How I Adapt Therapy for Clients with ADHD
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Time management, difficulties with focus and emotional regulation, can make traditional therapy harder for clients with ADHD
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Counsellor Elaine Rose Benardout explains how she adapts her therapy practice
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We have therapists and counsellors who specialise in working with ADHD - find them here
In his book The Gift of Therapy, psychiatrist Irvin Yalom suggests that psychotherapists can place too much emphasis on diagnosis*. Since therapy consists of a gradual unfolding process, he suggests that diagnosis limits vision – the ability to relate to the other as a person.
Indeed it is the case that we, as therapists, accept the client as they are, offering unconditional empathy and support, regardless of their diagnosed or undiagnosed conditions. But what if that condition was a neurodiversity such as ADHD, with its underlying issues impacting the therapy?
Standard therapeutic interventions were developed for neurotypical (NT) people. Neurodivergent (ND) clients require an informed approach for the therapy to be effective. And not all ND people are the same.
Whilst ADHD is associated with hyperactivity and impulsivity, it can also manifest in other ways including overthinking, unwanted and repetitive thoughts. Left untreated or undiagnosed, these thoughts can be persistent and disruptive. Co-occurring mental health conditions can include anxiety and depression.
People with ADHD experience executive function challenges, meaning they can struggle to manage time, organisation, emotions and behaviour. Executive functioning skills have a profound impact on one’s ability to function in the modern world.
Effective techniques to help to manage these skills can differ in a neurodivergent person. For example, practical approaches including a buddy system, visual aids and alarms, can assist with the executive function skills.
In working with some ND clients who find it difficult to manage time and are regularly late to the session, we agree a workable solution (reminder messages etc. and a degree of understanding if they are late). In the sessions, where they appear to be inattentive and unfocused, it is helpful to be mindful of their shorter focus, keeping sentences short and succinct. To treat them in a similar manner to a neurotypical counterpart may be counterproductive and even shaming for them.
Presenting issues common to ADHD include procrastination, anxiety and avoidance. When anxious feelings become too much, it is easier to turn to avoidance or procrastination as a way to divert attention. We can focus on working through the resultant feelings, including frustration and anger which can appear with greater frequency in ADHD.
Dopamine is the hormone which regulates motivation. It is associated with feelings of rewards, pleasure and being productive. People with ADHD have a marked lack of dopamine so may struggle with a lack of motivation, difficulty concentrating and feeling helpless. In searching for more pleasure, they may take risks and seek stimulation. This insight is valuable when working with ADHD as hormonal levels appear to have some contribution to mental health and overall happiness.
Many neurotypical people experience the negative self-evaluation of shame and regret. However, harmful and negative feelings appear more common in people with ADHD, especially given the frustrations that come from having the condition. Extreme emotional responses to painful experiences including rejection, hurt and failure can be worked through with the understanding of ADHD emotional reactivity.
Acknowledging ADHD in the therapy room is to allow more acceptance and compassion, so that what individuals are experiencing is not their fault. As one client told me, "less blaming and shaming is a powerful state to reach". Another commented that they can now accept that they felt different for good reason. Less self-loathing and more understanding.
To conclude, I believe that we, as professionals need to be knowledgeable as to what ADHD traits look like and help our clients to make sense of their situation. Rather than working with the ‘why’ we can look at ‘how’ these matters are handled.
As more people seek diagnosis for neurodivergence, it is increasingly important for therapists to hold an informed perspective, so that they can offer relevant therapeutic based strategies and appropriate support. In this way we meet neurodivergent individuals where they are.
*excludes more severe conditions such as schizophrenia or bipolar disorders
Elaine Rose Benardout is a verified Welldoing counsellor in London and online
