How might you offer PDA friendly practice?

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I offer care to PDA parents and PDA adults (sometimes they are both!) rather than doing family work or PDA child therapy except on rare occasions.

I have the greatest impact on the child’s life when the parent is able to have their own needs met.

I have also worked to contextualize the generations with parents so that they see their PDA child in their family lineage. The patterns that emerge from one generation to the next can offer insight to a parent into how to support their child. When patterns are consciously understood there is a greater likelihood of doing things differently with compassion for themselves and extended family.

Local PDA parent groups serve to “quicken” understanding, build self-confidence, combat isolation and shore up decision making. It also develops a community “next door” as parents can even meet in person. PDA parents need others for feedback and ongoing support and a parent group is a natural place to find this.

I am a guide to other professionals in their work, teaching the skills I’m using, and offering consults to parents for practical PDA affirming insights.

I seek to wrap around as much as I can for a family in my practice because PDA professional support is hard to find in my area. To address need I have fostered a professional consultation group of local therapists so that I have referrals I trust.

If you begin working with PDA, you’ll also recognize how great the need is. Don’t be intimidated. Just pick a place to start.

Is the PDA parent a PDA adult? Well not always but often. How do I know? Ultimately many parents will begin to question it themselves and ask me what I think. We consider it together. Some of my clients have gotten evaluations and confirmed they are PDA autistic.

I will however look for certain patterns that alert me to PDA traits.

This is what I see:

One or both parents will have extreme “reaction to” demands or expectation in parenting. You may learn that in the course of the parent’s life they have gone to “the extreme” or to the edge in one important way. Or, pushed themselves to meet an expectation and pulled back, with exhaustion, anxiety or a change of heart.

I see a dramatic change in the trajectory of one generation to the next. Maybe the grandparent was a reactive, aloof, emotionally neglectful parent, and the next generation, the PDA parent became a psychologist and earnest eagerly involved parent.

PDA parents will have false starts, multiple moves, breaks with family or community. The adult may have lost interest in something important or became anxious about continuing. There may be misunderstanding and hurt feelings in their relationships. It seems the parent has “lived 9 lives” in 1 and it feels like an interesting eclectic life.

They suspected that they had less energy, more anxiety and a harder time balancing things than their peers. They may have made choices to give up things they love to build a career and provide a stable life for their family.

But they feel shame and loss around “giving up” programs, friendships or letting go of parts of themselves. Aspects of who they are remain undeveloped and unexplored, even hidden, from themselves. Parenting their child causes them to face their own similarities. As their child is burning out, they may be too. Or, as I often hear, the parent is in an existential crisis where they are looking for meaning and to develop their deeper sense of purpose.

Parts of themselves are being revealed through their parenting. The PDA therapist has a key role in creating the safety and regulation to rework self-understanding.

The therapist might see a fixed pattern. The parent keeps doing the same thing in response to their child despite it having the same result. They may also do the opposite in a frantic effort to change things.

The parent may try to make things easier for the child in ways that push them to do or be what is expected. This is quite common.

The parent will talk about walking on eggshells or have no space to meet their own needs because they have a constant focus on their child.

They eventually come to see that their focus doesn’t help their child. Anywhere pressure, focus, expectations, and goals enter family life the child will avoid, resist and push back.

The parent who is a PDA adult, will have to struggle mightily resisting the fact that it is not in their control. It feels utterly stuck to them, this dynamic, and they are miserable. I often hear parents say things like “how can my child ever handle regular life”. I fear for my child’s future. I don’t know how to help them.

They feel utterly responsible for their child’s distress and that they must fix it and make it better.

The child may have significant rage and dysregulation. The parents will be frightened and in a constant state of hypervigilance.

Assess for these patterns in a family to understand and be sensitive to possible PDA in a parent.

In short: Look for racing thoughts, intensity of focus on one issue that returns over and over again, look for a feeling of stuckness, hopelessness and a struggle to find their way out.

These family dynamics confuse the traditional therapist. Is the PDA profile caused by trauma? Is the PDA profile actually a number of DSM mental health diagnoses in an autistic child that creates complexity and dysregulation?

This is what I think, after observing dynamics in over 200 families I’ve met professionally over the past few years. A PDA family is shaped by black and white thinking and either or thought process, with significant and notable parental frustration that no one understands their child or their family. They themselves are confused by their child and feel desperate to help them.

When things are “good” they are “really good”.

Their child may be very thoughtful and sweet, attempt to explain their distress and ask for the parent’s help. They will often say sorry and feel guilty for reactivity, aggression or not being able to meet expectations. The child is often incredibly creative, or, even gifted.

This will really confuse the therapist who does not know PDA. But this is something a PDA therapist sees in practice daily. Not understanding PDA and misreading family dynamics is the cause of so much systemic trauma for PDA families.

Thoughts:

Why is it so important to offer PDA supports in the whole family not just in the child? You will DE- pathologize the family dynamic with a focus on PDA through the generations. It is expressed as a reaction to where there was a lack of self-directed engagement with demands. You can offer relief in ways no technique can by simply depersonalizing the family’s experience. So much energy and motivation can then be tapped to create a family life they want.

