Sally is a 54-year-old woman.
Sally has struggled with agoraphobia, social anxiety and mental health since her 20’s and was diagnosed with chronic anxiety and depression.
Sally experienced a mental health breakdown 5 years ago which led to an inpatient hospital stay. It was at this time that a mental health professional suggested that she might be autistic and referred her for an assessment. Sally was diagnosed with autism in December 2022. Sally self-referred herself to our service, she stated in her referral form that she would like some additional support specific to her autism to enable her to improve aspects of her mental health, especially her agoraphobia which has a major impact on her day-to-day life.
Sally felt too anxious to take part in a video call for our first session, so we agreed to have a telephone call. During the session Sally described her struggles with agoraphobia and mental health. She mentioned that she was diagnosed with agoraphobia when she was 15 years old. She said that in the last 5 years she hasn’t been able to go to a shop or go anywhere apart from taking a taxi to and from work. Sally works as a teacher assistant in a primary school. She likes her job but finds it too much due to the workload, unpredictability and sensory environment and is currently experiencing meltdowns/overload at work. Our Autism Specialist Advisor asked Sally if she had disclosed her autism at work. Sally told us that she had disclosed to her deputy head teacher but hadn’t thought of disclosing any further. After the session with us we sent Sally further information about meltdowns, masking, and autism in women.
During the second session we introduced the concept of neurodiversity and discussed autism and communication. Sally expressed that she had aways been made to feel by professionals that there was something intrinsically wrong with her, that it was her anxiety and mental health causing her to struggle with her agoraphobia, but she never thought about it from the neurodiversity point of view. She has taken medication for depression and anxiety since she was 15 years old but felt nobody helped her understand what the underlying cause of her anxiety/depression was. As we looked through communication, Sally started to become more aware of her differences and her rights to access reasonable adjustments at work.
We looked at the pros and cons of disclosing with Sally and also suggested she could write a “guide to Sally” where she could explain what autism means for her day-to day and at work and also how she would like people she works closely with to help (we sent her an example of this).
When it came to the third session, Sally felt more comfortable and confident working with us and agreed to have a video call rather than a phone call. This was a big step for Sally. During the third session, Sally wanted to focus on her agoraphobia. She explained that in the last 5 years she hasn’t been able even to walk to the end of the road. She described the feeling that as soon as she goes out, she can’t breathe, her head spins and she might zone out not being aware of her surroundings. She said that sometimes it can take days for her to regulate back. Through talking to Sally, it became apparent how much sensory overload was impacting her agoraphobia. We focused on looking at sensory processing differences in autistic people and thought together how that could be affecting her. Sally immediately related it to vestibular hypersensitivity which she had had since childhood. We talked though with Sally about things that may help to manage sensory stimulation and avoid overload. We also discussed losing her sense of safety when she goes out and suggested to Sally always trying to plan an escape route if needed. We discussed things that calm her down and make Sally feel more relaxed. Sally agreed to take baby steps without pushing herself and going at a pace so that she could feel more in control. Sally explained that she always felt misunderstood by professionals as she has been told that the root of her struggles was “her nerves” and her agoraphobia has never been linked to her autism traits/differences before. She said that until now this made her feel guilty that she was not trying enough. We also sent Sally some information about breathing techniques, grounding technique and strategies to regulate her vestibular sense.
During the last and final session Sally discussed an incident that she had at work. We discussed meltdowns and overload and how this presents in Sally. We looked at her triggers and self-care after a meltdown/overload. We also talked through making an anxiety plan with Sally and using energy accounting to make sure she has time to recover and regulate. Sally agreed for us to put her on the waiting list for her to attend Autism West Midlands women’s discussion group. This group meets monthly but alternates face to face and online meetings. Sally would like to initially attend the online ones until she gradually feels comfortable attending in person.
After the sessions, Sally feels more confident in advocating for herself. Reframing her autism from the neurodiversity perspective gave Sally a new understanding and has boosted her self-esteem.
Hopefully she will continue her journey through accessing the women’s group.
