Month: December 2024

Attention Allies founder and specialist couples therapist Duncan E. Stafford offers some introductory insight to how SDT can be a strong, flexible and empowering framework to help support those living in mixed ADHD/neurotypical relationships.

(5 minute read)

Couples therapy involving one partner who has an ADHD neurotype requires a compassionate and structured approach to foster success. Traditional therapy models often unintentionally frame the work as an ADHD partner needing to be “fixed” or that they must be taught or learn “how to conform” to a neurotypical concept of relationships. This framing tends to alienate ADHDers and can exacerbate relational tensions rather than help to address them.

Many couples who seek help at my practice report that previous therapists had struggled to balance the needs of both partners, often overlooking or underestimating the distinct challenges and strengths associated with ADHD. Without proper recognition of these issues, therapy risks becoming another source of frustration for the mixed-neurotype couple, leaving them feeling unseen and unsupported.

From my 25 years of professional experience and 37 years in a successful, loving mixed-neurotype marriage, I’ve found that the core principles of Self-Determination Theory (SDT) – autonomy, competence and relatedness – provide a robust framework for fostering resilience, empathy and growth in couples therapy. These principles allow partners to navigate conflicts constructively and create a supportive, thriving relationship.

For individuals with ADHD, the often-reported challenges such as disorganisation, impulsivity and difficulties with emotional regulation can strain communication and mutual understanding in romantic relationships. If not addressed, these issues may lead to misaligned expectations, frustration and feelings of disconnect.

Introducing the SDT framework for couples work

SDT was developed by psychologists Edward Deci and Richard Ryan and was first comprehensively outlined in their 1985 book Intrinsic Motivation and Self-Determination in Human Behavior. Focused on understanding the factors that enhance or undermine motivation, SDT identifies three essential psychological needs:

Autonomy – the need to feel self-directed and in control of your own actions

Competence – the need to feel effective and capable

Relatedness – the need to feel connected, valued and have a sense of belonging.

An SDT-based approach to couples work will help both partners identify and meet their psychological needs while simultaneously promoting mutual respect and empathy within the couple. By empowering an ADHD partner to develop tailored strategies for managing their challenges, therapy can increase autonomy. The building of confidence through therapeutic work helps to develop abilities (competence), and enhancing emotional connection and understanding in couples work increases relatedness.

Therapy can transform recurring conflicts into opportunities for deeper connection and shared growth. This approach acknowledges the ADHD dynamics in the relationship – creating a pathway to sustainable harmony and partnership.

Beginning to apply SDT in ADHD/NT couples work

ADHDers often experience unique challenges in romantic relationships, and the common issues ADHD can bring often strain the communication systems and understanding of a couple. Using SDT in couples work provides a structured framework for addressing the issues and challenges that are especially prevalent in mixed-neurotype relationships.

When I first met Jess (diagnosed with ADHD) and Mo (neurotypical), their relationship was mired in daily conflict and palpable frustration. Sessions often began with a seemingly minor disagreement that quickly escalated. On one occasion, Mo was deeply frustrated because Jess had once again missed a deadline for paying a household bill. Despite repeated “requests” to “do it right next time,” Mo felt nothing ever changed, leaving her to shoulder most of the family responsibilities.

What I observed was a deeper pattern: Mo’s attempts to manage Jess’s behaviour were experienced by Jess as micromanagement, which undermined her competence (confidence in her ability to handle responsibilities) and autonomy (freedom to self-direct). For Jess, this dynamic triggered overwhelm and defensiveness.

The core issue lay in miscommunication of their individual needs and understanding of the other. As a neurotypical individual, Mo prioritised structure and predictability. Meanwhile, Jess’s ADHD presented challenges with timing and task prioritisation. These differing approaches turned relatively small issues into significant conflicts.

SDT strategies in action for Mo and Jess

Autonomy: Jess was encouraged to handle tasks in a way that worked for her. Mo’s request was for Jess to simply set up an automated payment, but this triggered Jess’s childhood memories of being seen as incompetent. Instead, Jess set about designing a visual task board that included a wider set of financial goals and accounts. With the use of colour and an impressively artistic hand-drawn financial flow chart, Jess successfully navigated the challenge and was able to stick to, and increase, her financial responsibilities for the family.

Competence: Therapy focused on building Jess’s skills without criticism, which helped her to feel more effective in managing responsibilities. Mo’s competence increased once she realised it wasn’t her responsibility to do things it had been mutually agreed Jess would do. Mo took pride in her new skill of “sitting back”.

Relatedness: Mo learned to express concerns empathetically, removing frustrated responses and replacing them with expressive dialogue like “I feel anxious when bills are late”. Jess was encouraged to share how constant reminders and micromanagement felt overwhelming, fostering mutual understanding.

