We believe that for psychotherapy for ADHD, the therapist must be familiar not only with the diagnostic symptoms of ADHD but also with the other symptoms, as all symptoms are relevant to treatment.
A therapist is a decisive authority who assesses whether the patient’s problems are caused by his disorder (the existence of which is not the responsibility of the person concerned) or by his own personal behavior, which is separate from the disorder and for which the person concerned is responsible.
If a therapist does not know all possible original ADHD symptoms (but only the diagnostic symptoms of DSM 5, for example), there is a considerable risk that causes and effects will be confused or that some behaviors will be attributed to the patient as personal deficits instead of being recorded as ADHD symptoms.
If an ADHD sufferer is assigned responsibility for things that lie in the area of non-capability, this can drive the ADHD sufferer even deeper into a feeling of inadequacy. ADHD sufferers already have considerable self-esteem problems.
Unfortunately, we know many ADHD sufferers who were more frustrated and hurt than before after spending several months in supposedly specialized ADHD clinics.
A therapist is - if they do it well and the fit is right - a kind of substitute caregiver. This role can go as far as being an aftercaregiver: the secure castle that gives the patient the feeling of being accepted equally with all their abilities and inabilities. Not coddling, but always benevolently encouraging. The wise father, the warm mother. Dumbledore, not Snape. Only on this basis can dysfunctional patterns be addressed without the person concerned perceiving themselves as wrong or inadequate.
A therapist has a position comparable to a judge due to his or her - from the patient’s point of view objective - knowledge of the psychological context. If the therapist questions the patient’s actions and reactions as being “the patient’s responsibility” or “not okay”, this is a very intensive intervention by an authority who - from the patient’s point of view - is called upon to do so.
If the therapist, in his dominant position as a result, assigns full responsibility for behaviors to the affected person due to a lack of knowledge of all the original ADHD symptoms, where the affected person is more likely to be a victim of the ADHD because he is at the mercy of them as a symptom and over which the affected person has less influence than non-affected persons precisely because of the ADHD symptomatically, this will massively increase the patient’s suffering.
Example:
One affected person told us about a (former) therapist who, with regard to his (severe but ADHD-phenotypical) motivation problems, told him that he couldn’t always just do what he wanted to do, but also had to do things that weren’t fun.
We observe that too few psychologists, psychiatrists and neurologists are able to adequately assess the connections between activity level/arousal and mood, in particular the phenomenon of dysphoria in the case of inactivity in ADHD, and that this results in a considerable number of misdiagnoses in the direction of depression.
A positive and supportive emotional atmosphere between patient and therapist is a basic prerequisite for fruitful therapy.
One study reports that it is already measurable in the first hour whether the therapy will be successful after 3 years - regardless of the form of therapy.
Patients and therapists were filmed during the first therapy session.
If there was a positive, accepting atmosphere between therapist and patient, the therapy was regularly successful after 3 years. If, on the other hand, a rather cool, distant atmosphere prevailed in the first hour, the therapy was regularly unsuccessful after 3 years.
Nevertheless (and in addition), some forms of therapy are more suitable for ADHD than others.
