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What Therapists Can Do
Effective treatment begins with recognizing that AD/HD has a neurogenetic basis. Once both partners understand the real problem, psychoeducation-focused therapy can help them identify AD/HD traits, such as impulsivity and distractibility, and address the emotional baggage of a lifetime of unresolved frustrations. Then the therapist can help clients develop new strategies for handling life's practical details, because with AD/HD, it's the practical matters that create so much daily stress.
Clarifying the neurobiological nature of AD/HD can go a long way toward increasing optimism and goodwill between partners. Late-diagnosis adults tend to describe themselves with terms like failure, defective, socially undesirable, and incompetent. Similarly, their mates have acquired self-blaming misattributions, like bad-tempered, nagging, and fault-finding. Correcting these cognitive distortions gives everyone the space to develop more productive strategies.
AD/HD experts agree that the best tool currently available for improving cognitive function is medication. If the client responds positively to medication, many treatment-disruptive symptoms, such as interrupting, deflecting responsibility, losing track of the discussion, and not listening attentively, are reduced or eliminated. Because clients spend more time with their therapist than with the prescribing physician, therapy is the logical place to examine a couple's attitudes toward medication to help inform their decision.
Many AD/HD clients have difficulty accurately monitoring their behavior and their response to medication. Therapists can play an important role by providing feedback to the physician and soliciting feedback from the spouse. They can assist in identifying poor health habits that worsen cognition, such as an unhealthy diet and insufficient sleep or exercise, and help the client practice new behaviors.
Experienced clinicians treating AD/HD use approaches that traditionally have been viewed as overstepping therapeutic boundaries or being too "active." For example, they might create automated e-mail reminders for clients. At each session's end, they may provide clients with a copy of their notes to help them remember what was discussed and the strategies that were developed. Giving clients structured tasks to work on between sessions accelerates therapy and provides opportunities to succeed during the week.
Medication can help immensely, but challenges remain. Developing and consistently using externally supportive strategies constitutes the heart of taking charge of this condition. For example, clutter and disorganization dog most couples affected by AD/HD. Consider teaming up with an AD/HD-savvy professional organizer to help establish work- and home-based systems. This not only boosts clients' confidence that workable solutions exist, but also relieves the non-AD/HD spouse from having to continue "nagging" to get things organized. It's helpful to devote in-session time to solving any compliance issues with these systems, such as helping AD/HD adults, who tend to think in all-or-nothing terms, understand that progress, not perfection, is the goal.