View Full Version : Why therapy?


acdc01
11-09-16, 03:05 AM
Has anyone here who doesn't have a comorbid actually benefited from therapy?

Another thread prompted this question in me. It actually makes me a little disappointed that people are recommended to try therapy for adhd.

It's like I have a biological condition that causes my mind to wander uncontrollably which thereby causes all the problems I have. That wandering isn't going to stop with therapy. You don't send a person with lung cancer to a therapist. Why would we do so for our biological condition?

That said, I can see how therapy might help someone who developed a comorbid mental illness or experienced emotional damage as a result of trauma caused indirectly by their adhd.

But for people who have just straight up adhd symptoms like difficulties paying attention, driving, losing stuff all the time,etc. - it makes no sense to me and I actually find it somewhat insulting to recommend therapy to someone who only has adhd.

ginniebean
11-09-16, 03:11 AM
Therapy for those with adhd is not to help with the adhd but rather the psychological damage done by having adhd. Unfortunately this gets lost in the chatter that very specific forms of therapy have been recommended and the findings have been that therapy that focuses on fixong adhd does more damage.

BellaVita
11-09-16, 03:28 AM
Therapy for those with adhd is not to help with the adhd but rather the psychological damage done by having adhd. Unfortunately this gets lost in the chatter that very specific forms of therapy have been recommended and the findings have been that therapy that focuses on fixong adhd does more damage.

I think most things involving "fixing" who someone really is has the potential to cause damage.

namazu
11-09-16, 04:07 AM
Therapy can also help in dealing with the ADHD itself more directly by providing:

1. Strategies. Ways to approach tasks and set up your environment that reduce the load on your working memory and impulse control, because medication likely doesn't take care of everything, and there are times when you are unmedicated.

2. Structure and feedback. A set time to reflect on your strategies (and medication!) to assess what's working, what's not working, and how you might try to improve things. Someone to bounce ideas off of. Someone neutral/friendly to be accountable to.

3. Support. With ADHD, there will likely be bumps in the road. Therapy (and/or support groups) can help you feel less alone and know that there are other people with the same struggles and other people who can help you through difficult times.

No, therapy cannot (at least, today) replace medication for those who need medication. But it can help with some things that medication doesn't (which is good, because only a minority of people with ADHD approach full relief with medication, and some of us can't take medication for various reasons), and teach and reinforce positive adaptive behaviors.

---------------------

For what it's worth, lthough I personally take medication, and I feel it has a great deal of value for many people with ADHD that therapy cannot replace, I question your premises.

First, people with cancer and other chronic conditions do often get therapy -- both psychotherapy and other forms of therapy. No, it doesn't cure the cancer, but it helps people cope with their emotions and their limitations, and encourages healthy self-care and other habits that can make a big difference in quality of life. Therapy plays a similar role with ADHD.

Second, even though there are not (yet!) psychotherapeutic options for ADHD that are very effective in reducing core symptoms, I think it's a mistake to assume that psychotherapy could not possibly touch a biological condition. Again -- I don't think you can simply talk or smile or game your way out of ADHD, and you should be wary of people/companies promising that. But learned behaviors/thinking patterns and biological systems do interact. Our brains are somewhat plastic, even as adults. This is why, for example, certain forms of cognitive-behavioral therapy can be very helpful in managing (biologically-based!) anxiety and compulsive behaviors.

Anyway -- I don't think it's wrong to question the value of therapy (or of specific therapies, or of therapy as a replacement for medication), but at the same time, I wouldn't dismiss therapy as worthless just because ADHD is biologically-based.

dvdnvwls
11-09-16, 02:13 PM
My father had cancer in his late 60s. At that time, I saw his calendar and thought "Even for someone with cancer, he goes to a lot of appointments with that one doctor." Years later, I realized it was a therapist. :)

ginniebean
11-09-16, 04:54 PM
"The Invisible Ropes of Adult ADHD, and How a Special Type of Therapy Can Help Set You Free" by J. Russell Ramsay, PhD. (http://www.printfriendly.com/print?source=homepage&url_s=uGGC%25dN%25cS%25cSnqHyGnquqErynGvBAFuvCFmoy BtFCBGmpn%25cScaba%25cSai%25cSvAIvFvoyr-EBCrF-Bs-nqHyG-nquq-nAq-uBJmuGzy)

ToneTone
11-09-16, 07:29 PM
Great question!

Therapy is indeed important for some cancer treatment. My then-girlfriend (and later wife) had breast cancer, and she was treated by an oncological surgeon and a plastic surgeon and so forth ... But she was immediately recommended for counseling and I attended a few of the sessions with her.

The cancer provoked all kinds of negative feelings about herself and her worth. The pending removal of her breasts made her fear for losing a key aspect of her femininity. She absolutely needed therapy to counteract possible depression and self-loathing brought on by the cancer. Your system is stressed to the maximum already with cancer. Her cancer involved a lot of procedures and surgeries. She needed all the support she could get.

So even if the cancer originally "caused" the stress, therapy aims to reign in that stress and minimize it.

You write: It's like I have a biological condition that causes my mind to wander uncontrollably which thereby causes all the problems I have.

