The following is a transcript of the radio interview with Grace Myhill, MSW on the show “Neurodiversity Experts Talk,” conducted by Nathalie Tandiwe on WBAI 99.5 FM. To listen to a recording of the interview, click here. (Program begins around the 2:10 time mark.)
Learn more about AANE’s course for couples and training for therapists.
Summary
- AANE’s Neurology Matters in Couples Therapy programming was created for therapists to learn to work effectively with neurodiverse couples — couples in which one or both partners have an Asperger/autism profile.
- Neurodiverse couples often present with issues that look just like typical couples issues, but the root cause is not the same; it is a neurological difference so it may need a different approach to improve the situation.
- Therapists without training may misunderstand individuals on the spectrum and their neurotypical partners, they may make false assumptions about the effort each are making, and they miss the opportunity to help both partners develop the concrete skills they need to improve their relationship, such as how to communicate and connect and reconnect with meaningful apologies when feelings are hurt.
Nathalie (02:12):
This is Natalie Tandiwe. You’re listening to the show, “Neurodiversity Experts Talk” on WBAI 99.5 FM listener supported radio streaming live in New York City online@wbai.org. The term neuro-diversity embraces differences in brain function and brain wiring as part of the expected diversity and variation in human beings. “Neurodiversity Experts Talk” features specialists in areas such as ADHD, autism, learning disabilities, and other neurodevelopmental based differences. Our guest today is Grace Myhill, MSW, Director of Couples and Partners Services, and the Peter M. Friedman Neurodiverse Couples Institute, both facilitated at the Asperger/Autism Network, anne.org. Grace is a pioneer, leader, and clinician trainer in the field of neurodiverse couples therapy. Since 2004, she’s worked with hundreds of neurodiverse couples in private practice and through the Asperger/Autism Network at the aane.org, neurodiverse couples coaching program. Welcome Grace!
Grace (03:23):
Thank you! So nice to be with you here.
Nathalie (03:26):
Oh, it’s really exciting to have you and to be able to learn some things today. I’m going to start really basic: What does the term “neurodiverse couple” mean? I haven’t heard that thrown around much.
Grace (03:39):
So we use it to describe a couple where one or both partners has an Asperger’s or autism profile.
Nathalie (03:47):
Okay. The term neurodiverse is broad and includes Asperger’s and autism. And it also, in the way people use it in everyday language, includes a lot of other profiles. How do you deal with that, given that you have such a niche within neurodiversity?
Grace (04:11):
Well, fortunately the tools and techniques that would help our neurodiverse couples meaning the ones with the Asperger’s/autism profiles would really help any couple. So we don’t get too bogged down by the label. In fact, we don’t require a formal diagnoses for any participation in any AANE program.
Nathalie (04:35):
That’s amazing. So that means that if I’m hearing this and I consider myself or my partner possibly to be neurodiverse, or to actually know of a neuro difference or a diagnosis, it doesn’t just have to be Asperger’s/autism. I could approach and find out whether or not there could be a fit here for support?
Grace (04:55):
Yes. So a lot of times people can have ADHD or ADD, and sometimes that is an incomplete diagnosis; they also are on the spectrum, and sometimes it is a complete diagnosis. So again, you know, we don’t really worry about distinguishing if we offer supports and the people find it helpful, then great!
Nathalie (05:20):
Okay. That’s really good to know. I know this sounds probably basic coming from an outsider, but I just want to paint a picture. What are the profiles or combinations that can constitute a neurodiverse couple? So do both people have to be… What does that look like?
Grace (05:38):
Okay. So it could be one person who these days is known as neurotypical and one person who is on the spectrum, it could be two people on the spectrum. And we also have worked with polyamorous couples and it’s not always just two people in the relationship as well.
Nathalie (05:59):
Okay. That is a great point. I actually was thinking about that before. And I’m so glad you brought that up. How did this niche of neurodiverse couples therapy emerge within the already existing framework of couples therapy?
