Choosing a suitable psychotherapist for ADHD
We believe that for psychotherapy for ADHD, the therapist must 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 assesses whether the patient’s problems are caused by his Disorder (the existence of which the person with ADHD is not responsible for), or by his own personal behavior, separate from the Disorder, for which the person with ADHD is responsible.
If a therapist does not know all possible original ADHD symptoms (but only the diagnostic symptoms of DSM 5, for example), there is a considerable risk that causes and effects will be confused or that some behaviors will be attributed to the patient as personal deficits instead of being recorded as ADHD symptoms.
If a person with ADHD is assigned responsibility for things that lie in the area of non-capability, this can drive the person with ADHD even deeper into a feeling of inadequacy. People with ADHD already have considerable self-esteem problems.
Unfortunately, we know quite a few people with ADHD who, after spending several months in supposedly specialized ADHD clinics, were more frustrated and hurt than before.
A therapist is - if they do it well and the fit is right - a kind of substitute caregiver. This role can go as far as being an aftercaregiver: the secure castle that gives the patient the feeling of being accepted equally with all their 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 with ADHD perceiving themselves as wrong or inadequate.
A therapist has a position comparable to a judge due to his or her - from the patient’s point of view objective - knowledge of the psychological contexts. If the therapist questions the patient’s actions and reactions as being “the patient’s responsibility” or “not okay”, this is a very intensive intervention by an authority who - from the patient’s point of view - is called upon to do so.
If the therapist, in his dominant position due to lack of knowledge of all original ADHD symptoms, assigns full responsibility to the person with ADHD for behaviors with regard to which the person with ADHD is rather a victim of the ADHD because he is at the mercy of them as a symptom and on which the person with ADHD has less influence than non-affected people precisely because of the ADHD symptomatically, this will massively increase the patient’s suffering.
Example:
One person with ADHD told us about a (former) therapist who, in relation to his (severe but ADHD-phenotypical) motivational problems, told him that he couldn’t always just do what he wanted to do, but that he also had to do things that weren’t fun.
We observe that too few psychologists, psychiatrists and neurologists are able to adequately assess the connections between activity level/arousal and mood, in particular the phenomenon of dysphoria with inactivity in ADHD, and that a considerable number of misdiagnoses of depression are made as a result.
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 atmosphere between therapist and patient, the therapy was regularly successful after 3 years. If, on the other hand, a rather cool, distant atmosphere prevailed in the first hour, the therapy was regularly unsuccessful after 3 years.
Nevertheless (and in addition), some forms of therapy are more suitable for ADHD than others.