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Neurodiverse Couples Counseling: This Is Just the Beginning…

Updated: Aug 18, 2023

By Barbara Grant, CAS, NCC, Hope For Couples:

Prior to understanding neurodiversity in my marriage(s), I had experienced several forms of Couple’s Therapy over the years, including the Gottman method, Emotionally Focused Therapy (EFT), and lastly, Traditional Behavioral Couples Therapy (TBCT). In all of these, the partner I attended therapy with was on the high-functioning end of the Autism spectrum, though undiagnosed. I had a fairly low opinion of couples therapy, since I always felt that the counselor wasn’t able to fully understand (or sympathize with) this issues I was experiencing in the relationship (I had in all cases been the partner who lobbied – or insisted – on marriage counseling.) It wasn’t until after all these failed attempts at getting help that I realized what was really at work in my relationship, and why most models of couples therapy are ineffective: Autism Spectrum Disorder (ASD; APA, 2013) is not so much a “disorder” as it is a difference, which brings into play a series of relationship challenges that are unique to “neuro-diverse” couples (i.e., one partner is “neuro-typical,” or NT, and the other is “neuro-diverse” or ND. The ASD partners are in the ND category. Again, nothing about ASD is inherently “dysfunctional,” but just very, very “different.” Because the partners have different neurological profiles, when compared, they are “neurodiverse” (AANE, 2020; Dashnaw, 2020). These differences have a huge impact on intimate relationship:

Even though many married couples struggle to spend quality time together, in a neurodiverse marriage, being together can be a real challenge. The partner with ASD often struggles with initiating and sustaining social-emotional reciprocity. He or she can also have a preoccupation with a special interest, and challenges with Theory of Mind, alexithymia and executive functioning—all ASD traits that can lead to spending a lot of time alone—or engaged in parallel play (Mendes, 2015, p. 117).

As Mendes points out, most ASD people have a different or under-developed “Theory of Mind” (meaning, they do not have the ability to easily imagine anything from someone else’s perspective.) The root of the word “Autism” is aut, which in Greek means “self.” So, an ASD person sees the world pretty much from their own perspective, without realizing that other perspectives are possible. This one trait single-handedly puts a lot of constraints on an ASD partner’s ability to have – and express – appropriate and reciprocal levels of understanding, empathy, and compassion or to anticipate a partner’s needs and proactively meet them (Dashnaw, 2020; Mendes, 2015). Couples therapy models like the Gottman method, EFT, Imago Relationship therapy, Bowenian Family Systems therapy and even TBCT don’t include strategies or interventions to discover or treat this deficit. Mendes explains why most therapists and models are ineffective:

An untrained couples’ counselor may not fully take into account the pervasive nature of ASD. The counselor may focus on just one or two traits such as the anxiety or anger of the partner with ASD. The counselor may then try to treat these two traits, without realizing that the anxiety may stem from sensory issues, or that the anger may be a result of taking everything their [NT] partner says literally. All in all, a non-ASD specialist may just not get the full picture of the individual with ASD and the neurodiverse marriage. (2015, p. 186).

There are other issues for ASD people, such as difficulties with maintaining eye contact, inappropriate social behavior or a lack of reciprocity in communication, extreme sensitivities to sensory stimuli (making sex and even physical affection difficult), a lack of understanding about romance or being emotionally appropriate and supportive, and even alexithymia, which is the inability to understand or register emotions accurately (Mendes, 2015). Most of the models therapists have studied are inappropriate under these constraints.

What’s more, ASD people are often exceptionally intelligent, and they use this gift to create “work-arounds” in relationship, in order to “mask” their traits, which they seem to learn early on are considered “deficits” by most people. Constant masking and compensating can lead to high levels of anxiety and even depression for the ASD person. These charged emotions often end up being vented in what are known as “melt-downs”: outbursts of anger, frustration and fear that are sadly characterized by blame-shifting (usually onto the NT spouse), and leave everyone stunned, hurt and confused. If the ASD person remains undiagnosed, or rejects even a self-diagnosis, there is not much that can be done to help them learn to be in the kind of the relationship that would help their NT partner (Dashnaw, 2020).

The ideal approach in helping ND couples is two-fold: identifying and stopping some of the negative behaviors (whether or not the ASD person agrees they are hurtful), and lots of cognitive behavioral work to identify wrong (or unrealistic) beliefs and expectations, together with strategies to develop communication and expand “Theory of Mind” on levels that both partners can manage. Additionally, a complete physical and assessment of other possible conditions, such as ADHD, can broaden the base of interventions and increase the likelihood of success. I have come to believe that one of the models that seems to fit the needs of ND couples is Integrative Behavioral Couples Therapy (Christensen & Doss, 2017), with some tweaks and adjustments (Mendes, 2015, p. 57). Therapists can acquire post-graduate training and certifications in autism, ADHD and neurodiverse couples work, which would equip them to offer a customized, integrative therapeutic approach to working with neurodiverse couples (AANE, 2020).

As neuroscience continues to make new discoveries, neurodiverse individuals and couples will have more and more options for support. Staying informed and engaged is essential, for therapists and clients alike!


American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Asperger/Autism Network (AANE). (2020). Neurology matters in couples counseling. The Peter M. Friedman Neurodiverse Couples Institute: A Program of AANE.

Christensen, A. and Doss, B.D. (2017, February). Integrative Behavioral Couple Therapy.

Dashnaw, D. (2020, January, 28). Are you in a neurodivergent marriage?

Mendes, E. A. (2015). Marriage and Lasting Relationships with Asperger's Syndrome (Autism Spectrum Disorder). Philadelphia, PA: Jessica Kingsley Publishers. Kindle Edition.

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