We understand that many people struggle to identify, express, and understand emotions. This condition is known as alexithymia and our therapists are prepared to meet you where we are and guide you towards your goals. ALEXITHYMIA < Back ALEXITHYMIA Do you struggle to recognize and express emotions? Do you feel a bit confused whenever a friend asks "How are you?" Are you uncomfortable around others who are processing their emotions? Do you prefer to "live in your head?" If you answer is "I think so" to most of these you, are probably in the right place. WHAT IS ALEXITHYMIA? Alexithymia is a condition characterized by challenges in identifying, understanding, and expressing emotions. Individuals with alexithymia may find it difficult to recognize their own feelings or the feelings of others. This can lead to challenges in forming and maintaining relationships, as well as navigating various social situations. Our counseling… Show More

The Neurodiversity Supplement to the family-of-origin worksheets, and the session where a neurodiverse couple works through it together, step by step. Show the full module text Module 11 — The Family You Grew Up In Was Neurodiverse Too Make sense of how the family you grew up in shapes the two of you now. Watch first: the Module 11 video A narrated video of about 3 minutes in a soft watercolor style that opens on a “Looking Back” house and closes on the Neurodiverse Couples Counseling Center logo. It walks through the family table that builds on your family drawing (who, what kind, how sure, and what you actually saw each relative do), a family tree that leads down to “You,” and struggles like “Masking to belong.” Scenes show an older couple at home and in a video-call session, and a journal for the days after the session. Watch the Module 11 video: The Family You Grew Up In Was Neurodiverse Too (MP4, about 3 minutes). The written lesson below covers the same ground in full. In Drawing the Family you put the neurodivergent people in your family on the page. This session goes deeper. The Neurodiversity Supplement , the second part of your family-of-origin worksheets, asks what it was like to grow up among them: what you saw them do, who understood you, and what you hid to belong. Before you go on, read through the questions once, so nothing on the pages comes as a surprise. The Supplement, in the order we take it Summary: what usually happens in the session 1 Written alone, opened together. Nothing you wrote is read aloud unless you choose it. 2 The family table. Building on your drawing: what you actually saw each relative do. 3 The early years. What was true before you can remember, and who might know. 4 Your inner life, joy first. How your thoughts and feelings were different from everyone else’s. 5 Your social life, and who understood you. What being different cost, and the one person who got it. 6 Diagnosis. Any word you were given, and what you made of it. 7 Masking at home. What you hid to belong, and whether there was anywhere you did not have to. 8 Your lineage, both halves. Your own traits, found in the family table, and what that changes. Not a form to work down. Your therapist chooses the questions that matter most for you, and over a few sessions that can be most of them. 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. Written alone, opened together The Supplement is optional. Your therapist suggests it when neurodivergence is already part of your story, and warns you first that writing it can open memories not yet named. You fill it in on your own, at your own pace. In the session you can read from what you wrote instead of answering on the spot, or pass on any question. How your therapist opens. You did this by yourself, and I have read all of it. I will not read any of it out loud. Your partner hears what you choose to say. Your partner’s part is to listen, not to fix or explain. Hearing it can stir feelings of their own, sometimes about the life you share now. Those matter too, and they get their own time. Step 2. The family table The first page builds on your family drawing. For each relative you marked, a table asks what kind, how sure (assessed, self-identified or suspected), and what you actually saw them do. Your therapist works from that last column. The family table goes deeper than the drawing: for each relative, what you actually saw them do. What they were called: difficult, highly strung, the one with nerves. What a child saw: what she could not stand, what he did at the same time every day. If the top of the table is blank. Most people draw a blank on anyone over fifty. That is a hole in the record, not in your memory. In England, about two in three autistic people have no diagnosis at all,1 a group two researchers named the lost generation.2 The family table. Your grandmother, the one everybody called highly strung. Whatever she was called, what did she actually do? The tall bar is children. The one you can barely see is their grandparents. Step 3. The early years Six short questions about the time before you can remember: the birth, when you talked and walked, whether things ever went backwards. These come back mostly blank, and that is not avoidance. I don’t know is a complete answer, and better than a guess. The early years. Most of this page is empty, which is honest. Who might know? A parent, an older sibling, a baby book? The way this goes wrong. The parent phone call goes wrong in a predictable way: the parent hears an accusation. So try saying why first: I am filling in some things I was too young to remember. Nothing is wrong. Stop when it turns, and bring what happened back to the room. Step 4. Your inner life, joy first Three questions: how you were different, when you first noticed, and which differences felt like strengths or were treated as weaknesses. Your therapist takes the strengths first, every time. Why joy comes first. It is the question people skip, at the kitchen table and in most therapy rooms. The answer is often the first good thing a person has said out loud about how they are wired. Joy. Before we go anywhere near what was hard: which of the ways you were different felt like strengths? Which of them brought you joy? Step 5. Your social life, and who understood you Nine questions about your social life as a child who was different: shamed or bullied, what it did at home and at school, how you coped, whether it still hurts. Most of them ask what went wrong. Where the sentence was written. Thousands of neurodiverse couples have told us that something is wrong with me was written in childhood, and often not by a parent. Close to half of autistic children are bullied at school.3 Passing as typical is its own route to the same belief, with nobody saying anything unkind.4 One question asks who made you feel understood, and how. That one gets protected time: feeling accepted by the people around you goes with doing well now.5 The answer is usually small and specific, and often something your partner could do. Who understood. You named somebody who made you feel understood. What did they actually do? Not who they were. What they did. 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. Some of these answers have not been said to anyone before. If one of them is too much today, the words move it to another day. Nothing is lost by waiting. Step 6. Diagnosis A short table for anything you were diagnosed with, identified in yourself, or suspect: the age, who said so, what you thought at the time. A nine-year-old given a word and not what it meant often concluded something was wrong with them. That conclusion is usually still running. Diagnosis. When they gave you the word, what did you think it meant? For some people the word came only in adulthood, or a different word came first. A late word can bring relief and grief together, and both belong here. Step 7. Masking at home The last page asks what unspoken rules you followed to be accepted in your own family, and what you hid or performed in order to belong. The page assumes home was where the mask came off, and often it was. When it was not, that is the answer that matters most. It usually has a person attached: the parent whose mood the household ran on, often the one nobody named. The off-switch. Was there anywhere you did not have to do it? Anywhere you got to just be however you were? A person who has had no off-switch anywhere will not have one in this marriage without something changing on purpose. Five rooms with the mask on and one with it off is, by the standards of the people we work with, a good childhood. If home was not safe. If home was frightening, not only tiring, you can tell your therapist on your own first. Some of it may belong in an individual session before it is shared as a couple, and nobody needs to call a parent who was not safe. Step 8. Your lineage, both halves The final question asks you to find your own traits in the family table. When a person finds one of theirs in two more relatives, something in their posture changes. Something is wrong with me. This is what my family is. The lineage, both halves. This clearly runs in your family. You were not the first one. You were the first one to have a name for it. And: it is still your relationship to run. Why there is a second half. It runs in the family says where a trait came from, and nothing about what happens next. If it starts to sound like a reason nothing can change, to either of you, bring that back to the room. Your therapist closes before capacity runs out; whatever is left on the pages keeps. After the session The grief lands late. Putting together a childhood nobody witnessed produces a specific grief, for a child nobody understood. It arrives days or weeks later, as flatness, irritability, or a sudden conviction that the therapy is not working. Now you both have a word for it, so neither of you needs to read it as a relapse. If it deepens, or has not lifted after a couple of weeks, tell your therapist; that is worth checking rather than waiting out. The workbook below is for the week after: the questions that mattered most, as you would answer them now, and how it has landed. If you were the partner listening and thought, this is me too , say so. It gets its own session, not twenty minutes of somebody else’s. Before you go on. The next module, Competing Sensory Needs, Then and Now , has its own optional worksheet, Competing Sensory Needs . If sensory issues were significant in your family, we strongly recommend it. If this is hard to do. If the pages are hard to face this month, do not push through them. Spend some time with your partner talking about what makes it hard, and share the feelings that come up when you think about your family. That conversation is part of the work. Will my partner hear everything I wrote on the worksheet? No. You fill in the Supplement on your own, at your own pace, and your therapist reads it, but nothing you wrote is read aloud unless you choose it. In the session you can read from what you wrote instead of answering on the spot, or pass on any question. Your partner hears only what you choose to say. What if I know nothing about my grandparents or my early years? That is common. Most people draw a blank on anyone over fifty, and that is a hole in the record, not in your memory. Many older autistic people have no diagnosis at all. For the early years, "I don't know" is a complete answer, and better than a guess. Your therapist may ask who might know, such as a parent, an older sibling or a baby book. Does "it runs in the family" mean nothing in our relationship can change? No. Finding your own traits in your family can move you from "something is wrong with me" to "this is what my family is." But it runs in the family says where a trait came from, and nothing about what happens next. It is still your relationship to run. If it starts to sound like a reason nothing can change, it helps to bring that back to the session. Why might I feel low or flat weeks after this session? Putting together a childhood nobody witnessed can bring a specific grief, for a child nobody understood. It can arrive days or weeks later, as flatness, irritability, or a sudden sense that therapy is not working. Knowing the word for it means neither of you has to read it as a relapse. If it deepens, or has not lifted after a couple of weeks, tell your therapist. Your workbook Your answers save to this device only - we cannot see a word of what you write. This one is for the week after the session, not the session itself. The questions that mattered, as you would answer them now A week later the answers are often different from the ones in the room. Nobody sees these unless you bring them. Which of the ways you were different felt like strengths, or brought you joy? Who made you feel understood, and what did they actually do? Was there anywhere you did not have to perform, anywhere you could just be however you were? — Yes, and I can name where, Somewhere, sort of, Nowhere, I have never thought about it before If yes: where, and what made it safe Seeing your traits as part of a family pattern rather than a personal flaw: — Changed how I see myself, Changed it a little, Did not change anything, I do not see the pattern, Too early to say If you were the partner listening One question, and it is the one people do not say out loud. Somewhere on those pages, did you find yourself? — Yes, Maybe, No, I would rather not say yet A few days on Fill this in a few days after the session, not the same evening. A few days on, how has it landed? — Fine, Flat, Short-tempered, Sad, Relieved, Convinced this is not working Whatever it is, one line about it for the next session 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 Nothing on the nine pages is a validated instrument. It is a structured way of putting together an account of a childhood, kept in three kinds of ink: what you remember, what someone can confirm, and what nobody knows. The studies behind this module support the reasons for the questions, not the questions themselves. The undiagnosed figure comes from prospectively collected English primary-care records for one year, which is about as clean as this kind of count gets.1 The caution is geographic: it describes one country’s record-keeping. The lost-generation framing is a review, cited for the idea.2 That undiagnosed relatives survive in family language as character rather than condition is our observation, with no study behind the vocabulary. The bullying figure is pooled across seventeen studies, and the path from being bullied to a core belief is plausible rather than demonstrated.3 The camouflaging study is ninety-two people describing their own experience; it says what passing can cost, not how common the cost is.4 The acceptance study is one survey of 111 adults at a single point in time, so the direction is not established; it is quoted for the size of the association.5 The study Autism diagnoses in England, by age, in one year1 Who this research was done with. The couples studies behind most of this module 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. O'Nions E, Petersen I, Buckman JEJ, Charlton R, Cooper C, Corbett A, Happe F, Manthorpe J, Richards M, Saunders R, Zanker C, Mandy W, Stott J (2023) Autism in England: Assessing underdiagnosis in a population-based cohort study of prospectively collected primary care data. The Lancet Regional Health - Europe, 29, 100626 . https://doi.org/10.1016/j.lanepe.2023.100626 Population-based cohort using prospectively collected English primary-care records. Diagnosed autism prevalence in 2018 was 2.94 per cent among 10-14-year-olds and 0.02 per cent among those aged 70 and over. The authors estimated that between 435,700 and 1,197,300 autistic people in England were undiagnosed, 59 to 72 per cent of the autistic population. Limitation: one country's record-keeping in one year; the undiagnosed estimate depends on assumptions about true prevalence, which is why it is a range. 2. Lai MC, Baron-Cohen S (2015) Identifying the lost generation of adults with autism spectrum conditions. The Lancet Psychiatry, 2(11), 1013-1027 . https://doi.org/10.1016/S2215-0366(15)00277-1 Review article naming and characterizing the cohort of adults who reached adulthood before autism was widely recognized and who remain undiagnosed or misdiagnosed. Limitation: a review, not a study, and cited here for the framing rather than for any figure. 3. Maiano C, Normand CL, Salvas MC, Moullec G, Aime A (2016) Prevalence of school bullying among youth with autism spectrum disorders: A systematic review and meta-analysis. Autism Research, 9(6), 601-615 . https://doi.org/10.1002/aur.1568 Systematic review and meta-analysis of 17 studies of school bullying among autistic children and adolescents. Pooled prevalence of general victimization was about 44 per cent, and of verbal victimization about 50 per cent. Limitation: prevalence figures pooled across studies with different measures and settings, and the path from victimization to a later core belief is plausible rather than demonstrated by this study. 4. Hull L, Petrides KV, Allison C, Smith P, Baron-Cohen S, Lai MC, Mandy W (2017) "Putting on my best normal": Social camouflaging in adults with autism spectrum conditions. Journal of Autism and Developmental Disorders, 47(8), 2519-2534 . https://doi.org/10.1007/s10803-017-3166-5 92 autistic adults described in their own words why they camouflaged, what it consisted of, and its consequences, analyzed thematically into a three-stage model: motivations (fitting in, connecting with others), techniques (masking and compensation), and consequences (exhaustion, challenging stereotypes, and threats to self-perception and identity, including feeling fake or losing a sense of self). Limitation: a qualitative study, so it describes what camouflaging can involve and cost; it cannot say how common any of it is. 5. Cage E, Di Monaco J, Newell V (2018) Experiences of autism acceptance and mental health in autistic adults. Journal of Autism and Developmental Disorders, 48(2), 473-484 . https://doi.org/10.1007/s10803-017-3342-7 Survey of 111 autistic adults measuring perceived acceptance from others, personal acceptance of their autism, and depression, anxiety and stress. In the regression model, external acceptance and personal acceptance together predicted 52.1 per cent of the variance in depression scores. Limitation: cross-sectional, so the direction of the relationship is not established, and a single self-report sample. A childhood nobody was measuring, taken seriously The Neurodiverse Couples Counseling Center works with couples where one or both partners are autistic, ADHD or AuDHD. The neurodiversity supplement is read before you arrive, we start with joy and who understood you, and nothing you wrote is read aloud unless you choose it. Therapy for clients in California, coaching worldwide, all by telehealth. A first conversation costs nothing. Talk with our team Up next Module 12 — Competing Sensory Needs, Then and Now All 29 modules in The Neurodiverse Couples Repair Program