Well actually, no one condition causes ALL our problems. You’re not giving yourself enough credit. You are a complicated human being affected by many things beyond your ADHD. I have depression AND ADHD and even those two conditions together don't cause ALL my problems. We are all affected by love and loss and by how much our parents tended to us and how our siblings treated us and by our appearance and how people respond to our appearance and on and on.

The way I look at things, ADHD is so hard and frustrating its own. Therefore, I want to minimize all other problems—both clinical problems like depression and anxiety. But also I want to minimize “normal” stuff like insecurities, feelings of shame, lack of confidence, and even low levels of anxiety and fear and panic.

Or to say this positively, I want to be as psychogically healthy as I can be because coping successfully with ADHD requires a lot of creativity, resilience, patience and forgiveness. A little step such as learning better how to connect with people (something I've learned a lot about in therapy) is huge for my ADHD because I feel a lot less defective.

I don't have science to back this up, but I swear that feeling less defective helps with my ADHD. Maybe it just helps me not get bummed out by times the condition rears its frustrating head. It's impossible for me to think clearly or plan or execute anything if I'm feeling I'm a defective mess.

Tone

dvdnvwls
11-09-16, 11:10 PM
I've been to several therapists, all of them before ADHD was diagnosed. Not one of them ever suspected ADHD or any other neurological interference in what I was trying to do, despite extensive discussion of my history. Along with, obviously, many many long talks with this impulsive and very talkative guy who never got himself together and almost failed school despite being (in a couple of cases) obviously brighter than the therapist was.

Tetrahedra
11-09-16, 11:20 PM
I'm one of the big proponents of therapy because it's changed my life. Therapy isn't going to fix ADHD and make it go away, but it will help you develop strategies to help live with it. You can address the stresses and anxiety that ADHD brings on, and--perhaps most importantly--you receive validation that you have a real condition that causes a significant problem in your life. Therapy can help prevent future problems from coming up, or it can help redirect bad behaviors caused by ADHD into more positive, or at least less damaging, ones.

Good question, though. Thanks for asking it.

Cyllya
11-10-16, 02:13 AM
I'm frustrated with the therapy suggestions too.

I actually DO have co-morbids, but that just made it worse, because a lot of mental health professionals like to blame everything on depression. (I'm pretty sure they wouldn't be able to help with my depression either.)

I tried three different therapists for ADHD help, just because everyone keeps saying it'll be helpful. Nope. Useless. Waste of money. More adverse affects than amphetamine. (There is not much research on adverse effects of psychotherapy, but "there is an emerging consensus that unwanted events should be expected in about 5 to 20% of psychotherapy patients (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4219072/).")

The first therapist I saw basically ended up gaslighting me constantly, despite the best of intentions. (At least, when we weren't getting off topic talking about things that had nothing to do with ADHD--I suspect she listed it as a specialty because she has it herself, heh.) Whenever I described one of the challenges I wanted help with, she'd sometimes offer really banal obvious advice but would sometimes just insist that the problem wasn't real. I suppose she thought I was just being too hard on myself, but I even showed her photos. Having a therapist repeatedly argue against my perception of reality and my assessment of my abilities was honestly really mind-****ing and therefore emotionally disturbing. Fortunately, I was in a good place to get over it pretty fast (I could already do CBT-like practices on myself, my depressive disorder was in remission, I was knowledgeable about ADHD, I did not have a bunch of ADHD-related shame from childhood, etc), but I hate to think of a more vulnerable person being in that situation. There are many folks with ADHD who already have all sorts of issues with their self-perception due to past ADHD-related difficulties, so I think that sort of invalidation would be really bad for them.

The second therapist was useless and kind of dumb. He basically just kept telling me to see someone else more useful than him (a psychiatrist, for med adjustments), but then he got disagreeable when I terminated therapy with him. Weird. This one was on an online therapy service that charged $45 per week, with weekly payments required, so it was quite expensive.

The third therapist was knowledgeable about ADHD, and was able to understand what my problems were (mostly), and she was pleasant to talk to, but she couldn't help either.

So yeah, if someone asks to know what their treatment options are, I'll mention therapy/CBT so they know the option exists, but I'll put it around the same part of the list as neurofeedback training, excess nutritional supplements, and the Feingold program. I won't actually recommend it unless something about that person's description of their situation makes me think they would particularly benefit from therapy.

Therapy for those with adhd is not to help with the adhd but rather the psychological damage done by having adhd. Unfortunately this gets lost in the chatter that very specific forms of therapy have been recommended and the findings have been that therapy that focuses on fixong adhd does more damage.

Eh, several of the studies I've seen involve claims that certain therapies (usually CBT) actually help with ADHD symptoms. The problem with these are...
If you read the study text real carefully, you will find that when they say "symptoms," they are actually referencing a list of behaviors. They are not actually improving symptoms at all, just teaching coping techniques. But since the diagnostic criteria lists behaviors, they consider the behaviors to be symptoms, so they claim they are reducing symptoms.
I've yet to get any new coping techniques out of therapy. :mad: Perhaps this is because I have not gotten the correct sub-type (or sub-sub-type) of therapy, but they don't really let you pick. If there actually are therapists who could impart some mysterious secret super-special coping techniques, how am I supposed to find them or distinguish them from regular therapists who do CBT and list ADHD as a "specialty"?


