An interview with: Dr. Tony Meiners – Clinical Director

Dr. Meiners, What is the importance of scene construction when providing therapeutic care for a neurodivergent population?

I think scene construction is an important concept to keep in mind really for anyone, especially neurodivergent folks. And really in layman’s terms, it’s our ability to put ourself in our mind’s eye, whether in the future or in the past, you know, and it’s our ability to mentally generate like a, a spatially coherent image or scene in our mind that takes into account emotions, feelings, context, people, time, all of our senses. Why this is super important is ’cause I think anytime we’re talking about the past or the future, we have to, or it’s helpful to be able to kind of put ourself there so that we can kind of imagine either how we want the future to go or retail events in the past.

What are the obstacles neurodivergent clients might face with scene construction?

What we found in most recent, like brain literature is that there are little lesions in the hippocampus for a lot of neurodivergent folks, which is going to cause struggles when it comes to building a scene in our mind’s eye. Why is this important? Because I think if we’re talking about this in a therapeutic context, if I’m asking someone like, Hey, you’re experiencing suicidal ideation, you’re about to go on a trip, let’s create a safety plan or a cope ahead plan. So tell me about what triggers might come up or what you wanna do if this happens. That requires our brain to mentally generate a scene in the future of an event so that we can talk about it. If there are scene construction struggles, it’s gonna create certain roadblocks, frustration, maybe some dysregulation for people to, that struggle to put themself there.

Now another example is if I’m doing a trauma reprocessing an EMDR in the past, and I’m like, Hey, here’s this really traumatic memory, you know, one of the first things I ask people is an EMDR protocol is, build this image for me, right? What’s the picture that comes to mind? Tell me the thoughts that come up. What do you notice? What do you feel? Again, I’m really trying to create and build a scene in our mind. So if we have struggled to scene construction, a lot of times it can either come up blank or people feel like they can’t put themselves there, which then makes it hard to reprocess and talk about events in the past.

How does scene construction support clients outside of therapy?

You know, it’s not even just in a therapeutic context. But then you can also think about like relationships. If you’re having a hard time in a relationship and your partner wants to talk about something that happened last week that frustrated them, you’re gonna have to also mentally time travel to the past when the event happened. So you can kind of see why, if we struggle with scene construction, it makes it harder to do things that I think we take for granted sometimes. I think when we’re looking at neurodivergent informed care, there are ways that we can kind of tailor treatment conversations and ways to help these people.

One thing that comes to mind is we have to start very kind of basic surface level and build our way up from there. We have to scaffold to the imagination. So if I were to ask you a question of like, Hey, tell me about something in the future that might trigger you that we’re creating a safety plan. I’m gonna start by asking questions like, okay, where are you right now? Are you in your house? Are you in your room? You know, tell me about that. Who is in the room with you? Are you by yourself? Are your parents there? Is your loved one there? What do you think you might be feeling? Do you feel a heaviness? You know, do you feel, you know, a, cloudiness? And kind of ask these questions to really scaffold the imagination, and I’m doing that by asking very concrete prompts and then building from there. If some people that I will build, like externalized images of a scene. So sometimes people will draw out a scene, you know, if we’re going from the past and we’re talking about a traumatic memory, maybe they’ll actually kind of draw an image for me, you know, what the room looks like, who is in the room, and kind of start from there. I have some people where I actually have physical objects like, Hey, you know, this object is you, you know, this object over here is, is someone else in the room. You know, let’s create a border for the walls of what the room looks like, and then kind of externalize an image in that way.

So I think these are things that we need to keep in mind when we’re, anytime we’re talking about past or future, in order to help build a scene so that people can, you know, work through things in the past that they can, you know, plan for the future. You know, if they wanna set goals and have something they wanna do in three months, you know, we really have to scaffold and build, like, let’s talk step by step, you know, in a very concrete baseline way, and then build from there so that people can actually work towards and achieve goals.