POP QUIZ: Are You Asking the RIGHT Questions in Your Neurodiverse Relationship? Want to test your communication skills? Look at the questions below and ask: "Do I say more of the ❌'s or ✅'s?" There’s no shame either way—just insight. Want to test your communication skills? Look at the questions below and ask: "Do I say more of the ❌'s or ✅'s?" There’s no shame either way—just insight. Allistic to Autistic ❌ "Why aren't you listening to me?" ✅ "Did I catch you at a bad time to talk, or is something making this hard to take in?" ❌ "Can't you just be more flexible?" ✅ "What parts of our routine help you feel steady, and where could we build in some wiggle room together?" ❌ "Why don’t you care how I feel?" ✅ " I know you care in your own way —can you help me see how you usually show it?" Autistic to Allistic ❌ "Why are you always so emotional?" ✅ "Your feelings matter to me, even if I don’t always get it—can you walk me through what’s going on for you?" ❌ "Do we have to talk about this AGAIN?" ✅ "I know this is important to you. Can we find a rhythm for these talks that works better for both of us?" ❌ "Why can't you just say exactly what you mean ?" ✅ "Sometimes I need things to be really direct. Can we figure out a way to meet in the middle?" So, how’d that quiz go? If you ended up with more ❌s than ✅s, don’t stress. You’re in good company—most couples do! These habits are super common and totally normal. The good news? They’re also things you can work on. Just noticing them is already a big step in the right direction. 🌟 Try This Week: Pick just one ✅ or "better way" question and ask your partner this weekend. Watch how even a small shift makes things better! And, yes, I know this might feel impossibly hard. That’s exactly why neurodiverse couples therapy exists. One of our neuro-informed therapists can help you both learn how to ask questions and connect in new ways that can transform your relationship. Go deeper: Our free Neurodiverse Couples Repair Program has a whole module on this kind of conversation: Module 4, Neuro-Informed Reflective Listening . You've got this, Harry Motro Clinical Director, Neurodiverse Couples Counseling Center Take the First Step 🔦 Spotlight on Liz McClanahan Specialties · Neurodiverse Couples Therapy · Autism & ADHD · Parenting Autistic Children · Intimacy, Sex, Affair Recovery · Anger Management · Life Transitions Professional Qualifications · Neurodiverse Couples Specialist · Master’s Degree in Clinical Psychology from Azusa Pacific University (APU) · Registered Associate Marriage and Family Therapist Personal Experience · My husband is on the Autism Spectrum and received his diagnosis later in life. I am so proud of my 26-year marriage and the fact that we were able to reconcile after a divorce and remarry. · My two children are also on the Spectrum. They have taught me how differences can be intensely beautiful and frustrating at the same time. Learn more about Liz! Want to learn more about yourself? Explore our sister site, Adult Autism Assessment , and take a deeper dive into your journey of self-discovery. Click the links below to get started! Autism Screeners ADHD Screeners Tests Related to Autism & ADHD General Screeners Use our Trait Wheels to better understand your strengths and challenges: Autism Trait Wheel ADHD Trait Wheel AuDHD Trait Wheel

Frequently Asked Questions Tip: Want more resources? 📄 See our Quick Fact Sheet for a short, skimmable overview of our services. 📖 Read our in-depth Neurodiverse Couples Counseling Article for a full overview of challenges, therapy approaches, and more. FREQUENTLY ASKED QUESTIONS 1. What is neurodiverse couples counseling? Answer: Neurodiverse couples counseling is therapy designed for relationships where one or both partners are autistic, ADHD, or otherwise neurodivergent. It focuses on... Frequently Asked Questions Tip: Want more resources? 📄 See our Quick Fact Sheet for a short, skimmable overview of our services. 📖 Read our in-depth Neurodiverse Couples Counseling Article for a full overview of challenges, therapy approaches, and more. FREQUENTLY ASKED QUESTIONS 1. What is neurodiverse couples counseling? Answer: Neurodiverse couples counseling is therapy designed for relationships where one or both partners are autistic, ADHD, or otherwise neurodivergent. It focuses on improving communication, building emotional safety, and helping partners understand each other’s unique ways of thinking and feeling. Unlike traditional counseling, this approach uses strategies that account for neurological differences so couples feel understood and supported. 2. Can autistic or ADHD partners feel empathy and love? Answer: Yes. Autistic and ADHD partners are fully capable of empathy and love. They may simply express or process emotions differently. This difference is sometimes misunderstood as “lacking empathy,” but in reality, it’s about a mismatch in communication styles. Therapy helps both partners recognize and share empathy in ways that strengthen connection. 3. What is the Double Empathy Problem? Answer: The Double Empathy Problem describes how both autistic and neurotypical partners can struggle to understand each other’s perspectives. It’s not a “deficit” in one person—it’s a two-way misunderstanding caused by different communication and emotional styles. Counseling helps bridge this gap so both partners feel heard and valued. 4. What challenges bring neurodiverse couples to therapy? Answer: Common reasons include recurring conflicts about “tone” or chores , emotional distance, sensory overload, mismatched needs for intimacy, parenting struggles, or feeling like you’re speaking “different languages.” These challenges don’t mean your relationship is broken—they mean you may need tools built specifically for neurodiverse partnerships. 5. How does therapy for neurodiverse couples work? Answer: We focus on eliminating unhelpful patterns, creating emotional safety, and building a roadmap toward closeness. Sessions may involve the couple together, plus individual support for each partner. Our therapists teach practical strategies to improve communication, manage conflict, and reconnect —without blame, pressure, or trying to “fix” one person. 6. What makes your approach different from traditional couples therapy? Answer: Traditional therapy often overlooks neurodiversity, sometimes even suggesting autistic partners can’t feel empathy or love. We reject that myth. Our team customizes every counseling plan to the unique needs of each couple—we don’t believe in one-size-fits-all therapy. While many traditional approaches overlook neurodiversity, we design our methods specifically for autistic and ADHD partners and their loved ones. Three things set us apart: Ongoing Specialized Training – Every therapist receives weekly training on neurodiversity-focused content, ensuring our approaches stay current and effective. Collaborative Case Support – We hold weekly case consultations and supervision so that no couple’s challenges are handled in isolation—your therapist has a full team behind them. Continuous Professional Growth – All team members pursue ongoing continuing education in neurodiverse relationships, keeping us at the forefront of best practices. In addition, we use a strengths-based, solution-focused model that emphasizes safety, communication, and mutual understanding. With your permission, we may integrate a couples therapist plus individual therapists for each partner, coordinating care so both partners feel fully supported. 7. What if one partner isn’t sure about being autistic or ADHD? Answer: That’s okay. A formal diagnosis isn’t required to start . Many couples come to us simply because they notice “different wiring” is affecting communication and connection. Therapy works whether or not a diagnosis is in place—and if desired, we can help California residents explore assessments for autism or ADHD. 8. Will this type of counseling actually help our relationship? Answer: Yes. Research shows that solution-focused therapy helps couples shift away from blame and toward problem-solving and emotional connection (McDowell et al., 2023). Many neurodiverse couples who work with us report more trust, less conflict, and a stronger bond over time. Change is usually gradual, but very possible. 9. How long does it take to see progress? Answer: Many couples feel relief within the first few sessions once they understand their patterns and learn new strategies. Meaningful progress takes time, but with consistency, couples often notice more empathy, teamwork, and closeness after just a few months. 10. Who do you work with? Answer: We support neurodiverse couples nationwide through online therapy or coaching. 11. Do you take insurance? Answer: No, we are a private-pay practice. For California therapy clients, we can provide superbills for possible out-of-network reimbursement. Please note that coaching services (all clients outside California) are not covered by insurance. 12. What if we’re in crisis? Answer: While we are here to help, we are not a crisis service. If you are in immediate danger, please call 911. For urgent mental health support, dial or text 988 for the Suicide & Crisis Lifeline. Go deeper: Curious what the work looks like before you book? Our free Neurodiverse Couples Repair Program walks through it one module at a time, and Module 3, Your Goals , helps you set a plan you both want. LEARN MORE 📖 Read our in-depth Neurodiverse Couples Counseling Article for a full overview of challenges, therapy approaches, and more. 📄 See our Quick Fact Sheet for a short, skimmable overview of services. Last reviewed: Aug 22, 2025 • Author: Dr. Harry Motro, LMFT (Clinical Director) GETTING STARTED We would love to create a safe place for you to break the painful patterns of the past and communicate in a new way. Please fill out our contact form and we will be glad to connect you with one of our team members. Mitchell, P., Sheppard, E., & Cassidy, S. (2021). Autism and the double empathy problem: Implications for development and mental health. British Journal of Developmental Psychology, 39(1), 1–18. https://doi.org/10.1111/bjdp.12350 Use our Trait Wheels to better understand your strengths and challenges: Autism Trait Wheel ADHD Trait Wheel AuDHD Trait Wheel

When neuro-differences leave relationship trauma, couples get stuck. Trauma-informed neurodiverse couples therapy helps you heal and build bridges together. Trauma-Informed Neurodiverse Couples Therapy HEAL YOUR TRAUMA AND YOUR RELATIONSHIPS When one or both partners have been traumatized by relationship patterns rooted in their neuro-differences, the partners must overcome two distinct challenges: Heal the trauma , and Understand and build bridges across the neurological differences. Unfortunately, most approaches to Neurodiverse couples counseling do not adequately address the trauma. As a result, couples get stuck in trauma-fed reactive behaviors that keep them stuck. The diagram here explains Trauma-Informed Neurodiverse Couples Therapy as the path to lasting healing. Your therapist or coach will walk you step-by-step through the healing process. Trauma Cycle in Neurodiverse Couples This is the loop that keeps partners stuck . If you don’t interrupt it intentionally, it runs the relationship. Step 1: NT (Neuro-Typical) “Regular World” Reality: Everyday neurotypical norms create unintentional pressure on the ND partner to “be NT.” What it looks like: Rapid back-and-forth talk; reading between the lines; tone policing Unwritten rules about plans, timing, eye contact, social energy “If you cared, you’d just…” expectations across chores, parenting, money, sex, planning Impact: Not malice—just the default water the NT partner swims in. It still lands as pressure. Step 2: ND (Neuro-Divergent) – 1st-Level Coping (Masking) Reality: The ND partner masks to survive home/work demands. What it looks like: Acting “NT” to keep peace; rehearsed scripts; heavy self-monitoring High cognitive load, low authenticity; people-pleasing to avoid conflict Use Red/Yellow/Green capacity signals to communicate bandwidth without a fight Support moves: Masking boundaries: Agree on where masking is optional vs. harmful Spoon budgeting: Plan energy; stop spending spoons just to look “normal” Step 3: ND – Physical Cost Reality: Masking + constant adaptation drain the body. Fatigue hits. What it looks like: Sleep disruption; sensory hangovers; headaches, gut issues, immune dips Rising shutdown risk Support moves: Put Sleep • Food • Movement on a schedule (non-negotiable) Pre-plan recovery blocks, not “if there’s time” Step 4: ND – 2nd-Level Coping (Withdrawal) Reality: The ND partner withdraws to stabilize. What it looks like: Numbness or quiet; fewer words; reduced participation Looks like disinterest; actually a safety strategy Support moves (both partners): NT self-regulate first —don’t pursue while activated Use W.I.N. messages (see tool below) instead of criticism Schedule Critical Time Together (low-demand, predictable, short) Use a Relationship Schedule to kill decision fatigue Step 5: NT Trauma / “Cassandra Syndrome” Reality: The NT partner becomes flooded and feels unheard/rejected. What it looks like: Pursuing harder; “pep talks” that land as pressure; criticism spikes Rejection sensitivity on both sides escalates the spiral Support moves: Name the flood and pause Replace global criticism with specific, time-boxed asks using W.I.N. Step 6: ND – 3rd-Level Coping (Meltdown/Shutdown) Reality: The system tips. Meltdown or shutdown . What it looks like: Meltdown: escalation, overwhelm, explosive reactivity Shutdown: silent collapse, freeze, “checked out” Aftermath: regret, shame, isolation Emergency tools (decide in calm): Early-cue mindfulness (notice body first) Structured Time-Out (10 rules) : how to exit, where to go, how long, how to return Recovery Schedule to re-enter safely Step 7: ND – Trauma Impact (Loop Reset) Reality: Repetition hardens defenses and a failure narrative . What it looks like: “I’m the problem,” constant threat-scanning, distrust, depression/anxiety Living around the cycle instead of in relationship Support moves to stop the reset: Critical Time Apart (planned decompression, not punishment) Structured Exit Process during conflict to protect the bond Withdraw with reassurance (“I’m stepping away to calm, not to leave”) Committed re-engagement at a named time with a clear script Core Tools (Use Across the Cycle) Capacity & Energy Red/Yellow/Green Cards for bandwidth Spoon Theory for daily energy budgeting Communication & Safety W.I.N. Sharing + Response for hard topics (above) Structured Time-Outs (10 rules) for safe exits and returns Early-cue Mindfulness to spot escalation sooner Connection & Rhythm Relationship Schedule (predictable check-ins; low-demand time) Love List (small, specific actions that land for your partner) Critical Time Together (short, consistent, sensory-aware) Critical Time Apart (planned decompression) Recovery & Re-engagement Recovery Schedule after conflict Withdraw with reassurance Committed re-engagement at a specific time with a simple script The W.I.N. Tool Purpose: Clean, concrete communication that reduces overload and defensiveness. It has two sides: Sharing (speaker) and Response (listener). (From your handout.) 1) W.I.N. — Sharing (Speaker) When ____________________ (State your observations as facts —no judgments or mind-reading.) Example: “When I got home Wednesday, dishes were in the sink even though we agreed they’d be washed and put away.” I feel ____________________ (Name feelings, not accusations.) Example: “I feel disappointed, unsupported, and confused.” What I Need / would like to Negotiate is ____________________ (Make a specific, negotiable ask.) Example: “I need us to work better as a team and want to revisit how we share chores.” 2) W.I.N. — Response (Listener) Reflect the “When.” Show you heard the factual observation; use reflective listening . Validate the “I feel.” Example validation frame: “I can see how you’d feel disappointed and unsupported when you came home to unwashed dishes—that makes sense.” Be curious about the “N/Needs.” Ask open questions; invite options and shared problem-solving. Example: “Tell me more about what ‘better team’ looks like. What ideas do you have for chore-sharing?” Non-negotiables: Reflect → Validate → Curiosity (in that order). No fixing, defending, or counter-attacks during Response. The Good News If you change any of the steps above , the cycle begins to change . Pick two tools (W.I.N. + one scheduling or capacity tool) and practice them every day for four weeks . Consistency—not intensity—breaks the loop. Go deeper: To understand what keeps the cycle going, see Module 18, Underneath the Loop , part of our free Neurodiverse Couples Repair Program. Download Below: Trauma Cycle - Neurodiverse Couples -backup 8-12-22.pdf-2 .pdf Download PDF • 132KB Meet with our Client Care Coordinator Use our Trait Wheels to better understand your strengths and challenges: Autism Trait Wheel ADHD Trait Wheel AuDHD Trait Wheel

