The Sherkow Center Method: Dr. Sherkow’s psychoanalytic approach and method to ASD treatment with two examples
By Gillian Feit
Autism Spectrum Disorder (ASD) is defined as a “condition related to brain development that impacts how a person perceives and socializes with others, causing problems in social interaction and communication” by the Mayo Clinic (2018) . ASD is a disorder that is often associated with many clichés and is broadly misunderstood by the wider public. With further research deepening our understanding of the condition every year, it is vital to recognize that it is foremost a spectrum on which people react differently and exhibit a multitude of symptoms.
At the Sherkow Center, Dr. Sherkow’s psychoanalytic approach aims to understand and connect with patients, regardless of the severity of their ASD diagnosis to better address their difficulties and help them navigate life at home, school, and in society. Dr. Sherkow’s approach consists of any long-term form of combination of psychotherapy and medication, though not the first recourse, to treat her patients’ symptoms. Course of treatment depends case by case and can vary in scope, frequency, and duration of treatment.
During clinical sessions, Dr. Sherkow follows the patient in what they want to talk about or do before guiding the conversation to topics they may struggle with. An often struggled with concept is actually their diagnosis and how to come to terms with it. Other struggles can include important life transitions and navigating familial relationships, or overcoming impasses in development. In certain cases, such as Alex’s*, a 13 year old boy presenting with moderate to severe autism spectrum disorder, grapples with communication though he is verbal, maintaining eye contact, and normal development. His behavioral symptoms are associated with ASD: stimming, a long held hum which clinicians believe to be a coping mechanism from excessive sensory stimulation; and constant movement and curiosity in inanimate objects, specifically electronics and toys, which are a source of entertainment. During a given psychotherapy session, he will play with toys with Dr. Sherkow which are then used as proxies to express anger or other strong emotions, which subsequently allow Dr. Sherkow to understand associations Alex may be making. An example of this would be making toy cars crash as a means to express frustration, which Dr. Sherkow will inquire at who or what it is aimed at to make sense of Alex’s emotions and state of mind.
A second example to consider would be Chris, a 4 year old boy presenting with moderate autism confronting significant development setbacks. Chris struggles associating his mother as a separate entity from himself. Dr. Sherkow conducts dyadic treatment with Chris, which consists of both individual psychotherapy and working with his mother to ensure progress and development outside of therapy. During therapy, Dr. Sherkow emphasizes on helping Chris integrate and compartmentalize information. This occurs through creating patterns by emphasizing pronouns and names, and to whom they are referring, as well as repeating actions or terms that are linked to each other to help build those nascent connections and foundations (an example could be chicken nuggets is to food is to eating is to a statement such as ‘I like to eat chicken nuggets’). Chris is also medicated with risperidone, which is a second generation antipsychotic (SGA) and modulates serotonin and dopamine levels in the brain (National Alliance on Mental Illness, 2016). More recently, Chris has addressed his mother for the first time as “mommy”, indicating separation anxiety but also progress! He has also started acting out more in the classroom and crying. While it may seem like a setback for a 4 year old, it shows on the other hand he has just surpassed the individuation stage, where he is able to identify himself as a separate person, which usually occurs around 18 months in neurotypical individuals. This is a strong indication that he is resuming normal development instead of stagnating in his development.
The Spark program, a group approach to therapy, is another initiative started by Dr. Sherkow to improve her patients' social interactions. Spark recreates social settings outside of home that patients may struggle navigating. Volunteer neurotypical “buddies” are paired with patients to have discussions or play games in a non-stressful environment. As an addition to therapy, this program is beneficial in developing peer association and communication skills that can help patients feel more comfortable around people. Topics of discussion are very varied and are mostly emotion centered. A recent topic was how to manage frustration with curfews set by parents and understanding the reasons behind them. With younger patients, enacting short plays (drama psychotherapy) helps them label emotions they may be feeling and what the most appropriate response is; such as knowing to take a deep breath and not get upset when they are introduced to someone new. The goal here is to promote connecting the emotional brain to the thinking brain. A variety of emotions can be enacted, but some of the ones we address are jealousy, anxiety, and embarrassment (scenarios enacting these out can be wanting what someone else has, competing with friends, or failing to complete homework).
A comprehensive approach to treating individuals with autism with individual therapy, group therapy, and medication can help address a multitude of symptoms and improve their anxiety interacting with others around them. As an intern having participated in weekly Spark sessions and shadowed Dr. Sherkow, I can say I’ve seen significant progress in several patients who receive treatment from the Sherkow Center.
*Names have been changed to maintain confidentiality