After four years of collaboration, research, and writing—and bringing a combined 50 years of experience—psychologist Arthur Robin, PhD, and I are proud to introduce the first professional guide to Adult ADHD-Focused Couple Therapy™.
It’s nothing short of a revolution in how we support ADHD-challenged couples and individuals—both in therapy offices and at home.
For nearly two decades, I’ve heard from readers and support-group members whose experiences echoed mine and my husband’s:
- Therapy that didn’t “get” ADHD
- Professionals applying one-size-fits-all strategies
- Efforts that left both partners discouraged—or worse
That’s why we created this model. And it’s why I also built companion online training—to bring these essential strategies directly to both consumers and clinicians.
Why ADHD Couple Therapy?
For decades, I’ve heard from readers and members of my discussion group (running since 2004) as they shared their relationship challenges. One theme came through clearly: Traditional couple therapy wasn’t working. Too often, it made things worse.
The stories poured in—conflict, confusion, emotional exhaustion, children caught in the crossfire. Couples left therapy more discouraged than when they started. I recognized much of it from my own marriage.
Years ago, after my husband’s ADHD diagnosis in 1999, we finally gave up on couple therapy. We couldn’t bear the thought of paying another therapist while trying to “train” them in ADHD ourselves. We needed help, not blank stares or puzzled expressions.
It wasn’t that these therapists didn’t care. They just didn’t have the tools. The usual approaches to “communication” and “connection” didn’t apply—and sometimes made things worse. For example, we could talk a blue streak about the lack of cooperation in sharing household tasks and life responsibilities. Talking about the problems only made things worse. We needed action steps, proven strategies, real-life “hacks”.
So we tried to figure it out ourselves. It was a steep, sometimes painful, learning curve. But we made it. And now, through two widely praised books and direct-to-consumer online training, I’ve worked to shorten that curve for others.
Until Now? Mostly Two Poor Choices of ADHD Couple Therapy
For years, ADHD-challenged couples have faced two dismal choices—both almost guaranteed to fail:
Couple therapy that lacks ADHD-specific knowledge
ADHD treatment that overlooks the partner and the relationship—and might not even be evidence-based
As I wrote in Is It You, Me, or Adult A.D.D.?, the wrong therapy can be worse than no therapy at all.
That’s why Dr. Arthur Robin and I created a new model—Adult ADHD-Focused Couple Therapy™—one that carefully integrates two sets of proven approaches:
Effective couple therapy methods
Evidence-based adult ADHD treatment
This isn’t built on vague ideas about “communication,” “vulnerability,” or “intimacy.” It’s grounded in research and over 50 years of combined clinical experience.
And make no mistake: we focus on both the practical and the emotional. Why? Because emotional intimacy can’t thrive—let alone resuscitate—when the laundry piles up, the budget’s in shambles, and key responsibilities keep falling through the cracks.
What’s Different About Adult ADHD-Focused Couple Therapy™
Three times, the publisher asked me to write a professional guide for mental-health professionals working with ADHD-challenged couples. Twice, I declined. I simply couldn’t afford to take on even more pro bono work.
Typically, these kinds of clinical guides are written by academics—people with salaries and a mandate to publish. That’s not me.
By the third request, my week had been filled—again—with heartbreaking stories from couples still struggling, despite years of weekly therapy. Their stories echoed the same refrain I’d heard for two decades.
Against my better judgment, I relented. On one condition: that psychologist Arthur L. Robin, PhD, agree to co-author the book. We’d co-presented for years at professional conferences, and I knew we shared the same vision. Bless him—he said yes.
Four years later, the book is here. And with its debut, Routledge Press named Dr. Robin and me January Authors of the Month.
Experts Endorse Adult ADHD-Focused Couple Therapy™
Top experts in general couple therapy and in Adult ADHD praise this comprehensive, pragmatic guide.
Endorsers include psychologists Harville Hendrix, Douglas K. Snyder, and Russell Barkley, along with physicians Patricia Quinn, Lily Hechtman, Philip Asherson, and Martin Kutscher.
