‘PDA aware’ has become a bit of a buzzword in neuroaffirming circles over the last few years. It’s supposed to mean more than just being neuroaffirming: understanding how a nervous system might react to perceived demands. Clinicians who call themselves PDA aware talk about being low demand, respecting autonomy, using declarative language, reducing pressure and working collaboratively.

That’s fairly easy in a contained therapy room, in neat one-hour blocks. If it doesn’t work? See you next week, sunshine.

What happens when things get messy?

What happens when a clinician takes all that knowledge about PDA, applies it to a client’s supposed PDA ‘pathology’, decides how that client’s therapy will end, and then plans to ‘drip feed’ the decision, raising it “as a possibility first rather than an absolute”, so the client has time to come around to the view that it’s the right one?

Is that PDA aware? Or is it coercion in pyjamas?

I know which it felt like from where I was sitting.

True story. It happened to a friend of a friend of mine. Nope, sorry. That was a TV show from my childhood.

It happened to me.

Well, correction: it was the plan my therapist proposed to my treating team. I apparently derailed it before it could play out as intended, but that bit isn’t really the point.

To be fair to the plan, it also said the intention was to be transparent with me about both the decision and the rationale. I don’t know how you’re transparent about a decision you’ve planned to present as a possibility. I don’t doubt it was meant to be gentle. That’s exactly what worries me.

The point is, this wasn’t planned by someone who’d never heard of PDA, or who didn’t get autonomy, demand avoidance or why you’d want to reduce perceived threat. It was proposed by a clinician who understood PDA well.

Being PDA aware isn’t knowing which phrases to use in a calm, collaborative session, or swapping imperative language for declarative. It’s knowing how to respond when the metaphorical shit hits the fan.

The real test comes when the clinician and client want different things. When there’s a rupture. When the clinician has already picked a path and the client’s autonomy suddenly becomes an obstacle.

That’s when ‘PDA aware’ has to be more than a line in a practice bio.

If understanding someone’s nervous system is used to work out how to bring them around to an outcome that’s already been decided, while presenting it to them as only a possibility, then I have a much more uncomfortable question:

Is that accommodating someone’s need for autonomy, or is it a sophisticated way of getting around it?