Asperger Syndrome in the Counselling Room. by Maxine Aston
Article first published in the CPJ (Counselling and Psychotherapy Journal) June 2003
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How would you know if one partner of a couple sitting in front of you suffered from Asperger syndrome? Maxine Aston discusses this complex and often misunderstood disorder and explains why a counsellor's response to a couple disclosing Asperger's for the first time may be crucial.
For ease of reading I will refer to the male in the couple relationship as being the partner with Asperger syndrome (AS) and the female as being neurotypical (NT). As Asperger syndrome is a neurological disorder, neurotypical in this case presumes the absence of this disorder.
When John and Carol first came into the counselling room the counsellor felt an atmosphere of uncertainty about them, an awkwardness that suggested they were not sure whether they wanted to be there or not.
The couple sat in front of the counsellor. John gave the counsellor a look which seemed welcoming but very short lived as his eyes quickly took rest on the small table in the corner of the room. Carol apologised for them being late. The counsellor nodded in acknowledgement of this and then introduced herself, welcomed them to counselling, explained what an assessment interview involved and then discussed confidentiality. John did not look at the counsellor or his wife during this time; he did though glance around the room, spending a few seconds inspecting each chosen object until his gaze returned to the table. The counsellor felt uneasy because it felt as though he was not paying any attention to what she was saying.
Meanwhile Carol sat upright looking attentive and perplexed. Before the counsellor could finish her invitation to the couple to discuss their reason for being there Carol disclosed why they had come.
'I think he's got Asperger syndrome!' she said looking at her husband. The look was not reciprocated. 'I read an article in the paper and now I've read a book on it. You are the first person I've told. We need help. I cannot cope any more. I was going to leave him but then I read this article. I just know he's got Asperger's.
Beginning or the end
The scenario above, although fictional, is very typical. This disclosure in the counselling room can either be the start of a new kind of relationship for the couple or the end of it. In some cases this may partly depend on the awareness, understanding and response given by the counsellor.
Asperger syndrome is a very complex and often misunderstood disorder. It was once believed that AS individuals did not have the desire or ability to form an intimate relationship. It is now accepted that individuals do form couple relationships, may decide to marry, have children and often lead what might appear to be comfortable and socially acceptable lives. Often it is only those closest to the individual with Asperger syndrome, such as their parents and partners, who are truly aware of the problems the syndrome can cause.
Asperger syndrome is a pervasive developmental disorder caused by a neurological defect in the functioning of the brain, it affects one in 250 people (Kadesjo, Gillberg & Hagberg, 1999)1, it is thought this figure is much higher due to the amount of undiagnosed Asperger syndrome. It affects predominantly men with a male-to-female ratio of approximately 4:1 (Ehlers and Gillberg, 1993)2.
Asperger syndrome will cause difficulties in communication, both verbal and non-verbal, social interaction and imagination. It will inhibit the individual's ability to read another's state of mind and to empathetically relate to their emotional condition. There may be a need for strict routines and a tendency to an intense and absorbed preoccupation in a particular field or interest. It does not affect academic intelligence, only social intelligence. This could result in an individual who may have high academic achievements, a responsible and skilled profession or field of employment and yet be quite unskilled in social interaction and communication.
Communication and emotional reciprocity are often fundamental to whether a relationship works or not. They are the key ingredients to maintain a relationship in a workable and functional state. If one of the partners is affected by Asperger syndrome and therefore unable to give or even understand the need for these basic ingredients, then the relationship is almost certainly going to run into problems. This almost inevitable possibility will make it far more likely that a couple, in this situation, will at some time in their relationship seek couple counselling.
Research by Aston (2003)3 has shown that 75 per cent of couples affected by Asperger syndrome attended couple counselling. It has also shown that the majority of these were dissatisfied with the counselling they received and the consequences of this counselling on their relationship.
