Tell Me What You Fear and I Will Tell You What Has Happened to You

Fin arrives at his occupational therapy sessions carrying the weight of transition anxiety. Almost every Monday afternoon, getting into the car to come to the therapy centre is hard. He finds reasons, resists, says he is tired or that he does not want to go. And yet, his “mum”—his biological grandmother, whom he now calls mum—always manages to support him through this moment. She reduces language and explanations, stays calm, steady, and emotionally present, without pressure. Most importantly, she offers safety. Because of this consistent approach, Fin never misses his Monday session, and that continuity has become a key factor in his progress.

During therapy, Fin participates through approaches such as Sensory Integration, alongside relational, play‑based methods that support co‑regulation. These are carefully adapted for autistic children with a PDA profile (Pathological Demand Avoidance)—a profile in which everyday demands are experienced as a threat, leading to high anxiety and strong resistance. By lowering perceived demands and increasing a sense of control and safety, Fin is able to engage. Through movement, sensory experiences, body‑based play, and “just‑right challenge” activities, he begins to organise both his body and his emotions in a way that feels manageable.

Fin’s difficulty in coming to therapy is not about therapy itself—it is about fear. As D.W. Winnicott so powerfully said, “Tell me what you fear and I will tell you what has happened to you.” For Fin, fear is not rooted in the present moment, nor is it logical. It belongs to something that happened very early in life, before words, memory, or meaning were available to contain it. When this fear is triggered, his nervous system responds as if relationship and safety are under threat. Transitions, expectations, and loss of control can therefore feel overwhelming, not because they are dangerous now, but because they echo something unthinkable from the past.

Over time, through the reliability of the therapeutic relationship and the predictability of weekly sessions, Fin has made significant gains. He is gradually developing the ability to manage difficult emotions without immediate escalation. He is learning to access strategies—through sensory input and activity—to re‑regulate when his anxiety “fills his bucket.” Importantly, he is also beginning to participate more actively in positive and enjoyable moments within therapy and beyond.

Because fear and anxiety have long made it difficult for Fin to enjoy positive experiences, occupational therapy does more than build skills. It offers him repeated experiences of safety, attunement, and emotional holding.

Slowly, the fear begins to belong more to the past than to the present. And in that growing space of safety, Fin finds more room for joy—both in therapy and in life.