Adults with Asperger's and Building Self-Concept

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.

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.

The Hidden Autistics II: Asperger's in Adults and Empathy

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.

The Hidden Autistics - Asperger's in Adults

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.

NEW THERAPIST AT TERRA THERAPY P.C.

I'd like to welcome our new therapist, Kimm Klassen. Kimm earned her master's in social work at Eastern Washington University, and currently works as a therapist in the Bellevue Washington school district developing and implementing programs for kids and families with special needs.

Kimm brings a wealth of diverse experience with adolescents and adults on the spectrum, and currently works with couples in which one partner has Asperger's.

Kimm offers Saturday appointments in the Pioneer Building office, located in Downtown Seattle.

For more information please contact Kimm at (425) 445-7669.