Why ADHD Psychotherapists Need to Expand Their Clinical Toolkit
ADHD psychotherapists need to move beyond their traditional comfort zones if they are going to be truly effective in treating ADHD. Over the years, countless clients have told me that previous therapy helped them in important ways — improving insight, processing emotions, or addressing relationships — but never directly addressed the day-to-day challenges created by their ADHD.
We need to pay attention to what individuals with ADHD are telling us. Recent reports from the UK indicate that many people with ADHD are choosing to seek help from ADHD coaches — whose services are typically not covered by the National Health Service — rather than from psychotherapists whose services may be covered. Why? Because adults with ADHD and parents of children with ADHD are looking for practical help with the daily challenges that create chronic stress, overwhelm, and a sense of failure.
So why shouldn’t everyone simply turn to ADHD coaches?
Because ADHD rarely travels alone.
By adolescence and adulthood, co-occurring conditions are often a significant part of the clinical picture — including anxiety, depression, bipolar disorder, eating disorders, substance use disorders, autism spectrum disorder, premenstrual dysphoric disorder (PMDD), trauma-related conditions including complex PTSD, and suicidal thinking or behavior.
ADHD coaches can provide valuable support, but they are not trained or licensed to diagnose and treat the psychiatric and developmental conditions that so often accompany ADHD. That level of care requires graduate-level mental health training, extensive supervised clinical experience, and professional licensure to provide psychotherapy.
At the same time, we must acknowledge an important gap in our own field: too few psychotherapists have been trained to teach the practical strategies, habits, and real-world approaches that have become the focus of ADHD coaching. As a result, many individuals and families are left trying to choose between a coach who understands ADHD challenges but cannot treat co-occurring mental health issues, and a therapist who can treat emotional and psychiatric concerns but may not understand how to help clients manage ADHD in daily life.
Few people can afford — financially or practically — to work with both.
Interestingly, some licensed psychotherapists, including counselors and clinical social workers, have “jumped the fence” and begun practicing primarily as ADHD coaches. What is the problem with that? For many families, psychotherapy is at least partially covered by health insurance, while coaching typically is not. When trained clinicians leave the psychotherapy role entirely, access to comprehensive ADHD-informed mental health care becomes even more limited.
My rule of thumb is this: if there are no significant psychiatric or developmental concerns and a person’s needs are focused primarily on daily functioning, organization, time management, and life systems, referral to a well-trained ADHD coach may be the right choice.
However, research consistently shows that the majority of adults with ADHD have at least one co-occurring condition. This means that many individuals with ADHD need a clinician who can address both ADHD-related challenges and the emotional, relational, and psychiatric issues that accompany them.
And this brings us back to the central challenge: too few psychotherapists receive meaningful training in how to treat ADHD effectively.
Effective ADHD treatment requires much more than addressing symptoms of inattention, impulsivity, or hyperactivity. Clinicians must learn how ADHD shapes self-concept, emotional regulation, relationships, motivation, shame, distorted beliefs, and the ability to create sustainable life structures.
But the challenge goes even further — because ADHD is complex.
Across the entire field of mental health, we need to teach clinicians to view treatment through an ADHD-informed lens. For example, eating disorder programs need to recognize that appropriately prescribed stimulant
medication for ADHD may be an essential component of treatment for some individuals because improved impulse control and reduced self-stimulation seeking may directly affect disordered eating patterns.
The same principle applies across many areas of mental health care. We do not need to send individuals with ADHD to an ever-expanding list of separate specialists — one for executive functioning, another for relationships, another for emotional regulation, another for co-occurring disorders. Instead, we need to train clinicians to understand and treat the whole person with ADHD.
This is the mission of ILAT: to move beyond simply teaching clinicians about ADHD and provide the deeper training needed to know what to do about ADHD — across the lifespan and in all its complexity.
At ILAT (Institute for Lifespan ADHD Training), we are excited to introduce Ari Tuckman, PsyD as a member of the ILAT faculty who will offer an initial presentation on “therapeutic coaching” at the virtual ILAT Global Summit October 29-30.
Ari has been a highly respected psychotherapist and thought leader in the world of ADHD for many years. His books are thoughtful, readable, and provide a unique perspective as a clinical psychologist with more than 40,000 client hours who has integrated many coaching techniques into his psychotherapy for more than 25 years.
