Alison was 42 years old when she came to me for counselling. She had dyslexia and had been diagnosed at age 27. Following her diagnosis, her boss, who had been supportive of her seeking a diagnosis, began to use her diagnostic report to delegate work to her that the report said would present the greatest challenge for her. She had moved on to another job that was also ill-suited to her disability and was suffering depression, eating disorders and anxiety.
Some 10% of the population have dyslexia. Yet dyslexia is still widely misunderstood and under-acknowledged in society. It does not mean that someone cannot read or write, and their reading (dis)ability is unlikely to be their only symptom. A person’s dyslexia is as unique as their fingerprint.
It is the consistency, regularity and frequency with which someone experiences their dyslexic traits that determine their diagnosis when they are assessed, along with the typical traits of difficulties in processing reading, spelling, writing, maths etc.
Dyslexia is categorised under ‘learning disorders’ in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and yet NHS psychiatrists generally won’t see clients with dyslexia as it is regarded as an employment and education issue, not a mental disorder. Generations of adults alive today navigated the education system at a time when neurodiverse conditions were unheard of and, like Alison, still bear the scars.
There is little support for such people when they are diagnosed with dyslexia in adulthood, leaving them with nowhere to turn to for help to understand their diagnosis and the impact of dyslexia on their lives.
What is dyslexia?
The cerebral cortex of the brain is divided into four different lobes and each is responsible for processing different types of sensory information. There are two distinct differences about the functioning of the brains of people with dyslexia: first, they manifest malfunctions in the cortex, and second, they show less cerebral asymmetry (differentiated use of the left and right side of the brain) than non-dyslexic brains. People with dyslexia process information, data, language etc from the right side of their brains. Usually the left side of the brain performs this function while the right side processes emotions, creativity, intuition etc.
People with dyslexia often understand concepts more easily when communicated in pictures. When translating information from the spoken or written word, the dyslexic brain is better able to understand if there is also some kind of pictorial illustration. This can seem as if they are processing information slower than average, whereas in fact the brain of a person with dyslexia can process images at a far greater speed than can people without dyslexia: ‘An average person processes 150 images per second. A dyslexic brain can process between 1,500–4,000 images per second, in a three-dimensional way.’1
Cognitively, people with dyslexia may have poorer short-term memory and working memory and can struggle to store and retrieve verbal information. They can be quick to grasp ideas but just as quick to forget them because of an inability to retain the information in their long-term memory. Spelling can be inconsistent; they may be able to spell/read a particular word on one day and not the next, or even the next hour. Typical struggles are word retrieval, misuse of words, difficulty in proofreading, and particular difficulty with shorter words such as it, is, on, at, the, their/there etc, and names (people and places), because they don’t have an associated picture.
Dyslexia diagnosis
A diagnosis of dyslexia in adulthood can be both devastating and elating. This ‘diagnosis bombshell’ can spark emotions ranging from relief to sadness, anger, unfairness, hopelessness and denial, followed by a period of grieving for the loss of all the opportunities denied them by their struggles with the education system in childhood. Finally, their past difficulties make sense and they have a label for their struggles, but how does that label feel? And how does it now help?
Shame is common among people with dyslexia, often directly related to their struggles in the education system. Our academic system creates humiliation and embarrassment for those who can’t perform, leading to low self-esteem, lack of confidence and an external locus of evaluation. In one study, 33% of children with dyslexia in mainstream schools believed they were ‘stupid’, lazy or ‘thick’, and regarded themselves as less intelligent than their peers.2 These beliefs are commonly reported by adults with dyslexia, especially where their dyslexia has gone unrecognised. They may have devised ways of covering up their difficulties through fear of the shame of discovery.
Dyslexia can be misunderstood in the workplace. Linear thinkers can find it difficult to understand when someone with dyslexia struggles with time and organisation and may misinterpret these difficulties as signifying an inability to manage workplace procedures, reinforcing the individual’s negative self-perception. This can be frustrating and stressful for people with dyslexia and they may avoid career paths that might highlight their literacy, or other, difficulties. One client I saw had had numerous jobs by the age of 50, to ‘avoid being discovered’ when their difficulties with certain tasks became apparent to their employers.
Critical comments at work can trigger flashbacks to school and painful shaming experiences. Many people with dyslexia end up in jobs that are inappropriate to their skills, thereby reinforcing their negative perceptions of their abilities.