The folks who learned coping techniques from the therapy seemed to benefit, but I'm not sure they got more benefit than they'd get from perseverating on the ADHD-related sections of the internet for a while.

Therapy for those with adhd is not to help with the adhd but rather the psychological damage done by having adhd. Unfortunately this gets lost in the chatter that very specific forms of therapy have been recommended and the findings have been that therapy that focuses on fixong adhd does more damage.I think most things involving "fixing" who someone really is has the potential to cause damage.
No problems there--I wouldn't consider ADHD to be who I really am any more than I consider my gastrointestinal problems to be who I really am. So I'd be totally cool with treatments that tried to fix ADHD, if they actually succeeded (or had a chance to succeed, or had any benefit at all).

20thcenturyfox
11-10-16, 07:49 PM
While recent medication changes are definitely improving my energy level and ability to persist, in my case the baseline is so low I would still not consider this life worth living if I knew this small recent improvement were all I could ever achieve.

As valuable as it has been to learn something of the biological basis of ADHD, and as much as I recognize the difference medication makes, I don't read these, by themselves, as imposing any particular limitation on my abilities to set goals, apply effort, to initiate, to pay attention, to regulate my emotions, pick up on social cues, or what have you.

What I do see is that the harsh way I have been trying to do it has been needlessly painful, destructive of my own self-respect and wasteful of whatever energy and talents I do have. Along the way I seem to have taught myself habits of retreat and avoidance--both things I never did before. At a minimum these habits and ways of thinking are things I want to change.

However, I think neuroplasticity and mind-body connections hold out some additional possibilities for therapy to help me make changes in the way my brain and parasympathetic nervous system have become accustomed to functioning. I don't see why some anomalies (whether genetic or developmental) in the way my dopamine circuits work should make it "impossible" for me to receive, interpret and act on environmental signals reasonably efficiently and in a way that reasonably leads me toward my goals (which include fitting in reasonably well with other high-achieving NT's). I do realize that I am going to have to approach these challenges differently, break them down into ridiculously small chunks, invent workarounds, and practice, practice, practice (innovation and practice being the way neuroplasticity develops).

Whether I will live long enough to make significant progress toward the life I consider worthwhile, I don't know. But I figure I should take all the help I can get. Including therapy...though finding something geared to ADHD is shaping up to be a quest unto itself.

ToneTone
11-10-16, 09:54 PM
While recent medication changes are definitely improving my energy level and ability to persist, in my case the baseline is so low I would still not consider this life worth living if I knew this small recent improvement were all I could ever achieve.

As valuable as it has been to learn something of the biological basis of ADHD, and as much as I recognize the difference medication makes, I don't read these, by themselves, as imposing any particular limitation on my abilities to set goals, apply effort, to initiate, to pay attention, to regulate my emotions, pick up on social cues, or what have you.

What I do see is that the harsh way I have been trying to do it has been needlessly painful, destructive of my own self-respect and wasteful of whatever energy and talents I do have. Along the way I seem to have taught myself habits of retreat and avoidance--both things I never did before. At a minimum these habits and ways of thinking are things I want to change.

However, I think neuroplasticity and mind-body connections hold out some additional possibilities for therapy to help me make changes in the way my brain and parasympathetic nervous system have become accustomed to functioning. I don't see why some anomalies (whether genetic or developmental) in the way my dopamine circuits work should make it "impossible" for me to receive, interpret and act on environmental signals reasonably efficiently and in a way that reasonably leads me toward my goals (which include fitting in reasonably well with other high-achieving NT's). I do realize that I am going to have to approach these challenges differently, break them down into ridiculously small chunks, invent workarounds, and practice, practice, practice (innovation and practice being the way neuroplasticity develops).

Whether I will live long enough to make significant progress toward the life I consider worthwhile, I don't know. But I figure I should take all the help I can get. Including therapy...though finding something geared to ADHD is shaping up to be a quest unto itself.

WOW! ... Love it ... Man, you nailed it for me with your words about the harsh way you have been working ... and retreat and avoidance ... yes! ... I try so hard ... and then completely back off ... and I'm trying to do a little better each day in small ways .... It's amazing how many times I've undermined my progress by setting ridiculously ambitious goals ... and then feeling bummed out when I wear myself out and don't meet the goals ... and yes, therapy for me is partly all about setting reasonable goals.

Thanks for that!

Tone

20thcenturyfox
11-10-16, 11:46 PM
... therapy for me is partly all about setting reasonable goals....Tone
I'm one of the big proponents of therapy because it's changed my life. Therapy isn't going to fix ADHD and make it go away, but it will help you develop strategies to help live with it. You can address the stresses and anxiety that ADHD brings on, and--perhaps most importantly--you receive validation that you have a real condition that causes a significant problem in your life. Therapy can help prevent future problems from coming up, or it can help redirect bad behaviors caused by ADHD into more positive, or at least less damaging, ones....