In this process the parent will see THEMSELVES more clearly. They also like their child need to push back, question and find their own autonomous choices where they are not self-directed. They are looking to feel safe and find freedom to form their own unique identity.

In pushing back as an adult, they make developmental breathing room for themselves to more fully individuate while making the emotional space inside themselves to hold their child’s complex experience of life. Their child will have emotional room in the relationship to express their identity.

This is the power of the therapy space which when focused on supporting the parent helps the child.

When I regulate the holding of deep complex feeling I make it possible for the parent to offer the same to their family.

I also offer new ways they can choose to navigate demand avoidance grounded in personal meaning. I ask my clients to check themselves for purpose, motivation and meaning thereby processing their feelings as they go.

Does this matter, why and “where am I” in this situation are important questions that ground parenting and adulting to the moment and shift one out of fight or flight.

When things start to change for the better in a family it’s because the parent changes first.

A parent can shift the way that they feel and respond to their child. By tolerating, holding space for and being “OK” with big feelings, not looking to fix or change them, there is a pause or a suspension of demand avoidance. Instead of a breakdown in connection and communication there can be a “real talk” instead, like, “ok, now what. This is hard, I see that, I’m here for you.”

It is authentic to not attempt to “fix” a big feeling or make it better because you can’t. It is a natural boundary that offers emotional breathing room to consider how they can do something differently.

The parent and child then will be on a path to better communication together which naturally decreases the activation that fuels demand avoidance.

If you approached this parent as having GAD, OCD, ADHD or a PD you will have missed the underlying PDA relational pattern and family dynamic. Time and again I’ve seen mental health suffering be ameliorated by therapeutic practice that fosters attachment, psychodynamic awareness of larger family dynamics and developing ways to bring expansiveness to moments that otherwise would be locked in black and white thinking.

Then, what use to us are the diagnostic labels if they don’t lead to effective relief?

What is the PDA adult like in the therapy space?

The PDA adult will present as either having few words or rapid thoughts which can lack a central coherence.

“Communication is hard work” and while they want you to understand them, they can generally feel misunderstood and are not sure about you either. It will be hard for them to explain who they are and what they need. They may be irritable and avoid initial connection with you. Or they may be charming and agreeable yet not reveal much of substance initially.

They will come to your practice during a time of change or transition in their lives. They are aware that they need people who care to help them process their thinking. Previous therapies may have helped them for this reason. But while they understood theoretically how to apply them nothing changed.

Clients may say that they navigate life with their thoughts and have always been this way. They navigate their life by thinking and will call themselves “overthinkers”. They will comment on themselves, what they’re doing, and on others. They will share anecdote after anecdote. Thinking feels very important to them.

This can be exhausting. A PDA adult often seeks therapy when they feel trapped in a thought process unable to fully understand it to get out of it. There may be a lot of feeling close to the surface that can overtake and overwhelm them. The bigger the thinking, the bigger the feelings are underneath.

The therapist may see anxiety, OCD like thinking, and depressive negative self-critical thinking. This is where traditional therapists may have previously gotten stuck. A therapy must explore the PDA thought process and understand what it means to them not look to change it or even impact it. It may change. But in the process of understanding it more fully the PDA person makes their own choice to do so.

You will unclog the PDA “emotional filter” (Remember that?) This is the place holding big confusing feelings and experiences that locks the PDA person in avoidance. Understanding leads to emotions moving through the filter.

First, ask to understand their concerns fully, be sure you understand them, and validate their experience. You will then go on a search for meaning, purpose and “why” it’s important to them.

You will open up big picture questions to help your client see nuance and hold a space to put together a perspective that makes their feelings clearer to them. When they are there, in the big picture, they are no longer in fight or flight. The more often that they find this with you in your therapy the more their suffering decreases.

The client will push back on your word choice and the feedback you offer as a way for them to find their own authentic take. You will engage actively with this using humor, flexibility and insight. This creates a healthy regulation space.

The resistance will mean that growth is happening at a rapid rate. Resistance is your client’s way of engaging. They are actively wrestling with their internal conflicts.

Too much resistance can mean not enough safety. Not, necessarily because you did anything wrong, but because, you must stop. Here is a place where you explore what feelings are getting “stuck in the emotional filter” and you don’t go further until the client is ready.

If there is little resistance in the therapy the PDA adult is “hiding” what it is that they are feeling, is guarded, and not sure if they are safe.

If you can find even a piece of their engagement and hold it even for a very short time you have done good work. You will learn to disengage frequently and review and reflect back what you’ve discussed to slow down and allow insights to settle.

You will in essence cooperate with demand avoidance which allows you both to move through it together.

Remember:

~Lots of words and language is an avoidance strategy as it is a demand to search for context and land on a settled viewpoint.

~Few words in therapy is avoidance as well. It resists energy expenditure. Thinking is a demand. Engaging is a demand.

~There will be a need to break things down into its pieces looking for nuance in word choice so as to extract meaning.

~There will be a need to consider what it means and why it matters to the person with PDA.

~There will be extreme self-consciousness/shame/blame. Look for what might really matter to them if they felt freed from expectation.

~Address mental health suffering by the exploration of their autistic needs and how to meet them.