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25 to 35

These young adults enter therapy concerned that they are struggling to process their feelings, or they wonder if their previous depressions were autistic burnout. You may see intense tears and affect every session. You may also observe a high degree of attenuation and self-consciousness.

Like many young adults, they are working through family of origin issues in relationship to self-identity. But their feelings will be experienced through their “demand avoidance filter”. Depending on temperament, internal or external presentation and fit of family to temperament they will enter therapy with greater or lesser overt demand avoidance.

What do I mean and what does this look like?

The emotional filter will often catch the pieces that feel too big to manage without more context in their current stage of life. It can be related to finding meaningful work, finishing their education or developing confidence in their own maturity and skill.

Their path is slower, and their progress is uneven in the place that they feel stuck. They struggle to engage effectively with the issues related to these hard to manage pieces. They will show circular thinking here and won’t know how they feel.

The places that feel stuck they may have already attempted to address in previous therapies but found that their thought process felt intractable, and their affect was big and disconnected from thinking.

The issues they explore to find relief have a great deal of shame connected to them. Usually, exploring challenging family dynamics will over time release the feelings they had as a child which are free to then be considered with adult perspectives and an awareness of neurodiversity.

30 to 50

Overall, an adult with PDA is looking for authentic work, meaningful relationship and emotional expressiveness. This is true of all your clients, but for the PDA person it takes on a quixotic feel, almost as if the pursuit of the answer is a quest which is just as important as what is discovered. They will through the effort be thorough and meticulous to find their genuine authentic self.

If you meet someone who stays “stuck” a long time looking at the same themes and issues from various angles with a great deal of affect and resumes their engagement in the same way from week to week remember it is the pursuit of the answer which is just as important as the doing.

You can support this pursuit by asking and focusing on the questions that elicit authentic and genuine responses to themes that matter to your client.

The individual may be operating at a perpetual energy deficit. The thinking is not just “holding them in place” it’s also a “place holder” reminding them of who they are until they have the energy to act.

They expend a great deal of energy on their work and family. They have little left over. They are often looking for MORE BALANCE so that they have energy for themselves and what matters to them.

A supportive therapy is about energy and how to use it, how to care for and replenish it.

They may struggle with self-recrimination for the things that they can’t do at this time or haven’t done yet but would still like to do.

OFTEN hidden talents, bursts of productivity and growth occur at any time in life due to a change in the way the person prioritizes how they use their energy.

When the person has explored their reasoning, authenticity and more of who they are, they will direct their energy more effectively into what they actually want. Letting go of extraneous expectations as well as better supporting their autistic needs is neuroprotective and growth enhancing.

Conscious USE of their demand avoidance “emotional filter” can then become their “energy manager”. If motivation and purpose clarify feelings to go through the filter it is also then the fuel to restore and maintain energy and vitality.

It is not unusual for me to see PDA adults do things that they have never done before. Such as, go to college at a later age, learn how to identify and communicate their own feelings, move out, live independently and thrive, and find a meaningful career and relationship as well as self-confidence.

I work with adults who are gentle and soft spoken, thoughtful and kind, who as teens had been self-harming, reactive and frequently dysregulated. This same adult can have a career in a lucrative field, a long-term relationship and healthy connections with parents and friends. They can still withdraw, be reactive or avoidant. But these adults move through this with more self acceptance.

How do these adults use therapy?

Ultimately, they use psychodynamic therapy to know themselves through a safe relationship that reflects and mirrors their experiences. They can then understand parts of themselves that had previously not made sense.

ALL mental health symptoms in the PDA person can be addressed in this same manner.

The clinician as they always do will assess for safety and extreme symptoms just as they would in any other client and refer out for medications to help manage extreme symptoms.

You offer your professional perspectives and professional feedback. In fact, the PDA adult wants you to. But you see them through a PDA affirming lens and don’t interpret what you see you explore their experience of what they bring. You reduce tension by affirming and validating what you hear anticipating any resistance to feedback.

Then, you will communicate indirectly with observations while explicitly collaborating in a search to understand them. Be prepared for questions, challenges, confusion of context and resistance.

This is just good safe holding space so that extreme symptoms can return to a baseline through the good management of the therapy space.

The PDA “emotional filter” engages or disengages with challenging material. Where it disengages, you know that there is demand avoidance and you accommodate this by, breaking down an issue to reveal hidden unconscious emotions that need validation and mirroring.

MOST of the time when you approach your client in the manner described, they will work through the resistance with visible relief.

Questions you can use to frame your casework:

1. How do I meet them where they asked to be met so that it was client centered work?
2. How do I conceptualize the work with a PDA friendly focus?
3. How do I support their mental health symptoms by accommodating their need for PDA friendly language, context, meaning and self-direction?
4. What symptoms are ameliorated? What symptoms remain? Have I clarified how medication, sensory support, diet and sleep play a part in regulating mood?
5. Have we incorporated somatic awareness and embodiment of their own sensations and bodily cues into the therapy?
6. How am I fostering their search for self-directed meaning making?
7. How am I evaluating care through a PDA affirming lens? Am I discarding what is NOT helpful?