CHAPTER 12

FINDING THE RIGHT COUNSELOR, COACH, OR OTHER TREATMENT SOLUTION

Although the world is full of suffering, it is also full of the overcoming of it.

—Helen Keller

If you’ve gone to a parent, teacher, friend, professional organizer, or mental health professional who did not specialize in attention-deficit/hyperactivity disorder (ADHD) for help with your day-to-day functioning, chances are good that their efforts did not help you much, as they may have an incomplete or incorrect understanding of ADHD. You may feel disillusioned and demoralized and have learned to expect disappointment as a natural consequence of your efforts. This unfortunate and sometimes devastating mindset can be altered. If ADHD is properly managed, you can have significant and, sometimes, dramatic improvements in life functioning.

Sometimes simply being diagnosed and treated by a professional who really understands ADHD can bring tremendous relief. You may remember that when you were diagnosed, and you received an explanation for your lifelong pattern of difficulties, you finally felt understood for the first time. Just the realization that somebody truly understands and empathizes with the issues that you have been struggling with can be extraordinarily therapeutic. The challenge then becomes devising a treatment plan to help you live more effectively and, ultimately, gain better control over your ADHD-related behaviors.

In this chapter, I outline some of the current nonmedication-based treatment interventions for adults with ADHD, including the following:

• counseling/therapy,
• exercise and nutrition,
• ADHD coaching,
• accommodations, and
• multimodal treatment.

In addition, I provide a case example of a young man who tried unsuccessfully to treat his ADHD before finding the right service for him, a quiz to help you figure out which treatment option may be right for you, tips on locating an ADHD specialist, questions to ask a specialist, and help with overcoming any fears of treatment that you might have.

Adults living with ADHD have several treatment options that can help them to lead a happier, more productive life. Although treatments do not “cure” ADHD, they can certainly help you cope with the emotional, attitudinal, and behavioral issues, as well as the co-occurring conditions often associated with ADHD, such as depression and anxiety. Still, no one intervention technique has proven effective for all individuals with the disorder. As the consumer, it is up to you to research and attempt the treatment or combination of treatments that feel right for you.

WHAT THE EXPERTS SAY

At this time, psychopharmacology (discussed at length in Chapter 11 on medication) is the only rigorously studied treatment option for adults with ADHD. However, in controlled studies of stimulants and open studies of other medications commonly used to treat ADHD, 20% to 50% of adults are considered nonresponders. This means that the medications do not reduce symptoms sufficiently or the person suffers from bad side effects. Moreover, adults who are considered responders typically show only up to a 50% reduction in the core symptoms of ADHD. Given these data, medication alone is not considered the best treatment method for adults with ADHD.

Although medication may improve many of the central symptoms of ADHD (attentional problems, high activity, and impulsivity), most experts agree that it does not provide a person with concrete strategies and skills for coping with the disorder. Imagine a time when you sustained a physical injury. You probably took a pain-relieving medication to temporarily mask the soreness. Meanwhile, you knew that the medication did not actually help to heal the injury—to do that, you needed to nurse it, exercise, and mobilize it until it was again functioning to your standards. Similarly, quality-of-life impairments such as underachievement, disorganization, and problems with time management; weekly work- or school-related tasks; and relationship difficulties associated with ADHD in adulthood require active problem solving. These things can be achieved with skills training over and above medication management. To prove this point, in 1997 the National Institute of Mental Health (NIMH) conducted a study of multimodal treatment of ADHD (Arnold et al., 1997). This was the largest randomized treatment study ever done and has since been followed up on throughout the years. The outcome and the continued data solidified the fact that psychosocial treatments such as counseling or coaching, in combination with medication, result in the best outcomes for individuals with ADHD.

Complex regimens dramatically reduce treatment adherence. With a syndrome like ADHD, in which cognitive dysfunction occurs, it is absolutely essential that treatment is simple and structured (Geffen & Forster, 2018).

CAN YOU RELATE TO THIS?

