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|The Missing Piece - Page 3|
With my support, he joined a train club not too far from his home. Although this provided him with the beginnings of a motivating social experience rooted in his interest, he needed repeated prompting to attend the meetings. AS clients typically exhibit symptoms of social avoidance and must be encouraged to increase social interactions gradually
Steven is now attending a community college and is making slow but consistent progress toward a degree in computer science. An early focus for us was basic social skills. For example, he was unaware of the social taboo of staring at girls who were attractive to him. We practiced social presentation and nonverbal communication every week. We'd role-play situations and, as homework, I asked him to act out certain scenarios in his room and practice expressing specific emotions. Once we'd achieved a fairly acceptable repertoire, I photographed his best examples and he then placed these on the wall next to his mirror. This helped him practice what each expression felt and looked like on a daily basis.
He's become more aware of his body language and participates in an acting club on campus, actually preferring this over the train club. As our relationship has developed, he's begun to understand more clearly several key social concepts, such as the differences between certain types of conversation, which we continue to practice at each session. For example, the chit-chat (informal) mode of conversation was difficult for Steven to understand. He's had to learn that sometimes conversations have no point or purpose, and that someone doesn't have to have a correct or better opinion. He's also grasped the idea that one doesn't have to express one's opinion in every situation. The fruits of this work are reflected in Steven's reports of moments of social success and enjoyment. I plan on seeing him for at least another year, with the goal of gradually spacing our sessions more.
An Asperger's Marriage
Current data suggest that while most AS adults remain isolated, others can advance into the world of social relations. Two reports from Scandinavia indicate that almost 25 percent of men with AS eventually do marry. In my own practice, I've found that males with Asperger's often make extremely loyal and hard-working spouses. Their single-minded focus appears to filter out the distracting social world, and they often show immense dedication to their families. Given the obvious social difficulties associated with AS, I'm often asked at conferences what attracts neurotypical women to their husbands. Many of these women have told me that, at first, the "oddity" of their husbands appealed to them. One wife once said, "I was sick of men being flaky and uncommitted." Most believe that their husbands will improve over time, learning to open up and become more relational.
When such couples come in to therapy, it's almost always at the instigation of the wife, who recognizes that her hopes for change in her spouse are unlikely to be realized. After 10 years of marriage, Cathy had told her husband, Mark, a 35-year-old computer engineer, "Get some therapy or we're finished."
Mark arrives for the first session alone. This was intentional, as he'd requested an evaluation for AS. Typically, the spouses of AS husbands secretly hope to have them treated and returned home in some new and improved form. Cathy had recently read up on AS and was convinced it described her husband to a tee. She felt that his being in therapy might be the only way to save their marriage.
On his first visit, Mark mentions the marital issues that had brought him to see me, but also admits to "never being social." He then pauses, and continues thoughtfully, "Maybe Cathy is onto something." He explains that Cathy is his only close relationship. As if living out some extreme form of the male stereotype, Mark basically says he has no "use" for relationships or friends. He's always been a loner, he says, except when he talks to people online on his favorite World War II website. I tell him that, in my view, cyber-communications don't count as real "relationships." I'm single-minded on this issue. We have enough research with children to indicate that cyber-relationships and games are no substitute for real interactions and may only increase isolation.
I then ask Mark a question that I've found highly useful in diagnosing autism in adults: "Could you give me a brief history of what it was like growing up, what it was like to be Mark? Give me an autobiographical picture, as if you were writing a novel." He just stares—it's as if I'd just begun speaking Swahili. I repeat my question, throwing in examples: he can tell me about early family memories, talk about favorite times in school, describe difficult situations. What I then receive is a laundry list of data: where he'd lived as a child, how many years his family had spent there, what his father did, a countdown of his relatives, the names of schools he'd attended, what he'd studied, what he'd majored in. There's virtually nothing about people, relationships, personal experiences, or emotional responses to events.