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Clinical work will be a process of actively considering the viewpoint of your client with curiosity and an open mind.

You cannot talk them out of their views. That deprives them of autonomy. You can only offer information to consider, ask thoughtful questions, and give feedback. But you must make space graciously to disagree or have them say it “their way”.

Then you MUST affirm, validate and universalize experience. This offers the chance to make an initial connection.

Why MUST you affirm, validate and then universalize experience as you seek to connect?

A PDA person will feel SHAME that they find it hard to do what others can accomplish with ease. They can be highly self-critical and full of self-doubt. Then blame themselves for not being able to do it “right”. OR blame the environment or the person in charge.

You must first hold this through affirmation, validation and universalizing. But then, be prepared to be a mirror that shares observations with more nuance to support their understanding, awareness and regulation.

They know very few people struggling like they do. They feel very alone.

These feelings of blame and shame are a common pattern in PDA client work. They arise from their recognition that they think and process feelings differently than others and that society desires to shape it.

PDA identity unfolds with a vulnerable contextual memory to use as a reference point until something is well understood. So much of what is encountered is new in childhood.

As a PDA child is learning they are having to rethink the same steps as if it’s a new world. Therefore, they are thinking and rethinking in ways most kids don’t.

Each day they wake up to do it all over again.

How exhausting. How irritating. How humiliating. How confusing. Are you dumb they think? Are you pathetic? Are you to blame? I’ve heard all these statements from both kids and adults.

To let the mind rest just a little can possibly create misunderstanding and confusion with others which creates a feeling of panic, and this can be turned inward. They feel great shame that they need to rest and that their mind is drained.

Thinking and thinking a great deal is functional but exhausting!

When energy runs out to meet the moment and no help is forthcoming from the environment the Demand Avoidance emotional filter is activated, and they get stuck.

This is how you can conceptualize your PDA client. Working hard every day. Not as demand avoidant but as a hard worker that has spent all their cognitive energy.

You can affirm, validate and universalize this experience. It is a very common experience among PDA kids and adults.

Skills and theories that will underpin your work? First you must look for functionality in everything that you would categorize as a “symptom”. This is a client centered strength-based conceptualization.

After assessing for safety, look to elicit and build awareness of unmet need the accommodation of which has the great potential reduce mental health symptoms and generate ease and happiness.

In children and teens who are developing awareness one must look to understand the needs expressed in behavior and hold them in safety with a great deal of mirroring which is created when you affirm, validate, generalize, universalize and reflect observations. This is PDA affirming care.

Focus on blame and shame as black and white thinking that can very effectively clog their emotional filter by sending them into cognitive loops my adult clients feel as whirlpools or spirals, even, a “runaway train”.

Take time with the idea that their thinking functionally holds these strong feelings to examine them. THIS aspect of PDA processing is necessary. Then, another necessary affirming step is to process feelings in small manageable bits to demystify big reactions. This can be done through a safe connection with you, their therapist.

I see blame and shame as poles. Shame is on the one hand an acceptance of self-responsibility and blame is on the other hand a projection of responsibility onto others.

Poles clarify and center one’s focus. PDA individuals often rely on poles to ground a thought process. But this is the beginning of a process. A breaking down of the experience into smaller parts creates understanding. It opens a reflective process that connects big feelings to an experience which offers emotional salience and context that supports memory and growth. The therapy space can coregulate this so that the PDA person is able to freely consider information “in between the poles” and discover where the truth falls for them.

Offer a construct of how to consider blame and shame if they want to look at it with you. This builds meta cognition which is another functional PDA autistic strength that furthers emotional processing.

You can open a space to question what happened and challenge assumptions, others and their own. Questioning is a PDA trait you can use to foster health and freedom to explore personal identity. Conceptually, the therapeutic skills used are reframing, cognitive challenging and reworking of painful experiences.

Being a part of the world, a PDA child will begin to make sense of who they are in relationship to everyone else. They wonder why they are different, and this is true for every child.

