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The following are theories and SKILLS you can use to support PDA family dynamics and individual needs.

Carl Roger’s client centered theories ground the work. Stay close to your client’s presenting need and don’t introduce work, issues or interpretations that are not client driven. This provides ample validation and mirroring for the client and also positions them as the driver of the therapy.

Kahut’s theories of the “good” or good enough “object” explain to the clinician the importance of reacting with attunement and observation to the client. Your client can then gradually internalize a sense of trust and safety.

Psychoanalytic understanding of defenses helps the clinician enter big PDA feelings and react to them with insight and understanding. You can use them to enter big feelings and help your client master them.

Transference and countertransference underpin all relationships and provides the framework to process and understand the use of self in a genuine way and remain therapeutic.

Transference is the defensive shorthand the psyche uses instinctively to “recognize” a connection by cross referencing the new person with preexisting “internalized objects” like a sister, mother or best friend.

Your client experiences a transference, and the therapist does as well. If the therapist counters the “transference” with a reaction, it “lands in a place of strong feelings” in the therapist which is similar to the client’s feelings.

Counter transferential reactions must be explored by the therapist so that they don’t create a “re-enactment” of the feelings in the therapy relationship. The purpose of the therapy space is not to “re-enact” but to “re-work and repair”.

Negative transference:

The therapist will be aware of a client’s negative transference and will need to work hard to bring these feelings to light and validate them to build rapport. The therapist needs ego strength and sometimes consultation and supervision to support this.

The negative transference will create discomfort sitting with client feelings. The therapist may “counter” these feelings by looking for reasons to end the work. This happens because it lands in a similar place of strong feeling in the therapist who will “counter” the transference with their own feeling. This can feel incredibly uncomfortable for the therapist who will be confused and unsure why they have lost their footing and their therapeutic stance. The PDA person may expose the therapist’s fears.

This can be a common way PDA people exit therapy spaces. The therapist would be tasked here to realize that this “counter” transference reaction they are having is the same feeling their client has (wanting to end the work, feeling uncomfortable, wary, unsure, insecure, about them and the therapy). They must work to bring these feelings to light and validate and affirm them. If the therapist has the ego strength to do this, they can build rapport and develop a clear therapeutic alliance.

Positive transference needs attention and awareness in the therapy space as well. For example, PDA parents may reach out for parent therapy feeling intense pressure with a flood of feeling as well as an urgency to connect. If the therapist is older, a PDA parent themselves, and, has lived experience, the client may have a transference of relief in finding support but also a hope that they can lean on this person.

The therapist has their transference too. Maybe the client reminds them of themselves, and they feel great empathy and responsibility. Sounds like a good way to begin therapy, yes?

What is the countertransference then? If the therapist responds to the transference without working consciously to understand their own “counter” transference they may overextend themselves, giving extra time, attention and focus to this client and then feel just as their client feels.

They will begin to feel pressure, urgency and a flood of overwhelm at the thought of this client.

See how important it is to work with this?

THIS is often the clue for the therapist that they need a consultation or process time to catch themselves. While countertransference is indeed the therapists own feelings they are in reaction to the same feelings in their client. The inter-relational space has become porous and therefore no longer therapeutic. The therapist must see the “reaction” they have and process their own feelings outside the session to then be able to focus on their clients’ feelings.

The therapist has their own support needs. A consultation community, supervisor or therapist is helpful here.

A positive transference, while so helpful in initially connecting to your client, is a place a therapist “rides their own responses” and must work to bring their responses to conscious awareness so that they remain focused on their client.

This can be done in the “moment” if the therapist is very experienced, but it is practiced and studied. It is a discipline and not easy to produce rapport that remains therapeutic without becoming porous or in the case of negative transference, therapeutic without becoming rejecting.

This is a frequent experience when the therapist has merged more of their professional work with their personal awareness of PDA.

It is vital we understand transference and countertransference to develop safe rapport with clients. Practice seeing your positive transference everywhere you go. Why do you experience an instant sense of comfort with someone? Look closely at your “counter transferential” reactions anywhere as they happen in every relationship not just the therapy space. This is taking responsibility for your own emotional boundaries. Peer consults help you see yourself more clearly. Process work can also unfold in writing and in your own therapy or mindfulness practice.

Repetition compulsion causes an attraction to situations similar to the original wound to master the feeling. Knowing this helps the clinician understand the emotions that may be trapped in a stuck pattern of behavior that feels challenging or even traumatic.

This is a frequent occurrence in PDA family dynamics where parents and children seem to be stuck in the same loop or pattern of behavior and don’t know how to leave it. The issue to be explored is not the behavior but the emotions related to the original event that is being repeated.

Reaction formation occurs when someone has a strong ego dystonic feeling such as parental resentment or anger that they do not want to feel or act upon. The ego will therefore create an opposite reaction to suppress the rejected feeling.

You’ll observe that the individual experiencing a reaction formation has lost sight of their own needs. This is a common experience in PDA family dynamics. It is the ego’s defense against the darker feelings it doesn’t want to experience or act from. While protective of the ego anger and resentment will still appear in the relational space because a child needs safe congruent reactions which make emotional sense. Reaction formations often elicit anger rather than sooth.

Clinicians must look in all their PDA cases for transference, repetition compulsion and reaction formation because they are frequently used defenses in family dynamics where there are “big intense feelings”. Clinicians can find the “big intense feelings” by looking for patterns of behavior in the family and in their work which leads them to where strong feelings are stuck. You can use psychoeducation and validation in these places to empower and open up relational choices that can heal difficult dynamics.

Know how to identity and work with projection/projective identification.

This powerful defense described in psychoanalytic theory can be seen frequently in PDA family dynamics. PDA adults and children struggle to know their feelings and can more easily “see” them outside themselves through other’s reactions to them. A projection is a “piece” or a part of a person that is not known or integrated.

The PDA person may believe that someone else is “causing” their upset due to the relational confusion inherent in the power of this defense. The PDA person will have an unconscious drive to elicit this reaction in someone else to understand this emotion. This is a projection.

If the person accepts that they caused the reaction the projected feeling creates a “projective identification”.  This is quite common in PDA families. PDA parents may identify with the child’s feeling and look to sooth them.  As a result, neither has the chance to fully know their individual feelings. They may both get stuck there for quite some time. This is a very uncomfortable defense to be “stuck” in for both individuals.

These theories and common relational defenses are actively used to create and maintain a therapeutic safe space.

The therapist uses them to be therapeutically relational rather than reactive and then, MEET their client where their need is.  Supervision and consultation, professional mentoring, and the therapist’s own therapy provide safe footing to apply relational skill with a secure client center.

The next chapter will focus on how you can use your skill in working with defenses and your ability to maintain a client center to simply RELATE to your PDA client.

You can use these psychodynamic concepts frequently to support PDA affirming work and there will be examples of how to navigate the PDA client’s avoidance.

If you can master client centered work, psychodynamic theory and object relations you can serve as a powerful “coregulator” to explore their feelings, offer feedback and help the PDA child (or adult) navigate their relationships. When feelings are experienced and held safely in therapy, they are securely understood and available for day-to-day life.