Tuesday, December 3, 2013

The Outsourcing of Emotions: Adults on the Autism Spectrum

What gets repressed will be expressed...
not by you – but by your partner.

There’s this interesting phenomenon I notice amongst couples I work with.  It involves emotions, and how partners work together to manage unmanageable emotion loads.  They may not see it this way, but from my perspective it looks as though they are unconsciously dividing up and sharing emotions such that their partnership stays, although maybe uncomfortable, intact. 

As you probably know, lots of clients on the spectrum describe feeling “flat”, or emotionless.  They seem to have identified only two emotional states: undistrurbed and disturbed.  Distrubed emotional states are extremely uncomfortable and difficult to recover from, so, logically, many try not to get disturbed in the first place.

Between the Aspie client and his emotions is an extremely effective dam, and he feels little control over how wide, if at all, the floodgates are opened. While there may not be an accurate sense of what feelings actually lie on the other side of this dam, what is felt is a real dread of the size and intensity of these unknown emotions.  Clients seem to spend much of their time avoiding this dread, and occupying their interests and attention to this end.  They may spend time thickening the dam walls, by caking on layers of avoidance through distraction, compulsive working or even substance use.

This might work well, if only the emotions didn’t somehow leak out from beneath the dam, or spill over the top.  But, in fact, the dam does develop cracks. Minor cracks can bring anxiety and irritability, while major cracks can bring panic and apathy.   The great, nameless fear is that if the dam breaks, one might be engulfed, or even annihilated.  And since, when feelings leak out, they really do tend to be overwhelming, this theory gains credence over time.

In times where pressure mounts, the adult on the spectrum often employ one of two methods for emotion management – 1) he more frantically pursues his interests (because he’s increasingly desperate to distract from the pressure of mounting emotion), or 2) he provokes the emotion’s expression in his mate. I call this last tactic the outsourcing of emotions. It’s effective in the short-term, but can damage the attachment between partners.

What might this look like in everyday life? 

Say a family is attending a holiday party.  Let’s invite in our favorite hidden autistic adult, Joe. 

Joe and his wife (we’ll call her Jane) and two kids are preparing to leave for the event, and unspoken tension is high.  Joe is experiencing anxiety, but it’s a mindless kind of anxiety – he hasn’t really named the feeling, and therefore hasn’t had the opportunity to really solve for it.  What he does internally is a kind of disconnecting from the people around him.

Joe is on auto-pilot, and has decided the family should leave at 3:00 PM on the dot.  He fails to communicate this to anyone but himself, and instead imagines his family members know, or should know, about the deadline.  Of course, 3:00 o'clock comes, and 3:00 o'clock goes, and no one is ready to leave for the event.  Except Joe, that is.  He’s been alone waiting in the car for half an hour.

Once Joe can silently stew that his family members are not meeting expectations (of course there’s no way for them to meet expectations they don’t know exist!), he has a reason – a righteous reason! – for disconnecting.  Joe hasn’t learned how to rely on other people as sources of comfort; instead, they often feel to him like sources of danger.  Read on how this becomes a self-fulfilling prophecy, once the afternoon continues to degrade.

When finally Joe’s family members join him the car their emotional states have all arranged predictably: Joe is sullen and removed, Jane is frantically positive (trying to save the day from the inevitable), and the kids are becoming increasingly hyper and disorganized.  Once on the road, Joe begins driving with too much intensity, his jaw set and his gaze focused solely on the road.  When asked what’s bothering him, his reply is “nothing”, though various sources of stimuli are now crowding in on his consciousness – the noises, the sights, the chaos. Joe might truly believe at this point that his irritation is due to the missed deadline.

He may snap at the children, park too far away for his spouse’s taste, "sneak" an obvious glance at another woman – whatever the behavior, chances are he’ll continue until some unspoken line has been crossed.  Once it has, Jane becomes angry, and loses her temper.  She’s exhausted by the game they’re both playing, but unable to move differently in this very familiar dance.  “So many outings go this way,” she thinks.  “Why do I even try?”. 

