Saturday, May 23, 2009

Treating Couples with an ADHD Member

Many couples come in to therapy because they are frequently in conflict due to their different “brain styles”. As a clinical psychologist, one characteristic brain style I see is the AD(H)D type. The member who has this brain style may actually have the diagnosis of ADD with or without hyperactivity, or have ADD-like behaviors. Whether or not this member actually has ADD or is ADD-like, he or she is difficult to live with, since the other member often has a very different brain style. They have become a couple because of their commonalities and their differences. At first the differences seemed appealing ( “Opposites attract”) and provided a balance in the relationship until they started living together.

Initially, in the typical situation, the ADD member was probably playful, fun- loving, creative, witty, outgoing and spontaneous. However, as the relationship continued, he exhibited poor listening skills, disorganization, bad time management, inappropriate impulsivity, excessive need for novelty, and often, lack of attention to detail and follow through with requests from the other member. The other was found to be more serious, very focused, a good listener and planner, although not particularly spontaneous. The usual complaints come from the non-ADD member, who starts to act critical and parental towards the other, who resents it. The non-ADD=2
0person will often say, ”He’s passive aggressive”. The ADD-like member usually says, ”He’s so critical and treats me like a child. I do my best but nothing pleases him”.

My first job is to talk about brain styles and how they work and don’t work together. Usually, even if it is known that one member has ADD, neither member is aware of the negative as well as the positive impact of this on the relationship. I try to dismiss labels such as “passive aggressive” and “narcissistic”, and reframe various behaviors. I work on having each member becoming aware of adapting to the other’s brain style with the goal of integration. I always point out that the cores of both brain styles won’t change ,but some changes in interactional behavior is possible, if the positives in the relationship are realized. For example, the non-ADDer has to curb her parental tendencies and discuss with her ADD mate specific tasks and deadlines they both agree on. Also, it is often useful for each to have separate domains for chores, finances, planning vacations, using the best skills of each. The need for novelty and stimulation that the ADDer has, often is not matched by the lower level of external stimulation the non-ADDer needs. The ADD member often craves a novel or stimulating activity ( and it shouldn’t be a dangerous one ) by himself while the non-ADD member can enjoy a more relaxing activity in her leisure time (such as reading). An important focus of therapy is having the ADD couple work together as a team that realizes that one brain style is not better than the other, just different. As a result of all the couples with ADD I have treated, my most useful role is as an ADD coach.

To Be Successful, You Need Coaching for ADD


jasmine said...

This article gives hope that an ADDer and non-ADDER can work together to live in harmony. With coaching I can see how one learns to think a little differently. What do you call it when an ADDer 'forgets' that they are supposed to be trying to respond differently to triggers?

Dr. June Kaufman said...

I said that both members of the couple will find it hard to change their reactions to triggers. They need to cue each other and set aside specific time to review how they are changing or not changing their reactions to triggers