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ADHD

ADHD in Therapists

How ADHD can affect those who treat it.

Key points

  • ADHD can show up in unique ways in therapists, both as challenges and strengths.
  • ADHD can impact focus, organization, and various therapeutic skills.
  • ADHD can also make for creative problem-solving and increased connection to emotions.

When you hear ADHD, what comes to mind?

For many, the image of an elementary-age boy jumping up during class is typically what pops up first.

 Jr Korpa/Unsplash
ADHD is often misunderstood and stigmatized.
Source: Jr Korpa/Unsplash

In reality, the impacts of ADHD can be pervasive in any context, and they can show up in different ways based on the person themself, as well as the person’s day-to-day environment.

This includes, of course, those who often work directly with ADHD themselves: therapists.

ADHD at a Glance

ADHD is a neurodevelopmental disorder that primarily affects a person’s executive functioning.

In other words, it can significantly impair things like focus, memory, impulse control, motivation, processing speed, reward response, and emotion processing—to name a few.

Basically, people with ADHD don’t have the biological tools others have that allow them to use those processes effectively, if at all, depending on the situation.

This is one of the many reasons why ADHD is far more than what our society thinks it is. Unfortunately, though, ADHD is often swaddled in misinformation, which has created a deeply rooted stigma around the disorder itself.

 Diego PH/Unsplash
ADHD affects executive functioning.
Source: Diego PH/Unsplash

For one, the name is a profound oversimplification; people with ADHD don’t have a deficit in attention, per say, they have difficulty controlling their attention.

This is why we often see hyperfocus in ADHD too, where something captures a person’s attention to a point where they aren’t able to stop.

Hyperactivity, on the other hand, doesn’t always look like someone bouncing off the walls.

It can look like racing thoughts, fidgeting with a pencil, or making impulsive shopping choices—things that are less of the big, loud distractions that are commonly associated with ADHD.

This is also why it’s primarily diagnosed in children, the majority of whom are boys.

Now, it isn’t that school-age boys don't have ADHD. Many most certainly do. But, lack of information about ADHD and its treatments has left a lot of folks—typically adults whose symptoms were missed, and primarily women—to suffer quietly.

If you assume a disorder is only for young boys who can’t sit still in class, it’s hard to imagine a grown woman missed a rent payment because of that same disorder. She must be irresponsible, or lazy, right?

As with any group, therapists are far from immune from these issues. In fact, a therapist with ADHD can present a unique set of challenges and strengths when working in their practice.

Focus

Being a therapist means holding space for another person’s thoughts, feelings, and experiences, while simultaneously trying to pull out meaning and make connections.

 Milad Faulkarian/Unsplash
ADHD can create unique experiences with therapists.
Source: Milad Faulkarian/Unsplash

Staying present in this way takes quite a bit of focus, sustained for upwards of an hour, multiple times a day.

Since ADHD impairs attention control, that kind of focus takes a lot of energy. It can mean fighting against your own brain without the aid of common coping skills, like fidgets, or background noise.

This might also create a lot of anxiety, as the therapist worries that they’d missed something significant, or is trying to put extra effort into being focused.

This on its own can serve as one of the distractions in trying to fight for time.

Therapeutic Skills

One of the first things therapists learn about in their training are therapeutic skills—micro-skills like eye contact, body position, or cues like nodding or an encouraging “go on,” and macro-skills like the reflection of meaning.

These are the things that help create a safe and effective therapeutic space for the client. They are culturally, situationally, and client-dependent, but in many Western cultures, therapists are taught to maintain eye contact, and to encourage the client to do most of the talking.

In people with ADHD though, it can sometimes be difficult to process information while holding eye contact. For this reason, people with ADHD are scolded for being rude or not paying attention, when they are really taking in far more information than if they’d been worried about where their eyes are.

People with ADHD also tend to speak in ways that are viewed as tangential. This can make it harder to keep reflections or explanations brief.

Source: Mark Williams/Unsplash
ADHD can affect a therapist's focus, organization, and therapy skills.
Source: Mark Williams/Unsplash

Organization

The work of a therapist certainly doesn’t end when the session does.

Notes, scheduling, planning, navigating insurance companies—all these tasks require a lot of executive functioning to stay on track.

Even keeping client information straight can take up a lot of energy. If a therapist has a caseload of 20 to 30 clients, keeping track of background information, important life events, and more increases the chance of forgetting/mixing up certain details from person to person.

Naturally, this is stressful for a therapist with ADHD, and adds to the list of things they have to try and keep in mind while working, which adds to the stress already on their plate.

Creativity

All of the above being said, not all aspects of ADHD are impairing.

People with ADHD are well-known for their creativity. Often referred to as divergent thinking, ADHD can make it easier to think outside the box and come up with solutions to problems that others would not have thought of.

This can be exactly what people need when they come to therapy.

When a client presents with an issue, they’ve likely thought and/or talked through potential approaches already.

Therapists that can think quickly and creatively are well-suited, then, to help clients find alternate ways to address the things they are dealing with.

Empathy

Along those same lines, people with ADHD tend to experience emotions more intensely than people without ADHD.

Part of a therapist’s role is to hold space for the client’s feelings, and to use their own reactions to those feelings as tools for helping the client deal with them.

 Youssef Naddam/Unsplash
ADHD can make creativity and empathy effective tools for therapists.
Source: Youssef Naddam/Unsplash

If a therapist with ADHD is more likely to experience strong reactions, they can have easier access to those tools in session.

Of course, as with any therapist, therapists with ADHD should be mindful of letting those emotions flood them, but when used effectively it can be an asset when connecting with the clients in their care.

With so much stigma and misinformation, the obstacles of ADHD can go overlooked very easily, which can make it easy for these symptoms to really get in the way of daily life.

It also means that many people internalize these struggles as inherent flaws to be ashamed of, instead of differences in their brain that are out of their control.

This goes for children trying to navigate the classroom all the way to a therapist trying to provide support for their clients.

Now whether it’s keeping different drinks on hand during sessions, asking colleagues to work on notes together, or engaging in therapy modalities outside of traditional talk therapy (e.g., play therapy, equine therapy), sometimes it’s important to adapt to the way the ADHD brain works, instead of trying to fit into the mold of how a therapist should be.

The obstacles of ADHD are real, and they are exhausting, and in no way mean that a person with ADHD cannot thrive in any and all circumstances—especially as a therapist.

References

Skirrow, C., Ebner-Priemer, U., Reinhard, I., Malliaris, Y., Kuntsi, J., & Asherson, P. (2014). Everyday emotional experience of adults with attention deficit hyperactivity disorder: evidence for reactive and endogenous emotional lability. Psychological medicine, 44(16), 3571-3583.

Taylor, C. L., Esmaili Zaghi, A., Kaufman, J. C., Reis, S. M., & Renzulli, J. S. (2020). Divergent thinking and academic performance of students with attention deficit hyperactivity disorder characteristics in engineering. Journal of Engineering Education, 109(2), 213-229.

Rucklidge, J. J. (2010). Gender differences in attention-deficit/hyperactivity disorder. Psychiatric Clinics, 33(2), 357-373.

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