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.

Adults with Asperger's - The Eyes Have It

Researchers in 1997 (Baren-Cohen) found that adults with Asperger’s have difficulty reading mental states by looking at a person’s eyes – not only the expressions of the eyes, but the location of their gaze. These findings were expanded upon in 2002 (Rutherford), when researchers found that adults with AS have difficulty extrapolating people’s mental states from their vocalizations.

Take just a minute to imagine some of the implications.

• You might miss the message of a potential friend who uses vocal inflection to communicate her irritation with your long story; her social rejection results

• You might not see that the person gazing past you is no longer interested in your words; when he abruptly walks away, you’re left confused and mid-sentence

• You might not notice the heavy-lidded, far-away gaze of your partner, which implies her deep thought; when you interrupt her, her anger seems “out of the blue”

• You might not see the knowing glance between party goers when you introduce a boring topic; when you proceed to elaborate, group members leave

• You might miss the sarcasm of a coworker when he shares that a secret is “common knowledge”; when you mention it to a coworker the next day, you’ve unwittingly committed a serious social blunder

We constantly use our flexible and dynamic ability to read and react to myriad social cues to avoid social disasters. Adults with AS who may not have this luxury are left trying to navigate the social landscape with no real map. The negative reactions, indifference and subtle (or not-so-subtle) rejection they deal with can lead to social anxiety, confusion, avoidance, isolation, even depression.

You can cut some slack for those who struggle to keep up with an ever-changing social context by resisting the urge to expel them from the group. You can resist the urge to mock or embarrass. If you have social gifts, you can share them. Remember, adults with AS are often developing the computer programs you work with and performing the neurosurgery you may benefit from.

Asperger's: Are You Thinking What I'm Thinking??

"It just doesn't FEEL like you GET how I'm feeling..."

Have you ever heard this from a loved one?

Adults with Asperger's in relationships often hear similar complaints from their partners. Yet highly intelligent Aspies often find ways around this effect in work and other settings. What is it about intimate relationships which magnifies this effect, and what can Aspies do about it?

Adults with Asperger Syndrome are well known to have challenges with social interaction. Often, even long after the obvious signs of these challenges are gone, the adult Aspie often continues to "feel different". But they may be missing their own successes by focusing on the differences, rather than the similarities, between theirs and the social interaction outcomes of NTs.

It's often thought that these typical "social deficit symptoms" stem from so-called "mind-blindness" -- an inability to express a "theory of mind", or to grasp what other people may be thinking, feeling and intending. Yet did you know that adults with Asperger's, who are often highly intelligent, routinely pass tests designed to evaluate theory of mind?

In 2009 a team led by Uta Frith, of University College, London, and Atsushi Senju, of Birkbeck College, London, tracked the eyes of people with Asperger's while they took part in a standard test of theory of mind. The results were surprising.

The test, known as the Sally-Anne False Belief Task, works like this:

One character, Sally, places a marble in a basket and leaves the room. In her absence, another character, Anne, moves the marble to a box. When Sally returns, children are asked where she will look for her marble. If children understand that Sally's actions will be based on what she believes to be true, rather than the actual state of affairs, they should answer that she will look in the basket, rather than the box. This correct answer requires the child to predict Sally's behavior based on her now false belief.

Neurotypical children aged 4, and children with Down's syndrome, pass this test, while children and adults with autism spectrum disorders generally do not. Adults with Asperger's pass it -- but Professor Frith's study shows that their success may be due to a very different mechanism.

The team asked adults with Asperger's, and neurotypical (NT) adults, to take the Sally-Anne task while their eye movements were tracked. Both groups got the task right when assessed verbally, but their eye movements told a different story.

The NTadults generally took their first glance towards the correct place -- the basket where Sally thinks her marble is -- in anticipation that that is where she will look. However, members of the Asperger's group looked equally often at both the box and the basket before making their choice. They did not seem to have a spontaneous understanding of the right answer -- the direction of their first glance was a matter of chance.

The implications of this are fascinating. It may be that people with Asperger's do have difficulties with theory of mind: unlike those with NT brains, they lack the ability to jump straight to the right decision, almost as a matter of instinct. What they seem to do instead is to work out other people's beliefs and intentions by means of logical reasoning.

The finding is also encouraging news for therapy. Theory of mind in itself, it seems, can be learned. That is, the same results can be attained via "intuition" AND logic.

