was 16 then. She had never been in education since 11. That was the first time she'd ever done anything like that. In order for her to get support at college, which she then managed to go to college on the basis of having spent a fortnight with us and could demonstrate to college that she could commit to something, and was able to do that.

She had to have a psychology report, an educational psychologist's report. And what I personally found quite touching, and also quite a big responsibility, is that we were actually the only outside organization involved with that child, because she was homeschooled, didn't attend anything. There was nobody else to talk to the psychologist about her needs, and how best she learned. I spent a lot of time with the team that would've been supporting Zoe when she moved on to college, with the local authority, explaining how we supported Zoe. And again, I would say had I not been in the profession I was, I wouldn't have liked to have taken it on. And fortunately for me, the psychologist who was assessing Zoe, I knew her from school. She used to be my Ed Psych in school, so it was like, oh, that's great. We knew the language we could talk, which was really useful.

Having set that up for Zoe, and then her doing the two-week course, she was keen, and as she said in the little video clip, she was keen to start college, and excited to start college. And she has now just completed her first year at college, and has had really good attendance, a few ups and downs along the way, as most teenagers would do, but was very pleased to have finished her first year, and be accepted into the second year. We are just so pleased for her.

And the time with the donkeys, when you listen to her talking about it, she has a favorite donkey, and that's the donkey she's drawn to every time she comes, and the conversations that she would have with that donkey to help her work through some of her anxieties, and also helping him to work through some of his, because sometimes, we ask our donkeys to do things they don't necessarily understand. And it is those conversations that are helping the children or the young people that we're working with understand why we're doing this with the donkeys, and how do we teach them to do that, enables them themselves then to think about themselves, and how they can move forward as well.

Jennifer Smith:  Oh, wow. I recall also in the video, and correct me if I'm wrong, that Zoe was initially homeschooled due to bullying, and she developed some severe depression. And it sounds like because of the social support that you offered her as an adolescent, which is really critical to maintaining good mental health, that she was able to really develop great resilience. And, like you said, now she's in college, whereas before, it sounded like her life was almost at a debilitating level, where she was unable to really just get out there and function with others.

Ruth Stronge:  Yeah, it is amazing when you listen to what she says that we were the only place she would come, and then small number of people around her was all she could cope with. She wouldn't talk to anybody else. And some of the young people that we work with in BBC Children in Need who did that video always ask us can we give them a case study? They'd asked before, and Zoe wasn't ready to talk, because, and this is something we've had on a couple of occasions from our young people, when I come to the donkeys, this is special and I don't want anybody to spoil this, so I don't want to tell people at school, because that isn't a nice place where I want to be. This is my safe space.

For Zoe, on a number of fronts, it was very brave of her to talk about, not just what she had been through, but then almost that this is what she does, and she loves what she does, and she's a wonderful advocate for it. But it was an incredibly brave thing for her to do. And the amount, like you say, her resilience, and how far she has come is all credit to her. She's worked really hard.

Jennifer Smith:  Oh, fantastic. And the donkey that she likes is Norman, am I correct?

Ruth Stronge:  No, that's Walter. It's Walter.

Jennifer Smith:  Oh, Walter!

Ruth Stronge:  She likes Walter, and she says they have the same birthday. They're exactly the same age. Yeah, he's her favorite, and she does have a special relationship with him. He can be, as most animals can sometimes, he can be quite cheeky, and she won't stand any nonsense from him. One of the wonderful things that they did with this group of donkeys, and she was in charge of Walter, is one of the walks, I know you went on one of our walks, and one of the walks that we do, there's a little bridge going over a small stream, and if we could cross the bridge, we can go on longer walks.

But Walter couldn't cross the bridge. He just couldn't cross over this bridge, because of the running water underneath it. He was quite frightened. And for long, I'm saying years here, we would stand and look at this bridge. And one day I was on site, but I wasn't leading the group that Zoe was with. I think there was four young people with one of our other members of staff. And apparently, they'd gone out for a walk, and I knew they were due back at a certain time and they were late coming back.

As you do, I was worrying, where had they all gone? The parents were arriving, and they all came back laughing, but very late. And I said, "So, where have you been?" And Zoe said, "Well, I just said to Walter, 'today is the day we're going to cross that bridge. Sometimes, we have to do things like that. It's hard, but we can do it.'" And she got him to cross the bridge, and they all went over the bridge and could go for a walk. But he couldn't come back over the bridge, so they had to walk the long way round. They were all laughing. These young people were just howling with laughter that they've managed to do this with Walter, and Zoe had been wonderful and got him over there, but he said once was enough.

Jennifer Smith:  Oh, that's wonderful. And what a fulfilling experience for her to be able to get across, at least that one time.

Ruth Stronge:  He will go now. Next time, he was fine. He was just once was enough on that day. Because we do say to him now, "Zoe, are you going over the bridge?" and she says, "Yes, and we're coming back over the bridge, too."

Jennifer Smith:  So Walter had his own exposure therapy, it sounds like.

