David Smith, LCSW, is an autistic therapist who provides neurodiversity-affirming, trauma-informed therapy online in 5 states (Oregon, California, Idaho, Vermont, and Florida). He also provides clinical supervision for therapists working toward LCSW or LPC licensure in Oregon, particularly those who are neurodivergent themselves or who are passionate about supporting neurodivergent clients. In addition, he provides consultation, training, and workshops for medical practices and professionals, other therapists, employers, and school districts about ways to become more neurodiversity-affirming and supportive of neurodivergent people.

In this podcast episode: Neurodiversity-Affirming Therapy for Neurodivergent Clients, Families, and Therapists

Curt and Katie invited David Smith to talk more deeply about what neurodiversity-affirming care actually looks like in practice. This conversation moves beyond individual diagnosis and into the realities of therapy with neurodivergent adults, family systems where multiple members may be neurodivergent, the impact of PDA, and the ways neurodivergent therapists need to protect their own nervous systems to sustain good clinical work.

Key Takeaways for Therapists on Neurodivergent Clients, Family Systems, and Therapist Burnout

-Therapists often miss neurodivergence entirely and may conceptualize clients only through anxiety, depression, or cognitive distortions rather than recognizing the stress of living in environments not built for their nervous systems.

-Neurotypical therapists can work effectively with neurodivergent clients when they lead with curiosity, attunement, acceptance, flexibility, and a willingness to adapt expectations around eye contact, pacing, organization, and session behavior.

-David emphasizes that many common therapeutic approaches may need modification when the root issue is sensory overwhelm, nervous system dysregulation, or chronic stress rather than faulty thinking alone. -In family therapy, neurodivergence is often not limited to one person. Multiple family members may have different neurotypes, and that can shape attachment, communication, expectations, and what the family perceives as normal.

-PDA can look like oppositionality, but David reframes it as a nervous-system-level threat response to demands. Traditional rewards and consequences may not help and can backfire.

-Therapists working with parents of neurodivergent young people may need to offer psychoeducation, distress tolerance, and practical support rather than just individual therapy for the identified client.

-Destigmatizing conversations, psychoeducational handouts, and helping families become curious about neurodivergence can slowly open doors even when some family members are resistant.

-Neurodivergent therapists need more than generic self-care. Sustainable practice requires reducing demands, grounding, rest, and individualized regulation strategies that truly support the nervous system.