Autism, perimenopause and career: from panic to purpose in midlife.

This post is a transcript of my interview on the Neurodivergence and Mental Health Podcast with Sally Nilsson, a neurodivergent psychotherapist. The transcript has been lightly edited for readability and clarity, so it's not word-for-word accurate to the original recording. Listen to the full episode: Autistic Women & Perimenopause: Therapy, Burnout, and Embracing Change with Lii Brooke

Original podcast episode © Sally Nilsson, Neurodivergence and Mental Health Podcast. Transcript published with permission.

Sally: Hi Lii, it's really good to see you and welcome to the podcast.

Lii: Hi Sally, it's really good to see you again.

Sally: Excellent. We did have a chat before and I was so interested in what you were saying. And I was saying, you know, I've had a look at a lot of what you do and we're going to talk about all sorts of really interesting things. So can we just start by, can you just tell me and our audience, you know, a little bit about yourself, you know, your area of work and what's your neurodivergence?

Lii: Absolutely. Well, thank you for having me, Sally, first and foremost. I really appreciate it. It's always lovely to talk to another therapist and I feel quite privileged being on a podcast. My name is Lii Brooke. I'm an autistic therapist, data analyst and postgraduate researcher. And I specialise in supporting autistic professionals in demanding careers and I work from a therapy office in Gerrards Cross and I also work online across the UK and the Republic of Ireland.

Sally: Excellent. All right. Brilliant. And I'm going to ask you more about that because, I mean, I just remember when I first started doing this, well, five years ago, working just with neurodivergent clients. And we were all sort of going towards the same aim. You know, there weren't enough neurodivergent therapists working with neurodivergent clients. And it's growing. And there's a fantastic forum, isn't there? A Facebook group that now has 1,800 members. That's right. It's so wonderful. So we'll come on to that a little bit more. Now, I understand from our previous conversation that you loved studying and you've got something coming up in a few months, I gather. What is that, Lii?

Lii: Oh, well, I was thinking about that, actually, Sally, after our initial conversation. And I think I pretty much haven't stopped studying since I set my foot into primary school many, many years ago now. And I acquired a number of higher education qualifications along the way, normally whilst working full time as well. So the latest endeavour is going to be a doctorate in autism at Sheffield Hallam and it's actually officially starting in a few days' time.

Sally: Oh my gosh, how are you feeling about that?

Lii: I'm really looking forward to it. I've been working towards it for almost a decade in a rather crooked kind of way. And I did a postgraduate certificate in autism last year, which was brilliant. And Sheffield Hallam is one of the very few universities in the UK that takes a very autism affirmative approach on their programmes. So that was, I'm sure you'll understand, incredibly important to me.

Sally: Absolutely. And what area of autism? You know, they're often very specific because you might go, you're writing a thesis, you might be writing a book, and this can be used for research purposes, which is absolutely vital in our community. So tell me a little bit more about the details, if you can.

Lii: Yeah, absolutely. So my thesis title is "Autistic Heterogeneity: Uncovering Stories of Success and Wellness: A Mixed-Method Study." So that was a very carefully crafted title, which may yet change as things do in the course of seven years of doing a part-time doctorate. But essentially the aim of this mixed method research piece is to provide a statistically robust evidence base to propose an alternative definition of autism towards a more neutral stance and away from deficit focus.

Sally: And it's so important. I think for a lot of autistic people and some of the clients I've seen have been extraordinary, just absolutely extraordinary about the language, the English language as it is and the English language for normal people, neurotypical people. And I had one client, and I'm just generalising here, of course , who was inventing their own language. Because so much of the language doesn't work and it's... the language has come up for, you know, pathologised in the DSM-5 and things like that, and it doesn't fit. And a good example of that is ADHD, which I absolutely hate, because attention deficit, no, that's wrong. Hyperactive, well, only slightly, and a lot of us don't like that. And disorder, well, we don't like that either. So the fact that you're coming from such a positive angle with, you know, sort of changing that into a positive and success-driven paradigm, I think is amazing, so best of luck with that. And how long are you going to be doing that? Is that part-time? How long will that take?

