ADHD couples: solutions beyond traditional couples therapy

IMPORTANT: This blog is not a substitute for therapy, but provides evidenced-based education for the purposes of self-help, or to compliment the therapeutic process. ​ ​This blog is non-monetized.

By: Christina Crowe, RP, Clinical Supervisor and John Foulkes, RP, Clinical Supervisor

Some things unite us all. 

Couples who come to therapy together share many of the same problems across the board, despite coming from different cultures or socioeconomic backgrounds. Ultimately, we all understand what it’s like to experience trouble with the in-laws, money problems, issues with intimacy and sex, chore-sharing or parenting concerns.

In couples therapy today, there are a few well described and successful approaches, like Emotionally Focused Therapy (EFT), Gottman Method or Relational Theories.  Couples can find some kind initial success with these, and then there are a some couples who continue to struggle, despite both partners having the best intentions.

​Things some of these partners might find themselves thinking include,

  • Do they not pay attention to you because they really don’t care? Or because they can’t control where their attention is pulled? This falls under inattentiveness. 
  • Do they not realize you have to actually pay your bills every month? Or is it that tasks with multiple steps are challenging for a brain deficient in dopamine that signal when and what to do? This is inattentiveness, and interest-based nervous system. 
  • Did they have an affair because they don’t love you anymore? Or because their poor impulse control + dopamine seeking brain function + poor ability to think a few steps ahead into the future landed them there? ​
  • Are they gaslighting you? Or do they have such poor working memory function, they really do not have any recollection of conversations or agreements you have made in the past? 
  • Did you marry a narcissist? Or is it that neurodivergent brains can *seem* a bit narcissistic sometimes (Gee, all this person thinks of is themself!), however they are anything but.  By definition, ADHD brains lack the core ingredients for manipulation (intention + planning). 
Image of a couple, depicting a strained relationship

The central question in couples therapy that eventually prompts the deeper dive into an adult ADHD (attention deficit hyperactive disorder) assessment is this: Is your partner (or you) behaving the way they are in the relationship because they are choosing to do so, despite its effect on you?  Or are they committed to the relationship, yet despite all their best efforts, they can’t seem to get it together and do not know why

Any of the traditional couples therapy approaches can be used when trying to discern the answer to that question, as long as the therapist knows that is the question they should be probing.  

​A couple with undiagnosed (or diagnosed, but unmanaged) ADHD within the dynamic, has this as a major feature that sets them apart:  The reason these couples cannot be treated the same as ‘neurotypical’ couples is that the behaviour of the undiagnosed partner(s) is being largely driven by involuntary brain functionrather than by choice.

A RELATIONAL NEUROBIOLOGY FRAMEWORK

Image of a brain, depicting different regions involved in ADHD

A relational neurobiology framework means that we look at how the brain, which is charge of how we experience and learn within the world, contributes to our emotional experiences and our relationships, and how it can mess with them too! 

ADHD is a genetic, neurodevelopment condition that no one asks to be born with.  The estimated prevalence of ADHD amoung adults in Canada is about 1.5 – 2 million but only about 1 in 10 adults with ADHD are formally diagnosed in Canada (and similarly in the US).  ​

​Both stigma and a lack of education about what ADHD actually is prevents this from happening.  For the 8 in 10 undiagnosed adults, who then go on to suffer myriad ways as a result of not knowing, or being able to access care, the cost of those early missed opportunities can be far greater than they might have ever imagined. 

​Where are the 8 in 10 undiagnosed adults hiding? 

It has been shown that many of these undiagnosed adults are currently sitting on couple’s therapy couches (or video screens) today. 

A picture of a couple in therapy sitting on a gray couch

WHAT SHOULD WE DO ABOUT IT? 

The pros and cons of whether one should seek formal diagnosis, or go with self-diagnosis, are a personal choice, and detailed more on our ADHD Resource Page.  

When it comes to couples therapy,  symptoms affect not only the person, but the couple, and extends through family life.  In that context, it’s an important decision.  The benefit of formal diagnosis allows you to access all three of the pillars of treatment, offers legal, school and workplace protections (in Ontario) and might quite possibly save your marriage and your family life in the process. 

​When choosing a couple’s therapist, and you suspect this could be a factor (especially if you have a child, or sibling, with the diagnosis), you should seek a couple’s therapist with specific training in ADHD.  Couple therapists who lack the ability to recognize or factor in ADHD contributors to relationship distress could inadvertently make things worse.  Furthermore, therapists of any type who underestimate the role of neurobiology in dysfunctional behaviours and couple dynamics can also do harm to the couple.  

