Gina Pera's Adult ADHD Roller Coaster

Evidence-Based Therapy for ADHD-challenged Couples

April 22, 2021
Gina Pera's Adult ADHD Roller Coaster
Evidence-Based Therapy for ADHD-challenged Couples
Show Notes Transcript

Adult ADHD-Focused Couple Therapy  TM.  Why create a special model for Adult ADHD-challenged couples?   Why not just use standard couple therapy? 

Great questions. I’ll answer them, at least in part, in this podcast.  

·     I first explained in 2008 why standard couple therapy is typically unhelpful in my book, Is It You, Me, or Adult ADHD, including a chapter called “Why the Wrong Therapy is Worse Than No Therapy.”    This book is as relevant today as it was then.

·     My second book  is Adult ADHD-Focused Couple Therapy: Clinical Interventions, published in 2016.  

·     It is the first and only clinical guide presenting a couple-therapy model based on the evidence—that is, a careful and flexible merging of what works for Adult ADHD and what works for couple therapy.

About my co-author: Arthur L. Robin, PhD, has long helped individuals and couples affected by ADHD. His strategies are battle-tested. In his primary occupation, from which he is now retired, he trained psychologists working at a children’s hospital. Both his ADHD expertise and skill as an educator shine through our model’s interventions..

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·      Read the original blog post of this podcast here:  Q&A with the Experts: Adult ADHD-Focused Couple Therapy - TM

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Gina Pera
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Q&A with the Experts: Adult ADHD-Focused Couple Therapy

Adult ADHD-Focused Couple Therapy™.  Why create a special model—based on the evidence of what work— for Adult ADHD-challenged couples?   Why not just try standard couple therapy? Why not just Adult ADHD therapy and recruit the partner as the executive assistant……no, definitely not that.   We’ll explain why—and more—in four questions and answers below.

My second book (with psychologist Arthur L. Robin) is Adult ADHD-Focused Couple Therapy: Clinical Interventions.  It is the first and only clinical guide presenting a couple-therapy model based on the evidence—a careful and flexible merging of what works for Adult ADHD and what works for couple therapy. Preeminent experts in both fields highly praise the guide.

By the way, the term evidence-based means that published research has shown these methods to be effective. These are not simply personal, self-styled opinions. This term is bandied about a lot, but we take it seriously.

You can read more details about the book,  our contributors, our professional backgrounds, and professional endorsements at my training site:  Adult ADHD Success Training – The books

About the Authors

Through his decades in private practice, Dr. Robin has long helped individuals and couples affected by ADHD. His strategies are battle-tested. In his primary occupation, from which he is now retired, he trained psychologists working in a hospital setting. Both his ADHD expertise and skill as an educator shine through our model’s interventions.

Through my 20 years of work in this field, I’ve seen how dramatically the wrong therapy risks making a bad situation worse. Simply talking about the problems can prove toxic. So can misattributing the problems to ulterior motives—or childhood issues. Or trauma. Or any of a number of non-core causes.

ADHD-challenged couples deserve appropriate education, pragmatic strategies, and psychological support in resuscitating their relationships—and learning how to thrive together.

To help ADHD-challenged couples, Dr. Robin and I share a strong perspective: We must begin with basic practical strategies and gradually expand to include more complex and emotional issues.

Based on our model, we offer training, for consumers and clinicians. Learn more at Solving Your Adult ADHD Puzzle.

Professional Level 1 training is a home-study test offering 15 continuing-education hours, NBCC.


Now For The Four Questions

Our publisher, Routledge Press, asked us these four questions, posting our answers at its website (four years later, it’s no longer there). We were gratified that this prestigious publisher of professional guides named us Authors of the Month.

I’ve reprinted the first four questions and answers below.

1. What made you decide to write this book?

First, the situation is dire for ADHD-challenged couples worldwide. The past decade has seen an explosion of Adult ADHD awareness. Couples desperately seek clinical expertise and guidance. Yet they rarely find it.

Second, evidence-based interventions exist for adult ADHD (though rarely available). Such interventions also exist for couple therapy.  But no established interventions existed for ADHD-affected couples. We wrote this book to fill this void, by carefully blending two critical components. That is, evidence-based interventions for:

  1. Adult ADHD
  2. Couple therapy

To summarize, we wrote this book so that all therapists can

  1.  Understand how unrecognized or poorly managed ADHD can thwart positive clinical outcomes for individuals and couples, and
  2.  Implement state-of-the-art approaches designed to enrich their practice and clients’ lives in a way that is fair and respectful of each person and the relationship

In 250 tightly written pages, we present:

1. Supporting background on Adult ADHD for professionals new to the topic

2. Our flexible model, which acknowledges that many ADHD-challenged couples actually have a good relationship. They don’t need therapy per se. They need help learning and implementing practical, organizational challenges!

