 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.
0 Comments
 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.  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.  Recently I encountered a problem while collaborating with a group therapist with whom I share a patient. My patient has progressed quickly in therapy, as do many adults on the spectrum. However he did not start off as stereotypically autistic. In fact, initially he presented as many of my patients do: shy, articulate, witty. Good eye contact. Appropriate affect. Typical posture, gait and gesturing.
It took a few sessions to realize this fine gentleman suffered mightly with the symtoms of Asperger Syndrome, which he kept well managed and thoroughly hidden. Contrary to the stereotyoes of adults on the spectrum, my patient displayed no "meltdown" behavior, was keenly (TOO keenly) aware of people's reactions to him and exhibited no bizarre special interests or encyclopedic knowledge of vaccuum models. In fact, "Joe", as we'll call him, socialized quite well. He seemed quietly confident and wry, intelligent and perceptive. People responded well to him, really liked him, though probably none of them would describe him as a close friend. No one realized - in fact he often went without realizing - that his baseline anxiety approached panic on a regular basis. As soon as he was out of bed, existential angst was his constant companion. His difficulty managing his thoughts made rudimentary conversations minefields to be navigated. And navigate he did, dodging social errors with the same fright and determination one might actually dodge mines. After even minor social interactions he routinely found himself exhausted, and would retreat to soothing, isolated activity: sculpture, writing, woodworking. Not conversation with his wife. Diagnosing this man was problematic. He truly did not fit the criteria for Asperger Syndrome. In fact, the only person to suspect he was on the spectrum was his wife, who puzzled endlessly about this curious man. He seems so sensitive and kind, she would say. Yet he ignores my birthday and hangs up before saying goodbye. He's so charming with others, yet so silent at home. He never misses a deadline at work, yet cannot remember to give our dog his heart medication. Partners of people on the spectrum are drawn to what they can sense is inside their partner. Yet they feel shut out, left pining for connection with this special person who remains unreachable. It can be a confusing relationship, and one that can easily lead to resentment. So what was the problem I ran into with the collaborating therapist? She found it hilarious - outrageous! - that Joe had been diagnosed with Asperger's. When Joe would make an insightful comment during group session, this group therapist and members would share a hearty laugh, rolling their eyes that this sensitive man had been diagnosed as autistic. When Joe would tear up recounting his wife's rage and disappointment, he'd hear "So Mr. Autistic is shaking because his wife got angry! Ha ha! Shouldn't you be indifferent and focusing on dinosaurs?" (I'm sorry to say this is a direct quote.) The general public, even many clinicians, cannot believe someone like Joe can be autistic. His social deficits are so well hidden that he has convinced the world his autism does not exist. And he has perhaps convinced himself. One person remains unconvinced. His wife. After a long day of running what he terms his "social program", feigning natural banter and hiding anxiety, he is exhausted. His wife comes home to a man who has retreated to isolation as a desperate attempt to find peace and rest. I'd like to write more about this "hidden autistic" phenomena. Someone must. Adults on the spectrum are often too good at convincing others they are fine, have no emotions, are robotic. This is never the case, and the illusion can be dangerous to long-term mental health for autistics and their partners alike.  My husband zones out if too much is going on!
He's always focusing on details other people don't care about! It's like he needs to hibernate after a party! Am I the only one with social needs around here? My name is Cary Terra, and I work with lots of couples on the spectrum. Of course I'm generalizing with the title of this post - many of my clients with AS are female. For the sake of simplicity (for this entry, at least) let's assume our Aspie is male. So many partners enter into therapy feeling alone and exhausted. Often socially anxious themselves, they are tired of toting the social line alone. Without their efforts, I'm told, no holiday gifts would be sent, no brithday cards mailed, no housewarming parties attended. And I believe them. Their Aspie partners are often happy to hole up at home, friendless and isolated. There's only one problem: it only seems to bother ONE of them - the partner! Often the adult with Asperger's seems content, not only with his number of friends, but with the quality of his relationships. This can serve as a constant source of frustration to the more socially inclined partner, who feels building anxiety as the social circle shrinks over time. So what to do? Can an introvert be coached to behave as an extrovert? Can your introverted Aspie husband be trained to enjoy cooking classes, weddings and the lindy-hop? My opinion....is a resounding NO! There is a new trend amongst therapists, one of acknowledging the benefits and realities of introversion. Often passive and accomodating (though not always, of course), many men with AS will force themselves through work lunches, daily meetings, kids' birthday parties and holiday celebrations without acknowledging - even to themselves - their own anxiety and exhaustion. The truth is, socializing is not for everyone. Introversion is not pathology. Social anxiety is a reality for many, many adults - both introverted and extroverted. In fact, many of my couples experience similar levels of social anxiety - with one member pushing through it (extrovert) and one less likely to (introvert). Unfortunately many introverted clients come to treatment convinced they have a fundamental defect, even shame and guilt. It is crucial that partners, despite frustration and sometimes social embarassment, resist the urge to shame their introverted partner. Husbands with AS often have few sources of emotional support, leaving them vulnerable to partners' guilting or shaming. So why do partners guilt or shame their introverted partners? Sometimes it's out of loneliness, or a sense that things look "off" to neighbors or friends. Sometimes it's just being tired. But herein lies the key: the extroverted partner can meet her own needs by connecting with friends and maintaining relationships, all while respecting that her partner does not share these needs - and this might be part of what she found attractive in the first place! While this concept may seem simple, it does often mean adjusting your idea of what your relationship should look like. What expectations do you have regarding your social circle? What fears do you have regarding being isolated? How much responsibility do you take for your own social life? Are you holding your husband responsible for your own hidden social anxiety? Partners of adults with Asperger's often benefit, as much as do their partners, from learning that it is OK to be introverted: to pass on holiday obligations, to limit time at parties, to set boundaries on family time. In fact, such habits may be crucial to resource management for your relationship and for yourself. Through working with many Aspie couples I've come to notice an interesting phenomenon. The apparent lack of emotionality of the Aspie partner seems superficial. After gentle questioning it becomes apparent that many adults with AS are quite emotional - sometimes even overly sensitive - and many of them are suffering in silence.
