Q: I’m seeing more and more adults with attention deficit hyperactivity disorder (ADHD) in my psychotherapy practice. Too often, the skills and strategies we work on in our sessions don’t carry over into their daily lives. What can I do to make my work with ADHD clients more effective?
A: You’ve hit on a central issue that’s typically misunderstood about adult ADHD: the difficulties faced by adults (and children and teens, for that matter) with ADHD aren’t because they don’t know about coping skills or resist their use. Clients typically express their frustration with trying to implement the skills they’ve learned with statements such as “I know what I need to do. I could coach someone else about what to do. But I can’t do it for myself.”
As a cognitive behavioral therapist, I believe the key to improvement isn’t trying harder not to procrastinate, but seeing the components that lead to procrastination and then intervening to alter them. Of course, to achieve any behavioral change, clients must learn to do things differently. Thus, cognitive behavioral therapy (CBT) for adult ADHD emphasizes giving clients practice in developing tactics for overcoming procrastination. With practice, these coping skills become more habitual, and clients gain a sense of efficacy in managing their affairs, including managing inevitable slip-ups.
Although procrastination is at the core of many of the problems ADHD clients suffer from, each…