Getting the Help You Want: Neurodiverse Couples Therapy

Sarah Swenson, Licensed Clinical Health Counselor in Seattle WA

My work with neurodiverse couples all over the globe has shown me that the saddest and most common comments I hear are about their previous attempts at seeking counseling. Counseling did not provide support or insight, but was ineffective at best and sometimes even downright harmful. These negative experiences can lead to a strong disinclination to seek further 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. This included people with ADHD and dyslexia as well as autism.  

Her efforts were based in her concept that these are variations, not deficits, in the normal spectrum of human brain development. I mean neurodiverse coupleTherefore, I am referring to a couple where one partner is what we refer to as neurotypical (that describes roughly 97% of the global human population) and the other is neurodivergent with the traits of autism, whether diagnosed or undiagnosed. ADHD is often seen with autism, as it is often a diagnosis that was given to someone whose autism was not yet diagnosed. 

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 here is Differents. 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. 

Frustrating Sessions Caused by Faulty Assumptions 

Neurodiverse couples face unique challenges, in addition to the usual range of problems that couples encounter in their relationships. This sets them apart from neurotypical couples that licensed therapists can 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. These treatment modalities can present two major challenges for autistic individuals. 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 

One key point to remember is that graduate counseling education and postgraduate internships in the country lack deep emphasis on the concept of neurodiversity and how it applies to couples. The best and most competent therapists often overlook signs of autism and treat couples like they are neurotypical. It is difficult or intransigent 

Seeking Help, Finding Frustration 

Sometimes, therapists do consider autism, and suggest to a couple that they work with a neurodiversity specialistOr consider pursuing an evaluation to rule out autism or to diagnose it. Undiagnosed autistic partners may resist this suggestion, feeling blindsided. Labeled The abrupt end. The couple flees in disarray and rarely returns to counseling rooms. This is because the therapist failed to adequately explain the reasons for the suggestion or describe the benefits to the couple. 

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. For example, an autistic partner may be influenced by their life experiences to feel the need to take responsibility for others’ problems. 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. 

How Neurodiverse Couples Experience It 

Getting Neurotypical Partners 

In my years of working with neurodiverse couples I have heard some truly awful stories. Not a small number of women, for example, have been misdiagnosed with Borderline Personality Disorder by therapists who interpreted their frustration inaccurately. I am often referred to as having a neurotypical partner who has co-dependency or dependent personality. These are legitimate struggles that have been 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 

On the other hand, an autistic partner is often seen as being aloof, disinterested and even intentionally cruel. The autistic person is a common misconception that makes me shiver inside.s lack empathy. Pushing autistic partners to express their feelings or thoughts in sessions can increase the anxiety that is already present in most autistic people. It is extremely 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. The root causes of problems such as porn, affairs and flirtation, legal problems, and struggles to hold a job are often misattributed. Therapists will often suggest solutions that don’t align with the problem. 

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, find a specialist who can help you understand the neurodiverse relationship as well as the implications for both of you. It is possible to feel loved and accepted in a therapeutic relationship.’s therapist directory is a good place for you to start. You can search for therapists by their location or clinical specialty. Many therapists can now be found online. This means that your choices about therapists is not dependent on where you are located. 

Find someone to help you both understand neurodiversity. They can also work as an interpreter between your partner and you so that you can 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 All rights reserved. Permission to publish granted courtesy of Sarah Swenson, licensed Mental Health Counselor, Seattle, WA

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