Finding a Psychotherapist for ADHD: What People with ADHD Should Look For

The choice of therapist is far more important than the choice of therapy. The following factors correlate with therapeutic success¹

The quality of the therapist-patient relationship: 30%
The therapist’s personality: 20%
Disorder-specific techniques: 10 (to 15) %

A study on the therapeutic relationship and the Therapeutic Alliance Scale (TAB) questionnaire found that the therapist’s therapeutic effectiveness is determined in particular by the therapist’s fundamentally positive emotional attitude. In contrast, the patient’s initial attitude, the structural constitution of the patient or therapist, or the fit between the patient and therapist were not relevant.²

We believe that, for psychotherapy for ADHD, it is essential that the therapist be familiar not only with the diagnostic symptoms of ADHD but with all of the primary symptoms of ADHD, since all symptoms are relevant to treatment.

A therapist plays a crucial role in determining whether the patient’s problems are caused by his or her disorder (for which the patient is not responsible) or by personal behavior for which the patient is responsible—behavior that must be considered separately from the disorder.
If a therapist is not familiar with all possible primary ADHD symptoms (but, for example, only the diagnostic symptoms listed in the DSM-5), there is a significant risk that causes and effects will be confused, or that certain behaviors will be attributed to the patient as personal deficits rather than recognized as ADHD symptoms.
If a person with ADHD is held responsible for things that are beyond their ability, this can drive them even deeper into a sense of inadequacy. People with ADHD already struggle with significant self-esteem issues.

The quality of the relationship between the patient and the psychotherapist accounts for 30% of treatment success; the psychotherapist’s personality accounts for 20%; and the choice of therapeutic method, by contrast, accounts for only 10 (to 15)%.³

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—if they do their job well and the fit is right—is a kind of surrogate caregiver. This role can extend to providing a form of secondary parenting: a safe haven that gives the patient the feeling of being accepted equally, with all their strengths and weaknesses. Not coddling, but always offering benevolent support. The wise father, the warm mother. Dumbledore, not Snape. Only on this foundation can dysfunctional patterns be addressed without the people with ADHD perceiving themselves as wrong or inadequate.

Because of their knowledge of psychological dynamics—which the patient perceives as objective—a therapist holds a position comparable to that of a judge. If the therapist questions the patient’s behaviors and reactions as “the patient’s own responsibility” or “inappropriate,” this constitutes a very intense intervention by an authority figure who—from the patient’s perspective—is qualified to do so.

If the therapist, from his or her position of dominance and due to a lack of knowledge of all the primary ADHD symptoms, assigns full responsibility for certain behaviors to the person with ADHD, regarding which the patient is, in fact, a victim of ADHD—because they are at the mercy of these symptoms and, precisely because of ADHD, have less control over them than people with ADHD—this will massively increase the patient’s suffering.

Example:
One person with ADHD told us about a (former) therapist who, in reference to his (case-specific but ADHD-typical) motivation problems that he couldn’t always just do what he felt like doing, but also had to do things that weren’t fun.

We have observed that too few psychologists, psychiatrists, and neurologists are able to adequately assess the relationships between activity level/arousal and mood—particularly the phenomenon of dysphoria associated with inactivity in ADHD—and that this leads to a significant number of misdiagnoses of depression.

A positive and supportive emotional atmosphere between the patient and therapist is a fundamental prerequisite for successful therapy. There is evidence that a connection with the therapist that the patient perceives as positive makes a causal contribution to the success of therapy (SMD 0.58).⁴

A study reports that it is possible to determine as early as the first hour whether the treatment will be successful after 3 years—regardless of the type of treatment.
Patients and therapists were filmed during their first therapy session.
When a positive, accepting atmosphere prevailed between the therapist and the patient, the therapy was consistently successful after 3 years. If, on the other hand, a rather cold, distant atmosphere prevailed during the first session, the therapy was consistently unsuccessful after 3 years.

Nevertheless (and in addition), some forms of therapy are more suitable for ADHD than others.