The article below was originally written and published by Christine MacInnis on October 23, 2023 on the EMDRIA website: https://www.emdria.org/blog/emdr-therapy-and-adhd/
Tell us a little about you, your experience becoming an EMDR therapist, and your experience working with people who have ADHD.
As an ADHD human myself, I have had to prioritize self-compassion, permission to unmask, understanding how to be myself, and the challenges, frustrations, and celebrations of my neurotype. As a result, I find myself naturally attracting clients who are autistic and ADHD themselves, who are specifically looking for a therapist who has lived experience with neurodiversity. I grew up in a time when ADHD was stereotyped to be that kid in class who would never shut up, and in my case, it led to eye-rolling and sighing regarding my behavior. This created interesting work to bring to my therapist. As a former school counselor and now a mom of two teens, I feel it gave me a strong sense of compassion and patience in working with others, especially those who experience the same microaggressions when they unmask. ADHD also gives me the gift of hyperfocus on topics I love- ie, doing therapy, so my work is my passion and never gets boring for me.
I work closely with another population I am a part of- the LGBTQIA community. There is a researched correlation of the intersection between LGBTQIA+ identities and neurodiversity, and it is this intersectionality that makes up the bulk of my practice. In addition to my paid work, I also volunteer with PFLAG. I facilitate family groups that focus on education and support. So, my hyperfocus continues even into my volunteer work.
At the start of the pandemic, I saw my clients struggling with intense levels of trauma, so I decided to get trained in EMDR to have an alternative modality to assist them. I was thrilled when I learned that my trainer, Paula Merucci of EMDR Consulting, had the expertise I needed. Paula not only understood my neurodiversity, she understood my traumatic brain injury from a repaired aneurysm and that it would need some adaptations for EMDR to work successfully. Even while online, I felt cared for through my learning process by both her and one of her trainers, Eric Bruemmer. Eric taught me my very first adaptation that made EMDR successful for me, using big body movements (moving arms in and out while raised) rather than the traditional eye movements that fell short for my work. I was healed from a long-held simple trauma that day and, can I say, HOOKED. I became obsessed with making EMDR neurodivergent affirming that day and still practice it daily as a therapist. Since then, I have worked towards becoming an EMDRIA Consultant in Training (CIT), created an EMDRIA-approved continuing education training last August (“Special Considerations for EMDR with Autistic and ADHD Clients”), and run a Neurodiversity Affirming EMDR Facebook group where trained clinicians can find support and education from other lived experience clinicians who practice it as well.
Can you briefly help us understand a little more about ADHD types and how ADHD fits into the current framework around neurodivergence for you?
This could be a complex deep dive into the variations found within everyone’s brains and neurotypes as a whole, but I will try to keep it simple. If we stick with the strict DSM-5-TR (The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision) diagnosis, we would find ADHD listed under neurodevelopmental disorders. The diagnostic criteria to be considered for ADHD would be “marked inattention, hyperactivity, and impulsivity that interfere with functioning or development. There are three types:
Combined presentation, meaning all three are present
Predominantly inattention presentation
Predominantly hyperactivity-impulsivity presentation.
These symptoms must be present before age 12 and in two or more settings. There also needs to be clear evidence that it interferes with the quality of work, school, or social functioning. They cannot be a function of any other mental illness.” (American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596)
That’s the medical model definition of ADHD, but the real-life presentation can be so different from person to person. One may be inattentive if they are not interested in a topic (in my case, any math class I ever took) and hyper-focused on something they love (give me any psychological theory to dive into). There are a lot of myths swirling around about ADHD. For example, it has been stated that to truly assess an individual for ADHD, they need to be put on stimulant medications. If they no longer have symptoms, then they have ADHD. As someone who treats her ADHD with caffeine and lots of exercise, this seems silly to me. And because I don’t see the value in medication support (although I know it is a game changer for so many), I just think it’s odd to use medication as a diagnostic tool. That simply fits into the medical model of ADHD, which is just a small picture of what it really is and how this neurotype affects a person. In terms of how it fits into the current framework around neurodivergence, it’s looking into the person as a whole, whose identity as an ADHD human affects all aspects of their life. Some of those aspects are disabling, and some of those are strengths, and we should be working on making all aspects more adaptive for the individual to thrive. In my opinion, the focus should not be on pathologizing the very core of a person or making them feel stigmatized for who they are. The focus should be on self-determination, self-acceptance, and self-compassion as core values in doing the work to be affirming.
How can EMDR therapy help people struggling with ADHD? What successes have you seen?
