Wednesday, June 13, 2012

The Hidden Autistics IV: Relationship Counseling

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.