A big issue for many people with dyslexia is ‘perfectionism’. Often at school, when you got things wrong, it was an embarrassment, and so you strive for perfection to avoid the embarrassment – or become risk-averse. ‘When failing to be perfect [the individual] can become very self-critical... rarely happy and contented with something they've achieved.’3
‘People with dyslexia can feel anxiety in a range of situations where they run the risk of being seen by others as stupid or incompetent.’3 If they experience difficulty keeping up with conversation and take longer to express themselves, this can feel isolating and can lead to them withdrawing from social contact.
Dyslexia in the counselling room
When meeting these clients, I listen to their unique experience of dyslexia to gain an understanding of their specific and personal knowledge of the condition. Depending on their understanding, I may share a diagram with them, ‘The Make-up of Neuro-Diversity’,4 by Mary Colley, founder of DANDA, the Developmental Adult Neuro-Diversity Association, which maps the traits of all the main neurodiverse conditions, such as AD(H)D, dyspraxia, dyscalculia and autism spectrum disorder. I find the diagram helps normalise clients’ experiences.
Awareness, understanding and acceptance of disabilities are crucial for developing a positive self-concept. All counselling is about working with clients to help them be the best version of themselves. My work with these clients often starts by helping them to identify a trigger experience that affected their sense of self and highlighted their difference from others. I encourage the use of drawing, to help them communicate in their primary ‘visual’ language. In particular, we draw a timeline of their life from birth to the present day. I then ask them to recall their earliest memory and draw a representation of this, whether positive or negative. I can spend many sessions with a client purely on exploring one memory or drawing. Often the memory is negative and often one of shame, feeling less than and unable to perform some task that their peers can complete with ease. I work with clients on their locus of evaluation and on reframing the story that they have taken in from others that they are thick, stupid and less than their peers. I will use the timeline to pinpoint when these versions of themselves emerged and where they learned these negative self-images, in order to help them develop a new, authentic, internally originated version of themselves.
This was the case with Alison, who I introduced at the start of this article. She told me about an early memory from school when all the other children progressed from writing in pencil to using a fountain pen. Eventually, Alison was the only child in the class still using a pencil to write and the teacher told her she couldn’t use the fountain pen yet because her spelling and handwriting weren't good enough, ‘and she just needed to keep trying harder’. When she plotted this on her timeline, she could clearly see how the feelings of exclusion, stupidity, laziness and incapability she experienced had flowed through the rest of her life.
Another client (I will call her Vanessa) became totally unable to say who she was once she realised that her sense of self was entirely shaped by what other people said of her. She could not answer when asked, ‘Who is Vanessa?’ She literally did not have the words. I keep a range of cuddly toys in my therapy room, so I asked her to choose a toy that represented what kind of animal she would be. She picked two of the toys and, through exploring her reasons for choosing them, was able to come up with words such as playful, fun, intelligent, strong, resilient and determined.
In the space of one session, she had gone from only defining herself through other people’s words to having six words to describe how she perceived herself and, importantly, an associated picture by which to remember them.
Working with anxiety is also a big part of the work, as it is for many counsellors. A client with dyslexia once told me that processing all the myriad images in her brain was like being in a room full of puppies who refuse to all stay in their baskets and sleep at the same time; each one was a thought she couldn’t calm. With her permission, I have used this image with many other clients and it invariably resonates strongly with what is going on for them in their head.
When working with anxiety, I ask the clients to visualise a scale – a thermometer or dial with a range from one to 10. It is important the client creates the picture of it themselves in all its details – colour, shape, the font of the numbers. It is then their self-made image and they own it. I encourage them to use this tool when they get anxious, to visualise the level of their anxiety, and then to imagine turning down the dial to a more manageable number.
Dyslexia as a disability
Gaining a better understanding of their dyslexia in counselling can go hand in hand with the client accepting they have a disability. This can be experienced as upsetting, and clients may need to work towards acceptance of this too. Many don’t think of themselves as ‘disabled’ and do not want to, but accepting this description can help them see that they live in a linear world with linear demands that is not designed for them; that clients with dyslexia are (dis)abled and (dis)advantaged by the world they inhabit. Because of the way their brain is structured, people with dyslexia can struggle to process the same volume of information as others within what is perceived to be a normal time frame but doesn’t allow for the way their brain processes information. From writing down information in a time-limited test and remembering verbal instructions to reading signs and timetables and even simply using a public toilet, so many aspects of everyday life can be disabling for someone with dyslexia.
