Adult ADHD: How to discuss it with your therapist

By Arthur Newbould, LMHC

Maybe, as a child, you struggled with focusing in school or you often couldn’t sit still even when you wanted to. Back then, perhaps your teachers or parents told you, “All kids are like that! You just need to try harder to control yourself and pay attention, or you’re just a bad kid.” And so, you tried and tried. But no matter how successful you were at masking it, you always had the sense that something deep down inside you made it harder for you to navigate daily life than others.

Now you’re an adult, and it turns out that you were right all along. A doctor or psychiatrist has just diagnosed you for the first time with attention-deficit/hyperactivity disorder, or ADHD.

If this sounds anything like your personal story, know that you are far from alone. According to the National Institute of Mental Health, current prevalence of adult ADHD in the US is estimated at 4.4% of Americans between the ages of 18 and 44. Since ADHD can often go undiagnosed among both children and adults, furthermore, the actual number of those with the developmental disorder may be higher.

It’s always better late than never to receive an accurate psychiatric diagnosis, even if you’ve been struggling with symptoms since childhood. So now, armed with this information, you decide to start working with a therapist to address your ADHD-related challenges for the first time. Where to begin?

In my clinical practice, I have worked with a number of clients who have been in this situation and come away with deeper insight and helpful tools to manage their symptoms. Here are three tips to help you get the most out of working with your therapist on adult ADHD:

Remember: no judgment, no shame!

It’s only natural to enter into an interaction with another human being, particularly one you’ve never met before, and feel some concern about being judged. It’s also understandable to feel some internalized shame related to the still-all-too-real stigma that surrounds mental health diagnoses in society. But the great thing about therapy is that it is designed to be a space free of judgment! 

Whatever their background, your therapist is trained to conduct therapy without passing judgment or projecting shame onto you (at least, that’s how it’s supposed to be - don’t forget that you should always feel free to find a new therapist if it’s not a good fit). Moreover, as a person with ADHD, you are likely aware of the misconceptions that often exist about a disorder popularly associated with energetic children, but talking to a mental health professional is an opportunity to express your thoughts and feelings about it without encountering such misunderstanding or invalidation.

With all this in mind, you can feel empowered to talk about your experience with ADHD in therapy - how it’s affected your life, what you’ve done to manage it, etc. - with confidence that you are doing so in an environment characterized by confidentiality, privacy, and acceptance.

You are the expert on your own experience

One common misconception that clients often bring into therapy is the idea that they are simply bringing their humble selves in (passively) to be judged, evaluated, and treated (actively) by an “expert” - someone whose word should be taken as final and who should be perceived as authoritative and nearly omniscient.

While this is a caricature, I find that it represents an aspect of the medical model on which mental health treatment has long been based. You probably don’t have any medical training, so when you go to a doctor to be treated for what you suspect may be, say, an ear infection, you mostly just take whatever the doctor prescribes. That’s not how psychotherapy works!

You know yourself best, and you are the expert on your own experience. You may not see yourself the way others see you, sure, and your self-concept may be inherently subjective. But no one has known you so intimately or so long as you’ve known yourself, and that is an irreplaceable degree of authority! This is why therapy is a collaborative exercise: your therapist is the expert on the way therapy works, but you are the expert on yourself. Ultimately, it is you who has the prerogative and the power to make positive change in your life.

Therefore, don’t be afraid to bring all your knowledge about yourself to therapy. Is your ADHD presentation predominantly hyperactive, predominantly inattentive, or combined? Have you tried medication and found it particularly helpful or unhelpful, or do you think you would like to try it if you haven’t? Did you read a news article about ADHD or see a coping strategy for it on TikTok that resonated with you? Any such question will be intimately connected with your own experience, and your reported experience with ADHD will be integral in guiding your therapist’s work with you.

Think about how, exactly, therapy can help you

Entering therapy with some sense of what you want to get out of it is essential. Are you looking for someone to help you keep up with coping skills? To introduce you to new ones? To refer you to a psychiatrist? To simply help you try to figure it all out?

These are all great reasons to enter therapy when ADHD is a presenting concern. If you look at therapy as a practice that you can leverage to help you achieve your goals, your therapist should be more than happy to do everything within their training and expertise to aid you as you work toward that pursuit.

That being said, keep in mind that therapy is always but one piece of the puzzle of overall mental health care. Certain types of therapy, such as cognitive behavioral therapy (CBT), skills training, and neurofeedback are evidence-based for the treatment of ADHD. CBT can help you better understand the ways in which your thoughts influence your emotions and affect your behavior. In treating ADHD, you and the therapist would examine how your thinking contributes to emotional distress that might in turn increase unhelpful behaviors like procrastination and avoidance. In skills training, you and the therapist would work together to manage ADHD symptoms by learning and utilizing various skills including time management, memory enhancing, mindfulness, distress tolerance, and emotion regulation skills. Neurofeedback can also be used with a qualified therapist as a non-invasive and painless way to train brain waves to be more alert and focused. Additionally, there are other effective ways for managing ADHD alongside your work with a therapist. For example if you feel you could benefit from medication, a psychiatric provider could evaluate your suitability for the types of medications that address symptoms of ADHD, such as Adderall, and prescribe them to you. You might also consider employing the services of an ADHD coach, who can help to teach and reinforce skills in areas such as executive functioning in a non-clinical setting.

The above tips should, like anything else a therapist says, be taken with consideration of your own personal situation, including where you are in your life and how ready you are to begin work with a therapist. Remember also that ADHD can often co-occur with other mental health issues and disorders, including depression and anxiety, and it is important to address any others that you are experiencing as well. Therapy is a deeply personal choice!

But if you’re an adult with ADHD who feels ready to begin therapy to address it, I hope you find it helpful to remember these three main takeaways: no judgment is necessary, you know yourself best, and therapy is a tool to be utilized with intention!