ADHD and Therapy: Finding an Approach That Actually Works for Your Brain

You sit in the therapist's office. They ask you to "reflect on your feelings" or "sit with the discomfort." Your brain immediately wanders to seventeen different things. You notice the clock ticking. You wonder if you left the oven on. You realise you've lost track of what they just said. You feel guilty, stupid, broken.

The therapist—kind, well-meaning—doesn't seem to notice. Or they do, and they gently redirect you: "Try to stay present." You try. It doesn't work. You leave the session feeling worse than when you arrived, convinced therapy "just isn't for you."

Here's the truth: therapy absolutely can work for ADHD. But traditional talk therapy—designed with neurotypical brains in mind—often misses the mark. Not because there's anything wrong with you, but because the approach doesn't match how your brain processes information, regulates attention, or manages emotions.

Let me walk you through what makes ADHD brains different, why conventional therapy often falls short, and which approaches actually work.

TL;DR:

• ADHD brains process emotions, attention, and time differently—conventional therapy often doesn't account for this
• Traditional "just talk" approaches can feel frustrating or ineffective for ADHD adults
• Evidence-based ADHD therapy includes CBT, coaching, somatic work, and movement-based approaches
• The right therapist understands executive function challenges and adapts their approach accordingly
• Medication + therapy often works better than either alone
• You're not "bad at therapy"—you just need an approach suited to your neurology

Understanding the ADHD Brain (Briefly)

ADHD (Attention Deficit Hyperactivity Disorder) isn't about lacking attention—it's about inconsistent attention regulation. Your brain doesn't reliably direct focus where you want it. Sometimes you can hyperfocus for hours; other times you can't hold a thought for 30 seconds.

Key neurological differences include:

1. Executive Function Deficits Executive functions—planning, prioritising, organising, initiating tasks, emotional regulation—are impaired in ADHD. This isn't laziness or poor character. It's neurological.

2. Dopamine Dysregulation ADHD brains have lower baseline dopamine activity. Dopamine drives motivation, reward, and sustained attention. You're essentially running on a neurochemical deficit, making it harder to engage with tasks (including therapy) that don't provide immediate interest or reward.

3. Emotional Dysregulation Up to 70% of adults with ADHD experience significant emotional dysregulation—intense feelings that spike quickly, overwhelm easily, and take longer to settle. This isn't "being dramatic." It's part of the condition.

4. Time Blindness Many people with ADHD struggle with time perception. "Later" feels the same as "in three hours" or "next month." This makes it hard to estimate session length, recall what was discussed last week, or implement suggestions "between sessions."

5. Working Memory Challenges Holding information in mind whilst manipulating it (working memory) is harder with ADHD. You might forget what the therapist said by the time they finish the sentence. You might lose track mid-thought.

These aren't excuses—they're explanations. They're why generic therapy advice like "make a plan and follow through" often feels uselessly simplistic.

Why Traditional Therapy Often Fails ADHD Brains

Let's be specific about where traditional approaches struggle:

1. Too Much Sitting Still

Fifty minutes of sitting in a chair, making eye contact, tracking a conversation—this can be excruciating for ADHD brains. The effort required to appear attentive often drains the energy you'd use to actually process the session content.

One client told me: "I spent the whole session trying not to fidget. I have no idea what we talked about."

2. Open-Ended Conversations Feel Overwhelming

"Tell me what's on your mind" is a nightmare prompt for ADHD. Everything is on your mind. Simultaneously. Where do you even start? The lack of structure can feel paralysing rather than freeing.

3. Passive Listening Doesn't Engage ADHD Brains

Neurotypical therapy often involves a lot of talking and reflecting. For ADHD brains, which crave novelty, stimulation, and action, this can feel tedious. Attention drifts. You zone out. You feel guilty about zoning out, which makes it harder to re-engage.

4. Homework Gets Forgotten

Therapists love between-session tasks: journaling, thought records, practising techniques. For ADHD adults, remembering to do homework—let alone actually doing it—can be impossible. Then you feel shame, which you hide from your therapist, and the cycle continues.

5. Emotional Overwhelm Isn't Addressed as Neurological

When you have an intense emotional response, neurotypical-oriented therapists might explore psychological causes ("What does this remind you of from your past?"). Whilst that's sometimes useful, it can miss the neurological component: your emotional regulation system just works differently. You need strategies for that brain, not just insight.

6. Time Management Isn't Considered

Therapists may ask you to "notice patterns over the week" or "track your thoughts daily." If you experience time blindness, you genuinely can't remember what happened Tuesday vs Thursday. You're not being difficult—your brain doesn't file memories with reliable timestamps.

