Am I helping or interfering with my friend's mental health care?
February 4, 2019 7:18 AM   Subscribe

I encouraged a friend to seek treatment for ADHD. They did (yay!) But I'm not sure the therapist they've chosen is the right person, and now I don't know how far I should go in convincing them to see someone else.

After gently suggesting to my friend that they exhibit classic symptoms of ADHD that may be interfering with their daily life and functioning, my friend agreed with this assessment and agreed to consult with a therapist. I suggested several options for therapists and clinics who specialize in treating adult ADHD, but my friend opted to go to a psychologist recommended by another friend.

After the first consultation session, my friend told me several things that made me feel this therapist is not the best choice. The therapist practices CBT, but they do not specialize in or have any clinical experience with adult ADHD patients. Further, some things friend told me about the session were concerning to me and reflected the therapist's potential lack of knowledge about ADHD - i.e. suggesting in the very first session that medication wasn't a necessary part of treatment, that my friend had a "light case" of ADHD (how could therapist assess this within the first meeting, with only self-reported symptoms?), that hyperactivity/ADHD symptoms are a result of trauma, and pressuring my friend into committing to weekly talk therapy sessions for a fixed amount of time without allowing friend to consider options. (Worth noting: we live outside the US, in a country where understanding of ADHD is somewhat different but treatment modalities are generally the same.)

My friend's main reason for wanting to continue with this particular therapist is simply because the practictioner lives in friend's neighborhood and is convenient. This seems not a good rationale for committed to weekly therapy with the wrong practitioner.

I really want my friend to get the best care, and that the time they spend in therapy is really useful for them. At the same time I know it was already a big step to get friend to seek treatment at all, so I don't want to go too far in pressuring them to see someone else. Are my concerns justified and worth pursuing, or should I step back?
posted by azzurra to Health & Fitness (15 answers total) 2 users marked this as a favorite
It is really not up to you to evaluate your friend's therapist after one session. Maybe, if your friend had been in therapy for months and was not finding it useful and asked your advice, you could then express your opinion.

I wonder why you are so involved in this situation, emotionally? Do you have unmet needs or are you struggling with something yourself? Because this is kind of crazy levels of investment.
posted by warriorqueen at 7:30 AM on February 4, 2019 [36 favorites]

"My friend's main reason for wanting to continue with this particular therapist is simply because the practictioner lives in friend's neighborhood and is convenient. This seems not a good rationale for committed to weekly therapy with the wrong practitioner. "

Well.... location is an advantage in getting your friend to still go to treatment. If the "right" person for them is 2 hours away or something and that means they peter out and not go, that may not be the "right" situation for them either.

Also, if you live in a country where getting the "right" treatment is difficult, that might be a factor too.

But overall, this is Not Your Business and you can't fix or handle it for them.
posted by jenfullmoon at 7:37 AM on February 4, 2019 [8 favorites]

The first consultation session is barely enough for your friend, the patient to know if this course of action is right for them. You have more information about it than you should, really.

I encouraged a friend to seek treatment for ADHD. They did (yay!)

This is where your knowledge of their treatment should end. They’re pursuing treatment. Yay, as you said! Now let it take its own path.
posted by RainyJay at 7:42 AM on February 4, 2019 [11 favorites]

I'm not claiming to be any kind of expert but I think it is nice of you to be so concerned about your friend. We could all be better off caring more for each other rather than less. You may or may not be right about the therapist. I think all you can do is listen and express alternative opinions gently.
posted by RoadScholar at 7:52 AM on February 4, 2019 [6 favorites]

Everyone here is right, and yet having been lead down the path just recently by a therapist that believed my adhd was a result of trauma/ptsd (i have both! And it complicates everthing!), this frustrates me a lot. Most therapists don’t know adhd well enough to understand it in adults. I think the answer is to be a good friend and listen.

I wouldn’t push it, but I don’t think it would hurt to explain your reasoning. Also adhd is thought to be a combination of genetic and environmental factors. One contributing factor can be abuse in childhood. The problem is that many therapists don’t see that the damage is done developmentally and there isn’t fixing that. Therapist that work with trauma want to undo it, which can be to a point. And it’s just there is the practical matter than cause doesn’t matter day to day, yah got a developmental disorder that can be managed through medications and the right structural support.

