Pathological Demand Avoidance, also known as Pervasive Drive for Autonomy, is a profile most commonly associated with autism and, in some cases, ADHD or other neurodevelopmental conditions. First described in the United Kingdom in the 1980s, PDA has received growing attention in North America in recent years. Although it is not currently recognized as a standalone diagnosis in major classification systems, many individuals and families experience it as a distinct and meaningful pattern of needs and responses. PDA is often misunderstood or misidentified, particularly because individuals may appear sociable, articulate, and capable while internally experiencing extreme stress around everyday expectations.
At the heart of PDA is a high level of anxiety and an intense need for control over one’s own actions. People with a PDA profile experience ordinary demands as overwhelming, including things they may want or enjoy doing. These demands can involve daily tasks such as eating, sleeping, dressing, and attending school or work, as well as social expectations or internal bodily needs. Avoidance is not a deliberate choice or a form of manipulation; rather, it is a stress response driven by a nervous system that perceives loss of autonomy as a threat.
Demands for someone with PDA are not limited to direct instructions. They also include casual suggestions, expectations based on routines or social roles, praise that creates pressure to perform again, internal sensations such as hunger or illness, and even self-imposed goals. Because these demands accumulate, a person’s capacity to cope can fluctuate widely. What seems manageable one day may feel impossible the next. This helps explain why behavior can appear inconsistent across settings or situations.
PDA can be understood as a nervous system difference. Individuals with this profile tend to have heightened sensitivity to perceived threat, particularly when their freedom to choose is limited. When this happens, their bodies may enter a fight, flight, freeze, or fawn response. These reactions can look like arguing, refusing, running away, shutting down, becoming overly controlling or submissive, lying, joking compulsively, forgetting, fainting, or escaping into fantasy. These responses are not planned strategies but automatic attempts to regain safety and control. In this framework, behavior is a form of communication about stress and unmet needs.
Traditional behavior-based approaches often fail for people with PDA because they increase pressure and reduce autonomy. Systems based on rewards, consequences, or rigid routines tend to make anxiety worse rather than better. From the perspective of the person with PDA, such strategies feel like coercion, even when they are well intentioned. Avoiding demands is therefore a matter of being unable to comply, not refusing to do so. Many individuals mask their distress in certain environments, especially at school or in clinical settings, which can lead professionals to underestimate their support needs.
Effective support focuses on relationship, trust, and collaboration rather than control. Individuals with PDA are more likely to engage when they feel respected and when their autonomy is protected. Indirect language, shared decision-making, humor, and flexibility can reduce the sense of threat associated with demands. Explaining the deeper reasons behind requests can help them make sense of what is being asked and why. Emotional co-regulation is also essential, as PDA individuals are highly sensitive to the emotional states of others. When adults remain calm and regulated, it becomes easier for the individual to do the same.
It is equally important to recognize what does not help. Punishment, lectures, shaming, and rigid enforcement of rules tend to escalate distress rather than resolve it. Challenging behavior should be understood as a signal that something is wrong, not as the problem itself. Support requires weighing whether a task is truly worth the emotional and physiological cost for the individual at that moment.
Many people come to understand PDA during a period of burnout, which occurs when prolonged stress leads to a significant loss of coping capacity. Burnout is often marked by increased avoidance, intense mood swings, heightened anxiety, withdrawal from social interaction, and intolerance of previously manageable demands. Recovery from burnout requires very low levels of demand, extended time to rest and feel safe, and a slow, pressure-free return to activities. It also requires that others in the person’s life understand what burnout is and how to avoid pushing too hard, too soon.
In conclusion, PDA challenges conventional ideas about motivation and discipline. Instead of focusing on how to make someone comply, support involves asking how to help them feel safe enough to participate. Maintaining emotional calm, resisting punitive instincts, and prioritizing connection are essential. People with PDA cannot regulate their emotions if those around them are dysregulated. With understanding and the right environment, individuals with PDA can be imaginative, empathetic, spontaneous, and deeply insightful. When their nervous systems are supported rather than threatened, they are far more able to engage with the world in meaningful ways.
Understanding why people commit crimes is essential for building effective rehabilitation programs and reducing reoffending. At the heart of this work lies the concept of criminogenic needs—the dynamic factors that drive criminal behavior. Unlike fixed characteristics such as age or criminal history, criminogenic needs can be changed through targeted, evidence-based interventions. Because of this, they play a crucial role in shaping modern correctional practice and public safety strategies.
What Are Criminogenic Needs?
Criminogenic needs are dynamic risk factors—areas of a person’s life, behavior, or mindset that increase the likelihood of criminal activity and can be improved through intervention. These include substance misuse, negative peer associations, or antisocial attitudes. When these factors are present, an individual is more likely to offend; when they are addressed, the risk of reoffending decreases.
This makes criminogenic needs especially important within the criminal justice system. While static risk factors such as past convictions or early exposure to crime can predict future behavior, they cannot be changed. Criminogenic needs, however, offer an actionable pathway toward rehabilitation.
Key Characteristics of Criminogenic Needs
Criminogenic needs stand out because they influence criminal behavior directly, are changeable through targeted treatment or support, provide clear intervention points for reducing reoffending, and guide individualized rehabilitation plans. By focusing on these dynamic areas, practitioners can help individuals build the skills, habits, and supports necessary to avoid future criminal involvement.
Major Categories of Criminogenic Needs
Antisocial Attitudes and Beliefs
Holding beliefs that support or justify criminal behavior – such as hostility toward authority, lack of empathy, or rationalizations for wrongdoing – significantly increases the likelihood of reoffending.
Antisocial Peer Associations
Spending time with individuals engaged in criminal or high-risk activities reinforces harmful behaviors and normalizes offending.
Substance Abuse
Addiction or heavy substance use can impair judgment, fuel risky behavior, and drive individuals to commit crimes to sustain their habits.
Family and Relationship Problems
Dysfunctional family environments, exposure to criminal role models, lack of support, or poor supervision can contribute to criminal involvement.
Education and Employment Challenges
Low educational attainment, a history of job instability, or lack of employable skills can create financial strain and leave individuals with unstructured time, both of which increase the risk of offending.
Limited Prosocial Leisure Activities
When individuals lack healthy and meaningful ways to spend their time, they may drift toward risky or illegal activities.
Behavioral and Personality Traits
Impulsivity, poor problem-solving skills, aggression, and difficulty managing emotions increase the likelihood of criminal acts.
How Criminogenic Needs Are Identified
Professionals identify criminogenic needs using structured, validated assessment tools. These instruments evaluate a person’s attitudes, behavioral patterns, life circumstances, and history to provide a clear picture of their risk level and intervention needs. The process often includes interviews, reviews of personal and criminal history, analysis of social relationships and substance use, and assessments of thinking patterns and decision-making. These tools promote consistency and reduce reliance on subjective judgment.
Why Understanding Criminogenic Needs Matters
Focusing on criminogenic needs is fundamental to effective rehabilitation. By targeting the root causes of criminal behavior, interventions can reduce reoffending, promote long-term behavioral change, improve public safety, ensure efficient use of resources, and support individualized case planning. Rather than applying general or one-size-fits-all responses, professionals can tailor programs such as cognitive-behavioral therapy, substance abuse treatment, employment support, or relationship counseling to the areas that matter most.
Conclusion
Criminogenic needs provide a roadmap for meaningful change. By identifying and addressing the dynamic factors that contribute to criminal behavior, the criminal justice system can better support individuals in building safer, healthier lives while reducing the risk of reoffending. Understanding these needs is crucial for effective, humane, and evidence-based rehabilitation.
