Friday, January 1, 2010
Asperger's and Couples Therapy
My name is Cary Terra, LMFT and I am a psychotherapist in practice in Seattle, WA. In graduate school I received much training in working with couples, and went on later to my practicum work, where I worked with couples struggling with issues of all sorts.
Therapists are trained to recognize and decode relationship patterns. There are many patterns, and no couple adheres to a single pattern all the time. But by and large the training prepares the therapist for recognizing these familiar dances couples do with one another. Recognizing these patterns is the foundation for any work with couples, regardless of the type of therapy used in treatment.
There are so many different approaches to treatment when it comes to couples, and of course there is much debate amongst professionals regarding which treatment modalities are most effective.
When it comes to couples in which one partner has Asperger Syndrome (or something close to it), research on effective treatments for couples is scarce. So what works?
Most research on therapy and adults with Asperger’s supports Cognitive Behavioral Therapy (CBT) techniques. This modality assists the client in identifying and changing cognitive distortions, thereby enabling him or her to change their resulting feelings and behaviors. This modality is well researched, and is built upon the assumption that cognitions preface affects. Of course it is useful to understand how our thoughts, emotions and behaviors are linked. Without this understanding, the adult with Asperger’s can experience their inner emotional world as a chaotic, foggy maze without a logical destination. Adding the logic piece to this world via CBT can demystify the land of emotion, easing the client’s anxiety and increasing the client’s sense of mastery.
Sounds simple. But is it?
CBT can be very effective, no doubt. But it does little to help the client clarify any issues originating in the unconscious. Unconscious motives, which often steer relationship choices, are often affect-laden, and often have little conscious thoughts associated with them. Thus, the individual with Asperger’s may see obstacles involved in a relationship with a specific potential partner, may find the relationship fraught with drama he or she finds unbearable, and may feel controlled by relationship anxieties and fears. Yet this same individual, even after identifying cognitive distortions and working to change behaviors, may feel viscerally drawn to the relationship, with little insight as to why.
Yet understanding why often feels necessary for a deep sense of clarity for many individuals.
In my experience, a blend of Cognitive Behavioral Therapy (CBT) and Family Systems works best. Family Systems is a modality which focuses on how systems of relationships evolve and are perpetuated, even passed down through generations. Writer and Systems therapist Harriet Lerner, PhD writes in her book The Dance of Intimacy, “An intimate relationship is one in which neither party silences, sacrifices, or betrays the self and each party expresses strength and vulnerability, weakness and competence in a balanced way.”
Family Systems attempts to assist clients in identifying blocks to this aim in their current relationships and past family relationships, so that these obstacles can be slowly removed in a way that fosters independence and dependence, in healthy balance.
I find that individuals with Asperger’s often pair up with partners who are emotionally driven and expressive. This can serve as a wonderful complementary dyad at first, but often over time the system becomes magnified in its intensity and polarity. Individuals in such relationships can benefit from striving for balance individually. If this does not happen, the Aspie adult can over time become dependent on his or her partner for a sense of emotional engagement, connectedness to others and “normal” appearance.
So how can the Aspie in such a relationship make gains towards balance? I have found many Aspie adults have had success with volunteering, joining special interest clubs and working on mindfulness. A therapist can also help with addressing specific trouble spots in a regimented way to help diminish anxiety and that “alien feeling” which can be a source of superiority, but also of confusion and pain.
Relationships can be extraordinarily challenging for adults with Asperger Syndrome. The stress of navigating intimacy for the individual with AS can be extremely high, and this is crucial information for both the Aspie and his or her partner to understand and respect. It is important to remember that if you have Asperger's and are in a relationship, you must take time to nurture your own unique ways of being in the world. This includes scheduled time for solitary activities and planned opportunities for engagement in special interest activities. I often tell clients that investing in these activities is like eating for the Aspie - it is non-negotiable, and going without it can cause damage to not only the relationship, but to the Aspie's mental health. This investment is part of, as Lerner points out, working towards individual competence and balance. And this balance can help prevent a host of relationship mishaps, such as dependence, resentment, passive-aggressiveness and more.
For more information on Harriet Lerner, PhD, visit her website at www.harrietlerner.com .