Support Workers Perspectives on Counselling for those

Diagnosed with Autism Spectrum Disorder

Jordan Purcell

Matriculation: S1108777

PSYCHOLOGY EMPIRICAL PROJECT

MHC821090

Supervisor: Rosemarie Lynass

2014/15

Word Count: 9596 An empirical project submitted in part

fulfilment of the requirements for the award of the BA Social

Sciences (Honours) Degree.

Contents

Acknowledgements 2

Abstract 3

Introduction 5

Methodology 20

Design 20

Participants 20

Materials 21

Apparatus 22

Procedure 22

The Interview 25

Approach to Analysis 26

Reflexivity 29

Ethical Issues 30

Analysis/Discussion 33

References 46

1

Appendices 52

2

Acknowledgements

Firstly, I would like to say thank you to my empirical project supervisor Rosemarie Lynass.

Without your support and encouragement this year, I would most definitely not have been

able to complete my project and I am so grateful to you for allowing me to focus on a topic

that means so much to me.

I would also like to say thank you to my family, most importantly my Mum and Dad, my

sister Robyn and my boyfriend Martin. I know that you have all been on the receiving end of

my tantrums and moaning throughout my four years at university so I feel you all deserve a

special thanks for putting up with me. Thanks for encouraging me to try my hardest and for

having faith in me when I didn’t have faith in myself. Hopefully it has all paid off!

Dylan, thank you for being there for the past fifteen years and letting me cuddle you

whenever I was stressed or upset throughout my time at primary school, high school, college

and university.

Also, to my cousin Rebecca, I don’t think I could have gotten through this year at university

without having you to freak out to and listen to my moaning. Thank you! And to my cousin

Lauren, thank you for offering to help me when I was stressing out and listening to my

greetin’. You’re the best!

I would like to say thank you to my friends Jenna, Emma and Lauren, with a special mention

to Chanelle and Karly. The past five years have flown in and I couldn’t imagine going

through college and university without you both. Can’t wait to celebrate!

Lastly, to my Uncle Colin. You inspired me to do this more than you’ll ever know x

3

Abstract

Autism Spectrum Disorder is a neurodevelopmental disorder that is increasing in diagnoses

rapidly (Happe, Ronald & Plommin, 2006; Kazdin, 2000). Counselling is used as a method

of treatment and intervention for those with Autism Spectrum Disorder, focusing on adopting

a person-centred approach in order to shape the counselling session to suit the client. Despite

the prevalence of Autism and the ever growing popularity of ‘talking therapies’ such as

counselling, there has been very limited research into the areas of counselling and Autism.

This study sought to analyse support workers’ perspectives on counselling for those

diagnosed with Autism Spectrum Disorder, recruiting five participants from Strathclyde

Autistic Society who are employed as Home Support workers and Play Scheme workers.

This qualitative research used semi structured interviews and an inductive approach and

thematically analysed participant responses’ in order to identify support workers perspectives

on counselling for those with ASD and identifying perceived barriers in counselling,

determining whether counselling is viewed as a beneficial approach to helping those with

ASD and looking into awareness and accessibility to counselling. The data collected from

the semi-structured interviews was analysed thematically, with the researches identifying

codes and emerging themes in participant responses’. The study successfully identified

perceived barriers in counselling for those with ASD such as communication and social

interaction, and gauged that support workers’ have a generally positive view of counselling

for those with ASD, believing that it could be beneficial in helping clients’ deal with social

situations and coping mechanisms. The research also identified that there is a significant lack

of accessibility and awareness of counselling as an approach to helping those with ASD. The

research questions were successfully supported in their exploration of counselling as an

approach for those with ASD from the perspectives of support workers, however the research

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is determined to have limitations as it used an exclusively female sample and the sample size

is relatively small. These findings are discussed in relation to relevant literature and theory.

5

Introduction

Autism Spectrum Disorder (ASD) is a term which medical professionals and psychologists

have had difficulty in applying a definition to due to the broad spectrum of symptoms,

behaviours, mental processes and perspectives (Happe, Ronald & Plomin, 2006). According

to the American Psychiatric Association (APA), ASD can be defined as a

neurodevelopmental condition which is diagnosed on the basis of three behavioural

impairments: impaired social interaction, impaired communication and restricted and

repetitive interests and activities (APA, 1994). More recently, Kazdin (2000) has defined

ASD as a social impairment which can affect the ability to interpret social situations, the

feelings of others and having a significant effect on the individuals’ verbal and non-verbal

communication. Significant changes have been made in the fifth edition of the Diagnostic

and Statistical Manual of Mental Disorders (DSM-IV) in relation to the diagnosis criteria for

ASD. The DSM-IV has combined Autism, Asperger’s Syndrome (AS), Childhood

Disintegrative Disorder and Pervasive Developmental Disorder one diagnostic category

referred to as Autism Spectrum Disorder. These diagnoses are now grouped under the

heading of Neurodevelopmental Disorders (Buser, 2015).

Prevalence of Autism Spectrum Disorder

Statistics collaborated by the National Autistic Society (2014) show that one in every

hundredth individuals in the United Kingdom will be diagnosed with ASD (NHS, 2014). In

the United States of America, data collected by California’s Department of Developmental

Services (1999) reported a two hundred and seventy three percent increase in the number of 6

children entering treatment centres for ASD within the region over the course of eleven years.

This saw the prediction of one in two thousand five hundred individuals being diagnosed with

ASD prior to the 1990s increase sharply to one in every one hundred and ten (Bernier &

Gerdts, 2010). The American Academy of Pediatrics (2008) offer a number of factors in the

increase in diagnosis, such as the increasing number of behaviours and disorders which are

currently being considered in the definition of ASD in comparison to previous years and the

increasing awareness of ASD in both the medical profession and society (Oller & Oller,

2010).

Autism Epidemic

Many psychologists declare that society is currently experiencing a worldwide autism

epidemic (Eyal, Hart, Onculer, Oren & Rossi, 2010; Bock & Stauth, 2008). An epidemic is

defined as a widespread occurrence of a disease in a community at a particular time

(Stevenson, 2009). Eyal et al (2010) states that the reason for this epidemic is due to the

visibility of autism in modern society and not the epidemic highlighting the prevalence of

ASD diagnosis. Eyal et al believe that the frequency in diagnosis is due to the change in

diagnostic criteria in the DSM IV, greater awareness of ASD as a disorder and the behaviours

and disorders associated with ASD, and better detection services in the medical environment.

However, Kirby (2007) refutes the ideology of an autism epidemic and discusses the

controversial argument focusing on the possibility of children’s exposure to mercury through

vaccinations playing a key role in the surge of autism diagnoses. Jepson & Johnson (2007)

also argue that the changes made to the diagnostic criteria for ASD in the DSM-IV are not

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significant enough to encourage such a dramatic increase in in the diagnosis of ASD in recent

years, focusing on the increased awareness of the disorder in recent years and social

ignorance towards the disorder in years when the disorder was less common.

Person-Centred Therapy

Rogers’ (1950) concept of person-centred therapy is pivotal in relation to the discussion of

counselling for those diagnosed with Autism Spectrum Disorder (Chalk, 2012). Person-

centred therapy involves the process of clients assessing their perception of self, in

comparison to similar approaches such as psychodynamic psychotherapy, which is more

dependent on the counsellor’s ability to interpret the client’s unconscious thoughts and ideas

(Tudor & Worrall, 2006). The person-centred approach is an effective method of counselling

for individuals diagnosed with ASD as it provides clients with a social environment which

encourages their communication and engagement with the counsellor. Joseph et al. state that

the appropriate social environment encourages the development of emotional growth and the

actualisation of their inherent optimal nature. This provides clients with the ability to

communicate, which aides in the positive outcome of the therapy.

Robertson, Emmerson, Hatton, Elliot, McIntosh, Swift, Krijnen-Kemp, Towers, Romeo,

Knapp, Sanderson, Routledge, Oakes and Joyce (2005) conducted a study which explored the

effectiveness of person-centred therapy and provides evidence of how it is beneficial to those

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on the autistic spectrum. Robertson et al study used twenty-five participants who had been

diagnosed with learning disabilities such as ASD and Asperger Syndrome (AS) and took

place over a period of two and a half years, measuring the positive effects of person-centred

therapy. The study was conducted over four locations in England on the basis that person-

centred therapy was to be implemented with the aim of benefitting the client and having a

positive outcome for the client’s life experience, as opposed to seeking to meet organisational

obligations and requirements. These locations also had a diverse community, ranging from a

wide variety in ethnicity, affluence and urban/rural locations. The data collected in this

qualitative study was thematically analysed with the aim of identifying the effect that the

implementation of person-centred therapy can have on a participant with a learning disability

such as ASD or AS and the costs of such implementation. The results of the research showed

that clients’ participation in person-centred therapies were positively correlated with clients

increased involvement within the community, increased interaction with family and friends

and an increase in social activity. Furthermore, the results showed that person-centred

therapy had a negative effect on areas such as employment and physical health. This was

considered to be a negative consequence of the increased activity in social involvement.

However, it could be considered that those who qualified to participate in the person-centred

therapy could generally be of ill health which would have a significant effect on employment

and physical health, which is a possibility that has been explored in Emmerson’s later

research.

Emmerson and Baines (2010) carried out a study which sought to assess health inequalities of

those diagnosed with learning disabilities in Britain. Emmerson et al state that people

diagnosed with learning disabilities are proven to be more poorly in health than their non-9

disabled peers. Statistics provided in the research paper have indicated that people with

learning disabilities who reside in the Britain are evidenced to have earlier mortality rates and

are 2.5-4.5 times more likely to have poorer general health than their non-disabled peers.

These results could conflict with Emmerson’s earlier suggestions that person-centred therapy

has a negative effect on physical health and employment, as more recent research suggests

that individuals with learning disabilities generally have poor health which could therefore

have a negative effect on their likelihood to find stable employment.

Prouty’s theory of Pre-Therapy & Social Autism Pre-Therapy

Prouty’s theory of pre-therapy and social autism pre-therapy, also referred to as ‘contact

work’, is a method that is used to bring individuals diagnosed with learning disabilities, such

as Autism Spectrum Disorder, to a state of ‘psychological contact’. This theory is heavily

influenced by Rogers’ concept of person-centred therapy and is implemented with the aim of

bringing those who are regularly in a state of agitation or upset to a state in which they can

communicate (Cooper, O’Hara, Schmid & Bohart, 2013). As those with Autism Spectrum

Disorder are often in states of high stress regardless of their environment, Prouty’s concept of

pre-therapy allows for therapists and their clients to establish a means of communication and

therefore allows for emotional expression to take place (Prouty, 1994). Pre-therapy is the

concept and process of psychological contact, which is defined as a process where two

individuals are effected by and respond to one another. This forms the basis of a reciprocal

relationship (Rogers, 1957). When individuals’ who are participating in pre-therapy start to

engage meaningfully on a daily basis, they are determined as to be fully functioning. In order

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to become fully functioning, clients must experience three processes which are known as

reality contact function, affective contact function and communication contact function.

Reality contact function refers to the clients’ awareness of what is realistically happening in

their environment. Affective contact function refers to the clients’ ability and willingness to

experience feelings and emotions. Communication contact function refers to the clients’

ability and willingness to verbally communicate their thoughts, feelings, moods and emotions

to others in their environment in a socially acceptable manner which allows others to

understand them. The aim of pre-therapy is for every client to achieve psychological contact

with others. However, this is not always a realistic possibility as this is dependent on the

individuals’ abilities. Therefore, it can be determined that individuals’ diagnosed with low

functioning ASD might not have the ability to achieve the three contact functions. This can

sometimes result in pre-expressive behaviour, of which a consequence is people isolating

themselves, becoming withdrawn and expressing odd physical behaviours. Pre-therapy is

determined to be a positive process as it provides clients’ with the ability to function in

everyday life, to their full potential (Wilkins, 2009).

Sommerbeck (2001) suggests that pre-therapy could possibly be damaging to patients as the

processes could be perceived as patronising and condescending. This is because the process

require practitioners to mimic the behaviour of clients’, which could have a detrimental effect

on the client akin to the issues of ableism.

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Labelling Theory

The labelling theory is a sociological theory which was developed by Becker in 1963. The

labelling theory focuses mainly on two questions; why are some people chosen for labelling

rather than others? And what is the effect of official labelling on future behaviour?

(Farrington & Murray, 2013). Labelling refers to society’s tendency to assume that an

individual will adopt certain behaviours or attitudes which are stereotypically associated with,

in this case, those who have a mental illness or learning disability. This can often lead to

self-acceptance of being of a particular label and can often result in influencing an individual

to behave in a certain way and embracing this as their personal identity (Brain, 2001). Scheff

(1966) constructed the first labelling theory in relation to mental health, which focused on

both informal labelling and official labelling processes Informal labelling refers to the

labelling from a spouse or friend, whilst formal labelling refers to the label which is applied

to a person through treatment contact, such as their participation in counselling (Aneshensel,

Phelan & Bierman, 2012). Pilgirm (2014) states that primary deviance arises from biological,

psychological and social sources but that the ultimate fate of the individual exhibiting the

behaviour is determined by contingent social-psychological factors. Secondary deviance is

therefore shaped by these social-psychological factors; namely the extent to which the

behaviour is tolerated or labelled and controlled. According to Pilgrim, these processes

amplify the role of the labelled individual.

Hodge (2012) conducted a study which focused on clients diagnosed with Asperger’s

Syndrome, and aimed to highlight how the processes of labelling can have a negative effect

on clients’ participation in counselling. Hodge’s findings showed that during their

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participation in counselling, clients’ diagnosed with AS may consciously make an effort to

appear neurotypical and exhibit behaviours they deem to be socially normal rather than give

in to AS tendencies, whilst other individuals are accepting of the label. This can often result

in problems between the counsellor and client establishing a relationship as those on the

spectrum are less likely to have the ability to honestly express their thoughts and feelings.

This can also be a problem as it makes it impossible to address issues which are required to

be discussed for a positive outcome of counselling.

Barriers

Barriers in social interaction and communication are a significant source of difficulty for

individuals diagnosed with ASD and can have a debilitating effect on their ability to tell

others how they are feeling, interpret social situations and empathise with others (NAS,

2015).

Ableism is defined as prejudice against individuals who are not able-bodied or have been

diagnosed with a disability (Colman, 2009). According to Rose (2010) ableism determines

ASD to be a disability and reinforces this negative affliction throughout society, through the

media and medical system and is significantly apparent in the education system.

