Making therapy more accessible for neurodivergent couples

Ann Hardy shows how taking a neuro-affirmative stance is a really important approach when working with neurodivergent couples

As a therapist, I see an increasing number of couples where one (and sometimes both) of the partners is autistic or has another neurological condition such as ADHD, dyslexia or dyscalculia.

My stance is neuro-affirmative, that is, I do not view neurodiversity or the neurodivergent partner as the “problem” within a couple; rather, I explore what both partners bring to the dynamic they jointly create, and what function their neurological differences might, often unconsciously, serve.

There are advantages in being in a relationship with someone whose brain processes information differently. If our partners are just like ourselves, we lose the opportunity to benefit from a different perspective and gain access to different skills. Neurological conditions tend to be described in terms of their deficits, but each has its positive side. While dyslexia does involve difficulties with word recognition and sequencing, the positive side can be enhanced visual skills and creativity; ADHD can involve impulsivity and a lack of inhibition, but its positive side is spontaneity and passion; a tendency to focus on the minutiae of things, rather than the overall picture, common in autistic people, can feel like a problem, until the small print of a mortgage contract needs to be checked, at which point it becomes a super-power.

However, relationships can present challenges for neurodiverse couples. For example, many autistic people struggle to understand what others may be thinking or feeling. For someone neurotypical, being with a partner who finds it harder to empathise can be frustrating and painful. The autistic partner, meanwhile, can feel criticised for not being a mind-reader. Sometimes the couple collude in a fantasy that, if the autistic partner just tries a bit harder, things will change, which can result in cycles of disappointment and blame when they do not.

For neurodivergent people, just finding partners can be challenging. A first date may be the archetypal occasion for masking (a common coping strategy by which neurodivergent individuals repress or disguise traits and interests in settings where to present as neurodivergent might be disadvantageous). The challenge is when to discard the mask. It can be heart-breaking to hear neurodivergent people speak about their fear that, should they reveal their authentic selves, they might be rejected by the person they’ve come to love.

For the neurotypical partner, it can be equally disturbing to realise that they might have fallen in love with the mask, a realisation that brings with it the need to mourn the loss of a loved one who, while not authentic, felt real. Therapy should be a space where all couples can develop fresh curiosity and compassion for each other and have the courage to reveal their true selves.

However, the consulting room can be scary for neurodivergent people. Talking therapies inherently privilege people who are comfortable with social situations and who find the “rules” of conversation easy to navigate.

As therapists, we are often geared to neurotypical needs and expectations. We tend to seek eye contact, which can be experienced as intrusive by many autistic people; in a couple session, we may cut one partner off if they speak for too long, but many autistic people can find themselves “info-dumping”, especially when feeling anxious. Many neurodivergent people have heightened or reduced sensitivity to sensory input. Simple adjustments, such as being able to dim lights or reduce noise, or provide fidget toys (or just let people know that it’s fine if they need to move around) can make the therapeutic environment more tolerable.

Several of my clients have told me that it was important that I accepted their neurodivergence without question. How professionals respond to disclosure matters; phrases like “I’m sorry to hear that” or “you don’t look autistic” may come from a place of what the therapist sees as care, but, from the individual’s perspective, they are harmful and invalidating.

There is nothing inherently disabling about neurological difference; it is the attitudes and structures of society that make someone disabled. Neurodivergent people mostly do not want therapy to “treat” their neurodivergence. They may want coaching to help them better navigate a world that has not been set up for their needs. And they have a right to access counselling and therapy for the same problems for which neurotypical people seek help.

As professionals, our duty is to ensure that we provide environments and practices that respect and enable everyone.

Ann Hardy, MA, MBACP, is a psychodynamic psychotherapist, working with couples and individuals from our Richmond centre in London.