Unfortunately, there really is a limit on what you can do. I have a friend who I’m convinced has adhd; we’ve talked at length and it comes down to her worrying she’ll have another issue to deal with. I’ve argued she might solve ones that are ongoing, like her anxiety if it’s from adhd. (We do have the type of friendship where we discuss and look to each other for advice on mental health, so it’s a bit different.) She doesn’t want to still, so that’s it.

I will say this, the idea that trauma is at the root and can be fixed is really appealing. I was convinced by the same therapist I mentioned above that an old injury acting up must be psychogenic. A round of prednisone answered that pretty quickly (yeah, placebo effect but also no, physical injury, physical treatment worked). The promise that if I could get my head to a better place regarding the trauma I faced would fix that was very seductive.
posted by [insert clever name here] at 7:56 AM on February 4, 2019 [4 favorites]

This seems not a good rationale for committed to weekly therapy with the wrong practitioner.

I did this. It was more important for me to get into a routine with a regular therapist with meetings I would actually GO to than to make sure I had the perfect fit. For many people just getting to an appointment is a hard part of the process. One of the interesting things about therapy in general is that results tend to not be correlated with any specific modality.

I'd let your friend work with this person who they seem to like for a little bit and if you really feel they're going down a bad path (i.e. something that is actually inhibiting their ability to work on whatever their issues are, as opposed to just not making progress) then it might be time to speak up. As for right now, I'd suggest stepping back and observing and just being generally supportive of your friend's progress. You can also suggest other resources, support groups, books etc that might help them in getting some balance of opinions/suggestions but I wouldn't be critical of their choice now that they've finally made one.
posted by jessamyn at 8:12 AM on February 4, 2019 [8 favorites]

If your friend is new to therapy, the most important thing is that they learn to stick with it. Many people will bail out of therapy after one or two sessions and never try again. In this case this therapist sounds decent but not perfect, and a decent therapist your friend actually sees is way better than a perfect one they never visit.

If I were you I would generally back off and let your friend see this therapist. You should gently ask in a few months how it's going and suggest your other one if they sound like they are frustrated or stuck, but micromanaging someone else's therapy experience is a good way to stress them out into never going back
posted by JZig at 8:14 AM on February 4, 2019 [3 favorites]

Best answer: Why not wait and see? If the friend reports that the therapist is actually making things worse, or is advancing really troubling ideas, that would be a time to bring up your concerns. Otherwise, maybe if in six months or a year your friend is like "this isn't helping", then maybe make some suggestions.

I think that it's easy to get committed to the ideal [but actually impossible] solution in the face of a less-good [but possible] solution. Maybe "friend goes to more distant therapist who is best for ADHD" is an ideal but not possible solution - your friend lacks the spoons to audition another therapist right now, it's too far, etc. Once the friend is familiar with therapy, the friend may feel more confident about going to a farther but more helpful therapist because they won't need to overcome the initial anxiety/effort barrier about therapy itself.

Also, if you're a responsible person it's really difficult to step back from nudging people to do [what you think is, or what is in certain ways only] the smartest thing. This is especially true if you are anxious or a perfectionist, because you just can't let your feelings about it go.

In my personal past, this has led both to overinvolvement and underinvolvement - like, trying to fix things that it's not my job or within my capacity to fix, or withdrawing too much because I have trouble managing appropriate involvement. However, I've observed that very often, people can successfully fix their own problems if they get modest support and nudging - it may take a while, but I really have noticed it to happen. It seems like you're providing modest support and nudging, and now it's time to let the process work for a while.
posted by Frowner at 8:20 AM on February 4, 2019 [11 favorites]

I'm on the other side, I have PTSD with disassociative aspects and don't have ADHD even though they can look fairly similar.

I agree with you that more professionals need to be acutely aware of the pervasivness of undiagnosed ADHD especially in women (but men get ingored too) . But unless you are a mental health professional and actually educated in both differentiating isn't easy.

