ADHD Couple Therapy: The Revolution Is On!

ADHD couple therapy

Introducing the first ADHD Couple Therapy professional guide, Adult ADHD-Focused Couple Therapy: Clinical Interventions

The goal?  Nothing short of a revolution. Training couple therapists. Teaching couples. Online. And in-person workshops. Check out ADHD Success Training.

After four years researching and writing, it’s here.

Why This Topic?

For 17 years, thousands of reader e-mails detailed their personal relationship challenges. Thousands of detailed posts in the discussion groups I’ve led for years do the same. As a result, I’ve heard way too many ADHD couple-therapy-gone wrong stories. The conflict. The strife. The hurt and confusion. Upset children. The futility. Ach.

As my Italian momma would say, “Basta!”  (Enough!)

Years ago, in my own marriage, my husband (diagnosed in 1999) and I gave up on couple therapy. In fact, we shuddered at the thought of trying to “train” yet another couple therapist in ADHD—and paying for the privilege!

There we’d sit in the therapists’ office, telling our stories of domestic quasi-mayhem. Why? We desperately needed someone to help us solve our mysteriously intractable problems. But there they’d sit, looking puzzled or having jaw-dropping expressions. They meant well, but they were out of their depth. You see, the typical “couples troubles” strategies didn’t apply. Sometimes, those strategies exacerbate a bad situation.

To avoid more painful and expensive therapy, we doubled-down on our efforts to work things out ourselves. Yet, it was a long and sharp learning curve. We both still bear some scars. The good news for you? We figured out that learning curve so you don’t have to.

Until Now? Mostly Two Dismal Choices

Until now, ADHD-challenged couples have mostly faced two dismal choices:

  1. Couple therapy that is not informed by ADHD-specific knowledge
  2. Adult ADHD therapy that overlooks the needs of the other partner and the relationship

As I wrote in my first book (Is It You, Me, or Adult A.D.D.?), the wrong therapy can be worse than no therapy at all.

With our new book, we (psychologist Arthur L. Robin and I) created a model that carefully merges two sets of therapeutic approaches:

  1. Those proven effective for couple therapy, and
  2. Those proven effective for adult ADHD treatment

In other words, we based these interventions not on loosey-goosey ideas about “communication” and “be vulnerable” and “intimacy”. Instead, we combined our 50 years of professional experience with the research-based evidence about what works.

Make no mistake: We focus on the practical as well as the emotional. Both are equally important. Why? Because emotional intimacy fails to flourish (or resuscitate!) when household chores are neglected, the budget is busted, and important commitments are forgotten.

ADHD couple therapy

A Bit Of Back Story

Three times, the publisher asked me to produce a guide for mental-health professionals, for helping ADHD-challenged couples. Twice, I declined. I simply couldn’t afford even more pro bono work. Typically, it’s academics who write these professional guides. (You know, people with salaries and an expectation to publish.)

By the third request, my week had been particularly peppered with stories from too many couples struggling—despite weekly therapy. Sometimes for years!  It only magnified the chorus I’d heard for 20 years.

That is to say, I weakened. I tentatively agreed—dependent upon psychologist Arthur L. Robin, PhD, agreeing to join me. We’ve co-presented at conferences for years on this topic. Bless him; he agreed. (You can read our bios here.)

Four years later, it’s here!  With its debut, Routledge Press named Dr. Robin and me January Authors of the Month:

ADHD couple therapy

Top Experts Praise Adult ADHD-Focused Couple Therapy

Top experts in the fields of general couple therapy and Adult ADHD have lavished praise upon this comprehensive, pragmatic guide.

These experts include psychologists Harville Hendrix, Douglas K. Snyder, Russell Barkley, and physicians Patricia Quinn, Lily Hechtman, Philip Asherson, and Martin Kutscher.  Click here to read the full endorsements and learn more about these experts.

ADHD couple therapy

What’s Covered In Adult ADHD-Focused Couple Therapy?

In 250 no-nonsense pages, we cover the gamut:

  • Explaining the wide variety of potential issues ADHD-challenged couples face
  • Zeroing in on very practical strategies
  • Healing what we’ve designated the “Adult ADHD-Focused Dysfunctional Interaction Cycle”
  • Working together on chores and planning, budgets, electronic addictions, and even sexual intimacy.
  • Explaining how to get the best results from medication—and how couple therapists can help in the process

We are grateful to guest contributors, including psychologist J. Russell Ramsay, who developed a couple-therapy intervention based on his CBT model for ADHD.

For a quick overview, here is the 250-page book’s Table of Contents:

Introduction

Section I: Adult ADHD and Relationships

  • Meet the Couples and Their Common Challenges, Gina Pera
  • Principles of ADHD-Focused Couple Therapy, Gina Pera

Section II: Clinical Interventions

  • Psychoeducation, Arthur L. Robin, PhD
  • CBT 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

Conclusions and Clinical Notes

Resources

Index

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 therapists.

The first course is available. It is a home-study test, a set of 20 multiple-choice questions based on reading the book. CE hours are available (NBCC).

(Readers can join our mailing list at ADHD Success Training to be informed when the training is available—or follow this blog to be updated.)

Soon, we will offer soup-to-nuts training for consumers.  This will help you get the most from Adult ADHD-Focused Couple Therapy™ with a trained clinician. It is also designed to help you even if you cannot find or afford appropriate therapy.

Professional Directory!

For years, I’ve fielded e-mail requests for referrals to professionals. The sad truth, I have a very short list to whom I can refer in confidence. Having traveled that path before them, I know the quality of therapy can make or break a relationship. Much hangs in the balance.

That’s why I have created an ADHD Professional Directory. Clinicians listed in the directory who successfully complete Level 1 training are invited to indicate that via a badge icon on their listing.

This directory will be worldwide. To learn more, visit the ADHD Success Training website.

 

ADHD couple therapy

 

Meanwhile, I’d love to know your reaction.

Are you happy to see a new clinical guide on couple therapy for ADHD?

Are you looking forward to the online training?

(I sure am looking forward to finishing and offering it!)

—Gina Pera

24 thoughts on “ADHD Couple Therapy: The Revolution Is On!”

  1. 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.

    1. 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

  2. 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.

    1. 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

  3. 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.

    1. 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

  4. 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.

    1. 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

  5. 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.

    1. 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

    1. Kidlet_Who_Cooks

      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?

    2. 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

  6. 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.

    1. Hi Drew,

      HAHA! So you sat there in session, just repeating what your wife said? I guess that beats countering her every word. 🙂

      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

    2. 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.

    3. 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

  7. 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

    1. 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

  8. 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.

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