Once Jane is angry, Joe can finally feel the sadness that has been fueling his behavior all along; and in this, he feels saner.  This seems so counterintuitive, doesn’t it?  But from Joe’s perspective, you see, the situation – and his reaction to it – now makes sense.  Joe finally feels like what he sees (his angry wife) has justified his internal state (anxious, excluded). And Jane has become the expresser of his angst; while he hangs back from the family, she has become irritable and overwhelmed.  Unconsciously, she has taken on his unbearable emotions.  At her own expense, she has served as an emotional surrogate of sorts.  Now Jane is feeling many of the feelings Joe had in the first place – Joe has outsourced his emotions.

The down side of this dynamic?   It is unconscious – Joe has not slowed down enough to identify, label, and communicate his distress (many clients don’t, because they feel unaware or ashamed that routine family outings cause them so much anxiety and confusion in the first place).  This outsourcing technique may save Joe the ego hit of having such struggles, but prevents his true solving of the problem.  What Joe actually learns, unconsciously, is that these states really are unbearable – that his spouse can bear them better, and will do so for him. 

Jane is also unconscious to this process, and is thus operating in the relationship in a way that damages her sense of self and sanity.  She may find, upon careful examination, that she has functioned this way in relationships before, especially in her family of origin (where we tend to learn these habits).  Perhaps she’s so good at intuiting the emotional states of others, that she confuses them with her own.

It’s so important to realize that there is no perpetrator here – Joe and Jane are both victims of this unconscious system. These roles and ways of transferring around unbearable emotion loads develop organically, and both members of the partnership play along.  Each feels as if s/he has no other options – he hasn’t found a way to deal effectively with his suffering without transferring it, and conveniently, she’s confused his suffering with her own, and therefore can't resist feeling it for him.

The fascinating part about this is that, in general, the outsourcing goes both ways.  There are plenty of times when the spouse does some outsourcing of her own – I hear about it in sessions when couples are discussing how much anxiety builds when, for example, guests come to the home.  In instances like these the roles are often reversed, with the Aspie partner working hard to absorb her unbearable levels of anxiety, and her neglecting to slow down long enough to truly manage her own emotional state.  The process might look very different on the surface, but a similar unconscious transfer of emotion is occurring.

Can we learn to operate differently in these situations?  Sometimes the patterns have been relived over and over, over years and years, maybe even passed on from generation to generation.  It seems so hopeless.  But it’s not.  The first step is to slow down and learn how to label emotion states.  I have many clients who cannot tell if they’re hungry, sad, tired or angry.  They skip over finding out, because they’re not good at it immediately, and because it takes time.  But it’s a crucial step to avoiding these mood management techniques that exploit relationships and erode our attachment.

(BTW- thank you to B.H. for encouraging me to get back to posting!)

Saturday, April 27, 2013

Adult Autism, Avoidance and Depression

In my work with adults on the spectrum I help adult clients take a look at a big theme: avoidance.

Avoidance is a theme, but not a constant pattern.  I've worked with many clients who, once they're interested in a task or problem, are the hardest workers I've ever known.

Yet these same clients may struggle with avoidance when it comes to everything from personal hygiene to buying Christmas presents.  It's puzzling to those around them, and even more puzzling to themselves.  Why can other people seem to "get it together" and "buckle down"?  Even clients who are functioning well are plagued by avoidance that causes anxiety and schedule disruption: a three-week project is avoided until the night before, then powered through at the last minute.  It's not as though the three weeks of avoidance were spent in blissful denial; rather, most clients describe an anxious, mental circling feeling that leaves them feeling dread.  So why not just approach the task earlier? Most determine that it must be a character failing.  What other reason could there be?

This avoidance may be depression in disguise.  Together, clients and I have come to understand that the autistic experience of depression often involves something other than the standard sadness we all associate with depression.  The autistic version of depression is dominated by apathy, and a pretty profound inertia that can make it hard to approach tasks or even move physically.  With our newer understanding of how depression's lowered dopamine levels impact motivation and drive, not just mood, (see http://www.sciencedaily.com/), this does make sense.  Still, recognizing depression when it doesn't necessarily involve a subjective sense of sadness, can be tricky. And that means that typical treatments that address sadness can be not only ineffective, but irrelevant.

