Author: duncan@therapy-space.co.uk

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ADHD and women

ADHD, perimenopause and sleep: The tale of Sleepless Beauty

Attention Allies psychotherapist Claire Wirsig explores what happens when ADHD and perimenopause collide – and sleep takes the hit. Forget fairytale slumber; this is the frazzled, middle -of-the-night edition, starring hormones, hyperfocus and too much thinking. In this article Claire unpacks why rest becomes elusive and how a dose of understanding and self-compassion can help you to find your way back to it.

(6 minute read)

In a popular fairy tale, Sleeping Beauty pricks her finger on a spinning wheel and falls into a deep sleep. Well, lucky her! When ADHDers prick their fingers on the perimenopause, they fall into restlessness and wakefulness. Instead of a 100-year nap, we get 3:17 a.m. wide-awake brain cinema featuring our never-ending to-do list, the perfect comeback for a conversation from last week and our latest ear worm (mine is ‘Oops Upside Your Head’ by The Gap Band). Here we explore the relationship between ADHD, perimenopause and sleep.

ADHD and sleep

Many ADHDers will have had the experience of struggling with sleep throughout our lifetimes. Not wanting to go to bed or take naps as children, then, when falling asleep, having vivid dreams or nightmares and waking up in the night. As teenagers, our time optimism and impulsivity can lead us to staying up late working, studying or partying, then crashing for 12 hours when we go to bed. Throughout adulthood, many ADHDers experience erratic sleep: being natural night owls, working hard and playing hard, or as parents surviving the early child-rearing years.

The connection between sleep deprivation and ADHD is a vicious cycle. Poor sleep heightens ADHD symptoms, making it even harder to concentrate, manage impulses and regulate emotions during the day. Adults with ADHD who don’t get enough restful sleep often experience increased irritability, forgetfulness and impulsiveness. Research suggests that roughly 60% of adults with ADHD screen positive for a sleep disorder (Wynchank, 2025).

It isn’t just medical conditions that affect sleep. ADHD traits themselves can be disruptive. Night-time presents the perfect opportunity to hyperfocus on a project – fewer distractions and interruptions (Pacheco, 2025). The quiet of the night can feel like the perfect environment to finally write that email, finish that spreadsheet or reorganise the entire digital photo archive from 2009. When we’re younger, we often have the energy to push through the next day on minimal sleep. As we get older, burning the candle at both ends becomes far less forgiving.

Perimenopause and sleep

In midlife, many of us become less physically active due to competing responsibilities. Even when we ramp up exercise, get fresh air and practise impeccable sleep hygiene (regular bedtimes, fewer screens and lavender-scented everything), ADHDers can still struggle to switch off. Adult hyperactivity is often internal – a restless, looping mind that never quite settles (thinkADHD, n.d.).

During perimenopause, the transition into periods stopping, many women and people who have periods experience increased difficulty with sleep. Symptoms include trouble falling asleep, staying asleep or feeling restored. One common experience is waking regularly between 3 and 4 a.m., then lying awake until the alarm goes off. The result? Grogginess all day, afternoon energy crashes and an internal debate about whether coffee is a lifeline or a betrayal of the next night’s sleep.

Poor sleep quality is an extremely common feature of perimenopause and has a ripple-on effect to other processes in the mind and body (Johns Hopkins Medicine, 2025). For example, when poor sleep impairs executive function, we can forget to take our magnesium tablet or to order our repeat HRT prescription in time. Even when we try ‘doing the right things’, sleeping issues can get in the way. We can feel frustration and shame of knowing what the right things are, yet still struggle to do them in the exhaustion of chronic sleep debt.

Changes in oestrogen and progesterone affect body temperature regulation, mood and circadian rhythms – all of which are closely linked to sleep (Newson, 2025). It’s not just the sleep disruption itself, but the anxiety around it. As sleep becomes unreliable, trust in one’s ability to sleep erodes. “What if I don’t sleep again tonight?” activates the stress response, making relaxation even harder. This creates a self-perpetuating loop of wakefulness, frustration and exhaustion (Johns Hopkins Medicine, 2025).

ADHD + perimenopause + poor sleep: The triple whammy

So, what happens when ADHD and perimenopause collide? For many, it feels like the coping strategies that once worked suddenly stop working. Hormonal fluctuations can intensify ADHD symptoms such as emotional dysregulation, brain fog and restlessness – especially at night. Sleep deprivation then amplifies everything further.

Many who have periods report that perimenopause is the time when their ADHD symptoms worsen, sometimes prompting a first diagnosis. Sleep disruption plays a central role in this experience. When sleep is poor, executive functioning suffers, resilience drops and daily life feels disproportionately hard.

It can be deeply disheartening to be doing all the “right things” but still struggle to sleep. What matters is finding the right approach for you. Support may include a combination of approaches: exercise, meditation, mindfulness, ADHD-aware counselling or psychotherapy, hormonal support, medication reviews and – perhaps most importantly – being kind of ourselves.

In fairy tale, the curse is broken by a kiss. In real life, Sleepless Beauty may need HRT and some lifestyle adjustments. Because if you’re awake at 3 a.m. anyway, even though you might feel like you’re cursed, you’re not. You’re just navigating a natural process alongside an active brain. We might all be seeking that fairy tale ending when it comes to sleep, but we’ll settle for doing our best along with a good dose of self-compassion.

 

References

Johns Hopkins Medicine (2025). How Does Menopause Affect My Sleep?
www.hopkinsmedicine.org/health/wellness-and-prevention/how-does-menopause-affect-my-sleep (accessed 28 February 2026).

Newson, L. (2025). Sleep and hormones. www.drlouisenewson.co.uk/knowledge/sleep-and-hormones (accessed 28 February 2026).

Pacheco, Danielle (2025). ADHD and sleep problems. www.sleepfoundation.org/mental-health/adhd-and-sleep (accessed 28 February 2026).

thinkADHD (n.d.). ADHD and sleep disorders. https://thinkadhd.co.uk/adhd-and/adhd-and-sleep-disorders/ (accessed 28 February 2026).

Wynchank, D. (2025). How to manage sleep in women with ADHD during (peri)menopause? National Library of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC12438809/ (accessed 28 February 2026).

 

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 2 March 2026

 

All rights reserved © Copyright Claire Wirsig 2026. Unauthorised use and/or duplication of this material without express and written permission from the authors of this post is strictly prohibited. Author contact via website Contact page.

Website version and image © Copyright Attention Allies 2026.

 

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Men and boys with ADHD Uncategorized

ADHD across generations: Boys and men growing up: 1966–2026 (Part 1: Now you are 60)

In a three-part series tracing 60 years of men’s experiences with ADHD, psychotherapists Duncan E. Stafford and Adam Wilson examine the silent shame of the 1960s to the hyper-aware digital age from the early noughties onwards. Blending social insight with personal voices, they offer a considered perspective on how shifting attitudes and the overlapping influences of class, culture and access to care have reshaped the struggles, strengths and self-understanding of boys and men living with ADHD across the generations.

