Coming to therapy can be overwhelming to a person with ADHD. The lighting in the waiting or the therapy room may emit a buzzing sound only they can hear. The different thoughts they have in their head may distract them from completing an intake session in one go. Sometimes, during intake, therapists share a lot of administrative information – confidentiality, appointment guidelines, assessment guidelines – that may just go through one ear and out the other for a person with ADHD, as they struggle with remembering details. Furthermore, having to sit down and focus on discussing presenting issues can make someone with ADHD feel restless, stressed or anxious. With these challenges, how can therapists make the process neurodiversity-affirming for clients with ADHD?
One of the ways I have found helpful is having small fidget items in the office for clients. Having fidget toys, stress balls and other knick knacks as options to touch or feel can help clients lower their stress levels tied to therapy and help them stay focused during sessions. It is not necessary that clients with ADHD will use these items. However, giving them the option to use them will give them the agency that they may lack in their daily lives.
Because the ADHD brain is incentivized by novel ideas, people with ADHD may jump from one topic to another during therapy. One moment, they may talk about their frustration with family. The next, they may be talking about their successes at work with their boss. These ideas may seem unrelated to an outsider but make perfect sense to the ADHD brain. The role of a therapist is not to intervene when these stories are told, but to listen and understand how these stories may relate to each other and how it affects the clients’ presenting issue. At times, these stories may genuinely not relate to therapy goals. When that happens, asking permission to gently redirect the client can help conversations stay focused on therapy goals.
Because individuals with ADHD have frequently encounter people being disappointed with them, they may not have built the emotional awareness and language around their feelings and how these feelings relate to their subsequent actions. Giving clients with ADHD space to discuss their feelings and using reflection of feelings to surface unspoken emotions can help clients make connections between their feelings and behavior. Empathetic listening, paired with executive function training (e.g. to-do lists and reminders, Pomodoro timers) can help clients develop an alert system before they start feeling dysregulated.
Tapping onto ADHD Strengths
Labelling ADHD as lack of attention is a misnomer. One of the key strengths of having ADHD is having the ability to hyperfocus, i.e. focusing on a particular task for a prolonged period, especially when interests are piqued. Reminding clients with ADHD of their strengths, which also includes being creative and their high adaptability and spontaneity can help them find pathways to diminish their self-blame and increase self-worth.
Is therapy helpful for someone with ADHD?
Living with ADHD does not need to be draining. It can be rewarding when strengths are tapped and tools gained to function in daily life. Creating an ADHD-friendly therapy space and being empathetic to the inner struggles of individuals with ADHD can help clients gain new ability to appreciate themselves, just as they are.
Evelyn Ooi, Pre-Graduate Student Counselor