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Hodge (2012) carried out various research which aimed to identify the barriers that are faced

by those on the Autism spectrum during their participation in counselling. Hodge’s initial

study which was carried out in 2012, and sought to explore the notion of ableism and

determined that experiencing the effects of ableism can have a significantly negative impact

on the process of counselling. Hodge assesses how ableism can have a detrimental effect on

an individuals’ ability to express any means of empathy they may feel, and explores how this

can make counselling a negative experience. Hodge uses the example of his client, a young

boy diagnosed with ASD and his experience of counselling. Hodge aimed to support

counsellors in assessing and discussing how individuals with ASD are likely to process and

interpret a counselling session, and how the prevalence and experience of ableism can effect

clients’ ability to feel comfortable enough in their environment to engage with the counsellor,

resulting in a positive perspective of counselling. Hodge suggested that in order to encourage

the positivity of counselling, counsellors should deem every counselling session to be an

organic process. Hodge also suggests that the counsellor approach every session with a fresh

mind set and clear perspective and should be prepared to view issues from the clients’ point

of view. This will encourage counsellor to establish a relationship with the client and aims to

result in a positive outcome.

Emotional Awareness

Autism Spectrum Disorder is one of the principal disorders which involve deficits of

empathy, with social communication considered to be the overarching core deficit amongst

those diagnosed with ASD. Although some people who have been diagnosed with ASD are

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less functionally impaired and still have normal vocabulary and sentence construction, in

childhood their praxis differs significantly from typically developing children. Individuals

diagnosed with ASD exhibit early deficits in social interaction and communication,

particularly difficulties in the ability to differentiate emotional facial expressions, basic

imitation abilities and empathy (Benson & Haith, 2010).

Silani, Bird, Brindley, Singer, Frith and Frith (2008) conducted research which sought to

explore those with Autisms’ inability to identify and define their own feelings. The research

used fifteen participants diagnosed with ASD, consisting of thirteen males and two females,

and a control group which was made up of thirteen participants with no known disorders

which effect emotional awareness, consisting of thirteen males and two females. Silani et al

measured this inability through the use of alexithymia and empathy questionnaires, assisted

by the use of fMRI in order to investigate participants’ brain activity whilst introspecting on

emotion. Participants were required to rate stimuli from the International Affective Picture

System twice, one according to a degree of un/pleasantness that the pictures induced, and the

second according to colour balance. The results of the study showed a significant difference

between the two groups in the alexithymia and empathy questionnaires, with a significant

correlation between the alexithymia and lack of empathy highlighting a link between

understanding one’s own emotions and the emotions of others. A significant difference

between both groups was also found in self-reporting, with the study showing that those with

ASD showed a reduced activation in self-reflection and mentalizing regions. Overall, the

results of the study showed that individuals diagnosed with ASD lack of emotional awareness

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is related to hypo activity, and that particular difficulties in emotional awareness are not

related to their impairments in self-reflection.

Research conducted by Baron-Cohen and Wheelwright (2004) questioned the self-reporting

methods used to measure levels of empathy of those diagnosed with ASD and proposed the

use of the Empathy Quotient (EQ), providing evidence of its reliability in determining a

difference in degrees of empathy between individuals with Autism and a control group. The

study used ninety participants consisting of sixty-five males and twenty-five females who had

been diagnosed with Autism and Asperger’s Syndrome (AS) and a control group which

consisted of an equal number of male and female participants. The results of study one

showed that the participant group consisting of those diagnosed with Autism and AS scored

significantly lower on the EQ than the age matched control group. Specifically, of the ASD

and AS group, eighty one percent of participants scored equal to or fewer than thirty points in

comparison to the control group of which only twelve percent scored equal to or less than

thirty points. The results of the study therefore confirmed that there is a significant deficit in

empathy between those with Autism and AS.

Deficits in Communication

The lack in communication skills and lingual abilities are unique to those diagnosed with

Autism. According to Frith (1989), all the impairments that are unique to autism are

concerned with the deficit of language for the purpose of communication. Frith states that

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this inability to achieve satisfactory communication can be identified with a limitation in the

computing of relevance and as a lack of taking account of mental states. This is determined

to be a consequence of a cognitive dysfunction, which leads to impairments in social

relationships and imaginative play.

Lord, Risi, Lambrecht, Cook, Leventhal, DiLavore, Pickles and Rutter (2000) conducted a

study which sought to measure social and communicative deficits associated with the Autism

spectrum. The two hundred and twenty three participants were made up of both adults and

children, all of whom had been diagnosed with Autism Spectrum Disorder or Pervasive

Development Disorder Not Otherwise Specified (PDDNOS). The information was measured

through the use of the Autism Diagnostic Observation Schedule- Generic (ADOS-G), which

is a semi-structured, standardized assessment of social interaction, communication, play and

imaginative use of materials. The observational schedule was comprised of four modules

which lasted for a period of thirty minutes, with each module differing in design according to

the participants’ individual level of expressive language. The findings of the study showed

that those diagnosed with ASD expressed significantly less communicational skills both

physically and verbally throughout all four modules in comparison to the participants

diagnosed with PDDNOS, therefore supporting the general consensus that ASD has a

debilitating effect on an individuals’ social interaction and communication. This is evidence

of the struggles faced by those diagnosed with ASD and can also offer an explanation for the

difficulties experienced by individuals with ASD when participating in face to face

approaches such as counselling.

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Accessibility to Counselling

Research into the commonality of those with ASD participating in counselling or being

offered counselling is extremely limited, as is the literature. Reeve (2000) cited in Hodge

(2012) states that a key factor in the lack of research into counselling for those on the autism

spectrum is the dependency on the clients’ financial situation. Reeve and Hodge offer their

perspective which suggests that the likelihood of non-disabled people being more financially

comfortable is increasingly higher than those who have been diagnosed with a learning

difficulty or disability, such as ASD as they are less likely to be in stable employment. Reeve

et al believe that this has a significant effect on the number of individuals on the spectrum

who participate in counselling. Most treatments offered to those with Autism by the National

Health Service in Britain are offered in early childhood upon diagnosis. Amongst these

common approaches are Applied Behavioural Analysis (ABA), dietary approaches and

medicinal approaches such as the prescription of antipsychotics, antiepileptic drugs and blood

pressure medication which aim to alleviate the behavioural symptoms of ASD (Turkington

and Anan, 2007). Hodge also states that there is a negative perception of counselling in

relation to autism and Asperger Syndrome as these conditions are often linked to anxiety and

depression which can steer professionals away from recommending counselling. As

counselling does not appear to be a typically common approach to autism treatment, this

could account for the lack of research in this area.

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Aims & Objectives of Research

Based on previous research and literature, this research aims to explore support workers

perspectives’ on counselling for those diagnosed with Autism Spectrum Disorder. The

research questions if there are any perceived barriers that support workers consider inhibiting

to those diagnosed with ASD during their participation in counselling and aims to identify

these barriers. The research also seeks to determine if counselling is a commonly discussed

and easily accessible source of treatment for individuals with ASD, questioning if support

workers determine that it is likely for individuals with ASD to actively seek counselling, and

if support workers think that counselling would be a beneficial source of help to those with

ASD. The research also explores support workers’ perspectives on how counselling could be

made more accessible to those with ASD.

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Methodology

Design

The research project used a qualitative, semi-structured face to face interview design. The

study aimed to analyse the perspectives of support workers who have worked alongside

individuals diagnosed with Autism Spectrum Disorder, exploring the benefits of those with

ASD participating in counselling and the perceived barriers that may have an effect on the

process and outcome of their participation in counselling. The study aimed to determine

whether support workers felt that counselling would be beneficial or unbeneficial to those

with ASD and aimed to identify support workers reasons pertaining to the ineffectiveness of

counselling for those diagnosed with Autism. For example, do support workers feel that

there are barriers that may have a significant effect on individuals diagnosed with ASD’s

ability to participate in counselling? An example of these issues could be communicative

issues or difficulties engaging effectively in social interaction.

Participants

A total of five participants were used in this study, which consisted of five females who are

currently or have previously been employed in the position of home support worker or play

scheme worker by Strathclyde Autistic Society. The researcher did not consciously recruit

five female participants, this was the result of a majority female populated workforce. The

principal investigator of the research project is also a current employee of Strathclyde

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Autistic Society so measures were taken to ensure that colleagues known to the investigator

were not recruited as participants for the study. An e-mail was sent to the chairwoman of the

charity giving a brief summary of the aims of the study and requesting the charity’s

permission to use employees of Strathclyde Autistic Society as participants in the research

study (Appendix A). Permission was granted from the chairwoman of the charity to

interview employees’ willing to take part in the research project (Appendix B). Participants

were recruited through the use of a recruitment e-mail (Appendix C) sent to their work e-mail

addresses which were provided by Strathclyde Autistic Society. The e-mail gave a brief

summary of the research, the length of time that was required for participation (estimated to

be between thirty and forty-five minutes) and contact details of both the principal investigator

and the supervisor should the participants require any further information and to inform the

researcher if the wished to confirm or decline their participation in the study.

Materials

Five consent forms (Appendix D) and five information sheets (Appendix E) were printed and

one was given to each of the participants upon arrival to the location of the research study.

Participants were also provided with pens to sign the consent forms. The researcher printed

five copies of the interview schedule (Appendix F), one for each interview. The interview

schedule was blank at one side in order for the researcher to take notes during the interview if

need be, using the pens provided. Five debrief sheets (Appendix G) were printed off to be

given to each participant at the end of the study.

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Apparatus

The interviews were recorded using the voice note recorder on an Apple iPhone 6 and were

then uploaded onto a password protected laptop and encrypted using 7zip encryption software

in order to protect the data collected.

Procedure

The current study obtained ethical approval from the Glasgow Caledonian Ethics Committee.

The information sheets and consent forms provided in the study met ethical guidelines and

were deemed to be sufficiently informative. A risk assessment form (Appendix H) was

completed by the researcher due to the study being conducted outside of university grounds

and to address ethical concerns raised by the researcher interviewing colleagues from

Strathclyde Autistic Society. The risk assessment form was analysed by the Glasgow

Caledonian Ethics Committee and approved. The debriefing material provided all necessary

information as it gave participants a brief summary of the purpose of the study and provided

contact details of the principal researcher and supervisor should the participant require any

further information regarding the study, have any questions about their participation or wish

to request their responses be withdrawn. The approved ethical application form is available,

see Appendix I.

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The participants who responded to the e-mail and granted their consent to participate in the

research were each contacted individually to arrange a date and time for the interviews to

take place. The interviews were conducted in a ground floor IT room within Centre 81, a

local community centre where the Strathclyde Autistic Society’s secondary office is also

based. The interviews were all conducted in the evening time, after the Strathclyde Autistic

Society’s office closed in order to prevent contact with other employees or bosses, in order to

minimise the chance of the possible encounters influencing the participants’ responses to the

interview questions. Other business’ bases and community classes continued to take place as

usual during the time of the interviews and the care takers remained in the building until the

centre closed which was before the end of the interviews. Participants were interviewed

separately.

Participants were directed to take a seat at the table in the room and were handed the

information sheet and consent form and were asked to read over these sheets and sign with

the pen provided should they wish to continue. The researcher advised the participants that

they would not be required to participate in the study for any longer than forty-five minutes.

The researcher then collected in the consent sheet and informed each participant that they

could keep the information sheet should they wish to. The participants were also informed

that whilst their contribution and participation in the study would be anonymous, it would not

be appropriate for them to refer to a specific client and they were asked to answer all

questions with a general perspective without focusing on one particular experience or

referring to one particular person. The participants were also advised that no information

23

would be discussed with the chairwoman, managers or other employees of Strathclyde

Autistic Society. However, should any participant communicate any information to the

researcher which gives the researcher cause for concern for the welfare of any individual,

employee or client, the researcher has a moral obligation to let the appropriate people know.

The researcher then advised each participant that the interview would be recorded using the

voice note recorder on an Apple iPhone 6 and requested their permission to do so. After

permission was granted from each participant, the researcher sat in a seat directly across from

the participant.

The researcher activated the voice recorder and asked each participant the five open ended

interview questions on the interview schedule. Whilst the participants provided their answers,

the researcher would occasionally write down notes on the blank spaces on the interview

schedule when necessary.

After all interview questions were asked by the researcher and answered by the participants,

the participants were debriefed using the standardised debriefing form. The participants were

thanked for their participation in the study verbally and any questions asked were addressed.

Participants were also informed of the aims and objectives of the study and were reminded to

take their information sheet which provided contact details for the researcher and research

supervisor. Participants were also informed of their right to withdraw from the study at any

24

time until the data is written up in the final report, however they were assured that they would

remain anonymous.

The information gathered through the interviews were transcribed verbatim and saved to a

word document using pseudonyms (Appendix J). The word document was then encrypted

using 7zip encryption software and saved onto a password protected laptop.

The Interview

The research used semi-structured interviews as a method of data collection. This was

determined to be the most suitable method of data collection for this study as this method

permits the researcher to request more information from a participant regarding the answering

of a question. This therefore allows the researcher to obtain sufficient information at a depth

that the researcher deems necessary, in order to make a reliable conclusion of the data

collected (Craighead & Nemeroff, 2002).

This was determined to be the most appropriate and effective method of data collection for

this study due to the nature of the study, as the main focus is exploring the perspectives of

support workers in relation to counselling for those on the Autism Spectrum. The questions

25

asked by the researcher require more than a yes or no answer and using a semi-structured

interviews allows the researcher to ask for further information pertaining to a participants’

answer, if necessary. The researcher consciously chose not to use other methods of data

collection such as questionnaires or structured interviews as these methods do not allow for

flexibility when asking questions and when receiving participant responses’ (Hersen, 2011).

Approach to Analysis

An inductive approach was adopted in the analysis of the data collected from the interviews.

An inductive approach is often used within qualitative analysis as this approach allows for the

data to lead to the emergence of concepts, which has been demonstrated within this research

through the identification of emerging patterns in participant response regarding the

perception of barriers in counselling, labelling and recurring themes in relation to the

exposure to counselling (Yin, 2011).

This was determined to be an appropriate approach to data analysis for this study as inductive

research begins with observations and proceeds with a search for patterns in what has been

observed. The researcher plays a key role when adopting an inductive approach to data

analysis, as it requires the analyst to have a strong reserve of insight and reflection in order to

successfully identify crucial patterns embedded within the observations (Babbie, 2009).

