Ask The Why with Dr Ingrid Boveda

The fastest way to derail care for autistic clients is to treat every behavior like a clue you already solved. Todd Weatherly sits down with Dr Ingrid Boveda, founding psychologist at Hive Psychological Services and co-founder of CoGenuity, to challenge the reflex to label first and ask later and to show what neurodivergent-informed assessment and treatment planning can look like when it actually fits real brains.

We dig into why “standard” mental health treatment often fails people on the autism spectrum: overwhelming group-heavy schedules, skills taught without a path to real-world use, and clinical assumptions that turn sensory overload into “defiance.” Dr Bovita explains how she approaches complex psychological assessment by spending less time fixating on test scores and more time translating the why behind behavior. We also talk about medication response differences, nervous system regulation, and how diagnostic labels can become incomplete stories that flatten a person’s strengths, needs, and identity.

If you work in behavioral health, support a neurodivergent loved one, or just want a smarter way to interpret behavior, this conversation gives you practical language and a clearer lens. Subscribe for more conversations on mental health and substance use treatment, share this episode with a clinician or parent who needs it, and leave a review with your biggest takeaway: where do you see “asking the why” change outcomes?

Transcript

Welcome And Guest Introduction

SPEAKER_03 0:00

Hello folks. Thanks for joining us on Head Inside Mental Health, featuring conversations about mental health and substance use treatment with experts, advocates, and professionals from across the country, sharing their thoughts and insights on the world of behavioral health care. Broadcasting on WPBM 1037, The Voice of Asheville, Independent Commercial Free Radio. I'm Todd Weatherly, your host, therapeutic consultant and behavioral health expert. With me today is Dr. Ingrid Bovita. Dr. Bovita received her master's and doctoral degrees from the University of Utah and specializes in assessment and diagnoses in clinically complex cases, particularly those involving during developmental differences. She is the founding psychologist at the Hive Psychological Services, a premier and neurodivergent-informed psychological testing practice, as well as the co-founder of Cogenuity, which provides QEEG and neurofeedback services nationally. Dr. B, as she is often called, identifies as neurodivergent, and much of her work is rooted in helping clients and their families better understand their unique profile of strengths and struggles. Understanding that some of these struggles need to be contextualized in societal norms of nor of normality, Dr. B personally understands what it feels like when all the pieces do not connect. Despite trying one's best, she is intent on shifting society's paradigm of how we help neurodivergent individuals and is passionate about working with families and educating providers, educators, and support persons toward these efforts. Dr. B, welcome to the show. Thanks for joining us.

SPEAKER_00 1:37

Yeah, thank you. Thanks for having me.

SPEAKER_03 1:39

The thing I was going to ask you about in working with people on the spectrum, because you and I both presented at the last uh the last autism symposium conference, uh not symposium,

When Standard Treatment Overwhelms Autistic Clients

SPEAKER_03 1:50

but the autism research symposium. There's a difference between those. And one of the things that I talked about in mind that you you hit on, and I thought I saw hit on in a few different places, was that how you know mental health treatments really failing people on the spectrum a lot. Because we, you know, a lot of people have been treating them the same way, you know. And they're they've got symptomology that's like that. They've got, you know, they they've got symptoms that look like OCD or they are OCD. They've got symptoms that look like personality disorder, which are kind of misdiagnosed, actually. Yeah. Um they might even have symptoms that people think are thought disorder, but they're not. They're just very deeply rooted in kind of their process and their rigidity and those kinds of things. And then they try treating them in these kinds in and what I refer to at times as pressure cookers, you know, the clinical pressure cookers. It's like group all day and uh, you know, individual therapy twice a week and all this other stuff. And and and it's too much for them. Yeah. Like a lot of them, it's really too much. And for others, like they can track the content and they can like they can uh they can teach DBT skills, but they can't use them at all.

SPEAKER_00 3:02

Yeah.

SPEAKER_01 3:03

Yeah.

SPEAKER_03 3:03

When on the assessment end, how are you like how are you dealing with that? Like what is your how are you putting a grip on that in terms of not only understanding this person's clinical assessment, but also like bringing it to families in a way that they can understand and bringing it to whoever consultant they may be involved with so that they place accurately and put them in a program that can give them the right resources? What is it, how does it look from your end, the assessment end, dealing with that?