ADHD has long been misunderstood and, for much of history, invisible. Yet its impact on those who live with it is profound and ongoing. This first part of our series charts the evolving landscape of ADHD for those who were born in 1966 and are now 60 years old. But each of the eras in this series brought its own challenges and breakthroughs, shaped by societal attitudes, available support and cultural change. It’s also important to recognise that these experiences were not evenly distributed; race, class and geography often determined who was punished, who was supported and who was overlooked. Through this journey, readers can gain some insight into how ADHD has been experienced, managed and redefined over time – and how hope and resilience continue to grow.

Now you are 60: Growing up before ADHD had a name

ADD and ADHD were not phrases you would have heard as a boy. Growing up from the mid-1960s to early 1980s Britain, experience varied sharply by class and background. If you were a working-class boy or from an immigrant family, you often faced even harsher control and discipline for your actions as there was less tolerance for difference. Your restlessness was read through the lens of social class or race rather than curiosity or energy.

Whatever your background, your restlessness was usually called something like “carelessness” or “stupidity”, sometimes “cheeky” or just “a handful”. Teachers said you had “ants in your pants” or that you “could do well – if only you tried harder”. Effort was seen as virtue, disobedience as sin. A few teachers went further, branding boys like you “defiant” or even “thick”. Officially, there was a label – “Hyperkinetic Disorder” – but it was buried in the pages of a manual few had opened.* Understanding was absent; patience was scarce. Punishment was ordinary; shame fundamental. The strap, slipper or cane could arrive for nothing more than fidgeting. From a young age, you discovered that misbehaving drew more attention from others than trying hard or doing well ever did.

You might have been clever – bright, curious, imaginative – but your mind ran too quickly for the world around you. Lessons dragged; thoughts collided. You forgot what you meant to say, lost track of books and pencils, then faced humiliation for what was always called “carelessness”. Teachers wrote: “He’s a capable boy but all too often lacks application and effort.” Parents echoed the refrain, exhausted by reports of daydreaming and backchat. The shame of being both “too much” and “not enough” settled deep inside. Being painfully sensitive, you masked to survive, turning humour into armour or self-mockery into protection. You found safety in distraction, hiding your restlessness and shame behind everything from charm to silence.

Friendships were uneven, relationships confusing. You longed to belong but often blundered. You were called “odd”, sometimes worse. Beneath it all was the quiet knowledge that you felt things more sharply than others and thought too fast yet had no words for why. The expectations on you as a male to not show weakness or express how you feel, to just get on with it, added to the complexity and masked burden. When full adulthood arrived – work, bills, more expectation – the routines others tolerated became traps. You thrived in bursts then frequently felt overwhelmed or burned out, astonishing colleagues with ideas and then vanishing into inertia. Each collapse renewed the accusation you’d absorbed as truth: “I’m lazy, unreliable, a failure.”

For many – especially those without access to private diagnosis or the language of psychology – understanding came slowly, if at all.

What therapy can do

Yet even in later life, therapy offers the chance to reframe your history. Years may have passed before understanding caught up – perhaps through a child’s diagnosis or a late-night documentary – but recognition brings both revelation and repair. While therapy is not always accessible, where it is, it can help you unpick the shame, mourn the loss of missed opportunity or potential, meet that younger self with honesty and recognise that healing doesn’t only happen in clinical spaces. At 60, you may finally see you were never stupid – only unseen in an age that refused to look – and celebrate what you have accomplished to be here in the present. Therapy can help to untangle that story and allow you the fullest life now.

In part 2 of this series, we look at what ADHD life is like for men born in 1986. Part 3 will look at men born in 2006.

 

Reference

* World Health Organization. International Classification of Diseases (ICD) manual, 8th and 9th revisions. Accessed 4 December 2025: www.who.int/standards/classifications/classification-of-diseases

 

Authors’ note

This piece draws primarily on experiences from white, British, middle-class contexts. ADHD, however, intersects deeply with race, class and gender, shaping who receives understanding and support. We acknowledge those differences and the ongoing need for broader, more inclusive stories.

 

Click the links if you’d like to visit Duncan’s therapy website or Adam’s therapy listing. Their directory entries for Attention Allies.

 

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Published 1 January 2026

 

All rights reserved © Copyright Duncan E. Stafford and Adam Wilson 2026. Unauthorised use and/or duplication of this material without express and written permission from the authors of this post is strictly prohibited. Author contact via website Contact page.

Website version and image © Copyright Attention Allies 2026.

Categories
Men and boys with ADHD

ADHD across generations: Boys and men growing up: 1966–2026 (Part 2: Now you are 40)

The 1980s is when ADHD really began to enter public debate. Blending social insight with personal voices, Stafford and Wilson offer a considered perspective on how shifting attitudes and the overlapping influences of class, culture and access to care have reshaped the struggles, strengths and self-understanding of boys and men living with ADHD across the generations.

ADHD has long been misunderstood and, for much of history, invisible. Yet its impact on those who live with it is profound and ongoing. This second part of our series charts the evolving landscape of ADHD for those born in 1986 and are now 40 years old. But each of the eras in this series brought its own challenges and breakthroughs, shaped by societal attitudes, available support and cultural change. It’s also important to recognise that these experiences were not evenly distributed; race, class and geography often determined who was punished, who was supported and who was overlooked. Through this journey, readers can gain insight into how ADHD has been experienced, managed and redefined over time – and how hope and resilience continue to grow.

Now you are 40: Growing up in the ADHD debate years

Being born in the mid-1980s, you grew up as ADHD entered public debate – though rarely with kindness. Discussion around ADHD – in education, the psychological professions and the media – often centred on white, middle-class families while boys from working-class or other ethnic and cultural backgrounds were more likely to be branded as disruptive than struggling. The tabloids called it a “modern excuse”, politicians railed against “soft discipline” and in staffrooms teachers muttered about “naughty boys needing a good clip round the ear”. Understanding was minimal – stigma loud.

At school you might have been the bright spark who couldn’t sit still, the one who made teachers laugh and lose patience in the same breath. You were in trouble before you knew you’d done it. You thought you weren’t being difficult, but excuses were unwelcome leading to punishment, detention and unachieved potential. “Focus!” they said. “You’re clever enough to know better.” You learned to perform competence within the rigid and confusing structures that surrounded you. You were painfully sensitive in direct opposition to the Boy Codes you grew up around,* easily sent spiralling in response to perceived rejection or a careless mistake. Fragile self-esteem masked as false confidence became camouflage to avoid the “stupid/lazy/weird” labels so casually attributed to you. You talked fast, improvised, juggled. Underneath, anxiety churned in response.

University or employment brought freedom and chaos as the scaffolding fell away – missed deadlines, forgotten essays or reports, unreturned calls. Perhaps you partied hard, crashed harder. Friends loved your energy then drifted when you disappeared. You instinctively apologised too often, meaning it every time but never sure why it kept happening. Confusion reigned.

