Professional Documents
Culture Documents
DOI 10.1007/s10591-012-9213-7
ORIGINAL PAPER
Abstract Available research demonstrates that autism spectrum disorders (ASDs) affect
couples in a variety of different ways. Some partners draw closer to one another through
the experience of caring for a child on the autism spectrum while others experience
relationship dissatisfaction, separation, and divorce. Yet other research reveals that many
couples raising children with ASDs may experience an initial dip in relationship satisfaction but, after adjusting to a new way of life and developing new expectations for their
children, are later able to bond in novel ways. Thus, a marriage-friendly approach to
therapy, which focuses on helping partners remain committed to each other through the
trials and tribulations of life, may allow these couples to work through the difficulties of
raising children on the autism spectrum without resorting to separation or divorce. Ethical
implications of a marriage-friendly approach to therapy with couples raising children with
ASDs are also considered.
Keywords Autism spectrum disorders Marriage Intimate relationships
Marriage-friendly therapy
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which does exist paints conflicting portraits of the outcomes for intimate partners raising
children with ASDs. Some studies suggest couples raising children with ASDs are more
susceptible to negative relationship outcomes (Hartley et al. 2010; Higgins et al. 2005;
Rodrigue et al. 1993), while others indicate that these couples may experience new levels
of relationship satisfaction in light of raising special needs children (Cowan 2010; King
et al. 2006). Thus, it appears that some couples are able to rally in the face of raising
children with ASDs while others buckle under the pressure.
Given the mixed results found in the literature on couples raising children with ASDs,
family therapists must be particularly sensitive when working with such couples, helping
those already struggling to maintain their relationships under the pressures of caring for a
child on the autism spectrum from rushing toward relationship dissolution too quickly.
Instead, as this paper will suggest, a marriage-friendly approach to couples therapy
(American Psychological Association [APA] 2006; Doherty 1995, 2001, 2002, 2006), in
which the therapist encourages couples to consider not only issues of individual happiness
but also those of commitment to ones partner and family, is most appropriate when
working with this special population. However, before providing a broader definition of
marriage-friendly therapy and detailing why this approach may fit well with couples
raising children on the autism spectrum, a brief overview of ASDs, the stressors related to
caring for children with ASDs, and how these stressors have been shown to impact couples
will be provided. Lastly, the ethical implications of a marriage-friendly approach to
treating couples with children on the autism spectrum, and suggestions for addressing these
implications, will also be considered.
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experience as an ambiguous loss (Boss 2000) in that these children are still physically
present in their parents lives but are no longer socially and emotionally who they used to
be. For these parents, the unclear nature of their loss keeps them from moving along with
the grief process as they become stuck in a paradox of the simultaneous absence and
presence of their children (Boss 2006). Simply put, for parents of children with ASDs the
child they thought they had is not the child they must learn to live with (OBrien 2007,
p. 135).
Additionally, as these children grow older their parents, other primary caregivers, and
siblings must deal with the presentation of ASD-related behaviors. Examples of these types
of behaviors may include: self-stimulatory behaviors (e.g., fixating on or repetitively
touching an object or part of ones own body for an extended period of time, or fixating on
or repetitively engaging in a particular type of body motion for an extended period of
time), self-injurious behaviors (e.g., repeatedly pounding ones head against the wall), and
temper tantrums (Higgins et al. 2005). Moreover, some children with ASDs may act in
aggressive and violent ways toward others (Gray 2002). All of these behaviors have the
potential to engender stress, frustration, and exhaustion in caregivers and family systems
(Ramisch 2012).
Having a child with an ASD diagnosis can be financially taxing to families as well. A
recent study on the average annual medical costs for Medicaid-enrolled children with
ASDs found that these children accrued $10,709 in medical expenses per child, nearly six
times higher than the average costs for children without ASDs ($1,812; Peacock et al.
2012). These figures corroborate the findings of Shimabukuro et al. (2008) who report
that yearly medical expenditures for individuals with ASDs are four to six times greater
than those for individuals without an ASD. Additionally, Ganz (2007) notes that direct
medical costs associated with caring for a child with an ASD average $35,000 annually
through the first 5 years of the childs life, while direct nonmedical costs (e.g., behavioral
therapy, occupational therapy, sensory equipment) vary from $10,000 to $16,000 per year
over the first 20 years. More intensive behavioral interventions for children with ASDs,
such as in-home therapy, may range in cost between $40,000 and $60,000 per child per
year (Amendah et al. 2011). Thus, on top of all the other systemic stressors related to
children on the autism spectrum, raising a child with an ASD is also a very expensive
endeavor.