Couples have reported feeling not understood, not heard and having their problems trivialised. Some women have been told by the counsellor that their AS partner's behaviour was simply being male! The difference between an AS male and a NT male is that of choice. The NT male can decide if he wishes to spend time in intimate conversation with his partner, he can make small talk and socialise if he wants and he can exercise control over rigid routines and interests. In most cases the NT male has a choice in what he does or does not do or put into the relationship, individuals with AS do not have this choice. They cannot fulfil their partners' emotional needs or meet the demands that are made in the average couple relationship.
By the time the couple get to the counselling room, the NT partner may appear quite desperate and frustrated by the difficulties and strain, the relationship has placed on her. She will be saying things like 'He can't talk about his feelings. he treats me like an object he is obsessed by routine. he constantly accuses me of criticising him.' Finally a thought that most NT women seem to express is, 'I think I am going mad!'
Meanwhile her partner will be saying things like, 'I don't know what she wants from me I wish she would just tell me how to make her happy.. I do everything I physically can to provide for her and the children and all she does is talk down to me and find fault.' The AS man may be very reactive to any form of criticism.
If there are children involved then there may be problems expressed by the couple in how they should be brought up. He may be focused on their academic achievement rather than their personal growth. She may well be saying that she has brought the children up alone with no input from their father. It is possible that she will have taken all the responsibility for the running of the home, the finances and any social arrangements. She may say this is because she cannot trust him to do anything for her.
To the counsellor this will appear quite contrary to what she sees in front of her. She will see a man who is quite likely to be very intelligent and hold down a very responsible job; announce that he really does not understand why she is never happy.
Asperger syndrome is a very complex disorder and the person with it can appear quite a paradox - he will seem a complete mismatch. He is likely to be intelligent, hardworking, faithful and yet unable to take responsibility for the most basic of household tasks that involve any intuition or foresight. It is unlikely she will let him take responsibility for looking after the children or dealing with tasks that involve other people.
How to respond
So when a counsellor is presented with a couple who are either aware or strongly suspect that the relationship is affected by Asperger syndrome, what is the most appropriate way for the counsellor to work with this couple?
Firstly it needs to be discussed, with the couple, if the counsellor is the best person for them and can give then the appropriate counselling and understanding they need. If not, it would be advisable to refer the couple to someone who is trained in this area. It is essential that the clients' needs take priority. Secondly it is very useful if the counsellor has had some personal experience of Autistic spectrum disorders. It is impossible to become familiar with Asperger syndrome via a textbook; first hand experience is worth its weight in gold.
The counsellor will need to assess the AS client's availability for counselling. Asperger syndrome is a spectrum disorder and this means it can vary greatly in severity. If the client appears to be severely affected by it or in complete denial that he has any problems and blames his partner or the children, then it is unlikely that counselling will be successful.
The couple may want to discuss with the counsellor whether or not to seek a diagnosis, if one has not already been obtained. When a person is self diagnosed or the partner is quite sure that it is Asperger syndrome, then it is unlikely they are wrong.
It is important to discuss with the couple the meaning of the label and the difference it will make to them individually and as a couple. If the decision is to have a diagnosis it is useful to first contact the National Autistic Society4 and obtain a list of recommended diagnosticians.
Many professionals still do not have an accurate understanding of what Asperger syndrome is. One couple reported they were told by their GP that Asperger syndrome did not affect adults, only children. Others have been told that people with Asperger's do not have relationships.
These views can be detrimental to a couple who have had the courage to look for help. It is important that the couple are referred to someone who has an understanding of Asperger's in adults.
If the decision is for the counsellor to work with the couple then a very clear contract needs to be negotiated. There is no cure for Asperger syndrome; it is a life long disorder. Some couples may hold the hope that counselling will get 'him' better but this hope is false. Change is very difficult to produce in the rigid and inflexible world of Asperger syndrome. Changes though are possible when there is incentive, motivation and commitment; these changes, although relevant, are often quite small.