Post-traumatic stress disorder (PTSD) has become one of the most pressing mental health issues among military veterans, particularly in the wake of modern conflicts in Iraq and Afghanistan. Years of exposure to intense combat, guerrilla warfare, and constant danger have left many veterans struggling with lasting psychological trauma. Despite increased public awareness and advances in treatment, PTSD continues to impose severe emotional, social, and economic burdens, both on individuals and on the healthcare system (Reisman, 2016).
PTSD among veterans is not a new phenomenon – it is a modern understanding of a condition that has existed as long as warfare itself. Historical records describe symptoms akin to PTSD as far back as ancient Greece, and over the centuries it has been labeled by many names, from “shell shock” during World War I to “battle fatigue” in World War II. The diagnosis of PTSD became formalized only in 1980, after the Vietnam War made clear the long-term psychological cost of combat. Contemporary studies estimate that between 13% and 30% of Iraq and Afghanistan veterans have experienced PTSD, with as many as half a million diagnosed cases over the past two decades (Reisman, 2016).
The condition rarely exists in isolation. Many veterans with PTSD also suffer from depression, anxiety, substance use disorders, and chronic pain, which together complicate both diagnosis and treatment. Depression is the most common comorbidity, and substance use is widespread among those attempting to cope with symptoms of trauma. Such overlapping conditions lead to higher rates of suicide, social isolation, and medical complications, making recovery a complex process requiring integrated care. Women veterans are particularly vulnerable, not only because of combat exposure but also due to the high prevalence of military sexual trauma, which can heighten the risk of developing PTSD (Reisman, 2016).
Diagnosis of PTSD involves both clinical interviews and self-report tools. Instruments such as the Clinician-Administered PTSD Scale (CAPS-5) and the PTSD Checklist (PCL-5) help determine symptom severity and functional impairment. The DSM-5 defines PTSD through four main symptom clusters—intrusion, avoidance, negative mood and cognition, and arousal—which reflect the range of ways trauma manifests in the mind and body. These diagnostic criteria guide clinicians toward evidence-based treatment approaches.
Cognitive-behavioral therapy (CBT) remains the most effective psychological treatment for PTSD. In particular, cognitive processing therapy (CPT) and prolonged exposure (PE) therapy are strongly supported by clinical evidence and widely used in veteran care. CPT focuses on identifying and restructuring distorted thoughts about the traumatic event, while PE encourages controlled and repeated engagement with trauma memories to reduce fear responses. Another therapy, eye-movement desensitization and reprocessing (EMDR), once met with skepticism, is now recognized internationally as an effective intervention that helps patients process trauma through guided eye movements and attention refocusing (Reisman, 2016).
While psychotherapy is the preferred first-line approach, pharmacological treatments are also important, particularly for those who do not respond fully to therapy. Selective serotonin reuptake inhibitors (SSRIs) such as sertraline and paroxetine are the only FDA-approved drugs for PTSD, although others like fluoxetine and venlafaxine are used off-label. These medications help regulate mood and anxiety symptoms but rarely lead to full remission. Researchers are increasingly investigating alternative pharmacological pathways, such as those involving GABA and glutamate neurotransmission. New drugs like vortioxetine, vilazodone, and even certain anticonvulsants such as topiramate are under study for their potential to modulate fear and memory processes. Some veterans also report relief from cannabis use, though its medical application remains controversial and tightly regulated (Reisman, 2016).
Combined treatment approaches – using both medication and psychotherapy – are often the most effective, particularly for veterans with severe or treatment-resistant PTSD. However, benzodiazepines, once commonly prescribed to manage anxiety, are now discouraged due to their limited efficacy and potential for dependency. The Veterans Affairs (VA) system has begun implementing education and shared decision-making programs to reduce benzodiazepine use and encourage evidence-based alternatives.
Beyond treatment, systemic and social barriers continue to hinder recovery. Many veterans face long wait times at VA facilities, limited access to mental health providers- especially in rural areas – and the persistent stigma associated with seeking psychological help. Cultural attitudes within the military often equate mental illness with weakness, deterring individuals from pursuing care. The VA has responded through public awareness campaigns like “About Face,” which normalizes PTSD treatment, and through telehealth services that provide remote therapy options. Studies indicate that telemedicine not only increases accessibility but also improves engagement and treatment adherence among veterans living far from urban centers (Reisman, 2016).
As more veterans seek care outside the VA system, the preparedness of community-based mental health providers has become a growing concern. Many civilian clinicians lack the training to address combat-related trauma effectively. To bridge this gap, the VA established the PTSD Consultation Program for Community Providers and partnered with organizations such as the Center for Deployment Psychology and Star Behavioral Health Providers, which train professionals in veteran-specific mental health care.
Despite ongoing research and program development, PTSD remains one of the most significant public health challenges facing veterans. Its economic cost exceeds billions of dollars annually, and its human cost is measured in the thousands of suicides that occur each year among former service members. Continued investment in both psychological and pharmacological research, alongside improved access to culturally competent care, is essential. Addressing PTSD requires not only medical intervention but also systemic reform and societal understanding to ensure that those who have endured the traumas of war receive the comprehensive care and dignity they deserve (Reisman, 2016).
Attachment theory provides one of the most insightful frameworks for understanding how individuals form, maintain, and sometimes sabotage their relationships. Developed by John Bowlby and later refined by Mary Ainsworth, attachment theory proposes that early interactions with caregivers shape internal models of security and trust that influence later relationships. Among the attachment patterns identified – secure, avoidant, and anxious – the anxious attachment style stands out as particularly associated with emotional dependency, fear of abandonment, and maladaptive interpersonal behaviors such as people-pleasing. People-pleasing can be seen as a behavioral manifestation of the anxious attachment system, a desperate attempt to maintain proximity and approval from significant others by sacrificing one’s own needs and autonomy. Although such behaviors may temporarily stabilize relationships, they tend to perpetuate insecurity, dissatisfaction, and emotional exhaustion. Understanding how anxious attachment leads to people-pleasing not only clarifies the roots of this behavior but also illuminates potential paths toward healthier relational dynamics.
Bowlby’s conceptualization of attachment as an innate survival mechanism underscores the human need for closeness and protection. In infancy, this attachment is primarily directed toward the caregiver, whose responsiveness determines the child’s sense of safety. Infants who experience consistent care develop secure attachments, internalizing the belief that others are reliable and that they themselves are worthy of love. Conversely, when caregivers are inconsistent – alternating between attentiveness and unresponsiveness—children may develop anxious attachment. They learn that love and care are unpredictable, fostering hypervigilance and a chronic fear of rejection. These early experiences become mental templates that persist into adulthood, shaping expectations and behaviors in close relationships. Adults with an anxious attachment style often seek excessive reassurance, interpret neutral cues as signs of disinterest, and overinvest emotionally in relationships to avoid perceived abandonment.
Empirical research has consistently demonstrated that early attachment patterns predict later relational outcomes. Securely attached adults tend to experience higher satisfaction, stability, and mutuality in their friendships and romantic partnerships. They are comfortable with intimacy and capable of managing separation without significant distress. In contrast, those with insecure attachment, particularly the anxious subtype, often report greater conflict, dependency, and ambivalence in their relationships. Studies have shown that anxious individuals display heightened physiological responses to perceived rejection and are prone to rumination about their partners’ availability. Their preoccupation with maintaining closeness can result in behavioral patterns that, paradoxically, undermine the very security they crave. One of the most common of these behaviors is people-pleasing – the excessive prioritization of others’ needs and desires at the expense of one’s own.
