Hi,

I've got a follow-up wiht the neurologist at the end of the month and since I had already mentioned to him that coaching did not work out for me, I guess we'll discuss this. I'm just curious as to what others do with coaching, and how it's SUPPOSED to work, as I felt quite cheated by what I got for my money.

I have AS and some ADHD-like organisational and concentration issues, the lady I had coaching with specialises in ADHD but says she had experience with AS as well.
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Organising Sessions:

I first got in touch via E-Mail and sent her a lot of info and already there were problems as she frequently failed to respond (although some of that was due to problems with the office of the neurologist who referred me, as they had not forwarded my details etc.) and also had weird working times - She only works until 4pm so most people who work just can't do coaching with her!

Thankfully I have Friday afternoons off so I could book some sessions then but already even though I had mentioned so often that I can ONLY get home before 4 on Fridays, she kept suggesting we talk on other days or kept cancelling possible appointments, saying "Oh but I am free on Monday" (well HELLO how many times do I have to explain this - I work until 4:30 Monday to Thursday!).

Once she had all my info we did an assessment over the phone, although she did not seem to ask me anything that she had not already been told several times, both by me and by the neurologist and psychiatrist who diagnosed me. She also seemed to think that all people with AS only have problems with focussing on details (and being slow because they do everything perfectly) and that I couldn't have that because I have some severe executive functioning problems.

The first big problem was that I had to tell her spontaneously "These are the things I struggle with" (concretely, exact descriptions of what goes wrong or what I specifically want to do), even though both myself and my psychiatrist had explained to her before that I have a BIG problem in spotting these problems and formulating the details of what specifically I struggle with or where I go wrong.

On her website it says one of the goals of coaching is working out your strengths and weaknesses - I hadn't expected this would simply consist of me telling her exactly what these were!
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The Sessions:

We did the sessions via ICQ because I have trouble retaining information from phone calls (I can waffle on but often don't even remember what I talked about), and while I admit some of the problems may have been due to her not being used to this medium, I still found these sessions very tedious and felt like I was just paying OTT (£40+ for 45 minutes) for being put through some cookie-cutter programme that had little to do with where things really went wrong for me or what I struggle with.

To start with, a lot of it was just stuff like writing down some sentences to motivate myself with - reminding myself of what I want and how fantastic it would be if I was successful etc. is all good and nice, but attempting to visualise my success (which is something I simply can't do - I struggle to even visualise everyday things that happen fairly regularly, let alone situations I have never encountered before!) really had no influence on my practical ability or inability to keep things in mind, remember and visualise tasks, keep track of things and find out why some things never seem to work!

In addition, I had spent so much of my life beating myself up trying to be something or someone I'm not, the LAST thing I needed was to remind myself several times a day of how I can't seem to do the things that come natural to others!
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My way of working with the material:

I *did* end up writing a lot about how I felt things went wrong, and where I realised I needed help (I had to write this in my spare time, taking up about 5 hours of my time that I normally spend on chores or relaxing after work), but instead of reading them and working on those points with me, the coach not only denied ever having received them (although she responded to the Email I sent them with!) and I had to spend much of the next session trying to recollect what I had written and convince her that I HAD done my homework, but she then just left it at that even though I had repeatedly asked if we could now tackle these issues and work out some practical implications!

She generally did not seem to take any notice of the info she already had, so much time was spent with me having to explain basic things over and over again, like what meds I was on, what was working and wasn't working etc. (she gave some useless advice that ANYONE who is familiar with the medication situation in the UK and the strict rules should know is not feasible!). When I complained about this she said that "repetition is important for the learning process" - ha ha, yes it would be if we were actually discussing something that *I* have to learn to understand! But no I had to repeat things for her because she seemingly didn't even bother checking her notes before each session!

She made me feel almost silly for wanting to keep organised - where I grew up it is not OK for people to throw rubbish everywhere, get into loads of debt, not get a job for years after leaving education (in spite of abilities and opportunities etc.) and so on and she made it look like I was totally anal for wanting to do things like vac under the bed (my partner and I have allergies and this is a task I want to do every few months but just can't get round to because I am so overwhelmed with everything else). I really was NOT talking about wanting things to be perfectionistic squeaky-clean and rigidly organised, just wanting some help to allow myself more efficient and less stressful ways of keeping things in check.

Even though I had tried to explain to her some of the problems I have, she just had this preconceived idea that I wanted to do everything perfectly (which is NOT the case, while I need order most things are chaotic and quite messy in our house and always have been) and tha tI just had to lighten up.