Parents of Children with ASDs
Given the aforementioned stressors involved in raising children with ASDs, it stands to
reason that parents would experience many individual and personal strains related to caring
for their special needs children. Some evidence of this has been demonstrated in the
literature on autism and its impact on parents, both as individuals and as partners. Namely,
available research demonstrates that, as compared to parents of children with typical needs,
mothers and fathers of children on the autism spectrum report lower individual levels of
marital happiness and relationship satisfaction (Brobst et al. 2009; Higgins et al. 2005),
lower levels of social support (Higgins et al. 2005), greater parenting stress (Brobst et al.
2009), and greater individual emotional distress and sense of isolation (Hamlyn-Wright
et al. 2007; Woodgate et al. 2008). Moreover, extant literature on the effects of autism on
the family system has shown that raising a child with an ASD can lead to heightened
experiences of both parental depression (Benson 2006; Gray 2002; Parkenham et al. 2005)
and anxiety (Gray 2002; Parkenham et al. 2005).
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Marriage-Friendly Therapy
The marriage-friendly therapy movement (also referred to as pro-marriage therapy; APA
2006; Doherty 1995, 2001, 2002, 2006) was born out of a belief that marriages in contemporary American society had become too heavily influenced by a culture of individualism and consumerism. These influences, marriage-friendly therapists argue, have
caused many marriageswhich, for the purposes of this paper will also be defined as
including gay and lesbian couples in committed relationshipsto dissolve unnecessarily.
That is, husbands and wives, under the influence of the prevailing sociocultural norms,
have traded in duty and commitment to ones relationship for personal happiness (Doherty
2002, 2006).
This culture of individualism and consumerism has also permeated the field of psychotherapy (Doherty 2001, 2006). Starting with Freud and psychoanalysis, the self has
consistently been valued in therapeutic settings over obligation to ones significant relationships. Today, marriage-friendly therapists maintain, many therapists (including marriage and family therapists) continue to provide deferential treatment to issues of individual
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happiness and ignore matters of responsibility and obligation to couple and family relationships. This is evidenced by the fact that therapists tend to be more comfortable asking
clients what they need and deserve from other family members than asking them what they
might owe to their families (Doherty 2001).
Because marriage-friendly therapists perceive many therapists to be biased toward
emphasizing individual desires over collective values when working with distressed couples, they distinguish themselves from other therapists in the following ways (Marriage
Friendly Therapists 2011):
1. They acknowledge the goodness and benefits of marital commitment for individuals,
couples, and families.
2. They believe that when treating couples in distress, the first course of action should be
working toward preservation of the relationship.
3. They recognize that promoting relationship commitment for distressed couples is not
something that should occur in situations where abuse or neglect between partners is
known or otherwise suspected.
4. They ultimately respect decisions couples make about staying together or divorcing,
even if those decisions differ from what the therapist would hope for.
5. They are explicit with couples about the potential systemic effects of their decisions to
remain together or divorce (e.g., how their children will be affected, how extended
family and their larger community will be impacted).
6. They promise to make use of supervision or consultation when feeling stuck in therapy
or when they believe a couple is moving prematurely toward a decision to divorce.
Generally, when working with clients considering divorce, a marriage-friendly therapist
views his or her role as holding onto a sense of hope that the relationship can be salvaged.
Thus, a marriage-friendly therapist will encourage a couple to make one last, valiant effort
to save their marriage before deciding to divorce, contending that a lifetime commitment
should not be withdrawn without an all-out effort to work things out. A therapist taking a
marriage-friendly therapy approach will also point out to the couple that many people who
decide to divorce do not consider the processes that lead to the dissolution of their relationships and, thus, go on to repeat the same patterns of behavior in future relationships.
Having called attention to a number of reasons why the couple should try to reconcile, the
marriage-friendly therapist will then ask the couple to agree to work together in couple
therapy for a period of time (ideally 6 months) with the topics of separation and divorce off
the table. If after this predetermined period of time one or both partners still feel divorce is
the best option, then the therapist will help the couple end their relationship on the best
possible terms (APA 2006).
