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By Unyte Editorial Team Reviewed by Unyte Clinical Team |
“How can I provide a relationship which this person may use for his own personal growth?”
— Carl R. Rogers
The therapeutic alliance is described as the “measure of the therapist’s and client’s mutual engagement in the work of therapy” (Stubbe, 2018), and is considered a fundamental factor in the effectiveness of clinical work. This relationship is influential and, for neurodivergent and autistic clients, especially susceptible to fractures as a result of healthcare systems unable to accommodate individuals presenting with communication, behavioral and sensory differences (Shaw et al., 2024).
Disconnects between therapist and client often occur when professionals rely on rigid clinical definitions of diagnoses and traditional therapeutic approaches that overlook the human being in front of them — a person whose own rigidity, impeded progress or disengagement from therapy may actually be the result of their nervous system’s physiological survival strategy.
In a recent Clinical Conversation hosted by Unyte Health, Sean Inderbitzen, LCSW, DSW, an autistic psychotherapist and researcher, and Jason Tafler, founder and CEO of Unyte Health and parent to an autistic son, explore the profound benefits that can emerge when providers adopt a nervous system-informed lens to care. In this blog, they delve into strategies that can transform the therapeutic relationship, shifting from outdated approaches of trying to “fix” to one grounded in thoughtful, intentional attunement.
Focus on a Person-Centered Approach
Being a supportive provider can start with reevaluating communication. To break out of limitations imposed by textbook clinical definitions of autism, Sean suggests that providers shift the language to position autism as a description of someone’s lived experience, not a static label to assign a client.
“Autism is an adjective, not a noun,” Sean explains. When providers treat autism as a box to check or a case to manage, they risk losing sight of the person in front of them. Sean’s own lived experience has informed his approach, as he balances a person-centered approach with a grounding in reality. “The care I’ve received has intersected in many ways the way I perceive myself and how to intervene for people like me.”
From a parent’s perspective, Jason saw his own mindset shift as his family sought the right support for his son, Aydan. Their family journey involved moving away from an achievement-oriented, “fix-them” mindset and toward a “state of allowance.”
“We came from the world where, if someone’s struggling, how do you fix them, how do you change them, how do you make them different?” Jason shares. “Where we’ve really shifted to now — and my wife even coaches parents with this — is how do you change yourself? How do you allow someone to be who they are, however they are, wherever they are at that moment? A lot of it comes back to attunement.”
Sean says he holds the “unpopular position that autists have social skill challenges, and this perspective is not something a fair number of my contemporaries are fans of,” which he explores in his new book, Neural Exercises for Autism: Embracing Your Capacity for Flexibility, Connection, and Joy. He believes that ignoring these difficulties in the name of providing “affirming” care can actually be a disservice to clients.
“I see the denial of this diagnostic criteria as to deny one’s suffering and right to self-determination,” Sean says. By acknowledging the reality of their experience, providers can both validate a client’s struggle and support their therapeutic goals. “Who am I to say they don’t need to fit in with society if they would like to, and who am I to deny that the world needs to change if they believe so?”
This philosophy aligns with the guiding principle from psychologist Carl R. Rogers, who pioneered the concept of person-centered psychotherapy: “How can I provide a relationship which this person may use for his own personal growth?” (Stubbe, 2018).
Beyond Behavior: The Nervous System-Informed Lens
Through the lens of Dr. Stephen Porges’ Polyvagal Theory, characteristics commonly associated with autistic individuals, such as appearing rigid or socially disconnected, can be interpreted as physiological survival states rather than identity traits.
“Polyvagal Theory frames autism as rigidity in mind [and] behavior, and social disengagement as a nervous system chronically in sympathetic and dorsal activation,” Sean says. “You can begin to see a person, their assumptions about themselves, others, and the world as rooted in defense, which can begin to explain a fair amount of rigidity and sense of disconnection they experience.”
In other words, when a client’s physiological state is rooted in defense, their rigidity is a protective mechanism. What appears as willful noncompliance may be the result of a nervous system that’s stuck in a state of chronic defense. For providers, it’s important to avoid reciprocating a client’s rigidity with their own.
Jason highlights that, in a therapeutic environment, “the relationship, safety and connection come first.” For his son, building this trust takes time, sometimes requiring a provider to do as little as sit in a chair outside the room until the foundation of safety is solid, rather than jumping into new interventions. Providers who approached his son with their rigid demands, he says, would trigger a fight-or-flight response that ultimately prevented any further work from being possible.
A key takeaway from Polyvagal Theory is shifting from monitoring outward behavior to focusing on supporting the nervous system, and “on the upstream developmental foundations of [autism] rather than its downstream behavioral symptoms and skill deficits” (Burgess, 2018). Recognizing that physiological safety is imperative to the therapeutic process can help providers move from a “fix-them” mindset toward one that centers on co-regulation. Rather than viewing rigidity as a hurdle, it may be a signal that more safety is required before proceeding with further work and, by establishing this foundation, the therapeutic alliance becomes a partnership rooted in attunement, not a series of clinical demands.
Show Empathy: Help Clients Navigate a System That’s Moving Too Fast
For Sean, a common barrier to establishing the therapeutic alliance is the combination of systemic pacing and nervous system load. A major theme he hears from clients is that the “system is moving faster than they are,” making it overwhelming to navigate when layering “processing speed differences with sensory processing and stress response differences.”
