Show the full module text
Module 29 — Knowing It Is Working
The ninety-day review: the four questions that show whether this work is moving, and what a flat quarter can mean.
Three months in, somebody asks whether it is working. Sometimes it is one of you, late at night. This module walks through the session where the two of you answer that, in the order it is asked.
The ninety-day review
Summary: what happens in the session
1 Your therapist says nothing new happens today. You each write your answers down before either of you says one out loud.
2 How long repair takes now. The first question: how long from a bad evening back to ordinary.
3 The count of bad evenings this month. A number, not a rating. None of them gets argued about again.
4 Your own side of the roadmap, rated. Each goal you set at the start, out of ten — and which has not moved.
5 The confidence question. The ending criterion, asked far earlier than feels natural.
6 The Check-Up, taken again. Twelve questions each, taken separately, with its limits said first.
7 A score that went the wrong way. The first check is whether the two of you are still using the same ruler.
8 The early-warning list, written down. Three things that show up in the two days before a bad stretch.
Built to be read twice: at about ninety days, and again at six months.
Step 1. Nothing new today
At about three months there is a session that looks different from the others. The whole hour goes on looking backward, which is the part couples skip.
How your therapist opens. Today we are not learning anything. We are going to look at four things and see what has changed since we started. Write each answer down before you say it.
Why you write first. Where one of you habitually adjusts to the other, a spoken second answer becomes a reply to the first, usually without either of you noticing.
Step 2. How long repair takes now
Ask a couple three months in whether things are better and you get a shrug and a qualified yes. Ask how long it takes to get back to normal after a bad evening and you get a number: four days at the start, about two hours some months later.
Repair time is the first thing to move, and it is the one to watch.
Repair time. The last time it went wrong, how long until we were back to normal? Not until it was resolved. Until we were ordinary with each other again.
It also predicts the outcome. In a study of couples followed over four years, how they were with each other in the conversation after a fight predicted divorce better than the fight itself did.1
The pot couples look at is the fourth one, happiness. It answers last, and differently depending on which of you is asked and what sort of week it was.
Step 3. The count of bad evenings
The second question wants one number and nothing else. Neither of you is asked which evenings they were, or how bad each one got, and that is deliberate.
The count. How many bad evenings this month? Just the number. We are not going to rate them and we are not going to argue about any of them again.
Why a count rather than a rating. Reports about feelings you are not having right now lean increasingly on beliefs about yourself.2 A count is steadier, and fairer to a partner whose read on their own state is shaky.
Step 4. Your side of the roadmap
The roadmap is the plan of what gets worked on first, built in the session called Your Goals. Each of you rates your own side out of ten every six to eight sessions, and today you read the whole run rather than the latest one.
The roadmap. Here is what I put on my side of the roadmap at the start. Reading it now, out of ten, where is each one? Which of them has not moved at all?
You can always say it. If any of this starts to feel like too much, you can say I am uncomfortable. That is a complete sentence. Nobody has to explain it or defend it. We stop, we look together at what is happening, and we decide as a group whether to stay with it or to understand first what is getting in the way.
This is the moment in the hour most people brace for, and hearing your partner rate something low can land as a verdict on you.
Step 5. The confidence question
This is the question that says when the work is finished, which is why it gets asked so early. An answer that keeps improving is the clearest sign the two of you are close to done.
Confidence. If that happened again next month, could the two of us handle it without help? Not perfectly. Just without needing somebody in the room.
These four are worth asking each other every few weeks, with the date written down. A private note works better than a chart on the fridge.
Step 6. The Check-Up, taken again
The Neurodiverse Relationship Check-Up asks twelve questions and counts how many you answer the settled way. That count is the score, and it names one of four patterns. Compare both results with the one you took before you started, if there was one.
Said before you take it. It cannot tell either of you whether you are autistic or ADHD. It gives one pattern even when two fit, and weighs every question equally, so eye contact counts the same as a crisis. The three bands are our judgment about where the lines go, not thresholds from a sample.
The four dynamics it names are recognizable, and that is the risk as much as the appeal. Read the label as a hypothesis and check it against your week.
Step 7. When a score goes the wrong way
The commonest false alarm in this program is a score that gets worse while things get better.
When something teaches you about the thing being measured, your inner scale moves, and a before-and-after comparison stops comparing like with like.3
The same evening, two rulers. Ninety days ago, one phrase covered a whole region: bad week.
Now: capacity, sensory load, shutdown, or genuinely upset with each other.
A person with five words reports more than a person with one, and the finer report reads as the worse result.
The check takes a minute: ask each other what the first number would have been with today’s words for it. The direction often reverses.
