Why couple counseling often fails if one of you is autistic

Therapy modalities are not designed for neurodiversity

Many of the couples with whom I have worked over the years have worked previously with one or even several couple counselors before contacting me. They often begin with an remarkably similar statement:

“This is our last attempt to get help. Couple counseling has never worked for us before.”

An even more distressing takeaway from couple counseling is this:

“Couple counseling didn’t help. In fact, it made things much worse between us.”

I’m always glad when these couples are willing to give working with a professional another chance and I welcome them to my practice. I realize how seriously they take their challenges and how much they desire to overcome them. They want to be understood better than they have been previously and are afraid their relationship might be hopelessly quagmired by their inability to fix it on their own.

Where we start when this happens

We begin our work together with a conversation about the fact that a couple’s difficult counseling experience matches that of so many other neurodiverse couples. It’s important for everyone to understand why and how this happens. It’s also important to acknowledge that this can happen through no fault of the couple, nor is it necessarily due to incompetence on the part of the therapist.

In this article, I will address the complicated reasons for this unfortunate mismatch of couple and therapist. I will also discuss how you can avoid having this experience yourself when you seek counseling support for your neurodiverse relationship.

The therapist’s role

In our formal education, our internships, and our subsequent professional experience, most therapists are only minimally exposed to the topic of autism. Unless they choose specifically to focus on it, very little formal attention is paid to it and even less attention is paid to what happens when an autistic person and a neurotypical person fall in love and enter an intimate romantic relationship.

The reasons for this are simple. There is so much coursework crammed into graduate programs that there is very little room for independent inquiry. In my own graduate work, for example, I was able to include exactly one elective course in a three-year academic program. My two-year clinical internship took place in the Outpatient Mental Health Clinic of the University of Washington/Harborview Medical Center. Very few of my patients during that time were autistic.

What happens is that for the most part, any familiarity with autism and neurodiversity, and specifically neurodiverse relationships, comes from a therapist’s personal choice to pursue further education and clinical experience within these areas.

There aren’t very many of us doing this specific work

This work is challenging. It’s also difficult. There are more specialists now supporting neurodiverse relationships than there were when I started out in the field but there are still very few who are truly able to understand a relationship from both the neurotypical partner’s point of view and that of the autistic partner in a way that is helpful, fair, and just to both. Maxine Aston, British psychologist and early advocate for neurodiverse couples, believes that in order for a therapist to do this work it is necessary for the neurotypical therapist, who can understand the NT partner, also to have personal experience with autistic individuals as well as clinical experience. I agree with her.

I am not at all convinced that an autistic therapist can understand the experience of the neurotypical partner. This is not to disparage autistic therapists. It is simply to say that the nature of the differences between being autistic and being neurotypical favor the NT therapist in terms of ability to understand the worlds of both partners well enough to be helpful to them in their struggles.

Why this matters so much

Most of the training for couple therapists includes therapeutic models that require personal insight and self-reflection by clients. Also, they require that an individual understand and be able to communicate emotions and feelings. This includes an assumption that an individual has the ability to recognize the emotions of others with reasonable accuracy.

These abilities are necessary, of course, in order to help one partner understand the other. They are also necessary in order for the therapist to be able to understand, support, and guide a couple toward resolving their challenges. If there is no previous experience looking inside onself with an open mind to identify and understand emotions, this new therapeutic process can take time and effort in order to bear fruit even for neurotypical individuals. For autistic individuals, it can feel like a nightmarish demand.

Why it’s so difficult for autistic individuals

Most autistic individuals with whom I have worked report feeling absolutely stuck if a couple therapist asks how a neurotypical partner’s comment affects him and expects an answer at that moment in the counseling session.

For example, a therapist might ask,

“What’s it like for you to hear your partner say that?”

or

“How do you think you might feel if that happened to you?”

Such questions in an unfamiliar setting asked by someone the person doesn’t know personally with the expectation of an immediate response of some sort can seem like an extraordinary demand to most autistic individuals. And yet these are standard questions that any couple therapist might ask one partner about the other.

So the autistic person might answer (in good faith) by saying

“I don’t know.”

At this point, the neurotypical partner might interject,

“See? This is what I get all the time: I don’t know.”

The therapist sees and feels the NT partner’s exasperation, while misconstruing the autistic partner’s reasons for making the I don’t know comment.

