When therapy hasn’t worked for your ADHD

When someone first comes to see me, I spend a lot of time on their history with therapy. What helped? What didn’t? What would they want to be different this time?

The answers usually fall into two groups.

When a therapist caused harm

Sometimes a past therapist hurt someone or let them down badly. Often it’s unintentional, from a therapist who doesn’t have the knowledge or experience to work with ADHD. Sometimes we even leave therapy feeling worse than when we got there.

When that’s the story, we start with repair. We go slowly, build trust at your pace, and set boundaries together so it doesn’t happen again.

When therapy was kind but went in circles

More often, the past therapist was kind. They listened well, they were empathetic, and they were good at validating what was going on. And still, something was missing.

Sessions can turn into weekly venting about problems, struggles and other issues. This can be healing for some people. Sometimes it falls short, and can even leave us feeling that we wasted our weekly therapy session. Venting to a paid therapist can protect relationships with friends and family that might wear thin otherwise. But it can feel like there is something missing in the therapy room.

This is often where it falls short for folks with ADHD. We can get “stuck” on an emotion, an idea, a train of thought. Without structure, tangible strategies and an action plan, it can feel like we’re coming to the therapy room just to spin around in circles. It might feel like there is no forward movement, change or growth. It can feel less about healing and more about coping with the week’s stress.

What I do differently

We start by exploring what you want to work on. You set the goals, and they can change.

From there, a few things are usually part of our work together:

• Practical strategies, tried as experiments. Workflows, accommodations and supports. We try something, see how it goes and tweak it. Plenty of things won’t work, and that tells us something too.
• Language for what’s going on. Learning about common neurodivergent traits gives context and can help connect us to community.
• Self-advocacy. How do I talk to myself about what’s happening? How do I explain it to the people around me?
• Internalized ableism. These are the social messages we have absorbed our whole lives about what is “normal,” and that we just need to try harder to fit in. Inevitably this causes shame and low self-worth, and damages our relationship with ourselves.
• Mindful Self-Compassion. I see this as the key missing piece. When we get the hang of self-compassion, it brings light and warmth to the parts of us that hold suffering, shame and trauma.

You already have strategies

Most people I work with already have strategies. Over the years they’ve built their own ways of getting through a world that isn’t designed for how they show up.

Much of our work in the therapy room is finding the best strategies, bringing awareness and intention to them, and building on them. There are sometimes a few new things to try from the research, or perhaps we come up with them together in the moment. This part of therapy takes reflection, creativity and a willingness to try something out as an experiment (knowing we might fail).

Why the practical side alone often doesn’t stick

Sometimes a strategy makes complete sense and still doesn’t happen. Things get in the way: past memories, trauma, experiences that keep resurfacing. Resmaa Menakem calls these soul wounds. We aren’t always aware of them, but folks with ADHD (and many of us in general) carry these things with us.

Talking through thoughts and core beliefs only reaches so far. When you aren’t seeing results from regular talk therapy, body-based approaches like Brainspotting can be something to try. Parts work can help us develop a more trusting and compassionate relationship with ourselves and our hard internal experiences.

There’s no set formula or manual for healing. We are all different and experience things differently. So when we work together, you take the lead on what we do with our time, and I can help guide if needed. We change from week to week and even hour by hour, so I try to make sure the therapy session is flexible enough to meet what’s needed in the moment.

Where I’m coming from

I was late diagnosed with ADHD as an adult, about two years ago. For most of my life before that, the same difficulties kept showing up: sadness, frustration, overwhelm, anxiousness, worry, rumination. I didn’t know why, and traditional ways of working with these issues didn’t seem to help much. There were times when I felt worse leaving the therapy room than when I arrived, filled with shame or self-doubt.

When I came to more acceptance of my diagnosis, I had a new perspective and context for these struggles. It filled in a lot of gaps and open questions I had been holding.

It was kind of like rewatching a movie with a trick ending. When I reflected on my life with a neurodivergent perspective, everything seemed to make sense, and it wasn’t all due to my personal failings or lack of effort.

That isn’t my whole story, and understanding myself as someone with ADHD didn’t solve everything. But it was a milestone in my healing and has opened me up to a foundation for developing a more rich, meaningful and authentic life in community.

Acceptance has taken a long time, and it’s still ongoing. Rationally, I know my brain just works differently. Emotionally, it takes longer. This can be especially true when you find out as an adult. Some of that slowness is internalized ableism, stigma, fear of being seen as different, or feeling that we can just keep pushing through. But in an almost counterintuitive way, I find that folks who build acceptance of their neurodiversity open doors that were locked shut. Doors that lead to bigger, healthier and more engaged lives.

If you’re thinking about trying again

I offer ADHD therapy in Milwaukee and online across Wisconsin and Missouri. You can read more about how I work on my therapy for adults with ADHD page.

If you’d like to think through what you want from therapy first, the Therapy fit self-reflection is free and private. And if you’re still making sense of your own traits, the ADHD trait self-reflection is there too.