Sean recalls a personal experience in the clinical setting after a transition between his primary care physicians. After a seemingly positive routine visit, the new physician informed him that due to a clerical error, she was actually not his new provider. She then refused to refill the daily medication he had relied on for years, and worsened the situation by deactivating Sean’s ability to communicate with her through the patient portal MyChart.
From a nervous system-informed perspective, clients move into states of defense when communication becomes unclear or systems feel rigid, but what matters is whether a pathway back to safety is possible. Sean references renowned researchers Ed Tronick and Claudia M. Gold, whose work found that relationships are built through repeated mismatch and repair rather than sustained attunement (2020). In this case, what could’ve been an opportunity to correct the mismatch turned into unnecessary stress for Sean due to the physician’s failure to repair.
“The ambiguity of the prescribers to give me a clear and direct sense of who she is to my clinical care team from the start was missing, and made me feel really misunderstood and almost had serious consequences to my medical care,” Sean says.
Jason again emphasizes the importance of providers being aware of their own rigidity, like in Sean’s example, and the external impact of the provider’s nervous system as essential parts of their role in the therapeutic journey.
“If you’re going to work with neurodivergent clients on self-awareness and self-regulation, what is your own practice to build awareness, regulation and resilience, so that when you’re with clients, you can hold that space — that container of safety?”
In fast-paced healthcare environments, missed opportunities for repair can build up. For Jason, a major green flag is a provider who demonstrates flexibility, with a willingness to “tailor the therapy or approach to the specific child or situation,” rather than imposing a preset treatment program. Additionally, slowing down, clarifying roles and maintaining communication to meet clients where their nervous systems are can all help support regulation and strengthen the therapeutic alliance.
Be Curious on the Path to Attunement
A truly neuroaffirming experience requires blending curiosity with deep emotional flexibility, particularly on the provider’s part.
Sean argues that providers must be “proactively curious about their performance,” which includes putting aside clinical ego and building a genuine partnership with the client. An ideal session, for example, involves the provider asking questions to the client, such as, “Did you feel heard, understood and respected?” “Did we work on and talk about what you wanted to?” “Was my approach a good fit for you?” and “Did this session feel right or not to you?”
“Proactive curiosity is a way to be mindful of one’s performance without tying ego to the outcomes,” Sean says.
Sean also shares concerns about provider bias. In 2012, researchers investigated self-assessment bias in mental health providers and found that, in a sample of 129 therapists, “25% of mental health professionals viewed their skill to be at the 90th percentile when compared to their peers, and none viewed themselves as below average” (Watfish et al., 2012).
“With neurodivergent clients, whose distress looks different, and arguable differences in neuroception, this risk for bias in one’s [Safe and Sound Protocol] practice is even riskier,” Sean says. “The opportunity for SSP providers is to learn from objective data to develop more accurate self-assessment, and make better adjustments to SSP practice through Feedback Informed Treatment.”
Individualized Care and Future Opportunities
There is no one-size-fits-all model when it comes to individualized care, but true neuroaffirming therapy aims to support the client in front of you while respecting the diversity of goals, “not just the ones our version of neuroaffirming care endorses,” Sean says. For example, success for one autistic person might be learning to unmask, while for another it might be increasing the ability to mask in order to navigate specific environments.
To Jason, Unyte Health’s role is “helping the helpers” by offering tools for nervous system regulation, such as the Safe and Sound Protocol (SSP). By first building the foundation for safety, providers can empower a client’s nervous system to become more receptive from the bottom up, thereby creating the physiological conditions for other therapeutic modalities to be accessible.
In summary, moving from judgment and rigidity to open-mindedness and curiosity, and staying grounded in the principles of person-centered, neuroaffirming care, are key to creating the foundation of safety and connection necessary for neurodivergent individuals to receive the care they need.
References
Burgess, C. (2018). Reframing autism spectrum disorder: ASD through a neuropsychological reframe. The Journal of Self-Reg, 2(1), 16–23. https://self-reg.ca/wp-content/uploads/2023/01/Reframed_Journal_Volume_2_Issue_1.pdf
Shaw, S. C., Carravallah, L., Johnson, M., O’Sullivan, J., Chown, N., Neilson, S., & Doherty, M. (2024). Barriers to healthcare and a ‘triple empathy problem’ may lead to adverse outcomes for autistic adults: A qualitative study. Autism : the international journal of research and practice, 28(7), 1746–1757. https://doi.org/10.1177/13623613231205629
Stubbe D. E. (2018). The Therapeutic Alliance: The Fundamental Element of Psychotherapy. Focus (American Psychiatric Publishing), 16(4), 402–403. https://doi.org/10.1176/appi.focus.20180022
Tronick, E., & Gold, C. M. (2020). The power of discord: Why the ups and downs of relationships are the secret to building resilience, flourishing, and trust. Little, Brown Spark.
Walfish, S., McAlister, B., O’Donnell, P., & Lambert, M. J. (2012). An investigation of self-assessment bias in mental health providers. Psychological reports, 110(2), 639–644. https://doi.org/10.2466/02.07.17.PR0.110.2.639-644
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