5 Questions to ask a therapist before starting ADHD therapy
(and the answers to watch out for)
I have seen thousands of people with ADHD brains transformed by ADHD therapy. Almost all of my clients come to me feeling like “a mess.” They are mad at themselves, confused why they can’t do what they know they should do and secretly (or not so secretly) feeling like they are inherently “lazy” or “stupid” or “crazy.” They leave therapy knowing what they have to offer the world, feeling good about themselves for it and knowing how to get themselves to bring all that goodness out.
That’s what therapy can do- it can reduce shame and guilt about symptoms, come up with novel, individualized solutions for symptoms, help facilitate communication in ADHD relationships and help people develop lives that work for their brains rather than force their brains into patterns and systems that just will never fit.
But, unfortunately, good ADHD therapy can be hard to find. They don’t teach how to work with adults with ADHD in school. You have to seek out your own training to really do it right.
And doing ADHD therapy isn’t for everyone. There are loads of amazing therapists that I know- kind, loving, brilliant clinicians that I would jump at the chance to send friends and family members to but that I would NEVER send someone with ADHD to. Because ADHD therapy needs to be approached differently than other therapies. Both the practical (time management, planning, organization etc.) and emotional (guilt, shame, anxiety, etc) aspects the ADHD experience need to be addressed. And a lot of those kind, loving brilliant clinicians are thrilled to talk about the emotional implications all day long but they just really don’t want to get their hands dirty with that practical stuff.
In order to make sure you are putting your hard-earned time and money into the best treatment for you and your brain, you want to ask any therapist you are working with these 5 questions. But be careful! Watch out for the answers that are red flags that you should run far and fast.
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1. What is your approach/ style/ orientation when working with ADHD clients?
Understanding how a clinician works with ADHD clients is an essential first question. This will give you an idea of both the methods that they use as well their general style and orientation to working with clients.
Ideally, a therapist will take a collaborative approach- they will partner with you (the real expert on your life) and help you find novel solutions and generate alternative perspectives.
You may also hear a therapist say that they use cognitive behavioral therapy (CBT) or solutions-focused therapy as a basis for their work with ADHD. These are both highly effective treatments that work to target both the thoughts and behaviors that are no longer working in your life. There is a lot of great evidence to support CBT and Solutions focused work for adult ADHD and it should always be at least part of any ADHD treatment module.
Answer to watch out for: Run far and fast from therapists that say they use an exclusively “psychodynamic or psychoanalytic” approach to working with ADHD. These are wonderful, effective treatments for many disorders. But they are not only largely ineffective for ADHD, they can even be harmful by inadvertently adding to the shame and quilt that so many adults with ADHD already feel.
2. How much experience and training do you have working with clients with ADHD?
The more experience and training a therapist have with working with people with ADHD the better. Though, the more experience and training any therapist has the higher their rates will be and just because someone doesn’t have years of experience working with ADHD in particular doesn’t mean they can’t do great work, particularly with good training.
That being said- if you can afford it- finding a therapist with at least several years of ADHD specific experience is likely to make your work smoother and faster.
3. Do you believe in using medication, nutrition, or exercise as adjuncts to treatment?
Research shows that additive treatments for ADHD are the most effective and long-lasting- so combining therapy with medication and lifestyle changes like nutrition, meditation, and exercise. But sticking to all these different regimens that can be so helpful can feel impossible with an ADHD brain! This is where good therapy backs a double punch. Good ADHD therapy not only will address the behaviors and thinking patterns that are no longer working in your life but will help you establish new routines and patterns that can add up and bring real relief to your symptoms.
Watch out for: Any therapist who is so steadfast and single-minded in their approach that they don’t recognize the value in alternative, complementary methods is someone to stay away from. The research is clear on the effectiveness of all of those methods and if they are warning you away from any of them on principle alone, they are either not aware of or trusting in the scientific research that has been done. Not, someone you want to work with.
4. What can I expect to gain from treatment?
This is a hard one to answer because what you get out of treatment depends largely on what you put into it and most therapists should be forthcoming with this. But you also want to know that the therapist you are speaking to has had good results with other people. Have they seen people make substantive progress through their work? What types of progress do they see? Do clients make progress on logistical/ practical issues as well as the way they feel about themselves?
Watch out for: Therapists that over promise- no therapist can guarantee results- there are too many variables at play. If a therapist tells you, they can promise that you will have huge results- run. Don’t walk. Run.
5. How do you work with the practical issues (like planning or organization) of ADHD?
ADHD therapy is a bit of a different beast than traditional talk therapy for issues like anxiety, depression or grief. You want a therapist who will take an active role. Someone that will offer suggestions and team up with you to find solutions that work for YOUR life. It will not help (and may even hurt) if a therapist offers solutions like “just use a planner” or “try setting a timer”. These strategies are not bad necessarily but good ADHD work gets into the nitty gritty of making these strategies work- HOW to use a planner, WHEN to plan, HOW to remember to plan and check the planner, WHY the planner is useful as well as exploring what history and feelings you might have around planning. Make sure that any therapist you work with is willing to get their hands dirty on these topics. Are they willing to, each week, check in on the strategies you came up with and problem solve with you to optimize them for your life? If so, you’ve got a keeper!
Watch out for: Therapists that have a passive or exploratory style. Therapists that don’t feel comfortable addressing the small details of HOW to make solutions work for you. Therapists that have ONE strategy that they offer everyone- no single ADHD brain is built like any other and therefore no one strategy can be effective for every ADHD brain.
Therapy is a hugely effective tool for adults with ADHD, with a little research, searching and effort you can find a therapist who can team up with you to help you develop a life that releases your creative genius and is optimized for your brain.
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