With the rise in diagnoses of autism spectrum disorders over the past 25 years and the advent of improved and earlier intervention, more autistic children and adults are presenting for psychodynamic psychotherapy.1 This paper explores the unique sensory processing difficulties that are intrinsic to most individuals with autism, and thus central to their ways of being. While these challenges have long been recognized, their impact on the therapeutic process deserves particular attention, as this lens is crucial if we are to improve our understanding of and therapeutic utility with this population. This focus can also help therapists to manage common countertransference reactions and enable us to better support and engage family members of the autistic individuals we treat.