🌟 ADHD Isn’t a Deficit—It’s a Different Way of Focusing ADHD isn't about a lack of focus—it's about a focus that operates on its own unique terms. Your ADHD brain is wired to zero in on what excites and engages you, unleashing incredible creativity and drive. But this same strength can also make it challenging to tackle tasks that don’t spark your interest, leaving you (and your loved ones) frustrated and misunderstood. It’s time to rethink ADHD as both a powerful tool and a challenge, and... 🌟 ADHD Isn’t a Deficit—It’s a Different Way of Focusing ADHD isn't about a lack of focus—it's about a focus that operates on its own unique terms. Your ADHD brain is wired to zero in on what excites and engages you, unleashing incredible creativity and drive. But this same strength can also make it challenging to tackle tasks that don’t spark your interest , leaving you (and your loved ones) frustrated and misunderstood. It’s time to rethink ADHD as both a powerful tool and a challenge, and to understand how to harness its full potential. 🧠 The ADHD Nervous System: Unleashing Strengths and Overcoming Struggles The ADHD brain is a powerhouse of potential, driven by an interest-based system that can propel you to remarkable heights or present significant challenges depending on the task at hand. 🌟 The Strength: Hyperfocus and Creativity One of the most powerful aspects of ADHD is hyperfocus —the ability to become intensely absorbed in activities that captivate you. This laser-like focus can lead to extraordinary productivity, creativity, and problem-solving abilities. When your interest is piqued, your brain engages fully, allowing you to dive deep and excel in ways that others might struggle to achieve. 😴 The Struggle: Managing Mundane Tasks However, the same brain that excels in areas of passion can struggle with mundane, repetitive tasks . When a task lacks stimulation or personal relevance, it can feel nearly impossible to complete. This can lead to procrastination, avoidance, and a cycle of frustration where the inability to finish these tasks diminishes your sense of accomplishment and self-worth. 🥶 Another Struggle: Overwhelm and ADHD Paralysis Another significant challenge is ADHD paralysis —a state of overwhelm that occurs when faced with too many tasks or too much information. This mental shutdown can leave you feeling stuck, unable to move forward, and further exacerbates feelings of shame and inadequacy. By understanding these strengths and struggles, you can learn to navigate the challenges while leveraging the incredible potential that comes with your unique way of thinking. 🛠️ Therapeutic Interventions: Using NICUP and MEDS to Thrive In therapy, understanding that the ADHD nervous system is driven by interest allows us to develop strategies that not only manage symptoms but also harness the unique strengths of ADHD. Here’s how we approach it: 💥 NICUP: Aligning Tasks with Your Brain’s Natural Preferences NICUP stands for N ovelty, I nterest, C hallenge, U rgency, and P assion—elements that are key to engaging the ADHD brain effectively: Novelty : Incorporating new elements into routine tasks can keep your brain engaged and focused. We explore ways to introduce freshness into your daily routines. Interest : We help you connect your responsibilities with your personal interests, ensuring that even mundane tasks carry some level of engagement for you. Challenge : Transforming tasks into challenges or competitions can tap into your natural drive, making it easier to stay focused and complete them. Urgency : Creating realistic deadlines or adding time constraints can stimulate your brain’s need for urgency, helping you maintain momentum. Passion : We work to align your tasks with your core passions, ensuring that what you do feels meaningful and motivating. 🧘 MEDS: Building a Foundation for Mental Wellness While NICUP focuses on task engagement, MEDS — M indfulness, E xercise, D iet, and S leep—provides the foundation for overall mental wellness: Mindfulness : Practicing mindfulness helps you become aware of your thoughts and behaviors, enabling you to manage distractions and reduce shame-based thinking. Exercise : Regular physical activity is essential not just for your body but for your brain, helping to regulate mood, improve focus, and alleviate anxiety. Diet : A balanced diet supports brain function and energy levels, making it easier to maintain focus and manage ADHD symptoms effectively. Sleep : Quality sleep is critical for resetting your brain and preparing you for the challenges of the next day. We work on strategies to improve sleep hygiene, which can have a significant impact on your ability to manage ADHD. 💬 Addressing Shame and Self-Worth in Therapy ADHD isn’t just about focus; it’s also about the emotional toll that comes with it. Many adults with ADHD struggle with feelings of shame, inadequacy, and low self-worth because of the challenges they face in meeting expectations—whether their own or others'. In therapy, we work on: Building Self-Compassion : Recognizing that ADHD is not a flaw but a different way of processing the world. This shift in perspective is crucial for healing. Reframing Negative Thoughts : Helping you identify and challenge the negative self-talk that often accompanies ADHD struggles. Creating a Supportive Network : Encouraging connection with others who understand ADHD, so you don’t feel isolated in your experiences. ADHD isn’t about a lack of focus; it’s about focusing differently. The therapy we offer is not just any therapy—it’s specialized and deeply understanding because our therapists don’t just know ADHD clinically—they live it. Our team includes clinicians who are ADHD’ers themselves, bringing a wealth of lived experience to their practice. They understand the unique challenges you face because they’ve been there too. Through this specialized lens, we help you navigate challenges, build self-worth, and harness your unique strengths. Go deeper: When hyperfocus pulls you away from your partner, Module 26, Time Together and Apart , in our free Neurodiverse Couples Repair Program, helps you both plan around it. Warmly, Harry Motro Clinical Director, Neurodiverse Couples Counseling Center 📝 Take Charge: Screeners to Better Understand Your ADHD Understanding your ADHD is the first step toward managing it effectively. We invite you to take one or more of the following screening tools to gain deeper insight into your symptoms and how they impact your daily life: 🧠 Adult ADHD Self-Report Scale (ASRSv1.1) A commonly used self-assessment tool for adult ADHD, the ASRSv1.1 consists of 18 questions designed to help identify ADHD symptoms. ⚡ Barratt Impulsiveness Scale (BIS-11) This 30-question screener focuses specifically on impulsivity traits, helping you understand how impulsiveness affects your life. 📋 Structured Adult ADHD Self-Test (SAAST) The SAAST covers 21 questions about concentration, impulsiveness, disorganization, and hyperactivity, providing a broad overview of how these traits manifest. 🧩 Copeland Symptom List for Adult ADD If you’re more concerned with attention deficit rather than hyperactivity, this 63-question screener zeroes in on symptoms related to inattention. Taking these screeners can offer valuable insights and guide you in seeking further evaluation or support. 📊 Stats of the Week Did you know? Prevalence: Approximately 8.7 million adults in the U.S. have ADHD. 1. ADHD Statistics And Facts In 2024 – Forbes Health Underdiagnosis: Many adults with ADHD remain undiagnosed. Studies suggest that less than 20% of adults with ADHD are aware of their condition. 1. Adult attention-deficit/hyperactivity disorder (ADHD) - Symptoms and causes - Mayo Clinic 2. Adult ADHD: Statistics and Facts - WebMD Gender Disparity: While more men are diagnosed with ADHD, women are often overlooked due to differences in symptoms presentation. 1. ADHD in Women - WebMD Comorbidities: ADHD often co-occurs with other mental health conditions, such as depression, anxiety, and substance abuse. 1. Attention-Deficit/Hyperactivity Disorder in Adults: What You Need to Know - National Institute of Mental Health (NIMH) Impact on Work and Relationships: ADHD can significantly impact an adult's career, relationships, and overall quality of life. 1. Attention-Deficit/Hyperactivity Disorder in Adults: What You Need to Know - National Institute of Mental Health (NIMH) Treatment Effectiveness: Treatment, including medication and therapy, can be highly effective for managing ADHD symptoms and improving overall well-being. 1 1. Adult ADHD: Symptoms, Statistics, Causes, Types, and Treatments - WebMD Ready to Get Started? Tell us a little about yourself, and our client care team will match you with the neurodiverse specialist who's right for you. Get Started Use our Trait Wheels to better understand your strengths and challenges: Autism Trait Wheel ADHD Trait Wheel AuDHD Trait Wheel

Feel like you speak different languages? Learn why communication breaks down between autistic, ADHD and neurotypical partners, and how to finally be heard. Neurodiverse Communication TIP: Want answers fast? Check out our 📄 Quick Guide on Communication in Neurodiverse Relationships for key facts, FAQs , and why you should choose us. SPEAKING DIFFERENT LANGUAGES? Why do we feel like we are speaking different languages when we try to talk to each other? Do your partner's words sound like "blah blah blah...", where you are not really hearing each other ? What hijacks our ability to communicate effectively? Do your conversations sound like: Tammy: "Look at me when I talk to you." Tim: "I am trying to but you're not making any sense. You said to walk the dog as soon as I felt like it. I never felt like it." Tammy: "You know that the dog needs a walk every day." Tim: "But you never said that." Tammy: "I've said that a million times. You just don't listen." I don't know of ONE neurodiverse couple who doesn't fall into this type of communication trap.. The root issue is: "We don't see the world the way the world is...we see the world the way WE are". We will continue to miscommunicate until we become aware of our different COMMUNICATION STYLES. WHAT'S YOUR COMMUNICATION STYLE? The neurodiverse and neurotypical communication styles can be broken down as follows: Logical vs. Emotional Concrete vs Abstract Absolutist vs. Relative Avoidant vs. Insistent Furthermore, we send and receive information through the following filters : our expectations and stereotypes, our wounds or defensiveness, our past experiences, and our mood at the moment. It is clear that many powerful forces color the way we hear our partner and express ourselves. COMMUNICATION STRATEGIES Our therapists are equipped with special tools and strategies to support you as you learn to communicate across the neurodivide. Some of the common strategies include: RECOGNIZE PATTERNS WITHOUT BLAME As a result of communication style differences and personal filters (as mentioned above), every couple will eventually fall into unproductive communication patterns. The first step to work on the unproductive pattern is to take an honest look at the pattern WITHOUT blaming each other. We encourage the framework to be: the " couple versus the pattern" , as opposed to " me against you ". With this team approach, the couple will learn how to describe the pattern in a clear way so they both agree what's happening. Next, they learn to recognize when the pattern starts and how to pause together and notice it. And, then they commit to ways to change the pattern when it happens in real life. CREATE TIME TO PROCESS Autism Spectrum (AS) partners often require additional time to process the issue at hand, especially if change is associated with the topic. To lessen the impact of processing times, the couples should collaborate to lessen the pressure for a quick response. An example of this could include sharing topics in advance. Also, talk times should be scheduled so that each partner has the energy to fully engage in the conversation. BITE-SIZED CONVERSATIONS Neurodiverse couples often need structure in their communications. Although this may initially seem cumbersome, many couples save HUGE amounts of time over the long term by communicating well up front. An example of breaking communication into steps is as follows: understanding the other's point of view, exploring the other partner's point of view, being clear about the feelings involved, being clear about the goal or request, brainstorming options, agreeing to try an approach, reviewing how it went, and affirming each other's efforts throughout the process. STARTING WELL Neurodiverse couples do well to avoid criticism and defensive . To do so, before you jump into the content of the conversation, introduce your topic with: a clear statement of your intention to be constructive , and your commitment to place a higher importance on the relationship than individual issues. Agree that you will pause the conversation if one person feels criticized. If the criticism/defensiveness pattern happens, reassure the partner and address these feelings before resuming the talk about content. BE CLEAR ABOUT DESIRES Let go of the fantasy that your partner should read your mind. "Theory of Mind" is regularly over-estimated in a typical relationship and even more problematic in a neurodiverse one. We encourage you to think of a strong relationship as one where: each person knows what they need, each partner can express that need with kindness and clarity to the other partner, the other partner truly considers it, the other partner lets the person making the request KNOW that he/she considered it, and the other partner feels free to explore and negotiate the request and then say yes or no. PUT IT IN WRITING By the way, clarity is often served by putting thoughts and feelings in writing. Many couples find it helpful to write out your thoughts before a conversation and, after reflecting on those thoughts, read them to your partner. Also, it can be helpful to take notes when listening. FIND TIME TO TALK If you rarely talk to each other, we suggest that you turn your communication into a new set of "habits" . The couple can work together to systematically build conversation into your daily routine. This may start out feeling forced but, with practice, will begin to feel organic and rewarding. Begin this process by making small adjustments to your schedules. Block regular times on your calendar (every day). Find bits of downtime and commit to talking to each other. Don't do this too fast because that may lead you to feel overly discouraged by inevitable failures. Rather, go slow and have small successes that encourage you. Examples of "small" ways to communication include: Agree to 3-minute greetings when you depart in the morning (even if you are working in the same house and going to different rooms). Pick one meal per day and have each person initiate a conversation on a topic. Get up 10 minutes earlier than usual so you can share your plans for that day. If you watch TV together, after it ends, take 10 minutes to share your thoughts about the show. For 10 minutes before going to sleep, try some ‘pillow talk’ to share thoughts that are sitting with you as you end your day. NON-VERBAL COMMUNICATION There is a well-known quote that says: "Someone with Autism has taught me that love needs no words." In the midst of learning all the skills discussed above, please remember that there are many ways to love someone. We hope that you always remain open to all kinds of expressions of love and appreciation. DOUBLE EMPATHY PROBLEM The Double Empathy Problem is a concept that has been gaining more attention in recent years, particularly in relation to Autism Spectrum Disorder (ASD). It refers to the idea that both neurotypical individuals and autistic individuals may struggle to understand each other’s perspectives, leading to communication breakdowns and misunderstandings. ORIGINS The Double Empathy Problem was first proposed by Damian Milton, a researcher and autistic activist, in his 2012 paper “On the Ontological Status of Autism: The ‘Double Empathy Problem’”. Milton argued that the traditional approach to autism research and intervention, which focuses on identifying and treating deficits in autistic individuals, fails to take into account the role of social and cultural context in shaping communication and interaction. According to Milton, both neurotypical and autistic individuals have their own unique sets of social and communicative norms, and failure to understand and accommodate for these differences can lead to mutual misunderstandings. IMPLICATIONS FOR AUTISM The Double Empathy Problem has important implications for how we think about and approach autism. One of the key implications is that interventions that focus solely on changing autistic behavior and communication may not be effective in improving social interactions with neurotypical individuals. Instead, it may be necessary to work on improving understanding and accommodation of autistic communication styles and social norms by neurotypical individuals as well. Furthermore, the Double Empathy Problem challenges the traditional notion that autistic individuals are inherently deficient in social skills or empathy. Rather, it suggests that social communication difficulties may arise from a lack of mutual understanding and accommodation between individuals with different communication styles and norms. OUR APPROACH In order to address the Double Empathy Problem, we propose. These include: Increasing your awareness: Raising your awareness about the Double Empathy Problem and the unique communication styles and social norms of autistic individuals can help to improve understanding and accommodation by neurotypical partners Collaborative communication: Encouraging collaborative communication and co-construction of meaning, where both parties work together to create shared understanding, can help to bridge communication gaps and reduce misunderstandings. Neurodiversity acceptance: Embracing neurodiversity and recognizing the value of different communication styles and social norms can help to promote greater understanding and accommodation of our autistic partners. Go deeper: To turn the daily habits above into something that lasts, try Module 28, Staying Close , from our free Neurodiverse Couples Repair Program. GETTING STARTED We would love to create a safe place for you to break the painful patterns of the past and communicate in a new way. Please fill out our contact form and we will be glad to connect you with one of our team members. Meet with our Client Care Coordinator Use our Trait Wheels to better understand your strengths and challenges: Autism Trait Wheel ADHD Trait Wheel AuDHD Trait Wheel

