COACHING FINAL REPORT

Client: A.Z., MSW 

TIME SUMMARY  

After ten hours of observation, I wrote an assessment and plan for coaching A.Z. over a six week period, with a suggested minimum of one face-to-face session per week and an average of three hours of telephone contact. In fact, we averaged over six hours per week of contact. There were a number of hours of contact in the week between observation the formal coaching.

This continuity allowed an excellent rapport to develop. Indeed, I have learned a lot from knowing A.Z.  I have a great deal of respect for what he is doing with his life. As I was able to clearly understand the internal pressures with which he has lived, I was impressed with how he has handled himself generally. 

I feel fortunate to have had the opportunity to work with A.Z. 

BACKGROUND

Initial concerns about A.Z.’s performance at work revolved around two central themes: his rapid descent into demanding behavior under certain circumstances, most commonly over issues of accommodations; and the questions raised by his supervisor over A.Z.’s overall suitability for the job of social worker. Things reached the boiling point when two consumers requested another counselor.  A.Z. began a three pronged strategy to help him deal with his stress: he began taking anti-anxiety medication, having cranio-sacral massage therapy, and began coaching.

Early in my conversations with A.Z. and SUPERVISOR, the issue of “autism” was raised as a result of some stereotypic behaviors often associated with autism. Needless to say, this raised the stakes. The question hovering in the background was, “If A.Z. has tendencies that are based in a developmental disorder, can he be in control with the consumers at all times?”

Other issues were there as well: the difficulty working seamlessly with team members, and the ability to effectively deal with vendors under circumstances in which A.Z.’s desire for answers was thwarted. The question of whether A.Z. had empathy was also raised.

WHAT ARE WE WORKING WITH?

Although I do not have the formal credentials to diagnose pervasive developmental disorders, I nevertheless set about learning enough to about autism spectrum syndromes to make a reasonable guess as to whether A.Z., in addition to being severely visually impaired, also might have one of the several disorders in the spectrum.

I think it is likely that A.Z. has Asperger Syndrome. A.Z. worked hard to let me into his head. As a result of his honesty, I was able to confirm his elaborate, structured and non-neurotypical schema for viewing the world. He has constructed a sophisticated inner life that has been driven by his almost painful desire to function as normally as possible in the world. This, in addition to a number of other behaviors, comes close to equaling Asperger Syndrome, in my lay opinion.

In addition, A.Z. is an Enneagram One. Some of the issues inherent in Asperger Syndrome intensify many tendencies of Ones. And under stress, all the difficulties of Ones would be compounded by the tendencies of someone with a PDD like Asperger Syndrome. It would be more than a double-whammy. 

A.Z. is a classic One in many ways. He cares deeply about being a good person and wants to move into action whenever he sees an injustice or problem. He feels called to serve a larger cause, as is common with Ones.

He also experiences the challenges of being a One, including the inability to turn away from challenges. Under stress, Ones can become sarcastic and hostile. The fear of losing control results in even tighter self-control. Obsessive thinking and compulsive behaviors are common in stressed Ones.

The world is either right or wrong for a stressed One. There is no room for gray areas. As Ones become healthier, they remain acutely aware of their own shortcomings – perhaps more so than any other type – but they learn to accept that there is a lot of space between their concept of right versus wrong.

When Ones struggle to stay true to their ideals, but have not found that inner place of self-acceptance and comfort, they can be repressed, resistant and have problems with aggression – often directed toward self, or expressed as sarcasm. 

A healthy One is a powerful, just advocate whose commitment to helping others sets a fine example for everyone.  Humor is a sign that a One is getting healthier and more secure.

ASPERGER SYNDROME IN BRIEF  

I think it would be helpful to include the relevant behaviors that are often labeled as autistic. In A.Z.’s case, I have either seen these, had them reported to me, or had A.Z. self-report. 

Because A.Z. exerts an enormous amount of control around clients, I observed only his difficulty with spatial orientation when in the presence of clients. Because he is visually-impaired, it is difficult to determine what the origin of this particular challenge is.

These are behaviors identified in The OASIS Guide to Asperger Syndrome [1] and part of A.Z.’s “repertoire” at times:  

What is impressive to me is that A.Z. is aware of these issues and has struggled to find ways to compensate or overcome them. The energy he has to expend, during a day many of us would consider normal, must be incredible.

Research in Norway [2] on congenitally blind children who had no known damage to the central nervous system, beyond their visual impairment, revealed that almost half of these children had enough criteria to meet the diagnostic criteria for autism. About one quarter were considered “strongly deviant” in behavior.  Not uncommon were “stereotypes, echolalia and limited interest in other children.” 

The author provides an excellent discussion of particular issues, and concludes….. “that a large portion of the congenitally blind children with autism or autism-like problems would not have had essential problems of this kind had they been sighted.”

He goes on to say, “Congenital blindness causes serious vulnerability regarding development. If the child has a neurological impairment on top of the blindness, the vulnerability may triple, or quadruple, or perhaps a lot more.” 

