This entirely subjective list comes from my 40 years of on-and-off therapy with psychiatrists and psychologists of a hundred different stripes. I’ve also included some examples and ideas from friends, as well as ADDitude readers who, after seeing my blog post on this subject, posted replies or e-mailed me suggestions.
Somewhere along the line, this therapist got the idea that what adults with attention deficit hyperactivity disorder (ADHD) need is a good rap on the knuckles and a serious time-out. You’ll know you’re in a session with a Disciplinarian when tasks are assigned to you, like homework, between sessions. Then come the rewards — usually in the form of approving nods and upbeat words, but I’ve read about adults being given or denied chocolate chip cookies in the context of this kind of therapy. What do these therapists think of us?
Self-respect is hard enough to come by in our world, without paying some smug geek to beat it out of you. Shame is a lousy tool to use for ADHD treatment. As far as I’m concerned, the last thing any ADHDer needs is one more person making them feel small.
The Nervous Nellie
This therapist is usually new on the job, or has a practice that caters to calmer, or more focused, patients than you. He or she seems to find what you say confusing and unnerving and spends most of your session asking you to clarify what you just said over and over again. I was new to my ADHD, trying to figure out what it all meant, when I had a short run with a doctor like this. Her office was near where I was working, and though she didn’t list ADHD as a specialty, I didn’t think that mattered.
Our sessions consisted of her saying, “I’m still not sure what you’re trying to say here” or, “Let’s try staying on one subject at a time” and, “I can’t help you when you get this agitated,” while trying not to hyperventilate, as she glanced at her watch and scooted her chair closer and closer to the door. After a while, I realized I was scaring the poor woman to death. So, I left her in peace, and went to find someone who maybe wasn’t terrified by over-the-top, excitable middle-aged guys like me. I also realized that when you’re looking for a therapist, whether he or she has experience treating ADHD and isn’t freaked out by the symptoms is more important than their office being convenient to your morning commute.
The Drug Pusher
This psychiatrist thinks medications will solve all your problems — and won't listen to you if you think they don't. In my early twenties, after having a mild breakdown, I ran into one of these types, whose solution for me was prescribing large doses of an antipsychotic. Week after week, I sobbed that the meds didn’t help, and, worse, that they turned the whole world into incomprehensible pudding. He just nodded and hmmm-hmmmed and made notes on his stupid, little pad.
When I finally understood that he didn’t care what I was thinking — he just wanted me sedated — I managed to quit him and the antipsychotics, and pull myself together on my own, for a while. You can probably tell I still hold a tiny grudge. But don’t get me wrong, with the help of a good psychiatrist, who listened to me, I found that I respond well to Adderall — and it’s helped change my life. But the key to the whole deal is the listening part.
If you’re ever in the middle of a therapy session and you get the impression that you’re a lab rat being nudged through a maze of leading questions that seem to have right or wrong answers, your doctor might be a Researcher. These therapists are trouble.
For one, they dehumanize, reducing you to the sum of your symptoms (this is a common trap patients and doctors both have to be careful to avoid). Even worse, Researchers are only interested in you as a test case for their pet theories. In total, they have very little real interest in your welfare — especially if what you say and/or do doesn’t end up supporting their theory. When you find yourself pushed into a corner you don’t recognize, and stamped with labels you don’t agree with, jump out of the maze, scamper for the exit, and find a doctor who doesn’t want waste your time trying to stick you in a box.
I like a joke as much as the next guy, but not so much when it's on me. How would you feel if you took your car to the shop for a safety check, and found your mechanic shaking his head and smiling patiently at the oh-so-amusing disrepair of the brakes and power steering?
Brain mechanics shouldn't find any humor in ADHD breakdowns either. I had one therapist give me that amused look, after I told him about having three panic attacks, in as many weeks, during business lunch at this one Italian restaurant. If you start to suspect your psychiatrist is using your pain for new material (“I mean I’ve got some crazy patients, but what’s going on with this guy and lunch? Is it the ziti?”), get out quick.
The Blame Gamer
In my thirties, I saw a psychologist who told me I had didn’t have a drinking problem — everything was my wife’s fault. He had me visualize a couch cushion as my dad's face and then act out fights with him. “Go on,” he’d say, “Let your anger out — hit the cushion — hit it hard.”
This guy was my all time fave for a while — someone else was to blame for every messed-up thing going on in my life and I got to saunter out of every therapy session as the righteous victim. What's not to love?
But I knew, somewhere in the back of my head, that I really was an alcoholic, no matter what this guy said, and my wife just wanted a slightly more peaceful life. As for the forced "father issues," my dad had always been loving and kind to me. I'm not so sure that was the case for the therapist, though.
