A new coaching client described her seven years of therapy as producing no results. She and her two children have ADD (Attention Deficit Disorder), her house is disorganized, she has trouble with follow-through, and after all that therapy, she felt that things were continuing to deteriorate. Her conclusion, and reason for contacting me, was that while she liked her therapists very much, they did not have any e S9905.html xperience working with ADD. She and her therapist agreed that the source of her problems was her ADD. They did not feel she suffered some serious underlying psychopathology brought about by significant disruption to her psychosexual development. She wanted to learn some new skills, get herself organized, and become reliable. She was being followed by a psychiatrist for psychostimulant medication and an antidepressant which she felt helped some, but she was very clear that she no longer needed therapy. She wanted coaching.

Since the publication of Driven to Distraction (Ratey and Hallowell, 1994), increasing numbers of adults have seen themselves depicted in books and articles describing ADD in adults. CHADD (Children and Adults with ADD) and other organizations representing the interests of adults with ADD have been organized. Findings (NIH Consensus Development Conference, 1998) suggest that ADD is both a widely over- and under-diagnosed disorder. For those who have been properly diagnosed, appropriate treatment has provided much needed relief and reassurance.

There are several interventions which are helpful to those coping with ADD (e.g., see Hallowell and Ratey, 1994, Nadeau 1995, NIH Consensus Development Conference, 1998). Coaching is an intervention that has been widely touted for adults with ADD.

The Unique Needs of Adults with ADD

As a psychologist who has been working with this population for most of my career, I was both intrigued and concerned about the proliferation of services being offered to adults with ADD. Clearly, this is a population already feeling vulnerable, and in some cases, desperate. Adults with ADD have experienced lifelong struggles to achieve the feeling of control over competing sources of distraction, disorganization, and inattentiveness. They want to maintain the creativity, intuitive thinking, and risk-taking that may reflect the positive contributions of ADD. They seek and welcome services that might enhance their productivity.

“Let the Buyer Beware”

Many coaches who recognized the opportunity to serve this population either offered their experience as “fellow ADDers” or as professional coaches (with training and backgrounds in any area ranging from sales to management consulting). Some received training from expensive coaching training programs but were not very familiar with ADD. Many ADD coaches feel that their personal experiences suffice to offer assistance in helping others. They may offer some much needed empathy and understanding. However, my contact with fellow mental health professionals and coaches suggested that few were thoroughly knowledgeable about ADD or were able to differentiate ADD from other “look-alike” disorders, i.e., disorders with symptoms that are similar to ADD symptoms.

A Lightbulb Lit Up

I realized that as a psychologist who had worked with ADD my entire career, much of the work I had been doing was indeed coaching. As I developed the marketing materials, I wanted to use to promote my coaching business, I realized the unique qualities psychology brings to coaching adults with ADD. I conceive of coaching adults with ADD as a collaborative educational process in which clients identify their objectives. Then, together, we concretize the objectives into operational terms. We identify the specific skill(s) to achieve the goals and work on learning and practicing the behaviors. This process is based on the present day concerns and goals that a client brings. The focus is on problem-solving and strategizing. The coach relates to the client as a consultant or teacher would, working alternately as motivational consultant, cheerleader, or strategist.

The Evolution of a Coach

As I continued to work on development goals for my coaching practice, I identified three areas I wanted to emphasize:

1. Coaching groups of professionals with ADD.

2. Training and supervising mental health professionals to effectively recognize and work with clients who have ADD. Many clients have comorbid symptoms that are resistant to treatment because of the unique characteristics of ADD. Psychologists who diagnose and treat ADD and its interactive impact with many other psychological disorders provide the services adults with ADD need.

3. Training and supervising mental health professionals to coach clients with ADD. Educating mental health professionals about ADD and successful coaching techniques ensures that qualified coaches are available to work with this population.

Establishing your own Coaching Practice

In considering establishing a coaching business, the key is to remember that we may already have such relationships with our clients. Particularly in these days of managed care, when therapy sessions are rationed and short-term treatment is the only covered insurance benefit, many of us have learned to adapt our skills to work only on specific, attainable, concrete goals. Coaching borrows from these practices. One may address several short-term goals with a client, or identify smaller, attainable steps that progress toward the final goal. Coaching skills demand the flexibility of defining and revising goals, trying new strategies and techniques while adapting others, and most importantly for the adult with ADD, understanding the unique cognitive processes that make up the syndrome so that the strategies that are chosen are reasonable and manageable.

Effective Coaching with ADD Adults

The effective coach must offer more than just good gimmicks or tricks. Many highly motivated adults with ADD have tried the electronic devices, timers, alarm clocks, and office and desk organizers (or they have heard about them and are wary about spending money on a gadget that they doubt will help them). Many ADDers have actually developed some tricks that work for them. Having doubted their judgement for much of their lives or felt uncomfortable with the unorthodox ways they accomplish their work, they frequently need the coach to work with them to ascertain what already works and apply it successfully to other aspects of their lives (Fisher 1998). An ADD psychologist-coach needs the expertise and skills in motivation, understanding of how to use an educational process to effect change, and knowledge about ADD.

Do I Have What it Takes?

