By Emma Spencer, Clinical Psychologist
Incorporating the Low Demand Approach to Therapy into everyday clinical practice can transform how we work with neurodivergent clients, especially those with Pathological Demand Avoidance (PDA). This framework reduces pressure and creates an environment where clients feel safe, understood, and empowered to engage in therapy at their own pace.
Here’s how you can integrate these six key principles into your practice:
Relationship: Building Trust and Connection
At the heart of the Low Demand Approach is the therapeutic relationship. Building a strong, trusting connection is foundational, especially with our PDA clients who are sensitive to demands.
- Start by building rapport: Spend time creating a relationship based on mutual respect and trust before diving into therapy. Allow your client to feel like your equal or even superior.
- Slow down the process: Give the client time to warm up and feel safe in the therapeutic environment. Don't rush into therapeutic tasks; instead, focus on connection first.
Client Autonomy: Respecting Client Control and Choice
Respecting client autonomy is central to the Low Demand Approach. This involves giving clients control over their therapeutic journey, from the pace of sessions to the direction of therapeutic goals.
- Empower clients to lead: Allow the client to set their own goals and decide on the pace of therapy. If they’re not ready for a particular therapeutic task, respect that and work with them on what feels manageable.
- Offer choices: Present multiple options during sessions—whether it’s how to explore a topic, which activities to engage in, or how they’d like to receive support. Giving clients agency reduces the feeling of pressure.
Creative and Flexible: Adapting the Therapy to Fit the Client
Flexibility is key in making therapy feel manageable for neurodivergent clients. The creative and flexible principle emphasises adapting therapeutic interventions to meet the client’s unique needs and interests.
- Tailor interventions creatively: Use the client’s interests or preferred activities as entry points for therapeutic work. For instance, if a client enjoys art, incorporate drawing or painting as a way to explore emotions or process experiences.
- Adjust techniques on the fly: Be willing to abandon a planned activity if it feels too demanding or overwhelming. Flexibility in session content and structure is crucial for maintaining engagement.
Domain Focused: Focusing on Specific Skills in Areas the Client Feels Safe
Rather than tackling broad therapeutic goals all at once, the domain-focused principle suggests focusing on specific areas that feel safe and manageable for the client.
- Identify domains of safety: Focus on areas where the client feels more comfortable. This could mean working on emotional regulation in small, manageable ways rather than diving into deep, complex topics.
- Build slowly on success: As the client experiences success in one domain, slowly expand to other areas of therapy, always maintaining a client-led pace.
Sensitivity to the Nervous System: Attuning to the Client’s Window of Tolerance
Clients with PDA or other neurodivergent profiles often have heightened sensitivities, especially in their nervous system responses to stress. Being mindful of their window of tolerance—the emotional space in which they can engage without feeling overwhelmed—is crucial.
- Monitor emotional and sensory regulation: Stay attuned to signs of emotional distress or sensory overload and adjust therapy accordingly. If a client seems to be nearing their limits, scale back and refocus on areas that feel safer.
- Create a calming environment: Ensure that the therapy space is comfortable and calming for the client’s sensory needs. This might involve adjusting lighting, sound, or seating arrangements.
Collaborative and Inclusive: Working with Parents, Carers, Educators, and Health Providers
The Low Demand Approach emphasizes the importance of including the client’s wider support network—parents, carers, educators, and other health professionals—to ensure consistency and holistic care.
- Involve the support network: Collaborate with key individuals in the client’s life to reinforce therapeutic strategies across different environments.
- Unified care: Work together to create care plans that can be applied both in therapy and daily life, ensuring consistency in support.
- Open communication: Maintain regular communication with all involved to monitor progress and adapt the approach as needed.
By integrating these six core principles—relationship, client autonomy, creativity and flexibility, domain-focused work, sensitivity to the nervous system, and collaboration and inclusion—clinicians can create a therapeutic environment that feels safe, non-threatening, and empowering for neurodivergent clients.
This approach allows for more meaningful engagement and ensures that therapy is adapted to the client’s unique needs. It respects their autonomy, reduces pressure, and builds on their strengths while maintaining an empathetic and flexible approach.
Whether you’re a psychologist, speech therapist, or occupational therapist, incorporating Low Demand principles can transform your practice, making therapy more accessible and effective for neurodivergent clients, especially those with a PDA profile.