Ruth Stronge:  His own exposure, but for her, when she was saying to him like, "Walter, we look at this so often, we are going to do this bridge now." And that was just like, yeah, you are an amazing young woman to be able to say, yeah, I'm going to do this, and do it for herself, and for him. So, yeah, it's lovely.

Jennifer Smith:  It's very empowering. That's wonderful. Thank you. During the pandemic, you started a Long Ears Listening Project. I know donkeys have long ears, but what is this project?

Ruth Stronge:  Long Ears Listening is really all my passions all in one place, which was quite a privilege to do. As an early years teacher, when I left school, I knew I still wanted contact with young children. We do a lot of work with young people and with adults, but young children is an interest I've taught all my life in the early years, we would call it here in the UK, and outdoors and environmental education is my other interest.

When I left school and worked with the donkeys full time, when the pandemic came, we have a lovely patch of woodland that we manage, and it was used a lot during the pandemic by people visiting. I would leave activities and resources in for people to use, and then when we could meet together, we started a formal parent and toddler group for parents, and it's outdoors in the woods, and the donkey comes every session and carries some of the resources. With a focus on language and literacy through storytelling, then, we have a group of parents who meet every Monday morning and share time together. And whilst it is an emphasis on language and literacy for them, it's also a time for them to get together and just be outdoors enjoying themselves, and giving their babies and young children exposure to nature, access to animals, in a friendly, supportive environment.

Jennifer Smith:  And the benefits of nature therapy, or ecotherapy, like you said, just spending time in nature, and then you're with an animal, and then there's the reading... It's just beneficial on so many levels.

Ruth Stronge:  It's been a fascinating journey, that one, as itself has developed, too. And we have a small number of songs that we now use every time we meet in Welsh, so that we are then doing that bilingually for them. And they are about donkeys, obviously, so we do a few counting rhymes that we have. If you've ever met early years teachers, they'll sing to anything, a song, a counting song or anything like that, to a familiar tune, so we've made up a couple of songs that we sing about donkeys to start it off, and just a relaxing place for them to be out there. And they all have a little activity bag, which would have some sensory activities in, and a book. And again, that bit started with COVID when we couldn't share resources the same, so everyone had to have their own resources, and we actually just kept that up. If the child is not old enough to walk around, they've still got activities that they can do and interact with their babies with, then.

Jennifer Smith:  Oh, that's great. This has been extremely informative, and I think this time has unfortunately flown, for me, anyway. As we wrap up, is there anything else that you'd like to share with our audience about the sanctuary, or anything else mental health related at all?

Ruth Stronge:  Yeah, I think one of the things that it makes me realize is that I started it probably by accident, and because I know the benefit I got from being with the donkeys, and stroking them, and mucking them out before and after school, and then part of my work, making time to be out of doors in nature was so important to me, personally. And to be able to offer those opportunities to other people that, as you said, I went back to Uni to do my clinical health psychology degree, because I'm thinking, I don't want to just be the person that says, "I know it's good, and it really is nice." I wanted to embed it in the research, really. And we still work with Bangor University to try and get the psychology students to use as case studies. And for us, it's often another pair of interested hands as well.

But we're really keen that the work we do is the best it can be, not only for the people we work with, but to give the work that we do with donkeys, who often get quite a bad press, or are often looked down upon, and they're very hardworking animals, to give them a value as well. Because it just doesn't happen by accident. If it looks from the outside that it's easy, then sometimes, I think, well, actually that means we're working really hard, and it is working well. But behind the scenes, all that theory, and the small steps, and the thinking about how people need to move forward, and how we can help them do that is important. And I guess I would also throw in as well that for our staff and volunteers, we try to make time for them always to have what we would call "donkey time," so that they have their own mental health moments where they can just be with the donkeys, and enjoy doing those things and being in the moment with them.

Jennifer Smith:  Oh, that's wonderful. For our audience listening, for those of you who are local, or plan on traveling to Wales or the Bangor area, we're definitely going to link up in the interview so people can check out your website. Also, learn about different ways to support your group, sponsorship opportunities. I know you have some wonderful little knitted donkeys. I forgot to bring mine. (*photo at bottom of page)

Ruth Stronge:  I forgot to leave one out as well. Yeah, should have done that.

Jennifer Smith:  Yeah, different ways to support you guys and this wonderful mission that you're doing, that's helping both donkeys and people in a really wonderful cycle. So, again, thank you Ruth Stronge, for speaking with us today. And tell Jenny the donkey that I said hello. That was my friend that day. And we wish you all the best.

Ruth Stronge:  Thank you very much for the opportunity to talk to you, and we would love to see people over here. It'd be amazing.

Jennifer Smith:  Thank you.

Jennifer Smith with Jenny the donkey. (left)

A souvenier “knitted donkey” from Snowdonia Donkeys posing for a picture near the sanctuary in Bangor, Wales. (right)

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.

Therapist Claire Jack on Autism Spectrum Disorder

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.