Tag / Adult ADHD

by Therapy place uk

Empowering ADHD/NT couples with self-determination theory (SDT)

(This blog article was originally posted as on Attention Allies: Therapists for ADHD in December 2024.)

Attention Allies founder and specialist couples therapist Duncan E. Stafford offers some introductory insight to how SDT can be a strong, flexible and empowering framework to help support those living in mixed ADHD/neurotypical relationships.

Couples therapy involving one partner who has an ADHD neurotype requires a compassionate and structured approach to foster success. Traditional therapy models often unintentionally frame the work as an ADHD partner needing to be “fixed” or that they must be taught or learn “how to conform” to a neurotypical concept of relationships. This framing tends to alienate ADHDers and can exacerbate relational tensions rather than help to address them.

Many couples who seek help at my practice report that previous therapists had struggled to balance the needs of both partners, often overlooking or underestimating the distinct challenges and strengths associated with ADHD. Without proper recognition of these issues, therapy risks becoming another source of frustration for the mixed-neurotype couple, leaving them feeling unseen and unsupported.

From my 25 years of professional experience and 37 years in a successful, loving mixed-neurotype marriage, I’ve found that the core principles of Self-Determination Theory (SDT) – autonomy, competence and relatedness – provide a robust framework for fostering resilience, empathy and growth in couples therapy. These principles allow partners to navigate conflicts constructively and create a supportive, thriving relationship.

For individuals with ADHD, the often-reported challenges such as disorganisation, impulsivity and difficulties with emotional regulation can strain communication and mutual understanding in romantic relationships. If not addressed, these issues may lead to misaligned expectations, frustration and feelings of disconnect.

Introducing the SDT framework for couples work

SDT was developed by psychologists Edward Deci and Richard Ryan and was first comprehensively outlined in their 1985 book Intrinsic Motivation and Self-Determination in Human Behavior. Focused on understanding the factors that enhance or undermine motivation, SDT identifies three essential psychological needs:

Autonomy – the need to feel self-directed and in control of your own actions

Competence – the need to feel effective and capable

Relatedness – the need to feel connected, valued and have a sense of belonging.

An SDT-based approach to couples work will help both partners identify and meet their psychological needs while simultaneously promoting mutual respect and empathy within the couple. By empowering an ADHD partner to develop tailored strategies for managing their challenges, therapy can increase autonomy. The building of confidence through therapeutic work helps to develop abilities (competence), and enhancing emotional connection and understanding in couples work increases relatedness.

Therapy can transform recurring conflicts into opportunities for deeper connection and shared growth. This approach acknowledges the ADHD dynamics in the relationship – creating a pathway to sustainable harmony and partnership.

Beginning to apply SDT in ADHD/NT couples work

ADHDers often experience unique challenges in romantic relationships, and the common issues ADHD can bring often strain the communication systems and understanding of a couple. Using SDT in couples work provides a structured framework for addressing the issues and challenges that are especially prevalent in mixed-neurotype relationships.

When I first met Jess (diagnosed with ADHD) and Mo (neurotypical), their relationship was mired in daily conflict and palpable frustration. Sessions often began with a seemingly minor disagreement that quickly escalated. On one occasion, Mo was deeply frustrated because Jess had once again missed a deadline for paying a household bill. Despite repeated “requests” to “do it right next time,” Mo felt nothing ever changed, leaving her to shoulder most of the family responsibilities.

What I observed was a deeper pattern: Mo’s attempts to manage Jess’s behaviour were experienced by Jess as micromanagement, which undermined her competence (confidence in her ability to handle responsibilities) and autonomy (freedom to self-direct). For Jess, this dynamic triggered overwhelm and defensiveness.

The core issue lay in miscommunication of their individual needs and understanding of the other. As a neurotypical individual, Mo prioritised structure and predictability. Meanwhile, Jess’s ADHD presented challenges with timing and task prioritisation. These differing approaches turned relatively small issues into significant conflicts.

