The Autism Society Event and Education Recordings Archive

Mental health clinicians see increasing numbers of adults with ASD seeking counseling, whether diagnosed or undiagnosed. ASD marriages share many features and challenges of non-spectrum marriages, but there are also unique aspects to these relationships. Specific issues arise in such areas as sensory, boundaries, executive function, and job instability, to name a few. If professionals aren’t attuned to these differences, counseling may be ineffective, and at times, detrimental. This workshop will summarize pertinent themes in ASD marriages and suggestions for helpful interventions. There is a definite need for qualified mental health professionals to effectively serve adults with ASD who are in committed intimate relationships and/or married.  Without the proper knowledge and training, uninformed professionals can be ineffective at the very least, and ultimately cause damage to the well-being of those clients seeking their expertise.  

It is important to remember that ASD marriages share many of the same features and challenges of non-spectrum marriages. As , author of “Beyond the Wall” is fond of saying, “people with Asperger Syndrome are just like anyone else, only more so!” But there are also unique aspects to these relationships that must be recognized by professionals and understood.

Many people with ASD have intimate relationships and/or marry, and in many cases, they are alive and well in their commitment and sense of connection to each other.  For seven years, I have had the pleasure of co-facilitating a couples’ group in, , where one or both people in the relationship are on spectrum. The level of support and caring that couples provide each other is enviable. 

These people have much to teach us. They have lived in a world that repeatedly judges them through a neurotypical lens.  Unfortunately, people on spectrum often gain recognition for performing according to mainstream cultural standards, rather than being celebrated for their unique gifts.

My learning is based on extensive reading, ASD listserves, the aforementioned couples’ group, private counseling clients and my own experiences.  Not only am I blessed with a 21-year-old son who has autism, but I am also married to someone with an advanced case of multiple sclerosis.  Given the executive function issues that appear with m.s., I often am able to personally relate to the ASD couples with whom I work.

Recent literature emerging in the field talks about the value of cognitive behavioral therapy (CBT) as an effective approach to working with ASD adults. In my thirty plus years of providing counseling, I have not typically practiced CBT. But with this population, other less structured theories and approaches (family of origin, gestalt, imago therapy, Jungian analysis, etc.) have generally been less useful.

I have found it most beneficial to provide a more structured approach, with a focus on concrete issues and identified problems as opposed to a looser, free-flowing process. For example, I might ask specific, concrete questions, e.g., “Tell me three things that work well in your relationship?  Describe one aspect of your relationship that you’d like to see improve. Tell me what I would see with a video camera if I were in your house during dinner time.”  Expect that ASD clients may need a longer time for processing information and answering questions.

Katherine Paxton, in Counseling People on the Autism Spectrum has discovered that concepts discussed during counseling are understood more easily when accompanied by written notes or diagrams.  One client aptly told her, “I can’t hear you until you write it down.”  I will often write down lists and key concepts during a session and offer a copy to my clients as they leave.  Having written notes to take with them can be useful in helping to generalize learning between sessions.

We have all been exposed to standard problem-solving approaches; defining the problem, gathering information, generating alternatives, developing an action plan and evaluating the outcome.  This kind of model can be presented in a worksheet format to a client or couple who bring a problem to the session.  What’s important here is that the clients have an opportunity to visually process a dilemma while breaking it down into workable steps.

These are only a handful of ideas for working with this population. As was mentioned earlier, it is also imperative that a therapist be tuned into some of the issues that might be uniquely present in ASD relationships. These include such areas as sensory processing, how emotions are experienced and expressed, black and white thinking, communication challenges, and difficulties with maintaining employment, to name a few.

Many ASD adults are undiagnosed when they marry.  By the time they attain adulthood, they have usually developed sophisticated masking and adaptive behaviors.  Nevertheless, these behaviors fail when the adult is under stress, and let’s face it, marriage can be stressful for anybody, whether or not they are on the spectrum!

Receiving a diagnosis of ASD at any age is life-changing.  Some adults experience relief at being able to make sense of things that have confused them all their lives. For others, it feels like a nightmare; they may indulge themselves with denial beyond the point where it is possible to maintain.  If a marriage is to survive long-term, denial is not an option.

The non-spectrum spouse can also feel relived to understand what felt chaotic, or they can feel cursed and stuck, with feelings of unfairness and getting a “raw deal.” These feelings must also be addressed if couples’ therapy is to be effective.

What are some of the cues that might make a counselor suspect that a client has undiagnosed ASD?  Black and white thinking, literal concrete thinking, sensory difficulties, discomfort with change, adherence to rituals, intense focus on a special interest, socially awkward ---this is only a handful of  factors that might lead to a referral to a diagnostician knowledgeable about the autism spectrum.

Participants in this session will come away with knowledge of what issues are unique in ASD intimate relationships and marriages. Having that knowledge, along with a solid grasp of which counseling strategies are effective, will ensure that couples where one or both partners have ASD will be more likely to receive quality services when they seek counseling.

Learning Objectives: