Attention-deficit/hyperactivity disorder (ADHD) is a neurological condition that is characterized by difficulty with executive functioning (planning, organization, emotional regulation, self-monitoring, time management, and self-control), a low threshold for boredom, and, in some cases, impulsivity.
TWO TYPES OF ADHD
ADHD (previously known as attention-deficit disorder or ADD) is subdivided into hyperactive and inattentive types. This means that, respectively, some with ADHD tend to be hyper and impulsive, while others are more inattentive and internally disorganized. This latter category is more common among females with the condition. As a matter of fact, women with ADHD often fly under the diagnostic radar, as gender roles can influence the way ADHD presents itself.
While children who get diagnosed with ADHD typically first show symptoms of hyperactivity and poor impulse control, adults who seek treatment for ADHD more often complain of difficulty with organization, time management, chronic procrastination, and motivation problems.
THE ROLE OF DEPRESSION AND LOW SELF-WORTH
Attention-deficit/hyperactivity disorder isn’t just about focus; depression and low self-worth are common secondary symptoms. People with ADHD have typically struggled tremendously in school and employment settings. They have often been told that they need to calm down, focus, and get with the program. This combination of experiencing painful struggles in school and work, being the target of frequent criticism, and having the nagging feeling that “I’m just not living up to my full potential” can really take a toll on one’s sense of Self.
The truth is, ADHD is not a disease to be cured, but rather a condition to be managed. In fact, there are some experts who challenge the notion that ADHD is a disorder.
THE UPSIDE OF ADHD
In his book, The ADHD Advantage, Dale Archer highlights the benefits of ADHD. Flipping the symptom profile around, Archer points out the strengths that many people with this condition have, such as “an ability to multitask, a propensity to thrive in situations of chaos; creative, nonlinear thinking; an adventurous spirit; a capacity for hyper-focus on something that fascinates you; resilience; high energy; a willingness to take calculated risks; and calmness under pressure.” If you are able to effectively harness these qualities, you can experience unique advantages in life. On the other hand, without adequate structure, support, and education, living with ADHD can cause tremendous difficulty and distress.
A BRIEF HISTORY OF ADHD
While many think of ADHD as a relatively new diagnosis, the phenomenon has been documented for centuries. In ancient Greece, Hippocrates, the father of modern medicine, wrote about patients who had difficulty focusing on any one task and reacted with exceptional speed to things around them. Other physicians and educators have made similar observations over the years. Early terminology for the disorder included “nervous child” and “hyperkinetic reaction of childhood.”
Modern psychiatry coined the term ADD, which was first introduced in 1980. It was later modified to ADHD in 1987. While originally considered a disorder of childhood that one will grow out of, it is now understood to be a lifelong condition.
Much controversy currently surrounds the diagnosis of ADHD, due largely to the aggressive marketing efforts of Big Pharma to medicate those with the condition. Beginning in the 1990s, widespread financial incentives for doctors to prescribe ADHD medications, combined with television ads targeted to frazzled educators and exhausted parents, led to an explosion of the diagnosis, especially in young children.
While some of this trend was clearly due to better assessment procedures, there was also a zeitgeist of labeling all hyper children as having the disorder. The unfortunate side effect of this was young children being overprescribed stimulant medication. While prescriptions for medication have arguably gotten out of control, for many with the disorder, medication is tremendously helpful, if not essential.
Richard Louv, author of Last Child in the Woods, has attempted to connect ADHD to what he has termed “nature-deficit disorder,” the result of society’s lack of connection to the natural world. While there is no empirical evidence to support the existence of nature-deficit disorder as a clinical syndrome, the concept bears further examination. As with any condition or disorder, there is always more to learn.
DIAGNOSIS AND TREATMENT
If you suspect that you may have ADHD, obtaining a proper diagnosis is key. Any licensed mental health professional can assess you for ADHD. In some cases, your therapist may refer you to a psychiatrist, psychologist, or neurologist who specializes in ADHD for further assessment and testing. Once an accurate diagnosis has been made, treatment can begin. Therapy for ADHD involves a combination of education, supportive counseling, mindfulness practice, and, in some cases, medication. In addition to traditional psychotherapy, individuals with ADHD may also benefit from working with a life coach.
If you have been diagnosed with ADHD, the first step is to learn as much as you can. Both Driven to Distraction and The ADHD Advantage are written by psychiatrists who themselves have ADHD. Both books are highly informative, accessible, compassionate, and practical in their approach.
The next step is to work with your therapist and other supportive people in your life to develop structure and habits that are tailored to your needs. Another aspect of your therapy may involve working through any difficult emotions associated with living with ADHD, including both past and present experiences that have caused distress.
Finally, it is important to note that, in many cases, ADHD presents unique challenges in relationships. It can be very helpful for your significant other and close relatives to become educated about the condition.
Sometimes, therapy goes off the rails. I’ve heard more stories than I can count about people’s bad experiences in counseling. I am always disheartened by them. Sadly, negative experiences on the therapy couch can discourage you from trying therapy again. The sooner you can determine that there is a problem, however, the sooner you can move on and find a better therapist, thus saving yourself precious time and resources.
If you’re unsure about whether your own therapy experience is appropriate, read on for information on some things that are not supposed to happen when you are getting professional help.
Some therapists are dangerous. Your therapist is responsible for maintaining certain fundamental boundaries at all times. It is their job to clearly define and reinforce the professional nature of the therapeutic relationship. The most critical boundaries are those that prohibit engaging in romantic or sexual relationships with clients. When this boundary is crossed, there is a great risk of serious psychological harm to clients. Other forms of boundary violations include engaging in other forms of detrimental relationships with clients outside of the office.