The principal researcher of this study was actively involved in conducting the experiment,

through the participation in face to face interviews with recruited participants and analysing

data through observation and identification of trends and patterns, rather than deciphering the

26

data with the aide of computer software analysis. The inductive approach was therefore an

effective method to use within this study as it was key in highlighting recurring issues and

trends in participant responses.

Thematic analysis is defined as a qualitative analytical method of “identifying, analysing and

reporting patterns and themes within data”. This method of analysis organises and describes

the data collected in significant detail and interprets various aspects within the topic of

research (Braun & Clarke, 2006).

The researcher followed the six step process of coding in order to identify, organise and

interpret the significant patterns which emerged throughout participant responses. The six

stages of coding that were followed were: familiarization with data, generating initial codes,

detecting themes amongst the codes, reviewing themes, defining and naming themes, and

writing up the final report (Saldana, 2008).

Following the process of coding, the researcher transcribed the recording of the interview

verbatim to separate word documents. The researcher read over the transcripts from each

interview several times in order to become familiar with the participant responses. The

27

researcher then highlighted specific areas of each transcript that were of interest, such as

similar responses from a number of participants, which is referred to as codes. The

researcher then sought to identify relationships or similarities between these codes and

grouped similar codes together. In thematic analysis this is referred to as a theme. These

themes were then labelled in relation to the group they belong to, such as the emerging theme

of barriers, with the codes being discussed under the heading of barriers. The codes were

grouped together and split into categories: ‘barriers’, ‘counselling: beneficial or

unbeneficial?’ and ‘exposure’. The category of ‘barriers’ consisted of three subcategories

which were labelled as social interaction, communication deficits and understanding emotion.

The category of ‘counselling: beneficial or unbeneficial?’ was considered as one theme. The

category of ‘exposure’ was subdivided into awareness and accessibility and awareness and

responsibility.

This was decided as an appropriate method of analysis for this research as it allowed the

researcher to highlight the recurring themes in the participant responses and allowed for the

researcher to discuss information collected through the interviews which supported the basis

for this study, such as identifying which barriers are perceived in counselling for those with

ASD.

28

Reflexivity

Finley (2003) defines reflexivity in qualitative research can as the researchers’ engagement in

self-aware meta-analysis, and awareness of the researchers’ role in the practice, process and

outcomes of qualitative research (Klenke, 2008). Reflexivity requires the acknowledgement

of the impossibility of researchers’ remaining ‘outside’ of one’s subject area during the

research process, and encourages the consideration of the ways in which a researcher’s

involvement with a specific study influences, acts upon and informs such research

(Nightingale & Cromby, 1999).

Willig (2001) identified two types of reflexivity in relation to research, termed personal and

epistemological reflexivity. Personal reflexivity considers the effect that the research process

has on researchers, and considers how this influence shapes researchers’ thoughts and beliefs

(Major & Savin-Baden, 2012). Epistemological reflexivity requires the critical interrogation

of how researchers have conducted research through aspects such as the design of the study,

the questions asked and the analysis of the results (Macfarlane, 2010).

Alvesson and Skoldberg (2009) suggest that there are two basic characteristics of reflexive

research, which are referred to as interpretation and reflection. Alvesson et al state that

interpretation fails to reflect any sense of reality, but instead is influenced by the assumptions,

political position, language and values. Reflection refers to the process of researches taking

29

into consideration the influence of themselves, their community and their traditions, effecting

the research. Reflection therefore becomes a form of interpretation and so is termed as being

reflexive.

Ethical Issues

The research faced a number of substantial ethical issues, however these ethical issues were

reported onto a risk assessment form and analysed and approved by the Glasgow Caledonian

University Ethics committee.

The first ethical issue that was considered was the interviews taking place off campus and in

a local community centre. The principal researcher and participants’ were all aware of the

location of fire exits and health and safety regulations within the building as they had all

completed the necessary training to work in the community centre due to the location of the

Strathclyde Autistic Society office being based within the centre.

The second ethical issue that was considered is the possible effect of the principal

investigator being a fellow employee of the company that the participants’ are also employed

by. However, an effort was made to recruit participants who were not familiar with the

30

researcher and had never worked alongside the researcher. Due to this, none of the five

participants were known to the researcher and so this minimised the effect that this could

have on participant responses.

The third ethical issue that was considered was the possibility of participants referring to a

particular client or colleague in their response to an interview question. The participants’

were asked in advance to only answer the questions with a general perspective of the issue

within the question. The participants were also informed that if they did refer to a specific

person, that information could not be used within the study and would be destroyed

immediately.

The fourth ethical issue that was considered by the researcher was the possibility of

participants attempting to discuss with the researcher any issues that they may have with their

employer, colleagues or job role due to them being employed by the same company.

However, participants were asked to remain professional in their responses and only provide

general information regarding the questions being asked in an effort to avoid this happening.

31

The fifth ethical issue that was considered by the researcher was the possibility of participants

providing information which may give the researcher cause for concern. For example, if a

participant admits to not following protocol which may put a client, the participant or other

employee’s in danger. Participants were informed before participating in the study that any

information provided that gives the researcher a cause for concern for the welfare of the

colleague or client, would have to be reported to the appropriate person at Strathclyde

Autistic Society.

32

Analysis/Discussion

This section of the report will analyse the themes and codes which were identified through

the thematic analysis of the interviews’. This will provide an in-depth analysis of the

results/findings and will analyse the relationship between these codes. Establishing themes

and patterns was a consequence of the thematic analysis that was conducted and so these

themes will be identified in this section of the report. The emergent theme of the interviews

will be discussed in relation to the literature and theory aforementioned in the paper.

Barriers

When participants were asked if they perceive there to be any barriers in counselling for

those with ASD, every participant identified a barrier that they considered would have a

negative impact on the process of counselling for clients’ with ASD. These barriers have

been split into three sub-categories:

Social Interaction

“In my experience it takes an awful lot, a considerable amount of time for both children and

adults with Autism to warm to you and build a trustworthy relationship so I’d imagine that

being questioned by someone they don’t know might make them feel quite intense, like they

are being interrogated and prodded to communicate feelings that they are uncomfortable

with. Quite a lot of clients I’ve worked with would be taken aback by it.” [Participant 1]

“…Some of them might struggle to settle in to the environment.” [Participant 2]

33

The issue of the difficulty in building a relationship was highlighted through participant

responses’. The participants also spoke of how being in the environment of a counsellors

office may be a significant barrier due to most individuals with ASD having issues with

physical proximity and feeling uncomfortable in social situations. As participants stated,

being in a room with a stranger in an environment which encourages communication and

interaction, may be a considerable issue. This issue with social interaction plays a pivotal

role in the effectiveness of counselling, for both the counsellor and the client (Hodge 2012;

Hodge 2012).

Communication Deficits

“I think there would be an initial barrier with communication. Like I said, a lot of clients I’ve

worked with who have been diagnosed with Autism have very limited communication or are

non-verbal, so there would be problems with their actual ability to communicate”

[Participant 1]

I think that communication is a very obvious barrier but in my opinion, I feel like it all comes

down to having appropriately trained staff who know the best ways to approach certain

issues without making the client feel uncomfortable and using methods that will encourage

communication.” [Participant 3]

“Most of the people that I work with just now communicate through idiosyncratic forms of

sign language so that would be a clear barrier for the counsellor. How would they be able to

communicate because a lot of people with Autism are maybe. Even if they aren’t non-verbal,

they’ve got severe verbal limitations in terms of communication so I think that would be a

definite barrier.” [Participant 5]34

Every participant stated that communication is a significant barrier in counselling, however

one issue that was highlighted by participants one and five was the difficulty in

communication with clients with ASD that are non-verbal.

Participant five stated that a method of communication used by many with ASD is

idiosyncratic forms of sign language, and stated that this as a definite barrier for both the

counsellor and the client, when attempting to deliver effective counselling. This significant

deficit in communication highlighted by participants is supported by the research of Lord,

Risi, Lambrecht, Cook, Leventhal, DiLavore, Pickles and Rutter (2000), whose insight into

communication deficit and issues with expressive language for those with ASD evidenced

that there is a significant barrier in this area.

Understanding Emotion

“Understanding tone. Facial Expressions. They might not convey what the counsellor’s

trying to get across.” [Participant 5]

“It can be hard for them to communicate how they’re feeling and their emotions, because a

lot of the time they don’t understand the emotion that they’re feeling. So I don’t really know

how they could tell a counsellor if they don’t know themselves.” [Participant 1]

Another significant issue that was recurrent in participant responses, was the issue of ASD

clients understanding of emotions. Participant five explained that through her experience of

35

work as a support worker she has become aware of how difficult it can be for those with ASD

to perceive the tone of someone’s voice and the significant problem in relating someone’s

facial expression to their emotions.

Participant one highlighted the issue of emotional awareness and remarked on the service

users’ inability to understand the complexity of emotion, not just in the case of interpreting

another person’s emotion, but understanding how they are feeling themselves, which is a

concept supported by the previous research of Silani, Bird, Brindley, Singer, Frith and Frith

(2008) and Baron-Cohen and Wheelwright (2004). The support worker expresses their

concern over the clients’ ability to effectively participate in a counselling session, which is

effectively a talking therapy, if they are unable to express themselves.

Counselling: Beneficial or Unbeneficial?

Assessing the results of the data analysis, it can be determined that support workers generally

do have a positive view of counselling for those with ASD and do feel that it could be

beneficial to those with ASD for a number of reasons:

“I think counselling could be helpful to people with Autism, cause I think it could address

different issues that they might be having in their life. For example, people with Autism can

struggle a lot with education and work, and counselling could actually provide them with

coping mechanisms for this. It might also be helpful for behavioural issues that people with

ASD might have. It could maybe provide them with calming methods if they suffer with

anxiety or anger issues that causes them to lash out.” [Participant 3]

36

“Definitely, I would say that it varies to each child or adult and it’s very context dependant,

according to that person’s personal circumstances. Like, for example, if they come from a

deprived background then I feel that counselling could help greatly with their communication

and social interaction skills. I definitely think that people diagnosed with Autism could

benefit from counselling. Even if it’s one to one counselling or group sessions, I think it could

help with their social interaction and stuff. Like, it might encourage them, if you know what I

mean?” [Participant 1]

“I think it would make people with Autism better equipped to deal with certain situations

better. They could have help in learning how to approach certain social situations and

learning appropriate ways to communicate and behave. That could be a great help in like

educational and social and work environments. (Pause) I think it could be especially helpful

for people with Autism that are in school or university, cause it would help them socialise

and would help them make friends. And that’s a key part of being a student and a pupil. I

think a lot of people with Autism find social situations like school and university really

difficult because of communication issues that people with Autism have. I think they’d find it

hard to make friends and feel accepted if they’re not able to express certain feelings and

interpret certain situations. So, I think if these issues were addressed in counselling it could

actually be a great help to them.” [Participant 4]

“I think it would depend on the persons circumstances, I think it would have different effects

on different people. So if someone had a bad background in the sense that they weren’t

mentally stimulated as they should’ve been and because of that they had issues with verbal or

physical communication, they would probably benefit from counselling cause it would

address their issues with communication and then hopefully help them learn to communicate

37

in a way that’s comfortable to them. I think that the type of counselling that people with

Autism receive would have an effect on whether it would be helpful or not.” [Participant 2]

The support workers determined that counselling could be beneficial in addressing

behavioural problems which are often experienced by those with ASD. A recurrent aspect

which the participants touched upon was how counselling could help those with ASD learn

how to cope during life experiences and social situations, such as going to school or

university or gaining employment. The participants also take into consideration how

counselling can be shaped to the individual, emphasising the benefits of a person-centred

approach (Rogers, 1950). These considerations of the benefits of a counselling session which

revolves around the needs of the client have been supported through the research of

Robertson et al (2005), whose exploration into the benefits of person-centred therapy for an

individual diagnosed with ASD, showed that participation in counselling benefitted

participants through an increase in community involvement and increased positive interaction

between the individual with ASD and their family and friends. This study gives evidence that

counselling can be beneficial to those with ASD, and lends support to the findings of the

research, that support workers feel that a person-centred counselling approach could be

beneficial to those with ASD.

Exposure

The analysis of the interviews highlighted the concerning issue of lack of exposure to

counselling as an option for those with ASD. This exhibited how there is a significant lack of

information available for those who have an interest in treatments and interventions for those 38

with Autism, whether that be an individual with Autism seeking counselling or relations or

Autism services seeking treatments on their behalf.

Awareness & Accessibility

When participants were asked how common they thought it would be for counselling to be

offered to those with ASD, four out of the five participants said that they determine it to be

uncommon for counselling to be offered to those with ASD:

“I don’t think it’s very common at all… I think people often maybe don’t realise the need for

people with Autism to be counselled and there’s maybe not enough experts in the field of

Autism to recognise their needs.” [Participant 3]

“I definitely don’t think there’s enough awareness that counselling is actually an option. It’s

rarely been discussed with clients that I’ve worked with over the last three years. I actually

know very little about it considering I’ve worked in this job for quite a while now, so I

definitely think that awareness must play a role in the reason why it’s not a common option.”

[Participant 4]

Two participants touched upon the lack of awareness of Autism as a disorder and of

counselling as a helpful resource for those diagnosed. This lack of awareness of counselling

for those diagnosed with ASD is concurrent with the lack of research in this area, however

the perception that there is not enough awareness of contradicts the previously discussed

theory of an autism epidemic (Eyal, Hart, Onculer, Oren & Rossi, 2010; Bock & Stauth,

2008). When answering question one, relating to the commonality of counselling being

39

offered to those with ASD, participants three and five both referred to being aware of service

users participating in the well-known approach of Applied Behavioural Analysis but both

have never experienced work with a client who has participated in or has been offered

counselling. This concern has been echoed in the literature of Reeve (2000) and Turkington

and Anan (2007) whose research into the lack of awareness of counselling for those with

ASD exposed factors such as financial problems and lack of availability or options from

doctors or Autism services, as predominant factors for such little research being conducted in

this area.

Accessibility & Responsibility

In relation to awareness, another emerging trend identified in data analysis was participants’

responses to the last interview question, which enquired about the accessibility of counselling

for those with Autism and asked participants how counselling could be made more readily

accessible to those with ASD (interview question five). All participant responses indicated

that counselling should be advertised in government funded sectors by teachers of pre-

schools, specialist schools and mainstream schools, doctors, support workers, counsellors

themselves, psychologists and social work departments:

With the indication that there is a significant lack of awareness of counselling as an active

resource which can be used to aide those with ASD, the question of responsibility arises.

