Adult ADHD Therapy: Finding the Right Therapist

From the WebMD Archives

For adults with ADHD, the standard treatment is medication. But experts say that ADHD therapy -- and other psychosocial treatments -- can play a key role alongside drugs.

“I think for many adults with ADHD, therapy is essential,” says David W. Goodman MD, assistant professor of psychiatry at the Johns Hopkins University School of Medicine.

While ADHD medicines are effective, they may not be enough. To use a phrase popular among ADHD specialists, pills don’t build skills. Even with medication, a person may still be struggling with the residual effects of adult ADHD - the disorganized habits, the low self-esteem. Therapy can address some of these key issues.

“With the ADHD medication as a foundation, it’s the psychosocial treatments that can come in and finish the job,” says J. Russell Ramsay, PhD, co-director of the University of Pennsylvania’s Adult ADHD Treatment and Research Program.

So how does ADHD therapy differ from traditional therapy? And how do you find a therapist? WebMD turned to the experts to get the details.

Treating ADHD With Therapy

Therapy for ADHD tends to be pretty different from typical therapy. Ramsay says that traditional, open-ended talk therapies often don’t work for people with ADHD. Why?

Adults with ADHD often need very practical, concrete help. While delving into personal issues can still be important, it’s the symptoms of ADHD, such as disorganization and forgetfulness, that are really interfering with their lives. “What people with ADHD really need to focus on is improving their functioning at work, in school, and in their relationships,” says Ramsay.

Ramsay stresses that most people with ADHD already know what they should be doing. “A guy with ADHD knows that it’s a problem that he’s always late on his taxes,” Ramsay says. “And he knows the solution, too -- stop procrastinating.” What he lacks is the set of skills that will help him get organized. ADHD therapy is typically about learning those skills and finding ways to overcome the impediments that ADHD sets in your path.

Although there haven’t been many studies of psychosocial treatments for ADHD, results have been promising. For instance, one 2006 study showed that medication combined with therapy eased the symptoms of ADHD, improved functioning, and reduced symptoms of anxiety and depression. A 2004 study found that psychosocial treatments were especially beneficial in people who only had a partial response to medication.

So what could psychosocial ADHD treatments do for you? They could help you:

  • Get organized. Psychosocial treatments focus on various ways to reduce the chaos in your life. People with ADHD need visual and auditory cues to remember things, says Goodman. He gets his patients to use certain tools systematically - ranging from Post-It Notes to PDAs - to help them function better. A therapist might have very specific recommendations, right down to how you organize your closet and where you put your keys when you get home from work. That level of specificity can be a huge help with adult ADHD.
  • Change your habits. Psychosocial treatments help people identify specific problematic behaviors and change them. You might learn ways to manage yourself, like using rewards as an incentive to get specific tasks done. Play that game of computer solitaire after you answer your boss’s emails.
  • Understand your condition. A therapist can help you understand how adult ADHD has affected your life. Once people realize that many of their problems are due to a medical condition and not some personal failing, they start to feel much better about themselves.
  • Challenge negative beliefs. Over the years, people with ADHD tend to have accumulated a lot of self-doubt. They come to think that many tasks are beyond them and give up. Therapy can help them question these self-limiting beliefs and overcome them.
  • Improve social skills. People who have grown up with ADHD may lack some important social skills. They might have poor communication or a tendency to interrupt when someone else is talking. ADHD therapy can help people learn how to pick up on social cues and read people better.
  • Repair relationships. ADHD in adults doesn’t only affect the person with the diagnosis - it affects his or her spouse, children, and friends. Sometimes, ADHD therapy can include other family members. It can be a good way to get them to better understand your condition and teach them ways to help. Family members may also have a lot of built-up anger toward a loved one with undiagnosed ADHD. Therapy can help them see that your forgetfulness isn’t a sign of self-centeredness. Instead, it’s a symptom of a condition that you’re learning how to control.
  • Treat other conditions. The odds that a person with ADHD also has another psychiatric condition are about 40%, says Goodman. “Rates of depression and anxiety are strikingly high in adults with ADHD,” says McCracken. “Those conditions really need therapy.”

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ADHD Therapy: Understanding Your Options

Therapists might use any number of approaches in treating ADHD in adults. By far the most common is a technique called cognitive behavioral therapy. This approach focuses on challenging some ingrained, negative thoughts and learning how to change your responses to them.



Cognitive behavioral therapy for ADHD is typically offered by therapists - psychologists, psychiatrists, or social workers. You might have one-on-one sessions with a therapist, or you might do it in a group. Couples or family therapy is another option. It all depends on what you need.

While not true therapy, another psychosocial approach is called ADHD coaching. Coaches are not necessarily trained to help you cope with the emotional impact of living with adult ADHD, like a therapist is. But coaching can help you deal with the problems ADHD causes. The focus tends to be very specific, zeroing in on effective time management and organization.

