Combining Therapies for NVLD, by Benjamin Meyer, LCSW, and Susan Micari, MS.Ed, BCET

By January 23, 2020 February 24th, 2020 Experts Blog

When I work with learning disabled adults, including those who are NVLD and may have been traumatized by their educational experiences, especially those around misunderstanding NVLD or being misunderstood by teachers or colleagues, I find that clients who are actively engaged in psychotherapy with a capable practitioner are in the best position to do and feel better about their issues and themselves, than those clients who are not so engaged.

My practice often derives referrals from psychiatrists and psychotherapists who are expert at the diagnosis and treatment of NVLD. Today, I would like to introduce the work of Christina Cummins, whose counseling practice uses DBT to approach helping NVLD people function better in the neurotypical world. While Dialectic Behavior Therapy was originally developed by Dr. Marsha Linehan of Columbia University for the treatment of Borderline Personality Disorder, it has since been used to help individuals whose emotional volatility around relationships and/or traumatic incidents has left them with few tools to cope with their tendency to become very stressed by interpersonal relationships.

People with NVLD often have trouble with social relationships because they may perceive and respond to opportunities to connect with others in atypical ways. They may be scarred by experiences of feeling different and at a loss socially in environments in which others seems to cope easily. Feeling left out and sometimes feeling toxic, NVLD people can become despondent and withdrawn, unable to take the risks that we all incur in reaching out to others, and especially vulnerable to these risks, because they have failed so often to find understanding from others whose minds work differently than theirs do. Shame and low self-esteem can be the result.

I was curious about Christina Cummins’ use of DBT skills to help those NVLD people who come to her for help, and together we are curious about how educational therapy and DBT can each enhance the speed and efficacy of an NVLD person’s progress in mindfulness, distress tolerance, interpersonal skills, and emotional regulation–so critical to building a healthy community at school, work, or at home. How can these skills allow an NVLD person to become better organized, better able to understand the relationships between complex ideas they may be studying or using at work, more skillful at self-advocacy, and better able to cope with visual-spatial information like math, graphs, maps and the like in their courses or work environment?

Clearly mindfulness is a help. The ability to name and know your own feeling states makes it possible to respond to stresses like due dates in a healthy and responsible way. Most NVLD people need help learning to maintain a schedule and break assignments down into parts that must be done before a project is due. Many need help knowing when their grasp of material has become a list of details that doesn’t add up to a main point, or interesting view of the whole topic they are researching or working with. Many NVLD people need practice understanding the context or emotional content of work, and practice predicting the outcome of their work on others.

Better distress tolerance would mean that NVLD people have fewer reasons to fall into procrastination. The feelings that arise when they have due dates can derail NVLD people who have little ability with executive functions and scheduling. Because many people don’t know how to begin the first steps of a project, they can put it off until the last minute, when the stress becomes intolerable. Then it is likely that a piece of research or writing will fail. It will be impossible to produce mature work at the last minute, and the NVLD person may see this as proof that they are defective. Of course, this isn’t true, but what I have seen over and over is a kind of dissociation from a realistic sense of time, and the effort that may be reasonably scheduled in a day to accomplish a goal.

These difficulties can cause interpersonal difficulties as loved ones, colleagues or supervisors lose faith in the NVLD person’s willingness and ability to be part of a team. Emotional regulation skills may weaken under pressure and the NVLD person become seen as a poor team player, an emotionally unstable person, or a person that just doesn’t fit the job, or if in school, the level of excellence that the class demands.

We educational therapists can help with the practical aspects of dealing with time, materials, comprehension, whole to part thinking, and executive function. But those individuals who are also engaged in cognitive work with a psychologist, counselor, or social worker are doubly able to make progress in their practical goals and to develop resilience and self-esteem, so critical to bearing the ups and downs of school and work.

It is good to collaborate with the therapists who treat NVLD clients, and there are many doctors in Manhattan whom I work with and whom I respect very much as caring therapists, but also as excellent collaborators in my own practical educational therapy work. They range from psychoanalysts, to psychiatrists and psychologists whose compassion and skills in psycho-dynamic psychotherapy pair well with my practical work as an educational therapist.

I had the pleasure of a long conversation with a counselor in New Jersey who told me about her adaption of DBT skills therapy to her NVLD clients, whom she treats. Christina Cummins, of, contacted me through a group I am part of that is devoted to building effective therapy practices. She has this to say about her use of Dialectic Behavior Therapy skills with NVLD clients:

Individuals with NVLD require a therapist who will believe in them and validate the difficulties they experience in their day to day lives. I help clients to understand that “Yes it may take you longer to complete any given work task; yes it will take a lot of hard work, AND you will be proud of yourself when you’re done.” I help NVLD people move away from black and white thinking throughout the treatment and reinforce it through as many different real life examples as possible.

Learning DBT skills seems to happen a little differently in the NVLD population than in populations that the therapy was designed for and is commonly used to treat. An ongoing client-therapist relationship is critical to success. Intellectually learning a skill and remembering to use it when emotionally overwhelmed takes practice within a therapeutic relationship in which trust has been established.

Though each NVLD person has a different threshold for their current capacity for change, DBT allows the therapist to examine this threshold and push to the point of positive (if difficult) change, and replaces helplessness with greater self-confidence.

In my partnerships with psychiatrists and psychologists who specialize in working with NVLD patients, I relish the curiosity, compassion, and collaboration that makes their work so effective. I have the privilege of weekly or monthly conversations with these doctors, when I relate how my client is responding to educational therapy in the realms of learning to organize, to comprehend inferences deeply, to create work on schedule and with confidence, to interpret visual and spatial material, and to put themselves in the shoes of their professors. I often seek feedback from collaborating doctors, and ask for their help if I am having trouble understanding a client’s behavior. When all goes well, I check in with the doctor to ask him or her to reinforce my client’s progress by calling attention to it.

NVLD or no, we all seem better able to remember what we do that is counterproductive more easily than we remember a newly successful skill, and so my NVLD clients need plenty of practice to see and appreciate change as they develop. They also need help recognizing successful sequences of new behaviors and realizing that these successes can be repeated. That’s where my cheerleading role as an educational therapist is important. I am my client’s biggest fan, and as a coach, I am trusted to call attention to challenges in a way that helps my client remain hopeful during the occasional setbacks that real change always includes.

Collaborative treatment allows an educational therapist to take up the role of case manager, and we communicate with parents, clients, doctors, schools and employers to help everyone understand NVLD, and to feel hopeful so that change, so fragile and gradual at first, can be supported. It is wonderful to see a client become more confident through gradual success. That is the goal, and that is the reward of being an educational therapist.

Benjamin Meyer, LCSW

I am a bilingual psychotherapist and executive functioning coach who specializes in working with young adults with NVLD, and I was inspired by my personal experience to help those I work with to transition to the professional and social demands of adult life. I believe that each person is unique, and that we are more than just our labels and diagnosis. I am a Project Social Ambassador for The NVLD Project.

Susan Micari, MS. Ed.

Board Certified Educational Therapist
Susan Micari is a Board Certified Educational Therapist who, together with Dr.Annalisa Perfetto, has started a practice for adults with learning disabilities called EdTherapyNYC. This practice addresses dyslexia, NVLD, ADHD and executive function deficits in adults who are in college, graduate school, and the work force.

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