Transcript
Speaker: Welcome to PDA Life, the podcast brought to you by the PDA Society, where we'll be exploring the highs and lows of pathological demand avoidance. I'm Rachel. And I'm Sarah, and we're your hosts.
Speaker: As the UK's only PDA charity, we're bringing together PDAs, carers, clinicians, and researchers to answer the questions which matter to you most. Hello, my name's Rachel, and I'm your host for today's podcast.
Speaker: Today, we're going to be talking about helpful therapies for PDA adults. Joining me today Beth Silcox and Rebecca Holmwood. Beth owns Lilyoak's psychological and counselling practice. She's a counsellor specialising in autism and ADHD, a SEND advisor and has spent over 20 years working with children with neurodiversity. And Rebecca is a family therapist at Silver Penguin Family Therapy, working with children, adolescents, adults and families. And she has a particular interest in neurodivergent affirming counselling, including how therapy can be adapted to support people with a PDA profile. So welcome both of you to our podcast.
Speaker: Thanks, Rachel. thank you So the first question, Beth, I'll ask and this one to you. Many therapists describe themselves as neurodiversity friendly, but what does genuine neuroaffirming practice look like in the therapy room for someone with a PDA profile?
Speaker: Yeah, absolutely. So I think neuroaffirming practices is more than someone being kind and i understanding to PDA or neurodiversity. It's about some really understanding the nuances of neurodiversity. It's on's a counsellor who's willing to make the changes for the client and not for their own needs or agenda and it's about finding someone who, finding a counsellor who really has that background. There's many ways that you can say that you're neuroaffirming or you understand that it it could be a two-hour CBD or someone like me and Bex who's got years of experience and wealth of kind of knowledge that can really
Speaker: make a difference for a client that comes in. Yeah so it's recognizing those subtle differences that that work for that client. Yeah absolutely and I think seeing the client as an individual that one fit, one practice won't fit all and what me and Bex do is really work with the client to work out what they need.
Speaker: i think that's a difference I can really see through someone who's may have done some training, which is brilliant, and someone who really understands it is that there's not one of the size that fits all. So about really understanding that client, finding out before we start what that client needs to make sure that we can provide what they need as well and really keeping the client as a focus.
Speaker: Okay, brilliant. So Rebecca then, why might traditional therapeutic approaches sometimes feel difficult or unsafe or counterproductive for PDA adults? Hmm, yeah.
Speaker: Well, I think it's a really good question. I think it's very much to do with the hidden demands of a lot of therapy in terms of the fact that, you know, from the very basics of we're expecting the client to turn up at a particular time, we're expecting them to open up emotionally about some really sort of difficult challenges and difficulties. And a lot of that can indirectly affect the threat response that an individual feels. um And I think if a therapist isn't really understanding of PDA and what that actually means, They can inadvertently cause a lot of um lot of threat, a lot of feelings of threat, open up a lot of very sort of challenging and upsetting feelings that the person might have been told about themselves in the past.
Speaker: And that can be really, really difficult and challenging. And that doesn't mean that therapy isn't going to work for a PDA. What it really means is finding the right therapist, really, finding somebody that really understands what PDA is about, really understands how that individual needs to work. and is able to give the autonomy that that that person really needs.
Speaker: I suppose then that that understanding is going to build trust, which we know is really important for PDAs, but is also really important in the therapeutic process, isn't it? Well, hugely. I think, you know, for a lot of people with PDA, trust is not something that is easy to come by. They've spent many years being misunderstood, possibly misdiagnosed, and they've got real and quite understandable issues around trusting people. And the therapist really needs to understand that. And actually, that can be a really important part of the therapy work itself. itself in terms of actually offering an environment where individuals can be themselves, can feel absolutely able to unmask and to share themselves wholly. and And as a therapeutic environment, that's what counsellors who understand PDA are looking to offer.
Speaker: Brilliant. So Beth, what practical changes then can make therapy feel that more collaborative and less threatening for someone whose nervous system is highly sensitive to demands?
Speaker: Yeah, so I found with the clients I've worked is keeping the client's choice. There can be, that with counselling, there are boundaries, there's ethical boundaries and there's boundaries with counselling, of course, have to be kept there and and are really important. But as much choice as you can give within the session, I found has been really helpful. So that could be how they want the the sessions to run.