None of this means therapy is useless for ADHD. It means generic therapy is often poorly suited to ADHD neurology. You need adapted approaches.

What Works: ADHD-Informed Therapeutic Approaches

1. CBT Adapted for ADHD

Cognitive Behavioural Therapy can work brilliantly for ADHD—when it's adapted.

Standard CBT assumes:

• You can identify thoughts, challenge them rationally, and change behaviour systematically
• You can complete structured homework
• Insight leads to behaviour change

ADHD-adapted CBT includes:

• External structure: Visual aids, checklists, reminders set during the session
• Simplified thought records: One sentence, not elaborate worksheets
• In-session practice: Doing exercises together, not just assigning homework
• Focus on executive function skills: Breaking tasks into tiny, manageable steps; creating systems that work with ADHD, not against it
• Emotion regulation techniques: Explicit teaching of skills to manage emotional intensity

A 2024 study in JAMA Network Open found that CBT specifically designed for adult ADHD reduced symptoms by 40-50% and significantly improved quality of life.

2. ADHD Coaching (Not Therapy, But Complementary)

ADHD coaching focuses on:

• Building systems and routines that account for executive function challenges
• External accountability
• Practical problem-solving (not deep emotional exploration)
• Goal-setting with ADHD-friendly strategies

Coaching is action-oriented, structured, and future-focused—often a better fit than traditional therapy for managing day-to-day ADHD challenges. However, coaching doesn't address underlying emotional issues or trauma, so combining therapy + coaching can be powerful.

3. Somatic and Body-Based Approaches

Because ADHD involves hyperactivity or restlessness, body-based therapy can be surprisingly effective:

Somatic Experiencing: Works with bodily sensations to process emotions and trauma. For ADHD brains that struggle to articulate feelings verbally, noticing "tightness in my chest" or "energy in my legs" can be more accessible.

Walking Therapy: Talking whilst walking in nature reduces the pressure to sit still and make constant eye contact. Movement helps ADHD brains think more clearly. (I offer walking therapy in South West London—it's transformative for many ADHD clients.)

Mindfulness with Movement: Traditional meditation is torture for many with ADHD. But mindful movement—yoga, tai chi, mindful walking—provides the stimulation ADHD brains need whilst still building present-moment awareness.

4. Acceptance and Commitment Therapy (ACT)

ACT teaches you to:

• Accept that your brain works differently (not "fix" it)
• Defuse from unhelpful thoughts without getting tangled in them
• Clarify your values and take action aligned with them, even when ADHD makes it hard

ACT is particularly helpful for ADHD because:

• It doesn't require meticulous thought tracking
• It emphasises action over rumination
• It normalises struggle rather than pathologising it
• It's flexible and adapts to your brain's needs on any given day

5. Psychoeducation

Simply understanding that your challenges are neurological, not character flaws, is therapeutic.

Learning about:

• How ADHD affects executive function
• Why you struggle with things others find easy
• What accommodations genuinely help

...can lift years of shame and self-blame. Many clients cry with relief when they realise they're not lazy, stupid, or fundamentally broken—they just have ADHD.

6. Group Therapy for ADHD

Group therapy specifically for ADHD adults offers:

• Normalisation: "Oh my god, you do that too?!"
• Shared strategies: learning what's worked for others
• Accountability and structure
• Reduction in isolation and shame

The social stimulation also helps ADHD brains stay engaged in ways that one-on-one therapy sometimes doesn't.

Finding an ADHD-Informed Therapist: What to Look For

Not every therapist understands ADHD. Here's how to find one who does:

Green Flags:

1. They explicitly mention ADHD/neurodivergence in their profile Don't assume general therapists will adapt. Look for someone who names ADHD as an area of expertise.

2. They're open to adapting session structure Ask: "How would you adapt your approach for someone with ADHD?" If they seem confused or suggest you "just try to focus harder," that's a red flag.

3. They understand executive function challenges A good ADHD therapist won't say, "Just make a plan and stick to it." They'll help you build systems that work with your brain.

4. They normalise ADHD experiences They should convey: "This is common with ADHD," not "Why haven't you done what I suggested?"

5. They offer flexible formats Walking therapy, online sessions with movement breaks, visual aids, recorded summaries—these signal ADHD awareness.

Questions to Ask:

• "Do you have experience working with ADHD adults?"
• "How do you adapt therapy for ADHD brains?"
• "What's your approach to homework if I struggle to complete it?"
• "Do you offer movement-based or walk-and-talk sessions?"
• "Are you familiar with the emotional dysregulation component of ADHD?"