SPEAKER_00 3:31

Yeah. So um, and I just I literally just finished uh a meeting with a consulting group and parent where we were discussing exactly this. So we have a few different things in it, but it at the end of the day, um, someone's test scores actually are kind of the lesser thing we talk about or the thing that is kind of we'll discuss it at a 30,000-foot level, um, unless there's something clearly significant about, for example, someone's cognitive profile. Um that's usually what I end up not spending a considerable amount of time discussing when I when I you know do a review of findings. Um I want the family treatment team, consultants, um, and depending on the client, the the client themselves, to understand why. Um, because it, and this kind of goes to the point that you were making, um, that we tend to we do a great job identifying what the behaviors are, right? They're being uh defiant to requests, or they're refusing this, or they push people away, then pull them back in, or their mood is labile and kind of all over the place. And we can think, as I mentioned these, we can think bipolar, BPD, right? Like all these different di oppositional defiant disorders. Like we can think about all these diagnostic labels, right? PDA, right. And then as soon as we, you know, in our minds, even kind of assign that label when we think about that person, we immediately look at them from the lens of that diagnostic profile. Um, what we tend to not look at, and this is where the why comes in, is you know, nervous system-wise, what is going on, medication uh interaction-wise, what what is going on? I mean, we we are seeing research just as a minor example that says that someone who is autistic, the way that medications interact with their brain is different. And that makes sense to me because the story tends to be they've been on all these meds, none of them seem to really work right. Um, and they tend to create side effects or cause secondary problems. Um, so immediately I'm like, yep, that that tracks, right? Um we are seeing behaviors and we're not thinking about why. So just, you know, and this was what part of what I had discussed today. When someone refuses something, is it, you know, we we can assume, oh, it's because they are lazy or they want to test boundaries or they want to assert control or whatever. Um, we're not thinking, well, perhaps there's something about the request that that has completely overwhelmed their nervous system to the point that um it's not that they want to be defined, it's that they cannot, there's something about the request that that is overwhelming to them. Um case in point, I worked with an adolescent female um a couple of years ago that uh went, was in treatment. All she wanted was friends, all the things. She's on the autism spectrum. Um, and there was somebody sitting next to her that was talking very loudly. She had her headphones on and she could still hear them. She took her headphones off and said, Could you shut the f up? And she great great, you know, great self-advocacy, right? Um, number one.

SPEAKER_02 7:10

Did you miss a beat?

SPEAKER_00 7:11

Yep, did miss a beat. Um, the kid did shut

Assessment That Focuses On The Why

SPEAKER_00 7:15

up, um, but she got in trouble. And when the therapist was processing things with the family and with me, because of course I did the testing, and it's like, help us understand why she would do this if she wants friends. Um, the therapist said, Well, you know, um she is pushing people away and she is doing this because she wants to, you know, she had this whole uh thought-out conceptualization for why this client had told this peer to shut the f up. Um, and and implemented consequences and decisions for that student um in in line with that conceptualization, which was rather punitive. So my question was, is this what the client said they were trying to do? Push someone away, um, be mean, whatever the conceptualization was. Um and then she said, Well, no, but this person has a history of X, Y, and Z. And I said, No, no, did you ask? And the answer was again, no. So I said, Well, why don't we ask this client what their intent was, what they were trying to accomplish, right? Um, so the client, you know, we asked the client, she's 15 years old, and she said, I just wanted her to stop talking so loudly. Now, of course, it didn't come out right, you know, and so there is some coaching around intent and impact kind of matching up. Um, but the intent wasn't to hurt or to be mean or anything um nefarious. It was just, I'm trying to listen to my music and calm down. And there's this really loud talking, and I just wanted her to stop. Um the way we work with that, the why, right? Therefore, is very, very different. And I just see that clinicians, we do this where we make these assumptions instead of asking what sounds like a stupid question, right? Because, you know, oh, the the the reason is obvious. No, it's not always obvious. Why? What was the intent? Um, and so I that's what I try and get people to understand is is what the why of the behavior, um, and how do we how do we work with that? Um, as well as like some of that nervous system stuff.

SPEAKER_03 9:33

Clinicians, they have a bit of a problem sometimes, I I think with Occam's razor, you know, the whole like simplest explanation is probably the right one.

