Thriving Family Therapy

Thriving Family Therapy K. David Smith, LCSW, Clinical Supervisor. Online therapy for autism, ADHD, complex & intergenerational trauma, and toxic stress.

I serve adults, teens, parents, and families in OR, CA, FL, ID, and VT. Autistic, neurodiversity-affirming, LGBTQIA+ allied. I’m a Licensed Clinical Social Worker who provides online teletherapy services to individuals and families throughout Oregon, Idaho, and Florida. I can serve clients in areas of the country or outside the US depending on local laws and regulations regarding telehealth. I am also a Certified Clinical Trauma Professional, Certified Family Trauma Professional, and Certified Autism Spectrum Disorder Clinical Specialist. I am passionate about working with people and families who have experienced trauma, abuse, divorce, and other difficult life challenges. I have worked extensively with individuals and families who experience Autism, ADHD, and other aspects of neurodiversity. Much of my professional experience has been as a school-based therapist in elementary schools. I come from a family of healers and helpers – doctors, nurses, chiropractors, therapists, pastors – so service to others is more or less in my blood. When I'm not seeing clients, you can find me hanging out with my family watching movies, traveling the world, or playing games. My three teenage boys and I are pretty much addicted to The Mandalorian and anything Star Wars-related and have watched almost every Marvel movie ever made. We also love to make music whenever we can. Between us, one or more members of my family play piano, guitar, saxophone, trumpet, drums, flute, and a little violin. Not much of that repertoire is me, but music is a big part of our lives. We also go on a lot of adventures together, and enjoy scuba diving, hiking, and exploring the world. On my own, I'm passionate about spending time in nature, especially sailing, scuba diving, and outdoor photography. I’ve traveled to 47 of the 50 US states and 17 other countries on 4 continents. These days I spend a lot of time in Mexico and other parts of Latin America with my wife, who is also a psychotherapist, born and licensed in Peru. I love to write and have several books in progress – a guide for parents and teachers of children with trauma, another to help healers and caregivers deal with burnout, and just for fun, a historical novel set in 8th-century Constantinople. I’m constantly learning and am usually in the middle of some new training program on an aspect of therapy and healing that I find interesting.

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07/21/2025

The Thriving Family Therapy newsletter is live! If you would like to subscribe, click here:

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My Youtube channel is now active! I plan to continue to add content more actively on topics related to neurodiversity, c...
07/15/2025

My Youtube channel is now active! I plan to continue to add content more actively on topics related to neurodiversity, complex trauma, PDA, parenting, and burnout, among others. Please follow and share!

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I did a follow-up interview with Jill Nicolini on the Global Podcast Network on July 9. We discussed the goal of increas...
07/15/2025

I did a follow-up interview with Jill Nicolini on the Global Podcast Network on July 9. We discussed the goal of increasing access to neurodiversity-affirming care for people with , , and other forms of , as well as , my journey, and common struggles neurodivergent individuals and their families face in a neurotypical world.

What do you think? Feel free to share your comments below.

Follow-up interview with Jill Nicolini on the Global Podcast Network, further exploring topics including neurodiversity-affirming care, expanding access to s...

07/08/2025

I've been doing a lot of research and reflection lately on the concept of Internalized PDA (Pathological Demand Avoidance/Pervasive Drive for Autonomy). Not only because I work with many clients and families where this is a feature of their experience, but because I'm finding that it explains a lot about my own life and patterns.

Internalized Pathological Demand Avoidance (iPDA) is often invisible. People may seem calm or compliant but are quietly struggling with intense anxiety triggered by everyday demands. This hidden form of PDA can lead to perfectionism, procrastination, masking, and burnout. Understanding and recognizing iPDA is crucial for effective support and validation. Learn more about how recognizing iPDA can transform lives.

