What's Best for Adult ADHD: Traditional Therapy or Cognitive Behavioral Therapy?

When diagnosed with ADHD, many adults choose to take medication. While this is often helpful, it doesn’t cure ADHD or take away all the symptoms. Finding ways, such as using organizational tools, reminder lists and alarms, is still important and need to be implementing in daily life. Besides managing symptoms, many adults with ADHD have related problems, such as anxiety, depression or low self-esteem. Some adults choose to use therapy to not only help manage symptoms but to address these coexisting conditions and related problems. But, what type of therapy should you choose?

Psychotherapy

Traditional therapy usually refers to talk psychotherapy or psychodynamic therapy. This type of therapy places a large emphasis on talking through your problems and delving into your past to uncover reasons for your feelings. During therapy sessions you try to determine why you behave in certain ways.

During therapy sessions, you set the agenda by discussing whatever is on your mind. The therapist often asks questions, encouraging you to look deep within yourself and your past to uncover reasons for your feelings. Because you are talking about very personal matters, the relationship between the therapist and the patient is very important. Therapy often lasts at least six months and can sometimes go on indefinitely.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) focuses on present day problems. It is based on the premise that thoughts cause feelings which cause behaviors. If you become aware of and change your thoughts, you can change your feelings and thereby change your behaviors.

Therapy sessions are highly structured and practical solutions to problems, such as anxiety, are taught. The educational aspect of CBT is very important and the goal is for you to be able to use the skills by yourself once therapy has ended. Typically, CBT lasts from between 12 weeks to six months. The average length of treatment is 16 weeks.

While it is important to trust and respect your therapist, the relationship between the therapist and patient is not the focus of treatment. Instead, each session focuses on a specific problem and the therapist teachers skills to address that issue. One central part of CBT is homework. This helps patients practice the skills in between sessions.

A therapist may talk about your history, in the context of understanding motives for your behaviors, however, the focus of the therapy is the here-and-now.

Proponents for Both

There are proponents for both types of therapies. Those who favor psychodynamic therapy argue that, for lasting change, the longer course of treatment is necessary. They also believe that addressing issues, without digging deep to find the cause of the issues, only gives temporary relief because the underlying reasons are not addressed. However, advocates for CBT believe that short-term therapy is better and the component of CBT that teaches people to self-counsel themselves once therapy has ended is better. They believe the cause to most difficulties comes from negative thoughts and teaching people how to change those thoughts helps them lead happier and more satisfying lives.

Characteristics of Psychodynamic and CBT

CBT

• Brief therapy - average length of treatment is 16 weeks
• Goal oriented and focused on present day problems and concerns
• Highly structured with a specific agenda for each session
• Homework is central to the success of CBT
• Considered collaborative between therapist and client
• More affordable because it is briefer
• Teaches self-counseling with end goal of the client using skills in different areas and throughout their life
• May address but does not delve into childhood issues or the past
• Requires commitment from client because of homework

Psychodynamic Therapy

• Can last from several months to indefinitely
• Relationship between therapist and client is central to success
• Allows client to have a sounding board and someplace to vent about difficulties
• Client sets agenda by discussing whatever is on their mind
• Focus is on past and here-and-now
• Looks for and addresses the root cause or underlying reason for feelings
• Benefits usually increase as more time is spent in therapy

Both CBT and psychodynamic therapy have advantages and disadvantages. It is important to find the type of therapy that best suits you.

References:

"Different Approaches to Psychotherapy," Date Unknown, Staff Writer, American Psychological Association

"Psychotherapies," Date Unknown, Staff Writer, National Institute of Mental Health