Click here to read the full endorsements and learn more about these experts.
What’s Inside Adult ADHD-Focused Couple Therapy™?
In 250 no-nonsense pages, the book covers the full range of clinical strategies for ADHD-affected couples, including:
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Explaining the diverse challenges ADHD-challenged couples face
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Applying highly practical, research-informed interventions
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Healing what we call the “Adult ADHD-Focused Dysfunctional Interaction Cycle”
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Working together on chores, planning, finances, electronic overuse—even sexual intimacy
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Understanding how to optimize ADHD medication—and how couple therapists can support the process
We’re also grateful for contributions from respected colleagues, including psychologist J. Russell Ramsay, who shares a couple-therapy adaptation of his CBT model for adult ADHD.
Table of Contents: Adult ADHD-Focused Couple Therapy™
For a quick overview, here is the book’s Table of Contents:
I: Adult ADHD and Relationships
- Meet the Couples and Their Common Challenges, Gina Pera
- Principles of ADHD-Focused Couple Therapy, Gina Pera
II: ADHD Couple Clinical Interventions
- Psychoeducation (Psychological Education on all things Adult ADHD), Arthur L. Robin, PhD
- Cognitive-Behavioral Therapy Model for ADHD-Challenged Couples, J. Russell Ramsay, PhD
- The Role of Medication, Gina Pera and Arthur L. Robin, PhD
- Behavior and Habit Change, Arthur L. Robin, PhD
- Imago Relationship Therapy Adapted for ADHD, Carol Ann Robbins, PhD
- Co-Parenting Strategies, Barbara Easterlin, PhD
Section III: Special Topics
- Money, Gina Pera
- Cyber-Addictions, Kevin Roberts, MA
- Sexual Intimacy, Gina Pera
For More Details on ADHD Couple Therapy
For more details on the topics: The Skyrocketing Demand for ADHD Couple Therapy.
Online Training! Therapists and Consumers
Now, we are excited to be offering online training for consumers and professionals alike: ADHD Success Training: Solving Your Adult ADHD Puzzle
The training is soup-to-nuts. It’s designed to help you, the adult with ADHD or loved one. This is what proper therapy for Adult ADHD looks like, individual or couple, but is almost impossible to find. For real-time discussions, join our Zoom meetings! Gina facilitates.
Professionals will find this training clearly detailed and step-by-step. While many clinical guides are largely narrative, this one focuses on specific interventions known critical for ADHD-challenged individuals and couples to get traction.
—Gina Pera
30 thoughts on “Revolutionizing ADHD Couple Therapy”
Hello Gina. I write from Mexico City. Late last year my girlfriend was diagnosed with ADHD. At first I did not think that this was the cause of various problems that we have had during the almost five years that we have been dating. Do you have any contact email to talk about my situation? I am looking for help, to understand my girlfriend better, and to know what I can do, since we have been through many stressful moments. Greetings.
Hi Victor,
You’re in luck. Mexico has a wonderful foundation devoted to ADHD. I donated the copyright for its translation of my first book, which seems to still be available at the website. I’m sure there are other resources, too.
Here is the link. https://www.cerebrofeliz.org/producto/eres-tu-soy-yo-o-el-tdah-en-adultos/
I also offer online programs. https://ginapera.adhdsuccesstraining.com/
I hope this helps,
G
Do you have a referral (or two or ten) for a person who does video counseling for couples and implements your approach. Yep, I’m one of those who doesn’t have the time nor patience to explain the chaos level in my home to a counselor and then help that counselor treat myself and my spouse (“all the while paying” haha, hall of fame hilarious). Bah. I could use your book on my own, but I’m dealing with some pride issues in my spouse. They would not take me “teaching/leading” them well and thy sure won’t be taking the time to go through it themselves. Frustrated, angry, and at the end of my rope. Again help (in the form of a referral) would be appreciated.
