Getting the Help You Want: Neurodiverse Couples Therapy

GoodTherapy | Getting the Help You Want: Neurodiverse Couples Therapy

by Sarah Swenson, Licensed Clinical Mental Health Counselor in Seattle, WA

Don’t Give Up on Couples Counseling! Find a Therapist Who Understands Neurodiversity Instead  

In my work with neurodiverse couples around the world, the most common and the saddest comments I hear relate to their previous attempts to seek counseling. Instead of providing support and insight into their experience, counseling seemed at best ineffective or at worst (and not infrequently) downright harmful. Naturally, these negative encounters create a strong disinclination toward further attempts to seek help. If this describes your views of couples counseling, and if you fear it would be hopeless for you and your partner, please mull over these comments and consider giving it another try. 

Understanding Neurodiversity 

First, let’s make sure we’re talking about the same thing when we speak of neurodiversity. It’s a term that has only been around since a graduate student coined it in her master’s thesis in 1997 to describe individuals who felt they didn’t fit comfortably into the larger social patterns of expectations. She included those with ADHD, dyslexia, and autism under this umbrella.  

Her efforts were based in her concept that these are variations, not deficits, in the normal spectrum of human brain development. When I say neurodiverse couple, therefore, I am specifically referring to a couple in which one partner is what we call neurotypical (that describes roughly 97% of the global human population) and the other is neurodivergent with the traits of autism, whether diagnosed or undiagnosed. I often see ADHD accompanying autism as well, since it is frequently a diagnosis given to individuals whose autism was not diagnosed at the time of evaluation. 

Treating Neurodiverse Couples 

Remember that autism is a result of differences in the structure of the brain, when compared to what we call the neurotypical brain, and these differences affect an individual’s perception of the world as well as their responses to it and, therefore, social interactions. The key word is differences. These differences need to be identified, accommodated, and supported within the counseling framework in order for both partners to feel heard and understood by themselves, by their partners, and by their therapists. 

Faulty Assumptions Lead to Frustrating Sessions 

Besides the normal range of relationship complications faced by all couples, neurodiverse couples experience unique challenges that set them apart from the neurotypical couples that licensed therapists are trained to treat. Traditional couples therapy modalities are generally emotion-focused and insight-based, often embedded in a cognitive-behavioral frame, and they can offer profound help to struggling neurotypical couples. However, these treatment modalities present two great challenges for an autistic individual. For various reasons, the autistic partner is likely to shut down completely in the counseling environment, where presumptions are based in the neurotypical experience and where departures from those expectations are misconstrued to be resistance, reluctance, or manipulation.  

This likelihood needs to be identified and embraced with compassion toward both partners, but what often happens instead is that the autistic partner is pushed in ways that don’t make sense to them, while the neurotypical partner may feel slightly vindicated in the moment but ultimately frustrated when they sense that “there is no follow-through by my partner after counseling sessions,” as it is often described to me. 

Ignorance Leads to Misunderstanding 

A key point is this: graduate counseling education and post-graduate internships across the country lack deep emphasis and training in the concept of neurodiversity as it applies to couples. The best and most competent therapists, therefore, often miss signs of autism and proceed as if a couple were neurotypical and difficult or intransigent 

Seeking Help, Finding Frustration 

Sometimes, therapists do consider autism, and suggest to a couple that they work with a neurodiversity specialist or consider pursuing an evaluation to rule out autism or to diagnose it. This suggestion can be met with resistance by an undiagnosed autistic partner, who feels blindsided and labeled abruptly. The couple leaves in tatters and often never returns to a counseling room because the therapist did not adequately explain their reasons for making the suggestion nor describe the benefits to the individual and to the couple seeking an evaluation. 