Speaker: So as a counsellor, you can say, do you want some support to start or do you want some quiet and some silence to give you chance to process it gives the client a choice in how these sessions can run also i find with language I'm very careful with the language you use so it is collaborative it works together it's not me putting on demand or asking the client to almost perform to meet my needs it's about the language that is working together what does the client need what what what can I do for them to help them feel more comfortable and you've just mentioned it with
Speaker: with them, Rebecca, is that if we can build that trust and build that space that the client can come in and feel that they can talk about what they want to talk about or start to feel more like themselves, and those little changes that we can make can actually be really quite big changes for the client. Definitely.
Speaker: So Rebecca, many PDA adults come to therapy carrying years of misunderstanding or even misdiagnosis. So how does that impact that therapeutic relationship then? So I think those kinds of previous diagnoses or misdiagnoses or those kind of, you know, sense of of not being, feeling not in the right place in the world is absolutely not a barrier at all to therapy.
Speaker: And I think it's really part of the work itself. um It's really giving space to that individual for them to have the opportunity to feel understood and be themselves, not to have to mask, not to have to be anything to anybody else other than just be themselves. And I think it's really powerful as a therapist where you can you can sit with someone and say, ah um I'm really interested to understand what life is like and how you experience the world being you and it's not about saying you know this is what a therapeutic model looks like and you need to fit within this it's about saying what can i offer you that allows you to have a better understanding of yourself and understand what you want and what you need going forward it's not just about a person a pdf changing it's about them being able to advocate for change for themselves ultimately
Speaker: yeah Yeah. And I guess from a PDA point of view, to have that space to be themselves and it be okay to be themselves is so important, isn't it? Yeah. you know, we know with with many PDAs, it is it's just vital that they they can be themselves, they can express themselves, that will get the anxiety down. And then I suppose you can really start with that therapeutic work.
Speaker: Yeah, absolutely. And I think it's about validating experience, isn't it? I think, you know, for many PDAs for many years, they've been told that they're not enough, that they're too much, that, you know, that they have, you know, potentially a personality disorder or some other misdiagnosis.
Speaker: And, you know, being told who you are for so long really adds to that sort of, you know, that threat response, that misunderstanding of oneself and the world. And it's incredibly powerful to to be heard and to say, you know, yeah, this is who I am. And and that's OK. I'm enough as I am. and I think that is a lot of the work. People really understanding that they are, you know, they are exactly who they are supposed to be.
Speaker: Yeah, yeah. And that is so important. Definitely. OK, so Beth, if if someone is looking for a counsellor or a therapist, what questions should they ask before committing to sessions?
Speaker: One thing i I think I say with questions is that, again, i talk about being the individual a lot, but it's about kind of the individual and what you are. seeking so it's about looking at what the counsellor offers as therapy so is it person-centred therapy where the client is the focus of that work is it something like CBT where there'll be lots of homework and worksheets and things to do so a little bit of it is knowing what you're seeking and asking those questions and then from a understanding PDA what is their and understanding of PDA and then what's their experience like I at the beginning just to differentiate between it a CBD course as someone who really understands how to work with someone with PDA and then questions about the session so asking what happens if I turn up late to a session how would that work what happens if in the session as a client I'm really not it's not helping me how would the counsellor support the client or if the client said actually this really isn't working for me how would the client the counsellor respond to that
Speaker: The one thing that I mean, Rebecca was spoken about as well, it's not only just the answers, it's it's listening to the tone of the answers. It's really listening to how the counsellor is responding. So, for example, um I know Rebecca and I both do initial call, so we give an initial call. If someone needs a second one or third email, that's absolutely fine because we really understand that sometimes you have more time to process it or you've forgotten what you actually wanted to ask or you just want to have that conversation again. It's those moments where you'll have a counsellor that goes, of course, no problem. This is where we can put you is what we can do. or someone who goes, actually, we've had your three, 15 minutes. It's those little nuances. It's how we say listen to the tone. Of course, the answers are important, but just really listen to how the counsellor is.
