The Social Therapy Dream Team: Paul & Kim

{Images taken by Coleen Hodges Photography, interview by Melissa Lane Isaksson.}

In a community filled with doctors, dietitians, therapists and specialists who focus on the diagnosis, brain function, deficits, and treatment of our children, it is always refreshing to come across professionals who have a different approach.  I have had the pleasure of crossing paths with some people in the ASD community here in Phoenix, AZ who are definitely worth knowing.  Their passion for understanding the “social thinking” of individuals on the spectrum is surpassed by no one.  They have a unique, innate ability to take the labyrinth of social rules and expectations which we as a society are all expected to adhere to, and make the concepts strategic and comprehensible for the ASD mind.  They spend their days building meaningful relationships with their clients and families, understanding and accepting their way of thinking, and finding ways to build their “toolbox” to successfully navigate the social world. Without further ado, I present to you the ASD dream-team of Paul Carollo and Kim Dionne.  

M: Melissa Lane Isaksson (interviewer) P: Paul K: Kim

M:  Thank you so much for taking the time from your busy schedules to meet with me and share your expertise with the Spectrum Inspired community.  Tell me a little bit about your background and what led you to your work specifically with individuals with ASD?

P: My journey began 18 years ago. After I graduated with my Masters in counseling, and began training in family systems therapy within an evidenced based program called Functional Family Therapy. It was during that time that I was assigned a young man who fascinated me. He was incredibly bright. He was able to recall facts and was able to share information about topics of interest with such detail. I was intrigued by these abilities, because on the outside he appeared to be just like many of the other young people I have worked with, but as I further developed my connection, I realized that socially he was functioning in a very different way. He liked to be with only adults, he was very anxious around groups of people, and he did not recognize the perspectives of others. This young man ignited an interest in me that was not there prior. I began to get involved in a variety of trainings in ABA, and social thinking practices. One year later my entire caseload was populated with children on the Autism spectrum. Due to the demand I was seeing, I developed a program called the Family Centered Autism Program. During that time I began training in positive behavioral support at NAU in pursuit of my BCBA.

K: We appreciate being asked to be a part of this wonderful organization! Thank you for taking the time to get to know us a little better. I have always had a special place in my heart for others with disabilities. In highschool, I enjoyed volunteering in the special education classes and trying to make others with unique needs be a part of the group. With that said, I followed my passion in wanting to help others by pursuing my psychology degree from Arizona State University. Towards the end of my bachelors, I was employed by an agency who worked with children on the Autism Spectrum. I was dedicated to one family specifically, who I spent much of my time in their home working with their young child who was diagnosed with Autism. It was this child who opened my eyes to the world of Autism! I learned more from him than I could have by sitting in a class or reading a text book. There was no turning back for me-I went on to pursue my Master’s in Community Counseling from the University of Phoenix and completed my internship with an autism program at a behavioral health agency. I was later hired as a clinical therapist for the program where my love for this unique and complex disability continued to explode. My professional, and personal, time has been dedicated to learning, connecting, and growing within the Autism community.

M: Tell me about your intake process.  What makes a particular individual a good candidate for your services?

P: I will defer to Kim for this one :)

K: So, a word to describe our approach would be “dynamic.” Paul and I don’t fit a specific mold. However, we do work with a population who are “higher functioning, have expressive and receptive communication, and operate out of a specific skill range in order to attend to the counseling environment. We are fully aware that our role is to continue developing and refining functional skills, so we do not expect the children we work with to be completely self sufficient or socially appropriate, otherwise where would we fit in? But, because our approach is cognitive and family focused at the core a good candidate would have some of these skills when beginning our services.

M: I have been so inspired by your work and have witnessed first hand the social success of individuals with whom you work. What are some of the social therapies you offer?

P:The social therapies we offer are based on concepts of social thinking and cognitive therapy. Within these therapies we offer social therapies for families. It is important to us to provide therapies which can generalize and having social therapy for families enables the concepts to generalize. Our social therapy group is another service which creates opportunities to develop and utilize the social therapy tools.