Grace (06:14):
So we started this program because families could not find the resources, meaning they wanted to find therapists to help them. They went to traditional therapists and whether they knew or didn’t know that they were neurodiverse at the time, they found that the results were not really helpful, and in many cases harmful. So a donor approached us and said that family couldn’t find the resources in their state, and they would like to basically offer us a grant to do a program to train therapists so that other people would not have to suffer the way they did by not having these resources. And so we started at the very beginning, before designing any courses, we offered a survey to neurodiverse couples–people who felt that they were in a nerodiverse relationship–and we asked many questions. And one of the questions was have you found traditional therapy helpful?
(07:23):
And if you’ve been to a therapist who knows about neurodiversity and a therapists who doesn’t, and it was really overwhelming the results. We got over 500 people participating in the survey, and it was a very high percentage of people who found it very unhelpful and harmful when the therapist didn’t know. I think there’s a reason for that. I think what looks like a traditional couples issue makes the therapist go down a certain path and they make assumptions. They think that if they just say to the couple “Oh, you should be more emotionally supportive to each other,” they make an assumption that each partner knows what that means. And so they send them home and they come back and it’s not working. And then the therapist can sometimes be blaming or shaming of one or both partners who are not doing the work.
(08:19):
And when you’re looking at that couple through a nerodiversity lens, and you understand that the root causes are the neurological differences between the partners. You also understand that a lot of people on the spectrum have never been taught things that other people intuitively learned. And so, for example, if you’re not looking at a person’s face, you’re missing a whole lot of non-verbal cues. And so a lot of the communication is lost. And a lot of the ways to respond in a supportive way are invisible. So a lot of the tools and techniques that we teach our therapists to work with couples who are neurdiverse will include very specific concrete strategies. And it won’t assume any level of knowledge. They will ask to make sure that everything’s understood, not with just a yes or no as the answer, but hearing it back in the person’s own words, what they feel that they have understood and picked up from the session. Otherwise, we experienced that a lot of people we work with have gotten to a certain age by “pretending to be normal.” That’s a quote of a book title and when you have certain coping strategies, because you have to pass as normal in the working world and in the academic world, the relationship world, whatever, you can fool therapists as well.
Nathalie (09:54):
Oh wow. You have said so much! I think one thread I want to pick out of what you mentioned is this admission that, which is so profound for people, that if you go to a therapist who is a traditionally, even highly trained, gifted therapist, but is not experienced in supporting atypical, neurodivergent, neuro-different people, you might not get anywhere. And at worst, you might actually experience harm. I think it’s so affirming to hear you say that. It’s something that I think people who have neuro-differences have been experiencing their entire life. And they’re not often affirmed in that sense–in that knowing that therapy isn’t going to help me. If anything, sometimes when people articulate, especially people who are having very apparent problems, articulate this idea that, “I’ve been to therapy. It wasn’t helpful. I found it actually frustrating.” Often they get push back and corrected over and over and told you just got to bang your head harder against that door for it to open. So it’s so huge to hear you say that.
Grace (11:24):
And that same message goes to the neurotypical partner in a neurodiverse relationship as well, because what the traditional therapist is seeing in the office is often very different from what’s happening at home. And sometimes they can appear to be controlling because they’re trying to compensate for some of the executive function challenges in their partner, or they’re sounding demanding, or sometimes even hysterical because they are really feeling depleted and that their emotional needs have not been met. And so when they come to therapy, they think that therapist is finally going to understand them and they have hope. And then when the therapist can sometimes think that the person in their office on the spectrum who is presenting very calmly and rationally and doesn’t understand the dynamic of what’s going on at home, they often can say to the neurotypical partner, you have to try harder. You have to do more. And they don’t realize that that partner has been trying very hard and doing a lot of things, but maybe not the right things, because they don’t know.
Nathalie (12:35):
Grace, you are saying everything! [STATION AND SHOW IDENTIFICATION]
(13:40):
Grace. I am so glad you’re here today. This is so amazing to hear. When you are invested in your relationship, in your marriage, and it’s not going well, or there are these essential challenges that just can’t be easily resolved, it is devastating–very crushing for people. So to hear what you’re sharing, and also just your tone, your positivity–I feel in your voice, that these kinds of problems can actually be solved. And that hopefulness, it’s so meaningful, especially since, as you pointed out in what you shared about these differences and in therapeutic effectiveness, that neurodiverse people are often facing situations where they’re not receiving affirmation and hope that problems can be faced and solved. So I’m just really excited about what you’re sharing with us today.
