One study found that 10 percent to 20 percent of adults seen in outpatient mental health settings have ADHD. Too often, they are being treated for comorbid anxiety, depression, addictions, etc. while the ADHD goes undiagnosed and untreated.
When it is treated, it is usually with traditional therapy models that don’t address practical matters where adults with ADHD need help the most. Therapists have not sufficiently addressed these needs and the field of ADHD coaching was born and people without clinical training are providing these services. Some therapists have responded by adding coaching to their repertoire.
I have written extensively about a four-part treatment model for adults with ADHD that includes education, medication, coaching and therapy (Integrative Treatment for Adult ADHD: A Practical, Easy-to-Use Guide for Clinicians, 2007).
Because ADHD is fundamentally a disorder of information-processing and self-regulation, these clients need practical strategies to help them manage responsibilities and therapy to address the fallout from a lifetime of struggle and setbacks. Therapy alone will not suffice if clients continue to have the same struggles that drive their low self-esteem, anxiety, depression, maladaptive coping mechanisms, etc. I liken it to trying to fill a bucket with a hole in the bottom.
Therapy vs. Coaching
Coaching, like therapy, has no single definition of what it entails or how it differs from therapy. One distinction often made is that coaching addresses the present and future whereas therapy focuses on the past, but this mostly seems to apply to psychoanalytic therapy. Others say coaching focuses on strengths whereas therapy focuses on diagnosable pathologies, but positive psychology would disagree.
“There is a great deal of overlap between coaching and some types of therapy,” says Michelle Novotni, Ph.D., of Wayne, Pa.
“Cognitive behavioral therapy and behavioral therapy are most closely aligned with coaching. There are elements of a number of other counseling theories.” When asked about the differences, Alan Graham, Ph.D., of Park Ridge, Ill, said, “This may be heretical to say but the answer is, not much.”
I make a rather over-simplified distinction that coaching involves helping clients more effectively manage practical matters that adults with ADHD invariably struggle with, such as time management, organization, priorities, etc. Therapy helps with the commonly comorbid anxiety and depression, etc.
Coaching and therapy can achieve similar goals from opposite directions, as Deborah Rowley, MSW, of Madison, Wisc., knows. “Therapy involves working on the ‘stuff’ on the inside to gain strength, insight and awareness in preparation for participating more fully and effectively when interacting with the outside environment. And at the same time, effective coaching efforts usually result in desired and improved internal experiences (relief, pride, etc.).”
David Giwerc, MCC, has trained more ADHD coaches than anyone else through his ADD Coach Academy. He says coaches “empower adults with ADHD to look at their strengths and successes first and then notice what is getting in the way of their ability to create consistent progress in their lives.” Some logistics may be different.
“Therapy is almost always done face to face,” says Marjorie Johnson, LCSW, of West Chester, Pa. “Coaching can be done either face to face or virtually on the phone or through Skype. The fees are different, the frequency of sessions may be different.”
Coaches will also often have more contact with clients between sessions. For example, Novotni recently had a client call her every morning for a week to ensure the client got out of bed on time – a common problem for adults with ADHD and one that almost cost this client her job. Few therapists would make such an arrangement and many might interpret it as dependent.
Explaining her rationale, Rowley says, “The foundational component in coaching is accountability. Traditional therapy does not go outside the treatment hour unless there is an emergency, so any accountability strategy utilized between sessions wouldn’t be used. With a pure therapy client, there might be homework to report something back during the next session. With coaching, the same client might email me a few sentences about her experience between sessions.”
Integrating coaching into therapy About half of those interviewed said they don’t mix therapy and coaching with the same client – it’s one or the other. The other half feel comfortable doing a combination.
Johnson keeps them separate based on the client. “In general, if a client is new to ADHD (recently diagnosed) or under the age of 16 or so I will use a counseling model to help them understand and cope with their diagnosis and learn how it affects their whole functioning. Once the client has been diagnosed for a while and is older they often have specific goals they want to pursue (e.g.., college or a job advancement or career change.) Then, coaching is the model I use.”
In my integrative model, I go both ways. I have therapy clients who also see an ADHD coach. But I also tend to mix in some coaching with my therapy clients, especially those with ADHD. Any therapy model that can tolerate an active and sometimes directive therapist can be adapted to more fully meet the unique needs of ADHD clients.
One reason I like to blend the two is that coaching often reveals important matters for therapy when coaching strategies that “should” work, don’t. When working with a client on getting to work on time, you may discover that the problem involves practical matters like getting to bed too late and getting distracted by having the TV on when getting ready. You may find that the client feels trapped in a hopeless job and avoids the pain temporarily by showing up late, even though it contributes to job problems.
Because coaches are not licensed by the states – yet, there are no formal training requirements. If you want to get into coaching, Alan Graham recommends, “Complete coach training. There is a different mindset that a coach uses.” However, there is a lot of variability in the quality and intensity of the programs. The International Coach Federation (ICF) accredits coaching programs of all sorts, whereas the Institute for the Advancement of ADHD Coaching (IAAC) and the Professional Association of ADHD Coaches (PAAC) focus on ADHD coaching. These accreditations aren’t required, but they are preferred.
You can include elements of coaching in your practice without making it official. Some clients may not need this, but clients with ADHD most likely will – and they will likely terminate prematurely if you don’t provide it.
It’s worth noting that although you may distinguish between coaching and therapy, if you are a licensed mental health practitioner, your licensing board probably won’t – coaching services will likely be seen as falling within the purview of your license. For example, coaching is often done by phone, making it easy to work with clients who live out of state.
This puts licensed clinicians at risk if the licensing board from a client’s state believes they are practicing in that state without a license. This is a relatively small risk, but some caution is warranted.
That said, coaching can be a helpful addition to your practice.
References available from the author.
Ari Tuckman, Psy.D., MBA, is the author of three books: Integrative Treatment for Adult ADHD; More Attention, Less Deficit; and Understand Your Brain, Get More Done. Information about his books and podcast can be found at adultADHDbook.com. His email address is: Ari@TuchmanPsych.com