There are always multiple aspects to mental health, and unless your friend expresses disatisfaction with her treatment I wouldn't push.
posted by AlexiaSky at 8:35 AM on February 4, 2019 [5 favorites]

You've done a good and caring thing in helping your friend start a diagnosis and treatment process. It's too soon to say whether this is the ideal option for them - but that it's a convenient option that they're at least currently willing to commit to, is a good start. I would leave it alone for now and check in down the road to see how they're feeling once they're into a groove.
posted by Stacey at 8:43 AM on February 4, 2019 [1 favorite]

Best answer: Please keep in mind that you don't actually know what the therapist said. You're getting a report from your friend, and your friend was likely nervous during the session. It's pretty common for people to struggle to remember the details of a therapy session, given how challenging a lot of the topics covered in therapy can be. Especially if you're meeting with a therapist for the first time, explaining your recent diagnosis with ADHD and your history of trauma, and doing all the other stuff that happens during a first therapy session, it's pretty easy to get confused on the details.

Maybe the therapist said, "I don't believe in medication for ADHD. You don't need it." Or maybe the therapist said, "Some people don't use medication to treat their ADHD." Or maybe the therapist said, "It's always your choice whether you take medication for your ADHD or not." All of those could be construed as the therapist saying that medication wasn't necessary, but they definitely mean different things and indicate a different attitude towards medication.

You care so much about your friend, and it's so wonderful that you are there to support your friend. But you're not in the therapy session, and so you're not in a good position to judge whether it's a good therapeutic fit for your friend or not.
posted by meese at 11:11 AM on February 4, 2019 [9 favorites]

I agree with the advice to wait and see how things go.

Also, unless I missed it you don't mention where your own expertise in the subject comes from. If you yourself were treated for ADHD, you can, if you ultimately feel that you want to speak up, say something like "for what it's worth, I received a different kind of treatment..." and describe your own experience. Or if you made your recommendations not on personal experience but on recommendations from friends, you could offer your friend to put them in touch with each other. If your recommendations were just based on something like an internet search, I'm not sure that's a good reason to feel confident about them (a place might look good on paper but not be a good fit for your friend). And if your acquaintance with these places is professional, then you probably know how gently you should broach the subject.
posted by trig at 12:04 PM on February 4, 2019 [1 favorite]

the practictioner lives in friend's neighborhood and is convenient

The non-ADHD-specialist therapist you actually go to is infinitely preferable to the specialist therapist that you don't.

I generally agree with others that you need to take a few steps back, here, but I think if your friend is working with a therapist who is pushing the trauma thing, it's worth just providing ongoing reminders when it comes up that other professionals approach things differently and your friend doesn't need to even GO to those other professionals in order to pick and choose the bits of this therapy experience that work for them and toss the bits that don't. That's the big thing that people new to therapy often don't get, that this isn't a religion and they aren't required to follow everything to the letter if it isn't actually working for them. That they can, in fact, push back when things feel wrong.

As long as your friend gets that much, they'll be able to make the call about when/if they need to switch practitioners themselves.
posted by Sequence at 12:20 PM on February 4, 2019 [1 favorite]

Best answer: It's very possible that your friend is dealing with more than "just" ADHD or something else that they don't feel ready to share with you just yet (or maybe ever!)

I agree that not every therapist and not every modality is automatically a good match. Perhaps this one will be surprisingly perfect or perhaps they won't be so good after all. I was very wary of taking any sort of medicine when I first started therapy; had a therapist immediately suggested I try, I would have stopped seeing them. I eventually decided to try an SSRI and am so glad I did; I may or may not continue to take it in the future. However, I'm also I came to it at my own pace with support from my therapist and then also psychiatrist. After years of trying to find a good therapist match, I found someone who was pretty good if not perfect. I saw her for a year and learned a lot but eventually felt stagnant. Then I switched to someone else who specialized in trauma and I've now seen her for 1.5 years. I will finish with her soon when I move; she's a perfect match for me, although it took time for us to build our relationship.

I think the best thing to do was encourage your friend to seek treatment, which she is doing. Now give her space and feedback as requested. Therapy is kind of like dating: most of us don't find the best partner on our first date but we can still learn and grow from each relationship.
posted by smorgasbord at 3:42 PM on February 4, 2019 [2 favorites]

You can always mention that you can help her find another therapist if this doesnt work out, and oh by the way so-and-so is supposed to be great. Then drop it.
posted by Amy93 at 3:51 PM on February 4, 2019

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