A score means only what it has been checked to mean in the people taking it.4 Almost no relationship measure has had that check with autistic adults, ours included. It helps to hold a number loosely rather than to measure nothing. A measure earns its place where things are not going well,5 because it shows early what is not moving.
Step 8. The early-warning list
The last part of the hour looks forward. Your therapist asks about the two days in front of a bad stretch, not the stretch itself. The answers are small and domestic, and the list can only be made while things are good.
The early-warning list. Give me three things that turn up in the two days before a bad week. Small ones. And when one of you notices one, what would help?
Agree the sentence for naming one along with the signs. Closer to “one of ours is happening” than “you are doing the thing again.”
The way this goes wrong. Six weeks of things going unusually well, and both of you decide the review is unnecessary. That is how the gains are usually lost. The routines drift one at a time, because nothing is going wrong, and the hard month finds none of the structure in place.
After the session
Afterward, amend the one-page account of how each of you is built, the working map you made earlier, rather than rewriting it. At six months, retake whichever of the wheels fits, the Autism Trait Wheel, the ADHD Trait Wheel or the AuDHD Trait Wheel from the session called Your Spiky Profile, and set the new shape beside the old one.
The spikes and dips are the profile, not the problem.
Watch the strength ring. The wheel rates each trait twice, as a challenge and as a strength. The challenges tend to stay where they were, because they describe how a nervous system is built. What moves is the strength rating.
Sometimes ninety days go by and nothing has moved. Three things explain that.
Three explanations for a flat quarter. Design: the agreements were built badly.
Account: the thing being treated is not the thing that is happening.
Capacity: both of you have been running on empty.
Design is the easiest to fix. Capacity is the one most often missed: two people running on empty describe a relationship with nothing good left in it, and all of that can be true of the last eighteen months without being true of the relationship. What separates them is a question about time. Was there a year when neither of you was flattened?
The workbook below is this review in your own words.
The one thing, if that is all you have. If this week has nothing in it, answer one question: the last time it went wrong, how long until you were back to normal? Write the number and the date somewhere you will find it.
Your workbook
Your answers save to this device only - we cannot see a word of what you write. This is the ninety-day review: the four questions, the Check-Up compared, your early-warning signs, and the honest page for a quarter in which nothing moved.
The four questions
Answer these separately, then compare. Put today's date next to them, because you will do this again at six months.
Last time it went wrong, how long until we were back to normal?
How many bad evenings this month? Just the number
Your side of the roadmap, each goal rated out of ten - and which one has not moved at all?
If that happened again next month, could the two of you handle it without help? — Yes, probably, Some of it, not all of it, Not yet, We have not had one to find out
The Check-Up and the early-warning list
Take the Check-Up separately and bring both results. For the list, describe the two days before a bad stretch, not the bad stretch. Small and domestic is right.
The Check-Up questions where the two of you chose different answers about the same household
Your three early-warning signs, and what you agree to do when one of you names one out loud
If nothing has moved
Answer this only if that is where you are. All three explanations are real, and they need different things.
Which of the three fits best, as far as you can tell? — The agreements were built badly, The account we are working from does not fit us, We are both running on empty and have been for a long time, We do not know, and that is worth saying out loud
Was there a year when neither of you was flattened? What were you like then?
Where this comes from
Every source below was checked against the published record. They are grouped by the kind of evidence they are, so the numbers may not run straight down the page — a number points back to where the source is used in the lesson.
Research discussion
The four measures, the ninety-day and six-month schedule, the retake of the Check-Up and the wheels, the early-warning question and the three explanations for a flat quarter are practice moves. They were developed in use with neurodiverse couples and have not been tested as a package.
The Check-Up is our own instrument. It has not been validated against any external criterion, its three bands were set on clinical judgment, it weighs all twelve questions equally, and it names one dynamic where two may fit. The lesson says all of that before asking you to take it.
The repair-time claim rests on one prospective study1 of seventy-nine couples, seventy-three of them followed up four years later. Emotions in the pleasant conversation after a conflict classified who had divorced better than the conflict conversation did. It is a small sample for a claim about prediction, and the classification rates were calculated on the same data the model was fitted to.
Two sources explain why we ask for counts and a written baseline. The emotional self-report review2 is a synthesis, not a trial. It argues that reports about feelings you are not currently having drift toward beliefs about yourself. The response-shift work3 comes from training evaluation, not couples work, and it is old. It is still the cleanest account of something that happens to nearly every couple in this program at about three months: the intervention changes the scale a person is using.
The depression-questionnaire validation4 is a self-selected online sample of autistic adults and concerns depression, not relationships. It is cited for what it implies: a measure has to be checked in a population before anyone can say what a score means there, and almost no relationship measure has been. The outcome-monitoring review5 is by researchers with a stake in the systems reviewed, the effects are modest, and none of the studies are of neurodiverse couples. It supports a narrow claim: look at the measure, and look soonest at the one that is not moving.