More effective, you might think, is addressing the behavioral side of therapy.  The behaviors of getting up, showering, getting some exercise, etc, etc, etc.  Surely focusing a bit on these aspects of healthy functioning is not irrelevant, but it's no fix, either.  For clients on the spectrum, work is to be done for a purpose.  A demand for purposeless work, or what feels like purposeless work, can actually exacerbate avoidance symptoms.

In my experience, clients on the spectrum who are dealing with avoidance as a powerful symptom of depression, are dealing with a symptom whose roots are in feelings of meaninglessness.  Folks on the spectrum often find meaning through curiosity - once that door is closed, it's difficult to manage mood and motivation.  In fact, it may be that the "special interest" phenomenon we see with autistic adults is the just the behavioral manifestation of the mood-altering function of learning.  So treatment - at least short-term treatment - for depressive symptoms often involves learning of some sort.

If you have a loved one on the spectrum who is struggling with avoidance as a symptom of depression, it may help to know that many clients describe feeling confused and helpless as to why the problem of avoidance persists. While avoidance may at times look oppositional ("Why can't he just remember to take out the bins on Thursday? Why is it always my job?"), I rarely have found this to be the case.

Identifying the mood components of the behavior is crucial to understanding why the problem exists and how to begin solving for it.  As we all know, nagging, reminding, lists, threats and even real-world consequences often are of no help.

As I work with more and more adults on the spectrum over time, it seems to me that it is crucial that mood is carefully assessed.  This can be tricky - if the autistic adult cannot self-report sadness (either because it is not felt or not identified), and if many of the behavioral markers of depression are missing (no tearfulness, suicidality, missed work, diet changes, etc), depression can be, and is often, missed.  If it is, the behaviors that keep depressive symptoms at bay will be intractable, and psychotherapy will devolve into going in circles.  This can be especially demoralizing for couples.

If you or a loved one is looking for help, working with a clinician experienced in autism in adults is crucial, so that symptoms that present much differently in the autistic individual can be identified and treated.  And above all, so the autistic individual can have the experience of being seen.

Thursday, April 18, 2013

Ticket-Punching: Couples on the Autism Spectrum

Many times in sessions with couples in which one partner is on the spectrum, much time is spent addressing an issue my wise Uncle Bob coined “ticket-punching”.

Here’s the definition:

Ticket-punching: v. an over-focus on schedules made, boxes checked and tasks accomplished, whereby the autistic adult is perceived as “missing the moment” and “more interested in lists than experiences”

This ticket-punching behavior, so I’m told, is especially prevalent during traveling.  Some adults on the spectrum may be great travel coordinators – almost too good at arranging tours, meals, destinations and activities.  His partner benefits greatly from this talent, of course: who wouldn’t love to have all these arrangements made competently, efficiently, and even cheaply?

But there does seem to be one problem.  The non-Aspie partner may complain of feeling alone on the trip, like the only one actually experiencing all these wonderfully scheduled happenings.  Out touring, she may look to her partner to share a smile of enjoyment, and find he’s busy consulting a map or phone, planning for the next event.  During dinner, she may move to share a taste of her dessert, only to find him more preoccupied with calculating the gratuity, the offered bite left untaken. At the end of the evening, she may find that they’re “sharing” a sunset – but instead of feeling companionship, she can sense he’s a million miles away.  It’s not a content quietness they’re enjoying, but a strained silence she’s enduring.

I often hear these clients ask Why?  Why go to all the trouble and expense, the time and the effort, only to stay so emotionally disconnected?  She may find trips less and less enjoyable because of the loneliness, or she may find the change of scenery a necessary distraction to home life.  Whatever the case, she’s often dissatisfied with the vacation, and the harder he works to make it a success, the less of a success it tends to be.