Most people who are doing therapy with this population are already probably providing coaching to many of their clients. Similarly, many executive management consultants are probably already working with many adults with ADD, although may not have formally diagnosed the disorder. Therefore, you may already be engaged in such a business.

In working with ADD adults it is important to operationalize goals, define strategies for achieving goals, and choose the skills to focus on so that the client can practice and work towards achieving them. Particularly for the ADD client, the psychologist-coach must keep things simple and manageable. Adults may be seeking a coach because they feel overwhelmed and out-of-control. The coach must counter with goals that are simple and attainable.

In understanding ADD, the psychologist-coach appreciates the positive qualities and attributes that are such vital parts of the person with ADD. ADD is a disorder in which the difficulties with executive functioning, inattentiveness and disorganization make it difficult to conform to the demands of our society. However, people with ADD are frequently creative, imaginative, risk-takers whose often non-linear thinking style can produce important results in whatever settings they find themselves. The understanding of what ADD is enables the coach to be encouraging, supportive, and realistic.

Virtual Coaching

Coaching adults with ADD lends itself very well to telephone consultation because:

1. People with ADD have difficulty organizing themselves, getting to an appointment on time can be so disruptive that the gains of the meeting can be undone by the distractions produced by getting there

2. Materials such as lists and calendars, goal sheets and schedules, have an increased chance of being accessible if the meeting is conducted by telephone from the client’s workspace at home or at their place of business

3. Many people with ADD have trouble getting started in the morning. They frequently find that their peak work occurs late into the night. The phone appointment in the morning can be a very useful start to the day; an organizing factor that takes advantage of the down time. It avoids the need to be dressed, breakfasted, and presentable in order to gain its advantages, which a face-to-face meeting usually demands.

4. Clients may be better able to control distractions in an environment of their choosing and with which they are familiar

Nuts and Bolts

Frequency of Sessions: The frequency and length of coaching sessions vary. Many coaches work with their ADD clients with greater frequency for shorter time periods. Some will check in with their clients as frequently as daily, Monday through Friday. Others rely on the time between sessions to help the coaching client work on skills. They may have one session weekly for thirty-minute or biweekly for hourly sessions. The client’s goals may define this.

Marketing: The demand for successful coaches is so high, that offering to speak to a local CHADD chapter on coaching, offering free introductory sessions, and advertising can bring the referrals that you want. Networking with colleagues is also a valuable source of referrals.

Liability Concerns

The major issues that I believe all psychologists pursuing a coaching business need to be mindful of, especially when working with a population with a diagnosable condition, is whether (and how) their licensure laws cover coaching. Coaching is not therapy. State licensing bodies are just beginning to consider how they might regulate these practices. Relying on the integrity of our professional code of conduct and ethics is essential to any of the professional activities in which we engage. It is also another value that we offer our coaching clients that distinguishes us from coaches trained in other ways. Therefore, I would strongly recommend that anyone setting up such a business consider discussing the materials you plan to use to describe yourself and your business with your local licensing board and review the materials with your malpractice insurer.

I found the attorney from my insurer to be extremely helpful in that regard. He spent time with me reviewing my materials. I also submitted my promotional and descriptive materials to my local licensing board for feedback regarding any areas that might be problematic from their perspective. I spent a great deal of time defining and clarifying the distinctions between coaching and therapy, identifying my code of ethics, especially with regard to clients who either were in therapy or needed to be in therapy. In working with people from around the nation and the world who frequently are self-diagnosed, in therapy, or in need of clinical intervention, therapeutic issues need to be deferred to a local professional. I wanted to be very clear that my coaching practice does not provide therapeutic services, nor would I work with an individual who may need such services but was using coaching in lieu of those services (either knowingly or not).

The Psychologist-Coach

As psychologists, we have unique expertise in motivation, skill training, and cognitive development that differentiates us from most other mental health professionals as well as lay people who become coaches because of their personal experiences. Adults with ADD are looking for support and expertise that will offer them opportunities to cope with their deficits so they can promote their strengths. The more knowledgeable you are, the more successful you will be. The demand is high and the need is great.

References

Fisher, D. (1998). Procrastination, http://www.TheADDvocate.com 1, 1.

Hallowell, E., & Ratey, J. (1994). Driven to distraction, New York: Pantheon Books.

Nadeau, K., (Ed.) 1995. A comprehensive guide to attention deficit disorder in adults: Research, diagnosis, treatment. New York: Brunner/Mazel.

National Institute of Health Consensus Development Conference. (1998, November). The diagnosis and treatment of attention deficity hyperactivity disorder.

Practice parameters for the assessment and treatment of children, adolescents, and adults with attention-defict/hyperactivity disorder. 1997, October, Supplement. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 10.

Dr. Fisher’s practice in Bethesda, Maryland specializes in the diagnosis and treatment of children, adolescents, and adults with school, work, learning difficulties and Attention Deficit/Hyperactivity Disorder. She has served as a professional advisor to her local CHADD’s Adult support group and currently is a member of its advisory board as well as the behavioral health advisory board of a local health insurance company. Her addresses are: E-mail dfisher@theaddvocate.com, web page http://www.TheADDvocate.com, and phone 301-652-4218.

By Deborah M. Fisher, Psy.D.