Working with a client whose autistic profile includes Pathological Demand Avoidance (PDA) involves a tailored, multi-faceted approach.
The foundations for a strong therapeutic relationship are important. These are things like creating a nonjudgmental, accepting environment and inviting the client to set the pace and boundaries. A counsellor with training in, and experience of, neurodivergence will be flexible in communication styles and the structuring of sessions to suit the client, who may be coming to therapy with a PDA diagnosis or not. They could be seeking discussion around it, and how it relates to autism.
PDA is a profile component for some individuals on the autism spectrum. It’s characterised by an anxiety-driven need to avoid and resist everyday demands and expectations that may be direct or implied. Those with PDA often exhibit high levels of anxiety and a need for control in social situations. They may use social strategies to avoid demands, appear sociable on the surface but lack depth in their social understanding, and experience intense mood swings and impulsivity.
A client on the spectrum with PDA can be helped to understand their own patterns of demand avoidance and identify the triggers for it. Coping strategies can be developed for managing the anxiety around demands, such as reframing negative self-talk; cultivating conscious awareness; and, learning mindfulness techniques for emotional regulation. Work can be undertaken on slowly increasing tolerance for demands, using a collaborative approach to set small, achievable goals.
Together, the client and counsellor can look at adopting assertiveness techniques for expressing needs. Negotiation skills can be practiced and ways sought to modify the client’s environment to reduce unnecessary demands, to build a more autism-friendly lifestyle. The counsellor might deploy what’s called a strengths-based approach, whereby they look to identify and leverage a client’s strengths and special interests, using these as motivation and rewards in managing demands. The counsellor would need to avoid creating too many demands in the therapeutic relationship itself. They can offer choices, use indirect language, and be flexible in their approach to avoid triggering the client’s demand avoidance.
It’s a good idea to explore strategies for explaining PDA to others when necessary. There’s no fix for PDA and any strategies adopted will ameliorate, not eradicate. They will have to be practiced, over and over, until they become routine. Clients need to know there’s a lot of work involved – it’s far from easy or quick – but outcomes can include a reduction in anxiety episodes and their intensity; fewer manifestations of distressed behaviours and overwhelm; and, feeling more confident and able to manage in situations that might have been too challenging before.
xph therapy offers integrative counselling, which means working with multiple therapy types, including CBT, psychotherapeutic and person-centred to develop a therapeutic pathway just for you, whatever outcome you’re hoping to achieve. Get in touch in a variety of ways. See the contact page for more info.