Lii: Yeah so that's part-time because I'll still be working full-time alongside it across two jobs: my data analysis job at a management consultancy and also my counselling work in private practice. So the PhD will have to be on a part-time basis and will take around seven years.

Sally: But I think that's fantastic because if I just look back over the last five years on how things have changed, the awareness and the progress as well, by year seven you might have to rewrite the thing. But it's really exciting and it'll be very organic, won't it?

Lii: Absolutely. And you're totally right in terms of autism as a research area is evolving at a brilliant speed. But I guess there's a challenge and opportunity within it in terms of who is contributing to that evolution of knowledge, right? So do we have autistic voices leading that gathering of information or not? Because I guess, it's an opportunity for autistic people to take control of the narrative and really contribute to authoritative knowledge about autism rather than let it be kind of taken over by political agendas and tensions in power, etc., which we are seeing across the globe at the moment.

Sally: Yes, I totally agree. And I think an example of that was even just a few years ago was when on panels, I mean, the Spectrum 10K. Oh, yes. That was awful. Spectrum 10K or whatever it was. And often on panels like that, they were all neurotypical people doing it. And I'm not saying they need to be all autistic people doing it, but at least it needs to be equal. And so I think that's so important. So thank you so much for telling us about that. That was brilliant, Lii.

Now, you had a different experience during your perimenopause journey. And that's one of the main reasons that I wanted you to come onto the podcast because there can be so many challenges and negative things about menopause but it's not the same for everybody. So please can you tell us what your experience has been and what age you were when you first noticed symptoms?

Lii: Absolutely. So I'm going to be 42 in a few months. And I guess I first noticed the common physical symptoms of perimenopause around a year ago.

And it really scared me, to be totally honest, because I still have two small children at home who require a lot of attention and effort. And my youngest at that point was only three. The memory of carrying a baby and, you know, giving birth and looking after a young infant was still very much fresh in my mind. I kind of was not ready for perimenopause quite yet but ready or not, here it comes.

And my first reaction was panic. It was panic. And I felt devastated. And I kind of felt that my life was over, to be totally honest. Yeah, I did. I did. Because everything kind of started crumbling, you know, how I saw myself, I was exhausted. And all of the usual stuff.

However, and this is where the difference comes in, I guess, I kind of took a long, hard look at myself in the mirror and said to myself, as one does: "Right, what we're going to do about it?"

Like, ageing is going to happen, right? You're going to have to decide how you cope with it, right? You can absolutely curl up in the corner and feel sorry for yourself. Now, caveat, this is me talking to me, not me talking to anybody else, ok? Personal view here. Or you can decide to make the most of it. Which one feels better, more useful here? And okay, so I kind of dragged myself up off the floor and said: "Right, we're going to make the most of it." And so I decided I'm going to go for the doctorate. And I'm going to do all the things that I wanted to do. I'm going to try and fit them into my life as much as possible.

And I read this book by Christiane Northrup, an American doctor. And it was massive, it's a really big book but it's so full of positivity. And it really stood out to me because I think from my experience, from what I've seen, it's one of the very few books that are positive about menopause.

Sally: What was the book called?

Lii: It's called *The Wisdom of Menopause* by Christiane Northrup. Yeah, I would highly recommend it. So it doesn't negate at all the experience a lot of people have, you know, the physical symptoms, the psychological symptoms. Of course, it's there.

But what it encourages you to do is to consider what's useful for you in the future. And what can you do with what you've got? It's a natural process, menopause and perimenopause. So I guess at least to a degree, it's up to us how we deal with it. And so I made a conscious decision to deal with it in the most positive way I can.