By your 20s the initials “ADHD” flickered on screens and in magazines, but adults weren’t supposed to have it. If you mentioned it, people smirked. You began to doubt yourself all over again. Work life in your 30s was a long balancing act reminiscent of school. You produced brilliance in bursts then stalled, procrastinated, or became paralysed by boredom or dread. Emails stacked up like accusations. You told yourself to “just get organised” as though willpower and vitriolic self-criticism could replace wiring. Terms such as “emotional dysregulation”, “short- term/working memory” and “executive function”, or any vocabulary that could soften the edges or ground you, were still alien to you. You were dependable in a crisis yet inconsistent in calm; hard was easy, easy was hard, alongside all the other paradoxes. The guilt was corrosive; the shame of not being able to do things you should just be able to do more deeply embedded. “He’s flaky, so inconsistent,” someone said once, and you believed them.

Now, at 40, exhaustion seeps through everything – the job, your home, the constant noise of screens and the world around you. You wake already behind, chasing lists you never finish. Relationships, money, work, addiction, stability can feel perilous. Coping has become habit, but the strategies wear thin, the mask slipping, not fitting who or where you are now.

What therapy can do

This is where therapy can shift the story. It’s not about curing the past but learning to live honestly with what’s left: to integrate the grief for what might have been, for how hard it didn’t have to be if only you’d known. For those able to access it, therapy offers perspective – a reminder that inconsistency was never moral weakness. It can help to rebuild trust in your own rhythm and bring space for rest and renewal. And for those without formal access to therapy, community, friendship and peer connection can hold that same potential for understanding and change. In a life shaped by pressure and performance, therapy can make the difference between surviving and truly living.

ADHD hasn’t disappeared with age; it’s changed shape, worn grooves into your life. The world still calls for efficiency, yet being human is slower, stranger. Facing patterns decades deep is not easy, but it’s real work – and it’s yours.

In part 3 of this series, we look at what ADHD life is like for men born in 2006. Part 1 can be read here.

 

Reference

* Pollack, William (1999). Real Boys: Rescuing Our Sons From the Myths of Boyhood. New York: Henry Holt & Co.

 

Authors’ note

This piece draws primarily on experiences from white, British, middle-class contexts. ADHD, however, intersects deeply with race, class and gender, shaping who receives understanding and support. We acknowledge those differences and the ongoing need for broader, more inclusive stories.

 

Click the links if you’d like to visit Duncan’s therapy website or Adam’s therapy listing. Their directory entries for Attention Allies.

 

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Published 7 January 2026

 

All rights reserved © Copyright Duncan E. Stafford and Adam Wilson 2026. Unauthorised use and/or duplication of this material without express and written permission from the authors of this post is strictly prohibited. Author contact via website Contact page.

Website version and image © Copyright Attention Allies 2026.

Categories
Men and boys with ADHD

ADHD across generations: Boys and men growing up: 1966–2026 (Part 3: Now you are 20)

The 2000s is when ADHD began to be recognised not just as a childhood issue but as a lifelong condition shaping adulthood too. Blending social insight with personal voices, Stafford and Wilson offer a considered perspective on how shifting attitudes and the overlapping influences of class, culture and access to care have reshaped the struggles, strengths and self-understanding of boys and men living with ADHD across the generations.

ADHD has long been misunderstood and, for much of history, invisible. Yet its impact on those who live with it is profound and ongoing. This third (and final) part of our series charts the evolving landscape of ADHD for those who were born in 2006 and are now 20 years old. But each of the eras in this series has brought its own challenges and breakthroughs, shaped by societal attitudes, available support and, for this younger age group in particular, cultural change. A significant shift came when the diagnostic criteria for ADHD in children and adults were expanded post-2013 with the introduction of DSM-5* and its influence on the NICE guidelines** – meaning more people could access a diagnosis. It’s also important to recognise that these experiences were not evenly distributed; race, class and geography often determined who was punished, who was supported and who was overlooked. Through this journey, readers can gain insight into how ADHD has been experienced, managed and redefined over time – and how hope and resilience continue to grow.

Now you are 20: An era towards awareness?

For a young man in Britain today, ADHD is everywhere – on TikTok, in the misinformation ecosystems, in classrooms and in conversation. Awareness has never been greater yet, beside this, confusion has grown. You may have been diagnosed early, had support plans at school and still feel misunderstood. Or you may have slid under the radar, with school’s still limited resources of the 21st century focused on the loudest, most physically hyperactive and disruptive boys. Teachers varied – some kind, some worn down – but the sense of being “too much” lingers. You might have been called “hyper”, “unmotivated” or, when tempers frayed, “a nightmare”. The words sting even when meant lightly. Your school experiences might also have been complicated by co-occurring conditions such as dyslexia, anxiety or autistic traits – things that often blurred together and made getting the right support even harder. You may, like men in previous generations, have masked these behaviours instinctively, trying to appear “fine” while feeling overwhelmed beneath the surface.

You live in a world that both celebrates and sells individuality and difference. Online, ADHD is content – bite-sized, relatable, sometimes trivialised. It’s easy to mistake recognition for healing. You scroll through others’ stories, nodding in empathy yet still feel apart. Knowing why you struggle doesn’t stop the struggle itself. Every app, every notification, fractures focus further. Distraction has become the default setting of modern life. On these platforms, you see ADHD, autism and other neurodivergent experiences side by side. It can feel validating but also confusing. You might recognise traits in yourself across different diagnoses before any professional does, leaving you uncertain about where you “fit”.

Emotionally, you stand in more open terrain. Talking about mental health isn’t the taboo it once was, especially for men, but openness brings its own pressure – to be articulate, self-aware, constantly improving. You may talk about feelings yet still find closeness hard to hold. Vulnerability can feel like exposure, not connection. You’ve inherited language to make some sense of your experiences, but not necessarily peace. You also have advantages others could only dream of – assessment, a wider range of medications, digital tools, community. Still, awareness isn’t equality. Many young people – particularly those from working-class or marginalised backgrounds – face barriers to assessment or stigma that echo older patterns of exclusion. The promise of progress often depends on who you are and where you live. You might feel both privileged and lost – aware that others your age are still fighting to be recognised at all – equipped with knowledge yet unsure what to do with it.

What therapy can do

Amid this, therapy offers something rare in the 21st century: stillness. For those who can access it, therapy can help you to understand how emotion, fear and energy intertwine and how to pause before spiralling. A therapist can’t fix the world’s pace, but they can help you find your own, bringing you to the present: “Where am I? How do I feel? What do I need?” For many in their early adult life today, therapy may also feel more culturally acceptable than it ever was for previous generations, framed less as a crisis response and more as a form of self-understanding. For others, that same understanding can emerge through friendship, mentorship or community – different but equally valid paths. And with the right support, you begin to notice small shifts: moments where you respond rather than react, where shame loosens its grip, where you catch yourself choosing differently. These are not dramatic transformations but steady ones, building a sense of agency that past generations rarely had space to imagine.Therapy may not make life easy, but it makes it honest – and in a world of noise, that honesty is its own quiet rebellion.

ADHD doesn’t end when you name it; naming is just the start.