Speaker: responding to you and and kind of reacting to your requests yeah that's a really that's a really good tip i think because it's it's that going over the above and having that understanding that is the important part isn't it it's that way if they can make that connection then i would have thought then the therapeutic process would we have more positive outcomes but if you can't make that connection then it's that that you're going to be more limited aren't you i suppose yeah absolutely and we talk lots about that therapeutic relationship and having and building that trust and having that space that as Rebecca was just saying about them to really work out who you are and go on that journey and for a client to really feel that they can trust their counsellor and say actually this isn't working for me and knowing they've had that pre-conversation to know what that might look like hopefully then will reduce that demand reduce the nervous system to really kind of settle the client say actually we you know what the cancer can offer and actually hopefully that will make that conversation a little bit easier but where with questions it will be different to everyone because of the individual really listening and trusting trusting your gut how someone's responding to you i it's really important yeah brilliant okay and then conversely then Rebecca are there any red flags that might suggest a therapist isn't going to be a good fit
Speaker: Well, yes, no, absolutely. I think probably the first one is the language that they use to describe PDA. I think if the language is medicalised or it's negative in any way, then that really isn't someone who's going to be understanding of your nervous system and have a deeper knowledge of of how you might behave. with threat responses or the demands that can you know come up in any form of of therapy. Because that's that's where you know the the therapist is key at really supporting the relationship, is understanding that and being able to respond to that quickly before it becomes an issue. So not really understanding PDA comes across very quickly, I think, in the language
Speaker: that counsellors and therapists might use. I think also sort of showing a rigidity about the work that they do. If you're looking at a therapist that perhaps does CBT, for example, if they're very rigid about the form that that might take, then that's really not necessarily going to work for somebody with with pda that flexibility is really really key think anyone who over promises as well isn't showing curiosity about the client the individual and an over promise of all we can we can sort this out we can fix this because therapy isn't about fixing Essentially, therapy is about understanding and the individual, the individual understanding themselves and and and moving forward, not necessarily a a quick fix. And I think making assumptions about PDA as well. I mean, every individual experiences the world differently and PDA is no exception to that. So, you know, it doesn't matter how much training you've done on PDA, it doesn't mean that you could possibly understand how it's you know affecting the individual sitting in front of you so keeping that curiosity key and also how they respect your boundaries as well so some of the questions that you might ask when you're initially trying to find a therapist may sort of you may ask some questions such as you know how do you respond to sort of missed appointments or how do you respond to me taking a break or how do you respond to me
Speaker: you know, pushing back if I don't feel like i can I can sort of do something within the sessions or some homework that you're asking me to do. I think you get a sense very quickly about, you know, how they're going to sort of work within your own sort of boundaries. And that's hugely important a PDIer to know that they've got the autonomy. So I think it's very much thinking about your own sort of internal autonomy, your own sort of internal motivation. And is this somebody who's going to respect that and be able to work with me safely?
Speaker: Yeah, brilliant. OK, some really good advice there. Thank you. Beth, for PDA adults who might have had a negative experience with therapy in the past, how can they approach trying again with therapy? Because that's, you know, i suppose there's going to be a barrier straight away there, isn't there? Because there's a negative, that negative memory is there. so you're going to make that anxiety even higher before you've got started.
Speaker: Yeah, absolutely. So i think the first thing is, as we're saying, is it is to find a counsellor who really understands PDA, someone who who can help the process and to approach it slowly. And you can approach these things slowly. So if you find a counsellor that you feel that you're gel with, you've asked the questions, you looked you've looked after those red flags that that um might not have worked, and it could be that some of the red flags we've just discussed is something that the client sits there thinking, oh, absolutely. Or that person thinking, oh, that happened to me. so So hope this will help people see that actually there are things that don't work.
Speaker: Find a counsellor that that you think you can gel with, that you can work with, and then you can take it slowly. So you can either verbally or maybe an email, share with your counsellor if you feel comfortable too. I should have bad experience in the past. This is what didn't work for me. That honesty at the beginning can be really helpful. But again, if you're not ready,
Speaker: it's okay to share these little things as you go through the daily process. As Rebecca said at the beginning, if the process starts the minute you meet, it's not a case of we'll fix this and then we'll move on to the next part of the journey. It's all part of the journey. So I think if you've had a bad experience, it's okay to come back. It's okay to work slowly. It's okay to work at your pace. And also if you meet someone and you start that journey and you think this is not working again, it's okay to say, actually, this isn't working. As counsellors, role on us to say actually we might not be the right counsellor for you and we can refer you on so there's lots of things that with the right counsellor are in place to support you and support you to move forward and i think with therapy that hasn't worked in the past there's so much trust and to be able to reach it again to reach to start think actually i I want to talk about this I want to work through this let's start again that it's it could be such a big step
Speaker: that having the right counsellor and be able to work, which I keep saying slowly, be able to work slowly and with something that you feel like you can trust and at your own pace. i think that also can then reduce the demand, reduce the need to keep your counsellor happy or do the the right thing is to just go on that journey at your own pace.