By applying SDT models, the conflict between Jess and Mo began to reduce. This allowed them to build further trust in one another, transforming challenges into opportunities for growth.

This article provides an introduction to how SDT can begin to reshape ingrained patterns in mixed ADHD/NT relationships. Visit us again for future articles on applying SDT in therapy.

You might also like to view Can autonomy, competence and relatedness be the adhders’ defence against Rejection Sensitive Dysphoria where you can read more about basic SDT in connection with ADHD.

Note: Jess and Mo are composite characters, inspired by a mix of consensually shared and fictionalised examples.

 

References

Deci, Edward L. and Richard M. Ryan. 1985. Intrinsic Motivation and Self-Determination in Human Behavior.

 

Click the links if you’d like to visit Duncan’s couples therapy website or his directory entry on Attention Allies.

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Published 8 December 2024

 

All rights reserved © Copyright Duncan E. Stafford 2024. Unauthorised use and/or duplication of this material without express and written permission from the author of this post is strictly prohibited. Author contact via website Contact page.

Website version and image © Copyright Attention Allies 2024.

Psychotherapeutic counsellor Bev Woolmer helps us to understand that ADHD doesn’t just happen in a vacuum. An ADHDer’s comorbid conditions can impact and/or mask symptoms of the condition.

(5 minute read)

Awareness, information and debate about ADHD have increased significantly. ADHD has become part of our social discourse and the increase of people seeking diagnosis and support is rising. It is likely that within our circles we know people with ADHD or we may be neurodiverse ourselves.

Data from the NHS Business Services Authority show that in 2022–2023, more adults were prescribed medication for ADHD than children – a rise of 32% in adult prescriptions (NHSBSA, 2023). In March 2024, the National Institute for Health and Care Excellence (NICE) estimated that 3 to 4% (roughly 1.9 million adults) and 708,000 children in the UK have a diagnosis of ADHD.

Statistics aren’t, generally speaking, my thing, but what resonates here for me, and something that is maybe less discussed, is ADHD and comorbidity (AADD UK; Plos One; The Understood Team). Comorbidity means the tendency for one condition to co-exist with another. What I recognise both personally and professionally is how anxiety and depression are often diagnosed, and what can often be missed are conditions within the umbrella of neurodiversity.

Recognising in later life that my brain is neuro-spicy, that there is a reason why numbers, “clumsiness”, not knowing my left or right, being a “daydreamer” (a firm favourite in school reports) all started to fall into place. I began to piece together the things that had challenged me and began to see all this was unique.

It is no surprise this is also a large feature within my work as a counsellor with clients. The privilege in holding space for others, where the mask they’ve worn can be explored with compassion and curiosity. A supportive ally on the journey of self-discovery, the reflecting back, seeing the signs and missed opportunities, often a grieving process, recognising the loss and the re-building.

This piecing together often brings into view co-morbidity and how the presence of these can affect ADHD symptoms as well as mask ADHD.

How anxiety and depression mask ADHD

Anxiety: this can impact the ability to concentrate, the racing of thoughts, constant worry and fear. It can exist as a generalised anxiety disorder and be experienced in relation to health or social anxiety. Perfectionism, and comparing oneself to others who seem to function and manage, are often internalised. About 50% of adults with ADHD will also have an anxiety disorder.

Depression: adults with ADHD are three times more likely to experience depression; they are more likely to be significantly affected by their symptoms than those with either disorder alone. Low mood and low self-esteem can impact self-image and can result in a sense of failure in not meeting expectations or goals. This can impact both personal and professional relationships, struggles with communication, reading body language and “fitting in”.

 

How specific learning differences mask ADHD

Specific learning differences are neurological conditions that can impact how a person learns. These are not related to intelligence, and those with one or more of these conditions are more likely to have ADHD or ASD than people who do not have a specific learning difference.

Dysgraphia: this can cause challenges with written expression, handwriting, spelling, grammar and putting thoughts onto paper as well as fine motor skills – for example, holding a pen.

Dyspraxia: challenges with movement and co-ordination, including poor hand-to-eye co-ordination, manual dexterity and poor balance. It can also affect language, perception and organising thoughts.

Dyscalculia: affects the ability to acquire arithmetic skills – for example, in performing mathematical calculations, understanding place value, reading timetables, telling and tracking of time, and challenges with distinguishing left and right.

Dyslexia: causes difficulties with reading, writing and spelling. It can cause confusion over the order of letters, which may be written the wrong way round. It can also cause challenges with following directions, perception, planning and organisation.