Conclusion

From the silent suffering of the 1960s (see part 1), via the start of debate (part 2) to the outspoken, complex digital world of today, the journey of men living with ADHD reveals both progress and persistence of struggle. Each generation has faced a shifting landscape of stigma, misunderstanding and gradual awareness. That landscape has never been experienced equally. Class, race and gender expression continue to shape who is believed, who is punished and who receives care.

Therapy and support have moved from rarity to recognition as vital tools for making sense, healing and self-understanding. Though every age brings its own challenges, the thread that binds them is enduring – the search for acceptance, clarity and a life lived honestly on one’s own terms. As society continues to learn and adapt, so grows the promise that ADHD is not a limitation but a different way of being – one that today merits respect for what it can offer, understanding of what it is and – perhaps most importantly – a future shaped by hope rather than misunderstanding.

 

References

* American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Washington, DC: American Psychiatric Association Publishing

** National Institute for Health and Care Excellence (NICE). Accessed 4 December 2025: www.nice.org.uk/guidance

 

Authors’ note

This piece draws primarily on experiences from white, British, middle-class contexts. ADHD, however, intersects deeply with race, class and gender, shaping who receives understanding and support. We acknowledge those differences and the ongoing need for broader, more inclusive stories.

 

Click the links if you’d like to visit Duncan’s therapy website or Adam’s therapy listing. Their directory entries for Attention Allies.

 

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Published 14 January 2026

 

All rights reserved © Copyright Duncan E. Stafford and Adam Wilson 2026. Unauthorised use and/or duplication of this material without express and written permission from the authors of this post is strictly prohibited. Author contact via website Contact page.

Website version and image © Copyright Attention Allies 2026.

Categories
ADHD and therapy process

The hidden heart of ADHD: How ADHD influences intimacy, friendship and the workplace (part 2)

Part 1 of this article explored how ADHD shapes more intimate relationships – the emotional regulation challenges, communication differences and relational sensitivities that can influence romantic partnerships. In this second part, therapists Bev Woolmer and Duncan E. Stafford turn to two other domains where the impact of ADHD can be heavily felt: the workplace and friendships. The demands of these areas of life can amplify stress for ADHDers, but with self-understanding and appropriate therapeutic support, they can also become encounters for growth, belonging and self-discovery.

(10 minute read)

Navigating the workplace: To mask or disclose?

While ADHD is commonly discussed in terms of focus, energy or productivity, many adults find that its most profound effects show up in how they relate to the people around them. Workplaces – with their implicit rules, shifting expectations, and high relational load – can feel particularly demanding.

One of the first dilemmas many ADHDers face at work is whether or not to disclose their diagnosis. Therapists often see clients wrestling with this decision, weighing the hope for understanding against the fear of stigma or misinterpretation. Below are two imagined case studies of the upsides and downsides of disclosure within a work environment.

The upside of disclosure for a graphic designer

A graphic designer who chose to disclose their ADHD to their manager was offered clearer project briefs, regular check-ins and the option to use noise-cancelling headphones without interruption. With these adjustments, their sense of autonomy increased, their competence felt more supported and their creativity flourished. They became one of the team’s most consistent idea contributors.

The downside of disclosure

At times, the disclosure led colleagues to over-associate the designer’s behaviour with their diagnosis. Both successes and struggles were occasionally attributed to “the ADHD”, which left the designer feeling reduced to a label rather than seen as a whole person. This created moments of discomfort and a sense of distance from the team.

The upside of disclosure for a logistics worker

After disclosing their ADHD, a logistics worker eventually gained access to supports that had not been available before: clearer shift outlines, permission to use planning tools during prep time and an occupational health assessment that identified helpful adjustments. Over time these changes improved predictability, strengthened their sense of competence and enhanced communication with a supportive supervisor.

The downside of disclosure

The initial response to the worker’s disclosure involved increased scrutiny, including stricter route checks and more frequent performance reviews. Instead of feeling supported, they felt monitored and under pressure. This reduced their sense of autonomy and created doubt about how their competence was perceived.

Outcomes

These contrasting experiences reflect what many ADHDers know intuitively: disclosure can lead to meaningful accommodations, or it can inadvertently trigger anxiety and scrutiny from a manager or employer.

When someone chooses not to disclose post diagnosis as an adult, they often increase their masking behaviours – an often-exhausting attempt to appear organised, attentive or calm when internally they may be juggling time blindness, emotional intensity or competing tasks. Masking at work can look like any or all of the following.

  • Overcompensating to appear “on top of things”.
  • Hiding piles of half-finished tasks.
  • Staying late to correct mistakes made during moments of distraction.
  • Suppressing emotional or sensory overwhelm.

Over time, this can lead to chronic burnout. A manager/employer might see “carelessness”, but the ADHDer may be working twice as hard as colleagues just to appear steady. The good news is that even small adjustments can make a significant difference – for example:

  • clear, structured feedback
  • predictable routines
  • transparent expectations
  • noise-cancelling headphones
  • flexibility in how or when tasks are completed
  • written summaries after meetings, and
  • permission to work in focused bursts rather than constantly switching tasks.

When workplaces commit to understanding ADHD, these small adjustments can transform an employee’s confidence and wellbeing. But until awareness is more widespread, many ADHDers will continue carrying the invisible weight of “holding it together”.

Friendships and belonging: The push and pull of connection

The relational themes of Part 1 – rejection sensitivity, emotional intensity and the need for acceptance – often show up just as strongly in friendships. Yet friendships are rarely given the same attention or support as romantic or family relationships, even though they are central to emotional wellbeing.

For many ADHDers, friendships offer lifelines of understanding, humour and connection. But they can also be fraught with misunderstanding, inconsistency or fear of rejection. Common patterns include the following.

  • Rejection sensitivity turning a slow text reply into perceived disinterest.
  • Time blindness leading to missed plans that strain trust.
  • Difficulty with boundaries resulting in giving too much or disappearing entirely.
  • Intense enthusiasm early in friendships, followed by guilt or shame if energy wanes.

These patterns are not failures of character; they are reflections of how an ADHD nervous system navigates connection and overwhelm.

Early experiences of “not fitting in”

Many adults with ADHD carry memories of childhood exclusion for being “too much”, “too loud”, “too intense” or “too sensitive”. These experiences can echo into adulthood, shaping how easily someone trusts new friends or how quickly they assume they’re being rejected. Therapists often support ADHD clients to gently unpick these old wounds, helping them recognise that the child who struggled socially was not “broken” but unsupported in their neurodivergent needs.

Gender, identity and social expectations

Relational dynamics also intersect with gender and social identity.

  • Women and people raised female are often expected to be socially organised, emotionally attuned and highly responsible – expectations that can heighten shame around ADHD traits.
  • Men and people raised male may face social pressure to appear controlled, focused or competent, which can make masking more rigid and emotionally costly.
  • LGBTQ+ ADHDers often navigate a double layer of “otherness”. While queer communities may welcome this sense of otherness, they do not necessarily understand neurodivergence or the specific ways in which ADHD shapes that experience – unless members of those communities are themselves similarly multiply marginalised.