Now, I can't say it's always brilliantly smooth. Of course, it's not, you know, but to give an example, my life used to be really driven by desire. I kind of feel ashamed saying I was having conversations with my husband and I said, do you know when I was younger (a year ago!), when I was younger, a year ago, I used to be driven by desire until that point all the time, and he looks at me and goes: "You do realise this is like every bloke's everyday normal." And I just thought, oh my God, ok, he's really not going to understand what I'm talking about here.

But on the other hand, it was a great relief for me to actually not be in that place anymore because I could make decisions coming from a different place, right? Because it was no longer about wanting to be wanted. For me, suddenly it was about wanting to do what I want to do, whether that is liked or not. So that's given me a kind of freedom within all the responsibilities and other constraints of my life that most people have anyway.

Sally: I think, I mean, I just find that so interesting and inspiring. Yeah. And relatable. We are different when, you know, having children changes us, you know, puberty changes us, but the menopause changes us as well. And we are different. And I know when I was 42 going into perimenopause, for the first three years, it was awful.

I mean, I mentioned it before, I'm not going to talk about it a lot, but it was really difficult, mainly psychologically. But then at 45 I wrote a book. Yeah. O-level English. You know, I wasn't great at school but I wasn't stupid, you know. But I wrote a book and that did it for me. Yeah, brilliant. You know, similar sort of thing. You are doing a doctorate.

And I read a fantastic article earlier, actually. I really loved it. I'm really glad I read it. It's about women over 50 and kind of becoming clever and more academic. And there's a funny thing, the physical side of us might change in all sorts of different ways, but our mind does something else. And I wonder, just a little hypothetical thing, I wonder...I wonder with women, an evolutionary thing, once we've finished child-rearing and we don't have the chemicals that we need in order to have more children, we shift into becoming wise.

And at 50, I became a psychotherapist. So there we are. You're a counsellor. You know, we go from the nurturing, the giving, all of those things and being a partner and everything that entails and then we go into menopause and then we become wise. Well, that's what I like to think about anyway.

You've read a lot and you've gone on this self-discovery, self-reflection journey. And there was one thing we were talking about before we came on today. And hopefully you'll share it because it was really lovely. You dream about a house in Kent, but it's much more than that. Tell us about that.

Lii: Yes. So I mentioned that my life is very full and it will continue to be so, I expect, until my youngest leaves home. If all goes well, I've got another 14 years to go of this rather intense child rearing activity. And I find it really hard. I'm not going to pretend that motherhood has been a natural process for me in any sense at all. I do find it very, very hard to the point of kind of clinical depression, which I've had before and I've managed.

However, responsibilities endure and they've got to be fulfilled. And so what I've noticed happening recently is an image floating up in my mind of a woman in this beautiful little old house in Kent, which is my favourite place in the world, Sandwich Bay. And she's there and she is a respected academic, apparently, in autism, fancy that. And she's got a cat and a dog and she lives alone in the house and works in counselling private practice and does teaching at a university and all of that.

And it took me some time to realise that I was putting together a future vision, which ties in with the whole decision that I took on menopause in terms of what I make with it. So this is a future me that I'm working towards. But she's coming to my rescue on a daily basis by giving me glimpses of what the future might look like if I just keep putting one foot in front of the other and don't give up. And whether it's some kind of twisted time warp where my future self is coming to pull me through or whether it's just a defence mechanism that my psyche has come up with to keep my kids safe, essentially, who knows? But I like it.

Sally: Yeah. And so you should. And I'm dreaming of a camper van. Brilliant. Of some description. Just something that has a little toilet in it, you know, and with big windows that I can have curtains on but I think it's a similar thing. It's not necessarily something I'm going to have and it doesn't necessarily mean I want to travel or I want to run away. It isn't about that. But when we have vivid imagination, if we're visual thinkers and pattern thinkers, I think it's wonderful to go into our minds with stories. Again, I had another client who had a parallel universe that had politics, royal families, everything in it. And it was a perfectly natural thing for that person. And I just think it's absolutely brilliant. So I love that. And I'm seeing you very, very vividly sitting by the fire reading. Being this woman. So keep the dream up. I think it's fantastic.