Empowering ourselves

Being able to understand ourselves, to name what challenges us, can enable and empower us. It can provide an opportunity to learn strategies, to reframe our story and to find a sense of self of who we are. As poet Maya Angelou says: “If you’re always trying to be normal, you will never know how amazing you can be.”

 

References

AADD UK. No date. Accessed 3 December 2024: https://aadduk.org/symptoms-diagnosis-treatment/comorbidities/

National Institute for Health and Care Excellence. 2024. Accessed 3 December 2024: https://cks.nice.org.uk/topics/attention-deficit-hyperactivity-disorder/background-information/prevalence/

NHS Business Services Authority. 2023. Accessed 3 December 2024: https://media.nhsbsa.nhs.uk/news/nhs-releases-mental-health-medicines-statistics-for-20222023-in-england

Plos One. No date. Accessed 3 December 2024. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0277175

The Understood Team. No date. Accessed 3 December 2024:https://www.understood.org/en/articles/adhd-comorbidity

 

In “ADHD, ME …”, sister poem of “ADHD? ME?”, poet Jackie Fernandez illuminates the work struggles she endured around her initial diagnosis just before the Covid-19 pandemic. Full of Jackie’s usual wit and charm, “ADHD, ME …” continues to allow readers into the thoughts and journey of one woman with a late diagnosis of ADHD.

 

I was diagnosed as we were going into lockdown

Covid taking over our lives

Boris acting like a clown

As we got used to living day and night in our dressing gowns.

 

It was only a week or so from getting this bombshell

I was assessed by a psychiatrist

Asking me loads of questions

About my childhood

About school

About the jobs I had and lost

With little notice

But at a great cost

To my confidence

Unsure of my skills

My experience

Was I any good at it?

Did I try my best?

Why couldn’t I fit in?

RSD wanting to put me in the bin

 

I worked for a charity

That supported people with disabilities

Providing stability

To folk who struggled with mobility

Or folk who were neurodivergent

Some very observant

Some obsessed with detergent

Some talking like a machine gun

Because in their head it was urgent.

 

I thought I was in the right place

To share my diagnosis with grace

And not hide my face.

 

I told my manager

I have ADHD

Could you share this with the board

It will shed light on how I work

And understand how ADHD can be a positive quirk

 

I didn’t get the response I expected

Words that would’ve been a warm embrace

But  in reality,

I’ve never felt so rejected.

 

She explained how now was not the right time

We had to focus on Covid-19

I had to look after my staff team

Steady the boat

Keep it afloat

 

A Secret

Like it was something so bad

So awful

So earth-shattering for them

 

I felt unimportant

But took it on the chin

I had to focus on my job

Put my feelings in the bin

 

The news was shared eventually

To all the board members

Who’d known me for years

But things did not look like they appeared

 

An email was sent out to all

Telling them of my ADHD

I was expecting to be bombarded with responses

Telling me its ok

We will support you

How have you managed for so long?

We are right behind you

You’ve done nothing wrong.

 

I was bombarded by silence

It   was    deafening

Soundless

So, so quiet

So, so still

Nobody said anything to me

It gave me quite a chill.

 

I had no support

They didn’t want a CEO to have ADHD

What an embarrassment I was to them

To have a disability

To not be neurotypical

“Normal”

A role model

To not be abnormal

 

I felt I let them down

I had taken a step down

I had lost my crown

 

Visit Jackie’s poetry site

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Published 6 December 2024

 

All rights reserved © Copyright Jackie Fernandez 2024. Unauthorised use and/or duplication of this material without express and written permission from the author of this post is strictly prohibited. Author contact via website Contact page.

Website version and image © Copyright Attention Allies 2024.

Counsellor, psychotherapist and supervisor Claire Wirsig invites readers inside some of the thought processes that a network and community of therapists (focused on neurodivergence) must also consider.

(5 minute read)

This blog post has been inspired by my deep care for people and reflecting on the many ways in which we can be “othered”. I also take inspiration from Eugene Ellis’ book The Race Conversation (2021), as well as other authors. I’m hoping to begin a useful “race conversation” within Attention Allies, and perhaps, beyond.

As therapists, we do a lot of reflecting on identity. The therapists within Attention Allies (myself included) support clients who have ADHD. We facilitate our clients to understand ADHD as a neurotype that lends itself to certain experiences, as well as supporting our clients to explore their own unique and individual identities within ADHD. The way ADHD presents and feels for one person will be entirely different for someone else.

Prior to doing this work with clients, we will have gone through our own respective therapy trainings and personal therapy, and reflected on our own identities. For me, a large part of these reflections had been about my gender and my culture. Even with all of this introspection, some pieces of the puzzle remained hidden. I remember with crystal clarity the moment it dawned on me: Never do I ever feel white. This is white privilege.

