Early in my practice in California my very first client - smart, sweet and sensitive - came in wanting some help with his relationship. Our dialogue seemed to flow pretty smoothly, but he spent most of our hours together staring - intently and without break - directly into my eyes. I had no idea what to make of it. He couldn't have had autism, of course - he not only made eye contact, he never stopped!
After a while I realized I wasn't going to find the answer in the DSM, as this client fit neatly into no diagnostic category. I knew I'd have to find a new therapeutic approach if I were going to help him at all. I could tell the approach was going to have to be more collaborative than is allowed in traditional therapy.
After we'd established a good and safe relationship, I asked him about his constant eye contact. "Oh yes," he replied. "I hate doing it, but in college I was accused of stealing, because I was broke and never looked people in the eye. It made people uncomfortable. So now I always do, constantly, so people are comfortable and know I am honest."
Aha! This client's efforts to guide communication according to objective rules had backfired, and his staring came off as unnerving. And he had no idea. My job as his therapist was to share how I experienced him, and so I did, gently.
He was shocked, of course. But we had a laugh and got to work, with a new problem to solve. How could he make more eye contact, but do it appropriately? We explored some techniques he could use to master his natural inclination to avoid looking into people's eyes. The solutions we came up with, however, addressed not just the comfort of his conversation partners, but his OWN comfort. This was a new concept for him. Having spent his life struggling to meet the demands of typical communication styles, he had long since stopped paying attention to how miserable he was trying to do so.
So he learned to gaze at the area between people's eyes, to make intermittent eye contact, to offer disclosures ("sorry if I look away a lot, it helps me think") and to pay attention to his own need to take breaks. You know what happened? He mastered a bit of effective communication. But more importantly, he learned that he can change his communication habits while providing for his own emotional wellbeing.
In my mind, this second lesson is vastly more important. Unfortunately, it is one often ignored by social skills programs and couples communication therapists. "Ignore your discomfort," they seem to advise, "and with time you'll learn to talk our way." Shake hands, make conversation, buy flowers, ask questions. Make eye contact, mimic others' posture, smile, look relaxed.
Learning to communicate in ways people understand is an obvious necessity for getting along in relationships and at work. But can adults with Asperger's modify their communication habits while respecting their own different styles of relating?
My answer: they must! And they can, though the work is less structured and cannot be found in a book. It requires careful investigation of the client's feelings and reactions, many of them unpleasant. It requires some humor and some experimentation, a lot of patience. And it works!
That first client of mine? He grew to make eye contact pretty comfortably in sessions. It's still hard for him when he's trying to glean a lot of new information from the person he's talking to, or if he's feeling threatened in any way. But he no longer ignores his own comfort for the sake of mimicking the style of others. Rather he meets people halfway - and thereby invites others to meet him halfway, too.
A regular occurrence during sessions in my practice is my encountering of what I call "autistic empathy".
An oxymoron, you say? I don't think so. In fact, this happens so often during sessions that I've begun to think of Asperger's as a disorder often characterized by too much empathy, not a lack thereof.
Before I get started on this idea - one I expect will be viewed with skepticism, at best - let me describe what happened during one such session, one that illustrates my point.
My client - let's call him "Giles" - and I were discussing the use of gaming as a self-soothing tool, one that may solve for otherwise overwhelming emotional states. Giles used few tools of escape, and we both agreed that his immersion in the world of online gaming came with a price.
At some point we compared his gaming to other self-soothing tools, and I mentioned my tool of choice: doughnuts. In response, Giles began to make a case for the harmlessness of doughnut overuse. After a couple of minutes straight of his explaining why I should not feel guilty about my doughnut habit, I realized he was concerned I might have grown embarrassed.
I stopped him. Could this be right? Indeed, it was. Giles, this adult with Asperger's, had sensed I was embarrassed, and was doing his best to make me comfortable. There was no other way to explain it: this was empathy.
In fact, many clients have demonstrated the same level of empathy in myriad ways during sessions. I see it when they tear-up describing their pet's pain. I see it in their silent withdrawal when a parent is unfairly raging. I see it in their pull towards social justice. I see it in Asperger's men's groups, during which they are gentle and supportive of each other in ways that violate male social norms.
In fact I often wonder if the withdrawal adults on the spectrum resort to is emotionally necessary. If they feel others' pain acutely, and on top of that often lack the social skills to offer "appropriate" comfort, what are they to do? Withdrawal and distancing become more than relating styles: they become necessary tools for self-preservation.
Picture the plight of the teenager on the spectrum who comes home after school to find parents who are quietly angry at each other. Because he is sensitive, he knows something is wrong. His body is on alert, and he wants to help. Because he is empathic, he would like to offer comfort. However, because he is bright and learns from patterns, he knows that historically he has said the "wrong" thing in these situations, which has made things worse. He determines, quite logically, that the best thing he can do is go to his room and put on an audiobook. Both parents notice this, and note how little he appears to care about anyone but himself.
Adults on the spectrum often over-empathize. To feel deeply, and fail miserably when they try to offer comfort, causes more injury than can be tolerated. Retreating offers solace. And confirms their image as non-empathic.
"Autistic empathy" is a powerful experience, and leaves the adult with no way to manage the strong emotions of others, which resonate so deeply in him. Our job in relating to them is to look past the veneer of calm or indifference with quiet curiosity, to resist the outrage we feel when someone displays so little outward reaction. Partners who do this are met with a rich world of sensitivity and attachment, the world they sense but cannot readily see.