The issue of limited interest in other children is common with Asperger Syndrome. A.Z. has explained to me the enormous time and effort he put into making himself interact with peers. He forced himself to find ways to be as normal as possible, and this took an extraordinary amount of focus and energy. It became clear to me that this effort was not for “him,” because it wasn’t what he wanted or what would meet his real needs for adult contact, but because he wanted to avoid behaviors that would embarrass his family. 

To consider that a pre-teen was able to comprehend what was normal versus abnormal, to sacrifice what he wanted, which was contact with teachers and other compassionate adults, build a mental schema of such power it could control behaviors that were actually physiologically based, in order to provide the appearance of normalcy for the sake of those closest to him boggles my mind. 

So we are left knowing that A.Z. has some issues that most of his fellow workers could barely imagine. Yet he has received repeated positive feedback on handling cases, and has a number of skills unique to him. He is able to be quite creative in how to solve his client’s challenges. His experience and knowledge make him a valuable addition to EMPLOYER, I think.

What is the relevance of all this in terms of A.Z.’s work?

SUPERVISING A.Z.

A.Z. is so powerfully self-motivated that he is likely to carry work home with him. This can be a problem if he doesn’t balance work with enjoyable, social activities. The challenge is not to be sure that A.Z. does his work, but that he doesn’t do it all the time. 

A.Z. is empathetic. I have no doubt that he cares deeply about people. This may not be obvious to someone who knows him casually. But, I spent almost 50 hours with A.Z. over a two month period.  I was able to get a good sense of how he felt about many things. 

One of the challenges of Enneagram Ones is knowing how to “feel” one’s feelings. This coupled with the inherent difficulty of appropriate social expression of emotions associated with Asperger Syndrome makes it a real puzzle for A.Z.  to demonstrate what he feels.

I think that A.Z.’s professional demeanor, combined with a natural enthusiasm that comes out often, is sufficient for his job.

I understand that  is now more relaxed with his peers. He and I have dissected the issue of getting help from other people. I think he is more comfortable seeking assistance and not taking the burden of the problem entirely on himself. (This is a classic One trait: “I am responsible for everything.”) A.Z. will ask for help if he needs it. He will also ask for additional information in situations before he agrees to undertake them. I think some positive reinforcement of this would be appropriate. 

Finally to the issue of demanding behavior: A.Z. is no happier with what happens to him when he gets locked into his spiral of obsession than any one else. He and I drew up a plan for preventing the spiral. I found it interesting that as we worked on the plan, A.Z. kept “ungeneralizing” what we were doing.

It was clear to me that the problem and solution were not situationally dependent, but A.Z. was driven to point out all the exceptions. It would have been amusing, except it was clear evidence of how his brain works. That difficulty generalizing from situation A to B is one of the key features of Asperger Syndrome. A.Z. is able to incorporate the rules into a process, but I suspect inside his head something stills says, “But, if this happens…..”  

The PLAN  

Goal: Define a process for handling accommodation and other challenges that results in a positive outcome for all concerned.

            GENERAL Steps  

Define the scope of the problem immediately:

1)   emergencies require getting assistance for self or others as rapidly as           possible

2)   all other issues can be accepted as part of the ups and downs of life and handled accordingly

Once the scope has been defined, before any action is taken:

1)   take a time out for several minutes for breathing exercises or other tension reducing measures

2)    determine if there is sufficient information to act on your own

   Monitor level of inner tension:

1)    if it reaches an unacceptable level, take a time out

2)     take a quick walk to the drinking fountain

3)     do not take further action until inner tension is at an acceptable level     

  Determine if someone nearby can be of assistance:

1)      if so, ask, keeping in mind that your problem is not their problem

Decide if someone in a supervisory position needs to be notified of the difficulty, in  the event that your ability to perform your job is interrupted:

1)     if so, make the appropriate call or calls in a matter-of-fact fashion

  If calls need to be made:

1)    determine where to start or ask someone for advice on where to start if uncertain

2)   remember that redundant information is fine, making assumptions may lead to problems

  All calls need to be made with the following understanding:

1)    the person answering is not responsible for solving your problem

2)    if it becomes clear that the person cannot help, ask for a referral to someone else

  If calls involve leaving a message and having to wait for help:

1)   decide how long to wait before taking further action based on a non-returned call (at least an hour before calling back under most circumstances)

2)   to avoid the sense that the problem must be solved immediately, establish a reasonable time frame based on your knowledge of how the system works, not sense of inner urgency, and stick to it.

Monitor inner level of tension and take a time out before making another call:     

1)   do not make calls if tense or anxious

Recognize that you may have to find other activities to occupy your mind and time if the

problem cannot be solved quickly:

1)   decide ahead of time what those will be – time outs, walks, making notes, making contact calls

  EXAMPLE OF THE PROCESS

For accommodation problems, A.Z. will begin by determining how complex he thinks the problem is. Some issues can be resolved by a sighted person who is familiar with the general EMPLOYER set up, others require help from outside agencies or persons with expertise.

