Posted by: counselorcarmella | August 24, 2011

Counseling People With ADD


One major task of  counseling someone with ADD is psychoeducation.  Encourage patients to learn about  ADD.  Knowledge is power.

 Individual counseling can help with the self esteem issues, maladaptive coping strategies,  grief, and negative self talk experienced by those who have been living with undiagnosed ADD.  Counseling may need to be a little more structured when  working with someone with ADD.

Sometimes, after the initial relief and excitement about  having a name for what they’re dealing with and options for treatment, someone with ADD will become discouraged because  the magic pill didn’t  make all their ADD related  problems go away.  They’ll still need  to put  effort into  things like  staying organized, managing their time, and  using social skills. 


Some people go through the experience of grieving  the life they think they could have had, how things could have been different, if they’d been diagnosed when they were younger.  A counselor can help   their client work through that process to come to a place of acceptance. Narrative therapy may help these clients rewrite their story  to focus on  what they’ve accomplished despite living with   an undiagnosed condition that made a lot of things harder for them. A counselor can help  a client with ADD begin looking towards the future and  the opportunities they may be able to  pursue now that they are receiving treatment. Clients might want to return to school or pursue a different career and involving a career  counselor may be helpful  so they  can assess their strengths and interests. A good counselor is going to help the client  see the strengths that come from having ADD. These can include creativity, spontaneity, and a tendency to think outside the box.    


Several CBT (cognitive behavioral therapies) programs have been  developed for  adults with ADD. Solution focused counseling can help with specific strategies for organization and time management. Some clients will need a structured anger management program due to  past and ongoing difficulties with anger.


Marital or family therapy may be  helpful in addressing relationship problems related to ADD. A lot of negative feelings can  be built up over time in families where ADD is present.  Everyone in the family needs to be educated about  ADD and   work needs to be done on learning to communicate better and heal some of the damage caused by ADD. Sometimes,  family members are angry and feel that the person with ADD has been given an excuse for bad behavior.  They are skeptical about the diagnosis. Sometimes, an adult with ADD is still being supported too much by  his/her parents. Or, the spouse can be functioning more like a parent.   Codependency can become an issue in ADD couples where you have  an over functioning  non ADD spouse and an under functioning ADD spouse.   The non ADD spouse will often say they feel like they’re more of a parent than a partner so we help  them  get into the role of support and encouragement and out of the role of caretaker. Co dependency is also a problem due to the high  rates of  substance abuse issues among those with ADD.  


Group counseling can help the  adult with ADD to gain support from others living with the condition and to practice social skills. Support groups serve a similar function. Some people make use of on line support groups and  virtual communities.  Some people are also going to need  a 12 step program like  AA or NA due to the substance abuse history.


While not true therapy, another psychosocial approach is called ADHD coaching. Coaches are not necessarily trained to help you cope with the emotional impact of living with adult ADHD, like a therapist is. But coaching can help you deal with the problems ADHD causes. The focus tends to be very specific, zeroing in on effective time management and organization.



  1. Excellent article!

    As a certified coaching pioneer, co-founder of the ADD Coaching field and the developer of the world’s first ADD-specific coach training curriculum from which many of the others evolved through my graduates, I want to tweak the last paragraph a bit for your readers. (BTW- I don’t use the “H” unless I want to refer specifically to ADD with gross motor hyperactivity, even though, as you know, ADHD is the “official” name of the disorder in the current DSM).

    Below — “therapy” is used to refer to the entire spectrum of therapeutic relationships (counseling through analysis).
    ADD Coaching is not only NOT “true therapy” as you say above, it is not therapy AT ALL. As I’m sure you know (but your readers may not), therapists are licensed, and to practice therapy without a license is not only an ethics violation in the coaching arena, it is illegal!

    Both ADD coaching and therapy with an ADD-aware therapist can help an ADDer deal with putting life together following an ADD diagnosis (and not every coach – or therapist – has the background and training necessary to do so, so make sure you check that part out before you hire either!)

    Either one can help you learn about ADD and either one can help you learn about and track your meds, which either a doctor or a therapist (depending on license) will prescribe and titrate (tweak). Either one can help you learn about YOU — but your therapist will work “on the inside” while your coach will help you put your external world together to reflect your inner work.

    Both will help you heal and move forward with hope and ambition, but only one – therapy – will help you process your emotions directly, and only one – therapy – works with ADDers who are struggling to overcome addictions (perhaps put in place initially as self-medication before diagnosis, but this is an arena in which ADD Coaches are careful to refer to therapists.)

    An ADD coach can help ADDers replace bad thinking habits, but not until they are at the place where they are no longer “hooked” by their “old tapes” – to use self-help jargon.

    That’s generally work done in therapy – going it alone is doing it the slow, hard, unnecessarily painful way, and no good ADD coach will work with you until you have done that work so that you are in a healthy place from which to move forward.

    There are also a few practitioners who are trained in both disciplines, who work with patients/clients as both therapist and coach. They frequently begin with therapy until the patient/client reaches the acceptance phase of the ADD grief cycle and has replaced what you call “maladaptive coping strategies” with healthy ones, and has worked through and shifted internalized negative self talk (coaches don’t work on as deep a level with self-esteem issues, although we do work with self-esteem and negative self talk on a cognitive level).

    Where Therapy is more emotional in approach, Coaching is more “pragmatic.” By that I mean, helping ADDers come up with the details of the systems they will develop to “work around” ADD Challenges, acting as both “coach” and “cheerleader” as they build the habit of using those systems. Said another way, your therapist helps you embrace life as worth living; your coach will help you actuate your game-plan once your emotions are congruent with your dreams.

    For the past 25 years, I have worked with clients who were in therapy and ADD coaching at the same time, I have worked with clients who have successfully completed therapy, I have worked with clients who never felt the need for therapy, and I have declined to work with clients whom I felt needed some therapy to process their emotions before they were ready to move forward with coaching.

    The important point is that ADD Coaching and “ADD therapy” work in different arenas, and in a different manner. Both are valuable, and may look similar, but they are not the same. If you need therapy there’s only ONE place to get it — from a trained and licensed ADD-aware therapist!

    mgh (Madelyn Griffith-Haynie, SCAC, MCC – blogging at ADDandSoMuchMore and ADDerWorld – dot com!)
    PS. About 15 years ago, I put together a handout summarizing The Difference between Coaching and Therapy with Dr. Lee Smith (both a licensed therapist and Master Certified Coach). Part of the training materials, I am in the process of posting it to my BlogSite in pdf format, along with other formatted materials. I’ll try to remember to return to post a download link once it is available.

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