If they give vague answers or seem dismissive, keep looking. The right therapist will welcome these questions.

ADHD Therapy + Medication: Why Both Often Works Best

This is a nuanced topic, but evidence overwhelmingly suggests that combining therapy and medication produces better outcomes than either alone.

Medication (usually stimulants like methylphenidate or lisdexamfetamine) helps with:

• Sustained attention
• Impulse control
• Working memory
• Emotional regulation

Therapy helps with:

• Building practical systems and strategies
• Processing shame and trauma
• Developing emotional awareness
• Improving relationships
• Addressing co-occurring anxiety or depression

Think of it this way: medication gives your brain the neurochemical support to engage with therapy. Therapy gives you the skills medication alone can't teach.

A 2025 meta-analysis found that adults who received both medication and CBT showed significantly greater improvement than those who received only one intervention.

That said, medication isn't compulsory. Some people manage ADHD effectively through therapy, lifestyle changes, and accommodations alone. It's a personal decision.

Practical Strategies You Can Implement Now

While finding the right therapist, here are strategies to try:

1. Externalise Everything

Your brain struggles to hold information internally. So don't. Use:

• Alarms and reminders (set them during therapy sessions for homework tasks)
• Visual checklists
• Voice memos to yourself
• Photos of important notes

2. Break Tasks into Absurdly Small Steps

Don't write: "Tidy living room." Write:

1. Put three items in correct room
2. Wipe coffee table
3. Fluff cushions

Tiny tasks are achievable. Vague big tasks trigger paralysis.

3. Use Body Doubling

Do tasks alongside another person (in person or virtually). The presence of someone else helps ADHD brains initiate and sustain focus. There are online body-doubling communities specifically for ADHD adults.

4. Practice Self-Compassion

You will forget things. You will lose track mid-conversation. You will struggle with tasks others find simple. That's ADHD, not moral failing. Speak to yourself as you would a friend with a broken leg: "This is harder for you right now, and that's okay."

5. Movement Helps Thinking

If you're stuck on something emotionally or mentally, go for a walk. Pace whilst on the phone. Do therapy tasks whilst moving. Your brain genuinely thinks better in motion.

6. Limit Options

Too many choices overwhelm ADHD brains. When therapists ask open-ended questions, it's okay to say: "Can you give me two or three options to choose from?" Structure helps.

ADHD and Co-Occurring Conditions

Around 80% of adults with ADHD have at least one other mental health condition:

• Anxiety: 50%
• Depression: 30-40%
• Trauma/PTSD: Higher rates than general population
• Substance use issues: Self-medication for undiagnosed/unmanaged ADHD is common

Good ADHD therapy addresses the whole picture, not just ADHD in isolation. If you have co-occurring anxiety or depression, treatment needs to account for both. Treating one without the other rarely works.

What to Expect from ADHD Therapy

Early sessions:

• Psychoeducation: understanding how ADHD affects you specifically
• Building therapeutic relationship
• Identifying primary challenges (executive function, emotional regulation, relationships, work)

Middle sessions:

• Skill-building: practical strategies tailored to your brain
• Addressing shame and self-esteem
• Processing any trauma or difficult experiences
• Developing self-compassion

Later sessions:

• Consolidation: what's working, what needs tweaking
• Relapse prevention: planning for setbacks
• Building long-term systems and support

Progress isn't linear. You'll have great weeks and terrible weeks. That's normal with ADHD. The goal isn't perfection—it's building a toolkit that helps you navigate life more effectively.

Final Thoughts: You're Not "Bad at Therapy"

If traditional therapy hasn't worked for you, please don't internalise that as your failure. You're not broken. You're not unteachable. You're not "too difficult."

You just need a therapeutic approach designed for your brain.

ADHD-informed therapy exists. ADHD-specialised therapists exist. Approaches that work with your neurology, not against it, exist.

The right therapist will celebrate when you remember to bring your notes. They'll offer movement breaks. They'll send session summaries via email because they know your working memory is shit. They'll laugh with you when you lose track mid-sentence—and gently help you find your way back.

That's what good ADHD therapy looks like. And it works.

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Looking for ADHD-informed therapy in London or online? I'm Annabel Kicks, a BACP-registered humanistic counsellor with experience working with neurodivergent clients. I offer flexible approaches including walking therapy, and I understand how ADHD brains work. Book a free 15-minute consultation to explore how we might work together.