An insurance company recently claimed that if ADHD is a neurobiological disorder, then it ought to be treated biologicallywith medications. Psychotherapy ought to be unnecessary. This will surprise any of us who are familiar with the extensive psychological consequences of ADHD, particularly in adulthood. We know that ADHD has a neurobiological basis, but that far from precludes that there are virtually always psychological implications.
So why do we focus so much on those first treatment decisions about diagnosis and medications? Even the insurance company mentioned above ultimately had to admit that this is a superficial approach to treating ADHD in adults. Nonetheless, many adults diagnosed with ADHD stop their own exploring of their ADHD once the medications are seen to work (or not). Too often, ADHD adults fall into this medical model of ADHD and, like the insurance company, they conclude that treatment of their neurobiological condition ends with neurobiological treatments.
This can lead to dangerous disappointments when the medication does not "cure" ADHD, nor solve the heap of life's problems that have accumulated in the pre-diagnosis years. This setback, in the context of a life of many unexplainable failures, can lead to the discouraged ADHD adult abandoning hopes for real change.
Sari Solden's new book takes the longer view. She elaborates on the period from before diagnosis through a full acceptance and embracing of the authentic self with ADHD. This life's work she sees altogether as a voyage of "three journeys." The first journeydiscovering the diagnosis and treating it medicallyis the most familiar. It is also the one that most other ADHD books primarily address. And Solden also covers this ground well.
But after diagnosis and medication, what should an ADHD adult expect? What should they try to do? The second and third journeys pick up from this point and fills in what the ADHD adult is really going to have to do. Reaching past advising that we all need to self-advocate, we need to build on our strengths, that we need to accept ourselves, Solden lays out the maps for these journeys in detailed, practical terms.
There are many nuggets to be mined here, but I would share one of my favorites. I often tell clients just starting work with me that there are two jobs that they can do in therapy. The first is to problem-solve about how to make their future work. They already expected that one. The second, less obvious one is to revise the history that they have created for themselves in their explanations of the their own behavior since childhood.
Their reaction may be to tell me that when they were in therapy before, they already had all of those "insights", and it didn't help at all. A therapist has already asked them to consider whether they may be expressing aggression or dependency in their irresponsible behavior, or suggested that they may have some unconscious desire to sabotage themselves. But these "insights" are the same toxic attributions about their behavior that they and everyone else inflicts on them to no avail. Like the injunction to "try harder", there is no way that the ADHD adult can use these to improve their ability to function. It condemns the ADHD adult for not controlling these things which they really cannot. So the ADHD adult is carrying a heavy load of self-recrimination that is not deserved, does not motivate or guide them, and about which they are not even fully aware.
So one of the greatest problems that an ADHD adult will immediately face is that they have acquired a distorted sense of who they are and their culpability in their difficulties. This is the history that therapy can help them revise. The ADHD adult can understand that the history they have created of themselves is flawed and inaccurate. There are other explanations for themselves which do not condemn them for not "trying harder."
Much of Solden's book revolves around how to reclaim an authentic self in the face of this distorted history. And from that, one can recreate a life which has gone off course. The ADHD adult has to separate themselves and their self-worth from the symptoms of ADHD. Solden emphasizes reconnecting with the dreams that unexplained ADHD symptoms may have prematurely cut off. With the spark of discovering who one really is, and recognizing one's strengths again, in the context of their challenges, Solden envisages a new life for ADHD adults which goes way beyond discovering how many milligrams of this or that one must take.
Solden's narrative includes both stories of others who have been on these journeys before and short exercises for self-exploration around the same issues. Perhaps the hidden gem is in the appendices, where she lays out in a more linear form all of the issue areas, approaches that may work, pitfalls, and suggestions about how to more forward. Some of this is detailed in the form of advice to a potential therapist, but we know that every ADHD adult is going to read this part of the book as well!
Solden somehow conveys the sense that she will be by your elbow as you move along these journeys. She also advocates that you find warm-blooded versions of her support in the people around you.
No doubt, some readers will be tempted to concretely measure themselves against Solden's mileposts. It will be tempting to ask whether they are finished with "Journey Two", or halfway through "Journey Three." The answers will only be partly discernible from this book. So much about these journeys is about how an ADHD adult connects with others in the world, giving the gift of their authentic self and receiving back the appreciation of others. The answer as to whether the journey is working will inevitably have to come from those connections themselves. Part of the journey may be testing out where one is on these excellent maps. But the map is not the territory, and only the journey will reveal the destinations.
TopThis work by Lew Mills is licensed under a Creative Commons Attribution 4.0 International License