Identifying the Partner of Someone Who May Be Autistic: They’re Usually Misdiagnosed

Therapist working with neurotypical partner in therapyEditor’s note: Sarah Swenson, LMHC is a private practice psychotherapist in Seattle, Washington, where she specializes in working with neurodiverse couples. Her continuing education presentation for GoodTherapy, titled “When Your Partner is on the Autism Spectrum: Individual Therapy for the Neurotypical Partner,” will take place on February 21, 2020 and is eligible for two CE credits. This event is available at no additional cost to Premium and Pro GoodTherapy Members (Basic Members and mental health professionals without membership can view this event live for $29.95). Learn more and register here.

Author’s note: Sometimes, of course, the neurotypical partner in a neurodiverse relationship is a man. I also work with gay and lesbian couples, and couples who are polyamorous. This article describes the client I encounter most frequently, a neurotypical woman married to an autistic man. Also, please bear in mind this guiding principle: If you’ve met one autistic person, you’ve met one autistic person. Nothing in this article will apply to everyone.

In my clinical practice as a therapist and in my international work as a coach, my clients are neurodiverse couples in which one partner is autistic and the other is not. As a result, I have come to know well one of the most misdiagnosed clients you will likely encounter. I’m speaking of a woman married to an autistic man who may or may not be formally diagnosed with autism (ASD).

When this woman comes in for individual counseling, she may have a flat affect. Her presenting concerns might sound vague, including hints of depression or anxiety. She may be self-effacing and ready to blame herself. She may stop and start, not seeming to know how to explain herself. She may appear embarrassed to be taking up your time.

Or she may seem full of rage. Her language might sound pressured, disorganized. She may be close to tears. She is the victim here, and she is furious.

Or she may simply present as hopeless.

I am not describing three separate women. You are likely to see all of this in the same woman in one session. Would you know how to understand her and offer her the support she needs?

She will not fully understand that over time, she has learned to minimize her needs and desires because conflict avoidance has become her chief survival strategy.

Meeting the Neurotypical Partner in Therapy

Most often, these clients are experiencing complex trauma (C-PTSD). They won’t be able to identify a specific traumatic injury because they are in a relationship that inadvertently creates the conditions of ongoing trauma. And since in this relationship there in no intention to harm, no intention to abuse, she is confused. She loves–or did love–her husband. She will tell you he is a good man.

She will not fully understand that over time, she has learned to minimize her needs and desires because conflict avoidance has become her chief survival strategy. She will tell you that she has changed. She will tell you she is not the woman she used to be. She feels less joy in life. She has let friendships fall away. She can’t muster interest in the things that used to give her pleasure. When asked, she is unlikely to be able to express her needs. She can’t remember what she needs. She knows this, however: she feels alone. And she may fear she’s losing her mind.

You’ve read her intake paperwork, so you will know that her husband is successful in his career, which may be in a highly competitive and well-respected field. When you talk to her, you’ll hear about his high intelligence and how well-regarded he is at work. As you get to know her better, she will tell you that everyone thinks that the two of them have the perfect marriage because that’s what it looks like from the outside. She realizes all marriages have problems. Her well-meaning friends certainly share enough of their stories that she feels a little guilty when inside she’s thinking, “Yes, but you don’t understand what it’s like for me…it’s different…I can’t explain it…”

She may sound petulant, self-involved, or impossible to please, due to the fact that she can express her pain but can’t put her finger on exactly what the problem is. She knows it has something to do with her husband and the way he treats her. Yet she has painted a picture of him that impresses you. You may think she is exhibiting narcissism as a result.

Another possibility is that he is a good man, but for some reason, he cannot seem to keep a job. He’s intelligent. He’s talented. But the financial strain of his chronic unemployment has pushed her to the brink. She is the sole earner. She manages the household. She supervises and provides for the children. She hides this internal familial dysfunction from her friends and her family. She has no one else to rely on. She is embarrassed. She is utterly exhausted. She can’t see a way out of her distress and she fears it may kill her. You may diagnose depression.