The following case describes a man who sought treatment for issues related to depression and ADHD symptoms, including lack of organization and time management, relationship problems, and trouble focusing. Eric was diagnosed with ADHD by his family doctor during his sophomore year of high school. He was prescribed Ritalin and took it on and off through college. Despite taking medication, he continued to struggle with poor grades and did not attempt any other form of treatment. He also had several undesirable side effects from the medication, including trouble sleeping, which made his ADHD symptoms worse. During college, Eric had to drop and repeat several classes, and he finally managed to barely graduate with a low grade point average after 5 1/2 years. This self-described “failure,” along with a failed relationship with his serious college girlfriend, caused Eric to spiral into a depression.

After college, Eric moved home for several months and applied for a number of jobs without success. He let his laundry pile up, left dirty dishes all over the house, and rarely left his bedroom. Finally, his mom insisted that he see a therapist if he wanted to continue to live at home. They found a counselor nearby who was covered by their insurance (although he was not an expert on ADHD) and made an appointment. Eric found the therapist likeable and enjoyed talking to him, but he felt that the “generic talk therapy” wasn’t getting him anywhere with his ADHD symptoms. Eric stated that their conversations centered mostly on his disappointments and feelings of depression. His impression was that, even though the therapist knew Eric had an ADHD diagnosis, because his issues didn’t center on school or work and the therapist did not specialize in ADHD, he did not give it much attention. Eric further said that although he always felt “a little better” immediately following their sessions, he felt like this was temporary and that therapy wasn’t helping him to “get any further in life.”

After almost a year, Eric decided to terminate therapy. He landed a part-time job as an executive assistant for a small business and was able to save up enough money to move out of his parents’ home. For a while, his depression seemed to lift enough to satisfy him. He even started dating a new woman, and things were going pretty well. However, now 25, Eric found himself pressured by his girlfriend to get engaged, and his boss was beginning to require more from him at work. Eric was beginning to spiral into another depression. Although he loved his girlfriend, something in him could not make the commitment, and he was having a hard time staying organized and focused in the office.

Because Eric had tried both medication and therapy and felt that neither had really helped, he struggled with what to do. Fortunately, he spoke with a friend, who let him know of a counselor and coach nearby who specialized in ADHD. As the new counselor and Eric talked, it became clear to him that he was a good candidate for ADHD coaching and cognitive behavior therapy (CBT) and that the reasons why his prior treatments had not worked well could be easily explained. When it came to his initial diagnosis, Eric’s doctor had done little in terms of explaining the ADHD diagnosis or treatment options. This left Eric and his family to make their own assumptions about what ADHD was, and the doctor’s prescription for stimulants led them to believe that medication was the only and best way to treat the disorder. Once on the medication, Eric did not communicate his struggles with side effects to his doctor and did not ask about alternative treatment options. In terms of therapy, the original counselor that Eric saw did not specialize in ADHD and unknowingly undermined Eric’s rehabilitation by placing little value on this diagnosis. Likewise, this therapist was not specifically trained in CBT, and Eric did not realize that psychological counseling had many different approaches. As a result of these experiences, Eric naturally came to assume that neither medication nor therapy was the right answer.

The specialist was able to convince Eric to give ADHD coaching and counseling a shot. Eric started having weekly sessions, engaging in both coaching and CBT methods. By setting some realistic goals and working with his counselor to reach those goals, Eric became more comfortable and effective at work, earning him a promotion; he was able to put his fears aside and propose to his girlfriend; and, best of all, he started to “feel good about life again.” Today, Eric is happily married with a baby on the way and working at a job he enjoys.

Eric’s case demonstrates several issues common to adults with ADHD when seeking treatment. Many individuals tend to become disillusioned and disappointed by their first attempts to seek services simply because they don’t know what to look for or the right questions to ask. However, the right treatment, with or without prescription medication, can help most adults with ADHD begin to reduce their symptoms and increase their arsenal of coping mechanisms. The following are descriptions of the current popular nonmedication- based treatment methods you may want to consider.

COUNSELING

Individual counseling and counseling groups can provide information, advocacy, instruction, and support. Several types of therapy or therapeutic interventions have been used for adults with ADHD; however, some, such as the following, are more beneficial than others:

• CBT,
• group therapy,
• mindfulness meditation,
• neurofeedback, and
• social skills training.