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First, marriage-friendly therapy with a distressed couple raising a child on the autism
spectrum can help the couple to carve out for themselves time and space to focus on their
relationship. This point is especially salient given the fact that many couples who survive
the difficulties of raising children with ASDs do so only after making it through a period of
decreased marital happiness and diminished relationship satisfaction (Cowan 2010; King
et al. 2006). As such, persuading a couple to agree to work on their marriage for a set
period of time, with the option to separate or divorce off the table, may very well prevent
the couple from ending their relationship during a dip in relationship satisfaction. In
addition, as many couples raising children with ASDs are unable to focus on their intimate
partnerships because of the demands placed on them by their children, a set period of time
to concentrate on a couples relationship in therapy can provide a place for both partners to
tease apart the issues contributing to their relational difficulties. This may also be a time for
the couple to work to make new meaning of their marriage vis-a`-vis the caregiving
responsibilities they have to their autistic child.
A second way marriage-friendly therapy may help distressed couples raising children
with ASDs relates to the therapist challenging couples individualistic, me-first views on
the nature of relationships. Challenging these views may be especially poignant for parents
of children with ASDs who are already experiencing lower individual levels of marital
happiness and relationship satisfaction (Brobst et al. 2009; Higgins et al. 2005), lower
levels of social support (Higgins et al. 2005), greater parenting stress (Brobst et al. 2009),
and greater individual emotional distress and isolation (Hamlyn-Wright et al. 2007;
Woodgate et al. 2008). This is because partners who are already feeling isolated, alone,
unsatisfied by their relationships, and in need of outside support may be more likely to
focus on what they believe they need for themselves to get by, as opposed to what their
relationships need to survive the stressors of caring for their special-needs children. As
such, a marriage-friendly approach can help individuals in these situations to see that
concentrating on what they deserve from their partners versus considering what they need
to do to maintain their marriages is to fall victim to the prevailing sociocultural norms that
do not value obligation, responsibility, and commitment. Instead, marriage-friendly therapy can help partners to see that focusing on their own wants will not help them to resolve
future relational problems, and that a lifetime commitment is worth one last shot despite
ones personal level of distress.
Finally, a marriage-friendly approach to therapy can help couples raising children with
ASDs to consider the potential implications of divorce for their children. Namely, although
studies on the effects of divorce on children suggest that some children adjust quite well in
the wake of their parents divorce and demonstrate increases in maturity, self-esteem, and
empathy (Coontz 1997; Gately and Schwebel 1993), children on the autism spectrum may
experience their parents divorce as a particularly trying process to adjust to. This is not to
say that children with ASDs are necessarily less able to adapt to parental divorce than
typically-abled children (as little to no research has been done on this subject). Rather,
because many children with ASDs often require a great deal of stability and predictability
within their environments, when these children are forced to deviate from their established
routines, they may become frustrated, throw temper-tantrums, or act violently toward
themselves or others (CDC 2012b). In the case of parental divorce, children with ASDs
may struggle in adapting to parental visitation schedules, following different rules in each
of their parents homes, and becoming accustomed to stepparents and stepsiblings. As
such, a marriage-friendly approach to therapy could help couples to consider the potential
systemic effects of divorce on their developmentally disabled children. Moreover, even if a
couple does decide to divorce, raising the issue of how ones children may be impacted by
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the divorce, and what the couple needs to do to help their child adjust to a restructured
family environment (Jennings 2005), may help parents think more specifically about how
to help their children on the autism spectrum deal with the transition.
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Conclusion
Autism spectrum disorders affect couples in a variety of different ways. For some, raising
children on the autism spectrum can cause them a great deal of stress, contributing to the
demise of their relationships, while others feel drawn closer together through the shared
experience of caring for an autistic child. Yet other couples experience an initial dip in
relationship satisfaction but, after adjusting to a new lifestyle and routine and developing
new expectations for their children, are later able to bond in new and meaningful ways. As
such, a marriage-friendly approach to therapy with couples raising children on the autism
spectrum can be beneficial as it allows a distressed couple to take time and space to focus
on their relationship and, potentially, be able to work through the dip in their relationship
without resorting to separation or divorce. This approach may also benefit autistic children
whose parents are considering divorce in that, if the parents are able to work through their
troubles, then the children will not have to experience a difficult change in routine and
family structure.
Despite the benefits of marriage-friendly therapy with couples raising children with
ASDs, there are several ethical implications that must be considered as well. Especially
important when taking a marriage-friendly approach to treating such couples is to
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recognize that, for some partners who are being actively abused, under a great deal of
duress, or ready to leave their intimate partnerships, taking such an approach may actually
cause more harm than good. However, if a therapist finds no contraindications to
employing a marriage-friendly approach with couples who have children on the autism
spectrum, this approach may go far in supporting couples dealing with relational distress
related to raising their special needs children.
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