Examinations of music therapy practice through a neurodiversity lens are generating and expanding discussions about considerations of harm in music therapy beyond contraindications. This philosophical inquiry contributes to both these efforts by centering the experiences of autistic individuals as an essential source of knowledge regarding potential harm in music therapy with autistic people. First-voice and allied literature are brought into dialogue with music therapy theory through the framework of the Music Therapy and Harm Model (Murakami, 2021). According to this model, it is the client who identifies the potential harms in music therapy, therefore music therapists working with autistic individuals must look to the experiences of autistic people to inform their understanding of harm. The literature revealed that the potential for harm resulted from dominant narratives of pathology, ableism, and the requirements of normalization. Allowing autistic individuals to identify harms in their music therapy experiences requires therapists to be open to various forms of communication, to presume competence, and to resist normalization by examining the foundational assumptions of their practice. Limitations of the philosophical inquiry, implications for research, practice, education, social justice, and recommendations for future research are discussed.