Making your therapy hour count: A practical guide for people with ADHD

Making the most of an hour of therapy can be challenging when you have ADHD. Here are some practical ways to help you get the best from your time.

Therapy offers an opportunity to pause, reflect and make sense of things that may be difficult to untangle on your own. But if you have ADHD, sitting down for an hour and keeping your attention on one conversation isn't necessarily easy!

You might arrive with lots of things you want to discuss, only to forget half of them once the session starts. You might find your thoughts wandering, become distracted by something in your environment, or suddenly remember something important just as the session is ending.

You may also find it difficult to organise your thoughts, prioritise what matters most or remember what you wanted to take away from the session.

None of this means that you aren't engaging with therapy or that you aren't making progress. It simply means that you may benefit from a few adjustments to help you work with your ADHD rather than against it.

Here are some suggestions.

Before your session

A little preparation can make a surprisingly big difference.

• Keep a running list of things you want to discuss. Use your phone, a notebook or a voice note. When something occurs to you during the week, jot it down rather than relying on your memory to bring it to the session.

• Choose one or two priorities. You may have a long list of things you want to explore, but trying to cover everything can leave you feeling overwhelmed. Think about what would be most helpful to focus on today.

• Allow time to transition. Rushing straight from work, household tasks or another activity into therapy can make it harder to settle and concentrate. Build in a few minutes to make the transition.

• Reduce practical distractions. If you're having online therapy, find somewhere reasonably quiet, silence notifications and close unnecessary tabs. Let other people know you need some uninterrupted time.

• Have what you need within reach. Keep a drink, tissues, notebook and pen nearby so that you don't have to interrupt yourself to find them.

  
  

During your session

You don't need to sit perfectly still, maintain constant eye contact or concentrate in exactly the same way as someone without ADHD. The important thing is finding ways to stay engaged that work for you.

• Tell your therapist what helps. If you concentrate better when doodling, moving around or looking away rather than making eye contact, let them know. These behaviours don't necessarily mean you're not listening.

• Use notes or prompts. Keep your list of topics visible. If your mind goes blank, you can refer back to it rather than trying to remember everything.

• Ask for a moment to gather your thoughts. Sometimes ideas come more quickly than you can organise them into words. It's perfectly fine to pause, think or ask your therapist to repeat something.

• Don't worry about going off on tangents. Sometimes an apparently unrelated thought leads to something important. However, if you notice that you've moved a long way from what you wanted to discuss, ask your therapist to help you return to it.

• Ask for things to be repeated or summarised. You might have understood something at the time but find it difficult to retain. A brief recap can help consolidate what you've been discussing.

• Notice when your attention is drifting. Rather than criticising yourself, simply acknowledge it and gently bring your attention back. If you need a short movement or sensory break, say so.

  
  

Making online therapy work for you

Online therapy can be a really helpful option if you have ADHD. You don't have to travel, you can attend from a familiar environment and you may find it easier to feel comfortable in your own space. However, being at home can also mean there are more opportunities for distraction!

Here are some practical ways to make online sessions work better for you:

• Choose your therapy space in advance. Ideally, find somewhere quiet where you won't be interrupted. It doesn't need to be a dedicated office, just somewhere you can feel comfortable and relatively undisturbed.

• Think about what's in your line of sight. A cluttered desk, an open laptop with multiple tabs or things happening around you can all compete for your attention. Try to create a relatively simple, uncluttered space.

• Put your phone out of reach. Even if you don't intend to use it, notifications and the temptation to check messages can interrupt your concentration. Consider putting it on silent or Do Not Disturb.

• Close unnecessary applications and browser tabs. If you're using a laptop, resist the temptation to multitask. Having emails, social media or work documents open makes it much easier for your attention to wander.

• Use headphones if possible. These can help reduce background noise and make it easier to focus on what your therapist is saying.

• Keep a fidget object nearby. If you find movement helps you concentrate, have something to fiddle with, a stress ball or a small sensory object. You might also find that standing up or moving around while listening helps you stay engaged.

• Have a notebook or your phone ready for notes. You can jot down thoughts as they occur, rather than interrupting the conversation or worrying that you'll forget them.

• Avoid trying to do other things at the same time. It can be tempting to tidy up, eat, check emails or respond to messages during an online session. Although multitasking may feel productive, it can make it harder to process what you're discussing.

• Build in a few minutes before and afterwards. It's easy to move straight from one online activity to another. Give yourself a little time to prepare beforehand and to reflect on the session afterwards, rather than immediately switching back to work or everyday demands.

• Have a back-up plan for technology problems. Make sure you know how to reconnect if your internet drops or the video call freezes. This avoids unnecessary stress if something goes wrong.

  
  

Most importantly, remember that you don't need to look attentive on screen in order to be attentive. You might concentrate better looking away from the camera, moving around or doodling. Let your therapist know what works for you so that you can find an approach that feels comfortable and sustainable.

The aim is to create an environment that makes it easier for you to be present, rather than expecting yourself to overcome every distraction through willpower alone.

Making the most of the end of the session

The final few minutes are particularly valuable. It can be easy to leave feeling that you've had an interesting conversation but struggle to remember exactly what you wanted to take away from it.

Try to reserve a little time to:

• Summarise what has been useful. What have you understood, noticed or seen differently?

• Identify any next steps. Is there something you want to think about, try out or pay attention to before your next session?

• Write things down. Don't rely on remembering an insight or an agreed action later. Make a brief note while it's still fresh.

• Check anything you're unsure about. If something hasn't quite made sense, or you feel you've missed an important point, this is a good time to ask.

  
  

Between sessions

Therapy doesn't have to be something you only think about during your scheduled hour. However, remembering to reflect on things between sessions can be another executive function challenge!

A few simple strategies can help:

• Keep a note on your phone where you can record thoughts, feelings or situations you'd like to explore.

• Set a reminder if you've agreed to try something out before your next appointment.

• Don't set yourself too many tasks. One small, realistic experiment is often more useful than an ambitious list of changes.

• If something doesn't work out as planned, make a note of what got in the way. This can be useful material for your next session, rather than another reason to criticise yourself.

  
  

And finally...

Perhaps the most important thing is to remember that therapy is a collaborative process, not a test of your ability to concentrate, organise your thoughts or remember everything.

You don't have to arrive with a perfectly organised account of what's been happening. You don't have to stay focused every minute or make the most of every second. Your therapist is there to help you make sense of things, including the difficulties that ADHD itself can bring to the therapeutic process. In fact, finding ways to recognise and accommodate your own executive function differences can be part of the therapeutic work itself.

The aim isn't to make yourself function like someone without ADHD. It's to discover what helps you thrive, using your own strengths and finding strategies that work for you.

A little preparation, a few practical adjustments and telling your therapist what could be helpful, can make that hour a much more valuable experience