People-pleasing, as a psychological construct, refers to a pervasive tendency to seek approval, avoid conflict, and gain affection through compliance and self-sacrifice. It is not simply politeness or altruism; rather, it involves an underlying fear that rejection or disapproval will result in the loss of the relationship. Anxiously attached individuals are particularly vulnerable to this dynamic. Because they equate love with acceptance and attention, they may adopt submissive or accommodating behaviors as strategies to secure attachment. They may agree to requests they find uncomfortable, suppress their opinions to avoid disapproval, or apologize excessively even when not at fault. On the surface, these behaviors appear prosocial – people-pleasers are often described as kind, helpful, and empathetic. However, beneath this facade lies anxiety, low self-worth, and an inability to assert personal boundaries.
The relationship between anxious attachment and people-pleasing can be better understood through the lens of emotion regulation. When anxiously attached individuals perceive potential threats to their relationship – such as conflict, criticism, or distance – they experience intense emotional distress. To alleviate this discomfort, they engage in what attachment theorists call “hyperactivating strategies.” These include excessive reassurance-seeking, clinging, and compliance – behaviors designed to elicit closeness or validation from the attachment figure. People-pleasing functions as one of these strategies: by accommodating others’ needs and suppressing one’s own, the individual temporarily reduces anxiety about abandonment. Yet, over time, these patterns reinforce dependency and prevent the development of authentic, reciprocal intimacy.
Neuroscientific research provides further evidence for this dynamic. Studies have found that individuals with an anxious attachment style exhibit heightened activation in brain regions associated with social pain and rejection, including the amygdala, dorsal anterior cingulate cortex, and anterior insula. This suggests that anxiously attached people literally experience social rejection as a threat to survival. Consequently, their efforts to prevent such rejection become compulsive and self-defeating. People-pleasing, in this sense, represents an attempt to regulate a hyperactive attachment system by ensuring relational security through constant appeasement. Unfortunately, this strategy often leads to resentment, burnout, and the perpetuation of insecure bonds.
Two major forms of people-pleasing behaviors can be distinguished in this context: harmful self-sacrifice and risky conformity. Harmful self-sacrifice involves consistently neglecting personal needs, values, or boundaries in order to satisfy others. An anxiously attached person may, for example, take on unreasonable tasks for a friend or partner, suppress emotional needs, or avoid expressing disagreement to maintain harmony. While self-sacrifice can be an expression of love when balanced and mutual, in the case of anxious attachment it often stems from fear rather than genuine care. Partners or friends may eventually perceive such constant giving as excessive or inauthentic, which can strain the relationship rather than strengthen it. Research indicates that individuals who engage in self-sacrificial behaviors out of fear of rejection report lower relationship satisfaction and greater emotional exhaustion.
Risky conformity, another manifestation of people-pleasing, refers to the tendency to adopt others’ behaviors or opinions – sometimes even engaging in harmful activities—to avoid rejection. Adolescents and young adults with anxious attachment, for instance, have been found more likely to conform to peers’ risky behaviors such as substance use or unsafe social practices. This is not due to impulsivity but rather to an overreliance on external validation. By mirroring others’ actions, anxiously attached individuals hope to maintain acceptance within the group. However, this conformity further erodes their sense of self, reinforcing the belief that approval must be earned through compliance rather than authenticity.
Over time, people-pleasing becomes part of a destructive cycle. The more an individual sacrifices their needs for others, the less confident they feel in their own worth. This diminished self-esteem, in turn, increases their dependence on external approval, perpetuating anxious attachment dynamics. Each act of self-denial or forced conformity strengthens the internal narrative of unworthiness and fear of abandonment. The result is a paradoxical relationship pattern: the very behaviors intended to preserve closeness ultimately generate distance, frustration, and instability. The partner or friend may grow weary of constant reassurance demands, while the anxious individual feels even more insecure, interpreting any withdrawal as confirmation of their fears.
Breaking this cycle requires both cognitive and behavioral change. Anxiously attached individuals can begin by cultivating a sense of internal security independent of external validation. One effective approach is the practice of emotional detachment – not in the sense of indifference, but as a balanced ability to be alone without distress. Learning to tolerate separation and uncertainty helps recalibrate the attachment system, reducing the compulsion to please others. Research suggests that when anxiously attached individuals believe that they will find new, supportive relationships, they are more capable of letting go of unhealthy ones. This cognitive reframing – recognizing that one’s worth and security do not depend on a single person – fosters resilience and reduces people-pleasing tendencies.
Another key step involves shifting perspective on social cues and perceived threats. Because anxious individuals tend to interpret neutral behaviors as signs of rejection, learning to reinterpret these cues can reduce unnecessary anxiety. Cognitive-behavioral strategies, such as identifying and challenging automatic negative thoughts, can help them recognize that not every delayed text or ambiguous remark indicates disapproval. Emotional regulation skills, such as mindfulness and grounding exercises, further assist in moderating hyperactive responses. By viewing others’ behaviors more objectively, anxiously attached individuals can respond with authenticity rather than compliance.
Open communication also plays a crucial role. People-pleasers often avoid expressing negative emotions or needs, fearing that honesty will lead to rejection. However, research demonstrates that constructive communication strengthens, rather than threatens, relationships. When anxiously attached individuals learn to express their needs clearly and respectfully, they invite reciprocity and reduce misunderstandings. This process requires courage and practice, as it contradicts the ingrained belief that love must be earned through self-denial. Over time, honest dialogue can transform relationships from asymmetrical dependence to mutual respect.
Equally important is the skill of assertive refusal. People-pleasers must learn to differentiate between kindness and compliance, understanding that saying “no” does not equate to rejection or selfishness. Setting boundaries is not only protective but also a sign of self-respect, signaling to others that their needs and comfort matter. Assertiveness training can help anxiously attached individuals develop this capacity, teaching them to decline requests without guilt or hostility. Small acts of refusal – such as declining an unreasonable favor or expressing disagreement – can gradually rewire the association between self-assertion and fear of abandonment. As individuals learn that healthy relationships withstand boundaries, their internal security strengthens.
Ultimately, the path from people-pleasing to secure relating involves cultivating self-compassion. Anxiously attached individuals often internalize shame about their dependency and emotional sensitivity. Recognizing that these tendencies arise from unmet childhood needs rather than personal weakness can be liberating. Self-compassion allows individuals to respond to their fears with understanding rather than criticism, creating the emotional safety necessary for change. Therapeutic interventions that emphasize self-acceptance, such as attachment-based therapy or mindfulness practices, have been shown to reduce attachment anxiety and foster healthier relational patterns.
In conclusion, the link between anxious attachment and people-pleasing illustrates how early experiences of inconsistency and insecurity shape lifelong relational strategies. People-pleasing emerges as an attempt to mitigate the pain of potential rejection by ensuring approval through compliance and self-sacrifice. Yet, these behaviors paradoxically deepen insecurity, undermine satisfaction, and perpetuate fragile relationships. By practicing detachment, reinterpreting social cues, communicating openly, and setting boundaries, anxiously attached individuals can begin to dismantle the cycle of people-pleasing and move toward genuine intimacy. Future research should continue to explore how attachment-based interventions can reduce people-pleasing behaviors across different cultural and gender contexts. Ultimately, healing anxious attachment is not about eliminating the desire for closeness but about learning to pursue connection from a place of confidence rather than fear – a transformation that replaces the compulsion to please with the capacity to love authentically.
Being a people-pleaser often begins as a desire to help, to be seen as kind, dependable, and cooperative. Yet this desire can slowly transform into a trap—one that ties self-worth to the approval of others. In the workplace, the people-pleaser is the person who cannot say no, who always volunteers for extra work, and who measures their value by how useful they are to the group. Despite their efforts, they are rarely appreciated, often becoming invisible or taken for granted.
