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Module 13 — What the Labels Were Describing
Put down an old label, and see yourself more fairly.
Watch first: the Module 13 video
A narrated, 3D-animated video of about 4 minutes that opens and closes on the Neurodiverse Couples Counseling Center logo. It traces an old label like “Lazy” or “Cold” back through the years with the question “When were you called that before?”, then sets each label beside what was really happening (“Starting is the hard part”). Scenes show a couple at home, a video-call session with a therapist, a late-night bedside clock and notebook, and each partner asking for one thing.
Watch the Module 13 video: What the Labels Were Describing (MP4, about 4 minutes). The written lesson below covers the same ground in full.
Most neurodivergent adults carry a label somebody else gave them a long time ago — “lazy,” “cold,” “too sensitive” — and by now they say it about themselves. So does the partner who is not neurodivergent: “too much,” “controlling.” In this session each of you looks at one of those labels again, and finds what was really happening underneath it.
Looking at the labels again
Summary: what usually happens in the session
1 You each keep a short log at home for a week. When something goes wrong between you, you write down what happened, and the story you are telling yourself about yourself and about your partner.
2 In the session, you both read the same evening. One of you reads an entry from your log. Your partner reads their own entry for that same evening.
3 Your therapist invites you to look at one label. A label you used about yourself, like lazy or too much. When were you called that before? Is it a pattern?
4 Together you find what was really happening. Your therapist offers another way of seeing it, and you put it into your own words.
5 You each come to understand your partner more deeply. From criticized, to tolerated, to accommodated, to understood.
6 You each ask for one thing. Now that your partner understands, one small thing they could do before the next session.
One way this session can go, not a script. Your therapist will shape it to the two of you and to their own way of working.
Step 1. You each keep a log for a week
The work turns now from the family you grew up in to how each of your brains works. It starts with a week of homework: the noticing log. When something goes wrong between you at home, you each write a short entry that night. Three to five entries is plenty, and you each keep your own.
What goes in an entry. What was happening. What your body did first. The story you told yourself about yourself. The story you told yourself about your partner. What you felt like doing, circled: argue, shut down, leave or fix. And one thing that helped, if anything did. If it is hard to tell what your body did or what you felt, “not sure” counts.
The only ask. Nothing has to change this week. The log is for noticing the pattern, not for fixing it. If you noticed everything and changed nothing, you did the homework well.
An entry takes about ninety seconds, which is the point: it has to be doable on the night it happens, in the state you are in.
Step 2. You both read the same evening
In the session, your therapist does not ask for the worst night. One of you picks any entry and reads the whole of it. Then your partner finds their entry for that same evening and reads the whole of theirs.
How your therapist sets it up. “Pick one entry, any one, and read us the whole thing.”
“Now you. Find that same evening in yours and read it to us.”
You will both want to talk about what you hear, and that is welcome. Often it is the first time both accounts of one evening have been heard without either one being argued with. By the end there are four stories about that evening in the room.
One evening, four stories. What I told myself about me: I am useless.
What I told myself about my partner: they do not care.
What my partner told themselves about them: I am too much.
What my partner told themselves about me: nothing I do is enough.
This session sets aside the two stories about each other. It is about the two each of you wrote about yourself: “useless,” “too much.” Labels like these did not start this week. They started long before, and they are still there at eleven at night.
How this actually runs. Nothing goes up on a screen. Your therapist says the two labels back to you out loud, and the three of you talk it through from there.
Step 3. Your therapist invites you to look at one label
Your therapist invites each of you to consider one label from your own sentence. Not five, and not a list: the one that carries the most weight. From “I am useless,” the label is useless. Then comes the question this session turns on, and it is not about your partner.
The question. “When were you called that before?”
“Not by your partner. Before. Who said it first, and how old were you?”
“Has that label, or one like it, followed you since?”
The answers often come quickly: a classroom, a kitchen table, a first job.
Before it gets asked. Saying who first called you that can be the hardest minute of the session. You can take your time, pass, or stop, and your therapist will follow your lead. If the label came with being hurt or frightened, or anything at home frightens you now, tell your therapist on your own first. That comes before this work.
