The Magic Wand for Treating Oppositional Clients
How motivational interviewing empowers clients labeled ODD or PDA.
Posted May 1, 2026 | Reviewed by Ekua Hagan
“Noah,” an older autistic teen , presented for his intake appointment. His referral for treatment included concerns of self-harm and the term “pathological demand avoidance.” I asked him to tell me briefly what he knew about his referral, and he responded, “Dad wanted me to come. Therapy doesn’t work for me, but I was curious about seeing an autistic therapist. I know I’m here for self-harm. I hit myself when I’m upset. I don’t hurt anyone else, so there isn’t a problem. ‘My body, my choice.’”
During trainings and consultations, I often get questions about treatment strategies for clients with oppositional defiant disorder (ODD) and pathological demand avoidance (PDA). (Note: PDA is not an official diagnosis, but is often used as a label attached to autistic people. The autism community has relabeled this as “persistent drive for autonomy.”) When this question is asked, I can almost feel the distress behind it. As a therapist who specializes in neurodivergent clients, who are more likely to be labeled as oppositional, I can definitely empathize, as supporting oppositional clients is challenging.
Why Are ODD and PDA More Common in This Population?
A simple reason for this frequent co-occurrence is that neurodivergent individuals are trying to navigate life in a world that was not designed for them and does not understand or appropriately accommodate their differences. This leaves a lot of neurodivergent people feeling angry and oppositional. It also leaves a lot of them feeling distress, even to the point of experiencing rejection-sensitive dysphoria (RSD), or extreme emotional pain, which is the opposite of ODD or PDA. These individuals will often do anything to ensure that others are not angry with them.
To put this in context of our stress responses, neurodivergent individuals going through life in a world not meant for them may spend a lot of time in their fight response (ODD, PDA) or their fawn response (RSD). Both options have protective factors, and both options can create problems for the individual. I often tell parents and providers that while working with an oppositional child, teen, or adult can be very stressful and frustrating, the alternative is a person who struggles to self-advocate and speak their mind, which can lead to increased risk of victimization.
Which Treatment Strategies Work Best for Oppositional Clients?
Traditional treatment strategies often do not work for oppositional clients because they are oppositional. For children, I usually recommend Ross Greene’s book, The Explosive Child . For teens and adults, when I answer the question on what strategy to use, professionals often look at me blankly for a moment as if they aren’t sure why they had not thought of this before. What is the answer? Motivational interviewing (MI).
Why Motivational Interviewing?
MI works for oppositional clients because it was initially created for substance users, many of whom are mandated to treatment. The goal of MI is not to influence or manipulate clients, but to join with them to help them identify their own change goals , and then encourage them to make those changes happen.
MI is person-centered, meaning that you are looking at the person first, not their deficits or your own goals for the individual. MI is about partnering with the person you are supporting and recognizing that the person is the expert on their own lives.
You start by working to build rapport and engagement by being your genuine self. You then establish the client’s goals, and while you are open about who you are and what you do, your goal is not manipulation, but to use their own change talk to evoke hope and confidence . The deeper listening that is emphasized in MI will also help you support clients who communicate differently, such as those who are bottom-up processors or experience alexithymia (trouble explaining physical or emotional states). Finally, this model emphasizes autonomy, which is often what the person labeled with ODD or PDA is looking for.
What Does This Look Like in Practice?
When we left Noah, he had just declared that I could not stop him from self-harming, as it was his body. I responded with a reflection, “You’re right, I can’t stop you. It’s your body.” Noah wasn’t sure how to respond to this, and it was clear that he had been prepared for a fight. I made clear that as a therapist, I wanted him to learn ways to cope that did not involve self-harm, but I worked to avoid pushing my own agenda and waited for his change talk.
Over the course of a few months, he identified that his triggers were related to missed meals or when he had forgotten to drink water for long periods. He independently set alarms to remind himself to eat and drink. His reports of self-harm gradually reduced, until he was going months between any self-harm episodes.
When our time together ended, he told me that I had been the best therapist he had ever had. He then paused, sat up straight, and shouted, “Hey, you didn’t do anything. I did all the work!” I laughed and agreed with him, telling him he had done a great job.
People often say there's no need to "reinvent the wheel." This very much applies here. There is no need to create new interventions for supporting oppositional clients because an evidence-based tool already exists. The 4 th edition of Miller and Rollnick’s book recognizes that many professionals outside of mental health are using MI to support the people they work with, so this is a tool that others in the person’s life can use. MI may not quite be a magic wand, but there is definitely something magical about helping an oppositional person find success in meeting their own change goals. It’s even more magical to empower them so that they feel like they did it all themselves.
To find a therapist, visit the Psychology Today Therapy Directory .
Miller, W. R., & Rollnick, S. (2023). Motivational interviewing: Helping people change and grow (4th ed.). Guilford Press.
Price, D. (2022). Unmasking autism: Discovering the new faces of neurodiversity . Harmony Books.
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Jennifer Cork, DSW, LCSW, is an autistic clinical social worker, Certified Autism Specialist (CAS), and ADHD-Certified Clinical Services Provider (ADHD-CCSP) .
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This article is part of the Bringwise Psychology Journal — daily insights on human behavior, mental health, and personal growth.