What Therapists Need to Know About Neurodivergent Clients and Families: An Interview with David Smith, LCSW

What Therapists Need to Know About Neurodivergent Clients and Families: An Interview with David Smith, LCSW

Curt and Katie talk with David Smith about neurodiversity-affirming therapy, autism, ADHD, PDA, family systems, and burnout for neurodivergent therapists. David shares both clinical expertise and lived experience as an autistic therapist, offering practical guidance for working more effectively with neurodivergent clients and the families around them.

About Our Guest: K. David Smith, LCSW

K. 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.

Key Takeaways

- Therapists often miss neurodivergence entirely and may treat anxiety, depression, or “thought errors” without considering whether a client is struggling in environments that were not built for their nervous system.

- Neurotypical therapists can work well with neurodivergent clients when they lead with curiosity, attunement, flexibility, and a willingness to adapt how therapy is structured.

- PDA can look like defiance, but David reframes it as an anxiety- and threat-based response to demands. Traditional rewards and consequences may backfire.

- Neurodivergence in families is often intergenerational, with different neurotypes shaping attachment, communication, expectations, and family roles.

- Neurodivergent therapists need more than generic self-care. Sustainable practice may require reducing demands, grounding, rest, and nervous-system-informed regulation.

Full show notes and transcript will be available at mtsgpodcast.com.

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