SDT strategies in action for Mo and Jess

Autonomy: Jess was encouraged to handle tasks in a way that worked for her. Mo’s request was for Jess to simply set up an automated payment, but this triggered Jess’s childhood memories of being seen as incompetent. Instead, Jess set about designing a visual task board that included a wider set of financial goals and accounts. With the use of colour and an impressively artistic hand-drawn financial flow chart, Jess successfully navigated the challenge and was able to stick to, and increase, her financial responsibilities for the family.

Competence: Therapy focused on building Jess’s skills without criticism, which helped her to feel more effective in managing responsibilities. Mo’s competence increased once she realised it wasn’t her responsibility to do things it had been mutually agreed Jess would do. Mo took pride in her new skill of “sitting back”.

Relatedness: Mo learned to express concerns empathetically, removing frustrated responses and replacing them with expressive dialogue like “I feel anxious when bills are late”. Jess was encouraged to share how constant reminders and micromanagement felt overwhelming, fostering mutual understanding.

By applying SDT models, the conflict between Jess and Mo began to reduce. This allowed them to build further trust in one another, transforming challenges into opportunities for growth.

This article provides an introduction to how SDT can begin to reshape ingrained patterns in mixed ADHD/NT relationships. Visit us again for future articles on applying SDT in therapy.

Note: Jess and Mo are composite characters, inspired by a mix of consensually shared and fictionalised examples.

References

Deci, Edward L. and Richard M. Ryan. 1985. Intrinsic Motivation and Self-Determination in Human Behavior.

Click the link if you’d like to visit Duncan’s couples therapy website 

All rights reserved © Copyright Duncan E. Stafford 2024. Unauthorised use and/or duplication of this material without express and written permission from the author of this post is strictly prohibited. Author contact via website Contact page.

Website version and image © Copyright Attention Allies 2024.

by Therapy place uk

Can self-determination theory be the ADHDers’ defence against RSD?

 (This blog article was originally posted as Can autonomy, competence and relatedness be the ADHDers’ defence against RSD? on Attention Allies: Therapists for ADHD in Nov 2024.)

RSD (Rejection Sensitive Dysphoria) is an overwhelming challenge for many ADHDers. However, I suggest that by focusing on autonomy, competence and relatedness (the three basic psychological needs outlined in self-determination theory (SDT)) we can begin to build ADHDers resilience against the intense emotional pain of RSD.

If you live with ADHD, you may have experienced the intense, sometimes overwhelming, set of emotions known as RSD (Rejection Sensitive Dysphoria). Although RSD doesn’t yet constitute a formal diagnosis, it’s a term that resonates deeply within the ADHD community.

RSD is generally understood as an extremely intense emotional reaction to perceived or actual rejection, criticism or failure. The emotional pain can be overwhelming, leading people to avoid social situations, withdraw from relationships or, in some cases, express explosive anger. These reactions can deeply affect an individual’s psychological needs, leaving life feeling like a series of high-stakes emotional hurdles.

Sam’s rejections 

Sam, who was diagnosed with ADHD aged 38, describes her past experience with RSD as feeling like an “internal ticking bomb”. In her words:

I was hypersensitive to anything that might feel like rejection. When I was in that headspace, neutral or sometimes even supportive comments would feel like attacks. 

This hypersensitivity undermined her sense of competence and her belief in her own ability to handle life’s ups and downs effectively. During times of real and perceived rejection, Sam’s confidence would plummet – being replaced by self-doubt and a sense of deep failure.

Before Sam entered coaching and therapy (where she developed skills that helped her to “step back from herself”) she strongly believed the classical thinking about ADHD: that she lacked control because of impaired executive function. Coaching and therapy that used SDT principles began to support and develop her sense of autonomy (our ability to regulate our own responses and manage the emotional world), helping her to become engaged and invested in personal change that no longer felt out of reach:

I went from feeling like my reactions had a life of their own to having a stepped framework to understand I could be autonomous and competent. The intense RSD feelings – the after effects of which could last for a few days – became something I began to deal with as soon as I was aware I’d been triggered.

