Counseling for ADHD

by John Fleming, Ph.D., C.Psych.

No two people with ADHD are alike; each brings a unique set of characteristics and experiences that have interacted with their ADHD over the course of their lifetime. What they do have in common is a brain with certain operating characteristics that can make life challenging.

Why would someone with newly diagnosed ADHD benefit from counseling?

Counseling not Psychoanalysis. It is important that counseling be understood as a pathway to success, rather than an admission of defeat or defectiveness. People mistakenly believe that seeing a counselor is a reflection of weakness. Psychologists and other counselors should be considered no different than other professionals that we use help in areas in which we are not expert.  It is hard to imagine someone being embarrassed because they consult an accountant or go to the dentist for problems with their teeth.

Not all psychological counseling is alike. What you don’t need is years of psychoanalysis. In fact this could be the worst thing for you. Generally, people with ADHD do not do well with open-ended discussions with no clear agenda. Individuals with ADHD don’t behave the way they do because of their relationships with their parents (though of course these relationships have made a contribution), they behave in some unusual ways because their brain works in some unusual ways. I have repeatedly heard from clients how they spent years in psychotherapy trying to understand their “passive-aggressive” behavior which was really nothing more than run-of-the-mill ADHD forgetfulness. People with ADHD need education about the way their brain works and an understanding of how their ADHD interacts with all of the other facets of their personality. They need to be respected for their strengths as they work to cope with their weaknesses. They typically need to develop clearer direction and purpose in their lives.

Another important factor in pursuing counseling pertains to the experience of the mental-health professional.  Since an important part of coping with ADHD is understanding how and where it impacts on one's life, it is quite important that the counselor have some experience in working with the condition. It also helps if they are comfortable with people known for their frank and sometimes-unusual ways of describing things and are comfortable in providing redirection when discussions move off course. Counselors come in many flavors and it is very much a personal decision as to whether a counselor feels “right”.  Make your choice of a counselor an active one, not a passive resignation. Shop around, don’t settle.

Counseling as a means of understanding yourself differently. You have spent your entire life (up to the point of a diagnosis) with a whole set of assumptions about who you are and why you behave the way you do. Many of these assumptions are wrong; they need to made conscious and reevaluated in light of a substantially new understanding. A diagnosis can be the beginning of a new self-image based on an accurate and realistic understanding of what makes you who you are. This is about acceptance, understanding, learning to laugh at yourself rather than feeling guilty, about taking responsibility for your actions, and finding creative and effective solutions.

People with ADHD naturally fall into patterns of reactive living. They respond to external pressures rather than pursue a course of action that is driven or guided by their values or beliefs. These values and beliefs need to be clarified, brought to the center of your life, and relied upon to ensure that your life is directed toward doing what is right and important to you.  Staying reactive tends to mean doing the things that apply the greatest pressure not the things that are most important. Good counseling for ADHD should help clarify what is truly important to a person so as to help give them some leverage in overcoming the doubts and fears that can so easily dominate an ADHD mind.

Finding your strengths. So often an ADHD history tells the tale of failure and doubt. These fears and doubts need to be put in their place and replaced by a life centered around strengths. Counseling should help you in finding ways of doing what you like and minimizing what you dislike. Critically this is not about avoiding your fears but rather minimizing unnecessary discomfort and saving your energy for overcoming those hurdles which are keeping you from living a more satisfying life.

Learning to work with the effects of medication. If you choose to use medication and it works for you, you may still need to learn how to change the way you approach life with a brain that is now working differently. Old habits die hard. Even if the brain based symptoms of ADHD are lessened, many people continue to live as if nothing has changed. They continue to rely on stress and adrenaline to stay focused, avoid arguments because before they were too afraid that they would not be able to think straight, and keep their expectations low so as to not fail, and on and on.

Approximately 70% of adults with ADHD also have what is charmingly called a comorbid disorder. For a host of reasons, people with ADHD are much more likely to develop problems with depression, anxiety, substance use, or problems getting along with others. While medication can help these conditions, they also respond to counseling which helps change the root causes of these conditions. Sometimes medication can have the somewhat disconcerting effect of increasing a person's awareness of some of the things that they are unhappy about. A fair number of people with ADHD have learned to use their inherent fogginess to prevent them from confronting some distasteful aspects of their life. Counseling can help these people face these issues directly and make positive change.

Another important aspect of counseling is related to working out the conflicts that are often created in relationships.  While partners with ADHD can be wonderfully exciting, sensitive, warm, and caring they can also be highly inconsistent, distracted, seemingly disinterested, avoidant, and sometimes struggle to communicate. ADHD should never be used as an excuse for destructive behavior, but it can make a very large difference to a relationship when both partners understand the contribution of this neurological condition and how they both can manage it more effectively.

Why medication is not enough. To begin, medication does not cure ADHD it will simply reduce the level of symptoms at best.  Even after finding the right medication and correct dose, people vary considerably in how much benefit they receive from medication. About 80% will receive some significant benefit. For some of these people the improvement will be very dramatic while for others it will be only modest.  Still others make an informed choice not to take medication.

Even if medication did eliminate symptoms it could not eliminate the years of experience where one learned to cope with a brain that worked in a somewhat peculiar way. It would not the erase the memory of failure and the insecurities that result from a lifetime of inconsistent achievement.  It wouldn't automatically alter assumptions about what someone can or cannot do. It takes hard work to change these fundamental assumptions and cognitive biases.

Medication works best when it is used in conjunction with external structures which helped define and limit the task at hand.  In children the structure is typically provided by a classroom environment where the expectations are pretty clearly defined. For example we are now doing silent reading of a given chapter after which we will answer questions about what we have just read. By contrast, adult life is characterized by a great increase in responsibilities wherein there are usually several different things a person might be doing at any given moment. These demands need to be prioritized and executed so that they are not continuously in competition for attention. If the medication serves to improve one's focus it is imperative to know where that focus should be directed.  Taking control of this process is critical for a sense of well-being. All too often people with ADHD allow external forces to determine where their energy is directed. This means that in some way, they are still waiting for the teacher or parent to tell them what to do. While it offers a solution to not knowing what to do, it also breeds tension and resentment.

People with ADHD typically need to learn how to establish their own agendas so that they adequately reflect their fundamental values and beliefs. The selection of what is worthy of their attention should be reflected in a measure of their overall satisfaction. Even those with substantial external success will often have limited satisfaction in their lives because they continue to be driven by external forces rather than being drawn along by the power of their own interests.

People with ADHD have spent their life trying to cope with an inconsistent and confusing brain function without the help of a user's manual.  Imagine how difficult it would be if you received a very complicated bit of machinery with no instructions. Since people with ADHD are notorious for jumping in without reading through the manual, they may never have read it anyway. That is why you owe yourself an opportunity to spend some time with an interactive guide in the form of a counselor.

While counseling will never come with a money back guarantee, most people who make a commitment to the process find themselves to be generally happier and more content but very often will find themselves to be more successful in their career.  By gaining help in understanding the things that you are best at and receiving guidance about how to minimize the damage of those things that are most difficult, you can greatly reduce both frustration and fatigue while greatly increasing the pleasure of building accomplishments.