Hi Gordy,
I feel your pain.
If I had enough professionals to refer to, I wouldn’t have spent 4 hard years producing the first ADHD couple therapy guide based on the evidence of what works. Not idiosyncratic opinions and psychobabble tropes shoe-horned onto ADHD. 🙂
THEN, I wouldn’t have spent several more years creating “direct to consumer” training.
But lucky for you, it’s ready and waiting. I haven’t written the blog post yet because I’m still tinkering with the information page.
Positive reviews are already trickling in. Including from couple therapists.
Despite the attempts by some (with an agenda) to paint my approach as “negative”, people actually familiar with it find it remarkably well-balanced and compassionate to everyone.
You can learn more here. Keep in mind: Couples needn’t take it together in order to benefit.
https://adhdsuccesstraining.com/adult-adhd-solving-the-four-essential-puzzle-pieces-consumers/
Seriously, this will be so much faster/easier and less fraught with minefields than therapy. If, after completion, there are still issues, then at least the ADHD-related boulders have been cleared.
Good luck!
g
Is this book, Adult ADHD Focused Couples Therapy meant only for those in the professional setting or can couples reap benefit from reading this?
HI D,
We wrote it for the couples themselves as much as the professionals. We assumed it would take a while for professionals to get up to speed. Meanwhile…couples need help.
In fact, we included in our contract that the price be made affordable for consumers. This is about 1/3 the price of most professional guides.
And the interventions are step by step (but not “cookie cutter”) rather than blah blah narrative. 🙂
g
My 12-year son has ADD/Anxiety. He is on Celexa for anxiety and intuitive only for ADHD. We had terrible problems with almost all stimulants causing him to talk about hurting himself. He would also get very volatile. The Intuniv isn’t doing much of anything to be honest. We have been doing CBT for about 6 months and was just told that she can’t really help him because his executive functioning is so bad. I am super nervous about putting him back on any kind of stimulant.
Hi Glen,
I appreciate your concerns about your son.
I can only offer some comments and questions that might get you thinking in new directions.
Are you sure that the diagnosis is correct? (BTW, there is no ADD diagnosis. There is only ADHD with three presentations—hyperactive, inattentive, and combined.)
Is the diagnosis complete? Is bipolar disorder a possibility? If even a small dose of stimulant sparked volatility, that might be worth investigating.
Could there have been birth trauma or head injury that affected your son’s cognition?
If he is your biological child, do you and/or your co-parent have ADHD? And, if so, is it being well-managed? Parental ADHD that goes poorly managed can have an adverse effect on a child, especially a child who is being treated for ADHD while the parent is not.
How about sleep, diet, and exercise/activities? A child who sleeps poorly, eats poorly, and exercises little—and maybe also overdoes it on the electronics—might have a poor response to even appropriate medication.
Re: Anxiety diagnosis. So often “anxiety” and “depression” are diagnosed before the ADHD is treated. And, it’s not an anxiety disorder or depression. It’s “cognitive anxiety” and “depression” related to ADHD.
Other times, there is truly an anxiety disorder, and its magnitude is such that it should be stabilized before treating the ADHD.
At any rate, I wonder why Celexa was chosen. Were there trials of any other medication? Was it started at a low dose and increased gradually? Was a stimulant tried on its own — that is, without Celexa? Perhaps the stimulant is interacting adversely with the Celexa? Did you try generic stimulants, not brand? That alone could be a major issue
Intuniv is not a first-line medication—though I know the marketing has been strong for years now. And some parents (and physicians) seem to think that a non-stimulant is safer.
I know that’s a lot to throw at you. Just hoping to spark some new ideas.
good luck!
g
This is very interesting and needed nowadays when just plain marital counseling would not simply work. Both the individuals in the relationship need to recognize ADHD needs and even their best combination and dose of medicine. Both parties should know that they can UNDERSTAND and COMMUNICATE with each other about ADHD openly. Also, I realize that one can lose track of time, so there has to be a proper organization and timetable of things, such as planning a date. A better way is to make a spreadsheet to even organize finances. ADHD makes a negative psyche overall, so it is important to get rid of Rejection Sensitive Dysphoria. Seeking couple therapy together in an intelligent way is the best option. Keep the dose proper in check too. I personally take Adderall XR and partner Ritalin.