What type of therapy have you found most helpful? Which symptoms or behaviours is it having the most success with? Where/how did you find it? What other sources of inspiration/encouragement have you found? Any suggestions to others looking for outside help?

ToneTone
11-11-16, 01:01 AM
Let's see I have had two really good therapists in the past 9 years.

One was a cognitive therapy person ... the other focuses on self-regulation ... and he uses CBT but also mindfulness and meditation and just flat-out brain power.

I didn't know the first person was a cognitive therapy proponent until she blurted it out one day ... Now, I can see it ... Basically, she was focused on the present. She noticed right away my tendency to people please. And we worked on letting that go, so I learning how to say "no" to people.

I see people pleasing and learning how to say no as extremely important because if you have ADHD, it's so important not to squander the limited executive function we have on other people's agendas.

On the flip side, she also spent a lot of time coaching me through how to connect with people, something I thought I knew how to do ... but really I didn't ...She quickly figured out how isolated I was. We practiced even specific language to use when interacting with people-- because the language I used was often off ... I meant to be offering people a compliment and it would come out as criticism ... I wanted to say yes, and I would say no because I thought I "should." ...

I didn't know she was a CBT person utnil one day she just blurted out that that was her method. She didn't advertise herself as a CBT person.

My current guy (the previous therapist didn't take insurance and I needed to find someone cheaper) used to be a hardcore ADHD person who used neurofeedback and biofeedback. But he ultimately concluded that there were a thousand varieties and shades of ADHD so why not just focus on helping individual clients understand their minds and work with their minds, their specific minds that is!

Frankly, I consider my current therapist more of a coach. I bring whatever problem I'm going through that I feel stuck on ... and we work it through ...

In between these two folks, I tried out about 5 or 6 other therapists. Once I had the first person (she was so good!), I couldn't settle for a mediocre person again!

Rather than approach, I would say:

1. A "fit" is really important. Someone you like and who you enjoy talking to and who consistently is helpful--even in the short term.

2. Both of these therapists I liked are off-the-charts smart. That's what jumps out at me ... that they just were so much quicker and sharper and more wise than the other therapists I tried out.

I say go for the best therapist--maybe a combination of comfort and brain power... vs. going for an approach ... And you can't always tell a therapist's approach by their self-descriptions in an ad somewhere.

Go visit a bunch ... it's Ok to therapist shop ... you'll know when you've encountered someone really sharp.

Hope that helps.

Tone

kilted_scotsman
11-11-16, 08:41 AM
On the flip side, she also spent a lot of time coaching me through how to connect with people, something I thought I knew how to do ... but really I didn't ...She quickly figured out how isolated I was. We practiced even specific language to use when interacting with people-- because the language I used was often off ... I meant to be offering people a compliment and it would come out as criticism ... I wanted to say yes, and I would say no because I thought I "should." ...

This is GOLD....... therapy is about relationships, and my experience is tha tADDers have problems with relationships with others, be they peers, parents, lovers, bosses, co-workers .....

If there is one thing that good therapy does it's to delve into relationships and how to be present in them...... retaining one's personal integrity while getting what one needs and giving others what they might need.....with all the asking, bargaining, potency and vulnerability that entails.

It's becoming very clear that our brains continue to grow neurons and connections throughout life, so we can change our brains through our thoughts and deeds. Therapy is an enriched environment for this process.....

acdc01
11-11-16, 09:48 AM
Thanks for all the posts. I liked the example of improving social skills a lot. I guess in theory it can help.

I wish there were better therapists out there though cause I've not known 1 person irl who has had a helpful instead of ineffective, even harmful experience with therapists. Glad at least a few people have had good experiences though obviously some have had very bad.

I wonder what the stats are on success rates of therapy for adhders if there are any. I suspect the odds are that you are much more likely to not be helped by a therapist than you are to be helped by one. Or that money would have been better spent on an adhd coach.I guess the slight chance of being helped is worth trying. But I do think people should definitely try other forms of help if they don't see improvement within a couple months. If something isn't working, switch before too long or you'll continue to suffer for years.

Unmanagable
11-11-16, 09:59 AM
I suffered through quite a few horrific therapists/counselors in my attempts to find help, too, but luckily found two fairly decent ones out of about 6 or 7 I tried.

I wish the process of finding one could be much more user friendly for the patient.

Having to pay the co-pay/office visit for each and every "interview" to find a good fit, and being required to see them at least a few times before knowing for sure, except for the few who are blatantly not suited to be therapists, makes it an even more daunting process to muddle through, especially when the struggle to get through a day is already in the severe range, be it with a single diagnosis of adhd, or a plethora of diagnoses, while trying to figure it all out.

The process itself ends up turning people off and away before they have a chance to find these so called diamonds in the rough.