The roots of this behavior usually reach back to childhood. From an early age, children learn that being “good” or “bad” depends on the emotional reactions of the adults around them. When being helpful and compliant earns affection and attention, that pattern becomes deeply ingrained. As adults, these early lessons evolve into a belief that one’s worth is defined by how much others approve or need them. The result is an endless cycle of seeking validation through service, at the cost of personal boundaries and emotional balance.
Breaking free from this pattern requires confronting the anxiety that drives it. For many, the thought of not pleasing others provokes deep discomfort—if they are not the helpful one, will they still matter? Learning to put oneself first begins by questioning motives: “Why am I doing this?” and “Who is this really for?” There is nothing wrong with being kind or cooperative, but when those actions come from fear of rejection rather than genuine choice, they stop being healthy.
Learning to say no is a vital skill. Practicing refusal, even in imagined situations, helps reveal the emotions that surface—guilt, shame, or fear of disapproval. Instead of burying those feelings, sitting with them allows understanding and growth. Each time a person resists the automatic “yes,” they reclaim a small part of their independence. Over time, the discomfort fades and is replaced by a sense of control and self-respect.
Another important realization is that self-worth is not dependent on how others see us. It is natural for relationships to involve mixed emotions—others will not always feel positively toward us, just as we cannot always be pleased with them. Accepting this ambivalence is part of emotional maturity. Likewise, understanding that disappointment is inevitable in human relationships allows us to connect more authentically. To never disappoint or be disappointed is to live without real connection or honesty.
The fantasy of the perfect workplace—where everyone is kind, cheerful, and endlessly supportive—does not exist. Real workplaces, like real families, are filled with differing moods, frustrations, and imperfections. Constantly striving to maintain harmony through self-sacrifice drains energy and erodes confidence. True teamwork does not come from pleasing everyone but from being honest, setting limits, and respecting both personal and collective boundaries.
Ultimately, the path away from people-pleasing is not about becoming unkind or unhelpful. It is about reclaiming the right to make choices that honor one’s own needs as much as others’. Saying no does not mean being selfish; it means recognizing that kindness has no value when it is forced or fearful. By letting go of the compulsion to please, a person creates space for authenticity, confidence, and genuine respect—both from themselves and from those around them.
The introduction of medical cannabis in the United Kingdom in November 2018 marked a significant milestone in the long and contentious history of cannabis policy. After decades of prohibition, cannabis was reclassified to allow its use for medicinal purposes, creating widespread public optimism that patients would finally gain access to this long-debated therapy. However, two years after legalization, the reality fell far short of expectations. Despite growing evidence of therapeutic potential and high public demand, only a handful of prescriptions had been issued by the National Health Service (NHS), leaving patients frustrated and many forced to seek cannabis from illicit sources. The article “Medical Cannabis in the UK: From Principle to Practice” by Schlag et al. (2020) explores this disparity between principle and practice, analysing the scientific evidence, ethical challenges, regulatory barriers, and potential future directions for medical cannabis in the UK. This essay critically examines these dimensions, highlighting the tension between patient need, scientific uncertainty, and institutional caution that continues to shape the medical cannabis debate.
At the heart of the issue lies the historical and political trajectory of cannabis itself. Once regarded as one of the world’s oldest medicines, cannabis was criminalised in the mid-twentieth century largely for political reasons rather than empirical evidence of harm. Its reintroduction as a medicinal substance, therefore, represents a partial correction of that political error. Yet, as Schlag et al. observe, the move from prohibition to prescription has been hampered by a lack of clinical evidence stemming from its former classification as a Schedule 1 drug. The National Institute for Health and Care Excellence (NICE) guidelines currently sanction only three cannabis-based medicinal products (CBMPs): Sativex for multiple sclerosis spasticity, Nabilone for chemotherapy-induced nausea and vomiting, and Epidyolex for severe, treatment-resistant epilepsy. For patients suffering from chronic pain, anxiety, or other debilitating conditions, this narrow scope of approved treatments is profoundly disappointing, especially when many report significant benefits from unlicensed or illicit cannabis use. The mismatch between clinical caution and patient experience reveals a deeper tension between traditional evidence-based medicine and the growing field of patient-reported outcomes.
Scientific research on medical cannabis remains in an early stage. The 2017 report by the National Academies of Sciences, Engineering, and Medicine (NASEM) summarised that substantial evidence supports cannabis’s efficacy in treating chronic pain, chemotherapy-induced nausea, and multiple sclerosis spasticity. Moderate evidence exists for improving sleep outcomes, while only limited evidence supports its use for conditions like anxiety, Tourette’s syndrome, or post-traumatic stress disorder. Schlag et al. highlight that the lack of large-scale randomised controlled trials (RCTs) has constrained acceptance by regulators and physicians alike. Yet, the absence of such data is itself a consequence of cannabis’s legal status, which for decades restricted research access. The authors argue that while RCTs remain the gold standard for clinical evidence, other forms of evidence — such as observational studies and patient-reported data — must also be valued. Indeed, real-world evidence from countries such as Canada and Germany demonstrates widespread patient satisfaction and quality-of-life improvements associated with medical cannabis. Studies have reported reductions in pain, anxiety, and opioid use, suggesting that cannabis may offer a safer alternative or adjunct to existing therapies. However, these findings remain controversial, as critics question the reliability of self-reported outcomes and warn against overgeneralisation.
Despite growing international support for medical cannabis, the UK faces unique barriers to implementation. One of the most prominent issues is the lack of physician education. Most British doctors have received no formal training in prescribing cannabis-based medicines, leading to uncertainty about dosages, formulations, and potential interactions. Schlag et al. cite initiatives such as the Academy of Medical Cannabis and Drug Science’s MyMedic platform as important steps toward filling this knowledge gap. Nevertheless, the inertia within medical education remains a key bottleneck. The reluctance of doctors is compounded by restrictive clinical guidelines that position cannabis as a last-resort treatment, permissible only when conventional medicines have failed. These guidelines, produced by authoritative bodies such as the Royal College of Physicians and the British Paediatric Neurology Association, create an environment of medical conservatism that discourages experimentation and innovation.
Another significant obstacle is the fear of adverse psychological effects, particularly psychosis and dependency. Public discourse around cannabis has long been dominated by the association between high-potency cannabis and mental illness, largely based on studies of recreational use. However, Schlag et al. argue that these concerns are often exaggerated or misapplied to medical contexts. The psychosis risk is primarily linked to high-THC, low-CBD street cannabis, whereas regulated medical formulations contain balanced cannabinoid profiles designed to mitigate such risks. Furthermore, data from Health Canada and other countries indicate a low incidence of dependence among medical users. Nonetheless, the perception of cannabis as a dangerous drug continues to influence prescribing behaviour, creating an implicit bias against its medical application. Overcoming this stigma requires not only education but also robust regulatory oversight to ensure product safety, dosage consistency, and responsible use.
Economic factors further complicate access. Because most NHS doctors refuse to prescribe cannabis, patients must rely on private clinics, where treatment can cost up to £40,000 per year. These prohibitive expenses reflect both import restrictions and the lack of domestic production infrastructure. Until recently, UK regulations required individual import licenses for each patient, causing delays and increasing costs. Although new provisions for bulk importation were introduced in 2020, the system remains inefficient compared to other European countries such as the Netherlands or Germany. Schlag et al. suggest that the high cost of medical cannabis is paradoxical, given that it has the potential to reduce healthcare expenditure by lowering reliance on opioids, benzodiazepines, and other costly medications. A comprehensive cost-benefit analysis might reveal that broader access to cannabis could be not only therapeutically beneficial but also economically rational.
