Q&A with the Experts: Adult ADHD-Focused Couple Therapy™

Adult ADHD-Focused Couple Therapy™.  Why create a special model for Adult ADHD-challenged couples?

What’s wrong with standard couple therapy? Why not just provide Adult ADHD therapy and recruit the partner as the executive assistant……no, definitely not that.   We’ll explain why—and more—in four questions and answers below.

My second book (with psychologist Arthur L. Robin, PhD) is Adult ADHD-Focused Couple Therapy: Clinical Interventions.  It is the first and only clinical guide to present a couple-therapy model based on the clinical evidence. That is, it is a careful and flexible merging of what works for Adult ADHD—and what works for couple therapy. Preeminent experts in both fields highly praise the guide.

The term evidence-based gets bandied about a lot. But we take it seriously. Evidence-based means that published research and clinical experience have shown these methods to be effective.

Ours are not simply personal, self-styled opinions by people who decided one day, “Hey, ADHD couple therapy is hot. Let’s crank out a book!”

The Co-Authors of ADHD-Focused 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, from which he is now retired, he trained psychologists working in a hospital setting. Both his ADHD expertise and skill as an educator shine through our model’s interventions.

Through my 25 years of work in this field, I (Gina Pera) have seen that the wrong therapy can make a bad situation worse. Dramatically so.

Simply talking about the problems can prove “toxic”. So can misattributing the problems to ulterior motives—or childhood issues. Or trauma. Or any of a number of non-core causes.

ADHD-challenged couples deserve:

• Compassion
• An intelligent approach
• Appropriate education
• Help with monitoring medication results
• Instruction in pragmatic strategies, and
• Psychological support in resuscitating their relationships—and learning how to thrive together.

To help ADHD-challenged couples, Dr. Robin and I share a strong perspective: We must begin with basic practical strategies and gradually expand to include more complex and emotional issues.

Based on our model, we offer courses for couples and individuals, consumers and clinicians Learn more at Adult ADHD: Solving the Four Essential Puzzle Pieces.

Now For The Four Questions

Our publisher, Routledge Press, asked us these four questions. Routledge posted our answers at the website (five years later, it’s no longer there).

We were gratified that this prestigious publisher of professional guides named us Authors of the Month.

I’ve reprinted the first four questions and answers below.

1. What made you decide to write Adult ADHD-Focused Couple Therapy™
2. What is the one thing you hope readers take away from Adult ADHD-Focused Couple Therapy™
3. Is there another point you’d like to highlight about ADHD relationships?
4. What is a common misconception about ADHD couple therapy that you’d like to clarify?

1. What made you decide to write Adult ADHD-Focused Couple Therapy™?

First, the situation is dire for ADHD-challenged couples worldwide. The past decade has seen an explosion of Adult ADHD awareness. [Covid-related pressures quadrupled that explosion.] Couples desperately seek clinical expertise and guidance. Yet they rarely find it.

Second, evidence-based interventions exist for adult ADHD, even if rarely available. Solid interventions also exist for couple therapy.

Trouble is, no  interventions existed for ADHD-affected couples. We wrote this book to fill this void, by carefully blending these two critical components. That is, evidence-based interventions for:

1. Adult ADHD
2. Couple therapy

To summarize, we wrote Adult ADHD-Focused Couple Therapy™ so that all therapists can

1. Understand how unrecognized or poorly managed ADHD can thwart positive clinical outcomes for individuals and couples, and
2. Implement state-of-the-art approaches designed to enrich their practice and clients’ lives in a way that is fair and respectful of each person and the relationship.

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 Adult ADHD-Focused Couple Therapy™?

Adult ADHD is not a fringe sub-specialty. Every mental-health professional should at least be familiar with its signs and treatments. Even if only to recognize when they are not up to the task.

Conservatively speaking, researchers estimate the 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: There are an estimated 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 misdiagnosis continues for decades (Misdiagnosed Until 39: “Best Week of My Life”).

When treatment misses the core issue of ADHD,  positive outcomes are rare. In fact, the wrong diagnosis and wrong treatment even risks exacerbating ADHD challenges. That is, the person experiences less motivation, initiation, impulse-control, working memory, and organization.

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: Our Adult ADHD-Focused Couple Therapy ™ interventions 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 ADHD Relationships?

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. These problems center on money, sex and intimacy, chore-sharing, co-parenting, communication, and the like. These issues don’t resolve with talk. In fact, only talking about the problems tends to worsen them. We can start resolving these issues by training in practical, collaborative strategies.

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 ADHD couple therapy that you would like to clarify?

Misconceptions about ADHD flood the Internet and popular media—and even the mental-health profession. We address several common misunderstandings in the book, including these two particularly dangerous myths:

1. The ADHD diagnosis pathologizes “normal human behavior”
2. 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 the clinical guidance needed to make lasting changes. Despite their therapists’ best, well-intentioned efforts.

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:

• Options in life,
• Self-fulfillment,
• Relationships of all types,
• Financial and job status, and
• Even the physical health of the people who have it—while also adversely affecting everyone in that person’s sphere of influence.

First-Person Post on ADHD and Relationships

To read one of Gina’s personal posts on ADHD and relationships:  Breaking Out of ADHD Relationship Dysfunction — After Not Breaking a Fall

How To Directly Access Adult ADHD-Focused Couple Therapy™

Why take the long, frustrating, and very expensive route to search for the right kind of help for Adult ADHD, in yourself or in your partner?

Finding the right therapist for Adult ADHD—especially one equipped to help both you and your partner—is extremely rare. Many therapists may claim ADHD expertise, yet their methods often miss the mark, leaving you feeling like you’re spinning your wheels. Unfortunately, it might take months and thousands of dollars before you realize it’s not working. (It might even be making things worse.)

By then, what resources will you have left? Time, money, and even optimism can run low.

That’s why I created the comprehensive program, Solving Your Adult ADHD Puzzle. It’s a complete, carefully structured system you can access anytime, anywhere, at your own pace—without the gamble.

This program not only teaches practical interventions, it also dives deep into essential physical strategies for managing ADHD:

1. Optimizing medication
2. Supporting sleep
3. Strengthening Executive Function through routines and practical tools.

Step by step, it’s extremely do-able. Many even find it entertaining! Supporting materials mean you can personalize the lessons. Even take the PDFs to a good therapist to help you work through. While the therapist might not have ADHD expertise, the worksheet will guide the process.

Within weeks, you’ll understand more about ADHD—especially your unique challenges—than most professionals you might encounter. (I’m not exaggerating.) And if you ever need a boost or just validation and camaraderie, our regular Zoom meetings are waiting for you.

The training is divided into three parts—Foundations, Physical Strategies, and Practical Supports—so you can begin where you need it most. Accessible 24/7 for life, it’s a resource you can revisit and grow with. Start making progress now, without the guesswork.

First published August 3, 2016
Updated August 2026