I just wanted to, you know, in thinking about what you offer the world and thinking about marriage, you know, something that strikes me is that marriage is so intrinsically challenging and in ways, and those challenges can show up in a lot of different areas just by virtue of two people joining their lives and co-creating a life together. Can you talk a little bit about how the challenges of a neurodiverse couple are distinct and, and in that those distinctions demand a different therapeutic model?
Grace (15:30):
Sure. I can give you a couple of examples. So often neurodiverse couples don’t even know that they’re neurodiverse. They often present with issues that look just like typical couples issues. One or both partners may be angry or sad about something that’s happening or not happening in their relationship. And once they recognize that they are neurodiverse, they can learn more about Asperger’s or autism, and they’re able to reframe the issues in their relationship once they understand that they each think and communicate differently because the root cause of their issues are their neurological differences, then they no longer take their partner’s responses so personally. So they can figure out together how to address the issue. Sometimes clients want to connect more, but they don’t know how to. And a traditional therapist might assume that the couple knows how to connect. So the therapist might read into the situation and come to an incorrect conclusion that one, or both partners don’t want to connect.
(16:31):
If the couples working with me or one of our AANE trained and certified couples therapists, this won’t be the case. They will learn concrete tools and strategies that will allow them to connect more, such as how to heal unresolved, painful, past issues by learning how to apologize in a meaningful way. This is a big one. We spend a lot of time talking about apologizing. Also, we talk a lot about communication. Neurodiverse couples don’t know how to bring up issues and their relationship with each other. One person gets perceived of as the critical one. And the other person gets perceived of as being avoidant. Working with specific tools and strategies that were developed with each partner’s neurological profile in mind, allows the couple to talk in a productive way about what each of their needs and expectations are.
Nathalie (17:26):
What would that look like? Just to make it so we can have a picture and a feel in our minds coming to you. We have one of these issues, we might fill out these profiles, this information, but let’s get to the meat of it: What would be unfolding in a session, perhaps?
Grace (17:45):
Sure. So let’s say a partner feels hurt. Let’s say the person on the spectrum said something in a very factual, abrupt way, and it hurt the neurotypical partner’s feelings, and they cry. The response to the neurotypical partner crying might be that the person on the spectrum either doesn’t notice and ignores it, gets annoyed by it, or just leaves the room. You know, it’s something that they are intentionally avoiding because they don’t know what to do. They don’t know what to say. So that’s a common cycle where then the neurotypical partner who started out being upset because their feelings were hurt, now there’s this compounding factor that they’re extra upset because of the way the person responded when they express their feelings, when they showed that they were sad. Or maybe they even try to say to their partner, “I’m upset because you didn’t give me emotional support when I was telling you what happened to my family member,” and the partner on the spectrum, again, they don’t know what to do. So it just makes for this circular mess where neither partner ends up feeling connected in those moments. And they never get resolved. The person on the spectrum doesn’t know how to bring it up again. So they avoid it, and this continues.
Now the roles are sometimes reversed for the same dynamic where sometimes the partner on the spectrum feels very criticized. And even when their partner says, you know, something that they feel is mundane, the partner hears it as critical. And then they have a big reaction to it. And the neurotypical partner doesn’t understand because they didn’t intend any criticism. They didn’t think they were being critical. So without the understanding of these neurological differences and the ability to reframe what’s happening, they often have these either explosions in the relationship or implosions where they just really don’t talk. They really avoid connection, which just adds to each partner feeling lonely, hopeless, and then they eventually, if they do seek out for therapy like we talked about earlier, it doesn’t really go well, unless the person has been trained to really understand what’s going on.
Nathalie (20:29):
Wow. That’s a lot. There are a few things that come to mind, but something that clicked for me, you mentioned the issue of how to apologize in a meaningful way. I think what’s so interesting about that is it’s an example of a skill that people across the neurodiversity spectrum haven’t necessarily learned or internalized or apply well. What does that look like to apologize in a meaningful way?