For example I have a problem with not being able to register gradual changes like things getting dustier or gaining weight slowly etc. and then being shocked half a year later ebcause *suddenly* everything is dirty - so I have to consciously check these things or do some cleaning routinely even if I can't tell it's dirty. Also if I skip some small thing one week (like watering the plants) then they're almost like they were never there on my to do list afterwards and I can hardly get back to remembering them as part of the weekly routine, let alone visualise myself doing them. These are both things I had realised in the past few years and although it's great that I know this, I have no idea where to start to actually COMBAT these mechanisms! And even though I had tried to explain them to her, she almost seemed to be blanking them out and before I'd finished typing or talking she'd be back to telling me use affirmative sentences or "think positive".

I tried in vain for decades to get relaxation techniques and autosuggestion to work for me and it just doesn't cut it, she knew this before we started but still she kept riding on and on about that stuff, cutting off any of my attempts to shed lights on these mechanisms or ask for help with practical implications :(
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Did it help:

Because the sessions and the writing I did (in vain as it was not read or integrated into the following sessions) took up so much time (I was very exhausted after the sessions on Friday, and either had to do some thinking or researching to try and understand what we just went through, or had to rush off into town because Friday is the only day I get to do certain things (like going to the bank etc.), I also fell behind drastically on all other chores so that when the 3 sessions ended (I paid for 4 but the last was just her recapping things on the phone for me) I was too overwhelmed to put most of the few practical things she had worked out with me (get a cleaner, shop online, start a hobby) into practice!

On the positive side yes it kick-started some thought processes (although with me this is usually delayed and can take up to a month to christallise and fo rme to be able to consciously analyse things and start tackling them) and I did start shopping online and am considering a cleaner (althugh my partner is embarrassed at the thought, and I can't really afford it).
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What I *really* want:

But what I really need is someone who can go over the mechanisms of how things go wrong, and work out PRACTICAL solutions that apply not only to MY SPECIFIC problems and abilities but also to MY SITUATION.

So how IS coaching supposed to work, and what other services can provide a more PRACTICAL approach, for example coming to my house, allowing me to show them how I work and what I do, and working out a practical solution together after analysing my mechanisms and where I do things right or wrong?

Maybe you need a therapist to examine things more indepth aboout how your mind works and the mental blocks and strengths and weaknesses. It's got to be someone who knows ADD though or they will blame all your problems on emotional issues. That's important too but it doesn't work if you don't agree with their opinion. Shrinks will try to be tactful with me & say yeah yeah you've got some ADD but what we really need to work on is your hidden feelings... sigh... But shrinks do know a lot and coaches are not shrinks.

I tried coaching for a while & it involved mostly making a task list and helping me work out which should be the priority next. THat was really helpful. The other part was checking on my progress in actually doing those tasks and adjusting the list as needed. This worked great when I was on a big deadline & needed to get a bunch of things done but then I started slacking & it felt like there was no point in calling to discuss what I still hadn't done.

"Shrinks will try to be tactful with me & say yeah yeah you've got some ADD but what we really need to work on is your hidden feelings... sigh... But shrinks do know a lot and coaches are not shrinks."

You see that's the impression I got from that coach - that she seemed to think it was all just emotional blocks etc. and ignored any of the documented processing etc. issues that I *do* have.

I really am a very coscientious and motivated person - I was always the kind of kid who'd HAVE to finish the homework tasks that nobody else bothered with (unless I forgot them, and even then I used to do them in the break before the lesson if someone reminded me!) even if I had to do them late at night.

I was also always the kind of kid who, when a lesson was cancelled or the teacher didn't turn up, would quietly become absorbed in exercises or homework tasks for whatever subject we were in at the time, while the rest of the class ran rampage around me - most of the time I genuinely didn't even register what they were up to, I was too absorbed in the work! (Admittedly I only did this because I dodn't know what else to do, and I must admit I spent a lot of my school years daydreaming and fantasizing about my interests, or secretly reading books under the desk etc.)

So I KNOW I am not trying to shun responsibility etc. and while I am conscientious, I also am by no means worried about doing everything 100 right.