The struggle of not finding quality care within the services made available through my insurance is what led me to seek help elsewhere, in what most refer to as the "snake oil" arena. Makes me incredibly grateful on one hand, and greatly saddened on the other.

kilted_scotsman
11-11-16, 11:12 AM
Research indicates that the success of therapy is dependant on

1) The quality of the relationship with the counsellor (high effect)
2) The willingness of the client to take risks, show up and "do the work" (high effect)
3) the modality of the counsellor (ie the type of counselling they were trianied in or say they offer) (Low effect)
4) The therapeutic environment.... room, cost etc (Low Effect)

My experience of therapist training in the UK is that it is not good and I suspect that's true elsewhere..... in an attempt to codify and monetise the process much of the original rigour has been lost resulting in far too many people who should be in therapy becoming therapists instead.

As with Unmanageable I've gone through several therapists..... 7 in total now, the first 3 were dire. Like Unmanageable I have also entered the "snake oil"/alternative arena and found it both exasperating and rewarding in equal measure.

All bar one short period of counselling has been private.


In the UK........
It is REALLY IMPORTANT to realise a counsellor or psychotherapist is usually NOT QUALIFIED to diagnose and SHOULD NOT put diagnoses into the clients mind.... once in there they are VERY difficult to dislodge. If the client raises the possibility of a diagnosis the therapist can discuss the implications of seeking a diagnosis and support the client through the process but should NOT offer any comment about the validity of a diagnosis.

I don't know what the situation is in the rest of the world but I would suspect it's similar, though UK training is increasingly blurring the edges as counsellors and psychotherapists use DSM diagnoses as shorthand for symptom clusters.

Bluechoo
11-11-16, 11:28 AM
I was skeptical of therapy for a long time, then I found out what it's really all about, and how normal it is for even normal people to benefit from it...

My most recent brush with therapy was with an online cognitive behavioral therapy tutorial. Even for a dumb online thing, it seemed to have some profound impact on my thinking. It is definitely a huge benefit for anyone who wants to actively turn their negative thinking around and come up with more positive, constructive ideas. I see CBT as a more 'in-the-moment' remedy. It has nothing to do with the past or how a parent screwed us up, but it focuses on exactly what you are experiencing now and shows you some tools you can use to alter it.

That is fascinating to me, regardless of ADHD.

ginniebean
11-11-16, 12:48 PM
I have over a long period of time seen many therapists. My main problem has been disbelief or minimization of adhd and the trendy pseudo sciency crap that for me has become a red flag for "I don't know wtf I'm doing". I have had positive experiences with therapists but it's been rare.

20thcenturyfox
11-11-16, 06:48 PM
Research indicates that the success of therapy is dependant on

1) The quality of the relationship with the counsellor (high effect)
2) The willingness of the client to take risks, show up and "do the work" (high effect)
3) the modality of the counsellor (ie the type of counselling they were trianied in or say they offer) (Low effect)
4) The therapeutic environment.... room, cost etc (Low Effect).

This focus on the quality of the therapist and the relationship is not something I found at all when I went looking on the current state of research into effective treatments for ADHD. And because it's still early days for ADHD, I had the impression that the volume of work in this area is decidedly thin. I also had the impression, that because everyone worldwide seems to publish in English, that I was getting more or less a global search universe. But now you have me wondering....what are we missing when we Google away?

The research Google.com serves up in North America appears to be worldwide but maybe isn't. For example we get the NICE report from the UK, and the European Consensus on Adult ADHD, both citing Safren SA: Cognitive-behavioral approaches to ADHD treatment in adulthood, as the sole randomized control trial (J Clin Psychiatry. 2006, 67 (Suppl 8): 46-50), and the latter citing Young & Amarasinghe: Non-phamacological Treatments for ADHD: a Lifespan Approach. J Child Psych&Psych, 2010, 1- 2:116-133. available free here: http://www.airipa.it/wp-content/uploads/2013/04/TratADHD010.pdf Purporting to cover the entire slender research literature on pp125-126, there is mention of CBT for ADHD as being evidence based, skills training based on DBT as being promising. CBT is described as being "highly structured" but there is no mention here of leader or relationship quality. Even in the next section on ADHD coaching, which being one-on-one must depend heavily on the therapist and the relationship, all the author's say is "Coaching is a derivative of cognitive behavioural paradigms (e.g., Brief Solution Focused Therapy) involving the development of a collaborative mentoring partnership which draws on an individual’s personal strengths and aims to provide structure, support and feedback. However, there is no standard methodology and the process of delivery varies considerably, including face-to-face contact, brief regular telephone conversations and/or email contact."

Although there are a growing number of published studies, particularly in Europe based on DBT, I've found only a few for which the full text was available at no charge, though they seem consistent with the key items cited in the UK and European consensus statements.