K: It is definitely challenging to describe what it is we “do” in therapy versus watching it, but as I mentioned our approach is dynamic. With that said, we use different treatment modalities. Counseling, family systems, social thinking, and principles of Applied Behavior Analysis are modalities most often used. Someone who has met one child with Autism has ONLY met one child with Autism. Because of this belief, our therapy needs to be flexible so that we can be as effective as possible when working with families and children. Therapy starts at the door, the first time we meet a family and child. We continually look for opportunities to connect the children we work with to social experiences/interactions even by incorporating our other clinicians at the agency who may join our sessions or having our children join social therapy groups.

M: In college I worked for a psychiatric and therapeutic service clinic in Madison, Wisconsin.  I was lucky to be able to observe amazing doctors and therapists who were ahead of the game at that particular time in ASD therapy; yet I watched parents religiously bring in their ASD kiddos who were less than thrilled to be there and not very receptive to treatment. What does a typical therapy setting look like for you?

P: Melissa, this is an interesting process. The goal for us is to provide an overall family experience. It starts with just the parents for the first few sessions. The goal is to provide an orientation to the process, and to be able to join with the family. During this time we have specific goals to help set the stage for the therapy to be successful.  Once this is achieved we embark on folding in the young person. Here is where it becomes different for us,  because a session for us starts in the waiting room. Our goals is to create a safe place, and to decrease anxiety. This time is for developing an orientation around the process of what to expect, and take care of anything which might compete with the opportunity to learn.  We work on creating opportunities to learn and to practice. We use the family as a help reinforce and strengthen the connection to the process.

K: Family involvement. For our therapy to be effective, the parent needs to be involved in the service...We don’t look to “fix” the child with Autism, rather how to strengthen the family unit while building skills and refining existing ones. We first meet with the parent/s for a series of sessions prior to introducing the child into therapy. Again, this is to assess and explore different family dynamics and potential barriers to healthy connections among family members, objects, and community. Once we feel we are ready to move to the next phase of treatment, we introduce the child into therapy, but the parent is still a part of the process. It’s important for everyone to be learning skills, understanding different ways to communicate, and meeting therapy expectations.

M: How do you gain buy-in with your clients?

P: I have found that buy-in is a process rather than an event for young people in the program. This process has several stages. The first stage is initiation which really involves understanding what the process is going to look like. For example, what is counseling? Or to those who have received counseling, how this is different. The next stage is accomodations which is learning how to incorporate the new information with their old information. In this stage it is important develop the youth’s framework which includes language, and their own social rules.  I have found in the this stage we start to get investment, and allows the final stage of assimilation to take place, which essentially is to connect and use session language and rules.

K: When we work with the young person, it is so crucial to develop a rapport. We may use a variety of tools to learn more about the child, but we set expectations about the therapy process up front so we avoid confusion about the process, our roles, and decrease anxiety. Taking time to learn about them, listening to them, while being sensitive to their needs helps to gain client buy in.

M: Unstructured social environments are often the most challenging environments for ASD individuals to navigate.  Social rules are situational and there are a lot of gray areas which make it so difficult for our literal, concrete, black and white thinkers to conceptualize.   What are some of the challenges you face when providing therapy?

P: There are so many challenges, but the one which seems to resonate with me is how anxiety impacts these young people, and as a result any skills they have learned are not demonstrated. Another big challenge is when negativity surfaces. Many young people struggle with connecting or joining because of the negative lens they are operating out of.

K: What you just described! Because there are so many gray areas it creates more anxiety with our kiddos. Anxiety can definitely be a challenge during therapy but typically a focus area. In addition, when the social world is not reinforcing for the young person maybe because he or she has been faced with social resistance, or lack of positive responsiveness from others, a young person’s social history is written with negativity. This can be challenging. If a child has a history with bullying, isolation, exclusion from the group, social motivation decreases. These factors mixed with how information is received and perceived, along with social rules, and being a literal concrete thinkers are areas we navigate and explore, but nonetheless can be large hurdles for us in therapy.

M: I have had the pleasure of working with students whom you have intensively worked with and their social skills, social awareness, and ability to self reflect undoubtedly surpass their peers.  Clearly your methods are effective.  Do you feel with therapy, early intervention is key or do you feel these skills can be acquired at any age?

