We believe that for psychotherapy in ADHD, it is imperative that the therapist be familiar not only with the diagnostic symptoms of ADHD but also with the other symptoms, as all symptoms are relevant to treatment.
A therapist is a crucial authority who evaluates whether the patient’s problems are caused by his or her disorder (the existence of which is not the fault of the individual), or by some behavior of his or her own, personal and separate from the disorder, for which the individual is responsible.
If a therapist does not know all possible original ADHD symptoms (but e.g. only the diagnostic symptoms of DSM 5), this bears the considerable risk that causes and effects are confused or that some behaviors are attributed to the patient as personal deficits instead of being recorded as ADHD symptoms.
If an ADHD sufferer is assigned responsibility for things that are in the realm of not being able to do, this can drive the ADHD sufferer even deeper into a feeling of being inadequate. ADHD sufferers already have considerable self-esteem problems.
Unfortunately, we know quite a few ADHD sufferers who, after spending several months in supposedly specialized ADHD clinics, were more frustrated and hurt than before.
A therapist is - if he does it well and the fit is right - a kind of substitute reference person. This role can go as far as the task of after-care: the safe castle that gives the patient the feeling of being accepted equally with all abilities and inabilities. Not coddling, but always benevolently encouraging. The wise father, the warm mother. Dumbledore, not Snape. Only on this basis can dysfunctional patterns be addressed without the person concerned perceiving himself as wrong or insufficient.
A therapist has a position comparable to a judge due to his - from the patient’s point of view objective - knowledge of the psychological context. If the therapist questions the patient’s actions and reactions as “the patient’s responsibility” or “not in order”, this is a very intensive intervention by an authority who - from the patient’s point of view - is appointed to do so.
If the therapist in his dominating position, due to lack of knowledge of all original ADHD symptoms, assigns full responsibility to the affected person for behaviors, regarding which the affected person is rather a victim of ADHD, because he is at their mercy as a symptom and on which the affected person, precisely because of ADHD, has symptomatically less influence than non-affected persons, this will massively increase the patient’s suffering.
A person affected told us about a (former) therapist who reproached him with regard to his (case-related severe, but ADHD phenotypical) motivation problems that he could not always only do what he felt like doing, but also had to do what was not fun.
We observe that too few psychologists, psychiatrists, and neurologists can adequately assess the relationships between activity level/arousal and mood, particularly the phenomenon of dysphoria in inactivity in ADHD, and that this results in significant misdiagnosis toward depression.
A positive and supportive emotional atmosphere between patient and therapist is a basic prerequisite for fruitful therapy.
One study reports that it is already measurable in the first hour whether the therapy will be successful after 3 years - regardless of the form of therapy.
Patients and therapists were filmed during the first therapy session.
If there was a positive, accepting mood between therapist and patient, therapy was regularly successful after 3 years. If, on the other hand, a rather cool, distant mood prevailed in the first hour, the therapy was regularly not successful after 3 years.
Nonetheless (and additionally), some forms of therapy are more appropriate for ADHD than others.