1. Knouse, et al, 2008, Recent developments in psychosocial treatments for adult ADHD https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2628311/

2. Safren's 2010 report Current Status of CBT of Adult ADHD https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909688/

3. Hirvikovski Reduced ADHD symptoms in adults with ADHD after structured skills training group: Results from a randomized controlled trial, 2011 Behavior Research and Therapy, https://www.researchgate.net/profile/Tatja_Hirvikoski/publication/49812090_Reduced_ADHD_symptoms_in_adults_with_ADHD _after_structured_skills_training_group_results_fr om_a_randomized_controlled_trial/links/00b4952c0a052eeeff000000.pdf

4. Young & Khondoker's CBT in medication-treated adults with ADHD and comorbidities, 2015 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4595859/

Unless I missed it, these all treat the behavioral methodologies as being virtually "out of the box" with no comment at all on leader differences and group interactions treated as invariably positive. I admit I took this as reflecting the more mechanical measurable behavioral paradigm (in contrast to traditional psychoanalysis where leader and relationship quality was always central). So it comes as a surprise that someone in the UK would be finding research pointing toward a completely different measure of success, though it sounds like it resonates with the very spotty experiences people here are reporting. If you do have links to research along completely different lines, I'm sure we'd appreciate your sending it along.

ToneTone
11-11-16, 10:08 PM
I don't see therapy as a first-order treatment for ADHD.

I see therapy as a treatment for the second-hand damage caused by ADHD: the hopelessness, lack of confidence, fear of failing again, a history of forgetting, history of failing to complete tasks and on and on. I see therapy as trying to contain, limit and reverse this damage.

And this is just me here ... treating that second-order damage is what allows me to experiment with new coping patterns, compensatory mechanisms and work-arounds to minimize the impact of the ADHD.

A personal example is that these days I am quicker than ever at recognizing when a task will overtax my executive function. I mean I call it out quickly! I have no resistance to saying "doing X will wear me out." So what I am learning to do is to look for a friend to help me think through the task. Heck, someties I ask them plan out the task for it. Consulting others like this is something I learned in therapy ... now I am comfortable consulting others with little shame or embarrassment.

So my work-around is to tap other people's planning and executive function skills as much as possible. But I couldn't use that work-around if I was demoralized.

On the patient-therapist relationship, no tharapeutic approach implements itself. So I see it as a sensible goal to find a therapist you connect with ... and if you're interested in a particular approach, find a therapist with that approach that you feel a fit with. All else equal--I'd bet the house that people grow more and change more with the therapist they really connect with than with one they don't. Heck, when I don't like the therapist, I don't want to go to sessions--let alone work between sessions on what we discussed the last time. To really grow I have to trust the therapist and share the most awkward and painful stuff ...

Some of the studies with CBT in the headline are written as if there is such a thing as a generic therapist who follows some standard, preditable method. Wrong-- it's the therapist who skillfully wields the method. And this very human and specific therapist has to approach the shy person differently than the outgoing person, the person with trauma different from the person without trauma, the person who seems uncomfortable and frightened differently than the person who seems relaxed and comfortable and on and on ...

Hope that clarifies a bit.

Tone

kilted_scotsman
11-12-16, 09:13 AM
Tone's post is spot on.....

There is a significant difference between psychiatrists and psychotherapists...... psychiatrists work with labels and approach the brain as a machine, psychotherapists see the person as a whole, with labels as a vague attempt to pin the tail on a donkey, without knowing if it's a donkey or an elephant.

DSM orientated psychiatry aims at having a standard response to a checklist of symptoms, with one psych coming to the same set of labels and treatments as another... the psych is an interchangeable cog in the medical machine.

Psychotherapists on the other hand are personal, and look at each client as a unique individual. The therapy co-created in the relationship is unique to that relationship. Therapists are not interchangeable.

This is why research showing therapy type "A" is a treatment for ADHD misses the point. Statistically it's almost impossible to control for relationship plus the studies usually are between CBT and no treatment at all. If the research used differnt modalities they would quickly find the research was showing the modality wasn't as statistically important as the therapist....which makes it tough when writing a job spec!

This is why finding the type of research I mentioned on a ADHD population is not available. The assumption is that the meta-analyses and sample sizes don't split out different diagnoses as psychotherapy tends not to put as much faith in the label as psychiatrists do, plus there are likely to be undiagnosed people in the samples.

For factors in therapy, Orlinsky & Howard look at one to one therapy and Yalom, Leibermann & Miles is the classic for Groups. I think the main Orlinsky & Howard is difficult to find as it was an article in a book, while the Yalom is on the net.

THere was an interesting TV program about this which put a whole bunch of people with different diagnoses, and a few NT's in a house, gave them tasks and then asked a group of psychs spot which person had which diagnosis. The psych's found this hard, often didn't agree, missed diagnoses, thought the NT's had diagnoses.... the whole range of errors was there. https://www.theguardian.com/society/joepublic/2008/nov/19/how-mad-are-you-mental-health

20thcenturyfox
11-12-16, 01:22 PM
I was skeptical of therapy for a long time, then I found out what it's really all about, and how normal it is for even normal people to benefit from it...

My most recent brush with therapy was with an online cognitive behavioral therapy tutorial. Even for a dumb online thing, it seemed to have some profound impact on my thinking. It is definitely a huge benefit for anyone who wants to actively turn their negative thinking around and come up with more positive, constructive ideas. I see CBT as a more 'in-the-moment' remedy. It has nothing to do with the past or how a parent screwed us up, but it focuses on exactly what you are experiencing now and shows you some tools you can use to alter it.

That is fascinating to me, regardless of ADHD.

Was this a tutorial that would be available to any of us?

