Emotion-focused therapy for autism spectrum disorder: a case conceptualization model for trauma-related experiences

“This can present a challenge for clients with autistic process who have cognitive empathy diiculties, such as self-awareness or theory of own mind (Williams 2010) and mentalization of others mind (Baron-Cohen 1997) as well as restricted repetitive thinking.”

“Further, up to 85% of individuals with ASD present with alexithymia (Hill and Berthoz 2010) as well as a general tendency to intellectualize rather than experience and process emotions (Mazefsky and White 2014).”

“However, research indicates that individuals with ASD possess di culties in self-understanding or theory of own mind (Williams 2010) as well as theory of mind (Baron-Cohen 1997) but not with afective empathy (Dziobek et al. 2007).”

“These autobiographical memory di culties consist of episodic elements including memory for personally experienced events contextualized within one’s sense of self over time (Conway et al. 2004).”

“ASD is also associated with diiculties regulating emotion and coping with stress (Mazefsky et al. 2013).”

“The initial step in EFT case formulation is to identify the client’s presenting problem through the client’s narrative (Elliott et al. 2004; Goldman and Greenberg 2015).”

“Individuals with ASD are generally believed to lack empathy (Gillberg 1992).”

“This ASD case conceptualization (Robinson 2017) has been guided by the framework initially developed on research on emotional transformation in experiential treatment of depression (Pascual-Leone and Greenberg 2007) and speciically for Generalized Anxiety Disorder (Timulak and Pascual-Leone 2014).”

“There is however, growing recognition that individuals with ASD are at increased risk to experiencing and be detrimentally afected by traumatic childhood events (Kerns et al. 2015).”

“Emotion recognition and insight play a key role in emotion regulation ability and the processing of trauma (Jones et al. 2011).”

“Although CBT produce encouraging results, and continues to evolve, some researchers have emphasized that there are still many individuals with ASD who do not respond well to CBT or who remain considerably symptomatic at the end of treatment (Weston et al. 2016).”

“Recent systematic and meta-analysis have shown that modiied CBT produce small to moderate efect sizes when based on informant or clinician outcome measures (Spain et al. 2015; Weston et al. 2016), with a small and non-significant efect size when using self-report measures.”

“One such HEP is emotion-focused therapy (EFT) that has a growing evidence base for conditions such as depression (Greenberg and Watson 2006) social anxiety (Elliott 2013; Shahar 2014) and generalized anxiety disorder (Timulak and McElvaney 2016) as well as complex trauma (Paivio and Pascual-Leone 2010).”

“These experienced core pain indicates that the client’s needs are not fully met (Greenberg 2011).”

“Research indicates that 74% of young people with ASD had clinically signiicant emotional diiculties, such as anger, sadness or anxiety, compared to 18% of TD peers (Totsika et al. 2011).”

“Children with disabilities are considered a vulnerable population (Cohen and Warren 1990) and are at greater risk of victimization than those without disabilities (Rand and Harrell 2009; Sullivan 2009).”

“EFT draws upon a Task Analytical methodology to study psychotherapeutic change within a discovery and validation phase (Greenberg 2007; Pascual-Leone et al.”

“For many autistic people, interaction with other autistic people is preferable to interacting with neurotypical people (Sinclair 2010).”

“EFT draws upon a Task Analytical methodology to study psychotherapeutic change within a discovery and validation phase (Greenberg 2007; Pascual-Leone et al. 2009).”

“The initial step in EFT case formulation is to identify the client’s presenting problem through the client’s narrative (Elliott et al. 2004; Goldman and Greenberg 2015).”

“One such HEP is emotion-focused therapy (EFT) that has a growing evidence base for conditions such as depression (Greenberg and Watson 2006) social anxiety (Elliott 2013; Shahar 2014) and generalized anxiety disorder (Timulak and McElvaney 2016) as well as complex trauma (Paivio and Pascual-Leone 2010).”

“In accordance with Timulak and Pascual-Leone (2014) it is hypothesized that negative self-judgment can be an introjected criticism from others.”

“The therapist looks for these global signs of distress and uses this as an emotion compass (Greenberg and Watson 2006) to point to the underlying painful emotion or core pain.”

