 How do adults on the spectrum build their self-image?
I've been thinking recently about this: how my clients have built and maintain self-concept. Most of us use relationships to some extent to gather information about ourselves and build self-image. Ongoing relationships help maintain and develop self-image. This is a healthy process (to the extent the relationships are healthy), and a normal part of development. Development teaches us that the reciprocity of early relationships is the first step in building identity. It is crucial to bonding and attachment - that seems obvious. If an infant has an "attuned" caregiver, s/he learns basic trust; that is, if needs are expressed, they are largely met. This starts immediately after birth: the infant cries, expressing distress. The infant is then cared for appropriately (whether that means being fed, changed, rocked, etc). Over time, these reciprocal experiences teach the infant, then toddler, then child, then adolescent, that relationships with people are sources of safety and nurturing. We learn, as a by-product, that we are worth this safety and nurturing. What happens, then, when the infant on the spectrum attempts to enter into this exchange? I can think of lots of ways the system may get disrupted. For instance, many parents recall that their babies (later diagnosed with a spectrum disorder) were inconsolable - obviously physically uncomfortbale, but only able to be soothed sporadically and unpredictably. Other parents recall babies who didn't cry at all - who seemed to lack the interest in communcation. Rather than express the need for caregiving, many of these young ones turn to self-soothing. In some ways they seem almost autonomous from the start - instead of wanting to be rocked to sleep, they rock themselves; instead of playing peek-a-boo with a parent, they flap their hands alone. If a child is uncomfortable in a way that cannot be interpreted or soothed by a caregiver, the consequences for attachment can be serious. I'm not sure many of my clients have found relationships soothing, though they do crave them. Many Aspie adults I see seem to have given up on bringing their distress to others for relief. Of course this contributes to self-sufficiency, but also to loneliness, especially when life or feelings are overwhelming. Their strategy, then, is to keep life and feelings from becoming overwhelming in the first place....leaving their partners wondering why they don't jump in to participate in stressful conversations or share emotional space with people they find unpredictable. But think about it - what if you couldn't lean on others when the going gets tough? What if you couldn't make your needs understood in order to get what you need? What if, instead, you were scolded, mocked or rejected? This may sound dramatic, but think of the engineer who truly does not know how to clean a bathroom, or the programmer who always seems to say the wrong thing. Over time these experiences teach the opposite of emotional reciprocity. Rather, they teach that interactions and relationships are often sources of pain. The first step for healing for adults on the spectrum, then, is often establishing a reciprocal relationship - with self. I know this sounds corny, but it's true. If I cannot establish a compassionate and attuned relationship with myself, I'm going to have a very difficult time communicating my needs to a partner. And partners are often desperate to be of help. When interdependency does not develop, they are left feeling ineffective, or worse, inadequate. This contributes to the desperation and rage I see in sessions, where each partner feels shut out, but for very different reasons. Back to reciprocal relationship with self. We all must become "attuned caregivers" to our selves. If we have missed this opportunity in childhood, for whatever the reason, we must develop this skill in adulthood. The first step of self-care is noticing our internal states, so that we can begin to establish a routine of awareness of self. For adults on the spectrum this is often new. If you or your partner has difficulty finding solace in relationships, you're not alone. You can learn to tune into your own emotional states and find healthy ways to meet your needs. You can learn to articulate what you feel and ask for what you need. Relationships with other human beings can become sources of support and love. I think it's never too late to establish new ways of attaching to others.
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 In working with couples in which one partner is on the spectrum I'm often struck with how similar their experiences, both big and small, are. Of course in initial sessions I get quite a different account from each partner. Because one partner in the relationship is often both vocal and articulate, I get lots of information from him/her. In fact, I depend on this partner to convey how s/he feels in the relationship. This ability to describe emotional states is a valuable part of therapy.
