On a monthly national conference call, a small group of clinicians who specialize in neurodiverse couples’ therapy meet for peer supervision, support and guidance. Clinicians spanning the country, from California to New York, discuss the current need for clinical expertise in providing appropriate supportive services to neurodiverse couples. Neurodiversity in couples is defined as having one or both partners on the autism spectrum (Myhill & Jekel, 2015). While there are a limited number of providers focusing their practices on couples’ services within the autism community, the clinicians presently doing this work see it as a fast growing area of need. While comprehensive work with neurodiverse couples spans all areas of the partnership, this will be a brief review of how some of the core principals of Autism Spectrum Disorder (ASD) impact intimacy and sex within the couple.
Myhill and Jekel (2015), highlight the importance of bringing neurodiversity to the forefront of couples’ therapy so individuals can better understand their partners’, as well as their own, neurological profiles. This is especially true when discussing intimacy and sex within the partnership. Without first acknowledging and understanding the ways in which ASD shapes these intimate interactions, a therapist is unable to provide appropriate tools to address the identified challenges in their sexual relationship. Of the hallmarks of ASD, this article will focus specifically on communication, sensory sensitivities and past experiences as they relate to sex (American Psychiatric Association, 2013). It should be noted that there are numerous variations and additions to this list that should also be explored when discussing intimacy within a neurodiverse couple.
Addressing barriers in communication is often one of the first goals in neurodiverse couples’ therapy. However, these communication deficits may be exacerbated when a couple is moving toward intimacy. These intimate interactions, from flirting to engaging in sexual activity, are often communicated through nonverbal cues such as eye contact, body language or micromovements. This unspoken language adds a layer of challenge for individuals who struggle with nonverbal communication (American Psychiatric Association, 2013). Once the fundamental neurological differences in communication are acknowledged in couples’ work, focus can shift to planning for alternative ways to communicate in a clear and direct manner. Some successful strategies in navigating this may include the use of “code words” to indicate boundaries or triggers, planned breaks for processing during tough interactions or more direct discussions when something does not go as planned or has been upsetting. This shift to using more direct and concrete language may be challenging, especially for a neurotypical partner, but can offset nonverbal communication mix-ups by clearly stating needs and wants during intimacy. Furthermore, having clear and direct conversations allows couples to be more explicit about consent and what is allowed and appreciated by both partners during sexual interactions.
Neurodiverse couples often express variations in sensory experiences as both a benefit and barrier to fulfilling sexual interactions. As a key feature of ASD, sensory sensitivities can be experienced with hypersensitivities, meaning over or more, or hyposensitivities, meaning under or less. Research by Tavassoli, et. al (2014), found that adults with ASD report more “over-responsivity” to sensory stimuli than a non-ASD control group in multiple sensory domains. In neurodiverse couples work, it is critical to understand and educate couples on the ways in which a partner with ASD may be differently impacted by touching and intimate sensory experiences. There are several ways in which neurological differences in sensory sensitivities play out in neurodiverse couples and these should all be examined. Challenges can arise if one partner has a greater need for intimate contact, hugging or touching while the other partner has a lesser need for physical contact or may struggle with it altogether. In regards to sexual activity, hypersensitivities may heighten sexual enjoyment for a partner with ASD, while simultaneously leaving the partner with more typical sensory experiences, or one with hyposensitivities, feeling sexually unsatisfied. An example of this in clinical practice was seen with a couple in which the partner with ASD experienced hyposensitivities, which caused a lack of awareness and understanding of the need to use different parts of his hand (ie. front versus back) and alter the pressure of his touch, when stimulating his partner’s body. This caused significant distress for the neurotypical partner who was frustrated by these interactions because she did not understand how her husband’s sensory experiences led to touching in a way that was more in line with his own experience of sensation versus her sensory needs. By educating neurodiverse couples on the ways in which sensory input is different for individuals with ASD, couples are able to identify how they each experience sensations and what they need from their partner to feel gratified during sex.
Lastly, an important lens to use when working with neurodiverse couples is their past experiences in both social and intimate relationships. While many individuals with ASD have a significant history of dating and sex, many have lesser or more limited experiences than their neurotypical counterparts. As an important note, while pubertal physical and hormonal development are the same for adolescents not on the spectrum, individuals with ASD often experience a delay in developing intimate relationships. This may stem from challenges in relationship building, disinterest in dating during adolescence due to other interests or goals, lack of sex education and so on (Aston & Attwood, 2014). Using this lens when working with neurodiverse couples helps us understand the breadth of an individual’s’ dating experience compared to their partner, who may or may not be on the spectrum. In practice, this can be seen as someone having unrealistic views of a relationship or misunderstanding the roles and responsibilities of each partner in this dynamic. Discussing the differences in experience as well as beliefs and expectations of romantic relationships are important in the foundation of couples’ therapy. This allows individuals to hear their partner’s viewpoint and expectations of sex and intimacy in the relationship. Often times, this is helpful for both ASD and non-ASD partners to begin to understand the frustrations or disappointments in these sexual interactions. This also normalizes the concept that individuals enter a partnership with a wide range of expectations, needs and desires of intimacy, which often stems from past experiences or a lack thereof.
Striking a Balance
Using a strengths-based lens, we often find that neurodiverse couples can pool their strengths within the partnership and find ways to be stronger and more effective together. Neurodiverse couples who seek counseling need therapists who understand their neurology and the importance of integrating this understanding of ASD into the clinical work (Myhill & Jekel, 2015). It is imperative that in couples’ therapy there is a specific and concrete focus on intimacy and sex. As noted throughout this article, there are often challenges faced in intimacy of neurodiverse partners, but through identification of neurological difference and directed clinical work, couples can strike a balance and identify ways to have rich and fulfilling intimacy within their partnership.
CDC. (2016). Facts about ASDs. Retrieved from http://www.cdc.gov/ncbddd/autism/index.html
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Aston, M. C., & Attwood, T. (2014). The other half of Asperger syndrome (autism spectrum disorder): A guide to living in an intimate relationship with a partner who is on the autism spectrum. London, UK: Jessica Kingsley.
Myhill, G., & Jekel, D. (2015, March). Neurology Matters: Recognizing, understanding, and treating neurodiverse couples in therapy. FOCUS, NASW Massachusetts Chapter.
Tavassoli, T., Miller, L. J., Schoen, S. A., Nielsen, D. M., & Baron-Cohen, S. (2013). Sensory over-responsivity in adults with autism spectrum conditions. Autism, 18(4), 428-432. doi:10.1177/1362361313477246