Adult ADHD-Focused Couple Therapy. Why create a special model to help couples challenged by Adult ADHD—in one or both partners? Why not just try standard couple therapy? Four questions and answers go a long way toward explaining that.
In case you missed it, my second book (with psychologist Arthur L. Robin) is Adult ADHD-Focused Couple Therapy: Clinical Interventions. It is the first and only clinical guide presenting a couple-therapy model based on the evidence—a careful merging of what works for Adult ADHD and what works for couple therapy.
Through his decades in private practice, Dr. Robin has long helped individuals and couples affected by ADHD. His strategies are battle-tested. In his primary occupation, he trained psychologists working at a children’s hospital. Both his ADHD expertise and skill as an educator shine through our model’s interventions. We share a belief that, to help ADHD-challenged couples, we must begin with teaching basic strategies and gradually expand to include more complex, emotional issues.
Based on our model, we are currently developing online training, for consumers and clinicians, at ADHDSuccessTraining.com —anticipated delivery: early spring 2020.
Routledge Press invited the Twitter public to ask us questions, with our answers to appear on the publisher’s page for the book. This prestigious publisher of professional guides named us its Authors of the Month.
I’ve reprinted the first four questions and answers below.
1. What made you decide to write this book?
First, the situation is dire for ADHD-challenged couples worldwide. The past decade has seen an explosion of Adult ADHD awareness. Couples desperately seek clinical expertise and guidance. Yet they rarely find it.
Second, evidence-based interventions exist for adult ADHD (though rarely available). But no established interventions existed for ADHD-affected couples. We wrote this book to fill this void, by carefully blending two critical components:
- Evidence-based interventions for adult ADHD
- Evidence-based couples’ interventions with sound behavioral principles.
(The term evidence-based means that published research has shown these methods effective. These are not simply personal, self-styled opinions.)
To summarize, we wrote this book so that all therapists can
- Understand how unrecognized or poorly managed ADHD can thwart positive clinical outcomes, and
- Implement state-of-the-art interventions designed to enrich their practice and clients’ lives.
In 250 tightly written pages, we present:
1. Supporting background on Adult ADHD for professionals new to the topic
2. Our flexible model, which acknowledges that many ADHD-challenged couples actually have a good relationship. They don’t need therapy per se. They need help learning and implementing practical, organizational challenges!
3. Step-by-step interventions targeting organizing (of time, priorities, and “stuff”), communication, procrastination, working as a team, managing finances, co-parenting, electronic addictions, and more.
4. Throughout the book, case couples illustrate how the interventions work in real life.
2. What is one thing you hope readers take away from this book?
Adult ADHD is not a fringe sub-specialty. Every mental-health professional should be familiar with its signs and treatments.
Conservatively speaking, researchers estimate worldwide ADHD prevalence rate at about 5 percent. More realistically, however, an estimated 10 -15 percent of the population suffers at least moderate ADHD-related impairment.
Consider the U.S. alone: 23-35 million adults with ADHD yet only 1 in 10 is diagnosed. Fewer still have received any type of treatment. We find similar prevalence rates worldwide.
An alarming fact: Adults with ADHD are much more likely to be diagnosed with conditions secondary to ADHD—depression, anxiety, substance-abuse, and even attachment disorders. Sometimes for decades (Misdiagnosed Until 39: “Best Week of My Life”)
When treatment misses the core issue of ADHD, however, positive outcomes are rare. In fact, the wrong diagnosis and wrong treatment even risks exacerbating ADHD challenges.
Couple therapy represents an excellent opportunity to screen for ADHD. In so doing, these couples gain a chance to enjoy real and lasting change. In fact, we maintain that undiagnosed ADHD is over-represented among couples seeking counseling.
Expanding the helpful reach even further: The interventions in Adult ADHD-Focused Couple Therapy ™ stand to help even greater numbers of people. That includes individuals who struggle with similar behaviors yet do not fully qualify for the ADHD diagnosis. After all, the associated traits of ADHD—procrastination, distractibility, emotional dysregulation, impulsivity, and the like—fall on a continuum in the human population.
3. Is there another point you’d like to highlight about this topic?
Yes! There is hope for couples teetering on the brink of disaster due to the poorly managed impact of adult ADHD on their relationships.
That hope, however, depends on understanding one critical point: ADHD has its basis in neurobiology. Brain-based challenges underlie many of the issues that bring these couples to therapy—problems around money, sex and intimacy, chore-sharing, co-parenting, communication, and the like.
Perhaps this endorsement drives home the point best. It comes from noted couple-therapy expert Douglas K. Snyder, PhD, co-editor of Treating Difficult Couples and the Clinical Handbook of Couple Therapy (5th ed.)
Couple therapy has moved well beyond interventions for intimate relationship distress. Increasingly, evidence-based extensions of couple therapy have been developed for treating emotional, behavioral, or physical health problems in one or both partners.
ADHD presents a critical destabilizing influence on couple relationships that has, heretofore, been largely understudied and under-treated. This book offers a treasure trove of evidence-based interventions for helping partners to cope with this personal and relational challenge.
4. What is a common misconception about this topic that you would like to clear up?
Misconceptions about ADHD flood the Internet and popular media—and even the mental-health profession. We address several common myths in the book, including that the ADHD diagnosis pathologizes “normal human behavior” and that couple therapy should be all about “appreciating differences.”
Taken by themselves, ADHD symptoms are indeed “normal human behaviors.” But it is both the number and intensity of these behaviors—combined with actual impairment in life—that makes the diagnosis.
Far from being a “new invention,” ADHD cuts across many of the problems that have historically brought legions of people to therapy, especially couple therapy. Yet, because their Adult ADHD was missed or its interventions poorly understood, these clients have rarely received—despite their therapists’ best intentions and efforts—the clinical guidance needed to make lasting changes.
Since the 1990s’ so-called Decade of the Brain, revolutionary brain-imaging methods have exponentially increased our understanding of this most complex human organ and, thus, conditions such as ADHD. To date, according to PubMed, more than 15,000 papers with ADHD or ADD as a major focus have been published since 1970.
The literature makes clear: ADHD is real, it is more common and impairing than most people realize, and its targeted treatments can be highly effective.
Equally well documented: ADHD neurobehaviors, when left unaddressed, can limit the options, the self-fulfillment, and even the physical health of the people who have it and adversely affect everyone in their spheres of influence.
First published August 3, 2016