Talking About ADHD in Therapy

I’m just curious, how do fellow brains talk about ADHD in your therapy sessions if you do see a counselor or therapist?

Most of the time my therapist and I talk about life things going on such as anxieties, stressors, mood, etc. We haven’t really formally tackled ADHD as part of that picture since the diagnosis.

Do you all use the therapy as a sort of coaching? Or does the therapist help educate you on ADHD?

Wondering if I should start making ADHD more a part of the work we’re doing, but I don’t know how it might be helpful in session.

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My therapy sessions have lately been turning into coaching. I find it very helpful, but that might be because I was finding the previous approach less helpful.

We would previously talk about anxiety/stressors/mood, but I have a number of people I can talk to about those things and I’m already familiar with many of the psychological concepts. So that element was something that I didn’t have a large need for.

We were also trying to work on changing habits, which I very much need, but the plans we made kept hitting obstacles related to my potential ADHD symptoms.

Once we cleared up where things were getting stuck, we started specifically tackling those obstacles and I think the end result seems somewhat like ADHD coaching.

I describe weak areas, we talk about how they show up in daily life and then we brainstorm workarounds.

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What are some examples of areas that you’ve brought up?

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So far we’ve worked on my difficulty with daily routines and are currently looking at my difficulty stopping/starting/switching tasks

Previously we had been having a lot of misunderstandings about what my actual problems were. To try to communicate I made my psychologist a giant mind map with the things I’m awful at, my compensating strategies (good and bad), and the things I’m amazing at. Now we are working our way around that map.

It was a really interesting project to try to visualize all those different elements of myself and my life and the ways they connected to one another.

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Oooh. I’ve never made a mind map. Any good tips on that?

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I started with 3 lists:

  1. Problems (eg prospective memory, fear of rejection)
  2. Workarounds (eg alarms/checklists, people pleasing)
  3. Strengths (eg intelligence, stubbornness)

I wrote the items on sticky notes (a different color for each list) and rearranged them to put related things together. My workarounds are always connected to one of my problems and they often connect to one of my strengths as well. I also gave the items a score to show which things had more or less effect on my life

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If you are up for it put the term MIND MAP in a search engine.

You can do one manually or with software (free and paid)

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I use my time with a counselor to deal with rather practical things, which tend to be dealing with other contacts and people, or thinking or solutions to things that I’m stressed out about and keep avoiding. The main goal is to get me to be independent so my counselor steers away from talk about existential anxiety, even though I often want to go down that path. I guess if you have ADHD your weaknesses are likely to be connected to the diagnosis so discussing them is gonna be related even it you don’t always make a point out of it. I do see a counselor who works in a ADHD program though so I don’t have to wonder if the person knows what I’m dealing with. From previous experience I do think it helps knowing that the person you’re talking to has an understanding of the diagnosis.

A mind-map or notes seems like a brilliant idea. Just thinking about how hard it is to do therapy when you have an attention-deficit. I mean you decide a time when you have to shift focus and stay focused on something, what if you just can’t collect your thoughts right there and then. Having things written down is so helpful.

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I see a psychiatrist for meds. Non-ADHD meds . . . though I do have ADHD. She herself has ADHD. Now I do not see her weekly or even monthly, however I can tell you that she, having the same diagnosis, has been invaluable. I have time for talk. It is 30 minutes. While not strictly “therapy”, it has been therapeutic.

For ongoing therapy she recommended Cognitive Behavioral Therapy (CBT) and referred me to a colleague. It was a negative experience. This therapist (a Licensed Clinical Social Worker - LCSW) needed to give me a diagnosis (to be paid by insurance). I shared with her, among other problems & behaviors, that ANGER was a challenge for me. So, what did she do? She asked me questions based on the DSM criteria for “Intermittent Explosive Disorder” and decided that that was the correct diagnosis.

Now at the time (I’m retired now) I was an LCSW, working in mental health. I was familiar with the DSM. I thought that she jumped to that diagnosis with no understanding about ADHD, and the poor impulse control and YES . . . ANGER ISSUES associated with ADHD. I discussed my disagreement with her diagnosis. She refused to review it and seemed hell-bent not to change it. When I persisted with my objection to her diagnosis, she said that we were not suited to work together and refused to see me anymore. Quite frankly I think she was threatened by the fact that I was an LCSW and “dared” (my characterization) to challenge her misguided diagnosis.

Now I have seen other therapists previously. I discussed my ADHD challenges. While they were well intending, they stuck to what they new best in the theory and style of therapy that they did.

I think that if a therapist is not thoroughly familiar with ADHD, better yet be a Brain, then that therapist is ill-equipped to help someone with ADHD.

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It’s an interesting dynamic. I have an LMSW and my therapist is a LLP. We can sometimes speak the same language, and she respects my experience, but being a provider in therapy always feels like it adds an extra layer of difficulty.

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It can be tricky! Especially when seeing someone who does not fully understand ADHD and cannot accept that learning can be a 2 way street!

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As it happens, yesterday in session I began to start talking about some of the challenges I face, usually in the evenings, with task follow-up and completion, organization, planning, and procrastination. I didn’t specifically connect it to my ADHD in the conversation even though I know it’s related. I’m thinking that I may have to start talking about some of this stuff in session, though I’m not sure how equipped my therapist will be to help with coaching or addressing it. It’s just interesting that it finally started to come up. Maybe because we had a sort of lull in general life stuff, even though it was connected.

I’m probably going to talk more about it next week when I see her, but I wanted to just note that it’s taken me this long to finally be willing to address it directly in session. I guess I’ve been afraid of judgment from my therapist before.

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