Cognitive Behavior Therapy

CBT has been shown to be one of the best forms of counseling for adults with ADHD (Weiss et al., 2012). Evidence powerfully backs using CBT with those diagnosed with ADHD. CBT is a form of psychotherapy that focuses on changing maladaptive patterns of thinking and the underlying beliefs that guide such thoughts. The hope is that learning to change these distorted thoughts can then lead to changes in behavior. For example, an adult with ADHD might think, “I am lazy.” A cognitive behavioral therapist would challenge this person to test this hypothesis and prove it wrong. Ideally, once the individual gains evidence that they are not actually lazy, their sense of self-worth and self-esteem increase, and fear-based behavior diminishes.

The ABC model of CBT consists of three parts to describe how you arrive at conclusions and whether these are healthy and productive. Understanding it is as simple as “ABC”:

• Activating event—the actual event and your immediate interpretations of the event
• Beliefs about the event—this evaluation can be rational or irrational
• Consequences—how you feel and what you do or other thoughts

Next, I present two scenarios, each consisting of the same activating event. However, as you can see, your evaluation and belief about the event can drastically change your outlook and improve your functioning as an adult with ADHD.

Scenario 1

1. Susan receives a poor performance review from her boss that states she seems “unmotivated, sloppy, and unfocused.”
2. Susan thinks, “I am such a stupid, lazy idiot.”
3. Susan stops giving any effort at her job and eventually gets laid off.

Scenario 2

1. Susan receives a poor performance review from her boss that states she seems “unmotivated, sloppy, and unfocused.”
2. Susan thinks, “I could really use some support to tackle my issues with organization, procrastination, and paying attention.”
3. Susan begins ADHD coaching sessions, develops strategies to overcome her weaknesses at work, and earns a promotion.

The key to understanding CBT is realizing that your moods and actions are driven by what you tell yourself in each situation and are not a direct result of the circumstances in your life. A therapist who specializes in CBT can help you to change your thought patterns using several techniques, such as journaling, relaxation, positive affirmations, and reflection.

Group Therapy

Although group therapy is underutilized and underresearched, hearing how others cope and manage their symptoms, realizing there are others who have similar problems, and having a safe and supportive place to ask questions and try out new behaviors and interpersonal skills are all valuable advantages of group counseling. On the other hand, groups reduce the amount of personal attention an individual will receive. Unless the therapist leading the group is mindful of each participant, it is easy for talkative types and attention seekers to take up much of the group’s time and energy. Plus, suggestions made by other members may or may not be agreeable to the advice of a professional. Still, for those looking for a budget-friendly, supportive environment to help manage their ADHD symptoms, group therapy can be a great option.

Mindfulness Meditation

A cost-effective option that many professionals in the field argue is helpful in improving focus and attention, as well as reducing stress, for adults with ADHD is the practice of mindfulness meditation. Doctors at the University of California, Los Angeles, have begun to examine the effectiveness of mindfulness meditation for adults with ADHD, with promising results. According to the authors (Zylowska et al., 2008),

Mindfulness meditation involves experiential learning via silent periods of sitting meditation or slow walking and purposeful attention to daily activities. Relaxation, although often induced during the training, is not the sole goal of the activity; rather, the main activity is a cognitive and intention-based process characterized by self-regulation and attention to the present moment with an open and accepting orientation towards one’s experiences. (p. 738)

Mindfulness meditation can be broken down into three basic steps: (a) bringing attention to an “attentional anchor,” such as breathing; (b) noting that distraction occurred and letting go of the distraction; and (c) refocusing back to the “attentional anchor.” Research has demonstrated that mindfulness meditation can reduce self-reported ADHD symptoms, improve attentional task performance, modulate the brain’s electrical activity, alter dopamine levels, and change neural activity.

Neurofeedback

Neurofeedback is a highly controversial technique that involves teaching an individual to produce more focused brain wave patterns. It was created to reduce ADHD symptoms such as distractibility and impulsivity. Using computer software to display scenes on which the user is supposed to focus, electrodes are attached to the scalp to measure the brain’s electrical activity. Although there is some evidence of its effectiveness, many professionals feel that neurofeedback is simply a more costly version of mindfulness meditation.

Social Skills Training

Although skill-building approaches, such as social skills training, have been recommended for adults with ADHD, research has demonstrated that such approaches have not been of much benefit to them. Social skills training is designed to help the individual learn appropriate behaviors and behave in a more socially acceptable way. In terms of ADHD, such behaviors may include impulsivity, aggression, and anger. Sessions are usually held in small-group settings so that members can practice and role play with one another for a designated amount of time. Such groups seem to have more effect on children with the disorder than on adults. Additionally, the short-term psychosocial treatment effects that do take place often do not typically generalize outside the context in which they are applied.