This is where I can geek out on this topic, so bear with me. I feel it helps to heal the many microaggressions and macro ones that ADHD folks deal with every day. For me, my second-grade report card had “needs improvement” regarding behavior underlined heavily in red pen. I recently found it and finally did not feel the overwhelming sense of shame but rather just mild frustration that a teacher would not better understand me or my need for stimulation in the classroom. Healing shame, rejection trauma (linked to rejection sensitivity), peer exclusion, lack of education support through higher education, negative beliefs, and navigating difficult relationships are all vital parts of healing that EMDR can support. The list is endless in areas where EMDR therapy can support an ADHD client throughout the 8 Phases. Phase 1 (history taking) is huge because there are so many areas where the ADHD client blames themselves and thinks they are the problem. Phase 2 (resourcing) is helpful because traditional tools like meditation often fall short for ADHD folks. Creative resourcing can be used in Phase 2; for example, using photos for a safe, calm space for those with trouble visualizing. Finding strong figures that could provide support during Phase 4 reprocessing can be helpful, like resource figures from video games, which can give a sense of safety they didn’t have at their disposal before. And, of course, Phase 4 reprocessing and installation can provide a way to ease self-loathing and negative beliefs they experienced throughout their lives due to the perception of their neurotype.
The one thing I will never ask EMDR therapy to do, however, is to cure the neurotype. Being an ADHD person is a neurotype and who they are. It comes with a specific set of challenges that can be disabling at times and can be undoubtedly overwhelming. But it can also be highly adaptive too. EMDR can help reduce the harm experienced by others. I have seen so much success in my clients (and myself!) reducing those feelings of shame and accepting themselves more compassionately.
Are there any cautionary measures you would like to mention regarding using EMDR therapy with those dealing with ADHD?
I like to say providing differential support rather than cautionary measures. For most, in Phase 4 of the work, the desensitization and reprocessing phase, eye movements are not enough to tax the dopamine-seeking behavior of the ADHD brain. Big body movements, like the arms in and out method taught to me by Eric Brummel, stomping feet back and forth, loud, bilateral tapping on legs, strong buzzers, and using sound used in conjunction, can usually help. I recommend repeating the last sentence the client processes out loud as a cognitive interweave to help with focus and attention without taking away from processing. I go into more detail with the neurobiology on why we need to tax the working memory differently and other interventions in my training: “Special Considerations for EMDR with Autistic and ADHD Clients.”
Are there any myths you would like to break about using EMDR therapy with these clients?
Yes! That we lack the focus and attention to do EMDR effectively. I am living proof as are my many clients that it is simply false!
Are there any specific complexities or difficulties people living with ADHD deal with that other populations may not? How does this affect therapy?
Definitely. There are many concerns that I will list below that may cause shame, which might then show up in therapy and trauma work. These concerns can affect all 8 phases of EMDR therapy, so they also bear mentioning here. Executive functioning, working memory, and inattention/forgetfulness impact daily life and relationships and are the basis for many to experience trauma. During Phase 1, history-taking, it’s fascinating to see how many negative self-beliefs develop simply by one being who they are.
In terms of how this affects EMDR processing, folks with ADHD are also affected at times with:
aphantasia (inability to visualize)
alexithymia (inability to identify emotions)
hyperfocus or inattention
dopamine-seeking brain that interferes with taxing the neuro-network
Low or high proprioception or interoception could affect information regarding body scans or using buzzers during processing.
Overall, training and consultation in working with ADHD clients and EMDR from clinicians with lived experience is helpful if you get stuck anywhere in the 8 phases of EMDR therapy.
What multicultural considerations might EMDR therapists need to consider regarding EMDR therapy and ADHD?
One area of special concern is that the presentation of ADHD can be so varied, specifically with gender. It’s noted in the DSM-5-TR that “male-identifying clients are diagnosed more with the hyperactive-impulsive type, whereas female-identifying clients are diagnosed more with the inattentive type”. One huge issue concerning this gross oversimplification is that female-identified patients are sometimes overlooked as having ADHD. They are more likely to be diagnosed with anxiety or bipolar disorders. This could lead to dangerously prescribing medication that would worsen ADHD symptomatology and keep the client from the relief and support of who they are. It doesn’t consider folks who do not fit the gender binary at all. I feel that using gender generalizations in diagnosis is simplistic and overreaching.
What is your favorite free resource to suggest to other EMDR therapists on this topic?
I keep an extensive resource list on my website that I am happy to share – Transcends Family Therapy.
What would you like people outside the EMDR community to know about EMDR therapy and ADHD?
To understand the trauma this community has experienced and be thoughtful in the approaches of doing EMDR therapy more effectively. I shared a lot of tips above, but don’t hesitate to reach out to other EMDR clinicians who have ADHD themselves for consultation because their lived experience is valuable. I am so grateful to Paula Merucci and Eric Bruemmer for the training they gave me. If not for their intervention, I would have thought EMDR was not for me and possibly other ADHD clients I would see.
References:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596