In PDA children however this is a more extreme experience as they experience BIG feelings. THIS is a real and universal experience in PDA children that can be generalized which reassures them that they are not alone.

LOOK to affirm and acknowledge this and call it something with them that appeals to the PDA’ers innate sense of justice, fairness and need for purposeful self-direction. Ask them to consider how having BIG feelings or sensitivity can be seen by them as part of their day-to-day life and ask them how they can “use it”. This functions to both support INTEGRATION and SELF-ACCEPTANCE.

PDA adults are often still coming to terms with their big feelings. They will always experience more intense reactions and sensations and always have. Therapists can go back to places in the PDA person’s history to affirm and validate, as well as rework these experiences, freeing emotional energy in the present from blame and shame.

THIS is activating their FILTER on purpose and using the FILTER to run the “thing” through again but this time with enough emotional flexibility to go through!!!! Then you will find the child or adult will have more ENERGY to meet demands in their life. You will “see” their relief.

How do you rework it and look to call blame and shame something else?

I find that even young PDA children crave exploring BIG questions while having their answers heard.

Throughout adulthood this, when known and understood, is an active coping mechanism and method of processing that encourages perspective, reassures and reduces attenuation as well as directs focus to what matters which becomes an organizing force for the PDA person.

Questions for children can be incredibly empowering. Does everyone do things the same way? Is there anything about difference that feels good? Are they different because they feel smart at something, or strong at something?

This is where conversations about neurodivergence are helpful and also identity affirming.

When these big questions are asked the PDA child softens their approaches, reveals their confusion safely and may be willing to hear more from you about what YOU think and how YOU consider things. This elicits PDA friendly parenting or therapy as a conversation just unfolds with listening and curiosity. If what you hear you affirm, you can frame it and then offer a FEEDBACK loop for the PDA person to consider new information.

Even with a feedback loop in place, the PDA person will still want to discern what THEY think not internalize your ideas. Enjoy this and come to welcome the building of their own more nuanced thinking.

A HEALTHY therapy for someone with PDA is to AFFIRM them. Look at them with neutrality so that what you are considering can be observed. Offer observations and then a BIG picture question that opens a feedback loop for further consideration. The PDA person will use such a space for personal meaning making. THIS is what a true client centered relationship is like.

The good question you ask will encompass what you hear them to have said but with movement and momentum offered toward curious exploration. This allows emotional space for perspective while also being less likely to create overwhelm and a therapeutic breach of trust as your reflections and questions stay “where the client is”.

Offer BIG picture questioning to your client. The best therapy does not teach, direct or advise. The BIG questions must “center” themselves in the PDA person’s concerns. The question then unlocks their own curiosity and attention. The answers are their own and as a result are self-directed and autonomous. I see therapy as a series of good questions that reflect how well I’ve listened.

Client centered care is PDA affirming. I also use the relationship to validate and generalize so that my PDA client has a corrective experience, a hallmark of repairing attachment and object relations. Psychodynamic space opens curiosity to explore personal meaning with a focus on understanding a complex family of origin and generate awareness of where impacts exist in the present.

Can you have a conceptualization of your work like this? This is NOT CBT, or, DBT. It is relational psychodynamic work for children. It is helping them see themselves more clearly in relationship to their family and community. Can young children reflect on their families and who they are in them? Most certainly. Even children as young as 5 and 6 can do a little work like this. By the time children are 10 to 12 years old therapy can meet a need to be heard, understood and affirmed. Therapy can even help translate this to their parent which serves to open communication, strengthen attachments as well as offering a child more ways to understand themselves in relationship.

This creates a path toward autonomy, self-awareness and emotional health as you can support strong connectedness to the people and places that matter to them as they grow. They are freer to engage in demands due to a clean “filter”.

Demand avoidance when it’s activated quite simply means that the child WANTS to engage but needs to figure out how and why it’s important. Asking “the big questions” in a safe feedback loop can make space to hold nuance and clarity.

This is a very traditional psychodynamic space. It works for PDA.