SPEAKER_01 9:42

Yeah.

SPEAKER_03 9:44

Why did you do this? Because I wanted him to be quiet.

SPEAKER_00 9:48

Because I wanted him to be quiet, right? And we're overcomplicating it. Like this is part of the attachment, or this is part of the you know, whatever. And it's like, no, she just wanted them to be quiet. Um so getting getting everyone to understand that.

SPEAKER_03 10:05

Well, I think that um, you know, the and to a certain extent, uh, you know, a clinician's value is around their ability to assess things that they're not necessarily told or not necessarily out of it. Sure. Yeah. You know, it's like if you're always using that as a mechanism, you know, that you're making determinations and putting behaviors in boxes and explaining them or deducing what they mean and so on without asking, it becomes a practice. And I I think this is where you know individuals on the spectrum have gotten a bit of a raw deal in treatment. Is that they, you know, we've already assigned we've assigned a lot of values and some clinical assumptions around uh what explains certain behaviors. And and you know, that might really that might apply. Um, as a person who's a diagnostic diagnostician, uh, and all clinicians are supposed to be that to a degree, you know, you you you go back to the boxes. It's like, well, a person with these behaviors, you know, this one, this one, this one, this one, it fit inside this box, that's this, that's you know, that's got this label and it means these things. And so I'm using a diagnostic profile mechanism that causes me to understand the root cause of some of these behaviors so that we can diagnose and treat. Except for the fact that none of it fits the person that you're dealing with.

SPEAKER_00 11:25

Yeah. Yeah.

SPEAKER_03 11:27

Um and then you forget to ask. You forget to ask. Why did you say that? Oh, because I wanted to be quiet. It's like, well, you know, yeah. Let's do some coaching about ways you could ask for that differently. Not saying that that's not a need or an invalid need of yours, but let's come up with some ways. And then all of a sudden you're not treating a malady, you're just coaching some language. You know, it's like, one, it's far easier to do what we're talking about than it is to do all this other these machinations around what is it, a treatment profile and a and you know, um a plan, a treatment plan that's going to exercise around this particular condition, all of which is erroneous because no one asked, or just be like, let's use some different words, and I think you get a better response from people.

SPEAKER_00 12:13

Right, right. Yeah. Let's match the intent with the impact a little bit. And I feel like, you know, diagnostic labels are are helpful because to your point, right, like you can then say, okay, here's the profile of a person, but it it it also I think collapses people into overly simplistic ways of looking at them. So if I told you, um, you know, so-and-so is autistic, you don't know really what that means because you know the spectrum is so broad, right? And it really is about understanding that person's profile of strengths and struggles. Um, versus we might go in and say, okay, autistic. So here's my understanding of their struggles around

Intent Versus Impact In Real Life

SPEAKER_00 12:55

relationships, their sensory profile, their engagement with their interests, and none of those things might be relevant for that person. Um, you might take ADHD and say that person can't pay attention. And I'm often educating people and saying ADHD is not a disorder of inattention, it's a difference in how the brain regulates attention and allocates its cognitive resources. And when you put it that way, it opens the door to discussing why they're so tired or why sleep is disrupted, or why sometimes they don't pick up on social cues because they've got their own thing that they're focused on. You know, it explains so many more things than you're inattentive. Um so it's kind of like um, I heard it at one point, right? Like, I think about diagnostic labels a little bit like stereotypes. And there was an awesome TED talk many years ago that I saw that said, you know, the problem with a stereotype is not that it's untrue, it's that it's incomplete. Um so that's how I approach a diagnostic label. It's it's a good start, but if I told you this person has autism or this person has ADHD, there's a benefit to like, okay, I kind of have like a you know script for what that means. The drawback is you run the risk of making that thing that may not even be that thorough, uh, their whole the everything about them, their whole story.

SPEAKER_02 14:23

Identity.

SPEAKER_03 14:23

Yeah.

SPEAKER_00 14:24

Yeah. Yep.