I've created a detailed article about iPDA - what it is, what's known about the underlying neuropsychology, what it looks like in children and adults, and how to support people who have iPDA features (whether that's yourself or a loved one). If you would like a copy of the materials, please message me or post a comment below, and I'll be happy to send it to you. Awareness helps.

Often, in relationships, we find ourselves caught in a reactive pattern of attack-avoid, criticize-defend, blame-deny. T...
07/07/2025

Often, in relationships, we find ourselves caught in a reactive pattern of attack-avoid, criticize-defend, blame-deny. This can occur in intimate relationships, between parents and children, between siblings, or in any other context in which we are in connection with others.

These patterns can be very destructive, no matter which position we occupy in the dynamic. At the extreme end, they can lead to physical and/or emotional abuse. But even at a more “normal” level, this cycle damages the self-esteem and emotional (and ultimately physical) well-being of everyone it touches. In families, it ripples out to impact everyone in the home, and models a behavioral archetype that will repeat in subsequent generations... until the pattern is broken.

How do you break the cycle?

Ultimately, any pattern of attack-defend relies on one or both parties feeling insecure in themselves and judgmental of both themselves and others. As the saying goes, “it takes two to tango” - but it only takes one partner to stop the dance.

If you are whole, peaceful, secure, loving, and free within yourself, you can break this pattern.

When you know, deep in your heart and body and soul, that you are free, you will know that others’ judgments, interpretations, and reactions have nothing to do with you. There will be nothing to defend. You will see that there is no “attack.” All that’s happening is that your shadow side and that of another person are dancing with one another.

The more you realize that you have your own work to do on yourself, and those around you have theirs, the more you will be able to step above and outside these patterns that occur and see them as information for your further growth - not something you have to fix, react to, or get upset about.

Go inside. Your answers - and your peace, love, freedom, and hope - lie within. Don’t react in the moment. Breathe, observe, be mindful of your thoughts and feelings (your own, not anyone else’s), wait. Discover what part of you is being “hooked,” and observe that as something that you need to work on - for yourself, not for anyone else.

You are responsible for your own growth and healing, and no one else’s. As you grow, learn, and expand, those around you will have the opportunity to do so as well. But it’s up to them to take that opportunity, or not. You have no control over their choice.

What can help you get to this place of internal peace, love, freedom, and acceptance? There are many tools that work, and I can help you discover those that work best for you. This work is very individual and specific, and depends on your strengths and goals.

The process of clearing your emotional space of past wounds, disappointments, and patterns that are no longer working for you is the most challenging, and rewarding, journey you can undertake. I would be honored to support you, wherever you are on that journey.

Within my home, there has been frequent debate about whether or not the whole concept of autism – and diagnosis of any k...
06/30/2025

Within my home, there has been frequent debate about whether or not the whole concept of autism – and diagnosis of any kind, whether it be autism, depression, anxiety, or whatever – is relevant or helpful.

My wife, who is a psychotherapist herself with 20 years of experience, was the one who first started calling attention to the possibility that I might be autistic.

At the time, I dismissed the idea. I’d been working with autistic children and their families for years and thought I knew what autism looks like. (I did – in children who are heavily impacted, non-verbal or only marginally verbal, mostly boys and mostly under 10 years old.) I was not yet educated on the full range of neurodivergence, like most therapists – indeed, like most people, including all too many professionals who specialize in autism. I wrote off my autistic features as the legacy of complex trauma and chronic toxic stress.

It was only when I went into private practice and started working with a broader range of autistic adults that I started taking the idea more seriously. Especially when my clients started calling me out (gently, and with great kindness and humor) on my “tisms.”

Eventually, as my practice became increasingly focused on neurodivergence-affirming therapy, it started to feel increasingly inauthentic to answer the most common question potential clients would ask – “Are you autistic yourself?” – by saying “I don’t know, my wife thinks so.” How could I truly support people who were newly diagnosed, on the path of discovery, or wrestling with the complex questions around autistic identity when I had avoided walking this path myself?

