Accessibility in therapy: ADHD
The prevalence of ADHD has seen a consistent rise in recent years. According to ADHD Aware, attention deficit hyperactivity disorder (ADHD) is a group of behavioural symptoms that include inattentiveness, hyperactivity and impulsiveness.
With this rise in the prevalence of ADHD, it follows that as counsellors, we are seeing more and more clients with ADHD.
Most adults with ADHD have suffered years of feeling demoralized, discouraged, and ineffective because of a long-standing history of frustrations and failures in school, work, family, and social domains. It is vital that as counsellors, we are not reinforcing these feelings of failure by trying to mould clients with ADHD into what is seen as ‘the norm’ by much of society.
As somebody who does not identify as having ADHD, I feel it is important to educate myself on how best to serve clients who do have ADHD. Part of this was a recent conversation I had with Katie -Marie Lynch about her experiences of what was useful and not so useful in counselling.
Katie-Marie was diagnosed with ADHD a couple of years ago. “when I was younger I had a few traits of things and I used to have weird body movements, like I’d roll my stomach, but I never really talked about it or told anyone.
And then when I got older I was like oh, not everyone does that. I went to the doctors and I got referred and then they were like ohh, so you have something like a very mild form of Tourettes and you have ADHD traits. I didn't really think about it after that. But then I used to work in special educational needs quite a lot. I remember one of the kids I was supporting, their educational psychiatrist came into assess them. They turned round to me and said ‘it's so good that the staff here are neurodivergent as well’. I was like, yeah, you know, just like looking around my shoulder, realising, ohh you mean me!”
Katie-Marie corroborated what has been found in research, explaining that there is a level of trauma associated with late diagnosis because you have that feeling that something's wrong, but you don't know what it is. People call you lazy or forgetful or stupid, or unorganized. You're always late for everything and you don't know why you're different.
Diagnosis has been a positive thing for Katie-Marie, who has had both counselling and ADHD coaching. When I asked how the counselling was, she laughed and said ‘awful’. When I enquired more about this, she explained a particular situation: I remember talking to a counsellor and I was saying like, I think there's something there. I know that I don't connect with people in the same way, I just feel a bit different and she was like ‘don't put yourself down’. I look back at it now and that was actually really not very helpful. I even remember saying to her I think I might be like autistic or something, and she was still like, ‘oh, you know, don't put yourself down’.
And I wasn't necessarily saying it was a bad thing.
But it wasn’t all negative, and Katie-Marie did recount some positive experiences with counsellors. I have compiled the positive behaviours of these counsellors, for us to learn from:
- It's so important knowing how that person feels about [ADHD] themselves before you make an assumption on it as well. When I started ADHD coaching, the first thing she asked was like, how, what does it look like for you?
How do you phrase it?
Some people have quirky names for it, and that's when I started using ‘neuro spicy’ as something that resonated for me. And then then whenever she talked about it, she was framing it in a way that made sense for me.
- It is helpful to have a therapist that has a background knowledge of it, or at least has made the effort to acknowledge it. It's tiring when you have to educate people all the time, like the basics of it, I understand it looks different for everyone and that is a part of therapy. But you shouldn't have to be the one that says this is or isn't a classic ADHD trait. It's such a waste of a session as well, because I've had counsellors in the past who have said ‘OK, educate me’ and I'm like, I don't mind telling you what it looks like for me, but I feel like it's good to have an underlying knowledge of the basics.
- There's something called RSD: rejection sensitivity, dysphoria. It’s really common with people who are neurodivergent and it's where you can get the wrong idea of the stick quite easily about certain things and we can take things a bit more personally than other people might. Things stay in your head for longer. Sometimes I found that counsellors that don't fully understand that sometimes can be a bit more blunt or say things in a way that might not necessarily be helpful. Like personally, I don't do well if someone is quite vague about things. It's like that balance between just say it as it is and like, don't leave it too open because my mind will just wonder for hours and hours about what they were trying to say.
- In terms of ‘rejection sensitivity, dysphoria’ (RSD) Katie-Marie found it helpful to be able to double check with counsellors what was meant: I could just ask again and be like can I ask why you're asking that and that was an OK conversation, a two way conversation. She also explained that people-pleasing can be a tendency with RSD and that people may be dishonest with counsellors about how well sessions are going so as not to upset them.
- Probably the hardest part of my ADHD is I have basically no short term memory – it is very, very, very poor and so quite often if I've been asked to think about something in the week before, it's not that I don't care that I’ve not been working on it. It's just that if I haven't written it down, it's probably gone out of my head.
- I had a counsellor that didn't last very long because he would say to me ‘right, Katie, we're gonna focus just on one thing this session, and let's try and keep your brain focused on one thought’. In the history of Katie, that has never happened. It's just not possible for me to stay stuck on one trail of thought.
That's just how my brain works. But OK, I know it's a balance between it's got a bit a structured session to a point, but it's just like it's never gonna be one thought process especially for ADHD.
- It looks so different in every person, so just asking the question ‘what does it look like for you?’ goes a long way. Especially with gender differences as well because I think quite often people assume that I am male ADHD by default. But it just looks so different to every person and it looks really different between different genders as well. I think in general people see ADHD as such a male thing and that it's because the diagnostic criteria is built around men. And specifically young boys and I think and it's a big reason why I guess women don't tend to get diagnosed til much later on is because typically men tend to be more physically hyperactive, whereas women will be more internalized hyperactive. But more recently, a lot of research is saying that it's because women are really good at masking. So that actually, if women were in an environment where we didn't feel like we had to, like, sit down and shut up, be quiet, be polite, be womanly, you know, then we probably would be presenting exactly the same.
- Questions such as Do you see it as a disability? Do you see it as a superpower? Are so useful. And like, where are you on the scale between like 0 is I hate it if I could take a pill now and get rid of it, then I would and ten is like it's the best thing about me.
And it was such a good question because it actually made me think as well that it’s not all bad.
- In terms of technology and working online, Katie-Marie explained that a lot of people with ADHD struggle with auditory processing. And so it's not essential but it is helpful to have subtitles. As well as limiting distractions such as phones going off.
- Timeblindness can be quite common with neurodivergent people so I find it quite helpful to know when I'm like half way through or 10 mins towards the end of a session so I know we're out before I start opening another can of worms. Katie-Marie also explained that her ADHD coach sent session reminders which was helpful.
A huge thank you to Katie-Marie for talking to me, and I hope this helps other counsellors and therapists as much as it has helped me. May we keep on educating ourselves in the service of clients.