A sex therapy session for neurodiverse couples on what sex is for, for each of you: three separate pulls, three reasons for sex, and your beliefs. Show the full module text Module 3 — What Sex Is For, for Each of You Hear what sex means to your partner, without a verdict. Watch first: the Module 3 video A narrated video of about 4 minutes in a layered paper-cutout style that opens and closes on the Neurodiverse Couples Counseling Center logo. It explores what sex is for, for each partner: cards for “Closeness,” “Stress Relief” and “Quiet Connection,” overlapping circles for sex drive, romantic love and the long-term bond, a “Societal Rules” collage, and circles moving from “Two Pictures” to “Shared Ground.” Couples appear at home and in video-call sessions with the therapist on a laptop, along with a “Sexual Beliefs Audit” checklist. Watch the Module 3 video: What Sex Is For, for Each of You (MP4, about 4 minutes). The written lesson below covers the same ground in full. One of you may reach for sex to feel close. The other may reach for it to unwind, or hardly reach for it at all and still feel deeply bonded. Many couples have never said out loud what sex is for, and each quietly assumes the other wants the same thing. What sex means to each of you Summary: what usually happens in the session 1 You each say what sex is for, for you. In your own words, with no right answer. 2 Your therapist describes three separate pulls. Sex drive, romantic love and the long-term bond, which can move apart. 3 You each name what brings you to sex. Sensation on your own terms, comfort, or play together. 4 You talk about what makes it safe enough to play. What helps each of you relax, and what puts you on guard. 5 You talk about where your ideas about sex came from. Family, culture, faith, friends, media, and years of masking. 6 You name what you share and where you differ. The overlap is your footing. The differences are the real conversation. 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 say what sex is for, for you Most people were not taught how to talk about what sex means to them. So your therapist often starts with one simple question, and asks each of you in turn. Answers vary a great deal. Feeling close. Feeling wanted. Release after a long day. Fun. Comfort. Some people say they are not sure, or that sex has mostly felt like an obligation. All of these are useful answers. You can write yours down first and read it out if that is easier. The opening question. What is sex for, for you? Not what it is supposed to be. What it actually is, or what you would like it to be. Curious, not right. There are no perfect words here, and your partner’s answer is not a correction of yours. Many couples are surprised by what they hear in these first few minutes. Step 2. Your therapist describes three separate pulls Researchers who study love describe three largely separate brain systems that draw people together.1 Sex drive is the wish for sexual contact and release. Romantic love is the “in love” pull toward one person. Attachment is the long-term bond, the sense of “we”. They are only partly connected. You can feel one without the others. A partner whose sex drive is low can still love you and feel deeply bonded. A partner with a strong drive is not necessarily asking for more love. Most long relationships draw on all three, in amounts that shift over the years. The levels are only an example. They shift with health, stress and life stage, so the same person can look different a year from now. In the figure: Three separate pulls drawn as three channels on a mixing desk: sex drive (wanting sexual contact and release), romantic love (the in-love pull toward one person) and attachment (the long-term bond). Each partner has a slider on each channel. In the example, Partner A's sex drive is low and attachment high; Partner B's are both high. If a drive has changed suddenly, your therapist may suggest a medical check as well, alongside therapy. Hormones, medications, sleep and health can all play a part, and Low Desire looks at this in detail. Three pulls. Which of these feels strongest for you right now? Has that changed since you first met? Step 3. You each name what brings you to sex Your therapist may describe three reasons people come to sex. The couples therapist Sue Johnson calls them sealed-off, solace and synchrony.2 In plain words: sex on your own terms, sex for comfort, and sex as play together. Most people move between all three over a week or a year, and a couple can be in different rows on the same night. In the figure: Why people come to sex: on your own terms (sealed-off), for comfort (solace), or to play together (synchrony). Playing together needs enough safety to take risks with each other. None of the three is wrong. Each has its place. Sex on your own terms can be healthy, including sex on your own, though it can also drift away from your partner. Some autistic people describe sex and touch as a way to calm and regulate,3 and that kind of comfort is real closeness. What we look for is whether playing together is possible for you as well, when you both want it. Naming your reasons. Think of the last few times. What brought you to it? Comfort, release, play, or something else? Step 4. You talk about what makes it safe enough to play Play needs safety: enough of it that taking a small risk with your partner feels possible. Taking a risk might mean saying what you like, trying something new, or letting your partner see you unmasked. Your therapist may ask each of you what helps you feel safe enough for that, and what puts you on guard. For many neurodivergent people the answers are practical. Knowing what to expect. Touch that does not arrive as a surprise. Being free to stim or go quiet without it being read as a rejection. A no that will not cost a day of silence. For a partner who has felt turned down, safety may mean knowing they are still wanted. If you do not feel safe. This conversation is about feeling at ease, not about danger. If either of you is afraid of the other, or sex has happened under pressure, tell your therapist on your own. Work on sex pauses while that is looked at. Step 5. You talk about where your ideas about sex came from Most adults carry beliefs about sex they never chose: from family, culture, faith, friends and media. Many neurodivergent people carry a second layer, often unnamed, about being too much or about hiding who they are in bed. Beliefs couples often bring. If my partner loves me, they should know what I want. If we have to plan it, it does not count. My sensory needs are too much to ask for. Going quiet during sex means I am not into it. Your therapist does not ask you to give any of these up in the session. The aim is to notice which ones are yours, and where they came from. Beliefs like these have the most power when they stay unspoken. Step 6. You name what you share and where you differ Toward the end, your therapist may invite you to put the two pictures side by side. Most couples find something sex is for, for both of them, even if it is small: a way back to each other after a hard week, or a place to laugh. One couple’s picture. Partner A says sex is mostly a way to feel close after time apart. Partner B says it is mostly a way to unwind, and that lying close without sex feels close too. What they share: both want it unhurried. Differences are not a verdict. One of you may value comfort and the other play. One may want predictability and the other surprise. The point is to understand each other, not to win. These differences are what the rest of this course helps you design around. Closing the session. What is one thing sex is for that you both want? We can build from there. After the session Your therapist may suggest one or both of two worksheets on our site. Each of you fills one in privately first. The Sexual Beliefs Audit lists common beliefs, inherited and neurodivergent, to mark agree, disagree or mixed. If you both want to, trade and read each other’s in silence, then each pick one belief you would like to change this year. The Sexual Values Sort asks each of you to rank 24 values, then compare your top six: where they overlap, and where they pull apart. Bring what you noticed to your next session. The gold pairs often lead to the most useful conversation, because neither of you may have known the other valued something so different. In the figure: Comparing your top six on the Sexual Values Sort : emotional safety and connection in both; predictability and wordlessness for Partner A pulling against spontaneity and verbal expression for Partner B. The workbook below is yours alone, for after the session. Many couples next look at How Neurodivergence Shapes Sex , which names what most often gets in the way. If this is hard to do. If this is too much right now, there is no need to push through. Spend some time with your partner talking about what makes it hard, and share what comes up: embarrassment, sadness about what sex has become, or worry that your answers will not match. That conversation is part of the work. Can my partner love me and still have a low sex drive? Yes. Researchers who study love describe three systems that draw people together: sex drive, romantic love and the long-term bond. They are only partly connected, so you can feel one without the others. A partner whose sex drive is low can still love you and feel deeply bonded. If a drive has changed suddenly, your therapist may suggest a medical check alongside therapy. Is it wrong to want sex mostly for comfort or release? No. Many people come to sex for one of three reasons: sensation or release on their own terms, comfort, or play together. None of the three is bad on its own, and most people move between them. Some autistic people describe sex and touch as a way to calm and regulate. Therapy looks at whether playing together is possible as well, when you both want it. What makes sex feel safe enough to enjoy together? Playing together happens when you feel safe enough to take risks with your partner, such as saying what you like or being unmasked. For many neurodivergent people that means knowing what to expect, touch that is not a surprise, freedom to stim or go quiet, and a no that will not cost a day of silence. If either partner is afraid, they can tell the therapist on their own. What if we want different things from sex? Differences are not a verdict on the relationship. One of you may value comfort and the other play, or one predictability and the other surprise. The aim is to understand each other, not to win. Many couples find at least one thing sex is for that they both want, and build from there. A worksheet such as the Sexual Values Sort can help you compare. Your workbook Your answers save to this device only - we cannot see a word of what you write. Fill this in on your own after the session. What sex is for, for me Answer these on your own, after the session. There are no wrong answers. Your answers stay on this device, so if you share it, your partner may be able to see them. Right now, sex is mostly for me about: — Feeling close, Feeling wanted, Comfort and calming down, Release or sensation, Play and fun together, Not sure yet Of the three pulls, which feels strongest for me right now? — Sex drive, Romantic love, The long-term bond, About even, Not sure Lately, what brings me to sex most often? — Sensation on my own terms, Comfort, Playing together, It has not been happening, Not sure How safe does it feel to take a risk with my partner, such as saying what I like? — Very safe, Fairly safe, Not very safe, Not safe at all Beliefs and common ground Write a line or two. If something here is about your safety, tell your therapist on your own. One belief about sex I picked up that I might like to change One thing I think sex could be for, for both of us 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 our clinical work with neurodiverse couples. They have not been tested in a formal trial. The ideas behind them come from three sources, none of which studied neurodiverse couples. The three pulls come from a paper by Helen Fisher and colleagues1 that proposes separate brain systems for sex drive, romantic attraction and attachment. It is a theory built on small brain-scanning studies and animal research, so it is a useful way of thinking rather than a settled fact about any one person. The three reasons people come to sex come from Sue Johnson’s book for couples,2 drawn from her Emotionally Focused Therapy. It is a clinical framework, not a research finding. The point about calming and regulating comes from a study of the written accounts of more than 120 autistic people.3 It shows the experience exists, not how common it is. 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. Clinically reviewed by Harry Motro, PsyD, LMFT · California LMFT #53452 · Founder and Clinical Director, Neurodiverse Couples Counseling Center · Clinical supervisor · Updated October 7, 2026 Peer-reviewed research 1. Fisher HE, Aron A, Brown LL (2006) Romantic love: a mammalian brain system for mate choice. Philosophical Transactions of the Royal Society B: Biological Sciences, 361(1476), 2173-2186 . https://doi.org/10.1098/rstb.2006.1938 A review proposing three brain systems for reproduction: the sex drive, romantic attraction and attachment, each linked with its own chemistry, which can act together or independently. It draws on brain-imaging studies of people in love and recently rejected, alongside animal and behavioral research. Limitation: a theoretical synthesis built on small imaging samples (17 people in love, 15 recently rejected) and animal work; not a study of couples or of neurodivergent people. 3. Gray S, Kirby AV, Holmes LG (2021) Autistic narratives of sensory features, sexuality, and relationships. Autism in Adulthood, 3(3), 238-246 . https://doi.org/10.1089/aut.2020.0049 Qualitative analysis of publicly available narratives from 5 books and 13 online forums (72 usernames) plus 49 survey responses, over 120 autistic people in total, coded deductively against Dunn's model of sensory processing and inductively for further themes. Touch, sight, sound and smell shaped sexual experience in both positive and negative ways; some described distress at particular sensations, others sought more intense sensation or used intimacy to calm and regulate; strategies included talking with partners and using substances to dull sensation. Limitation: qualitative and self-selected; cannot say how common any pattern is. Clinical sources and public data 2. Johnson SM (2008) Hold Me Tight: Seven Conversations for a Lifetime of Love. Little, Brown and Company, New York . https://www.hachettebookgroup.com/titles/dr-sue-johnson/hold-me-tight/9780316113007/ A book for couples based on Emotionally Focused Therapy. It describes three kinds of sex: sealed-off (focused on sensation, with emotion shut away), solace (seeking reassurance of being loved and desirable) and synchrony (two people who feel safe and seen, coming together in play). This module puts these in plain words. Limitation: a clinical framework written for the public, not a research finding; the three kinds have not been tested as categories. Further reading • Neurodiverse Couples Counseling Center (2026) Sexual Beliefs Audit. Practice materials, Neurodiverse Couples Counseling Center . https://www.neurodiversecouplescounseling.com/worksheets/sexual-beliefs-audit The practice's worksheet of inherited and neurodivergent-specific beliefs about sex, each marked agree, disagree or mixed; partners fill it in privately, trade and read in silence, and each pick one belief to change this year. Limitation: a clinical tool developed in use, not a validated instrument. • Neurodiverse Couples Counseling Center (2026) Sexual Values Sort. Practice materials, Neurodiverse Couples Counseling Center . https://www.neurodiversecouplescounseling.com/worksheets/sexual-values-sort The practice's worksheet of 24 sexual values, ranked by each partner and compared for top-six overlaps and mismatches. Limitation: a clinical tool developed in use, not a validated instrument. Find out what sex means to each of you The Neurodiverse Couples Counseling Center works with couples where one or both partners are autistic, ADHD or AuDHD, including on sex, desire and touch. We help each of you say what sex is for, hear your partner without a verdict, and build from what you share. Therapy for clients in California, coaching worldwide, all by telehealth. A first conversation costs nothing. Talk with our team Up next Module 4 — How Neurodivergence Shapes Sex All 24 modules in The Neurodiverse Sex Therapy Program