Who should be responsible for making the public more aware of counselling for those with

ASD? :

40

“I think it’s about identifying people who are in need of counselling with Autism early on. I

think doctors and support workers who are appropriately trained should have the

responsibility of letting people know that counselling is actually an option for people with

Autism. Even letting parents of children diagnosed with Autism know that there are different

types of counselling available that could suit their child’s needs and encouraging them to

explore their options. I suppose it’s important to empower people with Autism to know that

counselling is an option. I think that would let them know when and how to seek it and what

benefits they might get from it. Again ,I think that it would fall down to appropriately trained

counselling staff to let people know that counselling is available and to be able to sit down

with people with autism or their parent or guardian and explain the process to them to allow

them to decide if it’s a resource that they want to use. I think it’s really important to let

people know that there are a variety of techniques that are available, cause there are

different people who have different needs, and some counselling methods might be appealing

to some but not to others. Autism’s a wide spectrum, I think every person with Autism is

unique. So it’s important to let people know that there are a number of different counselling

approaches available, it’s not a one size fits all approach.” [Participant 3]

Every participant delegated responsibility to one of these areas without being asked, in

answer to the question of accessibility. This therefore highlighted the importance of

encouraging awareness and helped in identifying that there is an issue with limited awareness

and access to counselling in recent years.

41

Each of these themes are relative to the labelling theory (Becker, 1963; Scheff 1966; Hodge

2012) and it must be questioned if these perceived barriers in counselling could be a matter of

applying a general label to those on the Autism spectrum. Despite numerous participants

acknowledging how broad the spectrum is and how unique every person diagnosed with ASD

is, there does seem to be a general consensus that those with ASD do not have the ability or

coping mechanisms in order to participate in counselling.

The issue of lack of awareness and accessibility to counselling for those with ASD is also a

significant issue in terms of generalization, as both the literature and participant responses

have indicated that there is a concerning lack of awareness of counselling resources available

to those on the spectrum. This comes from a number of areas which have the responsibility

of offering therapies, interventions and treatments for those with ASD. Therefore, it could be

questioned if the labelling of those with ASD is effecting their accessibility to counselling

due to preconceived notions that those with ASD simply cannot communicate. Whilst a clear

lack in communication and social skills is evidenced throughout literature and research, it is

also necessary to maintain that every person on the spectrum is unique and giving them

access to a person-centred approach could be of great benefit to the population who have

been diagnosed with ASD.

The findings obtained from the thematic analysis of the interviewers has indicated an

emergence of patterns in participant responses regarding; awareness of counselling, barriers

faced by those with ASD during their participation in counselling, generally positive

perceptions of counselling for those with ASD from support workers’ perspectives and the

42

accessibility to counselling. This therefore supported the aims of the study which were to

identify these perceived barriers in counselling and determine if support workers’ determined

that counselling would be beneficial to those diagnosed with ASD.

Limitations & Future Research

The research being discussed can be criticised as it failed to recruit any male participants to

take part in the study. However, this sample was representative of the employees of

Strathclyde Autistic Society as the workforce is predominantly made up of females. Future

research would benefit from recruiting both male and female participants in order to

eliminate the possibility of gender bias effecting the results of the study. Future research

should aim to recruit an equal number of male and female participants in order to ensure a

fair representation of both sexes and ensuring that the study accounts for both male and

female perspectives.

A limitation of this study is the relatively small sample size of five participants. Whilst this

sample size was limited as the research was conducted in order to fulfil the requirements of a

BA Social Sciences (Hons) undergraduate empirical project, the word count was therefore

limited to eleven thousand words and the sample size was appropriate for the method of

thematic analysis. However, it can be argued that the responses of this small sample that

were collected and analysed, cannot be generalized to the population of support workers.

Future research in this area would benefit from using a larger sample size in order to benefit

from a larger volume of responses and significantly more data to analyse in order to support

or dispute the research question.43

Future research would benefit greatly from recruiting participants who work in the role of a

support worker, employed over multiple companies. This would be of significant benefit to

the study as it is a possibility that different companies have more or less exposure to certain

treatments for autism or may work with a different client group which could have an

important effect on the results. Strathclyde Autistic Society service users are predominantly

children and young adults who range from three years old to eighteen years old, both male

and female. Therefore, those employed by SAS do not work alongside adults over the age of

eighteen and may not be aware of counselling approaches which may be offered more

regularly to individuals on the spectrum that are over the age of eighteen. This may also have

had a significant effect on responses to the question of the likelihood of those with ASD

actively seeking counselling themselves. Five out of five participants determined that it

would not be likely for an individual with ASD to seek counselling with all suggesting that it

would be more likely for the service users’ parent or guardian to seek counselling on their

behalf. However, having only worked with clients up to the age of eighteen, it can be argued

that these clients are likely to still be living at home and will therefore remain under the

supervision of their parents. These service users may be less independent than those who live

themselves or with a partner, in residential care or in sheltered accommodation, and therefore

it would be beneficial to future research to recruit participants from companies that have

service users’ who range in age.

Thematic analysis calls for the researcher to be critically appraised throughout the research

report, as this method of analysis emphasises the key role of the researcher throughout the

44

research process (Braun & Clarke, 2006). This is also referred to as the process of

reflexivity, which can be determined to have played a significant role within this study.

Despite efforts being made by the researcher to eliminate the influence of both the researcher

and participants being employed by Strathclyde Autistic Society, this possibility must be

considered. Also, despite the researcher ensuring that they never worked alongside the

participants recruited for the study, the researcher is unable to determine if the participant has

possibly been exposed to conversation or information regarding the researcher. If the

participant has been exposed to information about the researcher before the interview, this

could have a significant effect on the validity and reliability of the answers provided by the

participants’. Future research could benefit from ensuring that the principal investigator of

the study is completely unfamiliar to the participants’ of the study in order to preserve the

validity of the information collected and analysed.

In conclusion, the research can be praised as it succeeded in exploring the area of counselling

for those with ASD from the perspectives of support workers, and also successfully identified

perceived barriers in counselling and raised significant concerns over the issue of lack of

awareness of counselling and a lack of accessibility to counselling despite a general

agreement in perspectives of the support workers’ and supporting literature evidencing that

counselling could be of significant help to those on the spectrum. However, future research

within this area should take into consideration the limitations and suggestions for future

research in order to improve upon this current study.

45

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Towers, C. Romeo, R. Knapp, M. Sanderson, H. Routledge, M. Oakes, P. Joyce, T (2005).

The Impact of Person-Centred Planning. Lancaster: Institute for Health Research. 1-5.

Rose, R. (2010). Confronting the Obstacles to Inclusion: International Responses to

Developing Inclusive Education. Oxon: Routledge. 23-27.

Saldana, J. (2008). The Coding Manual for Qualitative Researchers. London: Sage

Publications. 1-15.

Silani, G. Bird, G. Brindley, R. Singer, T. Frith, C. Frith, U. (2008). Levels of emotional

awareness and autism: an fMRI study. Social Neuroscience. 3 (2), 97-112.

Sommerbeck, L. (2011). An Introduction to Pre-therapy. Psychosis: Psychological, Social

and Integrative Approaches. 3 (3), 235-241.

Stevenson, A. (2009). Oxford Dictionary of English. 3rd ed. Oxford: Oxford University

Press. 589.

Tudor, K. Worrall, M. (2006). Person-Centred Therapy: A Clinical Philosophy. 3rd ed.

London: Routledge. 123.

Turkington, C. Annan, R. (2007). The Encyclopedia of Autism. New York: Infobase

Publishing. 111-114.

Wilkins, P. (2009). Person-Centred Therapy: 100 Key Points. East Sussex: Routledge. 107-

110.

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Yin, R.K. (2011). Qualitative Research from Start to Finish. New York: Guilford Press. 193-

195.

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Appendix A

Request for Permission

06/02/2015

Sent to: strathclyde81@yahoo.com

Sent from: jordanpurcell92@yahoo.co.uk

Subject: FAO Susan Dolan

Hi Susan,

I’m currently doing an empirical project for my last year on my BA Social Sciences course at Glasgow Caledonian University and the main focus of my study is support workers’ perspectives on counselling therapies for people with Autism Spectrum Disorder. The study is aiming to analyse any issues which may be identified by the participants such as communicational issues and will discuss if counselling therapies are beneficial or not for clients with Autism Spectrum Disorder. I am looking for your permission to use five home support and play scheme staff from Strathclyde Autistic Society as participants for my project. They will be asked to take part in an audio recorded interview which will last for thirty minutes at the most and will consist of five questions which will ask general questions about their perspectives of counselling for those with Autism Spectrum Disorder and will not ask any questions about any clients in particular. The interview will take place in an IT room in Centre 81 and participants will be recruited via e-mail to their employee e-mail address, if I have your permission. I will be the main researcher and will be overseen by Rosemarie Lynass from the psychology department at Glasgow Caledonian University. If you have any further questions before you make your decision please e-mail me at this e-mail address and I will get back to you as soon as possible. If you decide to give permission or wish to refuse, please e-mail me at this e-mail address also.

Thanks,

Jordan Purcell

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Appendix B

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Appendix C

Recruitment Email

I am a student on the BA Social Sciences program at Glasgow Caledonian University, and I am conducting a study to fulfil the requirements of a Psychology Empirical Project. The study concerns perceptions of counselling for individuals with Autism Spectrum Disorder, and involves assessing whether support workers feel that counselling is beneficial or not to those with Autism Spectrum Disorder and why. I am looking for participants who have been employed as support workers by Strathclyde Autistic Society for home support and play scheme work. I would be very grateful if you would be willing to take part in my study. If you are interested, please contact me at the address below. If you do so, you will have the chance to find out more about the study before coming to any decision. You would be under no obligation to take part.

My study is supervised by Rosemarie Lynass, and she can be contacted on R.Lynass@gcu.ac.uk. The use of email to recruit participants for this study has been approved by the Psychology Ethics Subcommittee.

Jordan Purcell

Jpurce200@caledonian.ac.uk

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Appendix D

PSYCHOLOGY EMPIRICAL PROJECT

JORDAN PURCELL

CONSENT FORM

Please initial box

1. I confirm that I have read and understood the information sheet dated 20/02/2015 for the above study and have had the opportunity to ask questions and have had these answered satisfactorily.

2. I understand that my participation is voluntary and that I am free to withdraw at any time without giving any reason without my medical care or legal rights being affected.

3. I agree to take part in the above study.

4. I understand that my participation will be recorded and analysed, anonymised

quotes may be used in publications about the research however it will not be

possible to identify me from this information. I give my permission for this.

5. I understand that the results from this work may be published however it will not be

possible to identify any participant from this

___________________________ ____________ ___________________________

Name or initials of participant Date Signature or initials

___________________________ ____________ __________________________

Name of person taking consent Date Signature

(if different from researcher)55

Appendix E

Appendix 5

Participant Information Sheet : Support Workers’ Perspectives on Counselling for those with Autism Spectrum Disorder

Introduction and study purpose

You are invited to take part in a study about the issues and benefits for those with Autism Spectrum Disorder when participating in counselling therapies in Glasgow. The aim of the study is to analyse whether support workers feel that clients with Autism Spectrum Disorder might benefit from counselling. The research is being carried out by Jordan Purcell at Glasgow Caledonian University under the supervision of Dr Rosemarie Lynass of Glasgow Caledonian University’s psychology department.

Your contribution to the study will help us to understand more about how support workers think and feel about the benefit of counselling for those with Autism Spectrum Disorder. Before you decide whether or not to take part, it is important for you to understand what participation in the study will involve for you. Please take time to read the following information carefully and discuss it with others if you wish. Please contact us at the address below if you would like more information.

What will I have to do if I take part?

If you are interested in taking part, you are asked to participate in an interview which will require you to answer approximately five questions which will be asked by the researcher. It may take approximately 30 minutes to complete. You will be asked to complete the consent form and read the information sheet before you participate in the study should you choose to do so.

Do I have to take part?

No. It is up to you to decide whether or not to take part. You can stop taking part in the study at any time, without giving a reason. This will not affect any medical care you might receive.

What are the possible disadvantages and risks of taking part?

You will be interviewed by a colleague of Strathclyde Autistic Society. Although there will be no personal questions regarding work ethos, if this does make you feel uncomfortable then you are free to refuse participation or to withdraw from the study at any time. None of the questions asked will be personally intrusive to the participant and will only ask for information regarding experience and perspectives, not personal feelings, e.g. “How common do you think it is for people with Autism Spectrum Disorder to be offered counselling? Why do you think this is?”. You should not give any

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personal information about yourself, the clients or the organisation at any point throughout the interview process. No individual information will be reported back to the manager, however information gathered across all of the interviews will be included in the final report.

What are the possible benefits of taking part?

We can’t promise that the study will help you personally. However, the results should help our understanding of support workers perspectives on the experience of counselling therapies for those with Autism Spectrum Disorder.

What happens when the research study stops?

Written reports of the study findings will be available from May 2015. However, if you wish, a copy of the report can be requested from Jordan Purcell at the e-mail address given at the end.

What if there is a problem?

If you are concerned about your participation in the study and would like to speak with someone out with the research team, please contact Rosemarie Lynass on the e-mail address given below.

What will happen to the information that you give?

The data will be collected through an iPhone. The data will then be stored onto the researcher’s laptop using an encryption program in order to ensure complete confidentiality. The data will then be transcribed by the researcher and put into the empirical project. The encrypted data will then be destroyed and all information wiped from the hard drive of the laptop.

Will my taking part in this study be kept confidential?

Yes. Ethical and legal practice will be followed, and all of your information will be handled in confidence. . Names and addresses are stored securely, and will be destroyed after the study has been completed. The responses that you provide will be treated in confidence. Your rights are protected under the Data Protection Act and any information that might identify you will not be shared outside of the research team. No identifying information will appear in any documents or in the final report.

What will happen to the results of the research study?

The data will be analysed and will be available to a range of people, including the research team, health professionals and researchers through written reports, established website reports, the media, presentations and journal publications. However, it will not be possible to identify any individual participant from these reports or publications.

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Who has reviewed the study?

Ethical Approval has been granted by HLS committee.

Further information and contact details

You can get more study information or discuss the project with the research team at: Jordan Purcell, Glasgow Caledonian University, jpurce200@caledonian.ac.uk, 07736346053 or from the supervisor: Rosemarie Lynass, Glasgow Caledonian University, R.Lynass@gcu.ac.uk.