EXERCISE AND NUTRITION

Want a cheap and proven way to change your brain without the risk of side effects? Try exercise. Although keeping fit is important to all people, it can be particularly beneficial to adults with ADHD.

John Ratey, MD, an associate clinical professor of psychiatry at Harvard Medical School and author of Spark: The Revolutionary New Science of Exercise and the Brain, went as far as to say that exercise can be just as effective as medication for some people. There are several reasons for this: First, when you engage in exercise, you turn on the region of the brain affected by ADHD and increase the flow of dopamine and other chemicals that are normally lacking. Physical activity also requires you to use the skills that you may normally struggle with, such as paying attention, maintaining focus, sequencing, following through, and using memory effectively to further activate your brain. Second, exercise produces endorphins. These are hormonelike compounds that regulate mood, causing you to feel good after an intense workout. The third reason relates to the idea of what psychologist Dr. Martin Seligman of the University of Pennsylvania called learned helplessness. Learned helplessness occurs when, after experiencing several negative consequences, a person begins to believe that they have no control over their behavior. I have touched on this earlier in the book; these are the statements you probably replay over and over to yourself that can sabotage your efforts to change, such as “No matter what I do, I’ll always fail,” “I am just not smart,” or “I was just lucky on that one.” Several studies have found exercise to prevent this phenomenon from occurring.

A modified diet can be another way to inexpensively and safely reduce your ADHD symptoms. The U.S. Food and Drug Administration’s official stance is that there is not enough evidence to say that food additives can cause ADHD; however, some research has suggested that additives may be linked to exacerbated symptoms in people who already have ADHD. Identifying exactly which food dyes or additives might contribute to ADHD has proved more difficult. As a result, there are many proposed nutritional plans for adults with ADHD out there, and the verdict is out on exactly what approach is best. Still, a generally healthy, well-rounded diet that minimizes simple carbohydrates and maximizes high-protein and omega-3 rich foods, as well as nutrient-rich fruits and vegetables, is sure to help your brain function more effectively than one full of fatty or sugary cuisines. Whatever avenue you choose as far as your nutrition, seek the advice of a nutritionist or other medical professional who specializes in ADHD to avoid becoming victim to the latest unsubstantiated health craze.

ADHD COACHING

As discussed in Part I of this book, top ADHD expert Russell Barkley suggested that the problem for individuals with ADHD is not a skill deficit but, rather, a difficulty with behavioral execution and self-regulation. He suggested that adults with the disorder may possess knowledge of coping strategies effective for most people and may have even tried some of them for themselves. However, when significant difficulty arises because of underlying executive processing mechanisms, successful performance is unachievable. These individuals find it very difficult to sacrifice an immediate reward either to gain some longer-term reward or to avoid some later harm. Therefore, Barkley recommended interventions that provide a more effective course of action than teaching coping mechanisms or other non–performance-based techniques. Perhaps one of the most innovative and promising recent intervention methods as far as life management success is ADHD coaching, which offers a more highly structured, behavioral approach than traditional counseling.

ADHD coaching can help you develop coping skills and strategies to resolve many of your unwanted ADHD-related behaviors, and a growing amount of research has suggested its usefulness. ADHD coaching involves helping you deal with aspects of the disorder that interfere with academic or work performance and cope with ADHD-related difficulties such as procrastination, lack of concentration, ineffective self-regulation, poor planning, anxiety, social incompetence, or time management. Useful strategies you may learn in coaching include organizational skills, time management, and specific study skills. Coaching involves setting concrete, realistic goals and can extend to many facets of your life.

Coaching is similar to traditional counseling in several ways. Both coaching and traditional counseling establish helping relationships that are supportive, respectful, and confidential; work on setting goals and assessing priorities; and require a client who is willing to make changes in their behavior. However, most therapists also help to guide clients toward insight, or a deeper understanding of behavior, whereas coaches may or may not do this, depending on who is doing the coaching. Coaches do not have to be licensed or formally trained, or possess a formal degree. Unlike counselors, coaches who are not also licensed mental health professionals cannot explore serious emotional, cognitive, or behavioral problems of clinical intensity, such as depression, anxiety, or substance abuse, which can often coexist with ADHD. If any emotional issues arise during the coaching process, coaches who are not licensed therapists must have resources for referring the client to a mental health professional.

