My therapist is wonderful. She’s a young clinical social worker who has been supportive of me as I teach her about Autism and PDA. She’s helped me resolve trauma and heal relationship dynamics with EMDR and Internal Family Systems work, as well as simply being a co-regulating presence during my child’s burnout and my own. She’s been great for me, and I feel lucky to be in her practice.
But something changed recently.
Over the past several months, a pattern emerged. I became exhausted every time it was time for my therapy appointment. I assumed it was just part of my general social anxiety, but even with propranolol (beta blocker), my body had intense symptoms of threat.
Last Thursday I got on Zoom to meet with my therapist. As soon as I logged on I felt a massive change in my body. My heart rate increased. My breathing got shallow. Speaking became a huge physical effort. I could quite literally barely get the words out to talk with her.
I shared this with my therapist, and she said it seemed like it was time to listen to my body. I realized she was right. This was a PDA threat response, a body communication telling us both that therapy had become “a demand” - my body was perceiving our sessions as a threat.
This can happen for PDAers even for things we enjoy. When something is regular on the calendar, especially if there isn’t a dopamine hit or novelty associated with it, our bodies often start to perceive it as a threat.
So, it didn’t matter that there were more things I’d have liked to work through in therapy - my body was done for now & we had to listen.
As I teach my clients, the PDA threat response is a physiological limit, not a psychological one.
When I said I was scared to not be on my therapist’s case load at all, she said she was happy to keep me on, and simply hold off on regular sessions. I could contact her as needed and she usually has cancellations. This was a very PDA-affirming move.
Why? We dropped the demand for regular therapy sessions. This calmed my body down. But I am comforted to know I can reach out to her as needed. When I do, the session likely won’t be perceived by my body as a demand because I’ll have something specific to talk about, and it will be at a unique time & not a regularly recurring one. Novelty!
Often, parents of PDAers who are struggling have an understandable instinct to bring in a therapist, psychologist, or social worker to meet regularly with their child or teen.
Parents wonder "Should I put my struggling PDA child or teen in therapy? But how would I even get them to appointments?
Sometimes there is the impulse to bring someone physically into the home to calm down the family dynamics. Let’s look at the question of therapy for PDAers through the PDA Safe Circle™ model, and in light of the story I just shared. (Stay tuned for opportunities to learn the full model in 2025!)
In The PDA Safe Circle™, we use the visual metaphor of a circle to describe the PDAer’s nervous system capacity and lived experience of the world.
Things that our PDA nervous systems perceive as safe are allowed inside our personal safe circle. Things our body deems as threat are kept outside at all costs. So for a child or teen in burnout, their safe circle might look like this:
This kiddo may be going into fight/flight/freeze/shut down a lot of the time.
We can then visualize demands as arrows being shot at the safe circle. Each “hit” triggers stress, or even a full threat response. Over time, the arrows can shrink the size of the circle until it gets so small basic needs are outside, and threat response is very high.
This is burnout.
Our long term goal for a PDAer in distress is to Create Safety - i.e. allow the safe circle to widen so more of life fits inside the circle, and less triggers the threat response.
The only way to do this is by helping the person feel safe, and giving access what brings them joy.
It’s understandable to reach for a clinician to meet with a burned out child or teen, but due to the nature of the PDA nervous system, therapy itself is often perceived a bunch of arrows: Regular appointments, the social demands of a meeting, the potential for feeling low social status in relation to the clinician. This is why therapy is not often helpful for PDA kids and teens who are in burn out.
Often, the safe circle doesn’t have capacity to fit therapy inside.
Even when a PDAer’s safe circle does have capacity for therapy, we need to approach it carefully. (Remember my story: As an adult, in a time of my life when my safe circle is pretty large and I love my therapist, therapy STILL became a demand for me over time.)
PDA children and teens benefit when goal of the therapeutic relationship is not to fix behavior or make things at home better, but to simply to be a trusted confidant and co-regulator. Someone who can support their self-discovery about PDA (if a PDA identity can fit inside their safe circle!), and explore newfound self-knowledge about what helps them feel safe.
Some kiddos may be able to have a relationship with a therapist, but only feel safe if they are able to play a high status social role within the relationship.
For instance, a client of mine shared that her PDA child could not tolerate therapy until they came up with the idea of Therapy Book Club. The child - who is highly intellectual - now assigns a book to the therapist to read, and they discuss the book in their next session. This gives the child a high social status role to play - Book Assigner - and drops the demand that they talk directly about their own feelings, which was too hard for this kiddo. Instead, they talk about the characters in the book.
Last minute cancellations need to be expected and understood, or the clinician will likely get ejected from the safe circle.
For PDA children and teens in burnout, the highest leverage intervention is usually with their caregivers, not directly with them.
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