How I work with clients and their ADHD

The most frequent request I get from people who want to work on their ADHD is, “can you give me strategies and coping tips”? I want to address this, because I get that it is important to people. At the same time, I want to clarify what exactly I can help you with, so that if you are coming to see me, you know what to expect.

If you are MAINLY focused on getting strategies to be more productive and more organized, and your life feels great but for the darned executive functioning issues and you want “how-to’s”, I am NOT the person for you. I don’t mean that to be rejecting, but to give you guidance as to the best fit for help. The type of person who can help you with concrete goals of more productivity and maximized functioning is a Life Coach who specializes in ADHD. This person helps someone who is very motivated toward a specific goal, often related to work- or a life-productivity goal of some kind.

If your anxiety is high and it is interfering with your functioning, you may consider an ADHD-therapist who targets this anxiety, and specializes in a tried-and-true treatment for it, like CBT (Cognitive-behavioral therapy). The idea is to pinpoint distorted thinking that leads to maladaptive behaviors and help you restructure the thoughts and, in turn, develop more adaptive behaviors, be it at work, with family, or friends. This has shown high success for clients with anxiety or depression-related challenges for ADHD.

One thing to watch out for is “shiny object” syndrome, or reaching every week for a new treatment or therapist because they look interesting. This can be hard with the abundance of people out there. Yes, sometimes it helps to look around before you decide on the right fit, but try to see someone for at least six sessions before you decide that treatment is not working.

The other issue is expectation management. Interventions are vital, but they are not cures. So if you are looking for the holy grail that will make your symptoms vanish so that you can be productive and energetic 24/7, know that that may not be realistice. Interventions do bring change if you work them over time. And a medication assessment and intervention can bring significant changes to your ability to sustain focus and mental energy, but not necessarily to challenges like organizational skills. Often, change is incremental. If you organized one thing weekly, that is change. We can fall into the all-or-nothing thinking trap of, “either I get that promotion and beat my symptoms, or I failed and this was a waste of time and energy, because I still have challenges.” How can we measure progress in a more realistic way?

So assuming you have accounted for these things, I will lay out for you the kinds of things I have typically worked on well for my clients who have ADHD.

I work best with high-functioning women who are struggling with overwhelm related to life events. If they have ADHD, it makes things harder, but it is not necessarily the thing in life that is triggering them to come to therapy. It is an additional, annoying passenger in their life.

It doesn’t help, for sure, to have to organize your whole family's schedule if you already struggle with organization. And the women I see have often developed compensatory strategies for dealing with ADHD their entire lives, so they often have some strategies already. School systems usually overlooked girls with ADHD, especially since the symptoms are not disruptive to other students, and if the woman was a bright, creative child, interventions were minimal. She learned to cope, for better or worse. She learned to smile and behave, even if it was draining to keep acting as normal as possible. Then they became adults who did pretty well, but who still had challenges that had not been addressed. The experience of feeling “different”, or “not good enough”, and that they have to “mask” who they are, are often internalized and can make whatever stressor they are dealing with feel even more challenging. These women have a high sense of duty and loyalty, often, and they may be taking care of children, teens or aging parents, some of whom have their own challenges. These women may have unresolved relationship difficulties with a family member or friend. They may need someone to unburden their stress with. And they may want to process their emotions and reactions in a non-judgmental space, so they can be heard and they can process what happened, what is happening, and get some clarity on things so that they can move forward. This is the person I can best help as a therapist.

I am best described as someone who is ADHD-informed; on some days, we might discuss strategies that can help. I get ADHD. I know what it is to have high expectations on us, and let’s face it, it is usually women who are expected to shoulder the worry for their loved ones. And to be dealing with those demands, and others, when we have executive functioning challenges, is extra hard. It helps to have someone to talk to who gets that and can point you to some resources that will help. And I keep in mind that people, with our without ADHD, are not cookie-cutter, but often have a collection of challenges, strengths and experiences that are unique to them.

Because I also do trauma work, I am attuned to the ways such a woman might have been on the receiving end of not-so-nice treatment from peers in school. Girls especially sometimes bully, but they sometimes use social aggression, or ways to exclude others who are different. We may have recognized that we had gifts, such as being frank, creative, resourceful, or loyal. But often, we felt different and that felt isolating. And then in later years when we went to work, we carried that, and may have felt targeted for our difference in workplaces. Some of us circumvented this by choosing careers wherein we could work independently or for ourselves. For those more introverted among us, we preferred to not have to deal with an entire office and its intricate dynamics. We may have chosen partners who overall accept us as we are, but we may have given up some level of companionship and support in exchange for their acceptance of us.

We may have experienced RSJ (rejection-sensitive dysphoria), which is a hurt so severe it can sap all our energy when it hits. How to tell whether the issue is our own intense nervous system, or a traumatic incident? And does it matter, if all we want to do is get rid of the past hurt?

We may have issues with partners who accepted us and our challenges, but we sometimes have conflict with for any number of reasons. And the ADHD makes us an easy target, but it does not give someone the right to be cruel to us or neglect our legitimate needs, even when they are frustrated. Sometimes this can be worked on with communication exercises.

In short, if you are willing to look at the different layers of your life and what you are experiencing, you may find work with me more satisfying than not. Feel free to call me and get started.