Understanding these intersections helps therapists to support clients with nuance rather than assuming a one-size-fits-all relational model.

Finding a “niche”

A powerful turning point for many ADHDers is discovering friendships or communities where their intensity, humour, creativity or sensitivity are valued rather than criticised. These spaces might be neurodivergent-affirming groups, queer communities, creative circles, fandom spaces or informal networks built around shared interests. Not every friendship needs to last a lifetime to be meaningful; even short-term connections can offer nourishment, validation and hope.

Connecting the dots: From intimacy to workplace to friendship

Across both Part 1 and this part of  “The hidden heart of ADHD”, a consistent theme emerges: ADHD affects every level of human connection.

  • In intimate relationships it shapes communication, attachment and emotional rhythms.
  • In the workplace it influences confidence, masking and how support is negotiated.
  • In friendships it colours sensitivity, boundaries, and belonging.

But challenges also reveal strengths: creativity, empathy, insight, humour, loyalty, spontaneity and resilience. For therapists, partners, colleagues and friends, understanding these dynamics shifts the focus from “managing symptoms” to fostering environments where ADHDers can show up authentically.

Final thoughts: Towards thriving connections

Human beings are social animals but, for ADHDers, building relationships and friendships can be challenging. Having a sense of self and understanding how ADHD shows up for you – and working with that – are often the starting points to navigating relationships in all their forms.

Thriving happens when those with ADHD can identify their needs and articulate these to others. When unmasking is learned, when those with ADHD are seen and valued for their assets as well as their quirks, the joy of connection weaves into those spaces, and sparkles and dances to ADHD’s unique tune.

 

 

Click the links if you’d like to visit Duncan’s therapy website or Bev’s therapy website. Their directory entries for  Attention Allies.

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Published 10 December 2025

 

All rights reserved © Copyright Duncan E. Stafford and Bev Woolmer 2025. Unauthorised use and/or duplication of this material without express and written permission from the authors of this post is strictly prohibited. Author contact via website Contact page.

Website version and image © Copyright Attention Allies 2025.

Categories
ADHD and therapy process Uncategorized

The hidden heart of ADHD: How ADHD influences intimacy, friendship and the workplace (part 1)

From romantic relationships and friendships to life at work, ADHD can have a profound impact on the way we connect. In this article, therapists Duncan E. Stafford and Bev Woolmer explore some of the impacts of rejection sensitivity, communication differences and emotional regulation – offering practical strategies for ADHDers and those who support them to create healthier and more fulfilling relationships.

(10 minute read)

Attention Deficit Hyperactivity Disorder (ADHD) is often discussed in terms of focus, energy and productivity issues. But for many adults, the deepest challenges show up not in their work roles, but in their relationships with others. ADHD can shape the way that love, connection with friends and interactions with colleagues happen. Understanding these dynamics – whether as a therapist, a partner or as an ADHDer yourself – can transform relationships of all types from sources of stress into spaces of growth and support.

The weight of rejection in everyday interactions

One of the most profound experiences for many ADHDers struggling with relationships of any kind is heightened sensitivity to rejection. Often referred to as “rejection sensitivity” or, when experienced more intensely, Rejection Sensitive Dysphoria (RSD)* (Bruised/RSD; RSD and SDT), this emotional response can make seemingly simple interactions – such as a delayed email reply, a curt tone of voice, or even neutral feedback from a trusted person – feel deeply painful. An ADHDer may quickly interpret these moments as “They don’t like me” or “I’ve failed again”, even when no actual rejection has taken place.

This heightened perception of rejection affects more than just the individual; its emotional ripples can extend into friendships, romantic partnerships, family relationships and workplace dynamics. ADHD-informed therapists can play a vital role in helping clients to recognise, challenge and separate emotional reactions from objective facts. This process takes time, but it fosters greater self-awareness and emotional regulation, allowing the client to respond more adaptively rather than reactively.

There’s a number of amygdala-calming** techniques that can help in managing intense emotional responses. These may include physical movement, specific breathing practices, meditation, mindfulness exercises and spending time in nature. Such activities can soothe the nervous system and create space between stimulus and response.

Encouraging the development of self-compassion is equally important. Many individuals with ADHD are their own harshest critics. Therapists can guide clients to notice and soften negative self-talk – inviting them to ask, “What would I say to a friend in this situation?” and considering offering themselves the same kindness.

Practices such as journalling, radical acceptance and sensory grounding can further support emotional regulation. With consistent practice, these tools can reduce the sting of perceived rejection and help clients to navigate emotional spirals with greater resilience, ultimately protecting and strengthening their relationships rather than allowing temporary pain to create lasting ruptures.

Building love: Couples work and romantic partnerships

If rejection sensitivity shows how vulnerable ADHDers can feel, therapeutic couples work reveals how those sensitivities and differences play out in intimate partnerships.

When ADHD is part of a relationship – whether in one or both partners – its effects can ripple through daily routines, implicit and overt communication, and intimacy. Couples therapy can play a powerful role in helping to smooth the “bumps” that ADHD introduces into relationships. However, doing so requires flexibility and creativity from the therapist, as well as genuine curiosity and openness from both partners. Together, the couple must be willing to examine not only their individual patterns and ways of relating, but also to collaboratively build a new paradigm – one that co-creates a new functional and successful relationship,

Defining the couple: Therapists must acknowledge and recognise that couples come in many forms. Beyond neurodivergent pairings, relationships also exist within diverse structures and identities – including, but not being limited to, polyamorous constellations, queer partnerships or kink-based dynamics. ADHD manifests and plays out differently across these relationship forms, and sensitivity to each couple’s unique context is essential.

Relationship differences: A neurotypical partner may find comfort in structure and routine, while a partner with ADHD might thrive on novelty and spontaneity. Two partners with ADHD may feel deeply understood by one another, yet still face challenges around organisation or household management. In ADHD–autistic partnerships, the dynamic can be “beautifully” complementary or sometimes more complex – each pairing offering unique opportunities for understanding and growth.

Therapy engagement: Because of these dynamics, practical and open therapy approaches work best when they are engaging and/or embodied. Approaches that include, for example, transparent, self-disclosing discussions, creative problem solving, and activities and experiential role-play can all supercharge the process. Traditional sit-and-talk therapy may often feel restricting or even fall flat for some ADHD clients, especially those who learn best by doing.

Challenges: Yet even with open – “creative” – strategies, living together often magnifies ADHD challenges. The “drudge” of household routines, bills and chores can quickly become battlegrounds, especially under stressful living circumstances (as many couples discovered during COVID-19 lockdowns). Emotional regulation also plays a huge role. Impulsive reactions, for example, may be continually misinterpreted as hostility, when in more measured review it is clear that they’re simple expressions of overwhelm.

Creating a supportive home might mean:

  • structuring the environment to minimise distractions
  • respecting the need for personal space, and
  • allowing for differences in organisation and tolerance.