Sometimes, from session to session, you’ll see her condemn her husband and the way he cannot seem to do anything right, from loading the dishwasher (“I even made a little diagram and taped it to the counter!”) to listening to her when she’s upset (“He always wants to fix everything and doesn’t even notice I’m crying!”). Next session, she will be filled with compassion for him because he honestly seems to be doing the best he can. She’s just expecting perfection from him. He’s human. (“Why do I always have to be like this? Why can’t I just let him be himself?”) You may wonder if you’re seeing borderline personality.

And when she paints a complex picture of her experience with him that screams “Run for your life!” you may wonder why she can’t decide to leave. You consider codependency.

This is the woman married to an autistic man before she understands that he is autistic and before she understands what autism means in a relationship. I agree with you that it is difficult to identify her based on the information described above. Here are some important things to consider that may help you sort this all out.

Signs You’re Working with the Neurotypical Partner in a Neurodiverse Relationship

The primary area of conflict for many neurodiverse couples can be broken into two components: emotional connection and communication. Many of the women I work with identify the courtship phase of their relationship as short, comfortable, and consistent. More often than not, however, they can look back and identify what they call red flags: his quirky manners, his deeply focused conversations on things he’s interested in and silence when he’s not, his apparent discomfort at expressing emotion. At the time, they interpreted these things to be endearing eccentricity, intelligence and skill, and admirable reticence–the stiff upper lip.

For reasons of misinterpretation like this, they went forward to the commitment of marriage. Only with time did the veil slip away, and they realized they were habitually filling in with projections about what their partner’s behaviors and comments meant on the basis of what they would mean if they did these things themselves. In other words, they applied neurotypical standards and expectations to the behavior of an autistic individual. Slowly but surely, their sense of who their husband actually is erodes until they often become quite uncertain about who he actually is.

The primary area of conflict for many neurodiverse couples can be broken into two components: emotional connection and communication.

Over the course of the marriage, this woman will feel minimized and criticized. She will express her husband’s constant negativity and say that she’s begun to feel negative about everything, too. Her descriptions of their sex life will be particularly illuminating.

Generally, by the time these women come to therapy, their sex lives are completely ruptured. They have to think when you ask them about it. They’ll tell you they don’t remember precisely when or how, but at some point, things just stopped. For some, it has been months, but for most it’s been a matter of years. And, frankly, when their sex lives were more active, it wasn’t all that rewarding: it felt mechanical, always the same, with no foreplay and no sense of intimacy.

She doesn’t miss the specifics of sexual encounters with her husband, but she craves sexual intimacy. She craves intimacy, period. She wonders whether she should have an affair, though she doesn’t really want to go outside her marriage to have her needs met. She’ll just stifle them for a while, hoping they subside. Instead, she worries that they will continue to grow. She may not be able to look you in the eye at this point. She is desperate not to be viewed as promiscuous, and she fears you will judge her.

There are exceptions. Sometimes, a woman will tell you she feels like a sex doll to her husband’s routine and frequent sexual demands. She continues to participate. She hates herself for her inability to stand up for herself, but she has tried, and it just seems pointless. She continues to acquiesce. She is becoming numb to her own sexuality, to any physical sensations at all. She cannot afford to feel aroused because she knows she will be disappointed once again.

As you know, diminished sexual intimacy in a relationship is usually a sign of severed communication. In the neurodiverse relationship, this is most often the case. The woman needs emotional connection before she can feel sexually vulnerable. She is unlikely to feel this with her autistic husband. I often hear from these women that they don’t feel safe enough emotionally to present themselves sexually to their husbands. She does not feel seen or heard or known by her husband, whose sexual needs are often more physiological than emotional. He doesn’t understand her withdrawal any more than she understands the way he treats her.