Beyond logistical and economic barriers, the article raises fundamental ethical questions. The authors emphasise that the rigid insistence on RCT evidence as the sole criterion for legitimacy may inadvertently harm patients who have exhausted conventional treatments. In such cases, patient autonomy and the principle of informed choice become ethically significant. Denying access to potentially beneficial treatments due to bureaucratic inertia or evidentiary conservatism can be viewed as a moral failure of the healthcare system. Schlag et al. argue that while clinicians must act cautiously, they also have an ethical duty to balance potential harms against the immediate suffering of patients. The reclassification of cannabis as a Schedule 2 substance implies legal recognition of its medical potential; therefore, withholding it on procedural grounds risks undermining public trust in the healthcare system. Moreover, when patients turn to illicit markets due to lack of access, they expose themselves to unregulated and potentially harmful products, highlighting the urgent need for a controlled but compassionate prescribing framework.
The authors propose several strategies for reconciling these competing imperatives. Education and monitoring are at the forefront of their recommendations. By collecting systematic data on prescriptions, patient outcomes, and adverse effects, regulators can bridge the gap between clinical trials and real-world practice. Initiatives such as Drug Science’s Project Twenty21 aim to create Europe’s largest medical cannabis registry, offering valuable insights into usage patterns and efficacy. Such registries could serve as dynamic feedback systems, allowing doctors to make evidence-informed decisions even in the absence of traditional RCTs. Schlag et al. also advocate for developing a hierarchy of evidence specific to cannabis-based medicines, recognising that their diversity of formulations and effects defies simple categorisation. The authors note that cannabis should not be treated as a single drug but rather as a family of compounds with complex pharmacological interactions, requiring a more nuanced approach to research and policy.
Communication with the public is another crucial component. The 2018 rescheduling generated widespread misunderstanding, with many patients assuming that cannabis would become readily available through the NHS. The resulting disappointment has eroded confidence in both the government and the medical establishment. Schlag et al. call for clearer, more transparent communication strategies that explain what medical cannabis can and cannot do. Overhyping its benefits risks creating false hope, while excessive caution perpetuates stigma and frustration. An informed public dialogue, grounded in scientific honesty and empathy for patient experience, is essential for building a sustainable framework.
In conclusion, Schlag et al.’s analysis reveals that the legalisation of medical cannabis in the UK has so far been more symbolic than substantive. While the rescheduling from Schedule 1 to Schedule 2 was a necessary first step, systemic barriers have prevented meaningful patient access. The article makes a compelling case for reform on multiple fronts: expanding the evidence base beyond RCTs, improving physician education, reducing economic barriers, and developing ethical and regulatory frameworks that prioritise patient welfare. The central message is that progress requires balance — between caution and compassion, between evidence and experience, between science and social justice. Cannabis is not a miracle cure, but neither should it be dismissed as a dangerous relic of counterculture. As the authors conclude, medical cannabis policy must evolve in a safe, ethical, and evidence-informed manner, ensuring that those who could genuinely benefit are no longer left behind. The challenge for the UK is not whether to allow medical cannabis, but how to implement it responsibly — transforming principle into practice and rhetoric into care.
The Good Lives Model (GLM) represents a positive and strengths-based approach to offender rehabilitation. Developed by Tony Ward in 2010, it focuses on promoting personal fulfilment, well-being, and the pursuit of meaningful life goals rather than solely addressing risk factors or deficits. While it differs in emphasis from the traditional Risk-Need-Responsivity (RNR) framework, the GLM complements risk management by providing a more holistic, person-centred and engaging structure for rehabilitation (Ward & Fortune, 2013).
At the core of the GLM lies the belief that all individuals strive to achieve certain “primary human goods.” These are fundamental needs and aspirations that contribute to psychological well-being, such as life, knowledge, creativity, pleasure, spirituality, friendship, community, inner peace, excellence in work and play, and excellence in agency or autonomy. People pursue these goods through “secondary goods,” which are the specific activities or means used to achieve them. For example, running might be a secondary good that satisfies the primary good of excellence in play. However, when individuals lack the internal skills or external resources to pursue these goods in healthy and pro-social ways, they may resort to harmful or illegal behaviours. A person might, for instance, engage in harmful sexual behaviour as a misguided attempt to meet needs for intimacy or inner peace (Willis, Yates, Gannon & Ward, 2012).
The GLM views intervention as a process that helps individuals build the skills, strengths, and supports necessary to pursue their goals without harming others. Practitioners work collaboratively with clients to explore their values, aspirations, and personal definitions of a “good life.” Together, they develop a Good Lives Plan, identifying alternative and socially acceptable ways to meet primary goods while addressing risk factors that could hinder success (Purvis, Ward & Willis, 2011). This approach aims to replace harmful behaviours with positive strategies that allow individuals to live meaningful, fulfilling lives that do not cause harm to others.
Although originally developed for adults who had engaged in sexual offending, the GLM has been successfully adapted for use with children and young people by G-MAP, a UK-based service. This adaptation, known as the GLM-A, simplifies the model’s language and concepts to make them accessible and relevant to younger audiences. In this version, “primary goods” are referred to as “my needs,” while secondary goods are described as “how I meet my needs.” The eleven adult-focused primary goods have been condensed into eight primary needs that are more suitable for young people: having fun, achieving, being one’s own person, having people in one’s life, having purpose and making a difference, emotional health, sexual health, and physical health.
The GLM-A provides a framework for understanding the needs that drive a young person’s behaviour and informs the interventions required to help them meet these needs in appropriate ways. Interventions are carried out collaboratively, involving the young person and their family or carers, and recognising the importance of the wider social and systemic context (Fortune, Ward & Print, 2014).
In Scotland, the G-MAP model has been implemented through the Safer Lives Programme, introduced in 2008. This programme trains practitioners to use the GLM-A as part of their therapeutic work with young people who display harmful sexual behaviour. Initial evaluations of the GLM-A have been highly positive (Leeson & Adshead, 2013). Practitioners reported that the model improved their understanding of young people’s behaviours, enhanced engagement with children and carers, and provided a motivational and hopeful framework for change. Young people themselves found the model easy to understand and empowering, as it helped them recognise why they acted as they did and what steps they could take to change.
Further research into the implementation of Safer Lives in Scotland (Simpson & Vaswani, 2015) found that practitioners viewed the GLM-A as enriching their practice, sometimes by adding useful tools, and at other times by transforming their overall approach. They appreciated the model’s alignment with person-centred and strengths-based values and welcomed its shift away from a purely risk-focused perspective toward one that fosters growth and rehabilitation.
Despite its strengths, some critics have argued that the GLM focuses too narrowly on individual change and does not give enough attention to the social contexts that influence offending behaviour. McNeill and Weaver (2010) suggest that building social capital—such as supportive relationships, community involvement, and legitimate opportunities for participation—is essential to long-term desistance from offending.
Although the GLM and GLM-A have been applied primarily to individuals engaging in harmful sexual behaviour, the principles are equally relevant to other forms of offending. By focusing on personal growth, well-being, and the pursuit of pro-social goals, the GLM offers a promising framework for a wide range of rehabilitative practices.
In conclusion, the Good Lives Model and its adaptation for young people mark an important shift in offender rehabilitation, moving from a focus on risk and deficit toward one of growth, meaning, and human potential. By understanding and addressing the underlying needs that drive behaviour, the GLM empowers individuals to build better lives for themselves and safer communities for others.
Autism spectrum disorder (ASD) is a lifelong developmental condition that affects how individuals perceive the world, process information, and relate to others. While much attention has historically been directed toward children with autism, recognition of the needs of autistic adults has been steadily growing in recent years. Research suggests that around 1% of the UK adult population, equating to roughly 700,000 people, are on the autism spectrum. Despite this significant figure, adults with autism often experience barriers in accessing support, navigating social services, and achieving independence in their daily lives.