And we both have different ways of reacting to it. It makes me cranky but he stays in much more composture. Also, Type A and Type B personality differs. Type A will show hyperactive symptoms to medication whereas Type B will just soothe the person together. Fighting it together.
Thanks for your comment, Elena.
Yes, ADHD-informed couple therapy is desperately needed. This is why Arthur E. Robin, PhD, and I spent four intensive years producing this model and this guide.
I hope you like it.
g
SO to share with others, please allow this follow-up. Yesterday I ordered the new book. It’s actually, a second copy. This one will be delivered to the Psychiatrist who sees my offspring. I can call to ask how my son is progressing. During the conversation, I wondered aloud if he was aware of the depressed state my son was in, a few weeks back. (or other dramatic expensive things) As I expected, the Doc hadn’t hear any mention of life in that regard. * If the patient doesn’t relate what is happening physically and mentally; share the ups and downs of life, it’s nearly impossible to help them. * I had to try. Something.
HI Sara,
I’m glad to read your follow-up. What you describe happens so often with couples, too. It’s extremely frustrating.
You should be able to send notes to your son’s physician. To follow privacy laws, the physician might not feel obliged to share with you information. But you can certainly communicate what’s happening.
g
I stumbled onto your column while googling “adderall and irritability”: 30-60 mg generic adderall daily + 6 mg alprazolam beginning w/the evening news. Irritability is an understatement. I am destroying my spouse and debasing myself. It suddenly dawned on me that my tantrums follow a pattern: the twice daily shift in drug effectiveness. My tantrums, becoming both more common & more vicious, have created guilt that is paralyzingly.
Your columns & books may save me–at least you’ve shown me my instinct about the drugs is worth pursuing. By the way, I’m one of those Ph.D.’s too bright to be ADD, but I usually don’t know what month it is & no one can walk through the disarray in my home. The humiliation is unbearable.
Hi Lea,
Please…find a new MD. ASAP.
And, read my book’s section on medication. (You can read the rest later.)
That much Adderall and a benzodiazepine? I’d like to kick your prescribing physician into next year.
I do offer limited telephone consulting. Will be adding some time to the calendar soon. If you are interested, watch for my blog posts.
Meanwhile, see if you can recruit your wife’s help. Both of you read the medication chapters out loud, together. Then find a new doc and be prepared to self-advocate.
g
Gina, I purchased your first book last year ….. read it in two days with a highlighter w/OMG recognition. So much became clear. My divorce of 17 years ago. WHY? ‘Cause I know now what it’s like to live without grout in a tile floor!
Thinking back, there was a one time attempt at marriage counseling. After 2 joint sessions, the counselor made a statement directed at my husband. “Do you know why you are here?” Mr. Charming, smiled and shrugged his shoulders. We never went back. I had to earn a living.
My DX came 3 years ago when I asked my physician, “Could I possibly have ADD?” Did I always have it? I don’t know.
I’ve a different concern. And it is great. I purchased a second copy hoping my troubled, talented son would read it. As a grown man of 28, he is resistant to his genetic inheritance of ADHD. Yet life is so very difficult for him. He wasn’t the hyper child but the watchful one. So very inquisitive.
I called the Crisis Center today. As he drove away from my home I talked to a person on the phone who of course, could do nothing. I am so afraid I will loose him. This is the second time he has had a major melt down here, at home, in the driveway. This gentle fella is so thin, depressed, lost and hurting…. He can’t seem ask for help or recognize he could use some.
Gina, I will purchase your new book and hope for a the light so needed. I need a key. Thank you for your humor and skill of conveying the complexity of issues when living with ADD/ADHD.
