Doing Therapy with Children and Adolescents with Asperger Syndrome
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Praise for Doing Therapy with Children and Adolescents with Asperger Syndrome

"Providing an explanation of Asperger's based on a review of scientific research, Richard Bromfield describes how the characteristics of the syndrome affect the person's thoughts and experiences throughout childhood. Psychotherapy based on the practices described in this book will change the destiny of children and adults with Asperger Syndrome to one of greater connectivity to themselves and others. This should become the primary text for pshchotherapists working with children and adolescents with Asperger's."
—Tony Attwood, PhD, author of The Complete Guide to Asperger's Syndrome

"Dr. Blomfield generously shares his wisdom and experience in this very accessible, honest, and often moving book. Any clinician who reads it in its entirely—or even selects a chapter or two at random—will no doubt discover new paths to take their most complex and challenging clients and gain a greater appreciation for those with Asperger Syndrome. Bromfield gives us all a window into a world that is hard to describe, impossible to imagine, but needs and deserves to be understood."
Naomi Angoff Chedd, LMHC, Autism Specialist and coauthor of Replays

Cutting-edge guidance for effective treatment of children and adolescents with Asperger Syndrome

Diagnoses of Asperger Syndrome in children and adolescents are on the rise, and while some clinicians have training and experience in this area, most do not. Using vivid case material, Doing Therapy with Children and Adolescent with Asperger Syndrome offers clinicians the guidance they need to treat the young people they endeavor to help.


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.


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


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)

"As we increasingly recognize the parallel distress arising from mental and emo- tional ill health for many children and adolescents diagnosed with Asperger Syndrome this book is another welcome lens upon how those attempting to help can make a difference.
This hugely optimistic but realistic author leads the reader into his experience using the style of engagement which succeeded with his distressed, isolated and anxious patients, inviting our curiosity with a mixture of warmth and good humour.
The text is immersed in a sense of optimism which is easy to lose, when attempting to engage with the children and adolescents who shrink with anxiety from our well intentioned attempts to reach them. Richard Bromfield writes a passionate account of his therapeutic approach and belief in 'staying with' the apparently impossible to reach the child or adolescent who may feel cornered by our world into adapting coping mechanisms that may appear bizarre or unmanageable by the rest of us who are trying to help. He repeatedly emphasizes his message that the needs of these young people for emotional and psychological connection can be as strong as those who do not have a diagnosis of Aspergers Syndrome.
Written from a clearly transatlantic perspective Richard Bromfield's message is presented in clear and accessible language and combines clinical discussion with illustrations from his own practice, some spanning many years. The relatively small amount of clinical terminology frees the reader to explore the author's stories of his patients' growth and development. At the start the author invites us to think about the parental perspective, taking the view that their engagement in the process of therapeutic change is vital, though does not elaborate on how to manage this where, maybe, the parent has Aspergers too.
Through Richard Bromfield's friendly and engaging style of writing the reader's attention is soon captured and introduced to clinical dialogue relating to diagnosis and management. It is particularly helpful to read his repeated assertion that many of the therapeutic principles used apply to all children and adolescents 'with or without' Asperger Syndrome and their growth into adulthood. Richard Bromfield challenges clinical assumptions that those with Aspergers Syndrome have no capacity for empathy nor symbolic play (two diagnostic indicators) and he argues that through modelling and the enacting of relationship building with his patients he has acquired evidence that capacity to develop satisfactory relationships can be developed over time. This certainly raises some questions stemming from conventional models of psychotherapy, as he argues that concepts of love and reciprocity can be established through relationship modelling through therapy over a consid- erable period of time, time which is all but unavailable in pressurized public services in the UK, especially for children and young people on the autism spectrum.
You do not need to be a clinical psychologist to find seeds of inspiration in this book and the positive and practical ideas which as the author says apply to all children and adolescents. He focuses our attention on the aspects of 'sameness' between all children with or without the diagnosis in their need and search for friendship, acceptance, kindness and affection that are all so often denied. However, I would have welcomed expansion on the author's involvement of parents (and carers) especially where they too present features of Asperger Syndrome.
Against the context of stark, limited, UK specialist resources Richard Bromfield's ideas may appear impossibly inapplicable, but this text offers insights into psychotherapy which are reminiscent of Virginia Axeline's Dibs, in search of self. If you can, read this book and pass it on."
Isabel Martin, Argyll and Bute Council, Scotland

"This book is a joy to read, largely due to the author's chatty and jargon-free writing style. The reader is welcomed into his consulting room through the liberal use of snippets of case material to exemplify points. He writes with a self-questioning style, giving examples of his own thought processes in a way that helps a clinician to examine and so develop one’s own practice. Although the author is a renowned child psychologist, working at Harvard Medical School and with an extensive private practice, he writes with humility, not presenting a ‘‘know-it all’’ approach. Examples and scenarios apply not just to psychotherapy settings but to all clinical scenarios with young people. His great fondness for his patients is also apparent.
This book is refreshing in its strongly clinical focus. Too many texts are overwhelmed with theory and can leave the novice none the wiser about what one actually does with patients. I wish I had read this before I started seeing young people in therapeutic situations. I remember wondering to myself "But what am I actually supposed to say?" While this book does not provide all the answers, it offers countless possibilities and helps one to reflect on the options. However, for the theoretically hungry, the author refers on to appropriate texts.
Overall, I would recommend this book to both trainees and experienced clinicians as an easy-to-read, practical and thought-provoking guide to psychotherapy with children and adolescents."
Liz Searle, Specialist Registrar in Child and Adolescent Psychiatry, Great Ormond Street/Royal London Hospitals higher training scheme

"Doing Therapy with Children and Adolescents with Asperger Syndrome is a cutting-edge book that is sure to enhance practitioner libraries and edify the clinical mind and skills set. Bromfield reviews scientific research and provides radical and fascinating practice wisdom for clinicians who want to help clients who present with the ever growing diagnosis of AS. This book is a must-read for clinicians, parents of children with AS, and educators. Speech and language therapists might also find the book of value, as they are often important collaborators with clinicians working with young people with AS."
Lisa E. Cox, PhD, LCSW, MSW, Associate Professor, School of Social & Behavioral Sciences, The Richard Stockton College of New Jersey