Work with Neurodiverse Couples: Moving Forward

If you see enough of these signs in your client, I suggest asking whether she has considered that her husband might be autistic. In order to do this well, you’ll have to be certain she understands what you mean and why you’re asking. If she has not thought of this possibility herself, you’ll need to explain to her that autism is a result of neurological variance and not mental illness or personality disorder. You don’t want her to reject your suggestion on the basis of having misunderstood you.

Many times, though, women come in for counseling after having read articles of mine or other material on the internet and already suspect autism (some still call it Asperger’s) in their husbands. They want to know what to do. In this case, we discuss all the points mentioned above in terms of what it would mean if their husband were in fact autistic. I do not ever volunteer a diagnosis of autism without having met someone, but we do reality testing to rule it in or out as a differential. Then I suggest couple work. I help her with language for bringing this up to her husband, which is a sensitive task in itself.

Sometimes, after several sessions, we schedule a couple session, if the husband is willing to explore the possibility. It is often a watershed moment in a couple’s life to learn that there are reasons that explain their problems and that we can work together on psychoeducation and on communication strategies and skills that offer a path toward improved intimacy. The relationship will never be neurotypical or autistic, but it can become more rewarding for both partners.

Sometimes, the husband is unwilling to consider autism and will not come in for a couple session. He fears being judged. Labeled. Vilified. She cannot get through to him that this is a supportive process. He locks into his fears and there is nothing more to be done. In this case, I continue to work with the woman alone to help her understand her choices. They are not always binary. There are more options than staying married or getting divorced. We explore them all.

It is important never to minimize the experience and challenges faced by the autistic partner.

It is important never to minimize the experience and challenges faced by the autistic partner. This work is about identifying differences and creating more successful ways to communicate. There are good reasons why the autistic partner behaves the way he does and says the things he says. I have never met an autistic person who sets out intentionally to hurt his wife, and seldom have I encountered an autistic person who lies. Misrepresenting something has its own rational pathway for an autistic person, and I distinguish this from intentional lying. This is an example of the kind of subject we explore in couple sessions. Sometimes, the intense anger of the neurotypical partner can be diffused with education and compassion. Sometimes, the weight of this anger and feeling responsible for the relationship is too much for her.

If you have any suspicion about autism in a client’s partner, please tread carefully to explore the possibility. But do take the chance: otherwise, you could be missing the core challenge your neurotypical client is facing, which is the hub from which all her other apparently confusing behaviors emanate. The challenges to communication in the neurodiverse relationship are not insurmountable, but to ameliorate them requires sensitive counseling support. Educating yourself on the nature of autism, how it creates the lens through which a person experiences and interacts with reality, and how to help a couple bring implicit expectations to explicit and comprehensible statements are essential in this work. For initial solid grounding in the field of autism, I refer therapists to the work of Tony Atwood, PhD, and Simon Baron-Cohen, PhD.

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

  • Leave a Comment
  • jannette


    February 6th, 2020 at 9:57 AM

    excellent article. I am the sibling of a brother with autism who unfortunately died suddenly at the age of 68. He was never formally diagnosed . except for possible brain injury at birth . He was successful working for the transit authority, a dream job given his love of trains. He was married for over 40 years. The struggles in their relationship as he aged were magnified by his difficulty with abstract ideas, communication challenges, and extreme rigidity and resistance to any change. Your article help illuminate and validate the struggles I observed in their marriage and also my difficulty in intervening to help alleviate in mounting frustrations that occurred. I commend you on your work in this area and hope to meet you some day if I should find myself in Seattle

  • Sarah Swenson LMHC

    Sarah Swenson LMHC

    March 11th, 2020 at 11:00 AM

    Thank you, Jannette – I’m glad to know my writing has been helpful to you and I greatly appreciate your comments about my work. Warm regards to you.

  • Jenny


    March 11th, 2020 at 8:17 AM

    This is Me. I am the NT reading this article with so much explained. Relief of understanding.

  • Sarah Swenson LMHC

    Sarah Swenson LMHC

    March 11th, 2020 at 11:01 AM

    Hello, Jenny – I’m glad to hear that my writing has offered you support in understanding your experience. Warm regards to you.

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