Sincerely.
Dear Sara,
I read your comment to my blog on Mother’s Day, presumably when you posted it. And I was struck by how hard that day must have been for you.
Your story is not uncommon, unfortunately. Parents, grandparents, spouses, siblings, and friends find themselves distraught, unable to reach their loved one with ADHD and impress upon them the need for help.
It can be very hard for people who have lived many years without benefit of diagnosis to accept the idea of ADHD. They equate it with a branding of “see, you are deeply flawed.” Of course, that’s not what loved ones intend, but the fragile egos and lifetime of difficulty can negatively skew what is heard.
For some people, reading my book will be helpful. But for many, they need much more targeted help. (Plus, some simply have trouble with reading comprehension, much less on a book that will have perceived “negative” information in it).
That targeted helps includes actually identifying an ADHD specialist, making the appointment, and going with the person to the evaluation. Some truly need this kind of help, and it’s not “codependence.” It is common sense and compassion.
You can read about the justification for this in my book’s section called “Solving ADHD’s Double-Whammy.”
Good luck! Please keep us posted!
g
YES! A Professional directory!!! Sorely needed. Thank you Gina!
Hi Deb, thanks for validating the need!
g
Gina, this is long post – please see my question at the end.
Echoing the yes on the need for a listing of Doctors/Therapists Who Get This. No, not echoing – shouting, screaming, spray-painting the walls with ADHD graffiti.
So many pseudo listings already out there.
ANYONE can slap “ADHD” in the list of their “specialties”. Whether on a business website, a paid Psych Today listing, etc. Often – maybe, mostly – don’t mean a thing.
In early 2015, after just a couple of months of researching, I realized that ADHD explained not just my husband’s disorganization issues, but EVERY. BLOODY. THING.
Things that had been worsening, or emerging for the first time over the past 7-15 years.
In Summer 2015, my husband was officially diagnosed in his late 50s by a clinician whose meds protocol was in the stratosphere (UBER dosing at the start, not the recommended “low/slow” approach we knew from reading your book and others.) We didn’t know his approach going in, as doctor didn’t reveal his meds philosophy until AFTER DX). So we stopped seeing him and started looking elsewhere.
Unfortunately, from that point on we encountered an ugly combination of:
– a local CHADD chapter coordinated by That Impaired Woman and Aren’t We Cute and It’s a Gift (we’re in Pittsburgh – ’nuff said)
– STILL living with ADHD – symptoms worsening
– backlog of years of ADHD chaos and damage
– after significant improvement (due primarily to my simply slogging on), my PTSD, anxiety and other symptoms were getting worse, month by month, as we continued to live in ADHD hell. I had to apply for SSDI in 2012 – did not realize until later that MY legitimate disabilities were primarily in response to husband’s as-yet-un-DX ADHD. And the psychologist who did my 2012 assessment ONLY does testing – including for ADHD. He didn’t pick up a whiff of ADHD when I described my husband’s behavior. Clinicians we consulted last year concluded that this doctor really dropped the ball.
– husband’s trying but waffling on accepting DX/making changes – including sabotaging at least one appointment for testing
– profound interference from his family (who denied/minimized his DX – and made ME the “identified patient”) Absolutely an enabling/denial relationship – including his brother-in-law – who is administrative CHIEF OF PSYCHIATRY at a local prominent hospital (!)
– Post-DX: MONTHS of brick walls – dozens of referrals to clinicians, who didn’t return calls, weren’t accepting new patients, were clueless about ADHD in general, particularly in the dynamic of a marriage. In over six months of searching, NO medical/clinical/therapeutic help at all. This included a therapist who CLAIMED experience with ADHD-focused CBT – but never used it during our sessions with her. She ignored his bellowing, already DX symptoms – particularly his out-of-control cognitive distortions – and focused on my “issues” – which as I’d already indicated were secondary to/caused by living with undiagnosed ADHD for years. If I had any energy left, I’d file a complaint against her.
