"Our couple therapist thinks my husband is autistic"

"She says not to tell him, but I'm not sure." (Part 2 of 3)

Review

You might recall from my previous post that a woman sent me a note containing three questions. Here is the post, in case you missed it:

This is her second question:

Should my spouse be made aware of it [that the therapist believes him to be autistic] and, if so, how or when?

My response

Remember, I am answering these questions by explaining what I would do if I were the woman’s therapist. I can neither speak for nor criticize the position of another therapist because I cannot know the observations and discernment that preceded it.

Sometimes, this question arises in my work with couples when the neurotypical partner first contacts me about making an appointment. Often, it is because of a suspicion regarding neurodiversity rather than a confirmed diagnosis of autism that leads her (most frequently a woman, in my practice) to do so.

Sometimes, the neurotypical partner has approached the possibility of neurodivergence with her partner and he/she agrees with the suggestion of exploring the possibility. Often, this comes after a diagnosis of autism for a child, but not always. A child’s diagnosis sometimes starts to help a couple question some of their ongoing challenges and they’re both interested in understanding them better and seeking tools for improving communication.

At other times, the same suggestion is rejected out of hand. The neurotypical partner instead hears comments like the following.

“You think I’m the only reason we have problems?”

“So now I’m mentally ill?”

“How come no one in my life has ever suggested this before? What’s wrong with you?

“Who fed you that nonsense?”

The first kind of response is good for both partners: they can discuss neurodiversity and move forward in counseling. 

The second set of responses can be brutal for a neurotypical partner and are likely to be based in a series of misconceptions by the other partner, misconceptions that have impact on a his sense of self. This is a difficult spot to be in and perhaps individual counseling with a therapist who understands the neurodiverse relationship would be helpful.

Often, feeling unsure about which way a conversation might go with a partner who may be neurodivergent is enough to freeze a neurotypical partner into doing nothing. Nothing, at least until it becomes unbearable not to mention it. And this process can take years.

At other times, it is the couple’s therapist who suggests that exploring the idea of neurodiversity might create a helpful framework for understanding a couple’s challenges. When this happens, therapists who are skilled at working with neurodiverse couples proceed on that basis. Others who are not refer the couple to specialists.

What I do

When I work with a couple, I observe not only their interactions with each other but also with me. First, I eliminate any behavior that I could attribute to being in a new office with a new person speaking about personal matters. This can present a hurdle initially for many individuals. However, after a session or two, this can generally be ruled out.

These are some of the thoughts I hold as I begin working with a couple:

• I’m always attentive to how one partner interprets the behavior of the other and whether it seems accurate to me in light of the context as presented. 

• Is one partner insistent upon explaining why he did something instead of addressing the hurt feelings of the other, even after I ask about this? 

• Am I sensing the presence of what I call therapy person in one of the partners? By this I mean whether I have a hunch that one of the partners is performing according to an idea of how someone is supposed to behave and what someone is supposed to say in a therapy session? (Recognizing this is a sense I have developed over many years of working with couples. It is not a criticism, since this behavior can be a valid presentation of a persona of the person exhibiting the behavior, if that person is autistic.)

• Do I get the sense that these partners are weary of traveling the same paths toward unresolved challenges that they’ve faced repeatedly with no change in outcome? Do I sense despair that resolution could even be possible? Do they seem to be talking at crossed purposes when they talk about this?

• Does one partner seem more emotionally focused and the other more cognitively with responses and explanations? Are emotions adequately recognized and acknowledged?

• Have they told me that they’ve tried couple counseling one or several times in the past to no avail?

These observations apply to many couples, not just neurodiverse couples

Of course, all couples who seek counseling do so because they have problems. Many of the points above apply to any couple. But there is a qualitative difference that I sense in a neurodiverse couple that suggests an inability to change rather than an unwillingness to change in one of the partners. This is a key difference. It can explain why partners are unable to understand each other’s motivation accurately, which then leads to the ongoing heartbreak of unresolved challenges in their relationship.

What I do when I sense the possibility of neurodiversity

This is not a secret to keep to myself. My clients deserve to know what I am thinking. That’s why they contacted me. They want professional help.

The possibility of neurodiversity is a matter for both partners to consider. I bring the topic to the conversation by suggesting that we consider it as a frame. I mention some of the considerations that led me to believe this could be possible. If it proves helpful, it will offer understanding, compassion, and tools for improving communication.

Before moving on, I make certain that both partners have a clear and informed comprehension of neurodiversity, including the following aspects:

• The neurological underpinnings of the differences among human beings 

• What the advantages are to being neurotypical and to being autistic 

• Why neurodiversity persists in the human population globally after all these years of evolution and adaptation

• How the different brains experience and response to the environment including other people

• How these two brains are wired to understand and convey information and emotion

Where the challenges reside

I emphasize that we are taking about differences rather than deficits. I state that each neurotype does well on its own and that it is when the two try to communicate without understanding their differences that problems arise. The challenge lies in the space between two neurodiverse individuals.

Would I tell someone I suspected autism?

Absolutely. And I would explain why. And I would go through all the steps outlined above and suggest that we use the frame of neurodiversity to proceed as we discuss the issues the couple identifies in their relationship. My belief is that if it helps to do so, then our goals are being met.

On the other hand, if it doesn’t, if it appears not to be the case, we can discover and acknowledge that as well.

My experience shows me, however, that when I sense the presence of neurodiversity it is because it is there. I witness the release of pressure and misunderstandings between partners as we proceed with the business of developing tools for mutual understanding and higher likelihood of successful communication between them.

I help couples consider this possibility but not without all the supportive questions and information I mentioned above. 

So yes, to answer the question. I would let you and your partner both know in a couple session that I’m considering neurodiversity. I would explain why and how including the possibility could be helpful, as articulated above. I would not withhold this information if I believed it to be a possibilty that would explain your acknowledged difficulties. And I would make certain that before we ended the session, you both felt confident that moving forward is a distinct possibility.