Unlike counseling, coaching is far more pragmatic than many types of psychotherapy (with the exception of CBT). It is behavior oriented as opposed to insight oriented. Coaching can also be more flexible than therapy because many coaches do not require in-person meetings. The ADHD coach and client have a structured, goal-driven, strategy-oriented relationship. Goal completion and strategy building are the most important aspects of the coaching process. The focus is on developing strategies and skills to become more effective in everyday life. Each client receives individualized help. Different clients may require help in different areas of life (e.g., school, work, nutrition, exercise, stress management, and relationships). For each of these areas, the client and coach both agree on set strategies. It is the coach’s job to help the client understand how ADHD impacts his or her behavior and then to encourage the client’s motivation and active involvement in making changes to this behavior. The coach also elicits creative strategies to serve the needs of the client. The coach and client are in contact many times during a week to monitor progress and encourage accountability. Contact can include in-person meetings, phone calls, emails, or text messages.

ACCOMMODATIONS

Under the Americans With Disabilities Act (ADA), anyone who has a qualifying disability has the right to seek appropriate accommodations for a wide range of physical and psychiatric disabilities, including ADHD. Accommodations may be defined as assistive devices or adaptations that serve to ease the impact of the disability on a particular activity. Several tools and devices can help you with communicating, writing, staying organized, remembering important information and dates, or keeping track of time. Accommodations may also require slight adjustments to your school or work environment in order for you to work efficiently and effectively, such as a flexible work schedule, presenting information orally rather than creating a written report, or the use of a quiet private office.

The decision to become public with your disorder and exercise your right to accommodations is a very personal one. You may, rightly so, fear discrimination and the reactions of others. Unfortunately, we live in a world where not everyone understands mental health issues. Coworkers or friends may ignorantly think ADHD is “an excuse for laziness,” or a boss may not want to deal with a person who needs support. Although, under the law, such a boss would be in violation, life and relationships can be tricky.

When deciding whether to request accommodations at school or work, consider the following: If a person who is physically bound to a wheelchair requests the use of a wheelchair ramp to get into their place of work, do you think to yourself, “They have arms! Can’t they just crawl up?!” Of course not. More than likely, you think of the ramp as a way to level the playing field, so to speak—a way for the person to get from A to B with the same relative ease that you can. Similarly, you have the right to request modifications to your work environment to allow you to get from A to B with the same relative ease as your coworkers. Whether we’re talking wheelchair ramps or a quiet private office to help you focus, all individuals with disabilities have the right to accommodations. Fortunately for many people, the decision to disclose their ADHD and assert their right to accommodations is the right one, and most supervisors and staff are extremely understanding and helpful.

MULTIMODAL TREATMENT

Multimodal is simply a synonym for multiple modes, meaning multiple methods of treatment. Experts recommend multimodal treatment for adults with ADHD, including a combination of behavioral and medical interventions to help you succeed at home, work, and school. Standard psychotherapy in conjunction with medication continues to be a popular method of dealing with symptoms. However, behavioral options can include things like coaching or neurofeedback, and these may be better options for some. The important thing to keep in mind is that medication can provide increased focus or control, and behavioral treatments can provide increased coping skills—things that medication cannot teach.

TELEHEALTH

Telehealth is not a type of treatment but rather a mode of delivering treatment. One very positive thing to come out of health care as a result of the COVID-19 pandemic is the widespread use of telehealth services. Telehealth can refer to any health care services, including those for mental health-related issues, delivered via digital platforms or communication technologies such as computers and mobile devices. These services not only offer a convenience factor to patients but also allow providers to reach individuals who could not otherwise access services. Because of the availability of video conferencing programs, I have had the pleasure of providing services to adults from Costa Rica to Italy.

WHAT TYPE OF TREATMENT IS FOR ME?

Answer the following questions. Circle the letter or letters that best represent you for each one. When deciding on treatment, remember that multimodal (medication plus behavioral intervention) proves best.