Therapy helped Sam to recognise specific triggers that tended to precede these emotional surges, gradually supporting and developing her sense of autonomy. By becoming more aware of these triggers, she could manage her emotions before they spiralled out of control.

Connection amid emotional pain

RSD often chips away at our sense of connection to others (relatedness). When minor misunderstandings or perceived slights can feel like intense rejection it’s easy to question whether we’re genuinely accepted or valued by others. For Sam, this played out in her relationships with friends, family and colleagues. A seemingly casual comment, for example, could be misinterpreted as criticism, threatening her sense of security and belonging.

Our need for relatedness runs deep, but when RSD undermines our connections it can lead to social withdrawal or frustrated outbursts. Sam found that coaching and therapy helped to strengthen her communication skills so she could be clearer about her needs, feelings and boundaries, in turn easing the impact of RSD in her relationships.

Feeling with meaning

Many ADHD researchers suggest that emotional regulation issues stem partly from impulsivity and challenges with executive functioning. Yet for those with ADHD, emotional control often aligns with how competent, related and autonomous they feel. For example, when a task feels meaningful and we feel capable, emotional regulation is easier. When an ADHDer feels disconnected or the task lacks value and interest, managing emotions becomes considerably harder.

Ali, another person with ADHD, describes how, “when I’m feeling overwhelmed, it doesn’t take much to set me off. A crowded store or a car cutting me up in a queue would feel very personal, like an attack.” Ali found that his RSD was often connected to previous experiences of times when he’d felt invisible or unimportant leading him to spiral into feelings of rejection – even when he logically knew that wasn’t the case. Through therapy, Ali worked on recognising his emotional triggers and particularly developing his sense of competence. He additionally developed greater autonomy in handling his emotions, further reducing the power of RSD episodes over his life.

Recognition

Being able to recognise situations and people who challenge our fundamental experience of autonomy, competence and relatedness can help us to begin to gain control over RSD. Recognising triggers can begin the process of developing our autonomy, empowering us to manage our emotional responses. Techniques learned through therapy or coaching can help us to release pent-up emotions, fostering a sense of competence and self-efficacy. By nurturing supportive relationships, we can reinforce our relatedness, creating a safety net for times when RSD feels especially intense.

Sam’s journey through therapy highlighted the importance of strengthening all three of these psychological needs. When she learned how to identify her triggers, she gained autonomy; when she practised emotional regulation techniques, she built her competence and when she improved her communication with friends and family, she was able to see and develop her relatedness. Each of these shifts contributed to her ability to better manage RSD, improving her emotional health and overall wellbeing.

Understanding how RSD impacts our core needs of autonomy, competence and relatedness can offer those with ADHD a new way to navigate life’s challenges, build stronger connections and feel more secure within themself.

You can read more about adult ADHD on Attention Allies blog site.

All character-based realisations contained in this post are either of a fictional nature or have been derived from heavily disguised, consensually given information. 

All rights reserved © Copyright Duncan E. Stafford 2024. Unauthorised use and/or duplication of this material without express and written permission from the author of this post is strictly prohibited. Author contact via website Contact page.

Website version and image © Copyright Attention Allies 2024.

by Therapy place uk

Am I normal?

(This post was originally posted on Attention Allies: Therapists for ADHD in August 2024)

Psychotherapist, counsellor and ADHD coach Duncan E. Stafford hopes you “don’t feel normal”. Why is this and how can it help ADHDers to create useful tools for self-development?

The subject of “normal” in connection with adult ADHD is one that comes up regularly in my consulting room. Any quick search online for information about adult ADHD will support the persistent nature of questions like this, returning results such as:

  • “Can someone with ADHD have a normal life?”
  • “Is ADHD considered normal?”, and
  • “Can you be normal and have ADHD?”*

This fascinates me because the concept of the “normal” human being is both subjective and perhaps, surprisingly, a relatively new concept.

The word “normal” – from the Latin root normalis, meaning something made according to a carpenter’s square – hadn’t been applied to human beings before the nineteenth century, when Adolphe Quetelet published “On Man and the Development of His Faculties, or Essay on Social Physics”.