Your therapist is not counting labels. They are listening for how long one label has followed you, and who gave it to you first.
A label said once is somebody’s bad day. The same label from four people across thirty years starts to sound like a description of who you are.
That is what makes a label so heavy. It leaves you nowhere to go: there is nothing to do with “lazy” except be it or deny it. It can come true, because someone told for years that effort is wasted on them may stop trying, and that looks like more proof. And very often it was a misunderstanding. An ADHD brain called lazy was not only judged harshly. It was described wrongly.
Step 4. Together you find what was really happening
Now the two of you, with your therapist, look underneath the label at what was really happening on the days people used it.
Offering another way of seeing it. Can I offer a different way of looking at that? You can tell me if it does not fit. It is possible that what got called lazy was trouble getting started, not a lack of caring. What actually happens at the moment you sit down to begin?
Your therapist offers whichever common explanation fits the moment you describe.
For autism: sensory overload; how much a social day costs, and how long recovery takes; speaking directly instead of hinting.
For ADHD: losing track of time; holding things in mind; attention that drifts when nothing holds it and locks on when something does.
Many couples need both in mind at once. Your partner’s label gets the same care. Then each of you says the new understanding in your own words. Handed to you, it would only be a newer label.
The third label belongs to the other partner, who has often been carrying one just as long.
The way this goes wrong. “Lazy” comes down and “ADHD” goes up in its place, used the same way: that’s just his ADHD. A diagnosis used as a verdict is a new label with better manners. If you hear it happening, say so.
Sometimes the label is one you chose for yourself: “I’m fine.” It can be looked at the same way. What saying “fine” costs comes up later in this part of the program.
Step 5. You each come to understand your partner more deeply
Every trait you have talked about has been treated in one of four ways for years, by family, at work, and by each other. Naming them helps the two of you see where you are.
Four ways a trait gets treated. Criticized. What is wrong with you? The trait is treated as a fault. This is where the old labels came from.
Tolerated. That’s just how he is. The criticism stops. Nothing else changes.
Accommodated. I guess we work around it. Something practical changes, but years of working around someone without knowing why can turn into resentment.
Understood. Oh. I get it now.
Many couples who get this far have reached “tolerated,” and some “accommodated.” That is real work, done without help. It is not the end point, because the person being tolerated can usually feel it. “Understood” sounds like this: I see what that has cost you.
The rest of this program works toward the last two stops, one small request at a time rather than by a change of heart.
Your therapist asks each of you. Now that you have heard where that label came from, what do you understand about your partner that you did not before? Tell them.
Step 6. You each ask for one thing
Understanding shows up in what people do. So before the session ends, each of you names one small thing your partner could do before the next session, now that they understand. Not a feeling. Something they can do.
The question that ends the session. What would feeling understood look like this week? One thing, small enough to actually happen.
Then each of you says one thing about the way your partner’s brain works that you appreciate and have never said out loud.
After the session
What changes first is how you talk to each other, often mid-sentence. One of you starts to say you are so and stops, because you now know what was really going on. That pause is the session working. When an old label does slip out, try adding what you now understand.
The old label will still turn up at eleven at night. One with thirty years behind it does not leave after one conversation. But now there is a second sentence beside it, and you wrote that one.
The workbook. Room for the label, where it came from, what was really happening, and the one thing each of you asked for.
If this is hard to do. If this is too much right now, there is no need to push through it. Spend some time with your partner talking about what makes it hard, and share the feelings that come up: shame, anger at whoever said it first, sadness for the years the label cost. That conversation is part of the work.
What is the noticing log we keep before the session?
For a week before the session, you each keep your own short log at home. When something goes wrong between you, you write what happened, what your body did first, the story you told yourself about yourself and about your partner, what you felt like doing, and anything that helped. Three to five entries is plenty, and nothing has to change that week. The log is for noticing, not fixing.
What if saying who first called me that is too painful?