– lots of old baggage from previous traumas, losses – some of which may have been ADHD-related, some of which were just from being unlucky and outliers in other areas of our lives
Shorter version/longer story: I wish with all my heart that your clinicians’ book had come out a year or two sooner. This isn’t a criticism, just a fervent wish. If we knew what we were facing and had some resources for addressing it, we might have made progress, instead of disintegrating to the stage where we are now.
Because I honestly don’t know if this is redeemable at this point.
Not without the right doctors, the right meds (still no meds due to Last Summer’s Lunatic), the right family/social support (which has been absent in prior crises in our lives, particularly in this one). All my own issues have pushed me back into super-exhausted, barely functioning mode. Trying to get back to workt is not an option given my current setbacks, although I desperately want and need to get back to a professional job. My SSDI income not sufficient for all financial needs at this point. That’s a major issue, financially, logistically – and a longer story. I need time to rest, recuperate. I need my husband and me to get some competent help and support.
The only barest glimmer of hope I have is that I have just started seeing a therapist who specializes in trauma. She will see my husband as well – if he will agree to go. She is not an ADHD specialist – but she gets a lot of the concepts. In fact, she’s offered to read your clinicians’ book on the plane when she travels next week.
Question to myself at this point is, how much longer can I hang on? Because the cliff face is out of toe-holds – and I’m out of stamina.
Question to Gina: has ANYONE in/near Pittsburgh contacted you re: clinicians’ training with you?
Hi Kidlet,
How heart-breaking. It shouldn’t be this hard. 🙁
The book is just out, and it’s probably sitting in a stack of “read soon” books among the therapists who have it.
So, no, sorry, no Pittsburgh-based clinicians yet.
It sounds like you’ve settled on a wise strategy: Find a smart, compassionate therapist with whom you have rapport, and ask that therapist to read the book. It will definitely inform that therapist’s treatment of many other clients with trauma.
Unfortunately, the field of trauma therapy typically misses underlying neurobiology in client (and their parents), and so treatment takes their clients only so far.
Good luck!
g
Thanks, Gina. Perhaps our counseling bills would’ve been cut in half? As an ADHDer I really loved repeating back verbatim what my wife just said. Hopefully your book tells therapist to go ahead and skip that technique. We got lucky though and had a counselor that delved into ADHD after her own love interest was diagnosed.
Hi Drew,
HAHA! So you sat there in session, just repeating what your wife said??? 🙂
I’m glad you lucked out.
Even with therapists who recognize ADHD (which has happening increasingly), however, they don’t always know what to do. Including those therapists in a relationship with someone who has ADHD. (Sometimes especially those therapists can over-do it with the “understanding” and under-do the practical strategies.)
Thanks for your comment!
g
She did lead me to your book “You, Me or Adult ADHD.” I also confess that it was chucked at the wall a couple times before it was finished. I have recommended the new book to a couple marriage counselors I know.
Ha! Perfectly understandable, Drew! I get it. I truly do.
In fact, I felt like throwing it at the wall a few times before I was done with it. 😉
And THANK YOU for recommending the new book.
g
We need this! My husband, recently diagnosed with ADHD at 70 yrs. old, and I had our first marriage counseling session today. Helpful, but disappointing in that therapist never me motioned the adhd issue unless we brought it up There are no knowable therapists or support groups in our area for adult adhd
Hi Karen,
Oh dear.
Please don’t be afraid to take that bull by the horns.
If you like this therapist, you might gift a copy of the book and ask the therapist to read and follow the instructions. 😉
best,
g
This is a HUGE deal. Congratulations on the publication of what looks to be an excellent resource! And thank you so much for your hard work, Gina.
Thanks for your long-time support, Katharine! xo
wow, what a great resource this will be. thanks you SO much for all your hard work. i look forward to hearing of the fruit this book and the trainings will bring in the coming years. God bless you for pouring yourself out on our behalf! your resources are a true lifeline.
Thanks for your support, Susan! I appreciate it.
g