Grace (20:59):
Well, most people have a knee-jerk reaction when they’re asked to apologize, or when they’re in a position that they are expected to apologize where they say they didn’t intend what happened. They say that they didn’t mean it, their partners shouldn’t take it that way, their partner shouldn’t feel that way, it wasn’t what they said. So there’s a lot of defensiveness and all of that just adds to the disconnection. And so what really is helpful in those moments is for the person to acknowledge that they hurt their partner’s feelings, try to build that perspective-taking skill, where they can recognize, “I did something and it had an impact on the other person.” And so I teach them if you acknowledge that you did something, say what you did or said, or in some cases is what you didn’t do or didn’t say and that had an impact on your partner’s feelings.
Take a guess at how they’re feeling — that will make them feel like you are at least caring about their feelings, then ask the partner, is this right? Did they guess, right? It doesn’t matter if you guess wrong or right. What matters is your partner feels that even just by asking the question that you care, and it gives them permission to tell you more about their feelings. And so then after that, what often is never done is a remedy, right? So people always hurt them, their partners over and over and over again. But when you include a remedy as part of the apology, then both people really have to give serious thought to how can we prevent this situation from happening again in the future?
Nathalie (22:49):
Oh my God. Okay. Hold that thought right there. [STATION AND SHOW IDENTIFICATION] Okay, we’re going right back, and you just shared so much. And I know it probably sounds really simple to you as a therapist, but this is a complaint I hear from people across neurodiversities: neurotypical, atypical, neurodivergent–the hurt and pain of feeling that your partner or your friend or somebody important to you has dismissed — when you’ve spoken up and said, “You’ve hurt my feelings.” And I just want to reflect on what you shared on a positive approach to apologizing: acknowledging that you’ve hurt somebody with your words or your actions. And then the part you spoke about that was interesting was perspective-taking as somebody who has been told you’ve hurt me, that idea of going in and thinking about, well, how does my friend or my partner feel, and then actually mirroring back to them? “Hey, I’m thinking that when you said I hurt you, that you might’ve been feeling this way,” and waiting to hear whether or not you got that right, and hear their feedback. And then that part about remedy — pursuing a remedy. I mean, this is gold. Have you been sharing this far and wide? You could change the world with just this information — save many a marriage of every stripe, many a friendship, many a family!
Grace (24:49):
Would you like an example of how that would play out?
Nathalie (24:54):
Oh do it!
Grace (24:54):
Okay, I’ll give three examples, which is very common in my practice.
Nathalie (24:59):
Just give one, because we’re winding down on our segment.
Grace (25:02):
Yeah. Okay. So often a neurotypical person talks to connect. They’re not just trying to share information; they’re trying to connect. So they say something like, “It’s a nice day.” And their partner often– if their partner is on the spectrum– their partner often doesn’t respond at all. And that hurts the other partner’s feelings. It’s not that it happens once; it happens many times every day.
Nathalie (25:29):
It’s a pattern.
Grace (25:30):
It’s a pattern — exactly. So when the partner can say, “You know, it hurt me when I spoke yesterday and you didn’t respond at all.” And so the partner can say, “You know, when you spoke and I didn’t say anything, that must’ve made you feel like I don’t care about you, is that right?” And the partner could say, “You know, I actually felt invisible.” And so the person would repeat, “When you speak and I don’t answer, that makes you feel invisible.”
(26:00):
And then they can say, “Well, here’s the thing: I heard you, but I didn’t hear a question. So I didn’t think I needed to respond.” And so the other partner can say, “Wow, well from now on, please note that when I say anything, I’m trying to connect. And if I don’t hear something back, a comment or a question back, then I feel alone.” And so they can make an agreement. “Okay. From now on, when you say anything, then I’ll make a comment or question,” but the person might say, “I may forget. I’m not used to doing this.” So the other partner can say, “Well, I will remind you just by saying ‘question or comment, please?'” And person can say, “Okay. That would feel comfortable if you said that. That would remind me that you’re trying to connect. And I would try to respond to the question.”
Nathalie (26:52):
Oh, you’re out here doing the work of the goddess. I love it. That’s so simple and sweet and you laid it all out for us. [STATION AND PROGRAM IDENTIFICATION] Thank you for listening.
Transcript posted with permission.
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Training 101: Fundamentals of Working with Neurodiverse Couples in Therapy Certification 201: Case Presentations & Advanced Topics in Neurodiverse Couples Therapy