​Ultimately, clients might seem to improve functioning for a while, but inevitabley when brain function gets in the way of consistent improvement, the non-ADHD partner might come to believe its because their partner doesn’t care, or want to change, which is not the case. It’s important to know adult ADHD has many different presentations, but there are some core traits that most ADHD brains share in common:

  1. An interest-based nervous system – we can only do what we are interested, in regardless of whether it’s important to do; 
  2. Emotional reactivity – low frustration tolerance, irritability, quick temper. 
  3. Being overly sensitive to rejection or judgement – leading to destructive levels of defensiveness

By the time we’ve gotten to adulthood, we by and large have come up with some coping mechanisms that work for us.  We may or may not be aware of how those traits above affect those around us however, especially if we have landed in a line of work or school that we are organically interested in, we might be pulling good grades or making a fine living.  Our success in one part of our lives, can make us minimize all of the other things that are equally important, that might be falling apart. 

The issue isn’t with how we’ve adapted. 

In the best-case scenarios, the issue is the amount of cognitive energy and personal COST we have to relentlessly put into those coping strategies, and how all of the other things we aren’t good at (but are important in life) are weighing us (and the people we love) down.  

In the worst-case scenarios, we’ve already got a trail of broken relationships, anger, lost employment and tragically unreached potential behind us. 

Treatment is for the individual(s) and the couple.

Image of a brain synapse

Making an informed choice about medication.

The first line treatment for ADHD is medication for a reason.

​You know what to do, but can’t do it consistently.  Simply put, ADHD medication as a start, allows you to both do the things you should do, and stop the things you should consider not doing.  You can most certainly chose to forego medication, and some people cannot take the medication for other medical reasons. It’s just important to make an informed choice. 

​​Many people hear “treatment” and automatically think of their own experience with, or someone else’s, with antidepressant medication (depression is also both a common co-diagnosis and a misdiagnosis for masked ADHD).  The first-line medications for ADHD are primarily stimulants, not antidepressants.  

They are called stimulants not because they get you excited (ADHDer’s don’t need that!), but because they stimulate the brain’s dopamine receptors to either make better use of what dopamine is there, or to additionally create more.  Very simply put, dopamine is the neurotransmitter that tells your brain, do it again because that thing was good for our survival – the brain’s reward pathway.   The outcomes of stimulant medication for the 80% of people who find success with it, is that it directly facilitates internal motivation, more focus/concentration, feeling calmer, more patience, less impulsivity, the ability to follow through (all of the things dopamine is responsible for in humans). 

​These success factors are what allow one to more successfully engaged with ADHD-specific coaching and therapy, including couples therapy.  ADHD medication does NOT change your personality or your values or who you are.  It DOES allow you to actually meet AND KNOW yourself, for the first time perhaps. 

7 core areas

We focus on seven core area’s of relational functioning for couples. Some of the things a couple can tackle through ADHD Couples Therapy include:

Parenting.  Effective parenting requires a certain degree of consistency, a primary challenge with ADHD.  

​When a child also has ADHD—and, the genetic odds are strong—it is even more essential the couple shares and implements a set of parenting strategies they are BOTH responsible for and include structure and behavior modification.

Money.  ADHD-related traits can adversely affect finances in terms of both lowered income and increased unnecessary spending.  It is important to identify joint financial goals and implementing ADHD-informed habits to help you both meet your financial goals. 

Online behaviour.  ADHD neurobiology generally bestows a vulnerability to addictive behavior, including things like gaming and social media—all of which can impair relationships if being online takes the place of your loved one too often.  The therapist should engage both partners in overcoming these overuse behaviors and re-focusing on the relationship.

Re-balancing the workloads. A partner with ADHD often has trouble following through on boring tasks, like laundry, emptying the dishwasher, or meal planning.  To compensate, non-ADHD spouses often begin the cycle of ‘over-functioning’, leaving them exhausted and resentful.  One partner starts to feel as if the other is more like an extra child than their partner and spoiler alert ….that’s not hot. 

Re-connecting.  In the beginning, when you first met your partner, it was probably all fun and full of excitement – something shiny and new! (Novelty drives dopamine in human brains!).  Over time, things are less novel. What interests you versus your ADHD partner can create a gap in how you spend time and how you connect.  