P: We know now that early intervention creates opportunities to contact the skills to the people in their environment. Having families involved early in the process can help manufacture individual and family opportunities both within the family and community to practice. With that said, I have seen families and young people who have a lot of motivation around enhancing their skill sets, and even though they started later, we have seen significant progress.

K: I believe early intervention is important, but also the frequency and intensity of intervention should be assessed for each child. I have experience working with children who have been exposed to “too much” therapy at an early age. This created therapy resistance or burnout for the child, not to mention the parents. I think each family needs their time, whether that’s early on or later, in order to develop a comprehensive plan to meet their needs.

M: You have helped me problem solve and structure some high school social settings for students that I felt were nearly impossible to structure.  Your influence on my social skills instruction and mentoring have been very positive and effective. Who are your influences in the ASD therapy community?

P: I can only say  I feel blessed to have encountered many therapists, teachers, administrators who have influenced my work. To be honest with you, my real source of influence is the children and their families, and without them, I would not be here.

K: My work is influenced by the children and adults on the Autism Spectrum along with the resilient families we have the opportunity to connect with on a daily basis. There is no doubt that I have had wonderful experiences learning from other clinicians, professionals, and educators who have influenced my work as well.

M: A lot of our work requires the ability to be able build a relationship with our kiddos and to understand the perspectives of the individuals we work with.  Have you ever had a clients that you struggled to connect with?   How did you overcome this?   

P: This is a great question. Teaching connect requires that a platform be built to accommodate the connection. Sometimes there are variables which influence the connection such as preferred activities or changes in scheduling to be part of a therapy.

K: It would be unrealistic to say we have not been challenged with this. I would agree with Paul that in order to connect, one needs to be taught how to connect. So, we look to teach what connection is and how to connect through the child’s personal value system. We also understand that connection is a process, not an event, so being patient and consistent will help.

M: I see a lot of young adults on the spectrum turn to computers and video games to provide themselves opportunities for what I call “shielded social interaction.”  What advice would you give to the parents who are struggling to get their child motivated to navigate the social world beyond the screen in their bedroom?    

P: This is a huge challenge for families. We have had many conversations about the role technology can play in someone’s life. Looking at it on a case to case bases requires us to have a variety of different conversations. I try to look at technology as assistive technology. Does it connect you in a functional way to people, place and opportunities? If it does not, then we have to have the discussion around building bridges, and create surrogate replacements for the computer, so these individuals can establish healthy connections.

K: Technology is a powerful force and will continue to be. Technology can be a social tool if taught to be. We have seen “the screen” become very problematic when its accessible throughout the day without limitations and its use is solitary, most of the time. To increase motivation a parent may need to use what the young person values most, and if that’s technology then it does become the reinforcement but with healthy boundaries and setting these boundaries as early as possible.

M: It is no secret that bullying is a huge problem for kiddos on the spectrum.  What advice would you give parents of kiddos who are faced with bullying at school?  

P: The advice I would give families is to advocate immediately for their children. By the time a child offers any information which appears to be bullying, you can bet this has been going on for quite a while. Keeping our young people feeling safe,  connected, and in a predictable routine, creates a feeling of safety, and that is why it is so important to advocate for those elements . If those are compromised, and the outcome will not be positive.

K: Be an advocate! If you see behavioral changes and or appearance changes make note and coordinate meetings to further discuss and explore. So often, our children struggle to discriminate whether the actions of others is in fact bullying or friendship. Take time to listen, observe, and attempt to remain calm as difficult as it may be.  

M: You are both so innovative with your therapy approaches.  What do you see is next for your practice?

P: I see my practice evolving into the area of education and advocacy. I see so many areas that our young people can become a part of. My goals is to help our families and children break down walls which are creating barriers, and help them build bridges.

K: Honestly, I want to continue building awareness, acceptance, and support for this population. Regardless of what position I am in or who I work for, I want to stay connected to the Autism community to continue helping and learning.

M: Thank you so much for your time and sharing your wealth of knowledge.  I could spend days talking with the both of you about your stories, experiences and ideas.  It is apparent that you both have dedicated your careers to providing meaningful, outside of the box therapy for the ASD community.  

 

 

Spectrum Inspired.