But here’s what I suspect.  I suspect he has difficulty enjoying the trip, (unless he’s actively engaged in learning).  I suspect that opportunities to sit and enjoy the scenery are either solitary activities for him, or if engaged in together, leave him baffled as to what to say or do.  I think ticket-punching gives him a role to fill that allows him to watch his partner have fun and enjoy herself – and this is often the closest he feels he can come to having fun himself.  He’s much more comfortable with setting the stage for his loved ones to enjoy themselves than he is with joining them emotionally.  If he cannot join, he logics, he will make himself useful.  And he often does.

From his perspective, really enjoying himself, getting lost in the moment, means he is likely to do something “wrong”.  Fun may mean embarrassment over that goofy laugh, or laughing too loud or too hard or too long or at the wrong time.  Being unselfconscious could mean losing pace with the tour group because he is caught up in marveling at the stars, or ordering dinner before the server has taken his drink request, or starting to talk excitedly before his friend is finished with his story or missing the cue he was supposed to pick up that now is the time for silence.  Letting go and participating could mean possibly ruining the trip, alienating fellow travelers, making a fool of himself.  The risk-benefit analysis points to sticking to what he’s good at: setting the stage for others, who don’t make such errors.

And here’s another benefit: adults on the spectrum can often enjoy the memory of happenings much more easily than they can enjoy those happenings in the moment.  Visiting a happening via memory is risk-free – it’s safer to have fun once you cannot fail.  It’s not that adults on the spectrum don’t feel – very deeply, in fact.  It’s that feeling, and expressing that feeling, has become associated with things like embarrassment and failure.  Those of us who can enjoy a trip without obsessing on expectations and possible points of social failure are so lucky.

So you may try starting small.  If you and your partner want to try to experience the moment, why not take it slow.  Expect that a vacation to the Galapagos Islands will bring with it an immense amount of anxiety; a short drive to the park or dinner.  He may try talking before thinking too much about it, and you may try accepting social errors as part of the desensitization process.  If you both try to be present emotionally, perhaps you’ll find that silence can be more comfortable than you thought.

Sunday, February 24, 2013

Adults on the Spectrum: These are your Feet on Asperger's

When I first started working with adults on the spectrum there was no literature to refer to, and certainly no treatment guidelines.  It was a brand new frontier, and so exciting.  I haven’t lost that sense – that there’s an ever-expanding landscape of discovery when it comes to working with adults on the spectrum.  Part of the constant novelty lies in the complexity of the mind; our personalities and coping mechanisms emerge through a complicated interplay between environment and genetics.  Of course we all know this.  But most of us consider autism to be a strictly neurological disorder, with observable behavior manifestations.  After working with hundreds of adults, I’m beginning to have my doubts.

What emerges after working with so many adults on the spectrum are patterns.  These patterns reveal common threads between everything from client histories, to their private philosophical musings, to their choice of partners, to their sexuality, to the way they sit.  I’m not talking about anything near 100% consistency, of course.  But I am talking about unmistakable trends, the likes of which I’ve not seen in other populations.  I’ll be writing more about these trends in posts to come.

But for this short post I’d like to focus on one rather endearing trend: what adult clients do with their feet.  After seeing lots and lots of adults on the spectrum I couldn’t help but notice how they tend to sit.
Not all of them, mind you, just many more than I had ever seen when working with varied populations.

Since sitting in this manner is not socially sanctioned for adults (yes, even our sitting postures are guided many unwritten social mandates), it’s unusual to see adults, both men and women, sitting in this position.  Some of them let me take pictures of their feet.  I've got almost fifty of them! All the same position. It’s not a groundbreaking clinical observation, just a fun one, and one example of how people on the spectrum can transcend social expectations and teach us about ourselves.  Apparently sitting with your feet like this is really comfortable.  I’ve tried it now, and it made me remember how many comfortable things we give up when we enter the world of adulthood and social referencing.  The ability to be disconnected from social norms can cause problems - we hear lots about that - but it can also preserve behaviors that are timeless in their comfort and charm.