I'm a "perfectionist" at heart in that I have a high need for order and structure/predictability, but anyone who's ever lived with me or seen the state of my school and work materials will be able to tell you that "neat", "clean" or "tidy" are not the way to describe my environment (although I DO TRY to keep things neat and tidy - I am usually the only one who uses folders and other stationery equipment, yet my worksheets etc. are always filthy, torn, crumpled etc! My manager at work is always astounded by the disintegration of my holiday sheet, even though I carefully keep it in a separate plastic folder unlike everyone else who just keeps it in their desks :confused: )

I wasn't aware that therapists would do that kind of more practical stuff with you - I will certainly ask the neurologist so he may advise my GP for a referral.

Unfortunately there are not really any therapists and even fewer psychologists near here that know anything about autism spectrum disorders (the nearest is 1 hour from here and outside of my local health authority, so not covered by the local health service), and adult ADHD is practically unheard of in the UK and bar the very few private and even fewer NHS specialists (mainly neurologists and psychiatrists) there's hardly anyone in the medical field who even believes that adults can have ADHD!

I will try to E-Mail the nearest therapists (got a short list from the national autistic society) and see what their rates are like. The most experienced is Digby Tantam's service but that's 1 1/2 hours away and would most likely involve another full assessment which I really can't afford.

"I tried coaching for a while & it involved mostly making a task list and helping me work out which should be the priority next. THat was really helpful. The other part was checking on my progress in actually doing those tasks and adjusting the list as needed."

That's more the kind of thing I thought coaching would be, i.e. look at the things you want or need to do, possibly help work out what exactly they are, and find ways together on how to get there etc.

You might ask therapists what they think about cognitive behavioral therapy CBT. That's a more commonsense style, not overly freudian.

one guy i had to see to get my ritalin was like "so how do you get through every day life" like i was a freak or something... oh well .. no longer have to see that guy!

one guy i had to see to get my ritalin was like "so how do you get through every day life" like i was a freak or something... oh well .. no longer have to see that guy!
Well for me I have to say that question wouldn't freak me out so much... I find it hard...

It's amazing what difference the Ritalin script makes - the staff at the pharmacy are suddenly really kind, talk slowly, write down what they are explaining.

Hi,

I've got a follow-up wiht the neurologist at the end of the month and since I had already mentioned to him that coaching did not work out for me, I guess we'll discuss this. I'm just curious as to what others do with coaching, and how it's SUPPOSED to work, as I felt quite cheated by what I got for my money.
You've give an accurate and conscientious depiction of what you are dealing with, and that makes it easier to answer.

The major problem that exists here--and everywhere--is that the quality of ADHD is so subtle and so difficult to connect with the consequences. Another problem is that many coaches and most Psychiatrists and Neurologists do not have ADHD; and while this has a clear advantage, it imposes a few limitations.

The bottom line is that the whole field of ADD recognition and treatment and research is still in its infancy. Nobody is trained "well enough" to be knowledgeable in all of the aspects of this diverse disorder we call ADHD, to say nothing of the contributing factors of other commonly associated allied disorders. These really complicate diagnosis and appropriate treatment.

You have done a masterful job of defining the details of your problem. I have been involved in the field, both as physician, and as patient. Here's what I think is the best simple answer:

Find a physician--usually either a general practitioner who deals exclusively with ADHD and allied disorders, or locate a Psychiatrist or Neurologist who does the same. I say this for a very important reason:

Very very few professionals, however well-intended, understand fully the nature of the awesome responsibility of patient care--unless, they have practiced in a field where they--literally--have patients' lives in their hands.

There's something extremely sobering about this responsibility that forces a clinician to be extremely serious in being honest with him- or herself with respect to what they really know, really and reallly understand, including the consequences befalling the trusting patient.

It therefore comes as no surprise to discover that many non-physician practitioners have little in-depth understanding of patient care, whereas Nurse Practitioners, having practiced as nurses with this responsibility and have been so close to physicians also with this responsibility--tend to make better clinicians, even though they are not physicians.

In examing your very clear description of your coach, it was very clear to me that your coach had never had the responsibilities of a physician, nor had enough information regarding the various presentations of ADHD and the responses to treatment, chemical and other.

This is not an indictment of anyone. Your coach should of necessity work hand in hand with your physician; otherwise, they cannot possibly know enough to be an adjuvant to treatment.

Ask your doctor about coaching and ask specifically for recommendations or referrals to individuals they respect in the field.

You should not have to go through these contortions to get adequate help. The rule of thumb is the same one that applies in all relationships: If you are truly conscientious and still are not comfortable, simply move on, until you are secure. Do not accept the subtle guilt that accompanies this disorder.