So I'd like to talk to you a little bit more about being an autistic therapist because I'm a neurodivergent therapist myself. How do you support clients in sessions and what models or ways do you use in counselling that you found most effective?

Lii: Absolutely. I was originally trained as a person-centred counsellor. However, I tailor my approach to every single client who comes through my door. I specialise in working with autistic adults. And I found that actually, both due to my natural proclivity towards structure and due to a frequent preference from my client base for structure, solution-focused brief therapy does really well as a combination with the person-centred approach.

So person-centred works beautifully at the start of the therapy sessions now again the usual caveat this is my finding, my experience, applies to my practice. This is not to say that's how things should be done or should not be done. But I've been finding, person-centred is brilliant for when people just come in they might have a lot of emotional weight and mental load on them that they just want to literally dump on the table and feel relieved just from sharing their experience. That normally takes a couple of sessions. After that, once people arrive at a place of some kind of stability and balance where they've got the headspace to actually think about "Ok, what do I want to do with it now that I've parted with the weight of it all?" Then that's where the solution-focused brief approach comes in and we start elucidating the goals. OK, this is a situation, what is the vision for the future, what is the realistic version of that vision and how can we get there with the resources that you, the client, have got at this point in time. And then we work towards that but that's a very kind of generalised approach that differs.

Sally: Yeah and thank you so much for telling me that. And I think this is really interesting. Well, why shouldn't I be flag waving? I'm just going to be honest, you know, because I know that you're on the same Facebook group as me. And a number of us, 23 of us, wrote this book called *On Being an Autistic Therapist*. And it really talked about that, how as autistic and neurodivergent therapists we find our own way. It's so important for us to follow the rules and be ethical. And so we are ethical.

I'm a human givens therapist. And that's brief solution therapy. And of course, the person is the centre of the room anyway, I believe, of course, we all believe. But then I'll do some studying around transactional analysis. I might do some studying around gestalt, Jung. I might look at internal family systems and parts therapy and inner child work. It depends who the client is but when I have as much information that I can just be very holistic with that client, you know what I mean? Yeah. It's what you use.

And I do agree that most people want goals. They do want to say: "I just don't know what to do with myself." And once they've done what you've said, you've built rapport, you've listened, you've heard the story, then we can do this thing where I say here's a metaphorical table and we're just going to throw a load of stuff on it, we'll rummage about on it, we'll have a look at what works and take away what you think is good.

Lii: Yeah, absolutely, I pretty much say that word for word.

Sally: Yeah, brilliant. And there's so many different autistic therapists doing different things: EMDR, equine therapy…Thank you so much for telling me that.

So you've described your exercise routine as, and I love this, "regularly infrequent". Yeah, snap. I know what that means. I know there is one activity you particularly enjoy. Please can you tell us about it and really what you get out of it, Lii?

Lii: Yeah, absolutely. Well, we are talking about pole fitness. I'm not going to call it pole dancing because it's not about dancing, really. Pole fitness is all about strength. And yes, you can have choreography within it. But essentially, it's a group of women coming together and having wild fun whilst getting fitter. And we are of all ages and shapes. I love the studio in Hertfordshire where I go. I've been going there for years. I've kind of arrived at a plateau of my ability in pole. I can hold myself upside down, stick a leg out and an arm out.

Sally: I've seen it. It's amazing.

Lii: But that's it. You know, I've kind of realised, okay, I'm not gonna get much better than this, you know, given the natural resources I'm working with here. But that's fine. That kind of keeps my belly in a bit. And it does wonders for my head, to be honest with you, for my mental wellbeing, because when you're on the pole, you're working against gravity. It's like weightlifting, but the weight that you're lifting is yourself. So it can be quite significant. It is in my case!

