Supporting clients with ADHD
There’s a tendency in society for ADHD to be dismissed. Attitudes such as Everyone’s got ADHD these days, It’s just an excuse to be lazy/disruptive/disorganised/etc and They’re just not trying are only too common. It’s little surprise, then, that people with ADHD can be nervous about starting therapy, wondering if they are going to be faced with such invalidating perspectives.
It’s really important to choose a therapist who understands ADHD and knows how to work with it.
What is ADHD?
ADHD is a form of neurodivergence, in which increased or decreased activity in certain parts of the brain (compared to a neurotypical brain) cause a wide range of symptoms. These may include:
difficulty recognising and regulating one’s emotions
hyper-focus on tasks or, conversely, difficulty focusing on tasks
impulsivity
fidgeting
poor short-term memory.
There are different types of ADHD - some people struggle more with inattention, some with hyperactivity and impulsivity - and not everyone’s symptoms are the same. ADHD can be diagnosed in adults when a person has at least five symptoms (from a list of 18) that have been present for at least six months and started in childhood, that are exhibited in more than one setting, that interfere with daily functioning and that aren’t better explained by a different diagnosis.
This is clearly quite a high bar: just leaving your college assignments to the last minute, regularly losing your keys or finding it difficult to sit still don’t mean you have ADHD. There needs to be a cluster of symptoms and they need to affect different areas of your life for a sustained period.
That is why attitudes like Everyone’s got ADHD these days are so invalidating - they don’t recognise how much a person’s life has to be affected by ADHD in order for them to receive a diagnosis.
It’s also important to recognise that the symptoms of ADHD aren’t all negative. For example, ADHDers can be very focused on their passions and become experts in them. However, our society values neurotypical ways of behaving and that can make living with ADHD very hard.
Getting a diagnosis
For some people, getting a diagnosis of ADHD is very important. It validates their lived experience and gives them the confidence to ask others to make adaptations for them. For others, the diagnosis is just a label, and what’s important to them is finding strategies to manage their ADHD.
Getting an ADHD diagnosis can be a long and complex struggle. There is a lot of overlap between the traits of ADHD and those of other conditions such as anxiety and post-traumatic stress disorder (PTSD). On top of this, ADHDers often experience co-occurring conditions such as problems with sleep, substance use and obsessive-compulsive disorder (OCD). So it’s common for professionals to not spot the ADHD because what they see is all these other conditions.
As a psychotherapist, I am not qualified to diagnose. For that, you would need to see a psychiatrist, either privately or via a referral from your GP. However, if you’re thinking about seeking a diagnosis, I can support you through that process. That includes exploring what a diagnosis would mean for you and offering you assessments that will tell you whether you are likely to achieve the threshold for a diagnosis.
If your traits don’t reach the threshold, we can still work together to develop strategies that will help you to live well with them. And of course I will be there to support you with whatever feelings you have around the diagnostic process.
My approach
I recognise that some aspects of therapy can be particularly difficult for those with ADHD. Typically, ADHDers can struggle with the ‘blank slate’ approach to therapy where the therapist remains largely silent or the person-centred approach where the client is expected to take the lead. Instead, I take a more proactive, structured approach, clearly explaining what’s involved in therapy, setting out what the client can expect from me and how they can get the most out of their therapy. I am aware of the language I use and try to avoid ambiguous turns of phrase.
I also endeavour to make my therapy room a space where it is absolutely okay to have ADHD. My clients don’t need to apologise for who they are or to mask when they are with me. They are free to use sensory aids or to stim, for example. (Stimming is engaging in repetitive movements or behaviours to manage sensory overload.) I also avoid shaming clients who struggle with some of the boundaries of therapy, such as starting and ending sessions on time. Instead we find strategies to help the client manage the process without it becoming stressful.
What does the therapy cover?
When someone with ADHD comes to therapy with me, they can talk about their ADHD and what it’s like to live with it, and they can talk about anything else! I don’t assume that their ADHD is the most important issue - they might come to therapy because they are experiencing bereavement, trauma, work stress, family issues or any of the other pressures we all experience in life.
That said, there is a lot to talk about when it comes to ADHD. We can discuss their survival strategies, such as masking, people-pleasing or escaping to fantasy worlds. We can talk about how tiring it can be to live in a world that values neurotypicals over neurodivergents. We can explore the negative beliefs they have developed as a by-product of their ADHD (I’m not good enough, I’m a mess, I’m too loud, etc), reframe those in the context of an ableist society and shift some of the shame they hold.
Together, we can also develop strategies for living well with ADHD. I’m not talking about masking, withdrawing or other survival strategies that can be exhausting and demoralising to ADHDers. I’m talking about practical steps to take control, such as:
supporting executive function by using mobile phone apps
reducing sensory overload by better understanding sensory triggers
developing routines to consistently meet physical needs (eating and drinking regularly, sleeping well, etc)
learning to notice internal changes, such as irritation building up, and take action before becoming overloaded
practicing self-care and understanding how to conserve energy.
Above all, we can discuss whatever you would most like to discuss.
If you would like to find out more or to start therapy with me, I would love to help. Please do contact me or book an initial consultation.