As a therapist deeply immersed in the intricate dynamics of neurodiverse relationships, I've often found myself in the middle of the age-old debate: What holds more value, facts or feelings? 🤔 Picture this: one partner, with a furrowed brow, insists, "The facts clearly show I'm right! You are completely overreacting! You shouldn't feel that way." 😠 While the other, with a sigh of frustration, counters, "But you're missing how all this makes me feel, which is just as important." 😞... As a therapist deeply immersed in the intricate dynamics of neurodiverse relationships, I've often found myself in the middle of the age-old debate: What holds more value, facts or feelings? 🤔 Picture this: one partner, with a furrowed brow, insists, "The facts clearly show I'm right! You are completely overreacting! You shouldn't feel that way." 😠 While the other, with a sigh of frustration, counters, " But you're missing how all this makes me feel, which is just as important." 😞 This isn't just an argument; it's a vivid illustration of two fundamentally different ways of experiencing the world, each with its own language, trying desperately to be heard and understood. 🗣️ The Deep Roots of Emotions 🌱 A deeper dive into the nature of feelings reveals that they are often rooted in past experiences rather than the present moment. This is particularly true for individuals who have endured trauma. For them, current events can act as triggers, invoking disproportionate emotional responses that seem incongruent with the actual situation. It's akin to a geological fault line; when the present bumps against this line, it causes tremors that reverberate through our being, manifesting as intense emotions. Understanding an Outsized Reaction 😲😡😥😖 This understanding of emotions sheds light on why we might react strongly to certain situations that, to our partner, might seem minor. It's NOT the present circumstance that's solely responsible for our feelings; instead, it's our past experiences casting long shadows over our current perceptions. This shift from present to past can lead us to erroneously believe that, if only our partner would change, our emotional turmoil would subside. However, the key to mitigating these disproportionate reactions lies in having compassion for the underlying trauma, thereby recalibrating our emotional responses to better match the realities of the present. The Autistic Mistake: Dismissing Emotions ❌🧠 Unfortunately, autistic partners often make the mistake of arguing facts over feelings . The wiser path is acknowledging the reality and significance of feelings, while setting facts aside for the moment. Emotions are indicators, messengers that convey important insights about our inner world and our relationships. The Allistic Mistake: Equating Emotions to Truth ❌🔮 On the other hand, the mistake that an allistic partner makes is to elevate these feelings to the status of incontrovertible truths , allowing them to unjustifiably indict others or dictate our actions. This misstep can lead us down a path of misunderstanding and conflict, both with ourselves and others. Take a Pause: From Primal to Thoughtful Response ⏸️💡 One of the most effective strategies for navigating emotional triggers is the practice of pausing before reacting . This pause, a moment of intentional breath and reflection, allows us to move from a primal, reactive state to one of thoughtful response. It signals to our body that we are safe, enabling us to engage the more rational parts of our brain. Learning to pause and respond rather than react can result in a monumental shift for a couple. Feelings are Essential, Not Truth 💖 Feeling our feelings is essential. Resisting or denying them as an individual or a couple only amplifies their intensity and can lead to greater internal turmoil. Feelings are transient energies, constantly in flux. By allowing them to flow through us, they lose their power to overwhelm. Yet, remembering this truth can be challenging in moments of acute emotional distress. Ultimately, honoring our feelings while also recognizing that they are not infallible truths is a delicate balance to achieve. Feelings provide valuable insights into our emotional landscape, but they must be interpreted with caution and context, particularly when they stem from past traumas. Go deeper: In our free Neurodiverse Couples Repair Program, Module 19, Impact and Intent , shows how to let a feeling be heard before anyone argues the facts. Neurodiverse Couples Counseling 🤝 For neurodiverse couples grappling with facts and feelings, the support of a neurodiverse couples specialist can be an invaluable step towards healing and equilibrium. In doing so, we learn not only to honor our feelings but also to ensure they serve us in constructive ways, guiding us toward healthier, more informed choices in our lives. Click Here To Match With An Expert With heartfelt guidance and support, Harry Dr. Harry Motro, LMFT, PsyD Dr. Motro is a registered Marriage and Family Therapist #53452 and the Founder/Clinical Director of the Neurodiverse Couples Counseling Center. Ready to Get Started? Tell us a little about yourself, and our client care team will match you with the neurodiverse specialist who's right for you. Get Started Take an ASD/ADHD Screener Are you curious about whether or not you have autism/ADHD? Want to learn more about yourself and take the first step towards deeper self-understanding? We invite you to visit the Adult Autism Assessment Site and Take An ASD/ADHD Screener Use our Trait Wheels to better understand your strengths and challenges: Autism Trait Wheel ADHD Trait Wheel AuDHD Trait Wheel

When one child is diagnosed with autism or ADHD, families often start seeing patterns everywhere. The Genetic Ripple Effect explains why neurodivergent traits cluster across generations and what those percentages really mean. By Harry Motro Clinical Director, Neurodiverse Couples Counseling Center c Does autism run in families If you’ve ever watched a “hot take” about autism and felt your stomach tighten—because none of it matches your real life —you’re not imagining things. Because here’s the real-world problem: People argue i dentity vs. disability like it’s a team sport, while you’re over here trying to get through your day without burning out, melting down, shutting down, or feeling like you’re failing at “basic” life. That’s why I’m starting with a short TikTok from Ashley Kang , our autism advocate at She Rocks The Spectrum (part of our family of websites). TikTok link: https://www.tiktok.com/@sherocksthespectrum/video/7610263393840172301 If you’ve ever heard people argue, “Autism isn’t a disability—it’s an identity.” Then someone else fires back, “No, it’s definitely a disability.” Without realizing it, a lot of the fight is people using the same word, “disability,” to mean completely different things. Some people hear disability and think: broken, defective, less-than . Other people mean: a real limitation in daily life that deserves support, accommodations, and legal protection. Those are not the same idea. And when we mash them together, we get a loud, exhausting debate that doesn’t actually help autistic people live better. Why this question matters in real life This isn’t just philosophy. The identity vs. disability question can shape: whether you feel shame or self-respect whether you ask for accommodations or try to “push through.” whether therapy becomes “make me normal” or “help me build a life that fits me.” whether you feel understood by partners, family, employers, and even clinicians So let’s clean this up and make it useful. The three big ways people think about disability 1) The medical model This view tends to locate the “problem” inside the person and focuses on fixing or reducing symptoms. Sometimes that’s helpful (especially when someone is suffering and wants concrete support). Sometimes it turns into, “You should be more normal,” which is where shame and masking explode. 2) The social model The social model says: people are often “disabled” by barriers in society—systems, expectations, environments—not just by what’s happening inside their bodies or brains. That rings true for autism in a lot of everyday situations: offices built for constant small talk and open-floor noise schools that punish movement, stimming, or different learning styles workplaces that reward “looking confident” over being clear and accurate The social model is powerful because it points the spotlight at the world: “Maybe the environment is the problem.” 3) The biopsychosocial model (the “both/and” model that actually works) This approach says functioning and disability come from an interaction between the person and the environment. The WHO’s ICF framework spells this out directly: disability and functioning happen in context, and environmental factors matter. In plain English: Sometimes the world is the problem. Sometimes your nervous system is having a hard day, no matter how kind the world is. Often it’s both. And you don’t have to pick a team. So… is autism an identity or a disability? For many people, it’s both. Autism as identity Identity is about meaning: “This is how my brain works.” “This is part of who I am.” “I’m not going to treat my existence like a defect.” That can be deeply stabilizing—especially for late-diagnosed adults who spent years thinking they were “too much,” “too sensitive,” “lazy,” or “bad at life.” Autism as disability Disability, in the practical sense, is about impact: sensory overload that wipes you out communication mismatches that cost relationships or jobs executive function differences that make daily life feel like pushing a boulder uphill And here’s the key: calling something a disability doesn’t have to mean “I hate myself.” It can mean, “This is real, it affects my life, and I deserve support.” Advocacy groups like ASAN explicitly hold this stance: autism is a developmental disability, and disability is a natural part of human diversity. A hard truth people skip: society isn’t the only source of pain Sometimes the pro-social model accidentally implies: “If society accommodated perfectly, autistic people wouldn’t struggle.” That’s not always true. Many autistic people deal with sensory pain , shutdowns, sleep problems, burnout, inertia, or anxiety even in supportive environments. The environment matters hugely—but it’s not magic. (This is one reason the ICF “interaction” model is more realistic.) Language: “autistic person” vs “person with autism” Here’s the simplest version: There is no single “correct” choice that everyone agrees on. Research consistently shows preferences differ by group and culture. In a U.S. sample of autism stakeholders, autistic adults largely preferred identity-first language (“autistic person”), while professionals leaned more person-first. In a large Dutch sample, most autistic adults and parents preferred person-first language (“person with autism”). More broadly, disability-language preference varies across conditions and demographics, which supports a client-centered “ask and mirror” approach. What to do with this: Use the language that feels right to you. And if you’re in therapy, you get to tell your therapist what you prefer. Disability isn’t just a label—it’s also an access category In the U.S., disability status can unlock protections and accommodations. The ADA’s plain-language definition includes: an impairment that substantially limits major life activities, a record/history of that impairment, or being regarded as having it. That means for some people, embracing “disability” isn’t negative—it’s self-advocacy. It can sound like: “I’m not failing. I need accommodations.” “I’m not weak. This is a protected access need.” “I’m not dramatic. This is a real nervous-system limit.” Masking: why this debate gets emotional fast Many autistic people have spent years masking —studying social rules, forcing eye contact, copying tone, suppressing stims, performing “fine.” Masking can help someone survive… and also quietly wreck them. A review on stigma and camouflaging describes how these pressures can shape mental health outcomes and identity experience for autistic people. So when someone says, “Autism isn’t a disability,” an autistic person who’s exhausted might hear: “Then why are you struggling? You shouldn’t need support.” And when someone says, “Autism is a disability,” another autistic person might hear: “You’re defective. Try harder to be normal.” Both reactions make sense if you’ve lived either version. Two common traps (and how to avoid them) Trap 1: Romanticizing autism This is when “identity” talk turns into: “It’s just a difference! Everything’s fine!” That can erase real pain, burnout, and support needs—especially for people with higher support needs or additional diagnoses. Better: pride + realism. You can honor strengths without pretending it’s easy. Trap 2: Pathologizing autism This is when “disability” talk becomes a deficit list. That can reinforce shame and pressure to conform. A neurodivergence-informed therapy stance explicitly pushes back on default normalization and centers well-being and fit rather than “make you normal.” Better: support without shame. Treat needs as needs, not moral failings. How to use a “both/and” stance in your life (practical) Here are a few questions that actually help: When do I feel proud to be autistic? (What parts feel like “me,” not a problem?) Where do I feel genuinely limited or drained? (Not “should,” not “lazy,” just real-world impact.) Which parts are environment mismatch? (Noise, pace, social expectations, transitions, unclear instructions.) Which parts feel intrinsic to my nervous system? (Sensory sensitivity, shutdown patterns, cognitive fatigue, inertia.) What supports would reduce suffering the most? (Accommodations, routines, communication changes, relationship agreements, workload changes.) What’s my language preference right now? (It can change over time. You’re allowed.) What we aim for in therapy Good therapy for autistic clients (and autistic/allistic couples) shouldn’t force you into a box. The goal isn’t “identity-only” or “disability-only.” The goal is: self-understanding without self-hate support without infantilizing skill-building without erasing your neurology A life that fits your brain more often than it fights it Go deeper: In our free Neurodiverse Couples Repair Program, Module 13, What the Labels Were Describing , helps you set down old labels, and Module 16, Who I Am, in My Own Words , helps you tell your partner how you work. Get an Accommodation Letter Take the Sensory Profile Start the Self-Discovery Screener Harry Motro Clinical Director, Adult Autism Assessment Center, Neurodiverse Couples Counseling Center © 2025 New Path Family of Therapy Centers Inc. All rights reserved. No portion of these statements may be reproduced, redistributed, or used in any form without explicit written permission from the New Path Family of Therapy Centers. Want to learn more about yourself? Explore our sister site, Adult Autism Assessment , and take a deeper dive into your journey of self-discovery. Click the links below to get started! Autism Screeners ADHD Screeners Tests Related to Autism & ADHD General Screeners Resources & Further Reading Oliver, M. (1990). The Individual and Social Models of Disability. World Health Organization. International Classification of Functioning, Disability and Health (ICF). Rivera, R. A., & Bennetto, L. (2023). Applications of identity-based theories to understand the impact of stigma and camouflaging on mental health outcomes for autistic people. Frontiers in Psychiatry, 14 , 1243657. Taboas, A., Doepke, K., & Zimmerman, C. (2023). Preferences for identity-first versus person-first language in a US sample of autism stakeholders. Autism, 27 (2), 565–570. Buijsman, R., Begeer, S., & Scheeren, A. M. (2023). ‘Autistic person’ or ‘person with autism’? Person-first language preference in Dutch adults with autism and parents. Autism, 27 (3), 788–795. Grech, L. B., Koller, D., & Olley, A. (2024). Person-first and identity-first disability language: Informing client centred care. Social Science & Medicine, 362 , 117444. Autistic Self Advocacy Network. What We Believe. U.S. Department of Justice. Introduction to the Americans with Disabilities Act. Chapman, R., & Botha, M. (2023). Neurodivergence-informed therapy. Developmental Medicine & Child Neurology, 65 (3), 310–317. Use our Trait Wheels to better understand your strengths and challenges: Autism Trait Wheel ADHD Trait Wheel AuDHD Trait Wheel