What it also does is because you're working against gravity, you can't afford to kind of go elsewhere with your mind. You have to be present because if you let go of the pole, you're going to end up on the floor and it can hurt. So just thinking about not falling down for an hour and not letting any other rumination come in and intervene and the endorphins and the physical tiredness, all of that good stuff is brilliant. I don't do enough of it, but I would highly recommend it.

Sally: I think in my younger self, when I was more bendy, I'm more snappy now than bendy because my oestrogen picked up its suitcases and went to Mexico. But, you know, it would definitely have been something that I would have been interested in. And I think what you're saying is so true. This type of exercise — when you go into flow with something that's high risk — can be one of the best types of exercises you can do and you can put in things like surfing, cycling, rock climbing, bouldering, horse riding.

When our intrusive thoughts are so rampant, there's not enough flow of positive, focused attention to stop them coming in. But with pole dancing, you're going to land on your head, so you don't do that.

I think it's absolutely brilliant. I used to love climbing trees as a child so there might be wall climbing as long as I've got a harness or something.

So just because the podcast is about menopause, neurodivergence and mental health, it's good to touch on it. And you mentioned depression and I share that. I call myself a depressive realist. You know, and it's kind of more melancholy sometimes it's about big things like the world and the climate and worrying. People say "Don't think about the future, just be in the present all the time" but that's not realistic because we have children and we love our children and we love different things. How would you describe your own emotional wellbeing and what sort of techniques do you use for you to keep balance and get your needs met?

Lii: Thank you for that question. I think it's a really good question. My answer is: my mental wellbeing is precarious, to be totally honest. I try my best to hold it together. I'm not a great believer in techniques. Aside from box breathing, probably. Anything more convoluted technique-wise, I'm personally, again, the usual caveat, personal experience expressed here, personal opinion, I'm a bit sceptical about convoluted techniques because, and I hope you will understand where I'm coming from, I'm also a kind of pessimistic realist in terms of I think a lot of wellbeing comes from the environment and situational factors, right? So for me personally, and also as a therapist, I encourage my clients to look at the root causes rather than techniques that would somehow address the symptoms but not get to the actual crux of the matter.

So I think it's about getting to the root cause. Okay, what is causing distress here and what can be done about it? Then once that's addressed, techniques can come in whether it be box breathing or mindfulness or moving meditation, whatever you've got, really. But it's that and having agency, having some kind of power and control over your life, I think can be massively beneficial to one's sense of wellbeing, I guess, in general.

Sally: And you can't do pole fitness every day unless you've got a pole in your house. And so when those times of precariousness might arise, what would you do for yourself at that point just to unhook it and so that you can move on to another path or feel better?

Lii: Yeah, absolutely. That's a fair question. For me personally, time alone does wonders. I'm autistic, as I shared before, not that all autistic people need time alone, but in my experience, a lot do. And that's certainly very, very true for me. And it resonates with a lot of my clients. So I try to create as much as possible some time for me to process things, to self-regulate. And that needs to be done in isolation.

If I possibly can get out with my dog, that's another thing that really helps. And I think there's no replacement for attending to your physiological needs. So the foundational layer of Maslow's hierarchy, we can't bypass that as humans. It's what sustains life. We need our sleep. We need our nutrition, we need movement, and we need some social contact that is right for our psychology, I guess. And that will vary from one person to the other. But yes, attending to physiological needs, having time alone and getting out and about if I can.

Perimenopause, autism and career: key takeaways

On perimenopause: Initial panic can become purposeful redirection, whether that's a further study, career change or simply choosing for yourself instead of for others.

On career and motherhood: Struggling doesn't mean failing. Demanding professional lives and intensive parenting can coexist with persistent low mood and still be manageable.

On future-building: Envisioning your future self and taking concise action towards that goal can sustain you through the present.

On therapy: Structure plus empathy work well. Solution-focused approach combined with person-centred listening suit analytical minds navigating life transitions.

On self-care: Time alone, physiological needs (sleep, nutrition, movement, connection) and saying "no" aren't optional, they're your survival tools.

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