Structure can also be helpful in terms of managing household tasks and responsibilities.

ADHDtime: One powerful concept we use is what we call “ADHDtime”. This can be particularly useful to raise with mixed neurotype couples. ADHDtime is the moments or stretches within a day when the person with ADHD can unmask – when they are free to be fully themselves without having to conform to neurotypical expectations or social norms. During ADHDtime, there’s permission to follow curiosity, to hyperfocus, to move, to rest, or to switch tasks without judgement. The time might, for example, look like: pacing while listening to music, diving into a creative project late in the day, or needing a few quiet hours alone after a socially demanding period.

For some, ADHDtime might mean working in bursts rather than sticking to a rigid schedule, or expressing emotion with greater intensity and spontaneity. For others, it could be a period of stillness – time to recharge without pressure to “be productive”. These are not signs of dysfunction but expressions of a different rhythm, one that values authenticity over performance.

In healthy relationships, both partners learn to recognise and respect these rhythms. A supportive partner might understand that the ADHDer’s need to retreat or switch focus isn’t avoidance or disinterest, but a way of regulating energy and emotion. Similarly, the ADHDer can learn to communicate what they need, reducing misunderstandings. Over time, this mutual awareness helps to build trust and connection. When both people can acknowledge and tolerate difference – rather than seeing it as something to fix – they create space for genuine understanding, acceptance and emotional safety.

Attraction patterns: Why ADHDers can choose challenging partners

Alongside the dynamics within established partnerships, some people with ADHD also find themselves drawn to partners who appear avoidant, controlling or even coercive. This can sometimes stem from a high tolerance for stimulation or learned association between intensity and connection, which may unintentionally overshadow the need for safety and stability. Others may find it difficult to recognise unhealthy dynamics or boundary violations until the relationship has already become distressing or hard to leave.

This pattern reinforces why awareness is so crucial. With the right support, ADHDers can begin to notice red flags earlier, challenge unhelpful attraction patterns and seek out partners who offer stability without sacrificing passion.

In the second part of this article we will turn to two other domains where the impact of ADHD can be felt heavily: the workplace and friendships. The demands of these areas of life can amplify stress for ADHDers, but with self-understanding and appropriate therapeutic support, they can also become encounters for growth, belonging and self-discovery.


Footnotes
* Although RSD doesn’t yet constitute a formal diagnosis, it is a term that resonates deeply within the ADHD community.

** While some studies have reported differences in the amygdala among individuals diagnosed with ADHD – such as reduced volume or altered functional connectivity with the prefrontal cortex – these findings have not been consistently replicated. Evidence suggests that smaller amygdala volumes may be linked to difficulties with impulsivity and emotional regulation in certain individuals with ADHD, yet other studies report no significant volumetric differences or highlight region-specific variations instead. The amygdala, a central structure involved in emotional processing and the integration of affective responses with memory, is shaped by a complex interplay of biological, environmental and experiential factors. Thus, interpreting such variations purely as indicators of dysfunction risks oversimplifying the nuanced neurodevelopmental profiles associated with ADHD. This interpretation echoes broader critiques within psychiatry that caution against over-medicalising attentional and emotional differences which may represent natural expressions of human neurodiversity.

 

 

Click the links if you’d like to visit Duncan’s therapy website or Bev’s therapy website. Their directory entries for  Attention Allies.

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Published 1 December 2025

 

All rights reserved © Copyright Duncan E. Stafford and Bev Woolmer 2025. Unauthorised use and/or duplication of this material without express and written permission from the authors of this post is strictly prohibited. Author contact via website Contact page.

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Psychology models for ADHD: Beginning to rethink Kahler’s Drivers for neurodivergent brains

In another of our express read articles, transactional analysis-trained therapist Hayley Watkins explores classic psychology models through an ADHD lens and reveals a gap in how traits such as “Pleasing Others” or “Perfectionism” are experienced by neurodivergent brains.

(3 minute read)

I had a fascinating conversation with a client a few weeks ago.

To set the scene, I’ll quickly introduce myself: My name’s Hayley, and I love the mechanics of therapy. Don’t get me wrong, I enjoy connecting with my clients and being right there beside them while they go through life’s trials and tribulations, but for me, there’s a wonderful power in exploring what’s actually happening in whatever situation my client is facing.

Empathising with you because your dad keeps making withering remarks to you about why you can’t be better is what I’m here for. But knowing that your dad’s disappointed because he’s simultaneously expecting you to …

  • prove to him you’re a big boy/girl now who bows to nobody, not even him, and
  • defer to him because he’s the big guy around here and always will be (and probably isn’t ever going to see it any other way because “psychology doesn’t exist”)

… robs dad’s words of their sting.

That’s why I love a spot of psychological sleuthing – if and when my client is ready for it, of course!

Interestingly, talking with my client made me look at a model I use for that sort of sleuthing with fresh eyes.

We were exploring psychologist Taibi Kahler’s Drivers. Kahler identified five unconscious drivers – Be Perfect, Please Others, Hurry Up, Be Strong, Try Hard – that can foster both positive and destructive behaviours. Recognising them helps to cultivate the positive and manage the negative (Kahler, 1975), and I realised that Please Others works rather differently if you have ADHD, or autism, and perhaps all sorts of other neurospices.

Pleasing others is often taught from a neurotypical perspective: if you have a Please Others driver, you appease other people; you’re probably a social butterfly, communicate effectively, work well in a team …

But what is masking? Surely that’s Pleasing Others? Most of us – therapists, client and never-been-a-client alike – will be familiar with the effort we put into masking and how thankless it is. You can work hard to keep everyone happy and not upset anyone, but the rest of the group won’t remember the 19 times you got that right; they’ll remember the one time you misjudged it (or forgot to wait for the other person to stop talking, or showed up late, or used too direct a word … take your pick).

How about Be Perfect? How hard do you, reader, work at maintaining your diary so you’re not late for things? Surely the effort it takes to admin your way past an ADHD brain requires a perfectionism that most neurotypicals don’t get to see. They only see the end result: you showing up on time, which hardly looks like perfectionism. Yet, here we are.

I could explore Be Strong, Hurry Up and Try Hard too, and if this blog post does well I can revisit them, but I think we can see the problem here already.

Don’t get me wrong: I love this model, and I can’t tell you whether Dr Taibi Kahler considered neurodivergence while developing it (though it was developed in 1975, when there was so much less focus on neurodivergence, so it’s hard to be sure), but this is a dimension I wasn’t taught in college – to explore models to see whether they really fit my brain, or the brains of my clients. It’s important to make sure we do. Otherwise, it only tempts us to continue to hold ourselves to unreasonable standards – and that’s not therapeutic.

 

Reference
Kahler, T. (1975). https://authentictalent.be/tools/the-five-drivers-by-taibi-kahler/ (accessed 28 October 2025).

 

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

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Published 17 November 2025

 

All rights reserved © Copyright Hayley Watkins 2025. 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.

