Clients with Adult ADHD number in the tens of millions in the U.S. alone. And only 1 in 10 is diagnosed.
ADHD-related challenges underlie many of the issues that bring couples to therapy—money, sex, chore-sharing, co-parenting. Yet, they are too often seen as typical “couples troubles” and nothing to do with this neurogenetic brain condition.
The situation is dire. Thanks to burgeoning ADHD awareness, individuals and couples worldwide are seeking ADHD-Focused Couple Therapy. Yet they seldom find the therapeutic guidance they need.
Instead, they largely find:
- Couple therapists who lack the ability to recognize or factor in ADHD contributors to relationship distress.
- Individual therapists who might understand Adult ADHD but lack the ability to provide couple therapy in an equitable fashion, one that does not simply recruit the partner as a “helper” to the ADHD partner.
- Therapists of any type who underestimate the role of neurobiology in dysfunctional behaviors and couple dynamics.
The results? Clients might seem to improve functioning for a while; but the minute therapy stops, all progress stops, too.
That’s the best-case scenario. What is the worst case?
Therapy that fails to take ADHD contributors into account risks making a bad situation worse, adversely affecting the couple and their children for years to come. And leaving clinicians feeling befuddled and bereft.
Piecing the Puzzle:
ADHD-Focused Couple Therapy
We created this book to guide couple therapists in identifying and working successfully with these clients.
Moreover, our therapeutic interventions stand to help even greater numbers of people—individuals struggle with similar behaviors yet do not fully qualify for the ADHD diagnosis.
After all, the associated traits of ADHD—procrastination, distractibility, emotional dysregulation, and the like—fall on a continuum in the human population. Fortified with the knowledge and techniques in ADHD-Focused Couple Therapy, you can help these clients create positive changes they never thought possible.
Far from being a limited specialty, Adult ADHD cuts across many of the problems that have historically brought legions of people to therapy, especially couple therapy. Yet, because Adult ADHD was missed or its interventions poorly understood, these clients have rarely received—despite their therapists’ best intentions and efforts—the kind of guidance needed to make lasting changes.
That is all the more tragic considering that we now understand a great deal about Adult ADHD. In fact, you could say there has never been a better time to have ADHD. Yet, only 1 in ten U.S. adults thought to have ADHD are even diagnosed, much less receiving effective treatment.
A Nuts and Bolts Guide
ADHD became a well-known condition decades ago. Yet, much of the research and clinical discourse has focused on youth. In recent years, attention has expanded to the realm of Adult ADHD and the havoc it can wreak on many aspects of adult life, including driving safety, financial management, education and employment, and interpersonal difficulties.
Too often, ADHD is mistaken not only for “typical human problems” but also for other mental-health conditions, such as anxiety and depression. Though ADHD commonly co-exists with or can mimic such conditions, it requires specific treatment. In fact, medically treating the anxiety or depression alone can even exacerbate ADHD symptoms, given the complicated interactions of the neurotransmitters involved. The first-line medications for ADHD are primarily the stimulants, not antidepressants.
Excellent professional guides describe the theory and evidence. We refer to many of them. This “nuts and bolts” book, however, is designed to help you to immediately start benefiting from these strategies.
- Adult ADHD specialists gain a roadmap for carefully expanding treatment to include a client’s romantic partner.
- Individual therapists gain the knowledge to recognize Adult ADHD in their client and adopt the best practices for helping these clients in their relationships.
- Couple therapists gain guidance for adapting empirically supported couple-counseling principles to include the specific issues presented by ADHD in one or both partners.
What Is Covered?
Adult ADHD experts Gina Pera and Arthur Robin, PhD—together with contributors who are also experts in their specialties—provide the clinician with a step-by-step approach to helping couples enhance their relationship and improve domestic cooperation. Each step, however, acknowledges the complexity that are these clients. This is not a “cookie cutter” approach but rather a collection of sensibly sequential but flexible interventions.
This comprehensive guide covers:
- Medication guidelines
- Cognitive interventions
- Co-parenting techniques
- Habit change and Communication Strategies
- ADHD-specific clinical suggestions around three “hot spots”: sexuality, money, and cyber addictions.