What happens next?

If you decide you are interested in participating in the study after reading this information sheet, please e-mail the researcher Jordan Purcell and arrange a time for the interview. You will be given the consent sheet and information sheet upon arrival at the interview. If you would like to find out more about the research before participating please do not hesitate to contact Jordan Purcell. Thank you for taking the time to read this study information sheet.

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Appendix F

APPENDIX 6

Question 1.

How common do you think it is for people with Autism Spectrum Disorder to be offered counselling?

Why do you think this is?

Question 2.

How common do you think it is for people with ASD to seek counselling?

Why do you think this is?

Question 3.

Do you think that counselling could be helpful if it was offered to people with Autism Spectrum

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Disorder? Why?

Question 4.

Are there any barriers that you think would be faced by people with Autism Spectrum Disorder if they were to participate in counselling? What do you think these barriers might be?

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Question 5.

Are there any ways in which you think counselling could be made more accessible to those with ASD?

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Appendix G

Debrief

Thank you for your participation in the study, it is greatly appreciated. The aim of the study was to discuss whether counselling therapies are beneficial to those with Autism Spectrum Disorder from the perspectives of support workers. Please remember that any information you provided will remain confidential and will not be discussed with the head of the company or any employees unless it gives the researcher cause for concern that anyone is in danger. The main researcher and supervisor can be contacted via the contact details given to you in the information sheet and recruitment e-mail.

Thank you again,

Jordan Purcell

Principal Researcher

Glasgow Caledonian University

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Appendix H

Research-related Risk Assessment

Name of Interviewer/Researcher Miss Jordan Purcell

Name of Supervisor/Principal Investigator

Dr Rosemarie Lynass

Name of Study Support Workers Perspectives on Counselling for those with Autism Spectrum Disorder

Number of respondents 5

Date study start 20/02/2015

Date (approx) study ends 01/05//2015

Give a brief description of the study:-

The study aims to gather information on support workers perspectives on counselling for those with Autism Spectrum Disorder. The study aims to recruit five participants who will take part in an interview which will take place in an IT room at Centre 81, where the Strathclyde Autistic Society’s main office is based. The participants will be recruited via e-mail using the e-mail addresses which they use to contact Strathclyde Autistic Society and receive their time sheets and work information. The participants will be given the consent forms and information sheets to sign before they participate in the study should they choose to do so. The participants will then be asked five open ended questions regarding their experience in working with those with ASD and their experience and perspectives of counselling for those with ASD. Each interview should not take any longer than thirty minutes to complete. The participants will then be debriefed and thanked for their participation in the study. The data recorded will then be encrypted onto the researchers laptop and data will be transcribed and findings written into the final report.

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If you do not feel a risk assessment is necessary, please provide a rationale for this decision:

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Identifications of hazards

Please indicate in the table below hazards identified as pertinent to your research project and rate them and indicate your rating of the likelihood of the identified hazard causing actual harm. Please refer to research related risk assessment guidelines (Forms A & B).

Level of Risk = severity of harmful event x likelihood of event occurring

Risk Assessment and Response Matrix

Likelihood of Occurrence

⇓High 4 Tolerate/

Treat

7 Treat/

Transfer

9 Treat/Transfer/

Terminate

Medium 2 Tolerate/

Treat

5 Treat/

Transfer

8 Treat/Transfer/

Terminate

Low 1 Tolerate 3 Tolerate/

Treat

6 Treat/Transfer

Impact of Risk ⇒ Low Medium High

e.g. Hazard 1 medium likelihood of occurrence x low impact = tolerable or treat

Hazard 2 high likelihood of occurrence x high impact = treat, transfer or STOP

Hazard Severity Likelihood Treatment of Risk

1. Participants and researchers being colleagues

Low high tolerable

2. Not guaranteed anonymity Low high tolerable

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3. Interviews off campus Medium high treat

4. Participants divulging information of a personal nature or information which the researcher feels may put others in danger.

medium low Treat

Devising and implementing safe working practice

Describe below what measures will be taken to minimize the risks identified above and promote safe working practice:-

The participants of the study will be colleagues of the researcher. However, the researcher will not ask anyone who they have worked with closely or regularly on a one to one basis to participate in order not to jeopardize the studies ethical authenticity. The main researcher does not work alongside any other colleague at the moment during home support and has not for the past two years and has minimal contact with other employees as the only time they are required to see each other is at staff training or staff meetings which do not occur often.

As the participants are employees of the same company as the main researcher, the questions will be clearly relating to the participants general perspectives and not their perspectives or experience with any client in particular. Participants will be told before the interview not to divulge any personal information about themselves, clients or the organisation. If a participant says anything regarding their work which the researcher feels may put clients or other staff in danger, the researcher will have a duty of care to report this to Susan Dolan, the manager of Strathclyde Autistic Society.

Due to the researcher being a colleague, anonymity is not guaranteed as the researcher is able to identify the person whom they know as a colleague. However, the participant will be guaranteed complete confidentiality.

The interviews will take place off campus which is also a risk. However, the interviews have been arranged to take place in an IT room in centre 81, which is the community centre where the west Dunbartonshire office of Strathclyde Autistic Society is based. This means that this is a familiar environment for the participant and the participant and researcher are also aware of all health and safety and fire safety procedures. The interviews will take place in the evening, after the Strathclyde Autistic Society office has closed in order to prevent participants from feeling uncomfortable or being distracted by other employees of the charity. This will also prevent participants from discussing the interview beforehand. The leisure centre will still be open and there will be community classes taking place until 9pm, when the care taker will lock the building. The interviews will finish before the centre closes. This is normal practice, the Strathclyde Autistic Society office closes at 5pm every weekday.

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67

Appendix I

EC1 - Version 5 - August 2014

School of Health & Life Sciences

Application and Guidance notes for Ethical Approval for Research

The School of Health and Life Sciences has three departmental ethics committee. Please tick which committee you wish to submit your application to (please indicate with an X)

Nursing and Community Health (Chair: Dr Nicola Roberts)

Psychology, Social Work and Allied Health Sciences (Chair: Dr Phil Dalgarno)

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X

Life Sciences (Chair: Dr Les Wood)

Category of principal applicant (please indicate with an X)

Staff: Research student (PhD/Prof D/DPsych):

Taught postgraduate student: Undergraduate student:

Location of research work (please indicate with an X)

On campus: Off campus:

One copy of all of the paperwork for an ethics application should be submitted electronically to HLSEthics@gcu.ac.uk

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X

X

School of Health & Life Sciences Ethics Committee Application Form

Project Title: Support Workers’ Perspectives on Counselling for those with Autism Spectrum Disorder

Principal Investigator (s): Jordan Purcell

Email address:jpurce200@caledonian.ac.uk

Supervisor: Rosemarie Lynass

Other academic staff involved:

Project start date: October 2014 Project Duration: 8 months, May 2015

Date application Submitted: 20/02/2015

Is this a clinical trial: No

YOU MUST ANSWER ALL QUESTIONS YES NO N/A

1 Will you provide participants with a written information sheet in advance of the study describing the main procedures so that they are informed about what to expect in your study?

2 Will you tell participants that their participation is voluntary?

3 Will your participants be able to read and understand the participant information sheet?

4 Will you obtain written informed consent for participation?

(consent is implied for questionnaire studies)

5 Will you tell participants that they may withdraw from the research at any time without penalty and for any reason?

6 With questionnaires/interviews, will you give participants the option of omitting questions they do not want to answer?

7 Will you tell participants that their data will be treated with full confidentiality and that, if published, it will not be identifiable as theirs?

8 Will you give participants a brief explanation of the purpose of the study at the beginning of their participation in it, and answer any

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X

X

X

X

X

X

X

X

questions?

9a Will your project involve deliberately misleading participants in any way?

If YES, go to question 9b. Please note you must provide a justification in the research proposal.

9b If YES, will an explanation be offered following participation?

10 Is there a realistic risk of the participant/researcher experiencing either physical or psychological distress or discomfort?

If YES, give details in the research proposal and state how you will address these risks (e.g. who they can contact for help).

11 Do the participants fall into any of the following special groups? If the answer is YES, indicate which group(s) by ticking the appropriate box(es):

Children (under 18 years of age)

Children (under 5 years of age)

People with a disability such as learning and communication difficulties.

Please specify:

Pregnant women

People studied with respect to mental or sexual health

People in custody

People engaged in illegal activities (e.g. drug-taking)

Non-human animals

Patients/service users

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X

X

X

X

NOTE: You may also need to obtain clearance from Protection of Vulnerable Groups (PVG) or an equivalent authority.

You must tick either Box A or Box B below and provide all relevant information in support of your application. If you answered NO to any questions 1 – 3, 5-8, or YES to any questions 9 – 11, then you must check Box B.

A I consider that this project has no significant ethical implications to be brought to the attention of the University Research Ethics Committee.

Please provide a short study protocol in a separate attachment of no more than 2 sides of A4 (Arial font size 10). The accompanying notes give additional information about how to write the protocol. Your proposal must include the following sections:

1. Project title (with student name or staff member name clearly stated)2. Version number.3. Background information.4. Aims and objectives of the study.5. Brief description of participants and recruitment methods (sample, numbers, access,

recruitment and inclusion and exclusion criteria)6. Brief description of the research methods and measurements. Include details on how the

data will be securely stored and disposed of.7. Consent, confidentiality and anonymity8. Risks to participants/self

Arrangements for debriefing. You must also provide the intended (1) Participant Information Sheet(s), (2) Consent Form(s), (3) copies of any non-validated or validated tools/questionnaire(s), (4) details of interview questions you plan to use, (5) notices advertising the study, (6) draft letter(s) for gatekeeper access permission to recruit participants and (7) replies/proof of gatekeepers approval for access to recruit participants

B I consider that this project may have significant ethical implications that should be brought to the attention of the University Research Ethics Committee.

Please provide a short study protocol in a separate attachment of no more than 4 sides of A4 (Arial font size 10). The accompanying notes give additional information about how to write the protocol. Your protocol must include the following sections:

1. Project title (with student name or staff member name clearly stated)2. Version number.3. Background information.4. Aims and objectives of the study. 5. Brief description of participants and recruitment methods (sample, numbers, access,

recruitment and inclusion and exclusion criteria)6. Brief description of the research methods and measurements. Include details on how the

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X

data will be securely stored and disposed of.7. Consent, confidentiality and anonymity.8. Risks to participants/self (include a risk assessment form).9. Arrangements for debriefing.10. A clear statement of the ethical considerations raised by the project and how you intend to

deal with them.

You must also provide the intended (1) Participant Information Sheet(s), (2) Consent Form(s), (3) copies of any non validated or validated questionnaire(s), (4) details of interview questions you plan to use, (5) notices advertising the study, (6) Risk Assessment form, (7) draft letter(s) for gatekeeper access permission to recruit participants and (8) Replies/proof of gatekeepers approval for access to recruit participants

Declaration

I am familiar with the Declaration of Helsinki and professional body code of human research ethics (e.g. BPS), and have discussed them with the other researchers involved in the project. I confirm that my research abides within these guidelines.

SignatureDate

Principal Investigator Jordan Purcell 20/02/2015

Supervisor Rosemarie Lynass 20/02/2015

There is an obligation on the Principal Researcher and/or the Supervisor to bring to the attention of the Ethics Committee any issues with ethical implications not covered by the above checklists.

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Please complete the checklist with details of the documents which are included in your submission (where applicable)*

EC1 form X

2 page protocol (for those with no significant risks) or 4 page protocol (for those WITH significant risks)

X

Participant information sheet(s) X

Consent form(s) X

Non-validated or validated tools / questionnaires n/a

Interview guide/ schedule X

Advert / notices for study n/a

Risk assessment form (if applicable for those WITH significant risk))

X

Your letter(s) which request access permission to recruit participants

X

Gatekeepers approvals for access permission to recruit participant

X

*Paperwork associated with your application does not need to be anonymised. Only one set of these documents are needed. These can be sent as one large word document, please do not send a combined PDF document.

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Title: Support Workers’ Perspectives on Counselling for those with Autism Spectrum Disorder Principal Investigator: Jordan Purcell, Supervisor: Rosemarie Lynass.

Version 2: 19 th of February 2015

Introduction

Autism Spectrum Disorder (ASD) is a common developmental disability which can range extremely in severity and develops within the first three years of life. According to the American Psychological Association (APA), ASD involves social impairment and can affect the ability to interpret social situations, other people‘s feelings and also has a significant effect on verbal and non-verbal communication (Kazdin, 2000). Statistics calculated by the National Autistic Society estimate that one in every hundred people in the United Kingdom will be diagnosed with ASD and whilst there is no cure, there are a variety of treatments which are offered in order to help, with the most common being in the form of educational or behaviour support (NHS, 2014). There are various types of counselling therapies available for those on the autism spectrum and it can be discussed whether these approaches are effective in helping those with Autism Spectrum Disorder and similar disorders such as Asperger Syndrome. However, it is first necessary to discuss the background of the counselling theories at hand. Rogers’ (1950) concept of person-centred therapy is central in the discussion of counselling therapies for those with autism and similar conditions such as Asperger syndrome (Chalk, 2012). Person-centred therapy involves the process of clients assessing their perception of self, other therapies such as psychodynamic psychotherapy depend more on the counsellor to interpret the client’s unconscious thoughts and ideas (Tudor & Worrall, 2006). According to Joseph and Worsley (2005) person-centred therapy is an effective method of counselling for individuals with ASD and AS as it provides clients with a social environment which encourages them to engage with the counsellor. According to Joseph et al. the right social environment encourages the development of emotional growth and the actualisation of their inherent optimal nature. This provides clients with the ability to communicate, which aides in the positive outcome of the therapy. Robertson, Emmerson, Hatton, Elliot, McIntosh, Swift, Krijnen-Kemp, Towers, Romeo, Knapp, Sanderson, Routledge, Oakes and Joyce (2005) conducted research into the effectiveness of the person-centred concept which provides evidence for its benefits to those with ASD. Robertson et al conducted a study using twenty five people with learning disabilities such as ASD and Asperger Syndrome (AS) and was conducted over a two and a half year period, measuring the positive effects of person-centred therapy. The study chose four locations in England on the basis that person-centred therapy was to be implemented with the aim of benefitting the client and having a positive outcome for the client’s life experience, rather than aiming to meet organisational obligations and requirements. These localities also had a diverse community, ranging from a wide variety in ethnicity, affluence and urban/rural locations. The data collected in this qualitative study was analysed with the aim to identify the impact that the implementation of person-centred therapy can have on a participant with a learning disability such as ASD or AS and the costs of the implementation in person-centred therapy. Findings showed that the participation in person-centred therapies were associated with clients increase in community involvement, communication with family and friends and an increase in social activity. Furthermore, the study found that person-centred therapy had a negative effect on areas such as employment and physical health which could be a knock on effect of an increase in social involvement. However, it could be considered that those who qualified to participate in the person-centred therapy could generally be of ill health which is a possibility that has been explored in Emmerson’s later research. Emmerson and Baines (2010) conducted research into the health inequalities of individuals with learning disabilities in the United Kingdom. According to Emmerson et al. individuals with learning disabilities are proven to be of poorer health than their non-disabled peers. Statistics provided in the research paper have shown that those with learning disabilities who reside in the United Kingdom are shown to have earlier mortality rates and are 2.5-4.5 times more likely to be of poorer general health than their non-disabled peers. These findings could contradict Emmerson’s earlier suggestions that person-centred therapy has a negative impact on physical health and employment, as more current research states that those with learning disabilities are generally poorer in health which could also affect their employability.

