How an Evaluation for Autism Can Reduce Anxiety in Your Relationship

As a therapist working with neurodiverse couples in which one is autistic and the other neurotypical, I often encounter pairings in which one partner believes the other might be on the autism spectrum—and that partner refuses to consider it. He feels dragged into couples counseling, where most often they’ve already met with poor results. He has only reluctantly agreed to show up in my office as a last effort. Divorce is staring them in the eyes. Sometimes, he has even agreed to take one of the online quizzes for autism (a high score is suggestive for evaluation, but not diagnostic) and has rejected the results. Why wouldn’t he? He doesn’t know what to make of them. Neither does she.

This is what I hear him tell his partner after she first mentions the word “autism”:

“You think I’m defective!”

“You think everything’s my fault!”

“You’re not perfect either, you know.”

Needless to say, anxiety is high in both partners at this point. He’s feeling insulted and is showing signs of contempt, arms crossed, turning away from her. She is frustrated to the verge of tears, looking toward me with speechless supplication. Finally, she asks him, “Well, would you just consider getting evaluated?”

Sometimes he will say, “Absolutely not.” At that point, I acknowledge his response and take the conversation in another direction to explore the couple’s communication styles and blocks, attachment styles, language, and patterns. We can work together on those elements in the same way we would if a diagnosis were confirmed. My language will be different, of course, because I exclude mention of autism. Also, the psychoeducation regarding the neurology of autism is missing. Once I have a sense that he may in fact be autistic, however, in order to help a couple understand a particular communication block they are experiencing, I am likely to suggest something like a differential diagnosis and say to him:

“If you were autistic, you would likely be doing this as a result of a different kind of logical construction than your wife is using to understand a situation; you feel misunderstood by her rejection or disagreement. Autistic or not, your behavior feels intentionally hurtful to your wife, who has no other way of understanding it. Considering the possibility of autism offers another way of looking at both sides.”

We talk about abuse without intent, and how it still hurts, no matter what. We let her air her feelings without being judged or denied them. We explore how her neurotypical response to his behavior is predictable and no more a choice than his worldview is a choice.

These things start to make sense.

Gradually with these couples, it is possible he will begin to see that if he is autistic, many things about himself that have confused him for his whole life could possibly have a logical explanation. He may come to the point of saying something like, “Well, maybe we could just look at autism a little bit and see whether there’s something to it.” She may begin to relax because for the first time, she’s quietly beginning to see she’s not “crazy.” That’s when we discuss a formal evaluation.

There is no one test for autism, particularly in adults. When I do an evaluation, it consists of three or four sessions based in an exploration of social, educational, familial, and psychological history. I administer two instruments in session that come from the work of Simon Baron-Cohen, an autism researcher at Cambridge University for whom I have great respect. The last session is a couples session.

The individual sessions often become a surprisingly joyful experience of guided exploration of a person’s life in a way he has not been able to undertake on his own. He begins to make connections, draw conclusions, ask questions. For the first time in his life, he begins to understand he may be different from others, but there is nothing “wrong” with him. We identify the strengths and gifts that come with being autistic. We talk about the many examples of successful autistic individuals in history and in the present. We also have a frank discussion of the challenges. By the final session, his body language tells me he is relaxing to the idea of being autistic, to doing this kind of personal work, and to the opportunity to encounter his partner—and himself—in a new way.

I’ve seen formerly reluctant individuals begin to show up for their couples appointments with enthusiasm and even humor. My heart soars to see the progress couples make once they know what they’re dealing with. They still hit snags and they always will. But they are developing tools that will improve over time as long as they both remain alive to the love that drew them together in the first place.

The results of our evaluation usually either place him squarely within the diagnostic range for autism spectrum or approaching it in the subclinical range. Either way, when our work together continues, we work from the framework of neurodiversity.

I have developed a treatment protocol I call Neurodiverse Bonding Therapy©, which is where we move once the diagnostic procedure is complete. We begin with the basic psychoeducation of the neurology and autism. Most individuals who come to my office have already done a great deal of online research regarding autism. However, because there is so much conflicting, incomplete, and even inaccurate information floating around cyberspace, we start at the very beginning to be certain we are talking about the same thing, and so that we can refer to the neurology throughout our work together. This means not only understanding the autistic side of the partnership, but also the neurotypical side.

We move on next to how these differences appear to partners, what meaning they ascribe to their partner’s words and actions, and how the partner’s intentions may be quite different from how they are perceived. This is a big part of our work.

Next is deconstruction of communication, the actual use of language. We talk about intuition and lack of it, templates and protocols. We discuss skills for managing argument style, for keeping to the topic, and for recognizing when a conversation needs to be halted and postponed to an identified future time so both partners can refresh themselves. We discuss techniques and work-arounds, skills and interventions.

I’ve seen formerly reluctant individuals begin to show up for their couples appointments with enthusiasm and even humor. My heart soars to see the progress couples make once they know what they’re dealing with. They still hit snags and they always will. But they are developing tools that will improve over time as long as they both remain alive to the love that drew them together in the first place.

The evaluation for autism is often the release valve for enormous pent-up anxiety in both partners. Finally, they discover that what they are experiencing has a name: neurodiversity. And they realize that if they can name and understand their differences, they can learn to build bridges instead of feeling forever confined to living on the two parallel tracks of their past, which historically led to great pain and frustration, unfinished arguments, and loneliness.

They are not trapped. They know what they’re doing. They move on.

If you are considering autism in yourself or in your partner, I suggest starting with the AQ Test. If your score is high or ambiguous, you might benefit from seeking a formal evaluation. You can find local clinicians who offer these services by searching a directory or contacting a therapist in your area who works with autism and asking that person if they can offer you a referral.

Author’s note: I use the pronoun “he” to describe the autistic partner because the vast majority of neurodiverse couples with whom I work consist of an autistic man and a neurotypical woman. Certainly, it works both ways.

© Copyright 2018 GoodTherapy.org. All rights reserved.

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.