Watch out for this type: They’re seductive. Remember, therapists that listen are good, but they should also have a brain if they’re going to give you any useful help. You can’t find the strength inside yourself to discover ways to cope with, and understand, what’s going on in your head, if it's always everybody else’s fault.
The Quick Fixer
This mental health professional is continually saying “Uh huh” and nodding while you’re talking. Her scrip pad is out as you walk in. She has a packed schedule, and is most comfortable with the 15-minute med visit. And if you're lucky enough to get a full appointment, it just seems like three 15-minute sessions smashed together.
The uh-huh’s rain down like hail. Then comes a lightning bolt. No, it's just another “that sounds good,” to follow-up whatever incomplete thought is gushing out of your mouth. You are then hustled out with a rushed smile and a pat on the shoulder. Your doc hasn’t heard a word that you or she has uttered in all the time you’ve been seeing her. Whether this is a case of the "blind leading the blind," or just plain old greed, you’re not going to get any real help with your ADHD here. Take the last pat, and walk away. You probably won't be missed.
The Fuzzy Comforter
This therapist tends to be a psychologist, and often goes by a friendly nickname that combines the doctor title with his or her first name. (TV’s Dr. Phil is an extreme exception — see “The Disciplinarian.")
In contrast to the Nervous Nellie, the Fuzzy Comforter has nothing but heart-felt compassion for you — no matter what. You could go into your session ripping the head off a squirrel with your teeth and screaming like a drunken pirate, and the only reactions you’d get would be sympathetic nods and gentle encouragement. (Not that I’d ever harm a squirrel unless she started it.) I had a guy like this once with big understanding eyes, who kept an afghan throw on his lap. He'd get up at the end of every session to give me a hug. A hug? (Arrgh matey, I nearly run ‘im through with me cutlass!) He didn’t get that ADHDers don’t want sympathy; we want some help finding solutions and practical ways to cope.
The Dream Dissector
ADHD is confusing — whether you know you have it or not. It can co-exist with or lead to anxiety, panic attacks, and insomnia, among other common comorbidities. You can start to question the basic things you believe about yourself: Am I a good person? Does my messed up life have any meaning at all? If past ADHD treatments haven't provided satisfactory answers, then, as I did, you might decide to try a subconscious, deep-diving psychotherapy expedition with a Dream Dissector.
For some, this might be helpful — for me, not so much. When I started these sessions I hoped that we’d find the source of my panic, self-loathing, and inability to focus, lurking in the caverns of my sub-conscious dream life and eradicate them with the bright light of understanding. I read entries aloud from my dream journal, and the psychiatrist listened and made notes, then tried to find a consistent thread leading back to my childhood, but like my dreams, I kept changing the subject. Then I’d forget to write in my journal and forget my dreams. When I began to forget my appointments, the doctor and I decided to call it quits.
Now, I believe that when you’re going toe-to-toe with mental disorders — brain wiring problems like ADHD, hypomania, or bipolar disorder — you’re not going to get much help from trying to make sense of your dreams. I gave it the old college try (though I never had the patience to finish college), but all it did was double my anxiety because neither the Dream Dissector, nor I were able to make any sense of my subconscious. Even when I could manage to remember them, being the fractured dreams of an ADHD-hypomanic-neurotic-insomniac, they didn’t have enough focus to even begin to be analyzed.
The Distant Judge
I had a run-in with this type of therapist once. I should have known he was a bad fit as soon as I walked into his huge office. Original early American paintings and objects d’art adorned every inch of his walls, except for the space behind his desk, which was crowded with framed advanced degrees and a few pictures of the doctor talking with important people, no doubt. The chairs, ottomans, and couches were made of dark tufted leather with brass accents. Heavy swag curtains framed a tasteful garden view. I hope to never step into such an intimidating room again.
When the doc made his entrance, he sat behind his desk, then looked up at me and said, “Tell me about yourself.” I don’t remember what I said. But he leaned back in his chair, as I spoke, and made notes. Then he checked off some things on a form, and gave me my first ADHD prescription. While walking back to my car, I realized that the man had barely looked at me the whole time I was there. Now, maybe to you it seems obvious that this kind of guy is no one to go to for treatment. But it took me two more sessions before I realized that shuffling into a weekly audience with a puffed-up poo-bah was no way to get help dealing with my problems. So, once again, I was off on the search for that smart/listening/human type of therapist that those of us with adult ADHD really need.
More Articles on Alternative ADHD Treatments