Social workers are uniquely positioned to address these challenges by providing person-centred, strengths-based support that promotes wellbeing, independence, and inclusion. The Manual for Good Social Work Practice: Supporting Adults Who Have Autism (2015), commissioned by the Department of Health, offers practical guidance and values-based frameworks to improve outcomes for autistic adults and their carers. This essay critically examines the principles and practices outlined in the manual, with reference to the Care Act 2014 and the Mental Capacity Act 2005, highlighting best practice approaches in assessment, communication, carer support, crisis intervention, stress management, and advocacy.
Understanding Autism and Its Implications
Autism is described by the National Autistic Society as a “lifelong developmental disability that affects how a person communicates with, and relates to, other people, and how they make sense of the world around them.” Autism is a spectrum condition, meaning individuals share certain traits but experience them in unique ways. While some autistic adults live independently, others require specialist lifelong support due to co-occurring learning disabilities or sensory differences.
One of the greatest misconceptions is that autism manifests in a uniform way. In reality, the adage “if you’ve met one person with autism, you’ve met one person with autism” is particularly true. This underscores the necessity of person-centred approaches in social work. Each autistic adult has their own strengths, needs, coping mechanisms, and goals, which must be recognised without assumption. Furthermore, many autistic individuals experience heightened anxiety due to sensory overload, communication barriers, or difficulties adapting to change. Understanding these factors is fundamental for effective practice.
Core Principles of Social Work with Adults with Autism
The manual emphasises that good social work with autistic adults must be grounded in the principles of the Care Act 2014. These include promoting individual wellbeing, preventing or delaying the need for support, providing person-centred care, and supporting carers. For social workers, this means not only addressing needs but also recognising capabilities, fostering independence, and supporting community inclusion.
Ethical practice requires respect, empathy, and partnership working. Social workers should adopt a strengths-based lens, focusing on what individuals can do and how they can achieve their goals, rather than viewing autism through a deficit model. Additionally, the Mental Capacity Act 2005 requires practitioners to assume capacity unless proven otherwise, ensuring that autistic adults are supported to make decisions rather than having decisions made for them. These legal and ethical frameworks shape every aspect of practice.
Assessment Practices
Assessment is one of the most critical tasks in social work, but also one of the most complex when supporting autistic adults. The manual warns against condition-specific or assumption-based assessments. Instead, practitioners must invest time to build rapport, understand the individual’s perspective, and tailor the process to their communication style and pace.
Practical considerations include minimising repetition, scheduling short and focused visits, and ensuring the assessment environment is calm and sensory-friendly. Social workers should ask open but clear questions about relationships, daily routines, sources of stress, and goals for the future. Importantly, assessments must account for fluctuating abilities and co-existing conditions, as some adults may present differently depending on context.
Creative approaches are encouraged, such as using visual aids, structured agendas, or stress management plans co-designed with the person. For example, agreeing on contingency plans for stressful situations, or using health passports to reduce repetition at medical appointments. Such strategies respect the person’s autonomy while promoting clarity and accuracy in assessment outcomes.
Communication Strategies
Communication is often one of the most significant barriers faced by autistic adults, making this a vital area of social work practice. Clear, consistent, and respectful communication can foster trust and reduce anxiety. The manual highlights several best practices:
Preparation and consistency: Social workers should provide advance notice of meetings, share agendas, and keep appointments punctual. Changes in routine, appearance, or setting should be minimised where possible.
Avoiding jargon: Abstract language, metaphors, or ambiguous phrases can cause confusion. Clear, concrete language should be prioritised.
Respecting silence: Many autistic adults require additional processing time. Allowing silence, rather than rushing to fill it, demonstrates patience and respect.
Alternative communication modes: Some individuals may prefer written communication, email, or visual aids. Flexibility in communication methods is essential.
Trust-building is central. Consistency in behaviour, transparency about what is achievable, and sensitivity to sensory issues (such as noise, lighting, or strong perfumes) can help autistic adults feel safe and respected. Importantly, communication must be collaborative, enabling the individual to co-author their support and exercise choice.
Supporting Carers and Families
Carers—whether family members, friends, or partners—play a crucial role in supporting autistic adults, but they too need recognition, validation, and support. The Care Act 2014 establishes carers’ rights to assessment in their own right, acknowledging their needs as distinct from those of the cared-for person.
Social workers must avoid assumptions about carers, especially when parents of autistic adults are themselves autistic. Stigma and mistrust of services are common, stemming from past experiences of blame or exclusion. Good practice involves recognising carers as experts in the person’s life, consulting them respectfully, and planning for the long-term future when carers may no longer be able to provide support.
Supporting carers also means enabling them to pursue their own wellbeing, employment, and social lives. Facilitating access to respite, peer support networks, and community groups can help carers sustain their role without experiencing burnout. Ultimately, supporting carers is inseparable from supporting autistic adults, as both are deeply interconnected.
Crisis Intervention
Autistic adults often face unique challenges in times of crisis, whether related to mental health, social changes, or sensory overload. Effective crisis intervention requires preparation, empathy, and collaboration.
The manual emphasises understanding the individual’s own definition of crisis, which may differ significantly from a professional perspective. For example, a delayed bus may trigger overwhelming distress, while a seemingly “serious” issue may not be perceived as such by the person. Respecting this subjectivity is key.
Pre-emptive planning—such as role-playing scenarios, identifying triggers, and creating safety plans—can help reduce the intensity of crises. Social workers should remain calm, self-aware, and avoid reactive “knee-jerk” responses. At times, firm decision-making may be required to prevent harm, but this must be balanced with respect for autonomy and dignity.
Multi-agency collaboration is critical, as autistic adults often “fall through the gaps” between services. Social workers should coordinate with health professionals, mental health teams, and voluntary organisations, advocating for reasonable adjustments and rapid access to appropriate support.
Stress, Coping, and Minimisation
Stress is a near-constant factor for many autistic adults. What might seem trivial to others—such as a change in bus schedule, an unfamiliar environment, or sensory discomfort—can feel overwhelming. Social workers must approach these stressors with empathy rather than dismissal.
The manual highlights the risk of minimisation, where autistic adults may downplay their struggles as a coping strategy. Social workers should remain attentive, validate experiences, and encourage honest dialogue about stress. Special interests, often stereotyped as obsessions, can in fact serve as valuable coping mechanisms and sources of joy. Practitioners should respect and integrate these interests into support planning rather than pathologising them.
Parallel and contingency planning are also recommended. By preparing for multiple outcomes, autistic adults can feel more secure in navigating change and uncertainty. For example, if a preferred activity is cancelled, having an alternative plan in place can prevent escalation of anxiety.
Representation, Advocacy, and Wider Practice Issues
Advocacy is an essential component of social work with autistic adults, particularly when individuals face barriers in expressing their needs, navigating services, or challenging discrimination. Independent advocates can help ensure voices are heard, rights are respected, and decisions are genuinely person-centred.
Beyond individual cases, social workers also contribute to systemic change. By promoting autism awareness, challenging stereotypes, and building inclusive community services, they help create environments where autistic adults can thrive. This aligns with the Care Act’s emphasis on prevention, wellbeing, and community capacity building.
The manual also warns against deficit-based labels such as “high-functioning” or “low-functioning,” which oversimplify complex realities and can obscure genuine needs. Instead, practitioners should focus on practical support and empowerment, recognising that needs vary across contexts and over time.