Tetrahedra
11-12-16, 11:30 PM
What type of therapy have you found most helpful? Which symptoms or behaviours is it having the most success with? Where/how did you find it? What other sources of inspiration/encouragement have you found? Any suggestions to others looking for outside help?

I fell behind in the conversation a bit, so I'm going to backtrack to answer this.

I don't know the name of the therapy. Maybe it's CBT. My therapist has been helping me advocate for myself and set boundaries. I agree with whoever said that much of therapy revolves around relationships, and when you have significant social impairments, you really struggle with relationships. I have the fault of being too literal and too accepting, so he has been working with me to stand up for myself, choose my words more carefully, and know what battles to fight.

ToneTone
11-13-16, 12:47 AM
Great explanation Kilted. So interesting that you note that psychologists approach the person as a whole. Totally fits my experience. My current guy used to focus on ADHD; now he just sees ADHD as on a continuum of human brain patterns and not at at all a full description of a human being.

Tetrahedra, that does sound like CBT ... You're updating and revising your thinking, seeing new ways you can behave that you probably didn't see before ... I did a lot of work on boundaries as well. Not being able to set good boundaries is exhausting and demoralizing. Keep working on that one ... The payoff in being able to stand up for yourself is HUGE.

It's especially cool to hear that you are fine-tuning how to do all this. That's great work.

Tone

dvdnvwls
11-13-16, 01:21 AM
... And because it's still early days for ADHD, ...
"Early days"??? ADHD has been recognized (under different names) for decades.

aeon
11-13-16, 04:55 AM
"Early days"??? ADHD has been recognized (under different names) for decades.

Centuries, actually. ;)


Cheers,
Ian

Cyllya
11-13-16, 04:53 PM
There is a significant difference between psychiatrists and psychotherapists...... psychiatrists work with labels and approach the brain as a machine, psychotherapists see the person as a whole, with labels as a vague attempt to pin the tail on a donkey, without knowing if it's a donkey or an elephant.

DSM orientated psychiatry aims at having a standard response to a checklist of symptoms, with one psych coming to the same set of labels and treatments as another... the psych is an interchangeable cog in the medical machine.

Psychotherapists on the other hand are personal, and look at each client as a unique individual. The therapy co-created in the relationship is unique to that relationship. Therapists are not interchangeable.

Mmm, I have heard a few people complain because they went to a psychiatrist expecting psychotherapy and they got something other than psychotherapy. (Seems like an easy mistake to make.) But just because you're going to someone who actually does psychotherapy doesn't mean you're going to get good psychotherapy.

With my last therapist (the one that seemed smart, knowledgeable, and enjoyable to talk to), I expressed that I felt therapy wasn't helping. She agreed and said therapy doesn't normally help for those conditions that are more biological in nature. That kind of surprised me because, aren't all (or at least most) mental health problems biological conditions? Especially mood disorders? Doesn't therapy normally treat depression? So I described my experience with depression and how I knew it was a biological problem. And, I kid you not, she looked surprised. Apparently, the fact that depression was a biological health problem had never even been suggested to her before! Keep in mind, this was the best therapist I've had... so this makes me wonder just how many therapists have this huge blind spot in their understanding of the situation.

I guess it's kind of like, if your brain were a car, psychiatrists would be auto mechanics and therapists would be driving instructors. Except the mechanics are limited in how much they can fix the car, so the instructors are stuck trying to teach you to drive a broken car, but half of them don't realize the car can be broken or that it matters, and most of the rest get confused about how it's broken....

I don't see therapy as a first-order treatment for ADHD.

I see therapy as a treatment for the second-hand damage caused by ADHD: the hopelessness, lack of confidence, fear of failing again, a history of forgetting, history of failing to complete tasks and on and on. I see therapy as trying to contain, limit and reverse this damage.

Yeah, I think that's why I cringe at therapy being a blanket for-everyone recommendation.

Even though ADHD is defined by and diagnosed based on symptoms, those of us diagnosed with ADHD still have huge variation in which ADHD symptoms we have or the direct implications of those symptoms. So when you take a step back and look at the "second-hand damage" instead of the direct symptoms, there's going to be at least as much variation between people, if not more. And therapy seems to help with some things better than others....

... And because it's still early days for ADHD, ...
"Early days"??? ADHD has been recognized (under different names) for decades.
Centuries, actually. ;)
Yeah, but that's still pretty "early" in the grand scheme of things. This kind of research on ADHD seems to have started so much more recently compared to research on many other conditions, even other psychiatric conditions like depression. The fact that ADHD used to go by other names reflects a major change in understanding of the condition. (I don't like the current name either.)

acdc01
11-13-16, 05:23 PM
Yeah, I think that's why I cringe at therapy being a blanket for-everyone recommendation.

Even though ADHD is defined by and diagnosed based on symptoms, those of us diagnosed with ADHD still have huge variation in which ADHD symptoms we have or the direct implications of those symptoms. So when you take a step back and look at the "second-hand damage" instead of the direct symptoms, there's going to be at least as much variation between people, if not more. And therapy seems to help with some things better than others....


