Help finding a practical, hands-on med professional for ADHD
September 28, 2023 7:31 AM   Subscribe

I have a diagnosis of ADHD inattentive (ADD), a psych doc, & prescription meds. I've done talk therapy. I am desperately in need of practical, real help with learning to executive function. I'm probably describing an ADHD coach but my financial situation is bad so I need someone who is in network with BCBS insurance. I'm in CT, USA. Any suggestions, whether specific people or what the kinds of specialists who do practical work with people who have executive function disorders are called? ADHD levels of additional detail below the fold.

Therapists say nice things but I need actual help. Everyone acts like I'm functioning pretty good, but I'm sucking at ALL the iADLs. I shower once a week. I do not wash my face. I do brush my teeth once a day and honestly, thank god that comes easy. I do my laundry once a month. None of this is on purpose, I would really like to have clean clothes etc, I just am perpetually either not thinking of it or overwhelmed. (I'm better at taking care of my children & like, CPS isn't coming for them and in some ways I'm a great parent, but I never wanted to be an overall meh parent so there's a lot of room for improvement.) Sometimes I can do a few things every day for a week, or even the same thing a few days a week for nearly a month. Amazingly, haphazardly doing a few things here and there results in a gigantic mess, literally and figuratively. Therapists just go "it's okay, don't be hard on yourself" while I'm tens of thousands of dollars in credit card debt (kinda ignoring that money is real for three years piles up! it's mostly groceries and gas and interest) and the back part of the house is rotting out (should have fixed that gutter). "You should go back to the endocrinologist" yes I KNOW, I brought that up in the first place but that's one of the 64378843 things I'm currently having a hard time with.

No special new med (don't suggest a med change, please!) or productivity system (don't suggest an app, please!) is going to magically change anything. I need to be doing focused, purposeful, DAILY baby steps. I know that, but I really need someone to:
a) actually look at me & my problems & my life responsibilities,
b) tell me what those baby steps are (or guide me through figuring that out),
c) help me work through the inevitable overwhelm and but-what-abouts and panic,
d) pay attention to my progress or lack thereof.

I think this is stuff adults are expected to do for themselves but I've tried for decades and the hole just keeps getting deeper. Sometimes I do better, sometimes I do worse. Overall I'm better than I was 10 years ago when I discovered adult women can have ADD, but we're talking about going from an F to a D-.

I had one therapist who was really great at first: on day one she had me tidy up my table during our (remote) session. That kind of approach was very helpful, but after 2 or 3 months she became frustrated when introducing routines didn't totally fix me (eg, she told me I had emotional problems, denied that I could have ADHD, told me I'd tried nothing in regards to treatment, & subtly encouraged me to go back to the catholic church). I've seen a lot of different therapists, but she was the only one to start helping in a practical way and then really hurt me.
(To be clear, I'd never "broke up" with a therapist before her. I'm not belligerent or anything, you just tend to see a lot of different therapists over many years, a few moves, and a number of insurance issues.)

So I am flat out not interested in talking with anyone who isn't 10000% an expert in helping people with executive functioning disorders get better at iADLs.

But also I really seriously cannot afford more than my $15 copay through BCBS. I can't manage a whole out of network, pay in full and then get refunded by insurance thing.

I know this is a longshot. Hoping someone knows someone.
posted by anonymous to Health & Fitness (7 answers total) 11 users marked this as a favorite
Unfortunately I do not have any in-person doctor recommendations and have heard it is hard to find ADHD coaches who take insurance at all because it's not technically a "medical" problem according to most insurance companies.

I haven't used them myself, but several of my ADHD friends have had success with using ADHD coaching apps on their phones. One of the more "professional" ones is InFlow, which has structure and coaching but does have a monthly fee. There are some other newer apps as well.
posted by JZig at 8:22 AM on September 28, 2023

First, I know exactly what you mean and I have been exactly at the point where you are now (links to my previous asks, one of them is pretty emotional and desperate). You are not alone. And you are not doomed.

Second, IDK about coaches and therapists for this issue but I have been able to use the help of friends to great effect. But before I can use friends, I have to figure out the task I am working on and I have learned from looooooong experience that this can only be determined by me. Okay, I get that putting my thoughts out in this jumbled order is not helpful so I will try giving you a stepwise list.

