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Counseling Adults and Couples on the Autism Spectrum

Counseling Adults and Couples on the Autism Spectrum

A couple comes into your office complaining of problems with communication and conflict resolution.  Sounds pretty routine, right?  You know what to do because you’ve seen this scenario many times.  However, after a few sessions you begin to see that something is very different about this couple.

One partner, say it’s the husband in this case, is relatively okay with the relationship and can’t understand why his wife is making such a big deal out of things.  The wife complains of feeling lonely and disconnected from her husband.  She is tired of doing everything to keep things running in their household.  She complains that her husband is disengaged from the family focusing mostly on himself and his own interests.  He can’t seem to remember to do simple tasks and promises to help but doesn’t follow through.  When she reminds him of things he’s promised to do he reacts with extreme anger.  He won’t discuss it with her, he shuts down and goes into his own little world. The wife is left feeling frustrated and all alone. Because she’s afraid of his anger she stops asking him to do thing.

In your counseling sessions the husband promises to be more attentive to his wife’s needs and is given specific examples of what he should do.  He says he loves her and will do anything to save his marriage.  The wife is learning to be more assertive, asking for what she wants and needs.

When the couple returns to their next session you ask, “How did you do with your homework this week?” The husband looks at you with a blank stare, and asks “Homework, what homework?”  The wife says she has been working on being more assertive.  Her husband has no idea what he was supposed to do differently.  He continues to get angry and distance himself from his wife and family. He says, “I’m damned if I do, and damned if I don’t…so I’ve stopped trying’. He feels attacked in the session and blamed for all the problems in the marriage.

This scenario plays out week after week until the couple finally stops seeing you.

The husband in this case could very possibly have ASD, Autism Spectrum Disorder.  In the past when it was called Asperger Syndrome, it didn’t seem as severe as calling it autism.  Unfortunately, when the DSM 5 came out in 2013, there is no longer an Asperger Syndrome diagnosis. Instead, everyone is lumped into one big diagnosis of Autism Spectrum Disorder.   There are different levels of care required, but most people only hear the word autism. The negative stigma of having autism is still there for many people who think, “I don’t have autism. Isn’t that when kids are non-verbal, flapping their arms and having meltdowns?”  The answer is yes and no.  Because autism is on a spectrum there are many different ways it manifests itself in people.  Some people with ASD may be very impaired and need 24-hour care, others may be highly functional.

The husband in this case could be very high functioning and well regarded in the workplace possibly as an engineer or an IT expert.  People may think he’s a little quirky but they would never think he had autism.  Nor would he.

Having a partner with ASD presents many unique challenges. The longer you try to counsel this couple as neurotypical, the more frustrated they will become.  I have counseled many clients who have tried traditional counseling without knowing one had ASD.  They overwhelmingly have reported that the counseling did more harm than good.

Knowing some of the signs and symptoms of ASD could be very useful when deciding how to work with a couple like the one in this example. Unfortunately, most therapists and counselors have no idea what to look for.

Here are some things you might hear in session that could help you assess whether you should continue working with a couple or refer to a specialist.

Wife’s issues

I feel lonely, disconnected from my husband.

I have to do everything to keep the household running.

I think he loves me but he doesn’t know how to meet my needs.

He lacks empathy.

He is inappropriate in social situations.

He was very attentive when we dated.  He changed as soon as we got married.

He doesn’t comfort me when I’m sick or stressed.

He can’t remember anything.

He doesn’t like to go out with friends or family.

He has no friends.

He doesn’t want to have sex.

He doesn’t make eye contact.

Husband’s issues

I don’t understand why my wife is unhappy.

I’m okay with the way the relationship is.

If she could just be happy everything would be fine.

She nags me all the time about doing things around the house.

I don’t like to be around her family and friends. Why can’t she just accept that?

I’m dammed if I do, and damned if I don’t.  I can’t please her.

She’s the one with the problem. If you could fix her anger everything would be fine.


People with ASD have had it their entire life.  Reference the criteria in the DSM 5 and ask questions about the client’s childhood.  Did he have friends growing up? Did he have a special interest?  How did he like school?

If you feel your client may have ASD, seek advice from someone who specializes in ASD in adults.

Mary Einarson, LMFT, specializes in helping individuals and couples with ASD.  She is the founder of Spectrum Counseling in Plymouth.  She will be presenting a workshop for therapists on April 27, 2018.  For more information, contact Mary at mary@spectrumcounselingmn.com.