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Can you communicate effectively with a PDA client? The clinician develops a relationship through being able to communicate effectively. They will use PDA friendly phrasing, a neutral curious noncommittal tone and expansive big picture thinking that can also be explicit when needed.

To do this the clinician must master PDA friendly phrasing, which diffuses meaning rather than lands on a settled viewpoint. I use the skills of generalizing, universalizing and normalizing of the feelings and experiences of my clients. I will often share how others have experienced something similar and weave in an anecdote that they can relate to.

Clinicians are often unable to enter intense circular thinking making the mistake of ending it or directing it. PDA friendly communication will instead strive to enter a topic in an opening created by a curious real question or reflection. This respects circular thinking while also striving to neutralize the charge and intensity with their therapeutic skill. PDA communication can be entered through “friendly phrasing”.

Friendly phrasing reflects what is said but also includes the clinician’s additional thoughts that add feedback, reflection and navigates the confusion with further questions. In this way, communication is built on blocks of meaning previously heard and agreed upon.

Questions such as: “what does this mean to you”, and “why is this important”.

Often clinicians think of questions as demands. Are they?

Maybe. Although, in my work questions that consider the feelings motivating a behavior or reaction injects curiosity and expansiveness into areas that are not fully understood. My clients want to understand themselves.

Therefore, my questions accommodate PDA.

It makes it easier to engage with the demand to know themselves by offering engagement with their emotional motivations. The therapist has the skill to neutralize shame and defensiveness right away. Then, continue to use their therapeutic skill to hold the feeling and look for more context to understand it.

Holding feelings effectively can also be a challenge for the therapist in multiple ways.

PDA behavior or feelings can be pointed, hurtful or rejecting to the therapist or those that the PDA person cares about. Or, if internalized, they will be highly self-critical. The therapist will be therapeutic if they inject neutrality and curiosity.

The reactivity of the PDA person is an aspect of how they process emotion. Feelings are expressed with intensity. Contextual understanding reduces intensity and also integrates a more nuanced feeling state. This unfolds with time or in a regulated safe relationship. It isn’t that they are rejecting you or their other relationships. They are showing you something they need you to see and accept about them and if you create safety here, they can see you too. Are you able to navigate their intense feelings?

The PDA person will become very expressive when offered the chance to communicate through PDA friendly phrasing. It offers the immediate scaffolding for a safe emotional container.

These conversations will circle an issue. There should be no attempts at solving this issue or any application of technique. PDA therapy affirms circular thinking as a means of contextualizing and holding strong feeling.

When looking to address attenuation and intensity that naturally builds in circular thinking the therapist will go into something and then come out of it. You will engage and disengage using reflective listening and mirroring. If you can mirror and reflect to them what you see in neutral curious and expansive ways you will be allowed in to help them make sense of it.

This connective PDA friendly communication will look to create a hook for feeling to “hang it’s hat” on. The feelings can rest there at the end of the session. Be explicit about this. That, they can seek to return there to consider more nuance later and they can close it up at the end of the session.

Using PDA friendly communication allows the therapist a glimpse of the inner life of their client and create safety for their feelings to emerge.

When enough language that has “meaning” is woven together to hook a “feeling” the PDA person can HOLD the feeling without you. They HAVE it. It’s internalized. They can “pull it to them” any time as their contextual memory can now call it up when needed.

It is easy for the therapist to misunderstand or misinterpret their initial attempts to communicate or read behavior. The PDA person is often not sure what they feel at first and are showing initial pieces of their experience that are not easy for them to move through or engage with. Often feelings are more like sensations or impressions that need words to convey authentic meaning. The words can be effortful and present a demand.

Should you interpret your client based on reading their behavior or interpreting them at “face value” you will have MISSED capturing the feelings in the web that holds a regulated experience and a “hook” to relieve the pressure and attenuation. They will likely leave your therapy.

Pathological Demand avoidance expresses itself in the therapy space like classic psychodynamic resistance. This is the duality or conflict that exists inside the person trapping them there. Resistance in therapy is a defense that is self-protective pointing to strong confusing feelings that are not understood and integrated.

One way to find and release FEELING is for the clinician to look for where the client is showing resistance. They want something but don’t do it. If you “find the resistance” you will find FEELING.

WHY is this important?

Finding the feeling will allow the clinician the information they need for PDA friendly phrasing which is to engage in questions about what is being resisted, why it is hard and what about it means so much to them, rather than directly challenge the resistance. Then validate and affirm what they hear.

This is the KEY to providing ongoing, therapeutic support to the PDA person so mastering this through good effective practice is essential.

The inner world of the PDA person enjoys engaging with these questions. They can simultaneously engage with you and with their longing while also continuing to avoid change thereby letting them explore their resistance.

There you will encounter shame, hurt and negative thinking that is connected to real experiences and consider what has happened for them to feel this way.

Engaging with PDA friendly questions will result in an immediate release from fight or flight. Clients will often say: “that’s a good question”, “I never considered this” or “that’s very interesting”! The circular thinking stops.

My work is often made up of asking THE GOOD QUESTION and multiple GOOD QUESTIONS throughout a session.

When good questions are asked slowly and gently there will be a release of affect that surprises the PDA person.

Over time this process leads to emotional integration. The PDA person can reach for the feeling and know where to find it. They can better self-regulate.

THROUGH your relationship you create engagement with what is being avoided. Through your use of the “good question” and noncommittal open tone you go on a search together for their personal sense of meaning and purpose and their reasons why something matters.

Then, “through your relationship” you will watch the demand avoidance play out, only therapeutically, with you the therapist offering a reworking of the repetition compulsion, so the client finds mastery.

What about DROPPING DEMANDS in a therapy space?

Dropping demands is a common strategy to navigate demand avoidance. You may see this play out in therapy.

I will often reflect on where my client finds themselves in their experience of therapy to drop demands. I do this when ambivalence is expressed, or attenuation has increased. I hear “part of me wishes I could put the top back on the box”, or “I need to just let it sit for a while”.

I continue to engage but in a low demand way, where I simply validate this place in their growth, and look to support how they can restore their energy or motivation for change.

Often if the PDA client is a child the parents will be pressuring the therapist to “get some work done”. The therapist will feel the same pressure.

They may have learned about how important dropping demands can be for the PDA child but then don’t know how to foster further safety for growth. This can rupture the relationship due to a lack of connection to meaning and purpose for the client. PDA friendly communication can explore possible motivations for engaging. Do they want a place to share with privacy? Do they want their parent to understand them better. What’s the point of therapy?

Sometimes my adult clients will create a similar dynamic with me expressing a desire to “get work done” putting pressure on themselves to understand or know what they want. But they don’t trust themselves to slow down and pay attention and are moving too fast through content which can activate the therapist to look for solutions. Is your client being too demanding of themselves without understanding the motivations or feelings that underpin their intensity?

I see a low or no demand interaction as a response to address overwhelm, ambivalence or too much input. It is the other extreme of “pushing through and getting the work done”. It instead opens up time to replenish and restore energy, as well as let emotions come up into awareness.

I believe the PDA person navigates demands in day-to-day life when they engage in demands that matter to them and disengage to restore and replenish. They also seek to know what matters less to them to let go of demands that drain them.

Recognizing how energy is being used and directed in the therapy session and in their lives will therefore introduce a way to engage with this consciously. Therefore, I focus less on creating low demand parenting and more on balance and the need to develop a foundation for purpose and meaning to direct energy in a balanced way.

This is not easy to develop as it is a conscious effort for the PDA person. The therapist can be very important in fostering this self-awareness.