The NT partner will be making the majority of changes; she will be learning a new way of communicating with her partner. Many couples report that it is as though they talk in different languages. She will need to be direct, clear and precise, as he will find non-verbal communication almost impossible to read and accurately transmit. Double meanings, ambiguous innuendos and sarcasms, will be extremely difficult for him to interpret.
As he is unable to work out what she is thinking or empathise with her emotional state. He will have made assumptions for her thoughts and feelings if they have not been correctly and simply verbalised. These assumptions are likely to have been wrong and it is possible he will have developed a fear of not getting it right. Consequently he may have developed a safe strategy of not replying at all in order to avoid possible confrontation. This pattern of behaviour needs to be brought into the couples' awareness in order for change to occur.
Working with a couple when one partner has AS requires a completely different way of counselling than would have been learned in most counsellor training courses. The counsellor will be dealing with two different ways of thought processing.
Working with an AS adult will require a cognitive-behavioural approach. The counsellor will need to assess what is caused by Asperger's and what is due to the individual's basic personality traits. Asperger syndrome can exaggerate a person's temperament and can produce either a very passive personality or, a very controlling and sometimes aggressive personality type.
Communication between the couple and the counsellor will need to be direct and clear, not using double meanings or analogies that are too complex and abstract. Clear communication is vital and it will be the counsellor's role to sometimes act as interpreter for the couple and teach them to communicate in a more effective way.
Using lists and writing things down can be essential. The written word does not require the same form of thought processing as verbal communication and it can work far more successfully with individuals with Asperger. It will also help the couple to learn to use lists and dairies as part of their every day life. New methods and strategies will need to be learned and put into practice.
The NT partner may find trying to change her way of communicating tiring and unnatural. Encouragement and support, while offering understanding, will be crucial to her well-being and self esteem, that is probably already very low.
Given the constraints of this article it is impossible to incorporate all the issues and concerns that working with AS may present. This article therefore can only provide a mere insight into the challenges faced by a counsellor when working with a couple affected by Asperger syndrome. It could be said that Asperger syndrome is predominantly a relationship disorder and, as relationship problems are one of the main reasons many couples seek counselling, it is very likely that a counsellor will at some time encounter it. Awareness may be crucial to the couple or individual involved and as research has shown, it may make the difference between a couple staying together and parting.
1. Kadesjo, B., Gillberg, C., and Hagberg. (1999) 'Brief report: autism and Asperger syndrome in seven-year-old children; a total population study'. Journal of Autism and Developmental Disorders, 29 (4), pp.327-31
2. Ehlers, S., and Gillberg, C. (1993). The epidemiology for Asperger syndrome- a total population study.' Journal of Child Psychology and Psychiatry, 34. pp. 1327-50
3. Aston, M.C. (2003) Asperger in Love: Couple relationships and family affairs. London. Jessica Kingsley Publishers.
4. National Autistic Society, Head Office, 393 City Road, London EC1V 1NG. Tel. 020 7833 2299. Email: firstname.lastname@example.org
Aston, Maxine. (2001) The Other Half of Asperger syndrome. London. The National Autistic Society.
Aston, Maxine. (2003) Asperger in Love: Couple relationships and family affairs. London. Jessica Kingsley Publishers.
Slater-Walker, Gisela and Chris. (2002) An Asperger Marriage. London. Jessica Kingsley Publishers.
Stanford, Ashley. (2003) Asperger Syndrome and Long-Term Relationship. London. Jessica Kingsley Publishers.
Maxine Aston BSc Hon Psychology. Counsellor, CC Cert. Relate, C&G 7407 Further Education, Diploma in Casework Supervision & E.M.D.R. Practitioner.
Author of 'The Other-half of Asperger Syndrome' published by the National Autistic Society (2001) and 'Asperger in Love: Couple relationships and family affairs' Jessica Kingsley publishers.
Working as a counsellor and specialising in individuals, couples and families affected by Asperger syndrome.
Maxine delivers workshops for counsellors and professionals in an effort to raise awareness of Asperger syndrome. She is a regular speaker at both National and International conferences.
©2003 Maxine Aston