Saying who first called you that can be the hardest minute of the session. You can take your time, pass, or stop, and your therapist will follow your lead. If the label came with being hurt or frightened, or anything at home frightens you now, tell your therapist on your own first. That comes before this work.
Isn't swapping lazy for ADHD just another label?
It can be, if the diagnosis gets used the same way, as in "that's just his ADHD." A diagnosis used as a verdict is a new label with better manners, and if you hear it happening, you can say so. That is why each of you puts the new understanding into your own words, instead of having it handed to you.
What is the difference between being tolerated and being understood?
The module names four ways a trait gets treated: criticized, tolerated, accommodated and understood. Tolerated means the criticism stops but nothing else changes, and the person being tolerated can usually feel it. Accommodated means something practical changes, but years of working around someone without knowing why can turn into resentment. Understood sounds like this: I see what that has cost you.
Your workbook
Your answers save to this device only - we cannot see a word of what you write. This one is one entry from the log, the label underneath it, and where that label came from.
One entry from the log
Any entry. Not the worst one. Your partner will read their own entry for the same evening.
The situation, and what your body did first
The story you told yourself about you
The story you told yourself about your partner
The urge — Argue, Shut down, Leave, Fix, Something else
The one label
One label, not a list. The one that carries the most weight.
The label from your own sentence
Who said it first, and how old you were
Where else it has been said since, or a word close to it
What was really happening on the days people used it, in your own words
Understood, not tolerated
One thing, small enough to happen before the next session.
How does this trait usually get treated at home? — Criticized, Tolerated, Accommodated, Understood, It varies
What would feel like being understood rather than tolerated this week
One thing about the way your partner's brain works that you appreciate and have never said out loud
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 steps in this session come from clinical practice: the six-line noticing log, the two short lists and the four receptions. They have not been tested in a trial. The lesson claims one thing for the log: it helps you see what you feel more clearly. The closest study supports that. Students prompted by phone for a week to notice their feelings became clearer about them, and their mood did not get better or worse.1 They were students, not couples in therapy, and the study measured clarity, not what people did.
The word “fine” gets one paragraph here, partly because of the research. A review that pooled many studies of camouflaging (hiding autistic traits to fit in) found it went with more anxiety and depression.2 But each of those studies looked at people once, so they cannot say which came first, and the authors call them small. The only study we know of that followed the same people for about two years found, if anything, the reverse: more camouflaging at the start went with slightly fewer difficulties later, a small effect.3
One study that waited is not enough to turn the usual story around. It is enough that nobody should tell that story as a fact. The pattern couples recognize — the effort held up outside the house and set down inside it — comes from a survey of autistic adults about where they camouflage.4 Those who did it in some places and not others reported poorer mental health, and so did those who did a lot of it everywhere. It was a one-time survey, and it names no conditions, so neither do we.
If you want a questionnaire on this, the CAT-Q exists and your therapist can send it home with whichever of you it is about. The people who made it later advised clinicians not to use its score to make a diagnosis or to judge whether therapy is working,5 which is why we read it for the items that made somebody stop and never for the total. It was built and checked with autistic and non-autistic adults who filled it in online.6
Who this research was done with. The studies behind this module, none of them of 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.
Clinically reviewed by Harry Motro, PsyD, LMFT · California LMFT #53452 · Founder and Clinical Director, Neurodiverse Couples Counseling Center · Clinical supervisor · Updated September 27, 2026
Peer-reviewed research
1. Ottenstein C, Hasselhorn K, Lischetzke T (2024) Measurement reactivity in ambulatory assessment: Increase in emotional clarity over time independent of sampling frequency. Behavior Research Methods, 56(6), 6150-6164. https://doi.org/10.3758/s13428-024-02346-y 313 students were prompted on their phones either three or nine times a day for one week, with sampling frequency experimentally manipulated. Emotional clarity increased within participants over the week, and the increase did not differ between the two frequency groups; mood showed no systematic trend. Limitation: a student sample rather than a clinical one, and one week of monitoring; it measures clarity and mood, not behavior.
