Tailoring DBT for Autistic Clients

Amara Brook and Rachel Leah Kraus
Foreword by Charles R. Swenson

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August 20, 2026
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How can dialectical behavior therapy (DBT) help Autistic clients, and how should it be modified to do so most effectively? Grounded in the authors' clinical expertise, research, and lived experience, this much-needed book offers concrete advice for tailoring individual therapy, DBT skills training, coaching, and consultation team to meet the needs and characteristics of Autistic clients. Amara Brook and Rachel Leah Kraus describe ways to develop neurohumility as a clinician; support clients' autonomy and counteract chronic traumatic invalidation; and accommodate a range of sensory, communication, and executive function differences. Throughout, illustrative personal and clinical examples bring the principles to life.

“An essential, timely contribution. Drawing on both professional expertise and lived experience, Brook and Kraus offer a comprehensive, accessible, and neuroaffirmative framework for adapting DBT for autistic clients. The book integrates foundational information about autism and neurodiversity with concrete, clinically useful examples of how to modify DBT skills and overall treatment delivery. Going beyond surface-level accommodations, this practical guide is a 'must read' for DBT clinicians committed to ethical, neurodiversity-affirming care.”

—Kiki Fehling, PhD, DBT clinician, speaker, and author, Northampton, Massachusetts


Tailoring DBT for Autistic Clients is a rare gem—an insightful, wise, and deeply practical guide that DBT clinicians will turn to again and again. Brook and Kraus present a culturally competent and humble approach that is both comprehensive and easy to apply, making it invaluable for therapists at any stage of their careers. Offering deep insights and actionable strategies, this book meets a critical need.”

—Donna Henderson, PsyD, Neuropsychologist and Director of Autism Services, The Stixrud Group, Silver Spring, Maryland


“[The authors] are deeply informed by the science and personal experience of Autism, and one is struck by the freshness, expansiveness, and credibility of their observations, understandings, and recommendations for treatment. Their impactful acronym, ASCENT, presented in this manual, provides a helpful and memorable enumeration of Autistic traits and is worth the price of admission by itself. Their accounts of Autism, from the inside and outside, make clinical and human sense and inform a comprehensive, effective, compassionate approach to therapy.”

—from the Foreword by Charles R. Swenson, MD, Department of Psychiatry, University of Massachusetts Medical School


“This useful book fills a gap by illustrating the 'whats' and 'how-tos' of doing DBT in a neurodiversity-affirming way. In true dialectical fashion, Brook and Kraus synthesize acceptance and change throughout their work. At the same time as teaching neurodivergent clients the skills to navigate a world not designed for their brains, therapists must advocate for a more inclusive world. I recommend this book as essential reading for all DBT therapists.”

—Andrea Gold, PhD, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University

Table of Contents

Foreword, Charles R. Swenson

I. Understanding Neurodiversity and Autistic Needs

1. Introducing Neurodiversity

2. A Neurodiversity-Affirming Approach to DBT

3. Autistic Traits That Call for Tailoring DBT

4. Overview of Tailoring DBT for Autistic Clients: The ASCENT Model

II. Assessment and Treatment Planning

5. Neurodiversity-Informed Assessment sample

6. Collaborative Treatment Planning for Autistic Clients

III. Tailoring Individual Therapy

7. Setting Up Your Process and Space for Individual Therapy

8. Finishing Individual Therapy Pretreatment Tasks

9. Tailoring the Working Phases of Individual Therapy

IV. Tailoring Skills Training

10. Overview of Tailoring Skills Training: Things to Tailor

11. Pretreatment and Orientation to Group

12. Mindfulness Skills and Practice

13. Distress Tolerance Skills

14. Emotion Regulation Skills

15. Interpersonal Effectiveness Skills

V. Tailoring Other Components and Future Directions

16. Tailoring Coaching and Consultation Team

17. Conclusion and Future Directions

Appendix. Some of Our Favorite Resources for Learning More about Autism!

Glossary: Neurodiversity Lingo

References

Index


About the Authors

Amara Brook, PhD, ABPP (they/them), is Clinical Assistant Professor of Psychology at the University of Nevada, Reno, and has a private practice providing neurodiversity-affirming assessment and therapy. Dr. Brook's past roles include serving as Director of Postdoctoral Training and Dialectical Behavior Therapy (DBT) Team Coordinator at Kaiser and providing assessment and DBT in VA medical centers and schools. Their research and clinical interests include improving assessment for Autism and attention-deficit/hyperactivity disorder (ADHD) to be more accurate, affirming, and accessible, and tailoring DBT and related therapies to be more affirming and effective for Autistic and ADHD clients. Dr. Brook has published widely and frequently provides training and consultation to other clinicians around the world. Their website is www.flowps.com.

Rachel Leah Kraus, LCSW-C (she/her), is a clinical social worker in private practice in Maryland. She offers neurodiversity-affirmative, DBT-informed treatment to individuals who struggle with complex trauma, dissociative disorders, borderline personality disorder, and/or obsessive-compulsive disorder on top of an Autistic, attention-deficit/hyperactivity disorder (ADHD), or co-occurring Autistic and ADHD (AuDHD) neurotype. Additionally, she offers executive function coaching to clients, as well as professional training, supervision, and consultation to clinicians around the world. Ms. Kraus has been providing DBT-informed treatment since 2008 in a variety of contexts, including schools, residential treatment facilities, hospitals, and community mental health clinics. Her website is www.krauspsychotherapy.com.

Audience

Clinical psychologists, psychiatrists, clinical social workers, mental health counselors, and psychiatric nurses.