SPEAKER_03 14:26

You know, and I I I'm working with someone right now and he said something I thought was really interesting. Um, you know, an individual in the spectrum, uh, an adult who's been kind of dealing with this you know, older. Um, and he he said part of the issue that he deals with is that whenever he's whenever somebody is interfacing with somebody, he doesn't have anything to rely on. You know, if you walk out in the world um we and you pick up on social cues, and you're a person who doesn't struggle with these things, and you can, you know, walk in and start up a conversation and uh, you know, and talk about some general things and walk out and everything else. We have some we have some shared content that we can rely on. We have uh some shared understanding around the way the world works, we have some shared ability to pick up on social cues, we have some, you know, or even verbal cues. It's like, you know, this is the beginning of the conversation, and this is the part where we talk about stuff that's not really all that important. This is the part where we say goodbye because this conversation is over. That kind of stuff. A lot of stuff that many people will take for granted. And he said, you know, the thing is that every time I begin interfacing with somebody like this, I start from scratch every time. I have to build a framework for understanding every person and every scenario that I deal with. And it's exhausting.

SPEAKER_00 15:47

That's a lot of data.

SPEAKER_03 15:49

That's brilliant. I know, right? Like if you if like if all of a sudden it's like you walked into a different country all of a sudden, you didn't speak the language, you didn't know any of the customs, and you know all that other stuff. And every day you woke up, you woke, you woke up in a different country and you had to figure it out all again. It's like that would be exhausting. And that's how they feel when they walk through life. Um and then you put them, you put them into treatment where this is their experience of the world, uh, and what they're doing is walking into a group and talking to people all day long. It's no wonder they get fried from that experience. They don't want to do it anymore. They refuse to go to group. Oh, they're they're not engaging in treatment. It's like, no, you've overwhelmed them and they can't benefit from anything that's here. Um feel better, and more importantly, they don't feel safer. And I I think that that was another theme that we stuffed that we hit upon. It's like it a lot of a lot of what a person on the spectrum is dealing with is it's safety.

SPEAKER_00 16:48

Yeah.

SPEAKER_03 16:49

They're their nervous system is on this, is on hypervigilance all the time because they're they can't pick up the cues, they're not sure what to expect. Suddenly they're being judged or they've done something wrong or they said something, and everybody, you know, they have this kind of trauma, you know, repeatedly traumatizing experience every time they interface with the world. Um, and they just don't feel safe. So if I can get you to a place where you feel safe, then we might be able to do something that looks like training and coaching and and being able to interface with the world. How does that show up in an assessment in your view? Like when you see somebody, like when where does it show up in the places where you're looking closely?

SPEAKER_00 17:31

Well, there, you know, and this kind of goes with what you were saying. Um, when I think of an autistic person and I think of safety, I think about predictability. Um, and when you don't have predictability, right, you don't have trust. Um, now that we can we can argue, right? Oh, well, that's the case with non-autistic people. And sure, right? We all were there for the pandemic. We suddenly our predictability and you know, the world and people dying, and you know, say like all of these things were arise. Can I go somewhere?

SPEAKER_02 18:06

Can we fly yet? Can we wait a minute, can we go home or should we go stay home? I don't know what we need

Diagnostic Labels As Incomplete Stories

SPEAKER_02 18:10

to do.

SPEAKER_00 18:11

Yeah, when will this end? I don't know. Um, and so you know, I I think about that because our sense of prediction, our predictive systems were no longer functional for us, they no longer were something that we can rely on. And so this goes with what you're saying with that person you were talking about, that you know, if you don't have that script where you have to start over every time with everyone, you don't have predictability. You don't have something that you can say, well, this is how I expect this interaction to go. Um so you can't, you know, you you then are approaching every situation with a fundamental lack of of safety. Um, and in in an assessment room, it's it's very much the same thing. I recognize that I am a complete stranger. Um, some people don't have a script for, you know, testing, some have had testing before, and that's that's great. Um, and oftentimes their experience of testing was at best, it was really boring. At worst, I it was, you know, I don't want to say traumatic, but but unpleasant for whatever for whatever reason, right? And and so I I care about doing it differently. I think that there are ways of getting information um that don't involve constantly grilling somebody or um, you know how, you know, just just the way that that they they're engaged with testing just for long, long periods of time. Um, and all they want to do is find a connection point. And I used to do this where I would meet with somebody I knew what, you know, some of their interests were, and they would bring something up and I would essentially be like, oh, that's great, and let's move on back to testing. And then when I realized like this is how this person is trying to connect with me, which they totally don't have to do. They could just be like, this is a, you know, I don't like this. Um, when I realize that this is a way that is structured and predictable and more comfortable, uh a more comfortable way for them to connect with me, I, you know, it really changed the way that I do assessment. Um, because that that for me is is is crucial, not just for the quality of the data that that you get, but you actually get so much more in in outside of the questions you ask or the test items you administer. It's like I let parents talk on and on and on, not because I'm like, oh, I don't care, you know, I'm just gonna let their mouth run. It's because I actually get so much more valuable information outside of my structured questions from parents. Um, and it's the same with with clients. Um, but you know, I try and create as much predictability as possible. Here's what you can expect, here's what's expected of you. Um, but also that there are going to be some things that I'm not gonna be able to explain why I gave this or what the correct answer is or whatever, and there's a reason for it. So if I tell you, oh, I can't tell you that, right? Now you understand why.