1. How much would you pay for treatment of your ADHD symptoms?
   1. I’d rather put little or no money toward treatment.
   2. I am willing to put out several hundred dollars for treatment that has proven effective.
   3. I would pay several thousand dollars to try an up-and-coming, nontraditional approach.
   4. If it’s not free, I’m not trying it.
2. What type of interaction do you prefer?
   1. I like group settings where I can bounce ideas off of many people who have experienced similar situations.
   2. I like individualized, one-on-one attention with an expert.
   3. I prefer to work with technology rather than people.
   4. I like to try things on my own that don’t require professional help.
3. How much time are you willing to devote to treatment?
   1. I would like to find something ongoing but not necessarily weekly.
   2. I prefer regular weekly sessions, but ones that don’t go on for years and years.
   3. I want to know exactly how many sessions my treatment will take.
   4. I don’t want to spend any time outside of my home devoted to treatment.
4. How do you prefer to engage in problem solving?
   1. I like to get feedback from as many people as possible and weigh all the options.
   2. I want someone who has a lot of experience and expertise to offer their ideas.
   3. I don’t like the act of trying to problem solve—I’d rather try something up and coming that requires little problem solving on my part.
   4. If it’s free, I’ll try it.
5. What issues do you struggle with most in terms of your ADHD?
   1. Feeling misunderstood or underappreciated
   2. Time management, organization, goal setting
   3. Focus, control, impulsivity
   4. What don’t I struggle with?

Now, total the number of questions for which you selected answer A. Do the same for B, C, and D. If you answered mostly As, you may want to try group counseling or a support group. If you answered mostly Bs, you may want to try ADHD coaching or CBT. If you answered mostly Cs, you may want to try neurofeedback. If you answered mostly Ds, you may want to try mindfulness meditation, a nutrition and exercise regime, and the exercises in this book!

FINDING HELP

When it comes to finding a coach, therapist, or other ADHD specialist, one of the best places to start is with your friends and family, coworkers, and neighbors. Many people know someone with ADHD—be it their spouse or their best friend’s dog’s veterinarian’s brother. Ask around to find out who they went to for treatment and what they thought of the person they saw. If no one you know can refer you to someone they have personally dealt with in the field of ADHD, you still have options.

Resources

Here are some recommended websites:

• https://www.chadd.org—CHADD (Children and Adults With ADHD) is the nation’s leading nonprofit organization serving individuals with ADHD and their families. It has local chapters across the nation and a database in which you can search for all kinds of specialists in the world of ADHD, from psychiatrists to therapists to coaches. Many chapters of CHADD also offer free seminars and support groups.
• https://www.psychologytoday.com—This website allows you to search for a therapist using a refined search that includes “issues” (ADHD) and “treatment orientation” (CBT). There is also an option to search for group therapy.
• https://www.psychedconnections.com—Psych Ed Connections (PEC) is a nontraditional practice that combines the most effective aspects of CBT and ADHD coaching to help clients utilize their strengths and reach their goals. The website provides a description of how such a coaching approach can be helpful and who the treatment may benefit. When looking for a coach or therapist in your area, you may benefit from using the PEC website.

Here are some other helpful sources:

• The local university. Because ADHD affects many of today’s college students, more and more university counseling centers run treatment programs or know of specialists in the area to refer to. For example, Florida State University’s Adult Learning and Evaluation Center uses graduate-level counseling students as ADHD coaches (https://education.fsu.edu/alec/). Another benefit of going to a university is that the cost is usually far more affordable.
• Medical doctors. Whether it be your family doctor, a gynecologist, or your dentist, these medical professionals talk to dozens of people every day. They are also immersed in a world in which they often cross paths with professionals in similar fields (i.e., mental health).
• School psychologists, counselors, and teachers. Similar to medical doctors, teachers and counselors gain knowledge of ADHD specialists in two ways: through experience with students and parents and through professional associations. Even if your child’s teacher does not know of anyone, other staff at the school may. Most schools are required to have a school psychologist on staff to conduct testing, and this person should be able to recommend where to go for treatment.