Thankfully, these kinds of boundary violations are rare. The overwhelming majority of practicing therapists never cross these boundaries. But just like in any profession, there are always a few bad apples who use their position of power for personal gain, with no remorse about the harm they cause to others.
Therapists must also maintain other boundaries such as protecting patient confidentiality and handling any contact outside of sessions appropriately and with professionalism. For example, you and your therapist might have children that go to the same school, or you may have some other social overlap. Effective therapists know how to maintain healthy boundaries in all aspects of the therapeutic relationship. The healing power of psychotherapy depends in large part on the feeling of safety that is created by clearly defined boundaries.
Your therapist is responsible for creating a container for your healing work. This includes the physical space of their office, the time boundaries around each session, clear expectations about how much (if any) communication will occur outside of session, and any other aspect of the therapeutic relationship.
When you know that your therapist is creating and maintaining appropriate, strong borders around the relationship, it becomes easier to relax and let your guard down—which is necessary to obtain a good result from therapy.
LACK OF PROFESSIONALISM
Some therapists aren’t very grown up. Just as therapists must maintain appropriate boundaries, they must also conduct themselves in a professional manner during your time together.
This doesn’t mean that therapists have to act in a specific, prescribed way. Therapists, just like everyone else, have a wide variety of personality types. Many will utilize humor, liberally use four letter words, and share entertaining stories to prove a point. Others are more formal and reserved. As a matter of fact, it’s a good thing that therapists are a diverse bunch; how better to connect with the diverse clients they serve? While one person may relate well to a therapist who has a formal relationship style, someone else will prefer a therapist who is more casual in how they relate. These personality differences can enhance rapport, thus increasing client engagement.
While a therapist with a colorful personality is not a problem, one who engages in excessive self-disclosure is. If your therapist shares too much information about themselves, that is a red flag.
A small amount of self-disclosure for the purpose of making a personal connection or to make a point is considered clinically appropriate and is a normal part of therapy. Appropriate sharing will typically (1) last less than five minutes, (2) be in some way connected to your concerns, and (3) be presented in a way that you don’t feel burdened. In other words, you should not feel that your therapist is looking for emotional support from you.
On the other hand, if your therapist talks about themselves excessively, if their sharing is not designed to help you, or if their sharing simply makes you feel uncomfortable, there is a problem. If you find yourself getting confused about who is the therapist and who is client, it’s time to head for the door.
LACK OF ENGAGEMENT
Some therapists are phoning it in. They may have good boundaries and behave in a professional manner, and yet you get the feeling that they are not present, not paying close attention, or just don’t care.
This lack of engagement could be caused by any number or reasons—professional burnout, being in the wrong profession, being distracted by a personal crisis. But regardless of the reason, you get the feeling that your concerns are just not that important to your therapist.
If this is the case, it may be time to look elsewhere. After all, if you’re showing up and giving a full commitment to working on yourself, you have the right to expect your therapist to bring their A game as well. For your time together, you should expect 100 percent of their attention and resourcefulness.
LACK OF DIRECTION AND STRUCTURE
Some therapists simply aren’t effective. They might have a kind heart and a genuine desire to help, but their therapy lacks direction.
This can be a subtle point. There are many legitimate, effective forms of therapy (psychoanalysis and client-centered therapy, to name two) that are non-directive. With these forms of treatment, the therapist will ask open-ended questions and follow the client’s lead. These approaches can have a meandering quality, and some sessions may feel unstructured. The overall treatment plan, however, is guided by sound theories and does have a clinical strategy designed to help you reach your goals.
On the other hand, some therapists are not grounded in a strong theoretical foundation, and, thus, the therapy lacks adequate structure and direction.
If you suspect that your sessions are leading you on a journey to nowhere, don’t be afraid to ask your therapist some hard questions. What is their treatment plan? What theoretical orientation and/or clinical strategies are they drawing on? How do they view your problem and your goals? What is their plan to help you get where you want to go? You may be pleasantly surprised by the answer. On the other hand, if your therapist looks like a deer in the headlights when you ask the hard questions, it may be time to find someone new to work with.
Some therapists resist going deep. Many clinicians practicing today are trained in cognitive behavioral therapy or other similar modalities geared toward symptom reduction through short-term care. And while CBT is very effective, it is not a one-size-fits-all solution.
Too many times I have known clients who have finally gotten the nerve to get into therapy and made a connection with a therapist, only to be prematurely discharged from treatment as soon as their initial symptoms resolved.
Now, don’t get me wrong. Long-term, depth-oriented psychotherapy is certainly not for everyone. The great Milton Erickson and the many expert therapists who are a part of his lineage have proven that tremendous changes can occur from brief therapy. Short-term, strategic therapy certainly has its place.
The problem I wish to address here are those occasions when a therapist misses an opportunity to help a client who is motivated to do deep work. It’s not unusual for someone to seek therapy due to depression, anxiety, or a relationship problem, only to discover a deeper longing to know themselves better. If, however, your therapist recommends a premature end to therapy, the chance to go deeper, to explore past hurts, and to ultimately engage in a longer, more meaningful journey of analysis and self-discovery will have been lost.
This longer process is the original foundation of psychotherapy. Sadly, many therapists today are not properly trained in the core elements of analytical therapy and thus may not be comfortable going beyond the original problem toward a deeper exploration of the psyche.
It is my sincere hope that you will not run into any of these problems on your psychotherapy journey. If, however, you do encounter any of these pitfalls, don’t wait to take action and course correct. If your therapist has done something egregious, you should consider reporting them to their licensing board. In less severe cases, however, you may simply need to move on and find a new therapist to work with.