SPEAKER_03 21:25

Yeah, I I mean that's I think that for, you know, and as consultants, we look for assessment folks, and you know, as evidenced by you being on the show, it's like we look for people who can they can provide us with something that is greater than the sum of its clinical data.

SPEAKER_00 21:45

Yeah.

SPEAKER_03 21:46

You know what I mean? Like and and people will do this, and you see parents do it all the time. They'll dig into the scores and they'll try to understand what the scores are and try to, you know, try to put something to together that looks like their own understanding of what this. Is a person who can do a good assessment can do exactly what you're talking about, which is find different ways to information that's going to be really valuable to feed into what this assessment is and can speak to it. And it's like, I don't have a measure for this, but I let me point out something that I thought was really, really, you know, important in the time that we spent together. And, you know, these features came out or these responses came out of this person, and it occurred to me that, you know, that this was important or they didn't feel safe with this or whatever it was. And that's gonna be really critical wherever they go get care because those fa those people are gonna have to pick up on the same thing, figure out a way to like honor it with this person and give them, help them feel safe and move forward. Because if they don't have this, they're just gonna, they're gonna put up the

Safety Means Predictability In The Room

SPEAKER_03 22:55

same barriers and they're gonna not benefit from anything that's there, and they're gonna, you're gonna come away with diminished results, if any results at all. Sometimes it's worse when they come out, right?

SPEAKER_00 23:04

Yeah, and and I see, and I see with like um, and I'm sure you've seen this too, like when a clinician makes a treatment plan, they include like, I don't, I couldn't even, like, many, many goals. And all of these goals have are are important, right? Like we could argue, I I don't disagree with these goals. So many goals. So many goals, right? But that's another point of overwhelm. Um, you know, I I just finished working with a young adult um in a in a transition program that to his credit, incredibly motivated, wants to figure himself out, wants to get better. Um, but you know, he had these five goals, and each of them have these sub goals that he himself made. So his therapist was like, This is great, you know, like thank you for giving me these goals, and now I'll write them in clinical jargon and we'll satisfy that requirement. Um, and it's like, you know, and and the talk that that this client and I had was this is all great, absolutely, but you've got to focus on one, maybe two of these while you're here. Um because otherwise, like you're learning something new, you're trying to do something different. Um, and it's like people the the what I sort of compare that to is like January one, people join the gym, they completely overhaul their diet, uh, 180 degrees, they start taking the supplements, they start setting their timer to go to bed early and wake up early. Like they're making too many changes that that risk yeah, that risk it not being sustainable. Um, and so you can't focus on on all of those different things. Pick one, maybe two, um, and start there and get that get that going.

