Therapeutic Assessment of Cross-Neurotype Relationships

You have probably heard that the success rate for relationship therapy is low; however, I really believe that the deck is stacked against us from the get-go!

The reason for this injustice is that the clinician (and the clients) are often missing key pieces of vital information. As a board certified Couple and Family Psychologist, I have worked with many relationships over my 20 years in clinical practice and have run into some common scenarios of relationship therapy.

Scenario 1: The Surprise Ending

Dr: So, Partner A, what do you hope to get out of relationship therapy?

Partner A: This is Partner B’s idea. Partner B is miserable in our relationship and I don’t know why.

Dr: OK… so Partner B, what led you to reach out for relationship therapy?

Partner 2: Well, I don’t know if I’d say I’m “miserable,” but I haven’t been happy for a while and now I’m not sure if I want to move forward or not.

In scenarios like this one, usually around Session #3 or Session #4, the partners finally reveal some bombshell event (e.g., infidelity, worsened drug addiction, one partner’s desire to “open up” the relationship, revealed old murder charge, one partner has joined a cult) that led to the shift in their relationship or they admit that they’ve already started talking with divorce attorneys.

As you can imagine, surprise information completely changes the treatment strategy and conceptualization. However, because the therapist had been operating in the dark, therapy was not headed in a helpful direction and the partners end up stopping therapy early.

Scenario 2: The Old “Communication Skills” Ploy

Dr: Hello Partner C and Partner D, what brings you to relationship therapy today?

Partner C: For the most part, things are going great for us and I think we really just need to work on some communication skills.

Partner D: Yeah, honestly, we hardly ever argue, but when we do it seems to be about the same things over and over.

Upon further exploration of this scenario, it turns out that the poor communication is really due to systems-wide problems in the relationship that then cause arguments. Such as…

Partner C: … and then Partner D told our son he was grounded and I said, “no, he’s not, that’s too harsh”

OK, I’m just the psychologist, but I think most of us would not just call this a “communication problem”…

Similar to Scenario 1, because the treating clinician is given an inaccurate starting point, the treatment plan was not appropriate or adequate for the clients’ needs. The partners leave therapy because there has been a lack of improvement and the clinician is left feeling frustrated.

Scenario 3: The “No Goals” Goals

Dr: It’s good to meet the both of you. Who would like to start by letting me know what we’re working on?

Partner E: I guess I can start. We just have been feeling disconnected and so I think we just need a booster shot. It seems like it’s just been a gradual change over the years and neither of us are really sure what’s happened.

Dr: Partner F, would you say that’s what you’re thinking too?

Partner F: Yeah, I look at other relationships and they just seem a lot happier than us and I think we used to be like that too.

In Scenario 3, this is a very hard place to start therapy because the concepts are really vague and abstract – “disconnected” “booster” “happier.” These types of clients do not know what they want other than they want things to be better. A skilled clinician can, of course, get to the bottom of this and guide them through the formation of some concrete goals, but that process can take multiple sessions and can lead the clients to feel frustrated and pessimistic because they still haven’t dug into the meat of therapy yet. And… similar to the other two scenarios, this one can also easily lead to clients leaving therapy early.

Cross-Neurotype Relationships

Any relationship can be challenging because there are so many factors that may be playing a part. When one of those factors is differing neurotypes, than the complications can be even more... well, complicated!

What one person may call "messy" the other may call "vital," or what one person may call "your choice" the other may call "that's just the way I am."

Differences in characteristics/behaviors/approaches create one layer of difficulty, but another layer is the potentially traumatic past experiences of many autistic people. Many of those traumatic experiences took place within the context of relationships and interactions; thus, it is natural for those past experiences to also impact current relationships.

These additional layers of factors that can impact relationships is a strong reason to consider a therapeutic assessment of your relationship during/before relationship therapy.

Therapeutic Assessment of Cross-Neurotype Relationships

This is where therapeutic assessment can be really helpful.

Partners can get a therapeutic assessment either before starting relationship therapy or during the course of existing relationship therapy, when treatment has stalled or maybe when there is some type of rupture in the relationship between the clients and the clinician.

After a therapeutic assessment, not only will the treating clinician know what needs to be targeted, but the clients will also understand be on common ground about the priority needs in the relationship.

Similar to individual assessment, the partners will be evaluated using clinician interview and subjective, objective, and projective testing tools. Partners will be evaluated separately and together. The partners will be collaborators with Dr. Dug throughout the therapeutic assessment and thus, gain clarity and understanding along the way. More importantly though, they will have found common ground regarding their relationship priorities and increased optimism about their potential to transform the relationship.

If the partners already have a relationship clinician, that person will also collaborate with the testing process and be present for the final summary session. If there is not already a treating clinician in place, the partners will receive a letter they can share with their future clinician so that there is a clear set of goals moving forward.