See our this post referenced on The Atlantic: http://www.theatlantic.com/health/

Friday, November 9, 2012


In working with lots of couples in which one partner is on the spectrum, I cannot help but notice that many Aspies are coupled with highly relational people.  Perhaps this seems a common phenomenon – opposites do attract, after all.  But in these cases, partners seem more than just “opposites”. 

Partners of people on the spectrum often are more than just social – they’re often socially gifted.  These people can make friends with strangers in the checkout line, start up random conversations with people with seemingly no effort.  They’re often good with language – very good – and the path from their brain to their mouth seems short and straight (no pausing to find the perfect word, no searching for how to articulate a feeling).  When they’re angry, these partners are often even more articulate than usual – so quick with words that the Aspie cannot drum up a response before the partner is on to the next point.

I often refer to these non-Aspie partners as 98 Percenters.  These individuals are willing and able to do 98% of the work required to connect to another person.  Of course there are exceptions, but I find that the idea applies often.  So, who is the 98 Percenter?

  • Often extroverted, or a socially extroverted introvert
  • Can be emotionally labile – shifting and reactive moods
  • Socially adept – can fit in with many different kinds of people
  • Highly communicative of emotional states
  • Can seem very angry one minute, then pick up the ringing phone and seem cheery
  • Knows how to make people feel good
  • Often skilled with remembering details about people’s lives
  • Highly sensitive to others’ perceptions and judgments
  • Quick to anger
  • Prone to anxiety and/or depression
  • Excellent at chit chat  (though s/he may not like it)
  • Often interested in social justice (animal rights, etc)

It’s interesting that in sessions this highly communicative partner is often the person who answers my questions.  Sometimes they serve as a kind of bridge for the Aspie partner.  If I ask the Aspie partner a question that requires emotional analysis,  s/he will often look to the partner to answer it.  Of course this does make sense – it’s much more efficient, and the partner will be (perhaps) better at articulating the answer.  The truth is, the Aspie partner is just fine with answering – but allowing himself enough time to answer accurately would cause the conversation to lose its rhythm – and in general, this is a social no-no.

The 98 Percenter is often the kind of person who will “put herself out there” – risking rejection for the chance of connection.  S/he might reveal more about details Aspies consider to be personal (and therefore private) to casual friends. The 98 Percenter can be good at establishing what looks like instant intimacy.  I often hear from clients that “the party starts when she walks into the room”, or that people seem drawn to her.  It’s a sometimes dazzling level of attunement – the 98 Percenter can chit chat away while constantly monitoring how she’s being perceived and how others are feeling and perceiving.  That’s a lot of complexity, and it sure comes in handy.  However, when you’re 98% exposed, lots of things are revealed – including feelings like anger and resentment.  The Aspie partner experiences the lion’s share of this, and cannot usually understand why.

Sometimes this level of output comes at a price, and the 98 Percenter is exhausted after interacting – sometimes s/he has a hard time interacting at 50%.  In fact, if s/he’s not up to it, s/he may isolate until s/he can interact at her comfortable 98%.

Being a 98 Percenter sometimes means the individual is willing to do 98% of the work to connect to someone.  If there is an emotional space between two people, this person will just about fill it in order to connect – with emotional availability.  This works great for Aspie partners, in general, who seem less interested in letting it all hang out there – actually most of my Aspie clients seem more comfortable providing 2% - but an often pretty perfect 2%.  It seems like it should be a great system – because between the 98 Percenter and the complementary 2%, the whole emotional space should be filled, and partners should be able to feel connection.  But there’s a problem.

After a while, the 98 Percenter reports feeling tired and resentful.  What worked beautifully at first becomes mundane, then unsustainable.  As the 98 Percenter expresses relationship fatigue, then frustration, then desperation, the Aspie’s 2% seems unchanged.  This confounds, then enrages the 98 Percenter, who has felt willing to do so much work for so long, and is now looking for a little payback.