So I sought out a very good psychologist (Benjamin Neely) who specializes in adult autism evaluations. To my shock and at the same time no surprise at all, after reviewing my testing results it only took him 45 minutes of clarifying questions to confidently state, “Yep, you’re autistic.”

My world shifted, in a subtle way. Many misplaced puzzle pieces about my life suddenly slid into place. A wave of self-compassion washed over me. And grief. And rage – why had it taken so long for anyone to explain this to me? Why had I had to suffer this long, not knowing something so vital about myself? And forgiveness – how could anyone have known? And my inner justice warrior rose up – there are so many people like me, and so little information out there, and so much misunderstanding, and so much stigma, and so few resources to help.

These tectonic shifts in my self-concept and worldview continue, a year later, like aftershocks after the earthquake. Going deeper and deeper, in increasingly subtle ways. The land had steadied, but the reshaping of the landscape of self-concept (inner and outer) continues.

More importantly, my approach to my work as a therapist and so-called “autism specialist” also shifted in subtle but important ways. I say "so-called" because although I had taken the trainings and done a lot of good work supporting autistic people and their families and loved ones, in retrospect I had only scratched the surface. I certainly knew more than the average therapist who had not been trained in autism and could be more helpful. But I had not fully absorbed the information I had, and I could not fully walk in the shoes of the people I was helping.

It reminds me of what my ex-wife, an OB/Gyn, said about her approach to her work before and after having children. Prior to becoming a mother, she was a competent and highly skilled doctor who was good at the technical aspects of helping pregnant women deliver a healthy baby. After going through childbirth herself, she had a far deeper mind-body-spirit understanding of what her patients were going through. It made her work much more authentic, and much more compassionate.

I found the same, after my autism diagnosis. I wasn’t just a specialist with technical knowledge and a toolkit of possible coping skills and strategies to share. I became a fellow-traveler, searching for answers to complex questions, working with my clients (brothers and sisters) to map out largely unexplored territory together.

My quest for information and training became not academic, but personal. Typically, I went on a wide range of autistic deep dives on a wide range of subjects about neurodivergence and how to live a healthy and happy life with a complicated, delicately balanced nervous system in a world that is all too harsh, loud, demanding, and unwelcoming.

And I started trying to apply for myself some of the tools and techniques I’d been recommending to clients for years. With predictably mixed results.

Along the way, I started receiving a lot of the messages that so many so-called “high functioning” or “low support needs” or “Aspie” autistics receive.

“Don’t define yourself by your diagnosis.”

“Don’t use your autism as an excuse.”

“Why do you talk about autism so much?”

“Stop being so obsessed.”

“You don’t look autistic.”

Combined with the usual judgments and criticisms of my more autistic and PDA behaviors, and the usual lack of acknowledgment about what triggers and escalates these things and the difficulties in finding accommodations for my needs (even within my own home), this has made life very confusing at times.

How much does my autism – and, I now increasingly recognize, my internalized PDA – really define who I am?

How much do I want to define my life experience through this one particular lens?

Out of the myriad aspects of neurodivergent experience and identity, which ones fit me, and which don’t?

How much do I share about this experience, and with whom, and with what purpose?

How much masking should I continue to do, and in what settings? Where is it safe to unmask and let my inner freak flag fly?

And – this is probably unique to autistic therapists and other healthcare professionals – how much self-disclosure in my therapy sessions is healthy for my clients, and to what degree does it start to edge into a boundary violation or other ethical issues?

I continue to navigate these issues, sometimes in consultation with other professionals, both autistic and neurotypical. There are no easy or universal answers.

I do believe that it is important – no, vital – that I self-identify as an autistic therapist. Not just because that’s an important part of my authentic identity, and I wear the label with pride. But also because it might give courage and cover for other autistics of all types and in all professions to self-disclose (if they choose) with less shame and stigma. The more of us there are out there in public, showing the world just how diverse the neurodivergent community is and just how limited (and limiting) their stereotypes of us are, the better.