In the years before 1835, “normal” was a term used only in mathematics and related disciplines, including astronomy. Quetelet took the astronomer’s error curve or, as it became known, the “normal distribution curve” and applied it to measuring humans. And the rest, as they say, is history.

A subjective term

“Normal” in relation to people is a subjective term. When used as a description, it implies a thing that should be aimed for or agreed upon. Being “normal” in human terms suggests the acceptable boundaries of what a person is or should aim to be. “Normal” is applied to the body through size, weight, shape, strength and so on; it’s applied to the mind in terms of aspects such as cognitive ability, sanity, reasoning and perceptual speed, among other measures. If we look at the term historically, it has often been used to reinforce white, Western and middle-class people’s definitions and standards of humanity. And so, you might see why I have a problem with ADHDers asking if they are “normal”. I might even suggest: “Who wants to be ‘normal’?”

Our development since childhood has been measured against created “normal goals”. In school, our abilities are tested to see if we reach at least the minimum, “normal” or “average” of others in a range of things thought to be the most useful.

Hyperkinetic to ADHD

When I was at the end of my school education, the term ADD (1980)** had hardly begun to be used, and ADHD (1987)*** hadn’t yet been created. In my own school era (and perhaps even today), students with ADHD were likely to be castigated for their internal motor-driven impulses and told to sit down, behave, stop being careless, stop making silly mistakes and stop being naughty, disruptive or “stupid” rather than receiving positive comments about themselves. Nothing on the preceding list was valued as good “normal” behaviours in classrooms. But the balancing behaviours often seen in the hyperkinetic child – as pre-1980s psychiatry, developmental psychology and education then termed ADHDers – weren’t valued in such children. It was, and perhaps still is, almost invisible to many the ultra-inquisitiveness, robust enthusiasm, unusual or eccentric creativity, sweeping spontaneity, fantastical imagination, and lively conversational skills and personality that the ADHDer brings.

When an ADHDer asks me “Am I/Is it normal?”, I tend to answer “I hope not!”. I suggest that we replace “normal” with “typical” in terms of feelings and behaviour. From there we can often see what someone’s real question and/or concern about themself is: “Are there other people like me?” If that inquisitiveness (typical of many ADHDers) can be engaged with, it may allow the inquisitor to feel calmer, less alone and, importantly, able to ask more questions of themself and what I call “the soup” we were brought up in and live in. In creating an interest not in normality, but in similarity, we potentially lead to the prerequisite for the creation of vital personal tools for self-development. As a therapist, I can help ADHDers engage and support self-actualisation and self-determination.

Back to the curve?

So, are you tempted to plot all of this on a standard deviation curve? I’m not. To do so is to limit our creative engagement with understanding ourselves in an attempt to reach mythical, societally created norms.

I like to know what others do and why they think they do things, but I like to help ADHD people understand that living your life by comparison to created norms tends, on the whole, to make an ADHDer feel claustrophobic, tense and constricted at minimum. ADHDers don’t need more restriction or created failures; they need freedom to be, and for that they need flexibility.

Footnotes

* Retrieved from Google search 10 August 2024.

** The American Psychiatric Association released a third edition of the Diagnostic and Statistical Manual (DSM-III) in 1980 in which it renamed Hyperkinetic Reaction of Childhood to Attention Deficit Disorder (ADD). Two categories were outlined: with – and without – hyperactivity.

*** The American Psychiatric Association released a revised third edition of the Diagnostic and Statistical Manual (DSM-III-R) in 1987, in which it renamed ADD as Attention Deficit and Hyperactivity Disorder (ADHD).

You can read more blog about ADHD on the  Attention Allies blog pages.

All rights reserved © Copyright Duncan E. Stafford 2024. Unauthorised use and/or duplication of this material without express and written permission from the author of this post is strictly prohibited. Author contact via website Contact page.

Website version and image © Copyright Attention Allies 2024.