My opinion is that most of my Aspie clients are not unwilling to offer more than 2% emotional availability.  Under the surface they’re already offering more.  Most truly seem unschooled as to how to offer more (or in what form), and cannot tolerate much rejection.  S/he needs help understanding how and what and when to offer connection, and needs a recipe for success.

In typical relationships the percentages of emotional connection offered by partners differ, of course – but they do tend to wax and wane.  With Aspie relationships there’s less flexibility – but under the surface there’s also less variability on the part of the Aspie.  We can’t always strive to be a 50/50 relationship, but we can certainly find ways to limber up the system. And we do.

If you consider yourself to be a 98 Percenter, I really encourage you to think about how this ratio works (or worked) for you, and why.  Remember that it can translate to 98% of the emotional control and 98% of the emotional competence.  Finding ways to help your partner experiment with offering up more means you’ll need to give up some of that control and accept what is offered, as your Aspie partner experiments with the very scary process of revealing an imperfect self.

Monday, July 30, 2012

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.

Tuesday, July 17, 2012

Adults with Asperger's: Why Freezing Strawberries Can Be Hard

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.

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.

Saturday, June 9, 2012

The Hidden Autistics III: You Don't HAVE to Look Them in the Eye

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.

Thursday, June 7, 2012

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.

Saturday, May 26, 2012

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.

Sunday, March 18, 2012


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.

Saturday, November 26, 2011

Loving Your Introverted Husband with Asperger's

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.

Sunday, May 8, 2011

Can Aspies Write Science Fiction? Ask Katie Bridges.

Recently I received word that an ingenious woman with Asperger's had written a fascinating book called Warriors of the Edge: The Search for Stone. Intrigued, I learned more about this new author. So many of my clients dream of writing of the incredible worlds and plots swirling around in their wonderful minds. Here's a quick bio by a woman who (in April!) made it all happen.
My name is Katie Bridges and I am a science fiction author with a diagnosis of Asperger’s syndrome. I’ve had the diagnosis since 1998. Long before Asperger’s syndrome became known to the public, I would search for ways to describe what life was like for me. I would often say, “I feel like I’m suffering from a chronic state of culture shock while living within my own culture. Why is it so difficult to figure out what’s going on around me and adapt to it?”
I had perplexing communication disabilities, with a huge gap between my ability to communicate verbally and in written form. Writing came with ease for me. Forming thoughts verbally did not. I also had an intense need for repetition and sameness in my routine and activities.
I lived a mostly secluded life. Being around people left me feeling anxious and awkward. Having no friends of my own, I was kept from utter loneliness by an understanding husband and three loving children.
But even at home things were difficult for me. To keep myself from becoming completely unglued during times of distress, I would rock back and forth for long periods of time. I also figured out early on that pressure around my midsection would help to soothe me. If my panic sky-rocketed on me, I would yell for my husband saying, “Hurry! Squeeze me tight. I need pressure.” Hugs didn’t help. I needed a certain amount of pressure to help me get through my distress, almost to the point where I could barely breathe. No one understood why this would be of help to me.
It wasn’t until I received a diagnosis of Asperger’s syndrome that things began to turn around for me. I overcame difficulties I never thought would be possible to overcome. I didn’t do it alone. Assistance came from every direction as my husband sought out those who could help me.
The end result was that I was able to utilize the incredible focus I had and put it to work to write a novel. What had once been a problem for me was now an asset. I’d always been a writer, but I took that natural ability to focus and wrote a complex work of juvenile science fiction. My brain is wired to create details which can bring about a realistic feel, even when the subject matter is fictional. This has given my book a unique perspective. It’s what I have to offer as a person with Asperger’s syndrome. It has been thrilling for me to tell people about my book, which won the Rising Star award, a very rare designation for a children’s book. It’s not just the fact that I have a book on the market that makes me excited. It’s the fact that I overcame so much to get this far.
The name of my book is Warriors of the Edge: The Search for Stone by Katie Bridges. I hope you find it enjoyable!
To buy Katie's book (or just read about it!), click here:

Sunday, March 20, 2011

The Badger and The Mole

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.