Conclusion
Supporting adults with autism requires more than technical knowledge—it demands empathy, patience, flexibility, and a commitment to person-centred practice. Social workers must balance legal frameworks with ethical values, ensuring that autistic adults are empowered to live meaningful lives within their communities.
Best practice includes conducting holistic and creative assessments, fostering trust through clear communication, supporting carers as partners, preparing for crises with calm professionalism, and addressing stress with empathy and planning. Advocacy and representation further ensure that autistic adults are not marginalised but instead are recognised as equal participants in society.
As awareness of autism continues to grow, social workers must adapt, learn, and reflect, recognising that each individual’s journey is unique. The guidance provided in A Manual for Good Social Work Practice: Supporting Adults Who Have Autism offers a foundation, but it is through ongoing practice, reflection, and partnership with autistic people themselves that the profession can truly deliver the best outcomes.
PACE is a therapeutic approach developed by Dr. Dan Hughes more than two decades ago, designed to help adults build safe, meaningful, and trusting relationships with children and young people who have experienced trauma. Rooted in attachment-focused family therapy, PACE encourages adults to think, feel, communicate, and behave in ways that help children feel secure. It is not a rigid, step-by-step procedure, but rather a flexible mindset that integrates four essential qualities: Playfulness, Acceptance, Curiosity, and Empathy.
Children who have lived through traumatic experiences often struggle with trust, connection, and emotional regulation. Their interactions with adults may be shaped by fear, defensiveness, or shame, making it difficult to form stable attachments. PACE aims to create an environment where these children feel safe enough to explore emotions, express themselves, and build resilience. By adopting PACE, adults can slow down their own responses, regulate their emotions, and remain engaged even during challenging moments. This emotional regulation is essential: when adults stay calm and supportive, children are more likely to mirror that stability, gradually learning to manage their own intense emotions.
Ultimately, PACE offers both children and adults a pathway toward understanding, connection, and healing. Instead of focusing primarily on correcting behaviours, it emphasises relationship-building and emotional safety. In this way, it equips caregivers, teachers, and social workers with strategies to guide children through difficult emotions and behaviours, without compromising their sense of self-worth.
Playfulness
Playfulness is the first element of PACE and serves as an important bridge to closeness without fear. Many children affected by trauma may withdraw from joyful experiences, having lost hope in the possibility of fun or shared enjoyment. For some, affection feels threatening, and hugs or overt displays of love may be rejected. A playful stance provides a gentler alternative, allowing warmth and closeness without overwhelming the child.
Playfulness reassures children that conflicts or separations in a relationship are temporary and not damaging to the connection. In tense situations, a light tone of voice, animated facial expressions, or humour can defuse defensiveness and create opportunities for reconnection. This is not about minimising serious misbehaviour but about keeping minor incidents in perspective. For instance, when a child resists transitioning between activities, introducing a playful game or role-play can reduce resistance and maintain cooperation.
Practical strategies for playfulness include storytelling tones rather than lecturing, softening facial expressions, lowering body posture to avoid intimidating presence, or transforming routine tasks into small games. These subtle adjustments communicate warmth and safety while maintaining the adult’s authority.
Importantly, playfulness is not about distracting from difficulties or denying a child’s struggles. Instead, it signals to the child that relationships can contain joy, even in the presence of challenges. For children who expect rejection or punishment, playfulness can be a powerful reassurance that their presence is valued. Over time, playful interactions rebuild a child’s belief in positive connection and create space for emotional growth.
Acceptance
Acceptance in PACE communicates to a child that their inner world—thoughts, feelings, and intentions—is safe from judgment. For many children, especially those shaped by trauma, the fear of being criticised or rejected for their feelings can prevent honest expression. Acceptance means separating the child’s identity and intentions from their behaviours. Adults can challenge unsafe behaviours while still affirming the child’s worth and humanity.
For example, when a child declares, “You hate me,” a typical adult instinct may be to deny or correct the statement. However, PACE encourages an accepting response such as, “I’m sorry it feels that way to you. That must be really painful.” This communicates understanding without dismissal, showing the child that their perspective matters, even if it is painful or inaccurate.
Through acceptance, children learn that conflict does not equal rejection. They discover that behaviours can be addressed and limited without threatening their relationship or self-worth. Adults may say, “I’m disappointed by what you did, but I know you were upset. It doesn’t change how much I care about you.” Such statements reinforce the difference between disapproving of behaviour and rejecting the child as a person.
This practice strengthens children’s confidence in relationships, making them more willing to share vulnerabilities. Acceptance fosters resilience by teaching children that they can be loved despite their mistakes, and that their feelings—whether anger, fear, or sadness—are valid and worthy of attention.
Examples or how to express acceptance:
“I can see how you feel this is unfair. You wanted to play longer” “You probably think that I don’t care about what you want” “You were letting me know that you were really scared when you ran away from me” “I can hear you saying that you hate me and you’re feeling really cross. I’ll still be here for you after you calm down”. “I’m disappointed by what you did, but I know you were really upset. It doesn’t change how much I care about you”.
Curiosity
Curiosity is the element of PACE that invites children to explore and reflect on the reasons behind their behaviours. Many children, especially those living with trauma, may recognise that their actions are inappropriate but lack the words or awareness to explain why. Instead of asking “Why did you do that?” in a demanding or accusatory way, curiosity involves gentle wondering, aimed at understanding rather than interrogating.
For instance, rather than scolding a child for breaking a toy, an adult might say, “I’m wondering if you broke the toy because you were feeling angry.” Such open-ended reflections give children the opportunity to recognise and articulate their emotions without fear of judgment. The tone is vital: curiosity must be communicated lightly, with compassion rather than frustration.
Curiosity helps children distinguish between their behaviours and their identities. When adults show genuine interest in the underlying feelings—such as sadness, fear, or confusion—children begin to understand that their behaviours are expressions of unmet needs rather than evidence of being “bad.” This reduces shame and defensiveness, replacing them with healthier emotions such as guilt, which can motivate positive change.
Examples of curiosity include phrases like, “I wonder if…,” “Could it be…?,” or “Tell me if I’m getting this wrong.” These sentence starters signal openness and a desire to understand, not to correct. Over time, curiosity builds children’s capacity for self-reflection and strengthens trust in their caregivers.
Examples of curiosity:
“I’m wondering if you broke the toy because you were feeling angry.” “I’m thinking you’re a little nervous about going back to school today, and that’s why you don’t want to get ready this morning”. “I’ve noticed that you’ve been using a really loud voice, and if you’re trying to tell me that you’re angry with me.” “I’m a little confused. Usually you love going for a walk, but today you don’t want to go. I’m wondering what’s different about today”. “When she couldn’t play with you today, I’m wondering if you thought that meant she doesn’t like you.”
Empathy
Empathy is the heart of PACE, ensuring children feel that they do not face struggles alone. Empathy involves actively recognising and validating a child’s distress, demonstrating compassion and solidarity. For traumatised children, empathy communicates that their emotions are not too overwhelming or burdensome for the adult to handle.
Showing empathy requires both words and actions. Adults might say, “That must have been so painful,” or “You are really upset right now, and that’s so hard.” Such statements acknowledge the child’s feelings without minimising them. Non-verbal cues, such as calm body language, gentle tone, and attentive presence, reinforce the message.
Importantly, empathy is not about pity or indulgence. It is about recognising that behaviours often stem from deeper struggles and showing willingness to share in those struggles. By doing so, adults demonstrate resilience and commitment, reassuring the child that the relationship remains intact even during difficult moments.
For example, when a child lashes out after feeling excluded, empathy might sound like: “It hurt so much when she didn’t ask you to play. That must have felt confusing.” This helps the child name their emotions and feel understood. Over time, empathy helps children build trust in relationships, knowing that their vulnerabilities will be met with care rather than criticism.