For many adults with ADHD, treatment is a collaboration. A person might have a doctor prescribing medication while a therapist or coach (or both) uses psychosocial treatments.

ADHD Therapy Instead of Medication?

Because of side effects and other concerns, many adults are interested in treating ADHD without drugs. So is therapy alone - without medication -- ever enough?

While ADHD therapy on its own can work well with children, it’s usually less successful in adults, experts say. One 2008 study looked at the effects of cognitive behavioral therapy on adults with ADHD who were not on medication. While it helped, the results were modest. Therapy alone was significantly less effective than medication and therapy combined.

Ramsay does say that for certain adults who are functioning well and have very mild symptoms of adult ADHD, therapy by itself may be enough. And in cases where a person can’t take a medication because of health problems or side effects, therapy could be the only option. But generally, it’s best to see therapy as a complement to medication and not a replacement, he tells WebMD.

ADHD Therapy: Coping With Emotions

Despite all the focus on learning concrete skills, aspects of traditional talk therapy can still be helpful to people with adult ADHD. Just getting diagnosed can be profoundly emotional.

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“People who have just been diagnosed look back on their life through the lens of ADHD,” Ramsay says. “They start to wonder about what could have been different if only they’d been diagnosed earlier. Maybe they could have gone to college, or followed a different career path, or saved that relationship.”

Some are left with scars after a life with undiagnosed ADHD. “A lot of people with ADHD grew up being subject to ridicule and criticism,” Goodman tells WebMD. “They came to believe what people said about them, that they’re not smart or not capable.” Individual ADHD therapy can be a good way to work through some of these issues.

ADHD Therapy: Getting a Therapist

So given that treating ADHD takes some expertise, how do you find a good therapist? Here are some tips.

  • Talk to your doctor. If you’re already working with a doctor - preferably a psychiatrist - he or she may have good advice about whom to see for therapy. Some psychiatrists may use psychosocial techniques themselves.
  • Get in touch with a child psychiatrist. It might sound odd. But Goodman recommends calling a local medical center and asking to speak with someone in child psychiatry. Since ADHD in adults is still not well known, child psychiatrists often have the best grasp on ADHD treatment and can refer you to experts in your area.
  • Try a national organization. “Some advocacy organizations have professional directories online where people can access clinicians experienced in ADHD,” says Ramsay. He recommends CHADD (Children and Adults with Attention Deficit/Hyperactivity Disorder) and ADDA (Attention Deficit Disorder Association).

Once you’ve found a therapist, here are some things to ask - and to mull over.

  • Ask about experience. You really want to have a therapist who has experience in treating people - specifically adults - with ADHD. Find out about their training. In a therapist, look for a licensed psychologist, psychiatrist, or social worker. Keep in mind that coaching is a more informal treatment and that coaches are not licensed by the state.
  • Discuss the therapist’s approach. There are lots of different therapies that can help adults with ADHD. Try to get a sense of the approach that your therapist will take. Will it be exclusively focused on changing your behavior? Will you be tackling some deeper, emotional issues as well? Does the approach match what you want?
  • Find out what to expect. What are the specific goals of ADHD therapy? How long is it likely to last?
  • Make sure it’s a good fit. Your therapist doesn’t need to be your best friend. In fact, for therapy to work you need to have some distance. But it’s important that you develop an open and trusting relationship. If after a few sessions you don’t get a good vibe, you may want to consider trying someone else.

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Whatever you do, don’t take adult ADHD lightly. It’s a serious condition. Luckily, there’s a lot you can do about it.

“We’re finding more and more effective treatments for adult ADHD,” says Ramsay. “Getting an accurate diagnosis and good treatment can lead to profoundly positive changes in your life.”

WebMD Feature Reviewed by Brunilda Nazario, MD on September 04, 2008

Sources

SOURCES:

Lenard Adler MD, associate professor of psychiatry and child & adolescent psychiatry, director of the Adult ADHD Program, New York University School of Medicine, New York City.

David W. Goodman MD, assistant professor of psychiatry and behavioral sciences, Johns Hopkins University School of Medicine; director, Adult Attention Deficit Disorder Center of Maryland, Baltimore.

Kolar, D. Neuropsychiatric Disease and Treatment, February 2008; vol 4: pp 107-121.

James McCracken, MD, director of child and adolescent psychiatry, Semel Institute at the UCLA Medical Center, Los Angeles.

J. Russell Ramsay PhD, assistant professor of psychology in psychiatry; co-director, Penn Adult ADHD Treatment and Research Program, Hospital of the University of Pennsylvania, Philadelphia.

Weiss, M. Journal of Attention Disorders, 2008; vol 11: pp 642-651.

© 2008 WebMD, LLC. All rights reserved.

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