“One such HEP is emotion-focused therapy (EFT) that has a growing evidence base for conditions such as depression (Greenberg and Watson 2006) social anxiety (Elliott 2013; Shahar 2014) and generalized anxiety disorder (Timulak and McElvaney 2016) as well as complex trauma (Paivio and Pascual-Leone 2010).”

“Creating narratives about oneself requires internal coherence (Pascual-Leone 1990) a particular challenge for people with autistic process as they have autobiographical memory diiculties characterized by reduced speciicity, less detailed self-narratives with lower coherence (McDonnell et al. 2017).”

“One such HEP is emotion-focused therapy (EFT) that has a growing evidence base for conditions such as depression (Greenberg and Watson 2006) social anxiety (Elliott 2013; Shahar 2014) and generalized anxiety disorder (Timulak and McElvaney 2016) as well as complex trauma (Paivio and Pascual-Leone 2010).”

“Research indicates that once self-compassion and protective anger have been achieved and expressed, a grieving process can begin (Pascual-Leone and Greenberg 2007; McNally et al. 2014) as shown in the inal phase of the case conceptualization model (see phase 3 Fig.”

“Preliminary positive indings for Emotion-Focused Therapy for Autism Spectrum (EFT-AS; Robinson and Elliott 2017) have been reported.”

“…therapy there is an increasing focus on encouraging the individual to thrive with difference, without intending to treat or reduce the expressions of neurodiversity (McVey et al., 2021); compassion-focused therapies are increasingly indicated for neurodivergent clients (Robinson, 2018).”

“Although not included in the diagnostic criteria, alexithymia, or difficulty identifying and understanding emotions in self, is particularly relevant in the autistic population, impacting up to 85 percent of individuals [11].”

“Further, that painful experiences occur through misempathy within interpersonal encounters as a result of neurotypical-neurodivergent intersubjectivity (Robinson, 2018).”

“For example, autistic youth demonstrated the ability to accurately self-report their experiences and feelings in a qualitative study (Cage, Bird, and Pellicano 2016), autistic adolescents reported on the effectiveness of a resilience program (Mackay, Shochet, and Orr 2017), and an autistic adult reported the effects o…”

“Autistic adolescents are vulnerable to trauma-related experiences due to a diminished sense of self and lack of self-agency within interpersonal engagement (Robinson 2018).”

“…approaches, such as child abuse trauma (Carpenter et al., 2016; Harrington et al., 2021; Holowaty & Paivio, 2012; Mundorf & Paivio, 2011; Paivio et al., 2010), PTSD (Cucu-Ciuhan, 2015; Mikaeili et al., 2017; Murphy et al., 2019), and Autism Spectrum Disorder with resulting trauma (Robinson, 2018).”

“Research has demonstrated the productive use of EFT with autistic individuals in working through traumatic events in a group setting, which facilitated the transformation of emotional pain into a more adaptive emotions (Robinson & Elliott, 2017; Robinson, 2018).”

“In EFT framework for Autism Spectrum Disorder (EFT – ASD), the therapist selects autistic process (AP) markers from the therapy session using interpersonal process recall (IPR) and plays them in the subsequent IPR session (Robinson, 2018).”

“Robinson (2018) mengembangkan Emotion Focused Therapy dengan disertai teknik empty chair untuk mengatasi distres emosional, kesulitan interpersonal, dan trauma pada individu dengan autism spectrum disorder (ASD).”

“…autistic clients who wish to engage in a talking therapy with others and to focus on selfreflection, especially if they have had trauma-related experiences through isolation, rejection and painful victimization as a result of being autistic in a predominantly neurotypical world (Robinson, 2018).”

“In another work [17], the authors focus on individuals with ASD in dealing with emotional misunderstandings and trau-Authorized matic experiences in their interactions with typically developing peers.”

“…communicating with others, but not due to behavior, interests, or activities, as well as poor speech prosody (Ying Sng et al., 2018), inability to articulate feelings, and unable to understand irony or mockery in others’ speech (Deliens et al., 2018 ; Robinson, 2018) are other customary issues.”