Examples of empathy: “You are SO upset about this right now. That must be really hard!” “It hurt so much when she didn’t ask you to play. You were probably thinking ‘Why did she do that?’ It was a real shock for you.” “You wanted to have another turn so badly. You were so excited about it and it’s so unfair that we ran out of time”. “It seems to you like he hates you. That must be really hard. I know you like him a lot, so this is pretty confusing”. “I know it’s hard for you to hear what I’m saying.” “Me saying ‘No’ has made you angry with me. I get why you don’t want to talk to me right now”
PACE in Practice
While PACE is simple in principle, applying it consistently in real-life situations can be challenging. Adults often feel the urge to correct or discipline, especially when confronted with disrespect or aggression. Yet practice shows that PACE-oriented responses defuse conflict and build stronger relationships.
Take, for instance, Emily, who becomes angry when denied a turn on the swings, yelling “I hate you!” A typical response might involve correcting her rudeness. A PACE-ful approach, however, acknowledges her anger with playfulness and empathy: “Wow, you’re really angry! It feels rubbish when you can’t do what you want.” Such responses validate her feelings while keeping the relationship intact.
Similarly, when Tom swears at his dad after school, a typical response might be punishment. But with PACE, his dad could say, “I can see you’re really angry. I’m wondering if something happened at school.” This curiosity and empathy create space for Tom to share his feelings rather than escalating conflict.
These examples illustrate how PACE transforms discipline into connection. Instead of viewing behaviours as personal attacks or defiance, adults see them as expressions of inner struggles. By responding with playfulness, acceptance, curiosity, and empathy, adults guide children toward emotional regulation, resilience, and trust.
Example: Emily asks Mum if she can play on the swings. Mum says she can’t as they need to be home soon. Emily gets very upset and angry and starts yelling “that’s so unfair, I hate you. You’re horrible!!!!” Typical response: “Emily, don’t be so rude!” “Life’s unfair!” “I am not horrible and you don’t hate me.” PACE-ful response: “OH WOW [in an animated voice], you’re feeling REALLY ANGRY [with a concerned expression]….you think I’m being mean by not letting you go on the swings when you really want to go…I’m saying no and you really want to go and that feels rubbish…it’s so frustrating when someone says we can’t do something that we want to do!” “I’m really sorry you feel that I hate you Emily that must feel awful – no wonder you’re so angry and upset if you think I hate you! I’d want to scream and shout too…” “It’s rubbish that we can’t do the things we enjoy right now…I’m missing the swings too…maybe we could all have a think about what other games we could on our way home…”
The 4 R’s of Responding with PACE
To support practical application, PACE can be aligned with the “4 R’s of Responding”: Regulate, Relate, Reason, and Repair. These steps provide a framework for managing challenging behaviours while maintaining emotional safety.
Regulate involves calming both the child and the adult. Adults must notice their own emotional state, ensuring they remain calm, compassionate, and engaged. They also help the child regulate by addressing immediate safety concerns and using soothing, light-hearted approaches.
Relate comes next, where adults seek to understand the meaning behind the child’s behaviour. Using curiosity and empathy, they explore the child’s motives, fears, or frustrations, showing genuine interest in their experience.
Reason follows, when the adult and child can discuss the behaviour rationally. Logical consequences may be introduced here, but always in a way that separates the behaviour from the child’s worth.
Repair is the final step, ensuring the relationship remains strong. This might include offering a hug, doing something enjoyable together, or using words and actions to affirm ongoing love and connection.
For example, if a child breaks a jar in a supermarket, a PACE-ful process would involve regulating emotions first, then relating by wondering what feelings triggered the act. Once calm, the child can reason about consequences, such as writing a letter of apology. Finally, repairing the relationship reassures the child that the incident does not damage their bond with the adult.
This structured yet compassionate approach ensures that discipline is balanced with emotional safety, turning difficult incidents into opportunities for growth.
Conclusion
PACE offers a trauma-informed, attachment-based framework for supporting children and young people. By integrating Playfulness, Acceptance, Curiosity, and Empathy into everyday interactions, adults can build stronger, safer, and more trusting relationships. The approach recognises that behind every challenging behaviour is an unmet need, an unspoken emotion, or a legacy of trauma. Instead of focusing narrowly on behaviour management, PACE invites adults to engage with the whole child, affirming their worth and supporting their healing journey.
Through consistent practice, PACE not only helps children regulate emotions but also strengthens the resilience of caregivers, teachers, and social workers. The “4 R’s of Responding” provide a practical framework for applying these principles, ensuring that discipline and connection go hand in hand. Ultimately, PACE reminds us that children are not problems to be fixed but individuals to be understood, supported, and valued.
Trauma-informed social work practice is an approach to social work that takes into account the impact of trauma on the lives of individuals, families, and communities. This approach recognizes that trauma can have long-term effects on a person’s mental health, physical health, and well-being, and that individuals who have experienced trauma require specialized care and support.
The goal of trauma-informed social work practice is to create a safe and supportive environment for individuals who have experienced trauma. This approach emphasizes the importance of building trust and collaboration with clients, as well as empowering clients to make decisions about their own care. Trauma-informed social work practice also recognizes the role that societal and institutional trauma can play in the lives of individuals, and seeks to create change at a systemic level.
One of the key principles of trauma-informed social work practice is understanding the prevalence of trauma. Research has shown that a significant percentage of the population has experienced some form of trauma in their lives. This trauma can range from individual experiences, such as physical or sexual abuse, to collective experiences, such as discrimination or systemic oppression. Understanding the prevalence of trauma is essential in creating an environment that is sensitive to the needs of individuals who have experienced trauma.
Another principle of trauma-informed social work practice is the importance of safety. Trauma can create feelings of fear, anxiety, and vulnerability, which can make it difficult for individuals to engage in social work services. Trauma-informed social work practice emphasizes the importance of creating a safe environment for clients, both physically and emotionally. This may involve providing privacy and confidentiality, ensuring that clients have control over their own care, and creating a space that is calm and welcoming.
Trauma-informed social work practice also emphasizes the importance of empowerment. Clients who have experienced trauma often feel disempowered and may have difficulty trusting others. Trauma-informed social work practice seeks to empower clients by providing them with information, support, and tools to help them make decisions about their own care. This may involve working collaboratively with clients, recognizing their strengths and resources, and supporting them in setting goals that are meaningful to them.
Cultural humility is also a key aspect of trauma-informed social work practice. Social workers must recognize the ways in which cultural differences can impact the experience of trauma, as well as the ways in which cultural beliefs and practices can be a source of strength and resilience. Cultural humility involves recognizing one’s own cultural biases and limitations, and working to create a culturally responsive and inclusive environment for clients.
Finally, trauma-informed social work practice recognizes the importance of collaboration and partnership. Addressing the impact of trauma requires a multidisciplinary approach, and social workers must work collaboratively with other professionals, such as mental health providers, medical professionals, and educators. Trauma-informed social work practice also recognizes the importance of community partnerships, and seeks to create partnerships with community organizations and leaders to create a more supportive and responsive environment for individuals who have experienced trauma.
In conclusion, trauma-informed social work practice is an approach to social work that recognizes the impact of trauma on the lives of individuals, families, and communities. It emphasizes the importance of understanding the prevalence of trauma, creating a safe and empowering environment for clients, practicing cultural humility, and collaborating with other professionals and community partners. By adopting a trauma-informed approach, social workers can provide more effective care and support to individuals who have experienced trauma, and contribute to creating a more just and equitable society.
Beyond Barriers 