Neurodiverse Couples Counseling: A Guide for the Perplexed (Part I)
Tuesday, June 3, 2025.
Understanding What Every Couples Therapist Needs to Know Before They Begin
Let’s say you’re a seasoned couples therapist. You’ve got your EFT moves down, you’ve logged thousands of Gottman-style conflict interventions, and your shelves are sagging under the weight of Imago binders and co-regulation worksheets.
And then they walk in.
One partner is laser-focused on justice, logic, or cleaning the lint filter just so.
The other is overwhelmed, tearful, and convinced they’re being emotionally neglected.
They’ve tried to make sense of their dynamic, but all the usual scripts are breaking down. You quickly realize: this is not your typical couple.
Welcome to the world of neurodiverse couples counseling, where misattunements aren’t just communication problems—they’re neurological, sensory, and often invisible.
This is the guide for the therapist who feels competent… and suddenly, very perplexed.
What Makes Neurodiverse Couples Work So Different?
Neurodiverse couples—most commonly where one partner is autistic or ADHD and the other is neurotypical—present with a set of relational dynamics that don’t respond predictably to conventional therapeutic approaches.
Without proper training, therapists often misattribute neurodivergent traits to Avoidant Attachment, Passive-Aggression, or Narcissism. Yikes!
In other words: you think you’re working on marital conflict. But you’re actually missing a hidden operating system.
Here’s why this matters:
Emotional Expression Looks Different. Alexithymia, sensory overwhelm, or delayed emotional processing might be interpreted as coldness or withdrawal.
Cognitive Empathy and Affective Empathy are Not the Same. One partner may feel deeply and care profoundly but fail to mirror emotions in the expected way.
Masking and Camouflaging can make initial sessions misleading—and exhausting for the neurodivergent partner.
Literal vs. Inferential Communication Styles can create perpetual cycles of misinterpretation.
Five Core Competencies Every Therapist Needs
Before you offer to help a neurodiverse couple, you need more than a good heart and a Gottman card deck. You need specific, research-informed skills:
Diagnostic Humility
Stop trying to diagnose in session. Start learning how neurodivergence can mimic or mask other relational issues. Autistic shutdowns are not stonewalling. ADHD impulsivity is not gaslighting. If you don’t know the difference, you might do harm.
Neurobiology of Regulation
Understand how sensory processing differences, dopamine pathways, and executive functioning impact emotional regulation and intimacy. Traditional co-regulation strategies often need serious adaptation.
Neurodivergent Souls often Require Solo-Regulation before Co-Regulation.
There are somethings only deep training will give you.
Mixed Empathy Presentation
Know how to help neurotypical partners understand that empathy isn't always eye contact and nodding. It may be checking your tire pressure at 10 p.m. or fixing your broken laptop silently while you cry.
"If I didn’t care, I wouldn’t be trying so hard. I just don’t know how to show it the way she wants."
— Autistic husband in sessionLanguage as a Tool, Not a Trap
Be explicit. Be Concrete as Fu*k. Use visual aids, if need be. Normalize clarifying questions. Teach both partners how to signal distress or initiate bids for connection without relying on unreliable social intuition. In other words, no mind reading.
Deconstructing the “Fair Fight” Model
Traditional conflict models (e.g., taking turns, summarizing feelings) can backfire with neurodiverse couples. Instead, design systems of communication that account for asynchronous processing, the need for breaks, and the high cost of verbal overload.
Before You Sit with a Neurodiverse Couple: Training Essentials
If this work calls to you—and it should, because these couples deserve competent support—then your training needs to also include:
Autism and ADHD relationship dynamics.
Masking, shutdowns, meltdowns, and misinterpretations.
Neurodivergent sensory and sexual profiles.
Tools for emotional translation and executive scaffolding.
How to navigate “double empathy” problems. (Milton, 2012)
Don't stop at memoirs or TikToks. Dive into clinical trainings by neurodivergent educators, not just NT professionals explaining ND behavior.
I was trained by AANE. Consider starting there.
Final Thought: Don’t Be a Hero. Be a Translator.
Neurodiverse couples don’t need rescuing.
But they do need someone who can speak both languages without shaming either one.
When a therapist gets it—really gets it—something radical happens. Misunderstood behaviors become legible. Pain becomes manageable. Hope returns.
Be Well, Stay Kind, and Godspeed.
REFERENCES:
Milton, D. E. M. (2012). On the ontological status of autism: The ‘double empathy problem’. Disability & Society, 27(6), 883–887. https://doi.org/10.1080/09687599.2012.710008
Swenson, S. (2020). What is neurodiverse couples counseling? [Webinar]. Retrieved from https://www.sarahswenson.org
García, M., & Hall, S. S. (2021). The relationship experiences of autistic adults: A systematic review. Autism, 25(8), 2151–2166. https://doi.org/10.1177/13623613211002099
Koven, N. S., & Thomas, W. (2010). Mapping facets of alexithymia in healthy individuals: A multidimensional perspective. Personality and Individual Differences, 49(2), 116–121. https://doi.org/10.1016/j.paid.2010.03.019