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Categories
ADHD and Film

Films, family and ADHD

Films can hold up a mirror to the ADHD experience, offering moments of recognition, release and repair. In this reflective piece, Attention Allies counsellor Caroline O’Brien explores how cinema becomes a bridge between emotion and understanding – revealing how stories on screen can help families to navigate the complexities, tensions and connections that come with living with ADHD.

(6 minute read)

I love films and going to the cinema. It’s my ultimate escape, a chance to lose myself in a story and distract myself from my world. It’s also an opportunity to connect with the full range of my emotions and to reflect. Films sometimes crop up in my counselling conversations too. Reconnecting with the imagery, characters or narrative of a film can be a powerful way for people to identify, explore and process their experiences without feeling overwhelmed.

It’s amazing how film can do this. I remember watching Three Billboards Outside Ebbing, Missouri (2017) and unexpectedly connecting with feelings of intense rage as Mildred Hayes, a bereaved mother played by Frances McDormand, railed against the church and local law enforcement. I didn’t even know I possessed this rage when the film began, but there it was on the screen and in me at the same time. I learnt a lot about myself through that movie, and it helped me reflect on some difficult aspects of my formative years.

A film I remember for very different reasons is Everything Everywhere All at Once (2022). Firstly, because its complex narrative nearly melted my head, and secondly, because of the insight it gave me into what it is like to be my adult ADHD son* and why so many things seemed so difficult for us both when he was growing up.

For readers unfamiliar with the film, it’s the story of Evelyn Wang (played by Michelle Yeoh), an immigrant laundry owner in San Fernando, California, who connects with parallel versions of herself and “verse jumps” between different realities, battling to close a hole in the multiverse while also trying to run a laundry, complete her tax return and manage her relationship with her husband and teenage daughter.

Everything, everywhere, ADHD

I wasn’t aware when I watched Everything Everywhere All at Once that it was written with an ADHD character in mind, or that the writer and director, Daniel Kwan, first recognised his own ADHD while researching for the story. With hindsight, it’s no surprise it would take the brilliance of an ADHD brain to create a work of such intensity and frenetic pace that it could make my head feel like it had just been through several rotations in one of Evelyn’s washing machines. My son, on the other hand, emerged deeply satisfied by a cinema experience so stimulating for him that it shut out all distractions and occupied all his brains at once. I say “all his brains” because that’s how it feels as his parent; it’s like he has several brains firing simultaneously, or perhaps one super-brain with substations that can multitask, drop balls, pick them up (hopefully), add a few more in and achieve all kinds of wonders that I can’t. Often his brain works faster and on more impulses and parallel tasks than one man can realistically manage – meaning balls get dropped, people get frustrated and trials sometimes follow in the wake of his successes. Like us all, he’s learning – and I am learning to understand and support him, sometimes better than I could when he was a child.

So many things about our relationship make sense now – for example, why we could never agree on a film to watch (turns out he wasn’t just being difficult); why he would repeatedly ask me for a lift at the last minute (time optimism and the need for urgency before action were a repeated source of friction); and why we would get locked in disagreements (his hyperfocus and our mutual sensitivity to criticism ensured we each felt unfairly attacked by the other, every time). Aside from ADHD, we are both highly sensitive people (HSPs) and, as with Everything Everywhere All at Once, there were multiple themes – including family loss and generational trauma – interwoven in our narrative. It was tough!

Talking to family about ADHD

Perhaps unsurprisingly, family relationships feature a lot in my work with ADHD young people and adults, many of whom have only recently received a diagnosis. As was the case in our family, learning that you have ADHD can make sense of a lot of early experiences and this can feel both freeing and fraught at the same time. Navigating this with a counsellor or coach can help, particularly if they are neurodivergent themselves or have training and experience in supporting others who are. There can be a lot to process and, like the film’s protagonist, the people I meet are often trying to do this alongside managing a career or business, raising a family and generally fending off the force of an increasingly challenging world.

For some, talking things through with a counsellor can make sufficient sense of the past. Experiences can be explored and integrated, and people can start to feel more at ease with themselves and in their relationships. For others, conversations with family members feels important. Finding a way to approach and manage these conversations can seem daunting and knowing a counsellor is alongside you as you do so can be hugely supportive.

Sometimes people conclude that talking with family is too difficult, especially where parents are still holding their own unprocessed trauma or emotional difficulties and perceive conversations about family life and parenting as criticism. Others have parents who refuse to accept ADHD as a legitimate diagnosis or explanation for past or present events, leaving people wrestling with feelings of abandonment and isolation. Sharing this in a counselling environment is not necessarily easy but it can make the difference between coping and not coping, and open doorways to self-acceptance and inner growth.

Finding support

If this resonates, reading some of the other blogs on this website or exploring the options for in-person support could be a helpful next step. There are therapists here who will recognise your story and are able to listen, understand and support you. Referencing films is not a requirement, but if it helps, give it a go. If talking about movies helps you dialogue and get to the essence of what you’re thinking and feeling, that has to be good.

 

*I have created this article with the kind permission of my son.

 

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

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Published 3 November 2025

 

All rights reserved © Copyright Caroline O’Brien 2025. 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.

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IMPULSE: Playing with Reality – a review

As a therapist specialising in ADHD and the founder of Attention Allies here in Bristol, I’m always drawn to creative projects that attempt to illuminate what living with ADHD feels like from the inside. IMPULSE: Playing with Reality is one of the most inventive and affecting examples I’ve encountered – a 40-minute mixed-reality (MR) experience that transforms not only the space around you but your relationship with focus, frustration and control.

(3 minute read)

Blending game design, immersive storytelling and psychological provocation, IMPULSE pulls the participant into a world that feels at once playful and unsettling. The interactive “game” elements are brilliantly executed – simple on the surface yet calibrated to provoke the very sensations that so many people with ADHD know intimately: the pull of distraction; the irritation of missed cues; the sudden flood of stimulation followed by the crash of fatigue. As I moved through the MR presentation, I found myself fully engaged at how acutely it captured that cadence of hope and exasperation – of wanting to master the task while feeling it constantly slip away from you.

The narrative unfolds through the voices of two women and two men – each offering a foundation to ground the piece. Their stories offer a kind of psychological landscape, through which to explore impulse, emotion and attention. The creators have succeeded in presenting ADHD as something more textured than a set of symptoms, using metaphor and sensory design to evoke how thoughts can scatter or converge in unexpected ways. While the portrayals may not yet capture the full diversity of ADHD experience – particularly across class, culture and the huge difference ADHDers feel with differing levels of hyperactivity, medication and attentional focus – the MR presentation certainly resists the worst clichés and offers something accessible without oversimplifying. A deeper range of stories might have broadened the emotional resonance but what’s here is both generous and thought-provoking.

What impressed me most was how IMPULSE invites empathy through experiential participation rather than explanation. It doesn’t lecture the audience about ADHD; it lets them feel the effort, confusion and wonder of a mind that doesn’t easily settle. For many non-ADHD viewers, it will be a powerful gateway to understanding. For those who live and/or work with ADHD every day, it may feel like recognition – an imaginative reflection of an inner world that is, at last, being rendered much more visible.