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Barriers in social communication and the ability to interact with others is a main source of difficulty for those with ASD and can have a debilitating effect on their ability to tell others how they are feeling, interpret social situations and empathise with others (NAS, 2015). Research within this area is presently very limited. However, Hodge (2012) conducted numerous studies which sought to identify barriers which are faced by those with ASD whilst participating in counselling. Hodge’s initial study conducted in 2012 discussed the notion of ableism, which can be defined as prejudice against those who, in relation to this study, are not able-bodied or have been diagnosed with a disability (Colman, 2009). According to Hodge, the experience of ableism can have a significant negative impact on the practice of counselling. Hodge discusses how ableism can have an effect on the process of empathy and can turn counselling into a negative experience using the example of a young boy diagnosed with ASD and his participation in counselling. Hodge sought to support counsellors in assessing and discussing how individuals with ASD are likely to process and interpret a counselling session, and how experiencing ableism may effect clients’ ability to feel comfortable enough to engage in counselling and have a positive experience. Hodge suggested that in order to encourage the positivity of counselling, counsellors should treat every counselling session as an organic process and that the counsellor themselves should go into every session with open eyes and prepared to view things from the perspective of the client in order to effectively engage with the client and encourage a positive outcome.

Hodge’s later study (2012) focused on clients with AS and sought to identify how labelling can have a negative impact on clients’ participation in counselling. Labelling is a sociological theory which was developed by Becker in 1963. Although this theory is commonly associated with crime and deviant behaviour, it refers to behaviour which is out with the norm, behaviours which are often expressed by those who have a mental illness or learning disability. Labelling refers to society’s tendency to assume that an individual will adopt certain behaviours or attitudes which are stereotypically associated with, in this case, those who have a mental illness or learning disability. This can often lead to self-acceptance of being of a particular label and can often result in influencing an individual to behave in a certain way and embracing this as their personal identity (Brain, 2001). Hodge states that during counselling, some people diagnosed with AS may make an effort to appear neurotypical rather than give in to AS tendencies whilst others are accepting of the label. This can often result in difficulties establishing a therapist-client bond as those on the spectrum are less likely to have the ability to express their thoughts and feelings. This can also be a problem as it makes it impossible to address issues which are required to be discussed for a positive outcome of counselling.

Prouty’s concept of pre-therapy and social autism pre-therapy, also referred to as ‘contact work’, refers to a method used to bring people with learning disabilities, such as Autism Spectrum Disorder, to a state of ‘psychological contact’. This concept is a development influenced by Rogers’ person centred therapy and is used in order to bring individuals who are often in a state of agitation or upset to a state in which they can communicate. As individuals with Autism Spectrum Disorder are often in states of high stress despite their environment, Prouty’s theory of pre-therapy can allow for therapists and clients to communicate and so allows for emotional expression to occur (Prouty, 1994). Pre-therapy is the theory and process of psychological contact, which is defined as a process where two individuals are effected by and respond to one another, which forms the basis of a reciprocal relationship (Rogers, 1957). When clients participating in pre-therapy begin to engage meaningfully on a daily basis, they are deemed to be fully functioning. In order to become fully functioning, clients must endure three processes which are referred to as reality contact function, affective contact function and communication contact function. Reality contact function refers to the individuals’ awareness of what is occurring in the world around them and having a sense of reality, affective contact function is the individuals’ ability to experience feelings and emotions, whilst communication contact function refers to the individuals’ ability to verbally communicate their thoughts, feelings, moods and emotions to others in their environment in a socially acceptable manner which allows others to understand them. It is the aim of pre-therapy for every client to achieve psychological contact with others. However, this cannot always occur as it depends on the clients abilities. This means that those diagnosed with low functioning ASD may not have the ability to achieve the three contact functions which can result in pre-expressive behaviour which can result in clients isolating themselves, becoming withdrawn and expressing bizarre physical behaviours. Pre-therapy is deemed to have a positive impact as it gives clients’ the ability to function in everyday life to their full potential (Wilkins, 2009). Sommerbeck (2001) states that pre-therapy could be damaging to patients as the

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processes could be deemed patronising as practitioners will in a sense, be mimicking clients’ behaviour, which could have a negative effect on the client akin to the issues of ableism. With very limited research in this area of counselling, Reeve (2000) cited in Hodge (2012) suggests that a significant reason for the lack of research into counselling for those on the autism spectrum depends largely on the financial situation of the client. Reeve and Hodge state that non-disabled people are more likely to be financially better off than those who have been diagnosed with a disability which affects their access to therapies such as counselling. Hodge also states that there is a negative perception of counselling in relation to autism and Asperger Syndrome as these conditions are often linked to anxiety and depression which can steer professionals away from recommending counselling.

This study aims to explore support workers perceptions of the benefits of counselling as an intervention and will discuss any issues that support workers feel may affect those diagnosed with ASD’s ability to engage in counselling.

Aims and Objectives

This study aims to analyse the perspectives of support workers who have worked closely alongside those diagnosed with Autism Spectrum Disorder, regarding the benefits and barriers of those with ASD participating in counselling. The study aims to determine whether support workers feel that counselling would be beneficial or unbeneficial to those with ASD and aims to identify whether support workers feel that there are reasons why counselling would not be helpful to those diagnosed with Autism. For example, do support workers feel that there are social and communicative barriers which would prevent those with Autism from engaging in counselling therapies and does there seem to be an exclusion of those with autism being given access to counselling therapies despite research giving evidence of the benefits?

Participants and Recruitment Methods:

The participants for this study will be five support workers employed for home support or play scheme by Strathclyde Autistic Society. The main researcher is an employee of this charity and so has been given a list of work e-mail addresses for employees by the chairwoman of the charity in order to send out recruitment e-mails (see Appendix 1). Employees who have regularly worked with or are well known to the researcher will be excluded from participating in the study.

Design & Methods

The study will take place off campus in an IT room in Centre 81, which is a community centre where the West Dunbartonshire branch of Strathclyde Autistic Society is based. An e-mail has been sent to the manager of the charity requesting permission to use employees of Strathclyde Autistic Society as participants (Appendix 2). A letter of permission from the chairwoman of the charity has been attached (Appendix 3), participants will be recruited via e-mail. Recruitment e-mails will be sent to the same e-mail addresses that staff receive all work related e-mails from Strathclyde Autistic Society. The participants will be given the consent forms (Appendix 4) and information sheets (Appendix 5) in the interview room before they participate. Participants will be reminded that their participation is voluntary. The participant will be expected to spend thirty minutes at most in the interview and there will be no reward or incentive for participating. The study will consist of a semi structured interview with five open ended questions (see Appendix 6). The format of data recording which will be used is audio recording. The interview will be recording using an audio recording application on an apple iPhone. The data recorded will then be transcribed and all information transferred onto a laptop using an encryption software. The data collected will be confidential as the researcher will not discuss the data collected with anyone outside of the research team. However, anonymity of the participant cannot be guaranteed as the main researcher and the participants are employed by the same company. The data collected will only be accessed by the main researcher and will be stored onto a laptop whose sole user is the main researcher. The main researcher will also be the only person who has the password and security information to gain access to the encrypted documents in order to guarantee that data protection is being upheld and that the storage of the data abide the security policy of Glasgow Caledonian University.

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Risk to the Participants

Although there is no foreseen psychological or physical harm as a result of participating in the study, it is important to highlight the risks that have a possibility of occurring and it is necessary to discuss how these risks have been anticipated and will be prevented or treated.

Risk of conducting the study off campus: the study is being conducted off campus which could be identified as a significant risk to both the researcher and participants. However, the researcher and participants are familiar with the building as it is the location of their staff training and main office of Strathclyde Autistic Society. Therefore, they are well rehearsed in the health and safety procedures and are aware of all fire exits and safety procedures in the event of a fire.

Risk of using colleagues as participants: the researcher has chosen to exclude any colleagues whom they have worked with on a one to one basis during home support or who they know well, from the recruitment process. As the participants are known to the researcher, anonymity is not guaranteed. However, the researcher will be clear in letting potential participants know that they are not required to participate in the study, that it is a personal choice and they may withdraw from participating at any time should they wish to do so. The researcher will also refrain from asking about any personal difficulties during the interview process and will assure participants that the information collected will not be shared with the manager of the company nor any other employees unless the information provided causes the researcher concern for the safety of others.

Debriefing and Feedback Arrangements

The participants will then be thanked for their participation in the study and will be provided with information on the aim of the study, which will be to identify the benefits and costs of counselling therapies for those with Autism Spectrum Disorder and analyse any issues which have been highlighted from the data collected and previous research. The participants will also be reminded that they can withdraw their data from the study at any time should they wish to (Appendix 7).

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Appendix 1

Recruitment Email

I am a student on the BA Social Sciences program at Glasgow Caledonian University, and I am conducting a study to fulfil the requirements of a Psychology Empirical Project. The study concerns perceptions of counselling for individuals with Autism Spectrum Disorder, and involves assessing whether support workers feel that counselling is beneficial or not to those with Autism Spectrum Disorder and why. I am looking for participants who have been employed as support workers by Strathclyde Autistic Society for home support and play scheme work. I would be very grateful if you would be willing to take part in my study. If you are interested, please contact me at the address below. If you do so, you will have the chance to find out more about the study before coming to any decision. You would be under no obligation to take part.

My study is supervised by Rosemarie Lynass, and she can be contacted on R.Lynass@gcu.ac.uk. The use of email to recruit participants for this study has been approved by the Psychology Ethics Subcommittee.

Jordan Purcell

Jpurce200@caledonian.ac.uk

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Appendix 2

Request for Permission

06/02/2015

Sent to: strathclyde81@yahoo.com

Sent from: jordanpurcell92@yahoo.co.uk

Subject: FAO Susan Dolan

Hi Susan,

I’m currently doing an empirical project for my last year on my BA Social Sciences course at Glasgow Caledonian University and the main focus of my study is support workers’ perspectives on counselling therapies for people with Autism Spectrum Disorder. The study is aiming to analyse any issues which may be identified by the participants such as communicational issues and will discuss if counselling therapies are beneficial or not for clients with Autism Spectrum Disorder. I am looking for your permission to use five home support and play scheme staff from Strathclyde Autistic Society as participants for my project. They will be asked to take part in an audio recorded interview which will last for thirty minutes at the most and will consist of five questions which will ask general questions about their perspectives of counselling for those with Autism Spectrum Disorder and will not ask any questions about any clients in particular. The interview will take place in an IT room in Centre 81 and participants will be recruited via e-mail to their employee e-mail address, if I have your permission. I will be the main researcher and will be overseen by Rosemarie Lynass from the psychology department at Glasgow Caledonian University. If you have any further questions before you make your decision please e-mail me at this e-mail address and I will get back to you as soon as possible. If you decide to give permission or wish to refuse, please e-mail me at this e-mail address also.

Thanks,

Jordan Purcell

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APPENDIX 3

Strathclyde Autistic Society

10/02/2015

Strathclyde Autistic Society,

Centre 81,

2-16 Braes Avenue,

Whitecrook,

Clydebank,

West Dunbartonshire,

G81 1DW

0141 533 7070

To whom it may concern,

This letter has been written by myself, Susan Dolan, as proof in writing that I have given Jordan Purcell and the research team at Glasgow Caledonian University permission to recruit home support and playscheme staff from Strathclyde Autistic Society as participants for their study.

Yours sincerely,

Susan Dolan

Chairwoman of Strathclyde Autistic Society

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Appendix 4

PSYCHOLOGY EMPIRICAL PROJECT

JORDAN PURCELL

CONSENT FORM

Please initial box

4. I confirm that I have read and understood the information sheet dated 20/02/2015 for the above study and have had the opportunity to ask questions and have had these answered satisfactorily.

5. I understand that my participation is voluntary and that I am free to withdraw at any time without giving any reason without my medical care or legal rights being affected.

6. I agree to take part in the above study.

4. I understand that my participation will be recorded and analysed, anonymised

quotes may be used in publications about the research however it will not be

possible to identify me from this information. I give my permission for this.

5. I understand that the results from this work may be published however it will not be

possible to identify any participant from this

___________________________ ____________ ___________________________

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Name or initials of participant Date Signature or initials

___________________________ ____________ __________________________

Name of person taking consent Date Signature

(if different from researcher)

Appendix 5

Participant Information Sheet : Support Workers’ Perspectives on Counselling for those with Autism Spectrum Disorder

Introduction and study purpose

You are invited to take part in a study about the issues and benefits for those with Autism Spectrum Disorder when participating in counselling therapies in Glasgow. The aim of the study is to analyse whether support workers feel that clients with Autism Spectrum Disorder might benefit from counselling. The research is being carried out by Jordan Purcell at Glasgow Caledonian University under the supervision of Dr Rosemarie Lynass of Glasgow Caledonian University’s psychology department.

Your contribution to the study will help us to understand more about how support workers think and feel about the benefit of counselling for those with Autism Spectrum Disorder. Before you decide whether or not to take part, it is important for you to understand what participation in the study will involve for you. Please take time to read the following information carefully and discuss it with others if you wish. Please contact us at the address below if you would like more information.

What will I have to do if I take part?

If you are interested in taking part, you are asked to participate in an interview which will require you to answer approximately five questions which will be asked by the researcher. It may take approximately 30 minutes to complete. You will be asked to complete the consent form and read the information sheet before you participate in the study should you choose to do so.

