ADHD Therapies

Coach or Therapist: Who Should You See First?

You might feel like all of your problems would be solved if you could just figure out how to manage your time, but don’t be fooled: not everyone with ADHD is ready to start coaching right away. If you struggle with difficult emotions or the role your diagnosis plays in your life, you might be better off with an understanding therapist.

Two doors representing the ADHD coach and the therapist.

Many adults just diagnosed with attention deficit disorder (ADHD or ADD) rush out and get a coach to help them with their time management and organization problems. But sometimes seeing a therapist first can make coaching a bigger success. An ADHD diagnosis leaves many patients with feelings of shame that a therapist can help them process.

There are many signs that therapy is a better choice than coaching. Untreated co-occurring conditions — mood disorder, anxiety, substance abuse, and/or obsessive-compulsive disorder — should be treated with medication and/or therapy before coaching can be effective. Not being able to control our emotions is another reason to set up time with a therapist. A client has to be ready, willing, and able to be coached for the process to work.

Emotional Baggage

Sometimes the need for therapy is not apparent. Fred came to me ready to begin coaching. His ex-wife, with whom he had a great relationship, had purchased a gift certificate for Fred to work with me on setting professional goals. Fred’s plans were to leave the family business and start his own business on the West Coast, where he had established some contacts and resources. Together Fred and I defined the steps to accomplish this, and developed structures and strategies to achieve his goals. Every week Fred left with a list of things to get done and plans to accomplish them, and every week he returned with nothing crossed off the list.

When I asked what he spent his time on, the list of things he managed to do was long. We assessed what was wrong. It was not that he was distracted, since we had identified and worked on eliminating typical sources of distraction. Fred had also implemented visual reminder systems to keep him on track with his goals. It seemed like avoidance behavior to me. I suggested that, since coaching wasn’t working, something else might be preventing him from moving forward. We put coaching on hold until he talked with his therapist.

Three months later Fred returned with a list of goals, thanking me for suggesting he see his therapist. Emotional blocks were indeed preventing him from moving forward. Fred grinned and said, “Sandy, you were wrong about coaching not working at all. It’s been three whole months, and I haven’t lost my list!” We both laughed and reviewed his list and the strategies we had discussed. Fred reported the following week that nearly all the items on his list were completed, and his desk was starting to look like a workspace instead of a recycling bin.

[Free Guide: Alternative ADHD Treatments]

Distracted by a Divorce

Gwen was sure that coaching would help her develop better time management and organization systems to help her find a new job after her divorce. We talked about her resume and a template for a cover letter that she could customize for each application. We looked at her schedule and prioritized her responsibilities, carving out time for job-hunting by eliminating non-essential tasks. Gwen returned with reasonable explanations of why progress wasn’t made. The common denominator was “The Ex.” Even though the divorce was final, there were clear signs of co-dependency and blame.

Gwen had not accepted her divorced status or processed her resentment. Her emotional state kept her in constant turmoil and distracted her from the simplest tasks she set out to do. I suggested that it might be too soon to move forward with her goals, and that she may need time to heal.

I recommended a therapist who does brief cognitive behavioral therapy, and emphasized that a full understanding of the emotional factors holding her back could let her move forward. Three months later I got a call from Gwen’s therapist, saying that she was ready to resume working with me, and our first coaching session confirmed that. Gwen seemed calmer, happier, and more self-assured. Early on Gwen struggled to be consistent, but she took responsibility for her actions, and, with practice, was able to make less impulsive choices.

Many of my clients still see their therapists, and rely on therapy to work on their feelings of fear and anger. Coaching is a rewarding and beneficial experience when we are ready to be coached, but working with a therapist is often needed to make that happen.

[How Cognitive Behavioral Therapy Works]

Updated on February 25, 2019

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