add hampering therapy
October 3, 2011 4:21 AM   Subscribe

Can add interfere with someone's capacity to work the therapeutic process? Anecdotes and data both welcome. Particularly interested in therapy with homework eg CBT. When the add is treated, does therapy effectiveness increase?
posted by By The Grace of God to Health & Fitness (8 answers total)
Meds can help or hurt. At best, since ADHD can give "secondary gains" as a defense, getting it out of the way should remove one more obstacle.
posted by Obscure Reference at 5:12 AM on October 3, 2011

Response by poster: Sorry I'm daft, what does give secondary gains as a defense mean?
posted by By The Grace of God at 5:34 AM on October 3, 2011

My husband has ADHD and found it very hard to sit in therapy sessions without using his iPhone, etc. He is now seeing an ADHD specialist life coach and getting a lot more out of it. (The therapy was also with an ADHD specialist.)
posted by instamatic at 5:50 AM on October 3, 2011

Sorry I'm daft, what does give secondary gains as a defense mean?

Most symptoms have, in addition to their negative aspects, others that seem to make things better--e.g. alcoholics feel better for drinking at first. Similarly, the ability to avoid conflict by being inattentive works in the short run. You don't have to pay attention to the areas of your life that are in need of "work" and it's not your fault since your nervous system is to blame.
posted by Obscure Reference at 6:31 AM on October 3, 2011

What type of ADD, how severe and therapy for what?

I'm of the distractive type and reasonably functional when not on meds - in fact, when I'm not on meds I am distinctively more observant and creative (and maybe a skosh smarter) but pay for that by investing a lot of energy into observing everything around me above and beyond whatever I'm trying to pay attention to. In a one on one situation where there wasn't other, more interesting input, I'd do fine.

The think is, saying ADD is like saying "vision problems" - it doesn't really describe a single condition.
posted by Kid Charlemagne at 7:05 AM on October 3, 2011

My son benefited far more from his speech therapy after he started taking ADD medication. It's hard to pay attention to the work that you need to do if your ADD isn't under control.
posted by artistic verisimilitude at 11:48 AM on October 4, 2011

I mentioned ADHD to a new therapist in my first session. She never mentioned it in the following 6 months, where every session we focussed on setting up to-do lists, alarms, routines, and things like that.
Then, when I mentioned I would be seeing my Doctor again, she strongly encouraged me I look at medication treatment etc, and was willing to write a note explaining why she thought that would be good for the Doctor.

There was no point for me, focusing on anything other than what is classed as ADHD symptoms, regardless of what was going on, or if I was depressed, when 'adhd' (ie being below the bottom 5th percentile for being organised and functional) was having the biggest impact on my day-to-day life.
When I got depressed, and felt like I was failing at life, its because I genuinely was failing at a number of tasks I and others, felt I should be able to do, and was therefore feeling miserable. The accumulated failures often led me into cycles of deep depression every couple of years.

When I do take ADHD medication, I am *not* taking it for the 'ADHD' (somehow that wasn't enough of a motivator to feel like I'm not 'cheeting') - I am taking it so that I don't go through another depressive cycle.

If I'm functional, then I have a chance of looking at any other issues. Or doing 'homework' of any kind!
posted by Elysum at 8:31 PM on October 16, 2011

I absolutely have to be on meds (for bipolar disorder, ADHD, and other stuff) for any kind of therapy to be effective. And any part of the med cocktail going awry (as when Geodon was making me sleep all the time and screwing with my blood sugar) makes the therapy more or less useless except as a safety tool - I make zero progress. The ADHD in particular has to do with focus, concentration, and actually following through on plans. Which are all vital for therapy, especially CBT, actually working. CBT isn't really about the homework as much as about how it helps you change what you're actually doing on a day to day basis, so executive functioning is crucial.

My therapist has specifically put whole topics (working on my self-esteem, for instance) off limits while meds (specifically for ADHD in the most recent case) were being adjusted, if you want anecdotes. Like Elysum says, the symptoms of ADHD and depression (confusion, lack of focus, not getting anything done, failing at stuff, etc.) directly fuel the emotional "I hate myself and am worthless" stuff. Being on Vyvanse had an immediate and positive effect on my ability to follow through with things she asked me to do.

Having said that, I have six diagnoses, including OCD and panic disorder, so I don't know how much of my anecdote is applicable to others with less complicated situations. I do know there's support (outside of my brain, I mean) for statements like "medication helps the most with ADHD."
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 5:05 PM on October 17, 2011

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