Do I have to take part?

No. It is up to you to decide whether or not to take part. You can stop taking part in the study at any time, without giving a reason. This will not affect any medical care you might receive.

What are the possible disadvantages and risks of taking part?

You will be interviewed by a colleague of Strathclyde Autistic Society. Although there will be no personal questions regarding work ethos, if this does make you feel uncomfortable then you are free to refuse participation or to withdraw from the study at any time. None of the questions asked will be personally intrusive to the participant and will only ask for information regarding experience and

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perspectives, not personal feelings, e.g. “How common do you think it is for people with Autism Spectrum Disorder to be offered counselling? Why do you think this is?”. You should not give any personal information about yourself, the clients or the organisation at any point throughout the interview process. No individual information will be reported back to the manager, however information gathered across all of the interviews will be included in the final report.

What are the possible benefits of taking part?

We can’t promise that the study will help you personally. However, the results should help our understanding of support workers perspectives on the experience of counselling therapies for those with Autism Spectrum Disorder.

What happens when the research study stops?

Written reports of the study findings will be available from May 2015. However, if you wish, a copy of the report can be requested from Jordan Purcell at the e-mail address given at the end.

What if there is a problem?

If you are concerned about your participation in the study and would like to speak with someone out with the research team, please contact Rosemarie Lynass on the e-mail address given below.

What will happen to the information that you give?

The data will be collected through an iPhone. The data will then be stored onto the researcher’s laptop using an encryption program in order to ensure complete confidentiality. The data will then be transcribed by the researcher and put into the empirical project. The encrypted data will then be destroyed and all information wiped from the hard drive of the laptop.

Will my taking part in this study be kept confidential?

Yes. Ethical and legal practice will be followed, and all of your information will be handled in confidence. . Names and addresses are stored securely, and will be destroyed after the study has been completed. The responses that you provide will be treated in confidence. Your rights are protected under the Data Protection Act and any information that might identify you will not be shared outside of the research team. No identifying information will appear in any documents or in the final report.

What will happen to the results of the research study?

The data will be analysed and will be available to a range of people, including the research team, health professionals and researchers through written reports, established website reports, the media, presentations and journal publications. However, it will not be possible to identify any individual participant from these reports or publications.

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Who has reviewed the study?

Ethical Approval has been granted by HLS committee.

Further information and contact details

You can get more study information or discuss the project with the research team at: Jordan Purcell, Glasgow Caledonian University, jpurce200@caledonian.ac.uk, 07736346053 or from the supervisor: Rosemarie Lynass, Glasgow Caledonian University, R.Lynass@gcu.ac.uk.

What happens next?

If you decide you are interested in participating in the study after reading this information sheet, please e-mail the researcher Jordan Purcell and arrange a time for the interview. You will be given the consent sheet and information sheet upon arrival at the interview. If you would like to find out more about the research before participating please do not hesitate to contact Jordan Purcell. Thank you for taking the time to read this study information sheet.

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APPENDIX 6

Question 1.

How common do you think it is for people with Autism Spectrum Disorder to be offered counselling?

Why do you think this is?

Question 2.

How common do you think it is for people with ASD to seek counselling?

Why do you think this is?

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Question 3.

Do you think that counselling could be helpful if it was offered to people with Autism Spectrum Disorder? Why?

Question 4.

Are there any barriers that you think would be faced by people with Autism Spectrum Disorder if they were to participate in counselling? What do you think these barriers might be?

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Question 5.

Are there any ways in which you think counselling could be made more accessible to those with ASD?

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Appendix 7

Debrief

Thank you for your participation in the study, it is greatly appreciated. The aim of the study was to discuss whether counselling therapies are beneficial to those with Autism Spectrum Disorder from the perspectives of support workers. Please remember that any information you provided will remain confidential and will not be discussed with the head of the company or any employees unless it gives the researcher cause for concern that anyone is in danger. The main researcher and supervisor can be contacted via the contact details given to you in the information sheet and recruitment e-mail.

Thank you again,

Jordan Purcell

Principal Researcher

Glasgow Caledonian University

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Research-related Risk Assessment

Name of Interviewer/Researcher Miss Jordan Purcell

Name of Supervisor/Principal Investigator

Dr Rosemarie Lynass

Name of Study Support Workers Perspectives on Counselling for those with Autism Spectrum Disorder

Number of respondents 5

Date study start 20/02/2015

Date (approx) study ends 01/05//2015

Give a brief description of the study:-

The study aims to gather information on support workers perspectives on counselling for those with Autism Spectrum Disorder. The study aims to recruit five participants who will take part in an interview which will take place in an IT room at Centre 81, where the Strathclyde Autistic Society’s main office is based. The participants will be recruited via e-mail using the e-mail addresses which they use to contact Strathclyde Autistic Society and receive their time sheets and work information. The participants will be given the consent forms and information sheets to sign before they participate in the study should they choose to do so. The participants will then be asked five open ended questions regarding their experience in working with those with ASD and their experience and perspectives of counselling for those with ASD. Each interview should not take any longer than thirty minutes to complete. The participants will then be debriefed and thanked for their participation in the study. The data recorded will then be encrypted onto the researchers laptop and data will be transcribed and findings written into the final report.

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If you do not feel a risk assessment is necessary, please provide a rationale for this decision:

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Identifications of hazards

Please indicate in the table below hazards identified as pertinent to your research project and rate them and indicate your rating of the likelihood of the identified hazard causing actual harm. Please refer to research related risk assessment guidelines (Forms A & B).

Level of Risk = severity of harmful event x likelihood of event occurring

Risk Assessment and Response Matrix

Likelihood of Occurrence

⇓High 4 Tolerate/

Treat

7 Treat/

Transfer

9 Treat/Transfer/

Terminate

Medium 2 Tolerate/

Treat

5 Treat/

Transfer

8 Treat/Transfer/

Terminate

Low 1 Tolerate 3 Tolerate/

Treat

6 Treat/Transfer

Impact of Risk ⇒ Low Medium High

e.g. Hazard 1 medium likelihood of occurrence x low impact = tolerable or treat

Hazard 2 high likelihood of occurrence x high impact = treat, transfer or STOP

Hazard Severity Likelihood Treatment of Risk

5. Participants and researchers being colleagues

Low high tolerable

6. Not guaranteed anonymity Low high tolerable

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7. Interviews off campus Medium high treat

8. Participants divulging information of a personal nature or information which the researcher feels may put others in danger.

medium low Treat

Devising and implementing safe working practice

Describe below what measures will be taken to minimize the risks identified above and promote safe working practice:-

The participants of the study will be colleagues of the researcher. However, the researcher will not ask anyone who they have worked with closely or regularly on a one to one basis to participate in order not to jeopardize the studies ethical authenticity. The main researcher does not work alongside any other colleague at the moment during home support and has not for the past two years and has minimal contact with other employees as the only time they are required to see each other is at staff training or staff meetings which do not occur often.

As the participants are employees of the same company as the main researcher, the questions will be clearly relating to the participants general perspectives and not their perspectives or experience with any client in particular. Participants will be told before the interview not to divulge any personal information about themselves, clients or the organisation. If a participant says anything regarding their work which the researcher feels may put clients or other staff in danger, the researcher will have a duty of care to report this to Susan Dolan, the manager of Strathclyde Autistic Society.

Due to the researcher being a colleague, anonymity is not guaranteed as the researcher is able to identify the person whom they know as a colleague. However, the participant will be guaranteed complete confidentiality.

The interviews will take place off campus which is also a risk. However, the interviews have been arranged to take place in an IT room in centre 81, which is the community centre where the west Dunbartonshire office of Strathclyde Autistic Society is based. This means that this is a familiar environment for the participant and the participant and researcher are also aware of all health and safety and fire safety procedures. The interviews will take place in the evening, after the Strathclyde Autistic Society office has closed in order to prevent participants from feeling uncomfortable or being distracted by other employees of the charity. This will also prevent participants from discussing the interview beforehand. The leisure centre will still be open and there will be community classes taking place until 9pm, when the care taker will lock the building. The interviews will finish before the centre closes. This is normal practice, the Strathclyde Autistic Society office closes at 5pm every weekday.

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References

Brain, C. (2001). Advanced Psychology: Applications, Issues and Perspectives. Cheltenham: Nelson Thornes. 54-55.

Campbell, F. F. (2003). Review of the Research Literature on Educational Interventions for Pupils with Autism Spectrum Disorders. National Foundation for Educational Research. 1 (7), 12-13.

Colman, A (2009). A Dictionary of Psychology. 3rd ed. Oxford: Oxford University Press. 2.

Emmerson, E. Baines, S. (2010). Health Inequalities & People with Learning Disabilities in the UK. Improving Health and Lives: Learning Disabilities Observatory. 1 (2), 2-3.

Gillon, E. (2007). Person-Centred Counselling Psychology: An Introduction. Scotland: Sage. 113-116.

Hillier, A. Greher, G. Poto, N. Dougherty, M. (2011). Positive Outcomes Following Participation in a Music Intervention for Adolescents and Young Adults on the Autism Spectrum. Psychology of Music. 40 (2), 201-215

Hodge, N. (2012). Counselling, Autism and the Problem of Empathy. British Journal of Guidance and Counselling. 41 (2), 105-116.

Hodge, N. (2012). Counselling people labelled with Asperger Syndrome. Sage Handbook of Counselling and Psychotherapy. London: Sage. 554-558.

Joseph, S. Worsley, R. (2005). Person-Centred Psychopathology: A Positive Psychology of Mental Health. United Kingdom: PCCS Books. 22-23.

Kazdin, A.E. (2000). The Encyclopedia of Psychology (Vol. 1 – 8). New York: Oxford University Press/American Psychological Association.

Chalk, M. (2012). Psychotherapy with people with Asperger Syndrome; exploring ways to improve client and therapist well-being. (Unpublished Doctoral thesis, City University London).

Prouty, G. (1994). Theoretical Evolutions in Person-Centred/Experiential Therapy: Applications to Schizophrenic and Retarded. Westport: Greenwood Publishing Group. 49-98.

Robertson, J. Emmerson, E. Hatton, C. Elliot, J. McIntosh, B. Swift, P. Krijnen-Kemp, E. Towers, C. Romeo, R. Knapp, M. Sanderson, H. Routledge, M. Oakes, P. Joyce, T (2005). The Impact of Person-Centred Planning. Lancaster: Institute for Health Research. 1-5.

Sommerbeck, L. (2011). An Introduction to Pre-therapy. Psychosis: Psychological, Social and Integrative Approaches. 3 (3), 235-241.

Tudor, K. Worrall, M. (2006). Person-Centred Therapy: A Clinical Philosophy. 3rd ed. London: Routledge. 123.

Wilkins, P. (2009). Person-Centred Therapy: 100 Key Points. East Sussex: Routledge. 107-110.

National Autistic Society. (2014). Counselling. Available: http://www.autism.org.uk/living-with-autism/strategies-and-approaches/counselling.aspx. Last accessed 10/12/2014.

National Health Service Choices. (2014). Autism Spectrum Disorder. Available: http://www.nhs.uk/conditions/autistic-spectrum-disorder/Pages/Introduction.aspx. Last accessed 10/12/2014.

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Appendix J

Transcription Participant 1: KR

PI: “How common do you think it is for people with Autism Spectrum Disorder to be offered

counselling?”

P1: “Eh, in my experience, working with both children and adults with Autism, I would say

that it’s quite a common occurrence. Especially if they’re out of mainstream school then

they’re more likely to be offered a form of counselling. Especially if they’re struggling with

issues like social interaction or suffer with ADHD, counselling might be, like, a calming

method for them.”

PI: “How common do you think it is for people with Autism Spectrum Disorder to seek

counselling?”

P1: “Em (pause). I wouldn’t say that it would be very common. In my experience, a lot of the

clients I’ve worked with have had limited communication or have in fact been non-verbal so

it would be extremely difficult for them to enquire or seek counselling themselves. I think it

would more be down to a parent or guardian enquiring on their behalf, or so I would

imagine.”

PI: “Do you think that counselling could be helpful if it was offered to people with Autism

Spectrum Disorder?”

P1: “Definitely, I would say that it varies to each child or adult and it’s very context

dependant, according to that person’s personal circumstances. Like, for example, if they

come from a deprived background then I feel that counselling could help greatly with their

communication and social interaction skills. I definitely think that people diagnosed with

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Autism could benefit from counselling. Even if it’s one to one counselling or group sessions, I

think it could help with their social interaction and stuff. Like, it might encourage them, if

you know what I mean?”

PI: “Are there any barriers that you think could be faced by people with Autism Spectrum

Disorder if they were to participate in counselling?”

P1: “Definitely, I think there would be an initial barrier with communication. Like I said, a

lot of clients I’ve worked with who have been diagnosed with Autism have very limited

communication or are non-verbal so there would be problems with their actual ability to

communicate. It can be hard for them to communicate how they’re feeling and their

emotions, because a lot of the time they don’t understand the emotion that they’re feeling. So

I don’t really know how they could tell a counsellor if they don’t know themselves. (Pause) It

can be difficult for them to portray to someone, especially a stranger. In my experience it

takes an awful lot, a considerable amount of time for both children and adults with Autism to

warm to you and build a trustworthy relationship so I’d imagine that being questioned by

someone they don’t know might make them feel quite intense, like they are being interrogated

and prodded to communicate feelings that they are uncomfortable with. Quite a lot of clients

I’ve worked with would be taken aback by it.”

PI: “Are there any ways in which you think counselling could be made more accessible to

people with Autism Spectrum Disorder?”

P1: “Definitely. Like I said, in my experience it’s only ever been through specialist schools,

those that haven’t been enrolled in mainstream schools, those that have a social worker or

any other organisation that have been directly offered forms of counselling. So I think that

more drop in centres would be a great idea, especially for children and their parents. I don’t

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think that there is an awful lot of support for parents that have children with autism to help

them. It can have a massive strain on the family so it would be quite a great idea if you could

get family counselling where every member of the family could go and help communicate

their feelings to everyone and the child with autism might feel more comfortable as they’ll be

surrounded by familiar faces. It could even enable the parent to handle certain situations

better.”

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Transcription Participant 2: KD

PI: “How common do you think it is for people with Autism Spectrum Disorder to be offered

counselling?”

P2: “I’m only in my first year of support work and I haven’t worked with any client yet who’s

been offered any form of counselling. So judging from that I wouldn’t say it’s very common. I

haven’t heard anything from any conversations with any parents or teachers or clients

themselves that’s suggested that they participate or ever have participated in any type of

counselling or ever been offered counselling.”