It is a fascinating thing to watch, indeed. The adult with AS, often times experiencing severe anxiety, becomes....quiet. To the neurotypical adult, who expresses emotions interpersonally, this silence can mean only a handful of things, from disengagement to disinterest. In fact, I have worked with only a few adults with AS who do not suffer with severe anxiety or depression. While a few clients exhibit anger, sometimes overwhelming anger, most do not. Rather they retreat, and become unreachable when they feel threatened. The untrained therapist might view this retreat as passive-aggressive, even evidence of sociopathy. However as I experience this behavior in many different kinds of adults with AS, it is becoming clear to me that the behavior is not only means of protecting oneself, it may be largely involuntary. Partners of adults with AS may stray from the mid-line too, though in the opposite direction. The more their partners retreat, the louder they become, desperate to effect a response. The cycle is self-perpetuating, of course: the louder one becomes, the more the other involutarily withdraws. Yet who among us has been taught another approach? What options are there for cajoling a withdrawn adult to communicate? Answers to these questions are not easy to hear. They are painfully complex in their simplicity. They arouse in partners emotions such as righteous indignation and outrage. But the answers are solutions to bridging what appear to be unbridgeable gaps. The foundation to this bridge, of course, must be basic emotional stability and, above all, humility. It appears to this therapist that usually both partners stray from the mid-line of thought-emotion integration. Recognizing this and strategizing ways to meet in the middle can help couples - even those who seem miles apart - come together in deeper and more balanced ways.  When one partner in a couple has Asperger's, things can be....challenging. I often hear from partners of adults with AS statements like:
I fell in love with him/her because of a rare sweetness and vulnerability. I never thought I'd find someone so authentic - he/she plays no mind games. No matter how mad I get, my partner never shouts back or calls me names. I love his/her amazing mind and intelligence. So why then do couples struggle? So many couples I work with are or were in love. But as daily stressors increase, or the demands of everyday life multiply, couples get stuck, then angry. One partner may be reactive and need to process feelings verbally. The other partner may, when faced with intense emotion, freeze, withdraw, go silent or even flee. I sometimes picture these Aspie relationships as if between a badger and a mole. The more the badger digs, the more frantically he or she tries to connect, the deeper the mole retreats. The badger thinks the harder and faster he or she digs, the sooner the mole will be reached. The mole flees, hoping the badger will eventually give up and peace will be restored. It's as if each is operating on instinct, both wanting to connect, but unable to. This can lead the partner playing the beaver role exhausted and angry. It can leave the partner playing the mole role frightened and blank. This system is not unusual. Therapists have for years been describing a common "dance" of marriage as one involving two roles - one pursuing and one distancing. Under stress the pursuer steps up her or her efforts to connect. Under stress the distancer seeks less connection. The two partners struggle with opposite instincts, which increases the stress on the system and adds feelings of misunderstanding, anger, even abandonment. The system is stable and becomes exaggerated over time, as both partners become more and more reactive to their partner's behavior. In my experience, partners of adults with AS do well to unlearn the universal lesson of digging and relearn ways to communicate which are perceived as less threatening by their partners. Adults with AS, if they are to connect, must find a way to communicate with their partners in ways their partners can understand - usually verbally. This takes guidance and hard work. Can this really be done? Absolutely! While adjusting expectations (the beaver may never sit quietly and mute, the mole may never chatter away) can be helpful, I almost always find that there is much room for change in both partners, contrary to much published information on Asperger's marriages. Adults with AS often provide stability, loyalty, consistency. Others provide a childlike playfulness and an authenticity rare in adults. As with any marriage, accepting your partner while clearly communicating your needs can be crucial. A therapist familiar with AS may help you and your partner have these conversations and make real headway. |