Increasingly, I’m expanding my work beyond 1-on-1 therapy to include more advocacy, education, training, consultation, public speaking, and publication. I’m scheduled to appear on two podcasts in the next couple weeks. I’m starting to offer consultations on neurodivergence-affirming care to other therapists who are not autism specialists, as well as medical professionals, employers, educators, and others.

And most importantly, I’m starting to use my own voice with greater courage and openness. Opening up my 5th Chakra, if you will.

I encourage you to do the same. Please feel free to share your own experiences in the comment section. As the life coach Lisa Nichols says (paraphrasing), “Let your own light shine bright. If anyone doesn’t like it, give them shades.”

A deep, nuanced, and well-researched post on the so-called "autism epidemic." Well worth the time it takes to read all t...
04/14/2025

A deep, nuanced, and well-researched post on the so-called "autism epidemic." Well worth the time it takes to read all the way through.

Autism diagnoses are rising—but that doesn’t mean there’s an epidemic. Learn the real reasons behind the increase, from evolving diagnostic criteria to better recognition of underrepresented groups. A historical and human-centered look at autism's growing visibility.

Over the years, both personally and professionally, I have sought to understand the ways in which relationships—both ear...
02/12/2025

Over the years, both personally and professionally, I have sought to understand the ways in which relationships—both early and ongoing—shape our emotional and nervous system responses. My lived experience, combined with extensive study and clinical practice, has led me to develop a therapy approach grounded, in part, in relational neuropsychology.

Relational neuropsychology has its roots in attachment theory and neuroscience, with key contributions from researchers such as John Bowlby and Mary Ainsworth, who pioneered attachment theory, Allan Schore, who explored the role of early attachment in right-brain development and affect regulation, and Stephen Porges, who developed Polyvagal Theory to explain how the nervous system responds to social engagement and threat. Daniel Siegel and Louis Cozolino expanded this work by integrating neuroscience with psychotherapy, emphasizing the importance of interpersonal neurobiology. Jaak Panksepp, a pioneer in affective neuroscience, identified core emotional circuits in the brain that underlie our relational and emotional responses...

To read more, click below:

("Love" by Ukrainian sculptor Alexander Milov, Burning Man, 2015. Image credit Alec Kondush)

Over the years, both personally and professionally, I have sought to understand the ways in which relationships—both early and ongoing—shape our emotional and nervous system responses. My lived experience, combined with extensive study and clinical practice, has led me to develop a therapy appro...

An excellent article on ADHD in women (note: some adult men with ADHD will also find that this resonates).
12/27/2024

An excellent article on ADHD in women (note: some adult men with ADHD will also find that this resonates).

Last month, I took my car in to get it serviced. When I handed my keys over to the man behind the counter, he chuckled and held up my…

I experienced what was, in retrospect, my first episode of autistic burnout during my sophomore year at Harvard. I didn'...
11/07/2024

I experienced what was, in retrospect, my first episode of autistic burnout during my sophomore year at Harvard. I didn't know what it was at the time - I wasn't diagnosed with autism until this year, at 56 years old, and even if I had known I was autistic at the time, the concept of an "autistic burnout" didn't really exist in the late 1980s.

The stress and overwhelm from being enrolled in a highly competitive and demanding honors-only program at an Ivy League school, combined with losing the support system of friends I'd had during my first year (we went to different houses) and being several hundred miles from my family, were just unmanageable. I found it almost impossible to eat. I developed digestive issues so severe that I could only eat about five things without having stomach cramps so severe I wanted to stick a knife in my gut, because it would be less painful. I had to work with the cafeteria kitchen in my dorm to develop a special diet using completely clean, decontaminated utensils just to survive. I could barely make it to class. I was having panic attacks constantly. Being among people was unbearable. I didn't know what was happening - I thought I had cancer, or mono, or some rare genetic test.