What to Ask

Once you have finally located someone you think may be a good fit for treatment of your ADHD symptoms, you are not quite done. Think of the first session or telephone consultation as an interview. They need to win you over to get the job of being your professional of choice. Would you buy a car without first finding out how long it has been running, knowing the mileage, or whether it has been in any accidents? Of course not—you would be putting your life at stake. The same should go for your mental health treatment. Although your physical self may not be vulnerable during therapy or other treatment for ADHD, your psychological self is. Therefore, it is up to you to make sure that you are in the hands of an experienced, caring professional and that the method of treatment is right for you. Exhibit 12.1 lists just some of the possible questions you may want to ask before signing up for services.

EXHIBIT 12.1. Pretreatment Questions

• How long have you been doing this?
• How many clients do you see per week?
• Are there any risks to this treatment?
• When should I expect to see some results?
• Why do you believe in this treatment method?
• Are you licensed? In what? Any other credentials?
• Can you give me the name of a former client who may be willing to speak to me?
• What level of education do you have?
• How much does this cost?
• Do you accept my insurance?
• Additional questions:
  ______________________________________________________
  ______________________________________________________
  ______________________________________________________
  ______________________________________________________
  ______________________________________________________
  ______________________________________________________

ADDRESSING LAST-MINUTE FEARS

An important final step when deciding whether to pursue treatment for your ADHD is to ask yourself, “Is there anything holding me back from this?” Many people are too nervous or scared to seek help, whether it be because of a personal insecurity or fear of the stigma that, unfortunately, still exists in regard to seeking help with mental health. In Exhibit 12.2, check “yes” or “no” for each of the statements to gauge where your fear level lies. For those you answer with “yes,” read the corresponding challenge thought to help you to alleviate your fear.

EXHIBIT 12.2. Try It! Fear and Insecurities Checklist

Fear	Challenge Statement
I’m afraid people will look down on me or think I am “crazy” if I seek treatment.	Most people who undergo treatment for a mental health disorder are not seriously ill but, rather, simply need help working through some of the challenges life can present. In reality, those who are brave and self-assured enough to ask for help are far more well-adjusted than those who let their fear and insecurities keep them from reaching out.
I’m afraid of letting go and telling someone all my deep dark secrets—I don’t want them to think I am a bad person.	True professionals do not judge their clients. In fact, a professional will most likely respect and appreciate your ability to be honest. Furthermore, no matter how terrible you think your secret is, chances are your treatment provider has heard much worse!
I’m afraid that treatment will change me. I like some of my ADHD personality traits—they make me who I am.	Specialists who work with clients with ADHD do so because they enjoy and appreciate the personality traits that often accompany the client, such as charisma, energy, enthusiasm, creativity, and easygoingness. Treatment for ADHD aims only to affect change on the symptoms that negatively impact your life, not those that you appreciate or consider a part of your personality.
I’m afraid that seeking treatment means I am weak—shouldn’t I be able to handle my own problems?	It takes an incredibly strong person to ask for and accept help from others. Plus, sometimes it takes a fresh outside perspective to help you see things you cannot. Furthermore, most professionals who specialize in ADHD and mental health go to school for a very long time and work with people similar to you day in and day out, so they have gained a bit of extra knowledge and are eager to share.
I’m afraid of what I might uncover during treatment—what if I’m worse than I thought?	Chances are you won’t and you aren’t. However, anything you might uncover in treatment that you previously did not know about yourself can only help. Even if you did not know it on a conscious level, it was there somewhere, festering and affecting your life. Once issues are brought to the surface, they can be dealt with in a healthy, effective way.
Other Fear: ______________________ ______________________ ______________________	Your challenge thought: __________________________________ __________________________________ __________________________________
Other Fear: ______________________ ______________________ ______________________	Your challenge thought: __________________________________ __________________________________ __________________________________
Other Fear: ______________________ ______________________ ______________________	Your challenge thought: __________________________________ __________________________________ __________________________________

SUMMARY

Here are the important points you will want to take away from this chapter. Use the following checklist to note the areas you have thoroughly studied. Leave the box empty if it is an area you would like to come back to and review further.

• I understand what my (nonpharmacological) treatment options are.
• I have considered which type of treatment is for me.
• I have learned ways to locate a specialist in my area.
• I have learned how to “interview” a potential specialist before committing to treatment.
• I have learned how to overcome any lingering fears that I have regarding asking for or receiving professional help.