SPEAKER_03 24:55

Um well, and try not try not to look too far down the road, like, you know, like be here now, man. You know what I mean? Like, where are we at? Let's be where we're at. And it's obvious that we're trying to get somewhere else. But don't I think one of the mistakes that you see um that lots of people make, not just, you know, not just professionals in this field, but probably frankly in any field and people make for themselves is they they they put you know the goals as you say, but they've put this image of themselves or potentially the image of someone else that they're working with in a box. Here's this box of the person that I see that is successful having completed all of these goals. And and then and then you get attached to it. And then and then when it starts to not go at the pace you want it to go or diverts, you kind of get hung up um about like, oh, we gotta do something else. And we we we gotta move a little faster. And and then and then the person's work centers around them being impatient with how slow they're going towards this mark that they've established, this benchmark, or this box this person's supposed to fit in when they get to the end of it. Yeah, instead of just being with the person. Um, and I and this happened to me early on in my time in the field, and I had somebody, he was an older adult, uh, you know, a lot of medications, he was very social, like people. It's like, well, you could do things like be a Walmart greeter, or you could do, you know, volunteer down at the such and such or whatever. He's like, I really just want to be, and he, I mean, you know, this person was, you know, 50 plus at the time. Um, I really just want to be, you know, in a nursing home. Because in a nursing home, they did activities. They had they had medical, they had a nurse that he could see all the time because he spent a lot of time trying to go to the hospital. Something else was wrong with him. He was one of those guys. Yeah. Um, and he they also had lots of people. So there were people around that wanted to have conversation with people that didn't have a lot of people filling their lives. He knew it was an environment that he would probably thrive in, but everybody kept

Fewer Goals Better Outcomes

SPEAKER_03 27:05

going, no, you know, you could live independently and you can have these goals and you can do these things. We we beat our heads against a wall for a year trying to have him fit inside of this mold we had created. And when finally we were like, okay, nothing we're doing is gonna go. And maybe he's right, he just needs to go to an assisted living. He went to a he went to assisted living who's happy as a peach.

SPEAKER_01 27:27

Yeah.

SPEAKER_03 27:28

And he did actually end up going and doing some things that were different than what he would ordinarily do, but he had he had the base established. He knew what he needed, and we just didn't listen. You know what I mean? Like it was a huge lesson for me in general.

SPEAKER_00 27:42

Yeah, well, because we we always think that we're the ones with training, we know better than our clients. Um, and I'm guilty of that sometimes as well. And and sometimes it's like a lack of trust in that particular person, right? What if what you want is not what you need, or what if, you know, and we we see this a lot with adolescents where it's like, I just want to be home and you know, do all the things and leave me alone. And in those cases, you're like, no, no, like I need you to trust that that I I do know better about what what you need.

SPEAKER_01 28:15

Right.

SPEAKER_00 28:16

You need you need something other than being a basement baby. Um and so, and so you know, but there are other clients, yeah, exactly. Like the consensus is is you know clear here. But like, but yeah, there are clients where it's like, you know, they they know what will make them happy. Um so it is, it's a it's a balance, right? Um, where we're not assuming we know better every you know, in every way, every time with everyone.

SPEAKER_03 28:47

So we're not we're not saying they don't need help co-creating whatever that is. Right. It's just that exactly, you know, there's the saying in Nami has is nothing about us without us. It's like, you know, it like they need to be a part of this process so that they can help guide the thing because it's coming from them, you know. So they need professional help. We're not doing we're not arguing that, but some of that professional help needs to also know how to listen and you know, take different information in and everything else. I um I I think that uh we're looking at a transformation of the field, you know, with a lot more information. And I hope that that's gonna translate to a different way that that clinicians get trained as well. But you know, yeah, probably slow, but you know, when they get the world of the you know, wilderness and private pay and and those kinds of things, I kind of see a different model, and I think that that's probably where it all begins. But um Ingrid, thanks for being on the show.

SPEAKER_00 29:46

Yeah, of course, happy to be here.

SPEAKER_03 29:48

Dr. Ingrid Brovita joining us on Head Inside Mental Health Today. I'm Wedding Lee, your host. Look forward to seeing you folks next time. Take care.

Listening To Clients And Closing Thoughts

unknown 30:14

I've not been the pick up, I think the pop in the pick up, too picking the pop, I've not been up there, I've not been a pick up, not picked up, it became a pen, not picked up, it beat up, beat the pillow and the pillow beat the dots, it beat the pick up, it's not beat the dots, it beat up, beat the pick up, not every pick up, the pick up beat up, and I picked up it, I don't know.

SPEAKER_01 31:23

I'll feel so no be the last thing I can need to find our way on their so no need to last in here, need to find my way home. I feel so lonely and last in here, I scalp me on, need to find my way home. I want I feel so lonely and last in here, I scalp me on, I need to find my way home, I'll find my way home.