Masking ADHD in the Therapeutic Relationship: How Therapists Can Support, Not Dismiss
On May 1st, 2025, Gemma Pettit (MSc), Associate of RHCP and UKCP-Registered Psychotherapist, delivered a workshop as part of RHCP’s CPD Virtual Café. This blog summarises the discussions from that session, which we hope will offer valuable insights and education around ADHD.
Check out our upcoming CPD workshops at : The Therapists Virtual CPD Café | Eventbrite
In the growing landscape of mental health awareness, ADHD (Attention Deficit Hyperactivity Disorder) has emerged from the shadows, no longer just a diagnosis for hyperactive schoolboys but a nuanced, often misunderstood condition affecting adults of all genders. Yet, many therapists still feel unprepared when a client raises the question: “Could I have ADHD?”
This blog explores how we, as therapists, can compassionately and ethically respond to ADHD within the therapeutic relationship—rooted in insights from a powerful live training session led by a therapist with lived experience of ADHD.
Why Therapists Need to Pay Attention
Despite ADHD’s increasing visibility, the therapeutic world has often lagged behind. Many trainees and qualified therapists report little to no formal training in neurodivergence. Yet clients are asking—more than ever—for support navigating ADHD symptoms and seeking diagnosis.
This isn’t just about knowledge; it’s about power. When a client trusts us enough to voice curiosity or concern about ADHD, how we respond can help—or harm.
From Curiosity to Dismissal: The Risk of Medical Gaslighting
The presenter shares a personal and poignant experience: receiving her ADHD diagnosis just one day after a BBC exposé on private clinics. What should have been a validating moment quickly became a painful encounter with skepticism—even from trusted therapists and supervisors. She recalls being told:
- “I don’t believe in ADHD, it’s just trauma.”
- “You don’t seem ADHD to me.”
- “You should just give up sugar.”
These comments reflect a larger issue—medical gaslighting. Minimizing a client’s neurodivergent experience, even unintentionally, can cause serious harm.
ADHD Through a Holistic Lens
To support clients authentically, we must understand ADHD as more than fidgeting or forgetfulness. Using the work of Dr. Russell Barkley, the training explores ADHD as an executive function disorder—one that impairs self-regulation, memory, motivation, and emotional control.
It’s not a lack of willpower. It’s not laziness. Clients often know exactly what they need to do—they just can’t access the executive functioning resources to do it.
Key ADHD Features Relevant to Therapists
Here are a few key traits therapists might observe:
- Emotional dysregulation (especially rejection sensitivity)
- Time blindness and chronic lateness
- Task initiation and follow-through issues
- Difficulty with working memory and impulse control
- High variability in performance
Many of these are misunderstood as character flaws or signs of resistance. Reframing them through an ADHD lens fosters empathy, not judgment.
Shame, Stigma, and the Lost Generation
ADHD is still wildly underdiagnosed, particularly in women, non-binary people, and people of color. Research suggests women may hear up to 20,000 negative messages about themselves by age 10 if they are undiagnosed—messages that shape shame and self-worth.
This “lost generation” of adults who were never assessed as children now arrive in therapy carrying years of internalized failure and confusion. The therapist’s role is not to diagnose, but to validate, explore, and gently signpost.
The Positives We Mustn’t Miss
While the challenges of ADHD are real, this training also emphasizes the beautiful strengths that can accompany it:
- Creativity and quick thinking
- Hyperfocus and deep passions
- Empathy and sensitivity
- Resilience born from adversity
Therapists are encouraged to hold a balanced view, one that sees the person beyond the label.
Responding with Compassion and Curiosity
When a client mentions ADHD, how should a therapist respond?
- Stay curious. Ask what makes them think they might have ADHD.
- Avoid dismissive language. Don’t downplay their experience or offer simplistic advice.
- Understand your role. You are not a diagnostician, but you can provide valuable support.
- Offer practical adjustments. From session structure to communication style, small changes matter.
- Signpost respectfully. Help clients access further assessment or support if they wish.
A Call to Action
ADHD isn’t a trend—it’s a reality. And we, as mental health professionals, have a responsibility to engage with it thoughtfully. Whether or not we specialize in neurodiversity, our therapeutic stance can either empower or alienate.
Let’s be the profession that listens, learns, and leads with empathy.