What switches desire off, what turns it on, and the brakes that come with autism and ADHD: a sex therapy session for neurodiverse couples. Show the full module text Module 15 — Brakes and Accelerators Ease what switches desire off before adding anything new. Watch first: the Module 15 video A narrated video of about four minutes in a soft 3D paper-craft style in lavender and mint that opens and closes on the Neurodiverse Couples Counseling Center logo. It explains the “Dual Control Model” as a gauge with brake and accelerator controls, then lists “Neurodivergent Brakes” such as masking all day, a full sensory tank, and demands and friction. A couple meets their therapist on a video call, writes private lists at home, reads them together, and picks one brake to ease and one accelerator to add. Watch the Module 15 video: Brakes and Accelerators (MP4, about 4 minutes). The written lesson below covers the same ground in full. One of you has been reading about how to bring the spark back: candles, a weekend away, something new to try. The other knows the trouble is not a lack of anything exciting. It is the phone, the open argument, the day spent holding it together. This module walks through a session where you each list what turns desire on and what shuts it down. What turns desire on, and what shuts it down Summary: what usually happens in the session 1 Your therapist explains the two lists. What speeds desire up, and what slows it down or shuts it off. 2 You each list what slows your desire down. Privately, in writing: stress, pressure, pain, a busy mind. 3 You add the brakes that come with neurodivergence. Masking, a full sensory tank, shutdown, an ask that feels like a demand. 4 You each list what speeds your desire up. Including the ones standard advice rarely names, such as knowing the plan. 5 You read each other’s lists, brakes first. Then your therapist asks what surprised you. 6 You choose one brake to ease and one accelerator to add. The smallest and most concrete of each, agreed by both of you. 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. Your therapist explains the two lists Your therapist may start with a simple idea. Desire responds to two separate things. One is what turns you on, which speeds it up. The other is what turns you off or shuts you down, which slows it. Sex researchers call this the dual control model.1 A popular book for general readers explains it as brakes and accelerators, the words this session uses.2 What sits on each pedal differs from person to person, so two partners rarely have the same things on theirs. In the figure: Desire drawn as two pedals, like those in a car. The brake slows desire (for example stress, or a full sensory tank); the accelerator speeds it up (for example feeling close, or knowing the plan). The brake is held down, and while it is, pressing the accelerator harder does little. The Brakes & Accelerators worksheet has the full lists. Many couples start by adding more. When desire fades, the usual advice is a new place, a new outfit, more romance. In our work, the bigger change usually comes from easing a brake. Pressing harder on the accelerator does little while the brake is on. The two lists. Let’s not ask what is wrong with your desire. Let’s ask what turns it on for each of you, and what keeps switching it off. Step 2. You each list what slows your desire down Your therapist may ask each of you to jot down your own brakes on paper, privately, without looking at your partner’s. It helps to be specific. “I’m just stressed” says less than “work email on my phone at ten at night”. Your therapist may name some common brakes to jog your memory. Stress, tiredness or hunger. An argument that never got finished. Feeling rushed, or pressure to perform or to finish. Worry about your body, or about your partner’s pleasure. Watching yourself from the outside instead of feeling what is happening. Messages about sex you grew up with. Pain is a brake that needs a doctor too. If sex hurts, or if desire, arousal, erections or orgasm have changed suddenly, your therapist will usually suggest seeing a doctor as well. Some medications can also lower desire, and that is a question for whoever prescribed them. A medical check runs alongside therapy, not instead of it. Some problems need a specialist, such as a pelvic floor physical therapist, and your therapist will help you decide. Finding your brakes. Think of the last time you wanted to be close and then didn’t. What got in the way? Step 3. You add the brakes that come with neurodivergence Most lists of brakes were written for neurotypical bodies. So your therapist may go through a second set, the ones that often come with autism or ADHD. In our experience these tend to be the heaviest, and the least often said out loud. A partner who is not autistic or ADHD may recognize few of these, which is one reason to say them out loud. In the figure: Brakes that often come with neurodivergence: masking all day; a full sensory tank; shutdown; an ask that feels like a demand; being pulled out of deep focus; touch you did not expect. The Sexual Brakes worksheet has a page of these. Shutdown is not rejection. A partner in shutdown can look cold or far away. Usually they have simply run out of capacity. Saying so turns a silent no into information you can both use. Being asked can be the brake. For some people, even a kind invitation turns sex into a demand, and the wanting switches off. That is about how their nervous system meets pressure. It is not a judgment of the person who asked. Some people also expect to be turned down or criticized, and that fear is louder than desire. This is sometimes called rejection sensitivity. It is a description, not a diagnosis, and When “No” Lands Hard goes further into it. Masking and switching over are the subject of Energy, Masking, and the Onramp , and the senses of Your Sensory Map . Here you only mark which brakes are yours. Step 4. You each list what speeds your desire up Next comes the other list, again privately. Common accelerators include feeling close earlier in the day, a calm body that is rested and fed, a slow build-up without pressure, and feeling safe to say no. Some people like anticipation. Others like a surprise, within limits you have agreed. Accelerators standard advice rarely names. Knowing the plan. Predictability is not unsexy. For many, it is permission. Written words. A note or an agreed phrase, instead of an ask in the moment. One thing at a time. One sense, or one area of the body, at once. Room to be yourself. Permission to stim, make sound, move or be still, without performing. In autistic people’s own accounts, touch, sight, sound and smell made sex better for some and worse for others.3 So one person’s brake can be another’s accelerator. In our experience, a strong interest can work either way too: for some it pulls attention away, for others a story or setting they love draws them in. Exact words help. If a kind of touch is on your list, “soft” or “gentle” tells your partner very little. Your therapist may ask where, how firm and how slow. Plain words are fine. Nobody needs to be poetic. Step 5. You read each other’s lists, brakes first Now you swap lists, or read them out in turn. Your therapist usually suggests starting with the brakes, because that side tends to hold the bigger surprises. Try to take in your partner’s list before asking or explaining anything. It can sting to find something you do on your partner’s brake list, such as the way you reach for them or the hour you usually ask. That is news about what slows their body down. It is not a verdict on you, and the care behind what you did still counts. If one of you has a much longer brake list, that is common too, and it says nothing about who cares more. A brake is a condition you can change, not a flaw in either of you. After reading. Which of your partner’s brakes did you not know about? And which one feels easiest for you to help with? Step 6. You choose one brake to ease and one accelerator to add From your two sets of lists, you choose together one brake to ease and one accelerator to add. Your therapist will often steer you to the smallest, most concrete of each: phones charging in another room, a hard conversation moved out of the bedroom, a note in the morning instead of a question at night. The morning note fits both lists: for Partner A it is a note, not a question, and it lets Partner B feel chosen. In the figure: One couple's lists. Partner A's brakes: phone buzzing in bed, being asked then waiting, masking all day; accelerators: knowing the plan, a note not a question, one touch at a time. Partner B's brakes: feeling rushed, a fight left open, bright lights; accelerators: feeling chosen, time to talk first, a firm back rub. Chosen for the week: phones charge in the kitchen, and a morning note about tonight. The goal is not more sex. Easing a brake makes closeness easier to reach. Either of you can still say no on any evening, and the change has still done its job. Two yeses, and a safe no. Anything you try at home is something you have both agreed to here first, at the pace of whichever of you needs it slower. These tools are for relationships where both of you can say yes, no, wait or stop without being punished for it. If sex has happened under pressure, or if either of you is afraid of the other, tell your therapist on your own. The work on sex pauses while that is looked at. Choosing. What is the smallest brake we could ease this week? And what is one accelerator you would like to ask for? After the session The Brakes & Accelerators worksheet on our site has the full lists and four questions to talk over once you have compared. If you want to go deeper, Sexual Brakes and Sexual Accelerators each have a page for the ones that come with neurodivergence. If a kind of touch is on your list, Pleasure Mapping helps you find words for where and how. Fill in your own copy privately. You decide what, if anything, to share. Try the two changes you chose, and notice what happens, without grading it. Brakes shift with stress, health and the seasons of life, so many couples look at their lists again after a month: what lifted, and what is still there. The workbook below is for after the session, on your own first. If this is hard to do. If this is too much right now, there is no need to push through. Spend some time with your partner talking about what makes it hard. It might be hurt at seeing yourself on your partner’s brake list, embarrassment at naming what turns you on, or discouragement at how long one list is. That conversation is part of the work. Why does adding romance not fix low desire? Desire responds to two separate lists: what speeds it up and what slows it down or shuts it off. When desire fades, the usual advice is to add something new. In our work, the bigger change usually comes from easing a brake, such as stress, an open argument or pressure to perform. Pressing harder on the accelerator does little while the brake is on. What sexual brakes come with autism or ADHD? Many are rarely named in standard advice: masking all day, a sensory tank that is already full, shutdown, an invitation that feels like a demand, being pulled out of deep focus, and touch you did not expect. In our experience these tend to be the heaviest brakes. A partner in shutdown can look cold, but usually they have simply run out of capacity. What turns desire on for neurodivergent people? Common accelerators include feeling close earlier in the day, a calm body and feeling safe to say no. Some that standard advice rarely names are knowing the plan ahead, a written note instead of an ask in the moment, one sense or one area of the body at a time, and room to stim, move or be still without performing. What if I am on my partner's list of brakes? It can sting to find something you do on your partner's brake list, such as the way you reach for them or the hour you usually ask. That is news about what slows their body down, not a verdict on you, and the care behind what you did still counts. A brake is a condition you can change, not a flaw in either of you. Your workbook Your answers save to this device only - we cannot see a word of what you write. Fill this in AFTER the session, on your own first. My lists, after the session Answer these on your own first. Your answers stay on this device, so if you share it, your partner may be able to see them. Pick the closest option even if none is exact. Which kind of brake is heaviest for me right now? — Stress or tiredness, The senses, Masking or shutdown, Pressure or feeling rushed, A busy mind, Something between us, Pain or my body, Not sure Did my partner already know about my biggest brake? — Yes, Partly, No, I have not told them yet What surprised me more on my partner's lists? — Their brakes, Their accelerators, Neither, We have not compared yet Did I name an accelerator that standard advice rarely mentions? — Yes, No, Not sure What we chose, and how it went Fill in the first two after the session. Come back to the last one after you have tried the changes. The one brake we agreed to ease The one accelerator we agreed to add What I noticed when we tried them 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 our clinical work with neurodiverse couples and from our worksheets. They have not been tested in a formal trial. The idea that easing a brake often helps more than adding an accelerator is our clinical observation. Nagoski makes the same argument, but it has not been tested as a treatment. The dual control model was set out by Erick Janssen and John Bancroft.1 It describes sexual response as a balance between two separate systems, one that excites and one that inhibits, which differ from person to person. Their chapter reviews questionnaire and laboratory research with volunteers. It did not study couples or autistic and ADHD adults, and it did not test easing brakes as a treatment. Emily Nagoski’s book2 explains the same model for general readers as brakes and accelerators. It is popular science, not a study. The accounts of sex and the senses come from autistic people writing in five books, on online forums and in answers to a survey.3 They show that the same sensation can help or hinder, but not how common each experience is. 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. Clinically reviewed by Harry Motro, PsyD, LMFT · California LMFT #53452 · Founder and Clinical Director, Neurodiverse Couples Counseling Center · Clinical supervisor · Updated October 7, 2026 Peer-reviewed research 1. Janssen E, Bancroft J (2007) The dual control model: The role of sexual inhibition and excitation in sexual arousal and behavior. In E. Janssen (Ed.), The Psychophysiology of Sex (pp. 197-222). Indiana University Press, Bloomington . https://iupress.org/9780253348982/the-psychophysiology-of-sex Book chapter setting out the dual control model: sexual arousal and behavior depend on the balance between a sexual excitation system and a sexual inhibition system, which vary between individuals. The academic source the /sex page gives for brakes and accelerators. Limitation: a theoretical review of questionnaire and laboratory research with volunteers; not a study of couples or of autistic or ADHD adults, and not a treatment trial. 3. Gray S, Kirby AV, Holmes LG (2021) Autistic narratives of sensory features, sexuality, and relationships. Autism in Adulthood, 3(3), 238-246 . https://doi.org/10.1089/aut.2020.0049 Qualitative analysis of publicly available narratives from 5 books and 13 online forums (messages from 72 usernames) plus 49 answers to an open-ended survey question, coded deductively against Dunn's model of sensory processing and inductively for further themes. Touch, sight, sound and smell shaped sexual experience in both positive and negative ways; some described distress at particular sensations, others sought more intense sensation or used intimacy to calm and regulate; strategies included talking with partners and using substances to dull sensation. Limitation: qualitative and self-selected; cannot say how common any pattern is. Clinical sources and public data 2. Nagoski E (2015) Come as You Are: The Surprising New Science That Will Transform Your Sex Life. Simon & Schuster, New York . https://openlibrary.org/isbn/9781476762098 A book for general readers that translates the dual control model into sexual brakes and accelerators, and argues that sexual difficulties more often come from too much hitting the brakes than from too little reaching the accelerator, so reducing what hits the brakes matters as much as adding stimulation. Limitation: popular science, not a study; written mainly with women in mind. Further reading • Neurodiverse Couples Counseling Center (2026) Brakes & Accelerators. Practice materials, Neurodiverse Couples Counseling Center . https://www.neurodiversecouplescounseling.com/worksheets/brakes-accelerators The practice's worksheet for listing what slows desire down and what speeds it up, filled in privately, compared brakes first, and ending with one brake to remove and one accelerator to add. Limitation: a clinical tool developed in use, not a validated instrument. • Neurodiverse Couples Counseling Center (2026) Sexual Brakes. Practice materials, Neurodiverse Couples Counseling Center . https://www.neurodiversecouplescounseling.com/worksheets/sexual-brakes The practice's deeper worksheet on brakes, with a page of brakes that often come with neurodivergence and a removal plan. Limitation: a clinical tool developed in use, not a validated instrument. • Neurodiverse Couples Counseling Center (2026) Sexual Accelerators. Practice materials, Neurodiverse Couples Counseling Center . https://www.neurodiversecouplescounseling.com/worksheets/sexual-accelerators The practice's deeper worksheet on accelerators, starting with the ones that often come with neurodivergence (predictability, written communication, one channel at a time, sensory accommodations, unmasked safety). Limitation: a clinical tool developed in use, not a validated instrument. • Neurodiverse Couples Counseling Center (2026) Pleasure Mapping. Practice materials, Neurodiverse Couples Counseling Center . https://www.neurodiversecouplescounseling.com/worksheets/pleasure-mapping The practice's worksheet for building exact words for what touch feels good, and where, filled in privately and then shared. Limitation: a clinical tool developed in use, not a validated instrument. Find the brakes, together The Neurodiverse Couples Counseling Center helps couples where one or both partners are autistic, ADHD or AuDHD find what turns desire on and what shuts it down, including the brakes standard advice rarely names. Nothing sexual happens in our sessions. Therapy for clients in California, coaching worldwide, all by telehealth. A first conversation costs nothing. Talk with our team Up next Module 16 — Aftercare and Repair All 24 modules in The Neurodiverse Sex Therapy Program

