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Look to AFFIRM experiences, VALIDATE feelings and GENERALIZE any places a client and family feel stuck. Then, look to understand the FUNCTION of what would otherwise be understood as a symptom.

In working with a PDA client, you will be attempting to understand autistic processing and how it impacts their emotional lives. You are looking to support the client’s self-awareness and the environment’s accommodation of autism to ameliorate their mental health symptoms.

This is how to affirm the PDA profile. You reframe your clinical insight to see a symptom as an unmet need. Teach and affirm that by becoming aware of and meeting these needs that your client can free emotional energy to be more flexible, self-aware and regulated.

As a result:

How you CONCEPTUALIZE treatment will CHANGE how you speak to your client. You must, as your client will be sensitive to pathologizing and react with self-recrimination and then resist you.

You will need to take all your study of evidenced based technique which was designed to see quick change and symptom relief and set it aside. These techniques get in the way of developing relationship and maintaining a client center.

You will need to speak to your client in ways that discharge and diffuse any hierarchical aspects of your work and center choices and the power for change with your client.

You can certainly look at everything you do after your session and reinterpret it into evidenced based skills so that you function within insurance or system requirements.

But you will not operate from this place or you will lean on prescriptions that will undermine your client because solutions and relief arise from a real connection that can coregulate change.

You are left with the skills and theories that underpin the whole field. Those that use relationship to heal.

So, how do you then conceptualize a case in your practice to create this relationship?

Conceptualization of the work with PDA in the therapy space

General details:

Pervasive Demand avoidance can be conceptualized in therapy as an “emotional FILTER”. This is why you don’t see avoidance all the time, in all areas. A demand can be engaged with or resisted based on whether it made it through the filter. Too big of a demand will get stuck there and will be resisted.

Too many demands at once, too many demands that have already passed through that have clogged the filter, too LARGE of a demand, will create a natural resistance to the demand and get stuck in the filter.

The PDA child will consciously or unconsciously run their experiences through demand avoidance to decide if they will resist or engage.

This is functional. It keeps them from becoming overwhelmed. It is a self-protective mechanism that they will always need.

Internal presentations actively wrestle with demand avoidance in their thoughts and this is how the filter is expressed. The filter will contain a lot of thinking that the person can’t organize, decide the relevance of and then feel comfortable acting on or letting go of until they understand it fully.

External presentations show their avoidance through behavior and reactivity which is why the content of their filter contains confusing interactions that create misunderstanding. So, each behavior or reaction is only important in that there are feelings that have gotten stuck in the filter.

Both presentations will use socially masked methods of avoidance. If the environment doubles down and exerts pressure the pressure itself is a demand to contend with and it forces the “emotional filter” to resist overtly often pushing the individual into panic.

The more pressure the PDA person feels the more that they are forced to resist to protect themselves. It is how environments can either help or hinder the individual. Environments will want to encourage demand avoidant strategies that are socially mediated and able to be engaged with through their strength of intelligence, imagination, role play or desire for deep understanding. Any engagement that adds pressure be it punitive, exposure, challenge to autonomy or rewards will only engage further resistance.

Resisting allows the reduction of pressure. So, that the individual can remain a part of the group while attempting to re-regulate, understand the demand more fully and reapproach the demand later with greater capacity.

To resist can look like many things. Many PDA’ers go to the bathroom frequently or get frustrated at the door before school. They may get stomach aches or headaches. They may also be very silly to detract from the task or take a role of helper to avoid more complex nuanced demands. You may find them lost in their imagination or video games and be unable to shift gears.

They may vocally challenge and argue with a demand, or just refuse.

Often demands can be perceived as unfair or they don’t see the purpose or point of something. Sometimes there is a preference to do something else or want to engage but resist the transition as it was introduced too quickly.

The “things” that are resisted are demands. And simply, everything is a demand. Including things a child wants. So, anything can be resisted even eating and sleeping.

Demands may not prove an issue at ALL many days but on other days they DO. What does that mean? Sometimes all demands are avoided! HOW, do you understand this? How do you conceptualize the function of demand avoidance?

Energy expenditure!!

Does the PDA person have the energy to accomplish an expectation?

If they have a relationship with a trusted person or their own motivation to do something they can lean on this which helps them conserve energy. Demands go through the “emotional filter” as the adult makes it feel smaller when they help to shoulder the demand.

Personal motivation makes the demand easier. Understanding why and agreeing with the rational reduces anxiety which then allows the PDA’er to think more clearly through the demand.

These methods reduce the need to expend energy to think through how to accomplish a demand or the energy required to push through and do it anyway. It is accommodating autism to help the PDA person manage their energy.

In conceptualizing your work, you as the THERAPIST need to see the functionality of this. They MUST use their emotional filter to recognize a demand, determine the energy required to navigate it and determine if they can do it.

A water filter takes out impurities. An air filter improves the quality of the air. Your car filter maintains the engine. The PDA emotional filter screens out a demand the person has no energy for, doesn’t understand or has not enough steadiness for. The demands of life are always met either in relational safety or through self-direction and reasoning for a guide.

Ignoring their filter or being taught to ignore it will clog the filter. They will eventually reach a point where they will shut down or explode. They have a “backlog” of experiences that have never been understood and processed. They will then have numerous dysregulation triggers and have very little regulation for learning and day to day demands. Eventually this person will burnout.

Conceptualizing the functionality then of demand avoidance frees the therapist to genuinely consider how to encourage slowing down and exploring the hidden emotional life.

You then will explore what’s clogged in the filter. THIS is exactly where you need to be.

There you will meet PDA autistic confusion. You will see black and white thinking, circular thinking, rigidity, confusion and big intense sensations.

You will need to focus on what is clogging the filter. What is stuck in the FILTER is the WORK of therapy.

There is confused process, unresolved feeling and lots of thought framed by “what’s the purpose”, “why am I here”, “are you trustworthy”, “it’s hard to be here, I feel like I want to hide” or “I feel to blame”.

You can conceptualize the feelings here as CLASSIC resistance. It is psychoanalytic conflict where the child wants safety but doesn’t know if this is it, feels vulnerable inside but on the outside appears controlling or irritable. The PDA person will want to connect but doesn’t all at the same time.

Many clinicians personalize this and emotionally withdraw conceptualizing that they are not the right therapist or that the child is not ready for treatment.

They may also instruct in these moments, or, explain that they are trustworthy and why they can help.

These are YOUR thoughts not theirs and will only continue to clog the filter. They want you to validate what you observe not talk them out of it.

You are both human, with strong feelings, you both notice and observe and may be curious about why things happen as they do. Therapists, all your clients to be the expert on themselves.

If you can validate your clients with genuine feeling, you will MEET and join your client in the resistance to looking more closely at the “things” in the filter.

Do this actively. In a real and genuine way. You may have to stay there for a while and be comfortable with it. It will look like nothing is happening. But is that true? Contextual and episodic memory is only internalized in attachment after many repetitions. What is happening is the building of contextual felt safety. With the need to repeat it over and over before it is known.

If you find an issue clogging the filter, validate and affirm what you hear and then ask what they think and why. You will hear their emerging viewpoints in a rapport that will contain feedback. That’s the first step in connecting with a PDA child or adult.