When my therapist produced a ‘Treatment Summary,’ it read as though she was operating entirely on standard, hierarchical clinical risk models. In that traditional playbook, the calculation is fairly straightforward: you overwhelm the vulnerable client with a dense, highly pathologising, professional-looking document designed to make them feel small, clinically ‘unmanageable,’ and ultimately too exhausted to fight back. It is a top-down exercise in narrative control, involving flexing the power differential, to assert authority and close the book on a liability.

The audacity of the whole document starts with its very premise. This 20-page institutional manifesto of bullshit, which I was told took considerable time to produce (I may or may not have pointed out that it was considerable time spent on a document I didn’t ask for rather than the clinical records I actually wanted – #PDA), was apparently meant to act as a stand-in for the session notes I had been denied. When you perform a comprehensive autopsy, as I have, only two meagre pages are dedicated to summarising three years and 99 sessions of treatment. The remaining pages are a towering monument of defensive clinical justification, padded out with a generous side of ‘woe is me, the poor stressed clinician’ for good measure. It would have made for good toilet paper in the great toilet paper shortage of 2020.

Whatever the aim of a heavy, bureaucratic document like that, they accidentally tripped the wire on the one neurotype guaranteed to equalise the power dynamic with devastating precision.

Hello PDA. Welcome to the show.

For a PDA (Pervasive Drive for Autonomy) profile, institutional power carries no intrinsic weight. As I once said so eloquently to my therapist:

‘Our spidey senses are sharp, and our BS radars are on point. If you’re not being real, we’ll sniff it out in two seconds’ flat.’

and

‘I’m a PDAer so I don’t care whether someone is the Queen of Sheba, the Prime Minister, or Joe Blow down the street. Titles and credentials mean very little to me.’

Maybe she thought she’d be the exception, and the titles in her email signature would impress me. Titles, letterheads and credentials mean very little when a nervous system picks up coercion or incongruence. Back a PDAer into a corner with top-down, paternalistic demands and the survival response isn’t compliance or quiet retreat. It’s an absolute drive to fight back, tear down the constraints and get autonomy back.

Looking back, there’s an almost comical irony in it. She spent years praising the exact forensic skill set that’s now pulling her treatment summary apart. I once told her about my knack for spotting security vulnerabilities and systemic gaps. She was enthusiastic about it.

Did I mention this clinic is meant to know about PDA? Yeah. In textbooks, sure. In practice, that’s for the regulators to decide.

Here’s the thing about handing a detailed clinical document to someone with an obsessive eye for patterns. You’re not closing the file. You’re giving them a map of every gap in it. Whoops.

I read it in the aftermath of a severe eating disorder relapse and an ending I’d describe as catastrophic. Twenty pages of clinical jargon and risk-management checklists didn’t flatten me. I went through it line by line.

When you hand that kind of document to someone who doesn’t give a fuck about your branding or hierarchy, who sees straight through defensive peacocking and knows how to read the receipts, it isn’t a shield.

It’s an open invitation to audit.