Behind the Mask in Neurodiverse Relationships 🎭 Do you wear a mask? Let's be honest, these days we all wear masks. We put on a certain face for the world as we feel the tension of fitting in. For people on the autism spectrum, this tension gets cranked up to the max. Picture this: You're at a party – the music's pumping, laughter fills the air. Mary, who is neurotypical, moves with ease, her personality shining through. 💃 Meanwhile, John, who is autistic, navigates this social maze with a... Behind the Mask in Neurodiverse Relationships 🎭 Do you wear a mask? Let's be honest, these days we all wear masks. We put on a certain face for the world as we feel the tension of fitting in. For people on the autism spectrum, this tension gets cranked up to the max. Picture this: You're at a party – the music's pumping, laughter fills the air. Mary, who is neurotypical, moves with ease, her personality shining through. 💃 Meanwhile, John, who is autistic, navigates this social maze with a rehearsed grace, each smile and nod meticulously planned to camouflage his true self. 🥸 This effort, a profound act of 'masking', isn't just for tonight but is a constant presence, draining John's energy and straining the couple's connection. If left unchecked, this dynamic could threaten the very foundation of their relationship. What does it mean to mask oneself? 🤔 For many with autism, masking is a survival strategy . The goal is not merely to blend in but to avoid the friction of social judgment. This adaptive behavior, while protective in the moment, demands a significant emotional toll, reshaping one's self-expression to meet external expectations, often at great personal cost. 😪 Understanding masking is more complicated than it may appear at first glance. There are different ways to mask: Compensation: This is where one adopts behaviors deemed acceptable , molding their actions to fit a normative social mold. Suppression: Here, natural behaviors are stifled , hidden away to present what is perceived as 'normal.' Assimilation: In this act, one performs scripts that align with societal expectations , often feeling alien to one's nature. Do you recognize these behaviors in yourself? Or in your partner? 💵 The Profound Costs of Masking Now consider the emotional and psychological toll: the constant energy required to maintain this facade can lead to anxiety, depression, and even physical symptoms due to chronic stress. 🤒 Over time, this sustained effort can erode an individual's self-esteem and sense of identity, impacting both personal well-being and the vitality of their relationships. Moreover, misunderstandings that arise from masking can create emotional distance, leaving one partner feeling neglected and the other overwhelmed, complicating their ability to connect and communicate effectively. 💔 What to do? 📊 Measuring Masking with the CAT-Q Taking the Camouflaging Autistic Traits Questionnaire (CAT-Q) is an essential first step for those aiming to explore the extent of autistic masking. CAT-Q Questionnaire Available at no charge on the Adult Autism Assessment website, this tool includes 25 questions and can be completed in 5 to 7 minutes. It assesses various dimensions of masking, breaking down masking strategies so you can gain a deeper understanding of these behaviors' emotional and relational impacts. 🗣️ Have the Right Masking Conversation Instead of focusing solely on the frustrations that arise from autistic masking, let's delve into what's truly happening beneath the surface. Moving away from blame, we can foster a supportive environment by openly discussing the underlying challenges of masking. 💬 Exploring insights from the CAT-Q results allows us to understand the pressures and strategies involved, helping to cultivate empathy and strengthen our connections in a more meaningful and supportive way. 🛠️ Tailoring Social Situations Adapting social settings to reduce the need for masking, whether by choosing less demanding activities or creating signals for needed breaks , can alleviate stress and enhance engagement. Get really specific. Be creative and experiment with new ways of approaching tough situations. This proactive approach allows both partners to feel more in control and less anxious about social interactions, leading to more enjoyable and meaningful experiences together. Couples who try this are amazed at the freedom and relief that they experience. 🏠 Creating a Supportive Home Environment How can we make our homes refuges where unmasking is not just safe but welcomed? By respecting personal space, allowing for stimming or other natural behaviors, and setting clear expectations, we build trust and reduce the daily stress for the autistic partner. A nurturing home environment acts as a foundation for growth and healing, where both partners can truly relax and be themselves, strengthening the bonds of love and understanding. Unveiling the Mask, Not Eliminating It 👫 The key to a healthy relationship in a neurodiverse partnership isn't about eradicating masking entirely. It's about fostering open communication and acknowledging the mask itself. Imagine the mask not as a barrier to intimacy, but as a layer waiting to be understood. Through honest conversations, you and your partner can explore the situations where masking feels necessary and discuss strategies for minimizing it. 🗣️ By discussing the results of tools like the CAT-Q , you can gain a deeper understanding of masking's impact and build empathy for each other's experiences. This awareness allows you to create a safe space at home where unmasking feels natural, fostering genuine connection and a stronger bond. Remember, masking can be a coping mechanism, but it shouldn't come at the expense of your true selves. Let's work together to unveil the masks, not eliminate them, and celebrate the beautiful authenticity beneath. Go deeper: Masking often follows couples into the bedroom too. Module 6 of our Neurodiverse Sex Therapy Program, Energy, Masking, and the Onramp , looks at how it affects intimacy and what helps. Click Here To Match With An Expert All the best, Harry Dr. Harry Motro, LMFT, PsyD Dr. Motro is a registered Marriage and Family Therapist #53452 and the Founder/Clinical Director of the Neurodiverse Couples Counseling Center. Ready to Get Started? Tell us a little about yourself, and our client care team will match you with the neurodiverse specialist who's right for you. Get Started Take an ASD/ADHD Screener Are you curious about whether or not you have autism/ADHD? Want to learn more about yourself and take the first step towards deeper self-understanding? We invite you to visit the Adult Autism Assessment Site and Take An ASD/ADHD Assessment Use our Trait Wheels to better understand your strengths and challenges: Autism Trait Wheel ADHD Trait Wheel AuDHD Trait Wheel

Sex therapy for couples where one or both partners are autistic, ADHD or AuDHD: 24 modules on what happens in each session, and what to do after. Show the full page text The Neurodiverse Sex Therapy Program An introduction to sex therapy, and a companion to it, for couples where one or both partners are autistic, ADHD or AuDHD. Each module walks you through what tends to happen in one session, and then gives the two of you something to do after it. Nothing sexual happens in a session: it is all talk. Anything you try at home happens only if you both agree to it, at the pace of whichever of you needs it slower. Nothing here needs an account, and nothing you write leaves your own device. 24 of 24 modules are published and readable now. Any others are listed by name so you can see the whole shape of the program before you start it. There is a short video at the top of this page. What The Neurodiverse Sex Therapy Program is, who it is for, and what its six parts cover. It runs about 5 minutes. How to read it A framework, not a script. Each module describes one way a session can go. Every therapist at our center is an experienced clinician with their own way of working, and yours will shape each session to the two of you: changing the order, spending longer on some steps, skipping others, or trying something different. Use the modules to know roughly what to expect, not as a checklist your sessions have to follow. Parts One to Four run in order and each assumes the ones before it: starting the conversation, how your two brains shape sex, asking, answering and planning, and touch, one step at a time. Part Five does not: it is a shelf of the things that most often bring couples to sex therapy (Low Desire ; When One of You Wants It More ; Erections and Performance Anxiety ; Pain During Sex ; Porn and Secrecy ; Body Image ; Perimenopause and Menopause ), and you take the ones that are about your life. Where the body may be part of it, we ask you to see a doctor as well. Part Six is about making it yours. You do not have to be in therapy to use any of it. Part One - Starting the Conversation 1A — Your First Sex Therapy Session What to expect, and what never happens, when you first talk about sex. Read Your First Sex Therapy Session 1B — Talking About Talking About Sex Make the subject sayable before you try to solve anything. Read Talking About Talking About Sex 1C — What Sex Is For, for Each of You Hear what sex means to your partner, without a verdict. Read What Sex Is For, for Each of You Part Two - How Your Brains Shape Sex 2A — How Neurodivergence Shapes Sex Name what gets in the way, without blaming either of you. Read How Neurodivergence Shapes Sex 2B — Your Sensory Map Make the room fit both of your bodies. Read Your Sensory Map 2C — Energy, Masking, and the Onramp Save some energy for each other, and time to arrive. Read Energy, Masking, and the Onramp 2D — When “No” Lands Hard Make it safe to ask, and safe to say no. Read When “No” Lands Hard 2E — Orientation, Identity, and Desire Start from who you each are, not from the usual script. Read Orientation, Identity, and Desire Part Three - Asking, Answering, and Planning 3A — Saying It Plainly Plain words you agree on, so nobody has to guess. Read Saying It Plainly 3B — Yes, No, Maybe Find what you both want, with nobody talked into anything. Read Yes, No, Maybe 3C — The Daily Check-In Six numbers a day, so neither of you has to guess. Read The Daily Check-In 3D — Asking and Answering Make it easy to ask, and safe to give any answer. Read Asking and Answering 3E — Scheduling Intimacy Keep a time for each other, with no promise attached. Read Scheduling Intimacy Part Four - Touch, Step by Step 4A — Sensate Focus, One Step at a Time Find your way back to touch, with nothing to prove. Read Sensate Focus, One Step at a Time 4B — Brakes and Accelerators Ease what switches desire off before adding anything new. Read Brakes and Accelerators 4C — Aftercare and Repair Make the minutes after feel as safe as the rest. Read Aftercare and Repair Part Five - When Something Is Wrong 5A — Low Desire Find what is lowering desire, without blaming either of you. Read Low Desire 5B — When One of You Wants It More Plan for the desire you each have, not the one you expected. Read When One of You Wants It More 5C — Erections and Performance Anxiety Step out of the worry loop around sex, together. Read Erections and Performance Anxiety 5D — Pain During Sex Stop pushing through pain, and find help together. Read Pain During Sex 5E — Porn and Secrecy Talk about porn without shame, blame or hiding. Read Porn and Secrecy 5F — Body Image Spend less of sex watching yourself, and more of it feeling. Read Body Image 5G — Perimenopause and Menopause Work out the new rules for sex, together. Read Perimenopause and Menopause Part Six - Making It Yours 6A — Designing Your Own Relationship Keep what fits you both, and plan for the slips. Read Designing Your Own Relationship Working with us The Neurodiverse Couples Counseling Center works with couples where one or both partners are autistic, ADHD or AuDHD, including on sex, desire and touch. Everything described in these modules is part of how we work, shaped by your therapist to the two of you. Therapy for clients in California, coaching worldwide, all by telehealth. A first conversation costs nothing. Talk with our team . Acknowledgments The Neurodiverse Sex Therapy Program was compiled by, and written under the direction of, Harry Motro , LMFT, founder and clinical director of the Neurodiverse Couples Counseling Center. It represents the input of the whole clinical team. Every session it describes is one the center’s therapists run, in the way they run it, and the program exists because they were willing to say, in detail, what they actually do in the room. The clinical team. Our deepest thanks go to the therapists of the center. Their sessions are what these modules describe. Their worksheets, refined over thousands of hours with neurodiverse couples, are what the modules draw on: the Yes / No / Maybe Inventory , the Sensory Map , the Daily Check-In Tracker , the Scheduled Intimacy Agreement , Brakes and Accelerators , the Aftercare Plan , the Designer Relationship worksheet, and many others. Where a module says “we,” it means them. Meet the team . The couples. And to the couples. Everything here that is true was learned from people who sat in the room, tried it, told us when it did not work, and came back the next week. Nobody’s story is in these pages. Everybody’s is. The research. Each module lists its sources, with what each one can and cannot support, at the foot of its page. Across the program, the work we lean on, and are grateful for: Laura Pecora, Gary Mesibov and Mark Stokes on what the research shows about sexuality in autism Sarah Garfinkel and colleagues on how autistic people sense what is happening inside their own bodies Damian Milton on the double empathy problem Laura Hull and colleagues on social camouflaging Gray, Kirby and Holmes on autistic adults' own accounts of the senses, sexuality and relationships Helen Fisher, Arthur Aron and Lucy Brown on the brain systems behind desire, romantic love and attachment Sue Johnson on the conversations that keep couples close Dinah Murray, Mike Lesser and Wenn Lawson on monotropism Ari Tuckman on how ADHD shows up in a couple's sex life van Asselt, Reekers and Roke on rejection sensitivity in autistic adults Teresa Tavassoli and colleagues on sensory over-responsivity in autistic adults MacLennan, O'Brien and Tavassoli on the sensory experiences of autistic adults, in their own words Kathleen Hupfeld, Tessa Abagis and Priti Shah on hyperfocus in adult ADHD Steven Kapp and colleagues on autistic adults' views of stimming Beheshti, Chavanon and Christiansen on emotion dysregulation in adult ADHD Jeroen Dewinter, Hanneke De Graaf and Sander Begeer on sexual orientation and gender identity in autistic adults Varun Warrier and colleagues on autism among transgender and gender-diverse people Bush, Williams and Mendes on asexuality among autistic women Catherine Crompton and colleagues on information transfer between autistic and non-autistic people Emma Kinnaird, Catherine Stewart and Kate Tchanturia on alexithymia in autism Michael Robinson and Gerald Clore on how people report what they feel Ottenstein, Hasselhorn and Lischetzke on how checking in daily makes feelings clearer Paul Schrodt, Paul Witt and Jenna Shimkowski on the demand/withdraw pattern Ye In Hwang and colleagues on anxiety and uncertainty in autistic adults Rosemary Basson on responsive desire William Masters and Virginia Johnson on sensate focus Linda Weiner and Constance Avery-Clark on sensate focus in practice Erick Janssen and John Bancroft on the dual control model of sexual response Emily Nagoski on brakes and accelerators Roy Lewicki, Beth Polin and Robert Lount on what makes an apology work Marita McCabe and colleagues on how sexual difficulties are defined Jan Shifren and colleagues on how common sexual problems and distress are William Masters and Virginia Johnson on the human sexual response Raymond Rosen and colleagues on erections and general health Ronald Pyke on sexual performance anxiety Paris, Lodestone, Houser and Lewis on autistic shutdowns Elke Reissing and colleagues on how pain with penetration is now understood Moniek ter Kuile and colleagues on therapist-aided treatment for vaginismus Al Cooper on sexuality and the internet de Alarcón and colleagues on what is and is not known about online porn Shane Kraus, Valerie Voon and Marc Potenza on compulsive sexual behavior Yasisca Pujols, Cindy Meston and Brooke Seal on body image and sexual satisfaction Alexandra Leedham and colleagues on autism diagnosed in middle and late adulthood Rachel Moseley, Tara Druce and Julie Turner-Cobb on autistic people's own accounts of menopause Ginny Russell and colleagues on the autistic advantage Dora Raymaker and colleagues on autistic burnout Yuthika Girme, Nickola Overall and Simpson Faingataa on what shared time together does for a relationship We have tried to say what each study shows and no more. Where the program goes past the evidence, the module says so.

