Knowing what we know now about trauma recovery, we suddenly understand our past therapists much better and get that they weren't refusing to address certain issues, they were simply following protocol.

It's still not okay to leave your patient in the dark about that, though.

No good therapist is going to come right out and tell you, "I think you may have repressed trauma. Let's examine that and see if we can change your diagnosis from BPD to C-PTSD."

None. Because it's not safe.

But you don't have to say the T-word to explain what you're doing.

You can say, "The first step of recovery has to be stabilisation and I don't think your current situation is stable enough. You don't have an adequate support network. We need to work on these things before we can move on to the next step because otherwise it wouldn't work."

Right? Why not just *explain* that instead of pressuring patients to work on "social competence" and repeatedly redirecting their focus towards "problems in the here and now" despite their insistence that other things are bothering them way more?

Maybe I'm being too generous. Maybe none of them suspected a trauma history at all.

But even if that were true, they clearly used an approach that lines up with trauma recovery principles: stabilisation first.

So. Why not explain? Did they not know *why* that was the protocol?

Actually, I could see that happening. An education so overly focused on what to do when, you lose sight of the why.

"Patients will get better eventually if they do XYZ first, that's just how it is, and if they won't accept this without explanation, why, that's noncompliance"

Besides, there are ways to address the whole "but I don't know what's happening to me and it's scary" thing without delaying stabilisation??? A few reassuring comments here and there would suffice.

Especially like "what we're doing right now will eventually help with that, too."

You (the therapist) just have to make sure you don't end up sounding like *you're* engaging in magical thinking.

Presenting yourself as an expert who simply "knows how this works" isn't enough if the patient suspects there's stuff going on that no one's seen yet.

In our case, it turned out to be true. There was indeed stuff going on that *no one* recognised for what it was.

Does that mean the treatment approach was completely wrong? Not necessarily. But it felt like everyone was just ignoring our real problems, and that's not helpful.

Being autistic plays into this as well, I am sure. We're a lot less likely to accept "that's just how it is" as an explanation.

If the treatments had actually worked, maybe it wouldn't have been so bad to have some lingering confusion. But of course they didn't.

All of the many types of therapy we tried would have needed to be adapted for an autistic patient with chronic physical illness in order to be effective.

What "stability" looks like for us in the first place is very different from an able-bodied, allistic person's stability.

The "stability" a therapist will try to get you to achieve if they don't know you're autistic and think your physical symptoms are largely psychosomatic is in fact a highly stressful, traumatic, unsustainable state for us.

We were set up to fail from the start.

If that hadn't been the case - which is, I imagine, how it goes for a lot of allistic patients and maybe even a few autistic ones if they're lucky - we might have simply come to realise that the therapy was helping, so it didn't matter that we didn't have all the answers yet.

In the absence of either an explanation *or* evidence that the treatments were doing something, what were we supposed to think?

The natural conclusion is that either all these therapies are bullshit or you were misdiagnosed.

The real problem, as I see it, is that very few healthcare professionals take a holistic approach to helping people.

You have to be trauma-informed because anyone could have hidden trauma. You can't treat physical symptoms as psychosomatic until proven otherwise.

You have to know how to modify treatments for autistic people because there are a lot of us, and you have to be willing to try out those modifications *anytime* the usual approach doesn't seem to work, whether you suspect autism or not, because some of us mask well.

The same goes for ADHD and several other things.

You have to be open to the possibility that part of your patient's "depression" is in fact physical fatigue, or their "anxiety" caused by mast cell degranulation.

And the kicker is that none of it requires a diagnosis.

The modifications that make a treatment better-suited for certain neurodivergences don't even have to be called "the autism variant" or "the ADHD variant" etc.; the only reason why such labels ever make sense is that you can start there if someone comes in already diagnosed.

They could just as easily be called Variant A and Variant B, with the understanding that most people who respond best to Variant A will turn out to at least have some autistic traits and most people with an autism diagnosis will benefit from using that variant.

Similarly, there's no harm in modifying your approach to accommodate physical fatigue if the regular approach wasn't working, just in case - just to see if you get better results that way.

This is how it should be; how it *would* be if the system's main focus was helping people.

I'm sure there are lots of individual doctors and therapists whose main focus is helping people, but the system they operate in and that influenced their education is very much a capitalistic, ableist, racist, colonialist one.

It makes them less effective.

Well, this thread got a little out of hand - I think I covered at least 3 separate issues because they're so heavily intertwined. A stronger person might try to detangle them into separate threads, with links to each other, but alas … I cannot do that