ADHD in Therapy.

Article written by Becky Watherston BACP Acredd

Harnessing Existing Skills

One important consideration when working with clients with ADHD is identifying the skills they already possess and exploring how these can be utilised effectively. Many clients experience deep feelings of shame and a sense of not fitting into a world that feels inherently structured and rigid. While clients with ADHD often adapt their lives to be more fluid, this flexibility can sometimes lead to additional distress, especially when their routines clash with traditional expectations.

For instance, a significant number of my clients work in roles that do not adhere to conventional hours, such as shift work or evening shifts. This flexibility can be beneficial, as many struggle with the rigidity of a standard 9am-5pm schedule. However, challenges arise when social or personal expectations do not align with their unique schedules. For example, someone working a 5am-1pm shift may logically consider their after work hours as evening, but society often still views it as the afternoon, leading to guilt and shame if those hours are not as productive as expected. This dynamic can also affect relationships, where partners may expect household tasks to be completed with the perceived “extra time,” compounding feelings of inadequacy.

Adapting Therapeutic Approaches

Reflecting on my early career working with non-verbal children with Autism, I recall tailoring interventions to play to their strengths, such as using symbols (picture exchange communication system), photos or providing advance warnings. The underlying principle remains the same in my work with clients with ADHD, adapting strategies to the individual. With some clients, we have collaboratively restructured their perception of time by visually mapping out their weekly schedule, assigning blocks for work, rest, meals, sleep, and exercise. This approach empowers clients to take rest or leisure time when it suits their actual routine, such as enjoying television in the afternoon without guilt. It supports a balanced integration of flexibility and structure.

In addition, I worked with them in a traditional manner to address their drive for productivity, which often stemmed from childhood messages discouraging laziness. A tendency to please others sometimes caused the client to overstretch themselves, leading to burnout. These patterns, combined with the tendency of leaving tasks unfinished or getting easily distracted, resulted in increased guilt and self-loathing.

Combining Therapy and Life Coaching

My work with ADHD clients typically blends therapeutic techniques with life coaching depending on the client, this is always discussed before we start sessions and in collaboration with the client. Contrary to common misconceptions, people with ADHD can be highly productive when their abilities are refined to suit both their personal needs and societal demands. For example, one client knew she would hyper-focus on practising her musical instrument for extended periods. Together, we planned her schedule to accommodate these sessions without guilt, including a meal plan to remove the need for frequent shopping. She was able to refine her musical talent and focus on applying for roles using it without feeling like she should be doing something else.

Meal planning is a common challenge for clients with ADHD, often leading to reliance on takeaways, daily stress, wasted time and money. Simplifying these processes sometimes feels like “cheating” or failing to meet societal ideals, so we address the underlying beliefs about what one “should” do, challenging perfectionism and unrealistic expectations often perpetuated by social media.

Reframing and Structuring Therapy

Reframing is a well-established therapeutic technique, but when working with clients with ADHD, I pay particular attention to the assessment session, evaluating what does and does not work for each individual. I often have to reframe how I might work with this particular client. Tools and questions with clear direction are generally more effective, as broad or questions that are too open can be difficult for clients with ADHD to answer without losing focus. For example, rather than asking “what is your relationship with anger?”, I might narrow the question to “what is a tangible way you display anger?” or “how was anger expressed by your parents when you were a child?” from their answer we can then have more of a conversation and get to the same piece of information.

Identifying and Experiencing Emotions

Clients with ADHD or Autism, and especially those with both, sometimes called AuDHD, often encounter difficulties identifying and accessing their feelings. Traditional tools like the feeling wheel can be less effective if used on its own, and I find many clients look at it and respond with “I imagine I feel like this” or “logically I probably feel this.” To address this, we explore what those feelings might look like when expressed by others, helping clients to recognise and relate these experiences to themselves. For instance, if a client believes they feel scared, we might identify logically that they might feel overwhelmed, we then discuss how some who is overwhelmed might behave, such as struggling to function or being less productive. This process helps clients connect rational understanding with emotional experience, challenging stereotype, such as the misconception that people with autism lack empathy or emotion, which I have not found in my clinical experience.

The Importance of Ongoing Professional Development and Informed Choice in Therapy

The experiences I have encountered throughout my clinical practice underscore the necessity for therapists to engage in continual professional development and education, especially when confronted with new challenges or working with clients whose needs may differ from the mainstream. As therapeutic landscapes evolve and the diversity of client presentations increases, it is crucial for practitioners to remain adaptable and proactive in updating their knowledge and skills. This not only enhances the quality of care provided but also ensures that interventions are tailored to the unique circumstances of each client.

Equally important is the role of the client in the therapeutic process. Clients are encouraged to take an active role in their care by enquiring about the therapist’s background, expertise, and familiarity with their specific difficulties. By seeking information about a therapist’s experience with particular issues, clients can make more informed decisions about their healthcare, ensuring a better fit between their needs and the professional support they receive. This collaborative approach fosters trust and lays the groundwork for more effective and meaningful therapeutic outcomes.