​One partner wants to always do something new and exciting (the ADHDer constantly seeking to regulate dopamine levels), while the other partner finds contentment in just spending time, holding hands, and taking long walks in the park (their brain doesn’t have the burden of needing to self-stimulate before it can relax).  It’s easy for the non-ADHD partner to misunderstand the seemingly lack of interest as that they are not exciting enough, or able to relate to their partner anymore.

Your sex life.  ADHD symptoms can affect intimacy directly, such as being distractable during lovemaking.  Symptoms also have indirect effects, with workaday conflicts throwing schedules off too often.  Day to day intimacy can also be affected. You were the sun, moon and stars when you were dating … now you are as interesting as the wallpaper.  Where did the intensity of that hyperfocus go? Unfortunately, hyperfocus usually ends rather abruptly and once again, distraction becomes the norm.  The non-ADHD partner is left feeling confused, insecure and alone, wondering if the love has permanently gone.


Addiction. If you have struggled with addiction and not been screened for ADHD, it is strongly recommended.  Addiction in the general population is around 12-13%.  For ADHD-brained individuals, its closer to 60%. ​ Research shows stimulant medication has a protective benefit for kids and adults with ADHD, versus those who forego stimulant medication.  

Without medication, humans will  balance on the outside, for what we lack on the inside – basic homeostasis.  That is, if we have too low levels of brain dopamine, our brains will drive us to seek efficient sources of dopamine, programming built in for our survival.  For many ADHD brains, it can be food (a demonstrated link to eating disorders, especially overeating and binge-eating disorder), cannabis, alcohol, nicotine, online shopping, gambling, gaming, and so on.

Treatment with medication can greatly support the individual, and trauma-informed  CBT-for-ADHD focused therapy completes the individual picture.  

Then the couple can focus on which of the 7 core area’s they would like to work on, to get back to the relationship they know deep down inside they can have. 

Picture

A TAILORED APPROACH. 

Considering all the pieces of ADHD Couple therapy, it is so important for the person with ADHD, and the people who support them, to truly understand that both being born with ADHD and its ensuing dopamine-drive behaviours, are Not Their Fault.

It bears repeating. It is not your fault.

​But as far as ‘adulting’ goes however, we still have to do something about it. 

Image of the Dig A Little Deeper approach to ADHD therapy and coaching

Our approach at Dig A Little Deeper is always to tailor a plan specific to the couple, the couple’s values and goals for where they would like their relationship to be.  As ADHD couple’s therapist’s, we view the work through two lenses: relationship counselling combined with ADHD coaching techniques, to ensure all aspects of the relationship and each partner are considered.

Now that we know what we know, we can take the time we need, to unpack what it means for you both, process how it’s gotten you both here, and understand what it means to move forward with hope and positivity for your future. ​


Interested in hearing more from Christina & John?

Check out Episode 3: Making sense of ADHD Couple Life, on The Christina Crowe Podcast: making the invisible VISIBLE.

https://anchor.fm/christinacrowe/embed/episodes/E3-Making-sense-of-ADHD-Couple-Life–with-John-Foulkes–RP-e1ea104

MORE RESOURCES

​Check out our first 3 essential coaching articles on the Dig Deeper Blog:

1. Christina’s Pro Tips: Mastering Your Beautiful Brain. 
2. Managing ‘Overwhelm’ (and other invisible symptoms of ADHD)

​3. ADHD Essentials: 8 Tips for thriving with your ADHD brain ​(free download included!)


SIGN UP FOR OUR QUARTERLY(ISH) DIG DEEPER NEWSLETTER 

​When you sign up for the Dig Deeper Newsletter, you get access to our FREE DOWNLOAD, our ‘Starter Guide for ADHD’, with our recommended sources of quality information, podcasts and other recommendations. 

We also occasionally share free giveaways, discounts on DIY*ADHD (the online course) and update you about all things related to our practice and community. Your information is always confidential, and we promise not to ever abuse the privilege of being in your inbox. 

SIGN ME UP!

Share the Post:
Picture of ​Christina Crowe, H.BSc. MACP, RP

​Christina Crowe, H.BSc. MACP, RP

Registered Psychotherapist, Validated Clinical Supervisor, ADHD Therapist & Coach Podcast Host The Christina Crowe Podcast Christina is a Canadian Registered Psychotherapist, a member of CADDRA's Advocacy Committee and relentless mental health advocate. Christina believes great mental health information should be available to everyone, loves creating content that makes invisible things VISIBLE and finding new ways to bring healing experiences to as many people as possible.

Leave a Comment

Keep reading