Step ZERO is to trust yourself that you already know what needs to be done urgently, on the inside, and it's a matter of sitting down and asking yourself what that is and remaining calm while you find out the answer from yourself.

Step 1: Name one thing that is stressing you out and is urgently in need of a fix. (I know there is a long list of these things. Pick one. It's okay, you'll get to the others, stay calm, this is the process. Toss a coin. Roll a die. Pick one and GO.)

Step 2: What is the first action item you need to do to start fixing it? For example, if your chosen task from step 1 is ELIMINATE DEBT, then what is the first thing you need to do? It might be "find my bank paperwork" or "make a phone call to a financial advisor".

Step 3: What's the thing you need to do before you can do that first action item? For example, if your bank paperwork is in some box in the basement, but you can't go to the basement because you're afraid you'll find a mouse there, then maybe you should decide that you will put on your rubber boots and thick winter coat and fur hat and face-scarf and your chonkiest gloves (I'm assuming you do not own an actual hazmat suit?) and go down to the goddamn basement in your protective armor and bring that box upstairs so you can examine it in peace. WARNING: do not distract yourself with endless preliminary tasks, such as calling a pest control person or fixing your mouse phobia before you tackle the bank paperwork finding task! The point of this step is to find the quickest, hackiest, most cheating-est route back to step 2.

Step 4: Phone a friend and tell them you're trying to get some work done and can they please come hang out with you. While your friend is over at your place (or maybe on the phone or on a Zoom call with you), perform Step 3, and then Step 2.

Step 5: Repeat Steps 2, 3, and 4 until the task from Step 1 is complete. During wait times, such as when you are waiting for your friend to show up tomorrow as your body doubler, you can start a parallel process for a separate Step 1 task but (this is important) it should be from a completely different level category of urgency. Since you chose ELIMINATE DEBT as your first process, maybe choose TAKE A SHOWER or DO ONE LOAD OF LAUNDRY as your second. If you have capacity for a third, more power to you! But IME it is unlikely and that's totally fine. We are not machines. We just make progress.

Throughout the process, make it your mantra to let everything else go to hell. Your brain will try to trick you into going off on other quests because OH MY GOD YOU CAN'T POSSIBLY THINK THE BANK PAPERS ARE MORE IMPORTANT THAN THAT ROOF, WHAT IS WRONG WITH YOU, YOU PICKED THE WRONG TASK, GO BACK, RESTART!!!! You will calmly tell your brain that everything else can go to hell. Over and over and over again, you will tell your brain that everything else can go to hell. You will get to the other thing eventually, but until then it can go to hell.

IDK find your own mantra if that one doesn't work for you. I know people who recite poems or the Bene Gesserit litany against fear or Hail Marys or sing songs or whatever. Me, I just chant "everything else can go to hell, everything else can go to hell, everything else can go to hell" in a particular cadence while I doggedly continue to work on the present task, like a boot camp recruit doing military cadence.
posted by MiraK at 9:57 AM on September 28, 2023 [10 favorites]

This is who my wife saw who did this type of work covered by insurance. I am linking the bio not because i think this person is close to you (she's not) but because I think that the description may be useful in narrowing down what you are looking for.
posted by AlexiaSky at 10:05 AM on September 28, 2023

Professionals that help you with iADLs are called occupational therapists. Mental health OTs exist and can help with executive function. I live in Canada but I have received mental health OT services by doctors referral and by private pay.
posted by shock muppet at 10:09 AM on September 28, 2023 [4 favorites]

"How To Keep House While Drowning" is an excellently helpful book that might give you some baby steps until you find your trusted & affordable professional. It was written by KC Davis:
posted by dotparker at 10:10 AM on September 28, 2023 [3 favorites]

Marla Cummins is an ADHD coach but she also runs a weekly zoom support/problem solving group for adults with ADHD, which is very affordable (I think $15 a month), and which is a lovely community.
posted by wyzewoman at 12:24 PM on September 28, 2023

I like the idea of occupational therapy. A therapist who specializes in CBT for anxiety could help too.
posted by haptic_avenger at 8:19 PM on September 28, 2023 [1 favorite]

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