IMPULSE: Playing with Reality is an outstanding example of how immersive art can deepen understanding, evoke emotion and open new conversations about ADHD neurodiversity.

Duncan E. Stafford (Attention Allies Founder)

IMPULSE: Playing with Reality  plays at the Watershed (Undershed) until 2 November https://www.watershed.co.uk/whatson/13537/impulse-playing-with-reality

 

 

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

 

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Published 20 October 2025

 

All rights reserved © Copyright Duncan E. Stafford 2025. 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.

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Categories
ADHD and therapy process

Shared journeys: Redefining the therapist’s place in ADHD therapy

Therapy works best when it feels human. In this article, therapists Bev Woolmer and Duncan E. Stafford (Attention Allies founder) share why adopting a partnership model can transform ADHD therapy and lead to more meaningful outcomes.

(8 minute read)

The words we use to describe therapy carry deep meaning. Psychotherapy derives from the Greek roots of psyche, “soul”, and therapeia, “healer”. Counsellor is often attributed as meaning “someone who walks alongside”. These terms remind us that therapy has always been more than expertise. At its best, it is about journeying, guiding and carrying together. Yet in practice, the way therapy is structured does not always reflect this.

Moving beyond “expert mentality”

In the past, counselling and psychotherapy often placed the therapist in the role of “expert”. Historically this made sense, as early psychotherapists and analysts were psychiatrists – medical doctors whose authority carried weight both inside and outside the therapy room. Over time, therapists came to be seen as interpreters of truth, guiding clients from known and potentially fixed positions with roots in a medical model and the power that comes from that position.

For some, this approach, even now, could feel safe and reassuring. But for others, especially those with ADHD, it can create distance. If therapy feels like a top-down process where the therapist holds answers, clients may feel alienated. Certain therapy styles and modalities, if delivered rigidly, risk reinforcing imbalance. ADHDers often benefit most when approaches are adapted to be collaborative and flexible.

ADHD is often misunderstood in wider society. Many clients arrive in therapy with long histories of being judged, criticised or told they are “too much” or “not enough”. When we as therapists place ourselves on a pedestal, we risk repeating those patterns of disempowerment.

We believe that a pro-active approach whereby we are focused on equity is essential in working side by side with clients. We all have power and agency. Creating a relationship that shares power with another can be transformative; it strengthens collaboration and humanises the process making therapy more accessible and impactful.

Expert model vs partnership model

Aspect of therapy Expert model Partnership model
Therapist role Authority, interpreter, fixer Collaborator, guide, co-explorer
Relationship dynamic Hierarchical, top-down Equitable, being a supportive ally
Client experience Can feel judged, passive or dependent Feels validated, empowered and actively engaged
View of ADHD Pathology to be managed or corrected Lived experience with strengths and challenges to be honoured
Communication style Directive, advice-driven Curious, flexible, collaborative
Session structure Therapist sets focus and pace Client-led, supporting client’s goals
Humanisation Therapist maintains professional distance Authentic presence, appropriate self-disclosure
Growth process Therapist provides strategies clients should adopt Exploring strategies with client; autonomy as to what feels right for them

 

The power of humanisation

Research shows that trust and connection are the foundation of effective therapy. Humanising the process reduces distance and fosters real engagement. This is not about oversharing but about showing enough of ourselves to make therapy feel like a genuine relationship rather than a one-sided performance.

  • Sharing personal narratives: When appropriate, we may briefly share an experience of our own. This can normalise struggle, reduce shame and remind clients that therapists are also human beings navigating life.
  • Using anecdotes: Real-world examples help to make abstract concepts more tangible. A story about missing a train or juggling competing demands can suddenly make executive function challenges easier to grasp.

These small acts shift therapy from a top-down exercise to a meeting place of two people, where genuine connection and integrity is prized, honoured and valued. ADHD therapists can offer mirroring, celebration of authenticity, realness and directness, by speaking the same language within the neurodivergent umbrella.

Self-Determination Theory in ADHD therapy

Another framework we find invaluable is Self-Determination Theory (SDT) (Empowering ADHD/NT couples with self-determination theory (SDT) and Can autonomy, competence and relatedness be the ADHDers’ defence against RSD?). SDT identifies three core psychological needs:

  • Autonomy: Supporting clients to feel in control of their choices and relationships. For ADHDers, who may have experienced repeated attempts by others to control or “manage” them, creating or restoring autonomy can be profoundly healing.
  • Competence: Helping clients build the skills to manage life’s demands more effectively. This might include practising communication strategies, creating realistic planning systems or role-playing difficult conversations.
  • Relatedness: Strengthening connections that feel authentic and supportive. Therapy itself can model such connections, while also exploring how clients can cultivate it in their wider lives.

When we integrate SDT into our practice we create environments where ADHD clients feel engaged, confident and empowered to grow.

Partnership in action

So what does partnership look like in practice? Sometimes it means walking alongside. At other times it means getting into the boat with the client – picking up an oar to demonstrate a stroke or simply floating together as they show us their own way of navigating the waters.

Partnership also means listening closely to what ADHDers tell us works for them. Some clients, for example, will respond best to visual tools; others to movement-based exercises or felt-sense approaches. Our role is not to impose a method but to remain curious and flexible.

We also acknowledge that ADHD affects relationships, workplaces and friendships in distinct ways. Rejection sensitivity (Bruised/RSD), masking at work or difficulties with boundaries can all have profound impacts. By working collaboratively, we can explore these challenges without judgement and support clients to experiment with new ways of relating.

Towards a more human practice with ADHDers

As therapists specialising in ADHD, we see daily how powerful this shift can be. When clients are treated as equals, shame diminishes. When they experience us as partners in change rather than judges, resilience grows. When we openly acknowledge the challenges of ADHD while also celebrating creativity, spontaneity and intensity, meaningful change becomes possible.

As a profession, we are continuing, on the whole, to move away from models that position us as distanced experts. The future lies in approaches that are responsive, relational and deeply human. If we can embrace this shift collectively, we can create spaces that empower ADHDers and enrich our practice at the same time. As therapists, embracing partnership means humility in practice: inviting feedback, co-creating session agendas and showing clients that we don’t have all the answers, but that we are committed travelling companions. By taking this stance, we can build relationships that dismantle shame, grow resilience and allow ADHDers not just to cope but to thrive.

Therapy is not about fixing people. It is about walking alongside, in all seasons and all weathers, embracing the messiness of life as well as its beauty and joy. It is being with people, accepting who they are, their emotions and feelings, and being prepared to climb in the boat and sit with them seeing where the current takes us.

 

Click the links if you’d like to visit Duncan’s therapy website or Bev’s therapy website. Their directory entries for  Attention Allies.

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Published 5 October 2025

 

All rights reserved © Copyright Duncan E. Stafford and Bev Woolmer 2025. Unauthorised use and/or duplication of this material without express and written permission from the authors of this post is strictly prohibited. Author contact via website Contact page.

Website version and image © Copyright Attention Allies 2025.