- See chapter-by-chapter descriptions below.
More than twenty detailed case studies provide real-life examples of ways to implement the interventions.
Free downloads referenced in the book help implement the interventions covered in the book (e.g. Shared Responsibilities Checklist, Medication Monitoring Log, etc.).
Professional endorsements from a Who’s Who of both couple therapy and ADHD therapy praise the book.
Chapter 1: Meet the Couples and Their Common Challenges
by Gina Pera
Before delving into the stories of six real-life couples to illustrate familiar themes, this chapter briefly explores the shared foundation of these themes: ADHD symptoms, along with the poor coping strategies and cognitive distortions so common to late-diagnosis ADHD individuals and their partners.
Chapter 2: Principles of ADHD-Focused Couple Therapy
by Gina Pera
Drawing upon established principles of effective couple therapy and the particular concerns presented by ADHD symptoms, this chapter presents a flexible paradigm for addressing the full range of issues for any given couple.
Chapter 3: Psychoeducation
by Arthur L. Robin, PhD
Clinicians are guided in the foundational process of educating couples about ADHD, including handling their reactions to the diagnosis, addressing resistance, and increasing motivation to participate in the evidence-based change techniques offered in subsequent chapters.
Chapter 4: A CBT Model for ADHD-Challenged Couples
by J. Russell Ramsay, PhD
Cognitive-Behavioral therapy (CBT) has emerged as the psychosocial treatment of choice for Adult ADHD. Adapted here for the first time to serve couples by a leading clinician and researcher, this model addresses the effects of executive dysfunction on relationships, particularly those in which ADHD has long gone unidentified and negative patterns have become entrenched.
Chapter 5: The Role of Medication
by Gina Pera and Arthur L. Robin, PhD
Medication can provide the single most effective means of mitigating ADHD symptoms, but prescribing physicians are often rushed and inadequately trained. Empowering the couple to actively engage in the medication selection and titration process can be vital to a positive therapeutic outcome. Equally important: The therapist adjusting client expectations about the limits of medication and the importance of supportive strategies.
Chapter 6: Behavior and Habit Change
by Arthur L. Robin, PhD
The clinician builds a strong logistical framework for success by emphasizing and guiding the couples in teamwork around improving time management, memory management, and organizational techniques so as to more cooperatively accomplish the tasks of daily living.
Chapter 7: Imago Relationship Therapy Adapted for ADHD
by Carol Ann Robbins, PhD
ADHD neurobiology often contributes to the development of poor social and problem-solving skills. With certain adaptations, Imago Relationship Therapy (IRT) can assist these couples in slowing out-of-control interchanges and promoting better communications and cooperation.
Chapter 8: Co-Parenting Strategies
by Barbara Easterlin, PhD
Effective parenting requires a certain degree of consistency, a primary challenge with ADHD. When a child also has ADHD—and, the genetic odds are strong—it is even more imperative that the couple adopts a set of parenting strategies that are jointly supported and include structure and behavior modification.
Following the step-by-step interventions detailed in those five treatment chapters, the three special-topics chapters delve more deeply into three areas where these couples frequently suffer crushing misattributions and conflict:
Chapter 9: Money
by Gina Pera
ADHD-related traits can adversely affect finances in terms of both lowered income and increased outgo. It is important to work with these couples on identifying financial goals and implementing ADHD-informed habits to help meet those goals.
Chapter 10: Cyber Addictions
by Kevin Roberts, MA
ADHD neurobiology generally confers a vulnerability to addictive behaviors, including excessively pursuing “cyber” activities such as videogaming and social media—all of which can impair relationships. The clinician can engage both partners in strategies to assist the ADHD adult in overcoming these overuse behaviors and re-focusing on the relationship.
Chapter 11: Sexual Intimacy
by Gina Pera
ADHD symptoms can affect intimacy directly, such as being distractable during lovemaking, and indirectly, with workaday conflicts mutually dampening ardor. Because it is extremely difficult to find ADHD-informed sex therapists, it is vital that couple therapists at least be able to explain the nature of these challenges to clients.
Conclusions and Resources
In these final pages, we summarize and synthesize the book’s chief clinical points and refer to information sources.