Who this research was done with. The studies behind this module, none of them of neurodiverse couples, drew heavily on white, comparatively well-off, English-speaking participants. If your household carries pressures those samples did not — money, immigration, racism, disability, unsafe housing — the practice still applies, but the room you are practicing in is harder. That is the room, not you.
Peer-reviewed research
1. Gottman JM, Levenson RW (1999) Rebound from marital conflict and divorce prediction. Family Process, 38(3), 287-292. https://doi.org/10.1111/j.1545-5300.1999.00287.x Seventy-nine couples completed a laboratory assessment of three fifteen-minute conversations - events of the day, a conflict discussion, and a pleasant topic - with follow-up obtained from seventy-three of them (92.4 percent) four years later. Emotions coded in the pleasant conversation following the conflict classified divorce at 92.7 percent, against 82.6 percent from the conflict conversation itself. This is the basis for tracking repair time rather than conflict. Limitation: a small sample, classification computed on the same data used to build the model, and the same research group as the 1992 paper cited in Module 7B.
2. Robinson MD, Clore GL (2002) Belief and feeling: Evidence for an accessibility model of emotional self-report. Psychological Bulletin, 128(6), 934-960. https://doi.org/10.1037/0033-2909.128.6.934 A review organizing the evidence on emotional self-report around one distinction: emotion, which is episodic, experiential and contextual, and beliefs about emotion, which are semantic, conceptual and stripped of context. Reports about feelings not currently being experienced draw increasingly on the second. Used here for why a retrospective impression of the last month is a poor measure and a written baseline is a better one. Limitation: a theoretical review rather than a trial, and not specific to couples or to autistic or ADHD respondents.
3. Howard GS, Dailey PR (1979) Response-shift bias: A source of contamination of self-report measures. Journal of Applied Psychology, 64(2), 144-150. https://doi.org/10.1037/0021-9010.64.2.144 The paper that named response-shift bias: an intervention can change the internal standard a person uses to rate themselves, so that the same rating before and after no longer refers to the same thing. Later work by Bray, Maxwell and Howard reported that the resulting loss of statistical power could reach ninety percent. Used here for why a score can move the wrong way while the situation improves. Limitation: 1979, from training and program evaluation rather than clinical work, and never tested in couples therapy.
4. Williams ZJ, Everaert J, Gotham KO (2021) Measuring depression in autistic adults: Psychometric validation of the Beck Depression Inventory-II. Assessment, 28(3), 858-876. https://doi.org/10.1177/1073191120952889 Nine hundred and forty-seven autistic adults completing the BDI-II. Latent trait scores showed strong reliability and construct validity in this sample, with moderate discrimination between depressed and non-depressed participants (area under the curve 0.796; sensitivity 0.820, specificity 0.653). Cited for what it implies: measures require validation in the population using them, and few common questionnaires have had it. Limitation: a self-selected online sample, and about depression rather than relationship functioning.
5. Lambert MJ, Shimokawa K (2011) Collecting client feedback. Psychotherapy, 48(1), 72-79. https://doi.org/10.1037/a0022238 A review of routine outcome monitoring, concluding that collecting and acting on client feedback during treatment improves outcomes, with the benefit concentrated in cases that are not on track. Used here for the narrow claim that looking at a measure early is worth doing, especially the measure that has not moved. Limitation: reviewed by authors with a stake in the feedback systems concerned, effects are modest, individual rather than couples therapy, and no autistic or ADHD samples.
Further reading
• Neurodiverse Couples Counseling Center (2026) The Neurodiverse Relationship Check-Up; the Autism, ADHD and AuDHD Trait Wheel exercises. Practice materials, Neurodiverse Couples Counseling Center. https://www.neurodiversecouplescounseling.com/neurodiverse-couples-check-up The two instruments this module asks you to retake. The Check-Up is twelve questions scored on the count of settled answers, reported in three bands with one of four relationship dynamics named alongside it. The Trait Wheels rate sixteen items in eight areas, twice each, as challenge and as strength. Limitation: both are clinical tools developed in use and neither has been validated against an external criterion; the Check-Up's bands were set on judgment, it weighs every question equally, and it names one dynamic where two may fit.
The measure that moves first is the one nobody asks about
The Neurodiverse Couples Counseling Center works with couples where one or both partners are autistic, ADHD or AuDHD. We measure the work by how quickly the two of you repair rather than by a satisfaction score, and we ask early whether you could handle it without us. Therapy for clients in California, coaching worldwide, all by telehealth. A first conversation costs nothing.
Up next