PI: “How common do you think it is for people with Autism Spectrum Disorder to seek

counselling?”

P2: “I wouldn’t say it’s very common. I’ve only worked with younger clients so far but a lot

of them have problems communicating so they wouldn’t be able to seek it themselves, I don’t

think that they would know what to ask for or be able to tell people they’re looking for help. I

think with the younger children I work with, it would be a parent or guardian or teacher who

would maybe have the ability to recognise certain issues that could be helped by a form of

counselling. And it would then most likely be them who would actively seek counselling on

this persons behalf by like, speaking to a doctor, health care worker or even the head teacher

at their school.”

PI: “Do you think that counselling could be helpful if it was offered to people with Autism

Spectrum Disorder?”

P2: “Em, I think it would depend on the persons circumstances, I think it would have

different effects on different people. So if someone had a bad background in the sense that

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they weren’t mentally stimulated as they should’ve been and because of that they had issues

with verbal or physical communication, they would probably benefit from counselling cause

it would address their issues with communication and then hopefully help them learn to

communicate in a way that’s comfortable to them. I think that the type of counselling that

people with Autism receive would have an effect on whether it would be helpful or not, cause

I think a lot of people with Autism would be really uncomfortable being in an unfamiliar

environment with a stranger. Asking them to communicate and interact and stuff when they

might not be comfortable doing that. (Pause) I think a lot of people wouldn’t be able to

tolerate it. It might make them lash out or have a really bad effect on them. So I think that the

best way to make sure it’s useful would be to determine what kind of counselling would be

best suited to a particular person.”

PI: “Are there any barriers that you think would be faced by people with Autism Spectrum

Disorder if they were to participate in counselling?”

P2: “Eh, I think that communication would most likely be the biggest issue. From my

experience, a lot of people diagnosed with Autism most likely won’t be able to communicate

their thoughts or feelings. Some of them might struggle to settle in to the environment and

some might not understand what’s expected of them or what they’ve to do during a

counselling session, so I think there’s definitely some barriers there. A lot of the clients I’ve

worked with have struggled to develop relationships so I think that could be a problem for

the counsellor, trying to get a client to communicate with you when they’re struggling to

familiarise themselves with you.”

PI: “Are there any ways in which you think counselling could be made more accessible to

those with ASD?”

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P2: “I think that more people with autism and their families should be made aware that

counselling is an option for them when they’re diagnosed. It would be a good idea to maybe

have like, drop in counselling sessions in local community centres, that way everyone could

have access to counselling. I think it would be easier to get people with Autism to go to

counselling sessions if it’s somewhere local and familiar to them, like a community centre. It

could help them socially too. I think social workers should make sure that they’re letting

their clients know that counselling is available to them. I’ve worked alongside social

workers before and I’ve never heard them mention counselling, I think it should be made a

priority, like just to let families know what options are open to them when it comes to getting

help for people diagnosed with Autism.”

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Transcription Participant 3: SB

PI: “How common do you think it is for people with Autism Spectrum Disorder to be offered

counselling?”

P3: “I don’t think it’s very common at all.”

PI: “Why do you think this is?”

P3: “Em, I think people often maybe don’t realise the need for people with Autism to be

counselled and there’s maybe not enough experts in the field of Autism to recognise their

needs. I think people with Autism Spectrum Disorder might not have the ability to request

counselling or if it’s a child who has been diagnosed with autism, their parents might not

know that counselling is an option.”

PI: “How common do you think it is for people with ASD to seek counselling?”

P3: “I don’t think it’s very common for people with Autism Spectrum Disorder to seek

counselling because I think perhaps they don’t realise that it’s something that can be offered

and communication difficulties could prevent them from seeking help so that might be a

barrier to them actively seeking counselling themselves.”

PI: “Do you think that counselling could be helpful if it was offered to people with Autism

Spectrum Disorder?”

P3: “I think counselling could be helpful to people with Autism, cause I think it could address

different issues that they might be having in their life. For example, people with Autism can

struggle a lot with education and work, and counselling could actually provide them with

coping mechanisms for this. It might also be helpful for behavioural issues that people with

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ASD might have. It could maybe provide them with calming methods if they suffer with

anxiety or anger issues that causes them to lash out.”

PI: “Are there any barriers that you think would be faced by people with Autism Spectrum

Disorder if they were to participate in counselling? What do you think these barriers might

be?”

P3: “I think the main barriers that people with Autism would face would actually be the

ability to seek counselling. Probably in terms of if they actually participated in counselling, I

think a main barrier would be having staff who are adequately trained. I think that it’s really

important to have Autism counsellors who specialise in that field as I think that a client

having a bad counselling experience could have a really negative impact on them, especially

being autistic. A lot of people with Autism that I have worked with have been quite

traumatised by bad experiences and will refuse to take part in something that they have had a

negative experience with so I think that if counsellors want clients to willingly participate in

counselling and feel comfortable, they need to be appropriately equipped to deal with certain

Autism behaviours. I think that communication is a very obvious barrier but in my opinion, I

feel like it all comes down to having appropriately trained staff who know the best ways to

approach certain issues without making the client feel uncomfortable and using methods that

will encourage communication.”

PI: “Are there any ways in which you think counselling could be made more accessible to

those with ASD?”

P3: “I think it’s about identifying people who are in need of counselling with Autism early

on. I think doctors and support workers who are appropriately trained should have the

responsibility of letting people know that counselling is actually an option for people with

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Autism. Even letting parents of children diagnosed with Autism know that there are different

types of counselling available that could suit their child’s needs and encouraging them to

explore their options. I suppose it’s important to empower people with Autism to know that

counselling is an option. I think that would let them know when and how to seek it and what

benefits they might get from it. Again ,I think that it would fall down to appropriately trained

counselling staff to let people know that counselling is available and to be able to sit down

with people with autism or their parent or guardian and explain the process to them to allow

them to decide if it’s a resource that they want to use. I think it’s really important to let

people know that there are a variety of techniques that are available, cause there are

different people who have different needs, and some counselling methods might be appealing

to some but not to others. Autism’s a wide spectrum, I think every person with Autism is

unique. So it’s important to let people know that there are a number of different counselling

approaches available, it’s not a one size fits all approach.”

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Transcription Participant 4: CM

PI: “How common do you think it is for people with Autism Spectrum Disorder to be offered

counselling?”

P4: “Em, I work with younger kids with Autism so it’s not something that I’ve come across

that often. I’ve worked with Strathclyde Autistic Society for three years now and I can only

think of one time where I’ve been made aware that a client has been participating in a

therapy and that’s been ABA. I’m not sure if counselling is a method that’s more apparent

with older people on the spectrum rather than younger children. (Pause) I definitely don’t

think there’s enough awareness that counselling is actually an option. It’s rarely been

discussed with clients that I’ve worked with over the last three years. I actually know very

little about it considering I’ve worked in this job for quite a while now, so I definitely think

that awareness must play a role in the reason why it’s not a common option.”

PI: “How common do you think it is for people with ASD to seek counselling?”

P4: “I think it probably is quite uncommon because people with Autism tend to lack in

confidence when it comes to socializing. So I think it would maybe be quite hard for them to

take initiative and ask for counselling. Like, I can’t imagine that many people with Autism

would be comfortable asking a stranger for help. I think that the thought of participating in

something new would be very daunting for people who like routine and find it hard to cope

with change. Yeah, I think a lot of people with Autism would maybe find it overwhelming

asking for help and trying something new in an unfamiliar environment.”

PI: “Do you think that counselling could be helpful if it was offered to people with Autism

Spectrum Disorder?”

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P4: “Yeah, I do actually. I think it would make people with Autism better equipped to deal

with certain situations better. They could have help in learning how to approach certain

social situations and learning appropriate ways to communicate and behave. That could be a

great help in like educational and social and work environments. (Pause) I think it could be

especially helpful for people with Autism that are in school or university, cause it would help

them socialise and would help them make friends. And that’s a key part of being a student

and a pupil. I think a lot of people with Autism find social situations like school and

university really difficult because of communication issues that people with Autism have. I

think they’d find it hard to make friends and feel accepted if they’re not able to express

certain feelings and interpret certain situations. So, I think if these issues were addressed in

counselling it could actually be a great help to them.”

PI: “Are there any barriers that you think would be faced by people with Autism Spectrum

Disorder if they were to participate in counselling?”

P4: “Yeah, I think they might find it hard to actually communicate with the counsellor if they

struggle to communicate with people in general, so I’m not sure if one to one sessions would

really be beneficial to someone with Autism. Aswell, if a person with Autism has a set

routine they might struggle to actually allow this change in routine and integrate the

counselling sessions into their regular day time plans. I think that could be quite a big

barrier.”

PI: “Are there any ways in which you think counselling could be made more accessible to

those with ASD?”

P4: “I think there should be more advertising for counselling. Like pamphlets and posters

with information on different methods and in areas like social work departments and schools,

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so people can be made aware that counselling is actually an option for people on the

spectrum. Yeah, and I think that there actually has to be more awareness of Autism itself

because I feel that if people actually had an understanding of what autism is and the different

effects that it can have on people who have a diagnosis, then they might become more aware

of how counselling could actually apply to them and be beneficial.”

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NC Participant 5

PI: “How common do you think it is for people with Autism Spectrum Disorder to be offered

counselling?”

P5: “To be offered counselling?”

PI: “Yes.”

P5: “Probably not very common, I wouldn’t imagine.”

PI: “Why do you think this is?”

P5: “Well, most of the people I work with are non-verbal so it would be quite hard to have a

counselling session with them. But that’s just from my personal experience, there’s obviously

many other people that are verbal and able to comprehend that. (pause) But I wouldn’t

imagine it’s very common or very useful. That might sound a bit narrow minded but it’s just

because of my own views. I was going to say, I think it would depend, like, on how severe

they were on the spectrum, to be offered counselling. And what it was they were offered

counselling for. Cause if it was for their Autism, or if it was for separate issues that maybe

come as a factor because of their Autism. Like if they’re being bullied because they’ve got

social impairments or they find it hard to make relationships because they’ve got interaction

problems. So maybe they’d be offered counselling because of that. But in terms of being

offered counselling because of their Autism, I don’t think it would be very common or very

useful. Sorry.”

PI: “How common do you think it is for people with ASD to seek counselling?”

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P5: “To seek out counselling? Again, I don’t think it would be very useful. Again I think it

would depend what for and where they are on the spectrum. And the whole verbal/non-verbal

thing. But in terms of seeking it out, eh, no, not very common if it’s just a straight answer

like that. But everything is subject to individual circumstance. I think if they could

comprehend that counselling would be useful to them then yeah, they’d maybe seek

counselling. But I think a lot of the time people wouldn’t understand that they need it so it

would probably be like, their Mum or Dad that ask about it.”

PI: “Do you think that counselling could be helpful if it was offered to people with Autism

Spectrum Disorder?”

P5: “No.”

PI: “Why?”

P5: “Again, it depends on what (laughs), I feel like I’m just saying the same answer for every

question. Em, I think it would firstly depend if it was focusing on their Autism or if it was for

other problems. Or. And, how far they were on the spectrum, what severity they were. Aye.

So. I don’t know, it would depend on if it was for other problems. Like. Is ABA a form of

counselling?”

PI: “No, but carry on with what you were saying”.

P5: “Are you sure?”

PI: “Yeah, of course.”

P5: “Ok, well I don’t really believe in that anyway. ABA.”

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PI: “Why?”

P5: “Because I think it’s just aimed towards treatment, and I don’t believe in the whole

treatment thing. I think it’s not something that could be or should be treated. Em, so maybe

it (counselling) would be helpful in terms of behavioural control. Like, for things that. For

like behaviours or things that were seriously impacting on their lives then counselling could

be useful. What about CBT is that a form of counselling? Cause if it is then that could be

helpful as well. Like maybe for other issues, like if they’re being bullied at school or bullied

in the workplace if they were able to work. I don’t know, it just depends how severe they’re

Autism was and what the problem was. But then, counselling might work for someone that

doesn’t have Autism too, so I think it just depends on the person. Person-centred approach

(laughs)”.

PI: “Are there any barriers that you think would be faced by people with Autism Spectrum

Disorder if they were to participate in counselling?”

P5: “Yeah, well, em. Most of the people that I work with just now communicate through

idiosyncratic forms of sign language so that would be a clear barrier for the counsellor. How

would they be able to communicate because a lot of people with Autism are maybe. Even if

they aren’t non-verbal, they’ve got severe verbal limitations in terms of communication so I

think that would be a definite barrier. What else? Understanding tone. Facial Expressions.

They might not convey what the counsellor’s trying to get across. Em, what other barrriers

are there? Can you repeat the question?”

PI: “Yeah, are there any barriers that you think would be faced by people with Autism

Spectrum Disorder if they were to participate in counselling?”

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P5: “Ok. Oh! Attention span is another barrier. Maybe the counselling sessions are not

kinda (pause). Maybe they’re too generalised, like if they’re person-centred to suit a

person’s needs. With Autism, there is additional needs that come with every person and with

their Autism on top of that, there are going to be barriers. It might not be possible to revolve

a counselling session around someone with Autism because, like, their attention span is so

short, a lot of people can’t concentrate long enough to take part in something like that so that

might be a problem”.

PI: “Are there any ways that you think counselling could be made more accessible to those

with ASD?”

P5: “More accessible in terms of (pause)? Well, is CAMHS a form of counselling?”

PI: “They can offer counselling, yeah.”

P5: “Right, because from what I’ve heard through my work, they’re quite accessible. Like

they’re easy to get referred to by your GP. I’ve heard a lot of people that I work with go to

CAMHS. Don’t know how beneficial it is to them, but. Em, what was I saying? Sorry I go off

in a tangent.”

PI: “No, it’s ok. Are there any ways that you think counselling could be made more

accessible to those with ASD?”

P5: “I don’t really know if it will be beneficial but if they were to advertise it more, like

through their psychologists or GP’s could refer them on for a counselling session and see if

they do benefit from it. Where else? It would probably be good to advertise it through pre-

school and school, to catch it while they’re young. Cause it’s all about routine and

structure, so if they start going to counselling when they’re young, that will become part of

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their routine and they’ll be more adaptable and they’ll get more from it, it will be more

beneficial. Yeah, I think that’s a good idea, to advertise it and show parents and teachers

that it’s available. That’s it, I think.”

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