Before acting,  will take a few seconds to focus on his level of tension. He is well aware of the various escalating stages of his tension and anxiety, so he can monitor his inner state accurately.

If he feels any degree of tension, he will take a time out and do some breathing or other relaxation exercises.

A.Z.’s first step, if he thinks the accommodation problem is simple, will be to contact COUNSELOR for help. If COUNSELOR is not available, A.Z.  will contact another counselor, or a member of the support staff to help him figure out a solution.

If he cannot solve the problem with the help of EMPLOYER personnel, or if the initial problem seems to require more expertise than EMPLOYER personnel can provide (for example with JAWS), A.Z.  will take a time out for a few minutes before taking any kind of action. If he feels particularly tense and anxious, he will leave his desk, go get a drink of water, or walk around a bit until he feels more in control.

A.Z.  will then call the Cincinnati Association for the Blind and explain his accommodation problem. If he must leave a message, thus being unable to immediately solve his problem, he will assess how disruptive the problem is before taking another step. He will set a time limit in his mind before he makes another call. A.Z. should probably allow at least an hour to pass before deciding that CAB cannot help him. 

A.Z. is dependent on accommodations to perform his job. Being unable to perform his job creates a great deal of  tension and anxiety for him. 

If he is unable to use his computer, and is not sure when he will be able to process paperwork, A.Z. will inform SUPERVISOR via a quick, informative phone call, as well as letting support staff know that he cannot process any paperwork for an undetermined length of time. 

A.Z. will do whatever work he can without access to the computer until it is time to make the next help call.  If he feels anxiety building, he will take a longer time out or take a walk before taking any other action.

Once the time limit for hearing back from CAB has been passed, A.Z. will call the help desk in Columbus with a description of the problem. The person who answers may not be able to address A.Z.’s problem.

If he is not put in touch with someone who is familiar with his particular problem, before his tension reaches a certain point, A.Z. will cease and desist, take a time out and consider his next step carefully. 

A.Z. will carefully monitor his internal state during the phone calls. If he finds himself reaching the point of no return, he will discontinue the phone call politely and quickly. Perhaps he will simply thank the person for their time and state that he needs to attend to something.

It might be reasonable to contact Microsoft technical support with his problem. If so, A.Z. will wait until he feels reasonably relaxed before calling.

If the work day is coming to the end and A.Z.’s problem is unresolved, he will inform SUPERVISOR of the steps he has taken and ask for advice on where to start the next day. A.Z. can write up initial interviews at home, but little else can be done – no referrals, no access to the EMPLOYER network.

It is not likely that the accommodation problem will reach this level of complexity, but if it continues, A.Z. will need to take time outs frequently and make sure that he is clear about what SUPERVISOR and other team members expect from him until his access is fully restored. 

A.Z. will not call or talk with anyone while he feels especially tense or anxious. He will inform people matter-of-factly that he is unable to access his computer.

Sometimes accommodation problems result from insufficient information. A.Z. has resolved not to undertake any projects in the future unless he has complete information before starting.

If, for some reason, A.Z. finds himself with a time sensitive project and realizes he needs help, he will go through the following steps: ask another counselor for assistance, ask support staff for assistance. He will be as explicit as possible about his problem. He will take a time out if he finds himself getting tense. If he needs to excuse himself from the room and take a walk, he will do so by merely saying, “Excuse me, if you can wait a couple of minutes, I will be back.”

  In other words, by: 

1)      monitoring his internal state

2)      not acting when his tension reaches a certain point

3)      taking time outs between actions

4)      not making phone calls until he has relaxed

5)      excusing himself for several minutes for a walk to the drinking fountain

6)     informing appropriate personnel that he cannot complete certain aspects of his job 

A.Z. can prevent the spiral into demanding behavior. 

CONCLUSION  

I think A.Z. could benefit from ongoing reinforcement of his newly growing skills. He and I have discussed revisiting the coaching question in January. He is willing to pay me himself, but I am not sure that enough time has passed for his relationship as a EMPLOYER consumer to end. I know his case could be closed in December, but I am not sure that is a good idea simply because reinforcement is so important in A.Z.’s learning process. Additional oversight could serve as positive reinforcement. 

I have a few suggestions about activities that I have discussed with A.Z. that I will follow up on in December, but I am not doing any coaching with him per se. I suggested that he monitor how things went without the coaching.

I think A.Z.’s case presents an opportunity for EMPLOYER to examine some assumptions about its employees. If he ultimately is diagnosed with Asperger Syndrome, or a related PDD, it certainly would be a wonderful example of the rehabilitation process in action.


[1] The OASIS Guide to Asperger  Syndrome: Advice, Support, Insight, and Inspiration.  2001. Patricia Romanowski Bashe and Barbara L. Kirby. Crown Publishers. New York.
[2] Blindness and Autism: What is the relationship between blindness and autism-like difficulties in children? Knut Brandsborg. http://www.icevi.org/ (International Council for Education of People with Visual-Impairment.)

email: connie

copyright 2002                     constance lee menefee                  all rights reserved