But gathering information from the Aspie partner goes a little differently. Many folks with Asperger's have a difficult time recognizing and naming their emotional states. Most of my clients know if they're comfortable or not comfortable, but distinguishing between emotions like guilt and sadness, or happiness and excitement, is trickier. Funny that many of these adults enter into relationships with partners who are so highly empathic; I've heard couples report that the non-Aspie partner will know her partner is anxious before he does! This difficulty naming emotions wouldn't seem like too much of a disability, except that we rely on our ability to notice and name our internal states constantly - throughout interactions with everyone from the mail carrier to our spouse. Think of the lack of control that can come from not being able to name your emotion - how then can you modify your environment or the behavior of others to meet your emotional needs? Here's an example of the kind of interaction that can emerge: #1: I'm so angry with you for forgetting to freeze those strawberries! #2: I didn't forget. #1: Yes you did. You always do. I told you to freeze them, and there they sit on the counter! #2: That's because I haven't gotten to it yet. #1: Well when did you think I wanted them frozen? After they've gone moldy? #2: They're not moldy. #1: That's not the point! I asked you to do me a simple favor and you just won't do it! I really do have to do everything myself. Can 't you understand how that hurts me? #2: (silence)...beginning to shut down #1: Is that a "YES"? #2: (silence)....shut down In this example (as you may have guessed) Partner #2 is the partner with Asperger's. As tension rises during the conversation, he is unable to identify his emotional state - things are moving too quickly, and she's waiting for a response. There's no time to slow down and ask himself what he's feeling - to do so might even further escalate the situation. Because accessing emotion takes time - more time than is socially sanctioned - he may focus on the information coming his way - because frankly, he can process information with lightning speed. Once she's offered a statement that's untrue ("I really do have to do everything myself"), the conversation is largely over. He cannot correct her statement without furthering their journey down the rabbit hole. He cannot acquiesce, because the statement is not correct. With no option, he shuts down. In an effort to justify feelings, many of us exaggerate information. Without doing so, it seems, we are not taken seriously. But doing so invites debate. Were the strawberries really in danger of going moldy? Perhaps not. Because she has expressed her feelings in terms of information, the validity (or lack thereof) of the information is relevant. This debating of information is often a major way these conversations get derailed. But there's an exciting twist to this story. Healthy communication requires sharing perspective using reality-based language. It requires resisting the temptation to read into behaviors, to assume motives. Yet most of us are socialized to infuse our communication with emotional intensity when we feel unheard. Of course this will not work in an Aspie relationship. Nothing will close down a conversation more quickly. Healthy communication is literally the only thing that will work. If folks with Asperger's tend to miss emotional cues unless the cues are potent and unmistakable, it's natural for partners to want to amp up the intensity in an effort to be heard. It's painful when this backfires for both partners. Developing a system that helps you and your partner navigate conversations - and communicate intense emotions in non-threatening ways - is crucial. Without systems to manage these moments, partners will feel both bullied and unheard. While freezing strawberries may seem to be an inconsequential issue, it's often these everyday rough spots that couples address in sessions. When simple interactions can veer so far south, the couple is at risk for chronic hypervigilance and reactivity. More on these systems to come.  One of the frustrating things I encounter in my work is witnessing the damage done to clients (and to their relationships) by well-meaning therapists and books who believe Asperger's and relationships are incompatible.
I know, you think I am exaggerating. Really, though, people do think this. Consider a client I'll call Eloise, who came to see me in a "last ditch effort" (her words) to save her relationship. Having already visited two couples therapists for help in understanding how to relate to her Aspie husband, she was in the process of resigning herself to the "truth" they had shared with her: her relationship could never meet her emotional needs. Her best bet would be to reframe her relationship as a platonic partnership, and to get her emotional needs met elsewhere. The ideas of knitting clubs and online forums had been proposed, and Eloise was in a state of panic. After offering this brief history, Eloise stated her purpose in seeing me. She wanted help in moving through the grieving process. She needed to mourn, she said, mourn the normal relationship she would never have. She wanted to know if I could help her with this grief work, so she could move towards acceptance of this stunted marriage. She couldn't leave, she explained, because her husband was a wonderful person, though sadly therapists (and books!) had revealed that he was incapable of connecting to her emotionally. In responding to Eloise, my first task was to breathe through my outrage. The two therapists who had offered Eloise this glimpse of her marital destiny had not even met her husband. Both had "comforted" her by explaining that his withdrawal and disconnectedness had nothing to do with her - rather this was his neurological disorder at work, and nothing could fix it. Beyond the irresponsibility of this crystal ball therapy, their predictions made little sense given recent research on brain plasticity. (See this great TED talk on the subject at http://www.ted.com/talks/michael_merzenich_on_the_elastic_brain.html for a brief introduction.) The truth is that Asperger's, and its impact on relationships with self and others, is poorly understood, especially by many clinicians. And certainly no clinician should ever give a prediction for an individual's lifelong functioning, especially if that person has never been evaluated. Aspie couples come to therapy looking for tools and answers, and are often instead given prescriptions for hopelessness. It's one thing to talk conservatively about treatment goals; it's another thing to throw out goals altogether. Therapists often tell clients married to ASD adults that their partner cannot feel empathy and cannot truly love. Perhaps the reason I take such exception to this kind of dangerous feedback is that it's simply not true. All of my clients feel empathy, and all are capable of love. In fact many times my Aspie clients are shocked to find that their partner's faith in their love and loyalty can be compromised by a forgotten good-bye or missed eye-contact. One Aspie partner remarked: "How can our whole relationship hang by a thread? It makes me afraid to open my mouth for fear I'll accidentally destroy my marriage." Of course this anxiety furthers ASD clients' reluctance to establish connection, which furthers their partners' feelings of being ignored or neglected. Partners with Asperger's have often spent a lifetime making unpredictable relationship mistakes that carry real repercussions. When the probability is high that your efforts to connect will be met with rejection, it's awfully hard to justify the logic of continuing to try. Successful relationship therapy involves identifying triggers so that both partners can work towards feeling safe together. This is the foundation of building connection. Clinicians are trained to use good communication to build safety, rather than building safety to facilitate good communication. I'm proposing the notion of working together to establish safety first. This is crucial for creating a context in which people with Asperger's can experiment with being vulnerable, and non-Aspie partners can experiment with interpreting behaviors in brand new ways. |