The best GI specialists in Boston couldn't find a thing wrong with me, other than that I wasn't digesting fats and proteins well. They said to avoid the foods that caused problems. (That meant, well, food.) I started therapy for the first time, and was put on antidepressants, which didn't really help. I was surviving largely on black coffee (milk caused extreme GI upset), boiled plain chicken, steamed plain potatoes, and raw carrots and bell peppers. My mom made me a birthday "cake" that year made of a green pepper cut in half with a candle stuck in it.

It was a dark time in my life, one of the darkest I've ever been through. I ultimately decided to take a year off from college, feeling like an abject failure, and with no idea what was wrong with me. I spent the first few months just hibernating in my bedroom at my parents' house, playing board games with myself and reading, and hiding from the world. Going to therapy. And trying to put back together my shattered self-esteem, and my even more shattered body and nervous system.

The GI symptoms resolved within a few months, which at the time I attributed to a chiropractor correcting the curvature of my middle spine (from which all the nerves controlling the digestive system emerge). In retrospect, it was probably more related to the dramatic reduction in stress, having greatly increased support from my parents, and returning to a very familiar, supportive sensory environment in my old bedroom at my parents' house with limited "peopling" needed.

I ultimately recovered and was able to return to Harvard to complete my degree, ultimately receiving "cum laude" and being awarded magna cm laude in my department. Once I graduated, I left Cambridge and have never looked back. I've returned maybe 5 times in the past 35 years, mostly for recruiting events when I was a consultant. Harvard was a good place to have been, but for me, it was not a good place to be.

I've experienced multiple episodes of what I now know to be autistic burnout since then. Most recently, chronic, repeated periods of burnout every few months for the past 6 years when I was working toward my LCSW and having to navigate the stressful and not always supportive environment of community mental health. Again, it was a mystery trying to figure out why I would get sick, go into complete mental and emotional and physical collapse, experience extreme sensory and emotional overload, and have horrible brain fog and anxiety every 6-12 weeks for several years. It required a medical leave for 3 months at one point, and a change in jobs. And ultimately, a shift into private practice, 18 months ago, which was the best decision I've ever made, career-wise.

The autism diagnosis in July of this year, combined with everything I know as a clinician who specializes in neurodivergence and complex trauma, has finally clarified what was happening for all those years. It has also reduced my sense of shame and failure over all those episodes of collapse.

The concept of autistic burnout is still not well known, or well understood, outside the neurodivergent community. Even within the community, there still needs to be a lot more talk about what it is, what causes it, and how to prevent it - and how to recover, once you're in it.

This article does a good job of explaining the basics, as well as exploring the author's own personal experience. A good place to start.

I’ve had so many conversations about autistic burnout; it’s something that so many of us experience. Recently, I was asked for a definition…

I’m thrilled and grateful to announce (rather belatedly) that I earned my California LCSW license in July, 2024. This ad...
10/23/2024

I’m thrilled and grateful to announce (rather belatedly) that I earned my California LCSW license in July, 2024. This adds the Golden State to the areas in which I can provide services, which I deliver by telehealth only.

I can now serve individuals and families in Oregon, California, Idaho, Vermont, and Florida. Insurance coverage is available in some areas, and I can provide superbills for possible out-of-network coverage if I am not in-network with your insurer.

Again, I specialize in neurodiversity-affirming therapy for autism and ADHD (as an autistic therapist myself), as well as therapy for complex and intergenerational trauma, family dysfunction, and complicated families. Services are available for adults, young adults, teens and tweens, and parents.

You can find more information on my website, www.thrivingfamilytherapy.com.

Individual & Family TherapyONLINE IN OREGON, FLORIDA, VERMONT, & IDAHO Start Thriving Today! Helping you and your family go from surviving to thriving.Taking charge of your healing journey is a heroic step. Much like training for an athletic challenge, it requires dedication, courage, determination,...

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