Working with ADHD Couples: The Referee, the Detective, and the Whisperer

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.

Couples therapy isn’t just couples therapy, when attention deficit hyperactivity disorder (ADHD) is in the mix. We know couples living with ADHD have higher rates of separation and divorce, more affairs, more domestic violence, more conflict, and a harder time parenting together.

​Finally deciding to get professional help is often a major turning point for couples, especially when they finally address the elephant in the relationship – the symptoms of the ADHD. 

Despite all the disagreeing going on, one thing we can ALL agree on is, everyone comes to ADHD couples therapy with their own agenda.

One partner might be saying:

  • I want them to be more responsible,
  • I want them to pay more attention to me,
  • I want them to stop being so reactive.

The other partner might be saying:

  • I want them to trust that I care,
  • I want them to stop being so needy,
  • I want them to stop trying to fix me.

Imagine that you are witnessing a couple sharing these agendas for starting their therapy journey with their counsellor. A consistent and very human scenario plays out: one or both partners are going to get triggered either by protesting at hearing their partner’s complaints, or by turning away and shutting down.

Good news: the therapy has begun!

LET’S DO IT.

Instead of hoping the couple plays ‘nice’, the ADHD-adapted therapist expects that what happens at home between the partners when they’re in conflict (aka having competing agendas) will get activated in the session.

With ADHD in the mix for one or both partners, how (and how fast!) the ADHD couple gets triggered becomes the primary area of focus. Often, this can be more important than all the content shared in the session, or each partner’s agenda, or even solving issues*.

However, the ADHD-trigger IS the issue!

Not sure why? *Catch up with: ADHD couples: solutions beyond traditional couple’s therapy.

THE ROLE OF THE THERAPIST

Consider the ADHD ‘trigger’ as possibly the most basic and necessary starting point of ADHD-adapted couple’s therapy. If the ‘trigger’ can be tamed, the couple can then start letting go of their blame & shame routine.

In the beginning stages of therapy, the ADHD-adapted couple therapist will take on three different roles to shift the couple from being reactive and destructive to being more responsive and constructive.

​This is one huge step to better communication and connection.

1. THE REFEREE

It’s worth repeating here: the ADHD-adapted couple therapist is anticipating each member of the couple to show up with their guns loaded to further their own agenda. In no time, their signature power moves are played, with one partner typically pursuing & protesting and the other withdrawing & shutting down. Each of these stances are their attempts to control the other, manifesting as parent-child roles or the blame-shame cycle.

​Sound familiar?

Like an impartial referee the therapist is NOT there to keep score or pick sides, but rather to contain the drama (i.e., the he-said vs. she-said banter) in that moment. The therapist will ‘thank’ the couple for showing them how they get caught up so easily by the ADHD trigger.

It can be baffling to both partners the speed in which they get triggered. Consider that each partner brings their own anxiety or frustration ‘pilot light’ already lit and ready to flare up for conflict.

The therapist’s job is to say, “Here is what and why the ADHD trigger happens, and we get to be super interested when the pilot light blazes. When it does, my job is to get everyone to ‘un-trigger.” It can’t be stated enough the importance of being able to tap on the brakes to prevent further damage to the couple dynamic. No doubt a healthy transferable skill outside of the therapy office!

KEY POINT:

The couple – both partners contribute to the conflict; each person gets triggered and tangled in the negative dance in their own way, and impacts the other. 

2. THE DETECTIVE

What happens if ADHD has not been formally diagnosed in one or both partners?

What if one partner suspects the other partner has ADHD and they are refusing to get a diagnosis?

​What if the possibility of ADHD as a factor in the relationship has not even been raised by the couple?

We know that there are contraindications to couples therapy – meaning, instances whereby there are barriers to more successful outcomes. Untreated medical conditions are one of these, if their symptoms are the thing creating the barriers for the couple. 

Here is when the therapist plays detective – akin to a sleuth who must determine if ADHD is indeed a distinct factor in the couple’s dynamic. Consider if all stones are over-turned in the therapy process, including making sense of the relationship dynamics, and processing unresolved emotions and conflicts. Solutions can then be implemented for better communication, connection, and getting organized, etc.

If, after therapeutic and coaching interventions, there are still challenges with core areas of functioning, then it’s prudent to at least RULE OUT any diagnoses or need for medication for one or both partners.

​Since ADHD is correlated with OCD, anxiety, and depression, then comorbidities should be considered. Also, non-ADHD partners may benefit from getting assessed for anxiety or depression, considering their own emotional struggles when engaged in the ADHD-couple dynamic.

KEY POINT: 

Adhere to the 4-Pillar approach to address what may be going on,

  1. formal diagnosis and medication,
  2. executive function support via coaching,
  3. emotion function via psychotherapy, and
  4. relationship dynamics factors such as past trauma and attachment wound via couple counselling.

3. THE WHISPERER

Let’s face it: most couples want relief sooner than later, and often as soon as only a handful of sessions have been completed. Partners expect each other to be more attentive, carry their weight and get things done without reminders, and perfectly calm and nonreactive.

Unfortunately, this is a telltale sign that the ‘pilot light’ has been flaring up frequently for quite some time.

To better manage expectations, consider that addressing core areas of function must take a back seat to simply having one partner being in the same room listening openly when their partner is talking, without being overly triggered. Here, the therapist must serve as a whisperer to slow down the session and tamp down the flare-up of the pilot light in real-time.

Breaking patterns of going off topic, interrupting, gaslighting and denial, and defensiveness, can lead to the couple becoming more stable, and better able to communicate and connect with each other. It can take time and test the couple’s patience but it’s worth it. The key is to be able to make the shift in the therapy session, so that the couple can do it on their own, outside of the sessions.

KEY POINT: 

Staying in the ‘window of tolerating’ emotions and triggers, creates the opportunity to heal the ADHD couple relationship and allow it to thrive in new directions.

Happy couple giving each other a piggyback

If you are in couples therapy, and you aren’t sure what your therapist is doing, ask them.

​If ADHD, or suspected ADHD is in your mix, there is no doubt it is one of the most important things you as a couple should address. You’ve made it this far in reading this article so you are already well versed! A couples therapist who is either neurodivergent themselves, or well trained in the consequences of ADHD on romantic relationships will deploy the referee, the detective, and the whisperer to benefit your unique relationship. 

Consider ADHD-adapted couples therapy as a clear, simple, and constructive approach to starting your journey to keeping the love and partnership you want.

MORE RESOURCES

COUPLE THERAPISTS:

Looking to learn more about the experiential art of neurodivergent couples therapy?

DIY*ADHD: Couples is available now.  An online training from John and Christina designed for Couples Therapists, Counsellors or ADHD Coaches.

REFERENCES

Brian T. Wymbs, WillH. Canu, Gina M. Sacchetti, Loren M. Ranson, “Adult ADHD and romantic relationships: What we know and what we can do to help,” Journal of Marital and Family Therapy (2021), https://doi.org/10.1111/jmft.12475.

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Picture of ​Christina Crowe, H.BSc. MACP, RP, (S-Cert) OAMHP (she, her)

​Christina Crowe, H.BSc. MACP, RP, (S-Cert) OAMHP (she, her)

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.

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