Adults with Asperger's may arrive at social conclusions via logic, but feel exhausted after their success. It may be true that social interactions never do take on the intuitive, fluid quality many adults enjoy when communicating.

Perhaps when it comes to the social interactions of adults with Asperger's the most important part may not be the means, it may be the end itself. If you have Asperger's, you may benefit from focusing less on how you operate differently, and more on the results you achieve or want to achieve.

Chances are you're not coming across as poorly as you think.

Theory of Mind vs. Compassion in Asperger's

The couple was in the midst of a heated argument.

"Please stop looking at me like a dead cod fish!"

Believe it or not, statements like this from partners of adults with Asperger's are not all that uncommon. When confronted with a highly upset partner, some adults with Asperger's respond by shutting down completely, staring baffled at their partner instead conversing and adopting the pose of a....well....dead cod fish.

Often adults with Asperger's (ASD) are accused of by loved ones and friends, even coworkers, as LACKING EMPATHY. This is puzzling, as many Aspies report a heightened alarm system when confronted with emotional intensity. Do Aspies really lack empathy? Or are they shutting down when easily overwhelmed in emotionally charged situations, leading to a "non-empathic" presentation? Or is there some other explanation?

Theory of Mind
The typical individual, at an early age, develops the innate capacity to know and understand that other people have thoughts, feelings and desires that are different from his or her own. This understanding develops without effort, and is supported by the innate ability to engage in the nuances of interaction: body language, tone of voice, eye contact and other subtleties. This conceptualizing of "other" versus "self" is, what many researchers believe to be, the first step in empathy. In other words, it is very difficult to "empathize" with a separate person's unique experience without first understanding that their experience is just that - unique, or more aptly put, not the same as that of the self.

One of the most important milestones in theory of mind development is gaining the ability to attribute false belief: that is, to recognize that others can have beliefs about the world that are incorrect. To do this, it is suggested, one must understand how knowledge is formed, that people’s beliefs are based on their knowledge, that mental states can differ from reality, and that people’s behavior can be predicted by their mental states.

Researchers have investigated the false belief concept in intriguing ways. In one such experiment (often called the ‘Sally-Anne’ task), children are told or shown a story involving two characters. For example, the child is shown two dolls, Sally and Anne, who have a basket and a box, respectively. Sally also has a marble, which she places in her basket, and then leaves to take a walk. While she is out of the room, Anne takes the marble from the basket, eventually putting it in the box. Sally returns, and the child is then asked where Sally will look for the marble. The child passes the task if she answers that Sally will look in the basket, where she put the marble; the child fails the task if she answers that Sally will look in the box, where the child knows the marble is hidden, even though Sally cannot know, since she did not see it hidden there. In order to pass the task, the child must be able to understand that a person's mental representation of the situation is different from their own, and the child must be able to predict behavior based on that understanding. The results of research using false-belief tasks have been fairly consistent: most normally-developing children are unable to pass the tasks until around age four. Yet the test is often not passed by adults diagnosed with ASD.

Compassion
Is Theory of Mind a necessary foundation for compassion? Compassion is a human emotion prompted by the pain of others. More vigorous than empathy, the feeling commonly gives rise to an active desire to alleviate another person's suffering. It is often, though not inevitably, the key component in what manifests in the social context as altruism.

Though adult Aspies get stuck when it comes to understanding the WHY of another's emotions, they rarely seem to present with true indifference. Rather, many seem to adopt a position of indifference as a defense against an inherent lack of understanding of the basis for the emotions of others. It is, perhaps, this fundamental lack of understanding, COMBINED WITH an ultra sensitive and reactive physiological system, which leads to withdrawal. This withdrawal can leave loved ones feeling abandoned and uncared for, a recipe for problems in relationships.

"I love email," says one Aspie adult, "there's no overwhelm. I can read about my friend's upset without having to respond in the moment, manage eye contact, witness first hand things like crying and gesturing. Email is the grease of our relationship."

FINAL WORD
Before jumping to conclusions regarding your own or your partner's ability to empathize, remember that one truly cannot judge an Aspie by his or her cover. Professionals trained in working with autism spectrum disorders can help with adjusting terms of communication to prevent overwhelm and withdrawal, so that Aspies with compassion can be perceived as such.

There's nothing fishy about that.