Once the client understands and accepts this, the work can move on to exploring how they disclose their disability to others. This needs to be considered carefully, as there is so much ignorance and so many misunderstandings about dyslexia. These conversations can be practised in the safety of the counselling room, using two-chair work if that is helpful. In this way, the client gains confidence to explain their own disability and the knowledge to ask for what they need. At times, the counsellor may need to be more directive than is usual and give more advice, such as signposting clients to employment support and information about disability discrimination and the duties of employers to make reasonable adjustments. It can be hard to know whether to disclose dyslexia when applying for a job and run the risk of being turned down before even getting to interview, or not disclosing and having to conceal it once they are in post, then leave for fear they will be sacked and reinforcing their low self-esteem.
Self-disclosure
I believe my own experience as someone with dyslexia is an advantage when working with clients with dyslexia. Clients with dyslexia may prefer to see a counsellor who can communicate and understand them on a similar level and who understands their struggles to navigate through life. I understand the lesser-known traits of dyslexia and how these can stretch the boundaries of the counselling relationship. People with dyslexia may never have had the opportunity to talk about their struggles. They may have great difficulty in expressing their feelings. When under stress, their dyslexia deficits may be exacerbated; they may make more mistakes, struggle to find the right word, misread information/communication, lose things, forget appointments and ultimately shut down – what some call dyslexia meltdown.
In counselling, they may struggle to express themselves, or repeat content in sessions – sometimes in the same session – because of their difficulties with memory recall. Processing sensory information (light, sound etc) can also be a challenge and can become overwhelming. A client may be easily distracted and frequently lose their train of thought. It can be helpful if the counsellor is able to recognise these for what they are – symptoms of dyslexia – and be able to work with them. By giving them space to find the right word, acknowledging their frustration when they are sometimes unable to find it and suggesting alternatives, such as drawing it, a counsellor can offer an acceptance that they rarely find elsewhere in their life.
Disclosure of my dyslexia, when appropriate, can help clients appreciate how dyslexic traits manifest to others. I will explore with them how it feels to observe me when I have difficulty recalling a particular word or lose my train of thought.
My knowledge of dyslexia also helps when managing the practical ways in which it can affect the working relationship. Many clients can unintentionally push the boundaries. They may find it hard to remember the address, get lost and turn up at the wrong time, on the wrong day. They may forget to bring any money and be unable to use bank transfers. The counsellor then needs to reinforce these boundaries without the client feeling rejected because of the very difficulties they struggle with. My own disclosure can make it easier to have these conversations. I invite the client to say what is the easiest way for them to pay and how they like to be given directions. To me, this is making reasonable adjustments, as you would for any client with a disability.
Working with dyslexia is like working with any other disability; the person is more than their disability. The challenges for the counsellor can be disentangling dyslexia-related issues from general anxieties. Helping the client gain awareness of their dyslexia and how it uniquely manifests can lead to their understanding and accepting it and, at the same time, not letting it define them. Developing a sense of their difference and learning their specific positive attributes as a result of their dyslexia can give them a more balanced view of themselves. I know a client has turned a corner when they can acknowledge the gifts of their dyslexia and no longer wish there was a pill they could take (as many, sadly, do) to eliminate this part of themselves.
Laura Newman is a BACP-accredited counsellor in private practice in east London. Her foundation training was at the Minster Centre, and she specialised in a person-centred approach at New City College. Her background is in bereavement counselling and her work with clients with dyslexia draws on her training experience with GroOops: Dyslexia Aware Counselling. She also has a specialist interest in working with transgender issues and has published a book, A Love Less Ordinary. She is affiliated to the Gender Identity Research and Education Society. She also works in the NHS. www.lauranewmancounselling.co.uk
References
1. Cited on the British Dyslexia Association website at www.bdadyslexia.org.uk
2. Humphrey N, Mullins P. Personal constructs and attribution for academic success and failure in dyslexics. British Journal of Special Education 2002; 29(4): 196-203.
3. Alexander-Passe N. Dyslexia and mental health. London: Jessica Kingsley Publisher; 2015.
4. Colley M. The make-up of neuro-diversity. See, for example, www.achieveability.org.uk/files/1460064713/neurodiversity-with-reference-to-dyspraxia-mary-colly.pdf