Within the last decade, a shift has occurred in our understanding and support of autistic clients as clinical models move toward a neurodiversity-affirming stance. However, the majority of clinicians lack training in this approach, defaulting to past models that reduce autistic clients to a sum of their symptoms, often reported by caregivers, educators, and clinicians rather than the client. Notably, antiquated views of the ability for autistic clients to form a therapeutic alliance and have a collaborative voice in therapy can be retraumatizing of earlier mistreatment or misunderstanding by other people and by professionals in psychology, resulting in stigmatization and harmful treatment approaches. This skepticism about clinicians’ ability to meet the needs of autistic clients may lead to hesitancy in seeking therapy and increase both the expectation and the occurrence of ruptures. As autism is underdiagnosed, many autistic clients coming to therapy may not be recognized as such. Clinicians may grow exacerbated trying to treat secondary disorders such as social anxiety and depression without understanding the underlying issue, and attribute the difficulties around change to lack of effort or resistance. Therefore, this chapter aims to increase clinician’s knowledge of autism in efforts to navigate ruptures more effectively and to prevent early termination. Readers will gain a greater understanding of the sensory characteristics, emotion regulation, and social communication processes in autistic clients, increase understanding of interpersonal and trauma histories and how this relates to the alliance, and learn techniques to facilitate open communication and collaboration. The chapter discusses risk factors, warning signs of future rupture, and means of repair by using practical case and dialogue examples.