Speaker: Yes, I guess that pace is really important, isn't it? Because I think, you know, I think if a counsellor sets it up, OK, we've got six sessions, we've got to, you know, and we're going to put everything into that, then that's immediate extra demand, extra pressure, isn't it? Whereas if it's open-ended and it's like we will see where the path goes type approach, that's going to feel far less pressure, isn't it? And it's it's less of a demand then.
Speaker: And and and um we were just talking about questions. Again, that's a question to ask. There will be therapists that... their model is they work to six or 10 kind of sessions and and that and that could really put a demand on you. So to ask those questions so you know that you've got someone who can work long-term with you if that's what you and want to meet from the therapy. So yeah, absolutely.
Speaker: Yeah. Rebecca, many PDAs talk about masking or people pleasing or feeling misunderstood. How can therapy create space for someone to be genuinely themselves? How do you get to that genuine person?
Speaker: Yeah, I think PTAs over time become naturally very skilled at reading other people. o And i think often they appear more okay in a situation than they actually are. And I think from a therapeutic perspective, from a therapist's perspective, it's not just about hearing what your client's saying. It's really understanding how much effort they're putting into saying it and understanding when they're masking. And then it's about being able to provide provide the the space in order for them to unmask. And that takes a lot of time sometimes in order to get that trust, to be able to feel as a PDA that you can actually be genuine in yourself. in this space.
Speaker: So i think for the therapist themselves, um I think it's about being very explicit in their language. It's okay not to know the answer to a question that I've asked. It's okay not to feel ready to open up about your vulnerabilities at this time.
Speaker: It's okay not to make eye contact. It's okay to choose your own seat. It's okay to decide that you want to switch your camera off for this particular session. and And it's very gradually just allowing the individual to feel that they can slowly take off some of the armory that they've put on over the years. And that process can be quite quick or it can be really slow. It really depends on the individual and, and you know, their experience, their previous experiences.
Speaker: But I think from a therapeutic perspective, from a therapist perspective, I think one of the things that I'm really conscious of is and not rewarding my clients for masking.
Speaker: And this isn't just for PDAs. This is for, you know, this is for neurotypical and neurodivergent clients as well, because, you know, everybody puts on a bit of a front sometimes because sometimes we're hiding from ourselves as well but for pdos especially it's about not rewarding masking so it's not about sort of ah what i use the word sort of congratulating and i don't congratulate my therapy sessions but it's not about rewarding the clients for their sort of their performances for being articulate for for being you know very sort of suddenly insightful of of ah an emotion that they've been holding on because actually therapy is is at its very best in the real messy moments and the unstructured moments and the inarticulate moments and that's not just for the client that's for the therapist as well It doesn't look like the therapy that you see on the telly. It doesn't look like, you know, Hollywood movie.
Speaker: um It is a bit messy. It's a bit disjaunted. And, you know, that's the reality of it is a lot more comfortable than than I think a lot of people feel. So it is it's that sort of ability just to allow people. your clients will very gradually be themselves and in order to do that I think probably the strongest tool i don't know if Beth agrees with me in this one but the strongest tool I think we have is about being ourselves as well we absolutely and utterly you know we are not we are not the expert in the room the client is the expert in the room they're the expert themselves and we are there to facilitate a space where they can explore that yeah yeah I know that yeah that's great So Beth, how can supporters or partners or family members or even friends help a PDA adult access therapy, but without creating that additional pressure to do so? Yeah, absolutely. So I think accessing therapy can be lots of admin first. So researching therapies, finding out what they offer, speaking to therapists about prices or of and availability online, face face. So I'd say all of that
Speaker: Every searching admin, if you like, work would be really helpful for someone with PDA to support them. Without adding the extra pressure is if you're if if you're family member or a friend that wants to help, offering that information and allowing your friend or the the person with PDA to say no. So actually I've changed my mind. Just so just know the individual doesn't then feel that, gosh, you've done all this work and I have to go on this journey or I have to now speak to that one counsellor because you've found them for me.