Anti-racist activist Peggy McIntosh’s famous article “White Privilege” (1989) describes white privilege as “an invisible package of unearned assets that I can count on cashing in each day, but about which I was ‘meant’ to remain oblivious”. McIntosh goes on to list 26 of these unearned assets. I’m sure there are many more.

In my journey to better understanding white privilege, I read Reni Eddo-Lodge’s book Why I’m No Longer Talking to White People About Race (2018). In this book, Eddo-Lodge states: “Racism’s legacy … brings with it not just a disempowerment for those affected by it, but an empowerment for those who are not. That is white privilege. Racism bolsters white people’s life chances … it is designed to maintain a quiet dominance.”

Alongside examining my own experience of white privilege and reflections on how it affects my therapeutic work, I am curious about the subject of racism within the field of therapy, and how it shows up in different spaces. But before we delve into the matter further, let’s pause for a moment to think about how we engage with this subject.

Bringing up the subject of race/racism can give rise to strong bodily sensations and/or feelings. Some responses might include noticing an increased heartbeat, feeling defensive or shutting down. Ellis (2021) calls this phenomenon “race construct arousal”. In The Race Conversation, he explains that “when race is the focus, dissociation, confusion, anger and blame are the central experiences, along with dysregulation … and feeling psychologically unsafe”.

Ellis invites the reader to “be with” this arousal without “being” the arousal. “It involves staying at the contact boundary of our discomfort and, at the same time, compassionately meeting our implicit responses and biases.” I invite you, reader, to notice what you’re feeling now having read this far, and I invite you to stay at the contact boundary of what responses are aroused in you as you read this article.

On the homepage of our website it reads: “Attention Allies. Therapists for ADHD in Bristol”. Scrolling down, we have a group picture of what appears to be nine white-skinned faces (of which I am one). In relation to this image, I wonder whether Attention Allies is unconsciously bolstering the chances of therapeutic support for white people with ADHD and, as a consequence, neglecting and/or disempowering people of colour with ADHD?

Of course, Attention Allies is not alone in being a predominantly white therapy organisation. The therapy profession itself is aware of whiteness in the mental health professions. An online search revealed that 80% of NHS talking therapy staff are white and female (AI overview, 2024). According to the HCPC survey (Kanceljak and Calia), “90% of registered practitioner psychologists in the UK identify as White, followed by 4.3% Asian, 1.7% Black and 3.6% Other”.

During our last meeting of the Attention Allies, I had a discussion with some colleagues about whiteness in our group. We asked a number of questions of ourselves including inquiring if we were colluding with white privilege and if we were consciously or unconsciously sending out any messages the we are only here to support white people with ADHD. Are these experiences being seen and heard? Does our group seem like a community where those intersectional experiences can be seen and heard?

I don’t know and I can’t know the answers to these questions. But I feel strongly that we need to be asking questions like these – in our group, in the therapy profession, and as people living in this world.

Although this discussion will be ongoing, I will end this piece with another quotation from Eddo-Lodge:

Anti-racist work … needs to be led by the people at the sharp end of injustice. But I also believe that white people who recognise racism have an incredibly important part to play … Support looks like white advocacy for anti-racist causes in all-white spaces. White people, you need to talk to other white about race. Yes, you may be written off as a radical, but you have much less to lose (2018, pp.215–216).

 

References

AI overview on Google. Accessed 30 October 2024.

Eddo-Lodge, Reni. 2018. Why I’m No Longer Talking to White People About Race.

Ellis, Eugene. 2021. The Race Conversation: An Essential Guide to Creating Life-Changing Dialogue.

Kanceljak, Dan and Clara Calia. No date. “Diversity and Inclusion in UK Psychology: A Nationwide Survey”, The British Psychological Society. Accessed 30 October 2024: https://explore.bps.org.uk/content/bpscpf/1/369/15#:~:text=According%20to%20the%20HCPC%20survey,Black%20and%206.7%25%20as%20others

McIntosh, Peggy. 1989. “White Privilege: The Invisible Knapsack”, Peace and Freedom, July/August, 10–12. Accessed: www.nationalseedproject.org/key-seed-texts/white-privilege-unpacking-the-invisible-knapsack

 

Click the links if you’d like to visit Claire’s therapy website or her directory entry on Attention Allies.

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Published 6 December 2024

 

All rights reserved © Copyright Claire Wirsig 2024. Unauthorised use and/or duplication of this material without express and written permission from the author of this post is strictly prohibited. Author contact via website Contact page.

Website version and image © Copyright Attention Allies 2024.