A sex therapy session for neurodiverse couples about what it is like to talk about sex: what makes it hard, and what makes it easier. Show the full module text Module 2 — Talking About Talking About Sex Make the subject sayable before you try to solve anything. Watch first: the Module 2 video A narrated video of about 4 minutes in a flat illustrated style with flowing ribbons of navy, lavender and mint, opening and closing on the Neurodiverse Couples Counseling Center logo. A couple in two armchairs, with the therapist on a laptop on a small table, talks about talking about sex. On screen: “I am uncomfortable” as a complete sentence, “Observe without fixing,” family, school and faith, the six-part “What makes it hard” chart, and options such as “Plain, direct words” and “Writing thoughts first.” Watch the Module 2 video: Talking About Talking About Sex (MP4, about 4 minutes). The written lesson below covers the same ground in full. The two of you are on the couch, your therapist is on the screen, and the subject is sex. For many couples the hardest part is not sex itself. It is saying anything about it out loud while your partner listens, and this session is about exactly that. A conversation about the conversation Summary: what usually happens in the session 1 Your therapist says what this session is for. What it is like to talk about sex. Not your sex life itself. 2 You each choose how to answer. Out loud, or written down first and then read out. 3 You each notice what happens in your body. As the subject comes up, right then, in the session. 4 You each say what you were taught about sex. At home, at school, from a faith or from friends, in words or in silence. 5 You each name what makes talking about sex hard. Embarrassment, missing words, fear of judgment, missed hints, or being worn out. 6 You each pick what would make it easier. Writing first, plain words, a better time of day, or your therapist there. 7 Your therapist asks how the conversation went. And whether you would like to try a short one at home. 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. Your therapist says what this session is for Your therapist usually starts by saying what this hour is about. You will not be asked what you do in bed, how often, or what is missing. The only subject is what it is like for each of you to talk about sex at all. That may sound like a small thing to spend a session on. For many couples, it is the thing that has kept everything else stuck. Once you can talk about talking, the rest of the work usually gets easier. What this hour is for. Today is not about your sex life. It is about what it is like to talk about it. That is all we are doing. If it feels unsafe, not just awkward. Awkward is expected. Unsafe is different. If saying something about sex in front of your partner could lead to anger, punishment or pressure later, tell your therapist on your own. Work on sex pauses while that is looked at. Step 2. You each choose how to answer Before any question, your therapist may ask how each of you would like to answer. For some people the words come out loud. Others go blank when they try to speak about sex, and find the same words easy to write. Writing side by side. One way is for both of you to write at the same time, each on your own page, with your therapist there. Then you read your answers out, or swap pages. Doing a hard task alongside someone, sometimes called body-doubling, is familiar to many ADHD and autistic people, and here the hard task is the conversation itself. Writing is not a lesser answer. Many people find it easier to say what they mean on paper, and their partner hears it just the same. In the figure: Three ways to answer in the session: say it out loud; write it, then read it out; write side by side, then swap. You can change ways at any point. Choosing a way. Would you rather answer out loud, or write it first and read it to us? You can switch halfway through. Step 3. You each notice what happens in your body Your therapist may then ask a simple question: as the subject of sex comes up, what do you notice in your body? Some people feel their face get hot. Some feel a tight chest, a racing heart, or an urge to make a joke or change the subject. Some go blank. There is no right answer, and nothing to fix yet. Noticing comes first. For some autistic people, the body’s signals are harder to read in the moment,1 so “I am not sure” is a full answer. 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. In this session the discomfort is the subject, so saying it is not a detour. It is often the most useful thing either of you says all hour. Noticing. As we start, what are you noticing in your body right now? Not knowing is an answer too. Step 4. You each say what you were taught about sex Next, your therapist may ask where your ideas about sex came from. Most people learned something at home, at school, from a faith, from friends or from screens. Much of it was not said out loud at all. A family that never mentioned sex still taught something by not mentioning it. Your partner is not being asked to agree with what you were taught, or to argue with it. The listening partner’s job is to stay curious, not to be right. A sentence or two is enough. This is a first look, not a full history. What Sex Is For, for Each of You goes further into the beliefs each of you carries. Where it came from. What did you learn about sex growing up, from what people said, or from what nobody said? Step 5. You each name what makes talking about sex hard Then your therapist invites each of you to name what makes this subject hard to talk about. Not what makes it hard for your partner, just for you. Naming a barrier out loud often makes it smaller. Most people recognize more than one of these, and two partners often pick quite different ones. In the figure: What makes talking about sex hard: embarrassment; missing information; what you were taught; fear of judgment; hints that get missed; worn out from masking. The last two often weigh more for neurodivergent partners. Two that often weigh more for neurodivergent partners. Hints, sighs and hidden meanings are easy to miss for many autistic and ADHD people. One influential idea describes this as a two-way gap between different ways of communicating, not a failing in one partner.2 Masking, the effort of adjusting all day to fit in, is the other. Autistic adults in one study described it as exhausting,3 and there is often little left by evening for a hard talk. Both of you may find something on this list. A partner who is not neurodivergent may name fear of judgment, or years of hints that went unanswered. Both experiences are real. Neither of you is the problem. Naming it. What makes this subject hard to talk about, for you? Take your time. You can name more than one. Step 6. You each pick what would make it easier For each thing you named, your therapist may ask what would help. There are no perfect words, and nobody is expected to find them. Practice matters more than getting the words right. What helps is usually small and practical. It might be writing first and reading it out, or plain, direct words instead of hints. It might be a set time earlier in the day, before your energy runs out, or a short note or voice memo to each other instead of a talk at bedtime. Some couples keep the hardest parts for the session, with the therapist there. The bridge does not need to be finished in one session. Each plank you add makes the next conversation a little easier to cross. In the figure: A bridge built plank by plank across a river of what makes talking hard: embarrassment, fear of judgment, missed hints, being worn out. Partner B's planks are plain words and a voice memo earlier in the day; Partner A's are no perfect words and writing it first; in the middle, your therapist there. Each of you lays your own planks. Talking is part of what helps. In first-hand accounts of sex and the senses, autistic people describe talking with their partner as one of the ways they made sex work for them.4 What would help. Which of these would make it a little easier to talk next time? Step 7. Your therapist asks how the conversation went Near the end, your therapist usually asks how this was for each of you. Many people are surprised: it was hard, and it was also less hard than they feared. Some feel tired or raw. All of that is useful to hear. Your therapist may then ask whether you would like to try a short talk at home, in the way that helps you. It is an invitation, not homework you can fail. If either of you would rather wait, you wait. Nothing sexual is part of it, and nothing sexual needs to happen until you both feel safe, clear and unpressured. Closing. What was it like to talk about this today? Is there anything you would like to try before next time, or would you rather wait? After the session If you both agreed to try a talk at home , keep it short, ten minutes or so, at the time of day you picked and in the way that suits you. Keep to the same subject as the session: what it is like to talk, not what you want to change in bed. Either of you can stop at any point, with no reason given. The other leaves it there, and you bring it to your next session. One way it can go. Partner A writes two lines in the afternoon: “When sex comes up, I go blank. It is not that I do not care.” Partner B reads them after dinner and says one thing back: “Thank you. I go quiet too, because I am afraid of saying it wrong.” That can be the whole talk. The workbook below is for after the session. Fill it in on your own first, side by side if that helps. Then, if you both want to, read one answer to each other. Many couples go on to what sex means to each of them, in What Sex Is For, for Each of You . Your therapist will help you choose what comes next. If this is hard to do. If even this is too much right now, there is no need to push through. You can say so in the session, and your therapist will slow down. Or spend a few minutes with your partner on what makes it hard, and share the feelings that come up: embarrassment, shame, or fear of hurting each other. That conversation is part of the work. Why spend a whole therapy session talking about talking about sex? For many couples, the hardest part is not sex itself. It is saying anything about it out loud while a partner listens, and that silence can keep everything else stuck. The session is only about what it is like for each of you to talk about sex. You are not asked what you do in bed or how often. Once you can talk about talking, the rest of the work becomes possible. What if I go blank when I try to talk about sex? You can write your answer first and read it out, or both of you can write side by side at the same time and then swap pages, with your therapist there. Doing a hard task alongside someone, sometimes called body-doubling, is familiar to many ADHD and autistic people. Writing is not a lesser answer, and you can switch ways at any point. Why is talking about sex harder for some autistic or ADHD partners? Hints, sighs and hidden meanings can be easy to miss for many autistic and ADHD people, and this is better understood as a two-way gap between ways of communicating than as one partner's failing. Masking, the effort of adjusting all day to fit in, can also leave little energy by evening for a hard talk. A partner who is not neurodivergent may find it hard too. Neither of you is the problem. What can make talking about sex easier for a couple? What helps is usually small and practical: writing first and reading it out, plain and direct words instead of hints, a set time earlier in the day, or a short note or voice memo instead of a talk at bedtime. Some couples keep the hardest parts for the session, with the therapist there. There are no perfect words, and nobody is expected to find them. Your workbook Your answers save to this device only - we cannot see a word of what you write. Fill this in AFTER the session, on your own first. What it was like for me Answer these on your own. There are no wrong answers. Your answers stay on this device, so if you share it, your partner may be able to see them. Pick the closest option even if none is exact. When sex came up in the session, what did you notice most in your body? — Heat or blushing, A tight chest or racing heart, Going blank, Wanting to joke or change the subject, Nothing I could name, Something else Which makes talking about sex hardest for you? — Embarrassment, Not having the words or the facts, What I was taught, Fear of being judged, Hints and hidden meanings, Being worn out, Something else Which way of talking suits you best right now? — Out loud, Writing first, then reading it out, Writing side by side, A note or voice memo, Only in the session for now, Not sure yet Overall, how was the conversation for you? — Easier than I expected, About as hard as I expected, Harder than I expected, Not sure yet Two things to share, if you want to Write them here first. Read one to your partner only if you both want to. If something is about your safety, tell your therapist on your own instead. One thing you would like your partner to know about what makes this hard for you One thing that would make the next conversation a little easier 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 shape of this session comes from our clinical work with neurodiverse couples. It has not been tested in a formal trial. The body-signals study1 is small: 20 autistic adults and 20 others, counting their own heartbeat. It shows that a difference in reading the body exists, not how common it is. The idea of a two-way gap in communication2 began as a short essay, not a study, and researchers are still testing it. The masking study3 gathered 92 autistic adults’ own accounts of masking and what it costs them, including exhaustion. The study of sex and the senses4 gathered first-hand accounts from more than 120 autistic people. Both describe real experiences, but neither can say how often they happen. 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. Clinically reviewed by Harry Motro, PsyD, LMFT · California LMFT #53452 · Founder and Clinical Director, Neurodiverse Couples Counseling Center · Clinical supervisor · Updated October 7, 2026 Peer-reviewed research 1. Garfinkel SN, Tiley C, O'Keeffe S, Harrison NA, Seth AK, Critchley HD (2016) Discrepancies between dimensions of interoception in autism: Implications for emotion and anxiety. Biological Psychology, 114, 117-126 . https://doi.org/10.1016/j.biopsycho.2015.12.003 20 adults with autism spectrum conditions and 20 controls, measured on three dimensions: interoceptive accuracy (objective heartbeat detection), interoceptive sensibility (self-reported body awareness) and the metacognitive gap between them. The autistic group showed reduced accuracy alongside exaggerated sensibility, and the discrepancy between them, termed trait prediction error, correlated with deficits in emotion sensitivity and with anxiety symptoms. Limitation: 40 participants and a single narrow measure (heartbeat detection) of a broad construct. 2. Milton DEM (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 A current-issues piece introducing the term double empathy problem, critiquing the definition of autism as a deficit in theory of mind and reframing the difficulty as a question of reciprocity and mutuality in interaction. Limitation: a four-page sociological essay, not a study; cited as the origin of the idea. 3. Hull L, Petrides KV, Allison C, Smith P, Baron-Cohen S, Lai MC, Mandy W (2017) "Putting on my best normal": Social camouflaging in adults with autism spectrum conditions. Journal of Autism and Developmental Disorders, 47(8), 2519-2534 . https://doi.org/10.1007/s10803-017-3166-5 92 autistic adults described in their own words why they camouflaged, what it consisted of, and its consequences, analyzed thematically into a three-stage model: motivations (fitting in, connecting with others), techniques (masking and compensation), and consequences (exhaustion, challenging stereotypes, and threats to self-perception and identity, including feeling fake or losing a sense of self). Limitation: a qualitative study, so it describes what camouflaging can involve and cost; it cannot say how common any of it is. 4. Gray S, Kirby AV, Holmes LG (2021) Autistic narratives of sensory features, sexuality, and relationships. Autism in Adulthood, 3(3), 238-246 . https://doi.org/10.1089/aut.2020.0049 Qualitative analysis of publicly available narratives from 5 books and 13 online forums (72 usernames) plus 49 survey responses, over 120 autistic people in total, coded deductively against Dunn's model of sensory processing and inductively for further themes. Touch, sight, sound and smell shaped sexual experience in both positive and negative ways; some described distress at particular sensations, others sought more intense sensation or used intimacy to calm and regulate; strategies included talking with partners and using substances to dull sensation. Limitation: qualitative and self-selected; cannot say how common any pattern is. When talking about sex is the hard part Many couples we see can talk about almost anything except sex. In our sessions you can write first, go slowly and pass on any question, with a therapist who knows how autism and ADHD shape these conversations. Therapy for clients in California, coaching worldwide, all by telehealth. A first conversation costs nothing. Talk with our team Up next Module 3 — What Sex Is For, for Each of You All 24 modules in The Neurodiverse Sex Therapy Program