The more common reason couples leave counseling and don’t return is that they feel they are getting nowhere. The therapist’s ideas may sound good, but the couple senses they don’t address the root of their challenges, which they often struggle to express in a way that the therapist understands. They leave in great frustration, and often aggravation, especially if one partner inadvertently feels blamed for the other’s distress or feels identified as responsible for the dysfunction in their relationship. An autistic partner, for example, is often primed by life experience to feel blame where there is no intention to blame. This fact also needs to be understood and normalized for a couple, both to help them understand where they’ve been and preventively for the future. 

Getting What Neurodiverse Couples Experience 

Getting Neurotypical Partners 

In my years of work with neurodiverse couples, I have heard absolute horror stories. Not a small number of women, for example, have been misdiagnosed with Borderline Personality Disorder by therapists who interpreted their frustration inaccurately. I often hear about vague mentions of dependent personality or co-dependency on the part of the neurotypical partner whose legitimate struggles are misinterpreted. It is often suggested to the neurotypical partner that they stop viewing themselves as a victim in the relationship when they try to describe their inability to communicate clearly to their partner, no matter how they try. 

Getting Autistic Partners 

The autistic partner, on the other hand, is seen as aloof, disinterested, even intentionally cruel. A common misconception, and one that makes me seethe inside, is that autistic persons lack empathy. Pushing an autistic partner to express their thoughts or feelings in session can intensify the baseline anxiety already present in most autistic individuals. The experience is overwhelmingly unpleasant. 

Getting the Neurodiverse Couple’s Sexual Relationship 

A couple’s challenges in their sexual relationship are also frequently misunderstood. If the suggested antidotes to their problems don’t make sense to the autistic partner for reasons that make perfectly good sense to someone who understands autism, there is no follow-through. Use of porn, affairs, flirtation, alcohol use, struggles related to holding a job, and legal problems are all misattributed, and therefore suggested solutions by a well-meaning therapist most often do not align with the root issues. 

Finding Couples Therapy That Can Help 

The miracle is that so many couples do take a deep breath and are still willing to give counseling another chance.  

If you believe that either you or your partner might be autistic, and you are struggling to feel understood and supported by your therapist, please don’t give up. Instead, seek a specialist who understands the neurodiverse relationship and the implications for both partners. It truly is possible to feel embraced in a therapeutic relationship. 

The therapist directory here at GoodTherapy.org is a good place to start. You can search by location and clinical specialty. Many therapists work online now; thus, your choices regarding therapists are not so location-dependent. 

Find someone who can help you both understand what neurodiversity is and what it means, who can work as an interpreter between you and your partner, so that you understand yourself and your partner in ways that help you develop successful communication strategies. In this way, you can identify and explore the differences between you in good faith, with hope and compassion, and, in doing so, develop deeper connection and intimacy.  

Isn’t that why you sought therapy in the first place? 

© Copyright 2021 GoodTherapy.org. All rights reserved. Permission to publish granted by Sarah Swenson, Licensed Mental Health Counselor in Seattle, WA

  • 3 comments
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  • Xavier Dupree

    September 15th, 2021 at 8:49 AM

    Looking for a therapist that accepts Kaiser insurance and will do couples therapy.

  • Sara GT

    September 16th, 2021 at 7:59 AM

    Dear Xavier, We are here to help you find therapists in your area– please start by entering your city or ZIP code into the search field on this page: https://www.goodtherapy.org/find-therapist.html. Once you enter your information, you’ll be directed to a list of therapists and counselors who meet your criteria. On the left-hand side of the page, you can find filters to narrow down your therapist search, and one of them is for insurance companies. You may click to view our members’ full profiles and contact the therapists themselves for more information. If you need help finding a therapist, please feel free to call us for personal assistance. We are in the office Monday through Friday from 8:00 a.m. to 4:00 p.m. Mountain Time, and our phone number is 888-563-2112 ext 3. Kind regards, The GoodTherapy Team

  • Ramona H

    September 23rd, 2021 at 1:36 AM

    hi there, i didn’t see a search option for neurodiverse couples counseling. any other advise? do you take on clients via telehealth from across the country?

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