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Doing Therapy with Children and Adolescents with Asperger Syndrome


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Table of Contents

Preface viii Acknowledgments xvii Important Notes xviii 1 What Asperger's Means for the Child 1 2 Meet the Parents 11 3 Beginning Th erapy 19 4 Hypersensitivity 29 5 Anxiety 43 6 Communication 61 7 Intellect, Cognitive Style, and Creativity 77 8 Feelings and Depression 101 9 Social Difficulties 121 10 Theory of Mind and Other So-Called Impediments to Therapy 147 11 Connecting It All 169 Appendix: Working with Parents 175 References 187 Author Index 201 Subject Index 205 About the Author 217

About the Author

Richard Bromfiled, PhD, is on the clinical faculty of Harvard Medical School and maintains a practice outside Boston. He writes about children, psychotherapy, and family life for professionals and general readers. He is the author of Doing Child and Adolescent Psychotherapy Teens in Therapy, Nurturing the Self of the Child with Asperger?s , and Playing for Real.


Since Lorna Wing (1981) coined the term "Asperger's Syndrome" and provided the first descriptions in English of the profile of abilities of a child with Asperger's Syndrome, there has been an explosion of recognition and interest about the condition, resulting in hundreds of publications. Despite this explosion, there are very few books available to guide the therapist in designing and implementing psychotherapy for the child or adolescent with Asperger's. Dr Richard Bromfield, a clinical psychologist on the faculty of Harvard Medical School, has written a book that exactly meets this need. With eloquence and empathy, Dr Bromfield describes a new therapeutic approach for children and adolescents with Asperger Syndrome and High Functioning Autism. To inform his approach he draws from his clinical knowledge and wisdom based on nearly 30 years experience, the current research and clinical literature, and he illustrates his approach with many rich case examples drawn from his own practice. The approach described by Dr Bromfield [it]draws on and augments the best of the current therapies utilized for Asperger's Syndrome, including cognitive behaviour therapy, language therapies, behaviour therapy and person-centred therapy. It is a relationship-based, whole child approach, within which "what matters most is what children with Asperger's think, feel, say, do and experience" p. 1. Above all, Dr Bromfield advocates a particular attitude toward people with Asperger's because he has dis- covered that this attitude is a defining feature of successful therapy with a person with Asperger's. The attitude is one of respect, curiosity, enthusiasm, hopefulness, with a genuine focus on strengths and growth. The therapist who is infused with Dr Bromfield's vision would also be empirical, tenacious, self-reflective, humble and wise. He or she would be wise in these ways: open to new learning, able to incorporate this new learning into therapy and nondefensive in the face of mistakes. The specificity of Dr Bromfield's topic, his extensive clinical experience, his knowledge of current research, and his skill as a psychotherapist allows a depth of analysis about therapy with children and adolescents with Asperger's that has not been offered about this topic before. The companion volume for clinicians, equal in richness of understanding about Asperger's would be: "The Complete Guide to Asperger Syndrome" by Professor Tony Attwood (2007). Dr Bromfield shows a deep understanding about Asperger's syndrome, for e.g., his descriptions about the condition and his topics for therapeutic intervention both begin with sensory sensitivity, a crucial, but typically overlooked, area of difference and suffering for the person with Asperger's. He points out that "because they can be so hard to understand, children with Asperger's get less understanding, empathy, admiring and confirming?enormously less" p. 8. (my italics added). Dr Bromfield is a clinician, on a voyage of discovery through unchartered territory, drawing on 'pearls' of knowledge gained through the current available research findings, and importantly, discovering new 'pearls' and bringing them back for further analysis by both researchers and therapists. It is an exciting journey and a true testament to the scientist- practitioner model. I can highly recommend this volume as a valuable addition to any therapist's and parent's library. It is a much needed volume because it[this book] not only brings together current knowledge about Asperger's Syndrome, but also provides an excellent framework for how to assist, including how to start therapy, how to help with sensory sensitivities, anxiety, anger and depression, social and communication dif- ficulties, how to use and understand intellect, cognitive style, creativity, and 'theory of mind' in therapy; and how to work with parents. Some therapists will feel confronted by the advice "a therapist beginning with a child with Asperger's can never go too slowly" p. 20, especially in these money-conscious times, but we can take heart from the advice "... often, with Asperger's, slow is the fastest route" p. 68. The volume is highly readable and very moving, Dr Bromfield is an excellent communicator and his heart is in his work. He exhorts us, as therapists, to become involved, to try hard: that we do not have to be perfect or to know everything, and that, with the right approach and attitude, we have good reason to be optimistic about being part of a success story for the child with Asperger's. (Journal of Autism and Developmental Disorders) "Bromfield, who is a clinical psychologist, skillfully shares with the reader the beneficial knowledge that he has gained from his thirty years of experience in working with this specialized population. The book is filled with clearly conceptualized case examples that provide practical tips and fresh insights for the benefit of children and families impacted by Asperger's Disorder and high-functioning autism. Bromfield's relationship-based approach to therapy with this population is intended to be utilized in conjunction with other widely recognized, evidence-based interventions for treating children and youth diagnosed with autism spectrum disorders, such as behavioral therapies, speech and language therapies, and social skills training. As such, it is intended to supplement and to mutually inform ? rather than to supplant ? these allied approaches...[Bromefield] focus[es] the bulk of his discussion on practical strategies for carrying out psychotherapy with children with Asperger's within a context of "human connection and understanding" (p. 174). Bromfield's therapeutic approach with this population is a natural fit with social work's core value of "meeting the child where she is" (p. xviii). Bromfield (p. 99) aims to "see the child in his own completeness and reality" as he details viable methods for encouraging children's unique talents, skills, and predilections in a spirit of realistic optimism." (Child and Family Social Work, August 2011)

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