2. Khudiakova V, Russell E, Sowden-Carvalho S, Surtees ADR (2024) A systematic review and meta-analysis of mental health outcomes associated with camouflaging in autistic people. Research in Autism Spectrum Disorders, 118, 102492. https://doi.org/10.1016/j.rasd.2024.102492 Systematic review of 22 studies (16 pooled in meta-analysis, 6 reviewed narratively) with 5,897 autistic participants. Camouflaging showed significant moderate positive relationships with anxiety, depression and social anxiety and a small negative relationship with mental wellbeing; no moderator was significant. Limitation: the authors state that every included study was underpowered to detect small effects and many used insufficiently validated measures; the abstract gives no correlation coefficients, and the studies cannot establish causality.
3. van der Putten WJ, Mol AJJ, Radhoe TA, Torenvliet C, Agelink van Rentergem JA, Groenman AP, Geurts HM (2025) Camouflaging in autism: A cause or a consequence of mental health difficulties? Autism, 29(10), 2604-2617. https://doi.org/10.1177/13623613251347104 332 autistic adults aged 30 to 84 completed camouflaging and mental health measures at two timepoints about two years apart, analyzed with preregistered multilevel models. Higher initial camouflaging predicted a decrease in mental health difficulties and lower initial camouflaging an increase, a small effect; initial mental health did not consistently predict change in camouflaging, and the authors found no strong evidence that camouflaging leads to mental health difficulties. Limitation: two timepoints in an older, highly educated, predominantly white sample; the authors say more research is needed before drawing conclusions about directionality or causality.
4. Cage E, Troxell-Whitman Z (2019) Understanding the reasons, contexts and costs of camouflaging for autistic adults. Journal of Autism and Developmental Disorders, 49(5), 1899-1911. https://doi.org/10.1007/s10803-018-03878-x 262 autistic people reported their camouflaging behaviors, the contexts they camouflaged in, their reasons, and their mental health symptoms. Women were more likely to endorse conventional reasons such as getting by at work. Both camouflaging highly across contexts and switching between camouflaging in some contexts and not others related to poorer mental health. Limitation: cross-sectional and self-report, in a predominantly white, highly educated sample; the abstract reports poorer mental health rather than named conditions.
5. Hannon BR, Hull L, Lai MC, Magiati I, Mandy W (2026) The use and misuse of the Camouflaging Autistic Traits Questionnaire in autism research and clinical practice: Issues, considerations, and suggestions. Autism in Adulthood (online first). https://doi.org/10.1177/25739581261435868 Perspective piece by the CAT-Q's developers. The questionnaire is useful for research; very little research has examined it in clinical settings; the authors encourage clinicians to refrain from using CAT-Q scores in diagnostic decision-making or as an intervention monitoring or outcome tool. Limitation: a perspective article rather than a study, cited for its guidance.
6. Hull L, Mandy W, Lai MC, Baron-Cohen S, Allison C, Smith P, Petrides KV (2019) Development and validation of the Camouflaging Autistic Traits Questionnaire (CAT-Q). Journal of Autism and Developmental Disorders, 49(3), 819-833. https://doi.org/10.1007/s10803-018-3792-6 Online questionnaire study with 354 autistic and 478 non-autistic adults. Exploratory then confirmatory factor analysis produced a 25-item, three-factor measure with good fit, internal consistency of 0.94, preliminary three-month test-retest reliability of 0.77, and convergent validity against autistic traits, wellbeing, anxiety and depression. Limitation: self-report throughout, self-reported diagnoses, and test-retest in only 30 autistic participants; the factor names and the finding that autistic adults scored higher are reported in the body rather than the abstract.
The label somebody else gave you, looked at again
The Neurodiverse Couples Counseling Center works with couples where one or both partners are autistic, ADHD or AuDHD. The labels session reads one evening from each of your logs, invites each of you to look at the label you have carried longest, and helps you find what was really happening underneath it. Therapy for clients in California, coaching worldwide, all by telehealth. A first conversation costs nothing.
Up next
Module 14 — Your Spiky Profile