|Alan Sroufe CE Comments David Schnarch Great Attachment Debate Couples Clinical Mastery Ethics Men in Therapy Clinical Excellence Gender Issues The Future of Psychotherapy Attachment Theory Diets Challenging Cases Mind/Body Anxiety Trauma Etienne Wenger Attachment Couples Therapy Mindfulness Wendy Behary Brain Science Narcissistic Clients Linda Bacon Mary Jo Barrett Future of Psychotherapy William Doherty Symposium 2012 Community of Excellence|
|The Missing Piece - Page 4|
When I turn to his relationship with Cathy, Mark states that things haven't been too good lately. "I just don't understand what she wants and what she expects me to do," he says. It's clear that Mark is honestly confused and desperate about the situation. He'd thought that they were both ready to have children, and now she's indicated that she doesn't feel that way anymore.
I ask for an example of a typical area of conflict and he offers the ongoing fight about seeing friends. "Even if I do go out, she says I sit there and don't say anything, looking angry." Apparently Mark just doesn't pick up on the necessary social niceties of "meaningless" or non-instrumental conversation. He cares about Cathy, but is at a loss when it comes to imagining her needs or desires.
When I later meet with both Mark and Cathy, she tells me, "I think he cares about me in some way, but I'm not even sure of that lately." She shares that he appears to have no interest in socializing and describes their relationship as mostly "functional." Mark admits that he's persistently confused by her behavior and has learned to leave well enough alone. For an individual with AS, this is a perfectly viable, but eventually destructive, option. The computer room and his obsessive interests are waiting for him at any time, but he doesn't comprehend the possible relational ramifications of this temporary escape.
In couples treatment when one of them has AS, I initially explore and highlight the different operating systems or learning styles of the partners. This serves to normalize their struggle and lessens the tendency to blame the identified patient. I often use Jung's concept of The Thinking Introvert to encapsulate many features of adults with AS. I suggest that couples view Asperger's syndrome as an extreme variation of the thinking-introvert type, describing ways that this can cause conflicts with others who don't share this learning/person-ality style. My emphasis in the beginning is to work with partners to find ways to become aware of their differences and experiment with new ways of relating.
While couples work is part of my approach with Mark and Cathy, I'm concerned that too much emphasis on this could cause him to become overwhelmed and quit. I've found working with AS clients that it's vitally important to motivate and encourage them continually. Far more than his wife, Mark needs help learning concrete strategies to expand his capacity for relating to people. If they remain together, their marriage will have to adopt a new conversation, one that recognizes and accepts the reality of each one's inherent gifts and limitations.
Obsessing—a common feature of AS—often leads Mark to disconnect from Cathy and become totally absorbed in one of his habitual anxieties or fixations. In one conjoint session, she complains, "He'll suddenly change the subject or just get up, and then wonders why I'm angry." In both couples sessions and individual sessions with Mark, we take frequent steps back and attempt to understand how these breakdowns in relating occur, how to recognize them, and how to manage them. We role-play social situations again and again, and I ask him repeatedly to look at my facial expression. I give him software on social expressions to use at home. I regularly inform Cathy about the strategies I'm using and give her recommendations about how to alert Mark in critical moments. All of this work is reinforced in our couples sessions.
As both a duo and a threesome, we move repeatedly back and forth between enhanced social awareness and skill practice. Highlighting the different perspectives each brings to their marriage, Cathy is crowned the "relational expert," responsible for setting up procedures for social problem-management. In contrast, Mark is made the family's official financial and computer consultant. I keep encouraging them to explore their learning styles and individual ways of being in the world.
Mark and Cathy are now moving forward, and I see them every two weeks. I expect they'll continue to need counseling periodically in the years to come.
Is It Love?
I'm often asked about the kind of love adults with AS experience toward their partners and family members, because it doesn't appear to be grounded in the outward expression of warmth and caring that most of us strive for. Parents of children with AS often confide to me that they're unsure whether their children really feel loved, or even like a part of the family. In trying to explain the way people with AS express love, I often remember one of my early trainers who'd lived through the World War II blitz over London, when the city was ablaze every night as bombers unleashed their fury. I asked him what it was like to see this daily carnage and terror as a teenager. He calmly explained that he remembered often looking up at the bombers flying overhead and thinking "How very strange that people would do such a thing; it's really quite absurd."
This man cared deeply about his country and his people, yet expressed this reaction in a detached, unemotional manner. Did he care any less than the man or woman who screams hysterically about such atrocities?
I've always been taken by the idea that there are conventional and unconventional ways of expressing love in any given situation. As relational beings, we have to be clear about what kind of expression we need or desire. Like most high-functioning men with AS, Mark understood the core of love to be loyalty, dependability, and hard work. Cathy will need to come to terms with the possibility that this may not be enough for her. The decision about whether Mark ultimately offers her the kind of affection and growth she's looking for in a relationship can only be made by her.
Richard Howlin, Ph.D., is a clinical developmental psychologist and director of the Chelsea Center for Asperger Syndrome in Chelsea, Michigan. Contact: firstname.lastname@example.org. Tell us what you think about this article by e-mail at email@example.com, or at www.psychotherapynetworker.org. Log in and you'll find the comment section on every page of the online Magazine section.