Monday, September 17, 2012

NESCA News & Notes: Ellipses to Better Define Social Relationships

Note: Dr. Peter Vermeulen was a keynote speaker at the 2012 Social Thinking Provider?s Conference. He spoke on the topics of ?Relationship Development for People with ASD? in addition to ?Context Blindness.? During the talk on relationships, he spoke about the concept of Social Relationship Ellipses. ?Michelle Garcia Winner thought this idea was excellent and asked him if he could write this article in English since this topic has only be written about in Flemish (He is from Belgium).

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A relationship, especially an intimate relationship, poses a lot of challenges for people with an autism spectrum disorder or other social cognitive challenges. Or, as a young man with autism once told us: ?Relationships are 1000 times more difficult than math!?

Contrary to math, a relationship is built around an infinite number of unwritten rules and laws. And unwritten rule number one is: there are no fixed rules in a relationship. And that?s because a relationship is the result of the bonding of two unique people. It takes two to tango, but we all tango our own, unique way. So, every relationship is unique.

Nevertheless, there are certain elements that are important in every relationship. Pivotal building blocks in a relationship are: reciprocity, mutual respect, loyalty, mutual support, communication and understanding and honoring each other?s boundaries. The problem with these ?keys to a satisfying and healthy relationship? is that they are very abstract.

People with ASD and other social cognitive challenges may understand words like respect and support on a linguistic level, i.e., they probably can give you a definition of these words, but what is difficult for them is understand what these words imply in real life, in a concrete relationship.

That is the reason why education on relationships is so important for them. Most neurotypicals intuitively know how to translate the abstract keys into concrete behavior. They know to apply the building blocks within their own relationships. People with ASD often lack this (unconscious) intuition, so we can help them by giving them explicit knowledge of the building blocks of a relationship through teaching.

That is why, a couple of years ago, we started to develop a workbook for teens, tweens and adults with ASD on the topic of (intimate) relationships. That workbook contains two parts: part 1 on sexuality ( seks@autisme.kom) and part 2 on relationships (relaties@autisme.kom). You might wonder why we started with sexuality and not with relationships, but the reason was fairly simple: sex is less complicated than relationships. (Moreover, teens and tweens with ASD need information on sexuality, even if they don?t yet engage in an intimate relationship.)

Whenever we develop new materials, such as a workbook, we do tryouts with a least 100 people. Of course, there is no workbook or teaching strategy that is 100% effective for individuals with ASD, but with our tryouts we try to find out what works with our target group. And, indeed, the tryouts confirmed what we already knew: teaching about sexuality is easier than teaching about relationships (although many of you might think otherwise).

The most important lesson, however, we drew from these tryouts was this: when teaching about relationships, we should acknowledge diversity in perspective and values. The way neurotypicals look at (intimate) relationships is not necessarily the way people with ASD look at them.

And when we do not take into account the (possibly different) point of view of the person with ASD, the information we want to give in our education will not be picked up by the person, because there is no hook to hang the information on.

What we learned from our tryouts is this: when introducing a concept (such as friendship, respect, romance) always check their dictionary, to see how they interpret the concept. What you might call a ?best friend? is not necessarily the same of what a best friend might be for a person with ASD. Not only concepts might differ, also values and needs.

Most of the neurotypicals want to live together with the person they love, but I?ve met quite a lot of people with ASD who prefer ?living apart together? because they need time on their own, personal space or their own specific routines in order to be able to relate intimately to their beloved one. Living together is too stressful for them, often because of the sensory issues that are involved when living together. And, when stressed, nobody is able to interact and bond in a satisfying way.

When teaching about relationships we should be careful not to impose our model of relationships onto the teens, tweens and adults we work with. That became clear the in the very first session of our education program on relationships. In that first session we ask the person to map their relationships. The template that we used in the tryouts is one that is very well known and that can be found in almost every workbook on relationships: the circles of intimacy:

During a tryout session with adults, one of the adults told me that the template was a bit confusing for him and that he had trouble using it to map his relationships. This is how he filled in the template:

During the group discussion, he explained: ?I know I am supposed to put my wife in the inner circle of intimates, but to be honest, I have a much more intimate relationship with my psychiatrist. No, not a sexual relationship, but my psychiatrist knows more about my feelings than my wife, I can share more of my experiences with him than with my wife and I feel much more understood by him than by my wife, so I feel more close to him.?

This man was not the only one who had trouble filling in the template with the circles. It seemed that our neurotypical template did not work well for the people with ASD.

So, therefore we decided to develop another template that is more flexible and that covers not only the degrees or levels of intimacy, but also the personal experience of the relationship (do I feel good or bad in this relationship?) and the frequency of contact within the relationship (how often do I meet the person?).

We use ellipses and not concentric circles. This is an example of the template, filled in by the same adult mentioned above:

How does it work?

We tell the person first to write down the names of all the people they have a relationship with. Some people can be put together in a group, such as ?my colleagues,? to avoid that the person has to write down a lot of names.

We then show an example of the template (such as the one above) and ask them to map their relationships. Since there is no predefined number of ellipses, the person can draw as many ellipses as he wishes and name them as he wants. So, for instance, there was one young adult who made an ellipse for the people of the Autism and Asperger Advocacy group. The distance between the center (?me?) and the ellipse reflects how often the person interacts with the person or people in the ellipse. The line between ?me? and the ellipse can be given different colors and different degrees of thickness. Green, for instance, stands for a ?good relationship,? meaning that the person feels good in the relationship with that person/those people, red means a relationship that is experienced in a negative way. A thick line means that there is a close relationship, a strong bond.

We learned from the people with ASD that the closeness or strength of the relationship does not necessarily equal the frequency of contact, nor the positive evaluation of the relationship. Some people told us that they have a strong bond with someone they do not often meet. And in the example above, the adult told us he had a rather strong relationship with his parents and sister, but that he often has a conflict with them (hence, the red color).

We do not always use all the aspects or elements of this template. For some people, the difference between the strength of the bond (the thickness of the line) and the distance of the ellipse from the center is very confusing. We then leave out the thickness of the lines. In the example above, the adult told us that he has often contact with his colleagues, but only through e-mail and that he rarely meets his colleagues physically. We suggested he could express this by using a dotted line.

The template with the ellipses has proven to be more flexible than the traditional circles of intimacy. The template can be individualized and therefore gives us a better look at how the people with ASD (or other social cognition challenges) experience their relationships. We don?t force them into a neurotypical template but give them the freedom to express their own, individual, sometimes even idiosyncratic view.

The template with the ellipses is also a perfect starting point to explore the things a person values in relationships. Asking questions about why a person colored a certain line red or green for instance, will give you information about what he likes or dislikes in a relationship or people. In our workbook (relaties@autisme.kom), we also ask the person to put a date on the worksheet with the ellipses. That is very handy for when you want to teach about how relationships can develop or change over time.

The template of the ellipses is just one of the examples of how we should avoid forcing people with ASD into the neurotypical templates of relationships. If there is one thing I?ve learned throughout the tryouts with our workbooks on sexuality and relationships, it is this: it takes two to tango, but there are many ways to tango.

About? Peter Vermeulen, M.Sc., Ph.D.

Source: http://nesca-news.blogspot.com/2012/09/ellipses-to-better-define-social.html

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