3. Step-by-step interventions targeting organizing (of time, priorities, and “stuff”), communication, procrastination, working as a team, managing finances, co-parenting, electronic addictions, and more.

4.  Throughout the book, case couples illustrate how the interventions work in real life.

2. What is one thing you hope readers take away from this book?

Adult ADHD is not a fringe sub-specialty. Every mental-health professional should be familiar with its signs and treatments.

Conservatively speaking, researchers estimate the worldwide ADHD prevalence rate at about 5 percent. More realistically, however, an estimated 10 -15 percent of the population suffers at least moderate ADHD-related impairment.

Consider the U.S. alone: There are an estimated 23-35 million adults with ADHD. Yet only 1 in 10 is diagnosed. Fewer still have received any type of treatment. We find similar prevalence rates worldwide.

An alarming fact:  Adults with ADHD are much more likely to be diagnosed with conditions secondary to ADHD—depression, anxiety, substance-abuse, and even attachment disorders. Sometimes misdiagnosis continues for decades (Misdiagnosed Until 39: “Best Week of My Life”).

When treatment misses the core issue of ADHD,  positive outcomes are rare. In fact, the wrong diagnosis and wrong treatment even risks exacerbating ADHD challenges. That is, the person experiences less motivation, initiation, impulse-control, working memory, and organization.

Couple therapy represents an excellent opportunity to screen for ADHD. In so doing, these couples gain a chance to enjoy real and lasting change. In fact, we maintain that undiagnosed ADHD is over-represented among couples seeking counseling.

Expanding the helpful reach even further: Our Adult ADHD-Focused Couple Therapy ™ interventions stand to help even greater numbers of people. That includes individuals who struggle with similar behaviors yet do not fully qualify for the ADHD diagnosis. After all, the associated traits of ADHD—procrastination, distractibility, emotional dysregulation, impulsivity, and the like—fall on a continuum in the human population.


3. Is there another point you’d like to highlight about this topic?

Yes! There is hope for couples teetering on the brink of disaster due to the poorly managed impact of adult ADHD on their relationships.

That hope, however, depends on understanding one critical point: ADHD has its basis in neurobiology. Brain-based challenges underlie many of the issues that bring these couples to therapy. These problems center on money, sex and intimacy, chore-sharing, co-parenting, communication, and the like.

Perhaps this endorsement drives home the point best. It comes from noted couple-therapy expert Douglas K. Snyder, PhD, co-editor of Treating Difficult Couples and the Clinical Handbook of Couple Therapy (5th ed.) 

Couple therapy has moved well beyond interventions for intimate relationship distress. Increasingly, evidence-based extensions of couple therapy have been developed for treating emotional, behavioral, or physical health problems in one or both partners.

ADHD presents a critical destabilizing influence on couple relationships that has, heretofore, been largely understudied and under-treated. This book offers a treasure trove of evidence-based interventions for helping partners to cope with this personal and relational challenge.


4. What is a common misconception about this topic that you would like to clear up?

Misconceptions about ADHD flood the Internet and popular media—and even the mental-health profession. We address several common misunderstandings in the book, including these two particularly dangerous myths:

  1. The ADHD diagnosis pathologizes “normal human behavior”
  2. Couple therapy should be all about “appreciating differences.”

Taken by themselves, ADHD symptoms are indeed “normal human behaviors.” But it is both the number and intensity of these behaviors—combined with actual impairment in life—that makes the diagnosis.

Far from being a “new invention,” ADHD cuts across many of the problems that have historically brought legions of people to therapy, especially couple therapy. Yet, because their Adult ADHD was missed or its interventions poorly understood, these clients have rarely received the clinical guidance needed to make lasting changes. Despite their therapists’ best, well-intentioned efforts.

Since the 1990s’ so-called Decade of the Brain, revolutionary brain-imaging methods have exponentially increased our understanding of this most complex human organ and, thus, conditions such as ADHD. To date, according to PubMed, more than 15,000 papers with ADHD or ADD as a major focus have been published since 1970.

The literature makes clear: ADHD is real, it is more common and impairing than most people realize, and its targeted treatments can be highly effective.

Equally well documented: ADHD neurobehaviors, when left unaddressed, can limit:

  • Options in life,
  • Self-fulfillment,
  • Relationships of all types,
  • Financial and job status, and
  • Even the physical health of the people who have it—while also adversely affecting everyone in that person’s sphere of influence.

 Gina Pera

Adult ADHD-Focused Couple Therapy: Q&A with the Experts