Speaker: I think giving them, again, the choice, the the choice to say yes the choice to say no, it's really important. And also to make sure that you that no one's putting pressure on the individual to start therapy. and And I think that's with anyone, is that if you're going to go into counselling and have therapy, it has to be for you. You have to want to do it. But we're also really aware that there is such a lot of admin type research to do around finding a therapist and not only finding a therapist that may um have the time slot you want and and the the right modality you want, but then to and find out all that extra extra information. If someone can support you with that, then I think that would be really helpful. But yes, if you're that person supporting them, able to stand back and let some individual choose. Yeah, yeah. Because if they've got, you know, we know with PDA, is they've certainly got the drive to do things, but if the if that environment is right for them, so therefore...
Speaker: if they do have somebody supporting them, helping with that research. Because as you say, it's quite a lot of research that, you know, potentially that you could be doing. And then that just takes those demands away a bit, but still gives them the autonomy for them to be able to make their own choices. Isn't that important? Absolutely. think I'm big about as a counsellor, even when someone first contacts you, there is a certain amount questions going back. Are you looking for online or face-to-face? What's your VOD PT? Even to book the initial call. Would you like an initial call? When would you like it?
Speaker: Sometimes I'm really aware with my emails, as much as I try to reduce the demand as much as possible, there's a certain amount of needing diaries to fit and to make sure, even that for even for that like initial first call. And if someone PDA has reached out and done that first that that that first contact and then all these questions come back, that could feel like a lot of demand. So if someone could help them with that, think would be really helpful.
Speaker: No, that's great. Okay. So Rebecca, what would you say then to a PDA adult who's sitting on the fence about therapy? Well, it makes absolute sense to be unsure. And, you know, it can feel really, really demanding thing to have to think about. And it brings up lots of fears of being judged, of being misunderstood, of being analysed, the extra pressure or, you know, the expectation to change as well. So, you know, it's quite natural that a PDA would feel like that and and be sitting on the fence about, um about you know, trying therapy.
Speaker: or trying therapy again. I think what I'd probably say is that you don't have to decide everything all at once. You can take it really slowly. And I think initially it's about understanding that you don't need to commit to any of this until it feels safe enough to do so for you.
Speaker: You can start really slowly by maybe looking at a few profiles or having just one conversation or sending just one email. And, you know, good therapy isn't about making you less PDA. You know, it's really about allowing you to feel more accepting of yourself just as you are. It's about helping you to understand yourself with less shame. It's about protecting your energy. and it's about really allowing you to be able to communicate your needs and find ways of living that are more sustainable for you in the in the future. So this isn't necessarily about the type of demanding
Speaker: change that I think sometimes we think about when we're thinking about you know therapy we think about work that we've got to do and yes there is work that we have to do as an individual when we're in therapy but you know it's mostly about understanding ourselves and what we want and being them being able to communicate it and as I say we could you know you can take that really slowly and if you find the right therapist in order to do that then the work is definitely definitely less demanding Brilliant. OK, so to our last question, as so I'll come to both of you for this one. I'll come to you first, Beth. What's one thing you wish every therapist understood about PDA?
Speaker: I would say that it's about the individual still. It's about understanding... the person's individual needs. So if they come and tell you that they have PDA, that's really important, but for therapist not to only see the PDA, but also to understand that the client is seeking safety and seek and and seeking a journey which helps them feel safe in the process. And if that means extra calls the beginning or extra support in the sessions, it's actually brilliant because they are seeking what they need and to support that journey and not to view it as extra work for the counsellors meeting individual needs of the client which is what we are here to do.
Speaker: Brilliant okay great thanks and Rebecca? Gosh just one thing um i think it is that autonomy for the clients isn't a nice to have it's absolutely fundamental for safety. Yeah brilliant okay Oh, that's amazing. Thank you so much both. I found it really informative and I'm sure lots of our listeners would do, both counsellors and PDA adults themselves. So thank you so much for sharing your wealth of information with us. And I know we are going to go on and record a webinar, digging into this in a little bit more detail in a moment. So just from the podcast, thank you very much for both of you for coming along and sharing your ideas today. And thank you also to our listeners for listening to this episode. We hope you found it useful. and we'll look forward to hearing from you again soon.
Speaker: Take care, everybody.
