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Taylor, S., 2024. ADHD Diagnosis and Treament: A Therapist's Personal Journey. Reformulation, Winter, p.17-18.
Author: Stephen Taylor, RMN and Cognitive Analytical Therapist, Senior Clinical Nurse Specialist in Psychological Medicine, Honorary Lecturer in Mental Health Nursing UWL
After speaking to one of the editorial advisers of Reformulation, I had to reflect on one of the obvious symptoms of my own ADHD - the tendency to overshare personal information. She asked if I was aware that the general public would be able to read about my ADHD diagnosis. "No problem," I replied, an example of potential oversharing (Barkley, 2015). Could it also be considered unboundaried behaviour for a psychotherapist? Another possible ADHD trait? Although I had a background in forensic psychiatry earlier in my career, which taught strict boundaries, was I now overeager to share my experience as a drive to reduce potential shame arising from a positive diagnosis, especially for my patient’s. What I have learned is that a positive diagnosis of ADHD has caused epidemic eye rolling especially amongst fellow clinicians. It was only by listening to a podcast by Gabor Maté that I realised that I should probably seek an assessment. Considering my occupation, I sought help from a friend of mine who is a very well-respected Psychiatrist. I wanted a ‘specialist’ in ADHD assessments. He suggested that I could see the Psychiatrist that diagnosed him. ‘You have ADHD I asked incredulously? Yes, was his reply. Why didn’t you tell me? His response was a familiar one, that I have now recognised in many diagnosed clinicians. A positive ADHD diagnosis can also provoke scepticism, especially in a clinical environment (Kooij et al., 2019).
As a psychotherapist and clinical nurse practitioner with over 30 years of experience in cognitive analytic therapy (CAT), I was surprised to be diagnosed with ADHD at the age of 53. This personal experience led me to reflect on why ADHD often goes unnoticed, even among mental health professionals, and how CAT can be effectively combined with other therapies to support individuals with ADHD. But then what if you haven’t been diagnosed? I thought I was just crap at being a patient and even a fraud. Why did I struggle to walk the walk, even if I talked the talk?
Undiagnosed ADHD: A Common Oversight
ADHD is a neurobiological condition that can significantly impact an individual's ability to focus, regulate emotions, and manage daily tasks (Barkley, 2015). Yet, many people, including those in the mental health field, are unaware of the signs and symptoms. As a seasoned therapist, I now realise that I had exhibited ADHD-related behaviours for years, such as difficulty maintaining concentration, impulsivity, and emotional dysregulation. However, these were often attributed to other mental health issues or dismissed as personality traits.
The Power of Cognitive Analytic Therapy for ADHD
After my ADHD diagnosis, I began incorporating CAT, along with coaching and compassion-focused therapy (CFT) techniques, into my work with patients. This approach has proven highly effective in addressing the unique challenges faced by individuals with ADHD.
Through the Sequential Diagrammatic Reformulation (SDR), a core CAT tool, we mapped out the reciprocal patterns and rules contributing to many of my patient’s dopamine-seeking behaviours, such as substance abuse and financial difficulties. By understanding these underlying dynamics, we could develop healthier coping strategies and strengthen their self-compassion, often lacking in those with ADHD (Sedgwick, 2021).
The Importance of Medication and the Therapeutic Alliance
Psychostimulant medication, prescribed by a nonmedical prescriber like me, can play a crucial role in the treatment of ADHD. The medications help to regulate dopamine levels and improve focus and emotional management (Kooij et al., 2019). I am aware that some of my colleagues will be wondering why this article mentions medication, after all it is a CAT Journal? For many of us with ADHD, change can feel almost impossible without medication. Is it the patients fault that change feels impossible because of the brain? This asks the question should every CAT therapist consider the possibility of ADHD when seeing a patient for the first time? Especially as most CAT therapists are already qualified mental health professionals.
A Call to Action for Cognitive Analytic Therapists
When researching CAT and ADHD, I struggled to find relevant papers or articles. Even the new Oxford Handbook of Cognitive Analytic Therapy lacked a chapter on ADHD, while our CBT colleagues have published extensively on the topic. At a recent ADHD conference by the UK Adult ADHD Network (UKAAN), CBT was the only recommended psychotherapy. I had to sit through multiple presentations about the success of CBT and ADHD. Funnily enough nobody spoke about the role of early relationships/attachment in the development or expression of certain ADHD genes.
This experience led me to believe that all mental health professionals, including CAT therapists, should receive training in recognising and addressing the unique needs of individuals with ADHD. By incorporating ADHD-informed practices, we can better support patients and help them achieve lasting change. As a community, we must advocate for developing ADHD-specific CAT models and training programs to provide comprehensive, evidence-based care for this often-overlooked population.
Reflecting on my journey, I recognize that my boundaries could have been better in the past. However, embracing self-compassion has been transformative in coping with feelings of shame and the pressure of not being the perfect therapist. Self-compassion involves treating oneself with the same kindness and understanding that one would offer a friend, which has helped me accept my imperfections and learn from them. By practicing self-compassion, I have been able to set clearer professional boundaries, maintain a healthier work-life balance, and provide better care for my patients. This approach not only mitigates the negative impact of ADHD on my professional life but also fosters resilience and emotional well-being, enabling me to be more present and effective in my therapeutic practice. This paragraph integrates the importance of self-compassion in managing professional boundaries and highlights its benefits for both personal and professional growth.
Stephen started working in mental health nursing 36 years ago in forensic psychiatry (Ashworth Hospital). He relocated to London 20 years ago to work as a Community Psychiatric Nurse. He trained as a CAT Therapist in 2011. Stephen left the NHS in 2017 to work in private practice. His last job was working for the Tavistock NHS trust. Stephen was diagnosed with ADHD at the age of 53.
References:
Barkley, R.A. (2015). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (4th ed.). Guilford Press.
Kooij, J.J.S., Bijlenga, D., Salerno, L., Jaeschke, R., Bitter, I., Balázs, J., & Asherson, P. (2019). Updated European consensus statement on diagnosis and treatment of adult ADHD. European Psychiatry, 56, 14-34.
Sedgwick, J.A. (2021). Cognitive analytic therapy for people with ADHD: A new approach. Routledge.