What Tonetone said about therapy not treating direct symptoms, only second hand damage is exactly what I was trying to say in my original post. So you and I share the exact same sentiment. That said, I'm not as against therapy in theory any more because let's face it, life will mess people up to the point where second hand damage occurs in everyone, not just adders so therapy could in theory help everyone.

But in practice, most therapists really seem clueless. I'd bet a lot of them wouldn't even understand how you can't treat direct symptoms of adhd and will keep trying to do so.

Posts here seem to support the idea that youre much more likely to get a useless or even harmful therapist than a helpful one. Guess it might be worth kissing a bunch of frogs to find a prince, but Us adhders really need to be on the alert not to mistake frogs for princes.

Tetrahedra
11-13-16, 11:38 PM
But in practice, most therapists really seem clueless.

Clueless in everything or just ADHD?

dvdnvwls
11-14-16, 01:29 AM
Far too many therapists are clueless in all areas except the one little aspect of life that they were forced by their own circumstances to become familiar with. They go through a horrible experience, come out of it with one single precious piece of information that they wish they had had years earlier, and conclude that this little piece of information is how they will save everyone in the world from all their difficulties. Then they go to school, learn a few things, forget the things they learned, and go out into the world again with a fancy looking diploma - and just that one original solitary bit of one-size-fits-all "therapy" to dole out to every person who comes through the door.

kilted_scotsman
11-14-16, 06:43 AM
Having experienced a range of psychotherapy training here in the UK I would agree that far too many therapists exit training with a Diploma, still living behind their own anxieties and defences. In that I agree with dvdnvwls.

In addition the rapid advances in neuroscience haven't made it into psychotherapy as many therapists and counsellors aren't scientifically or technically minded. This is sad because big chunks of therapy are being validated by neuroscience. (See Louis Cozolino's The Neuroscience of Psychotherapy etc).

Cozolino writes that successful therapy has 4 essentials
1) A safe and trusting relationship (with the therapist or therapy group)
2) Mild stress (he calls this "optimal arousal")
3) Activation of both emotion AND cognition......
4) Co-creation of new narrative.

This backs up what the founders of several branches of psychotherapy found through acute observation.

What I find interesting is that the old style psychotherapists were eclectic, they borrowed extensively from others and believed it was essential to pursue their own personal growth process in order to help others do so. Losing this latter part means that some people are going through training never having experienced therapy or been challenged about their beliefs, which is having a corrosive effect on the profession. In trying to be a profession they are losing that which made them effective professionals.

The old style therapists experimented hugely, doing things that challenged themselves and those around them, they were often activists, took all sorts of hallucinogenic materials, experimented with relationships and did things that would get them thrown out of modern counselling classes. (eg Gabrielle Roth's description of meeting Fritz Perls at Esalen in her book "Maps to Ecstasy")

Though I advocate therapy as part of a process of living with ADHD/ASD my own experience is that trainee counsellors and therapists (and their trainers) have been the people LEAST likely to explore what that might mean for me and others like me.

When I look for a therapist I am looking for someone who has done some living, experimented a bit and has a good chunk of bodywork under their belt. Unfortunately such people are rare and often marginalised or ostracised by their younger peers. The qualification they have and their accreditation are secondary.

acdc01
11-14-16, 10:38 AM
Clueless in everything or just ADHD?

I mean everything, including adhd. I'm sounding more negative than I intend to. I don't want to scare someone away who really feels they need to try therapy though they really should set a deadline for assessing whether their therapy is working or not.

Tetrahedra
11-14-16, 12:41 PM
While I do still think this is a good topic and I like reading everyone's replies, I am really worried that someone's going to read this and then decide that they don't want therapy.

I don't know much about comparing old school therapists to modern ones, so I can't comment much on that, nor do I know enough therapists to understand how much knowledge any of them have. I will say that I had to go through a handful of therapists before I found one that worked well for me, and I quite enjoy my time in therapy because he's really good at what he does. He's not perfect, and there are some things he doesn't know about, which is reasonable for any person not to know everything. I refuse to speak in sweeping generalizations that everyone in an entire profession is messed up because it's not a fair or accurate assessment. It's like lawyers: everyone makes fun of them and calls them corrupt, but there are some very intelligent, compassionate lawyers out there.

acdc01
11-15-16, 10:38 PM
While I do still think this is a good topic and I like reading everyone's replies, I am really worried that someone's going to read this and then decide that they don't want therapy.

Yeah, I can see your point. People shouldn't forget there have been positive comments too. In my mind, therapy might still be worth trying for secondary damage like poor self esteem, poor social skills, etc. But you may have to go through several therapists before you find a good one.

In a way, I find it encouraging to know that beforehand. That way expectations are lowered and if I ended up getting a bad therapist, I wouldn't be devestated and know to just try another one.

sarahsweets
11-16-16, 05:37 AM
Speaking as someone who spent like 16 years or so in therapy- I found it helpful in dealing with trauma and learning to be a grown up with kids and responsibilities when I was in my 20's. I reached a ceiling though where there was just not much more progress to be made and it was more like shooting the sh*t with my therapist so I had to "break" up with the therapist.