What happens next

If the therapist hears I don’t know often enough in session with a couple, she or he might begin to consider a number of incorrect possibilties.

1. Is this person here only because his partner demanded counseling?

2. Is this person so traumatized by something in his past that he’s blocked from identifying and accessing his own emotions?

3. Does this person have any interest in working through the challenges in the relationship or is he already out the door?

4. Is “I don’t know” a passive-aggressive comment that is similar to other comments this partner hears frequently?

5. Does he hold his partner in such low regard that he won’t respect her enough to offer any information?

6. Is he fearful of retribution if he reveals his own emotions?

The problematic Differential Diagnosis

There are myriad other deductions a therapist might hold in what we call a differential diagnosis, which is our way of considering various explanations for behaviors we are trying to understand. We do this with every client in order to be the most helpful relative to the concerns they identify.

In most therapy practices, these deductions seldom include the possibility that neurodiversity might explain what the therapist is observing play out in this couple’s relationship. This is not because the therapist is incompetent. She or he is not considering neurodiversity because of most likely not being able to recognize in a couple early enough it when they see it. This is beginning to change, of course, but the number of couples who tell me about adverse experiences in couple counseling suggests that it’s not changing very quickly.

The reason this can be such a disaster is because the way a therapist understands a couple determines the way she or he will offer support and guidance.

The disaster unfolds like this

The therapist also misunderstands what she observes in the neurotypical partner, who to her might appear impatient, contemptuous, hostile, closed-minded, hypercritical, emotionally unstable, and possibly personality disordered.

It is not unusual for this partner to be referred to psychiatry for an evaluation of a mood disorder. Often, because on the surface she may meet criteria, the NT partner then begins a series of trials with antidepressents or anti-anxiety medications, none of which are helpful.

What are these professionals missing?

They are seeing the result of a distressing intimate neurodiverse relationship and not recognizing it as such. They are treating these couples and individuals as if their behaviors were motivated strictly by neurotypical experience. This can drive an additional wedge between a distressed couple because it adds a new set of expectations and demands on both of them that just don’t feel right to them, though they’re not quite able to put their fingers on the reason for this.

Part of the reason this can be problematic is because they trust the therapist’s expertise and figure that if the therapist’s suggestions don’t help them or, worse, if suggestions feel irrelevant, there’s something really wrong with them. It confirms their fears that their relationship might be doomed.

Here are just some of the considerations therapists are missing, and I will explore each of these in depth in an article or a workshop for paid subscribers at another time:

• the motivations for what appear to be the same behavior can be vastly different for neurotypical and autistic individuals: what appears to be narcissistic may, for example, be self-related behavior instead

• the processing speed between NT and autistic persons is different, making the autistic partner’s need for more time to answer appear to be a choice rather than a need

• most autistic individuals express challenges when asked to identify, name, and bring to language their own emotions unless they’ve been practicing this for some time; not being able to do this in session can look like reticence or unwillingness to participate

• many autistic individuals have a smaller vocabulary for desribing emotions than their NT partners, who are able to use a robust vocabulary and nuance in describing theirs, which can appear to be disengagement or disinterest

• the NT partner might be exhausted, which can appear as defensiveness

• the autistic partner is most likely anxious, which often looks like defensiveness

• the NT partner’s frustration can appear to be anger or even contempt

What this all means for you

If you’ve had any of these challenges while seeking help for your relationship, I can certainly understand if you’ve decided that no therapist has anything to offer you. I would like you, however, please not to give up. Finding a therapist who understands neurodiversity and can respectfully hold up each partner is possible. It depends on your willingness to ask questions of any potential therapist regarding their experience working with neurodiverse couples and their understanding of the differences between an autistic partner and a neurotypical partner and what the implications are of these differences.

In most therapist directories, you can search by location as well as specialty. Be sure to use a search term such neurodiversity or neurodiverse couple. Then be sure that the therapist actually specializes in working with these relationships. It is not enough to have autism or neurodiversity mentioned as items in a long list of clinical specialties on a therapist’s profile.

A final thought

The neurodiverse couple benefits from working with a specialist who understands both partners and the neurodiverse relationship itself and who has significant experience working with these couples.

To be continued…

I will address the question of how to find a therapist who understands neurodiversity in greater detail at another time. Meanwhile, please know that you’re not alone if you’ve had difficult experiences in counseling, and also please believe that there really are professionals who can understand you and offer you useful support.