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What to know about ADHD: Medications + Strategies from Clinicians and Prescribers

In this podcast episode, Miranda Barker, LICSW is interviewing therapists ⁠Davin Cobb, LAMFT⁠, ⁠Christina Gonzalez, LCSW⁠, and Physician Assistant ⁠Joey Lusvardi⁠, PA-C to discuss:

  • Diagnosing ADHD in Therapy
  • Strategies for managing ADHD
  • Common medications used for managing ADHD
  • How to deal with ADHD as a therapist

Check out the full podcast episode and the transcript below.

Read the Transcript:

Miranda (Host): Welcome to the Therapist Thrival Guide. My name is Miranda Barker. I’m a licensed clinical social worker. Today we are talking about ADHD and we have some awesome experts with us today. I’m going to let you guys introduce yourselves. Davin, do you want to go first?

Davin: Sure. My name is Davin Cobb. I am a licensed associate marriage and family therapist.

I work at an Ellie Buckhead location in Georgia.

Christina: I am Christina Gonzalez. I am a licensed clinical social worker at of Elemental Health of Central Jersey, located in the Flemington office.

Joey: I’m Joey Lusvardi. I am a physician assistant and I work remotely, but I’m based in Minnesota.

Miranda: Awesome. I love having episodes like this where we can pull, number one, clinicians in from all over the country.

Number two, when we can have a prescriber here to talk about these specific diagnoses. So Joey, you’re kind of like our guest of honor because it’s important to be able to talk about how prescribers and therapists can be talking, can be working together, especially when it comes to ADHD and like some of these diagnoses where medication is super helpful and effective and all those things.

So wanted to just kind of get started by talking about if you are a therapist working with a client. And you kind of suspect that they have ADHD or perhaps they’ve said, you know, I’ve been wondering, I saw a TikTok the other day and I had a lot of the symptoms that this person was talking about. I think I might have ADHD.

What is our like first step? What are, what do you do?

Christina: I mean, for me, I kind of like run it down with my clients of what does that look like? How are you associating with it? It can be very real of like, yeah, you are having these symptoms, but is it isolated or is it kind of a constant thing and kind of doing an inventory with them of how long do you feel like this has been going on and what does that look like for you?

Miranda: Kind of starting there with them. What some of the common symptoms that you do see for people who, Who actually have ADHD then?

Christina: So the fidgeting, inability to kind of stay focused impulse control. I see a lot of kids in adolescence. So it’s like that impulsivity of going from like, Being completely fine to like, I’m going to have an anger outburst and do something that I’m not going to be able to come back from and I’m like, okay, that, that you see, but I guess for like the adults, it’s more of like the executive functioning piece of it, of time management and.

Kind of creating routines and structures for themselves, which can be helpful.

Miranda: awesome. What about you Davin? What when a client says like hey, I think I might have ADHD What’s your first step? What do you normally do with them?

Davin: Yeah, very similar to Christina. I try to one I like to normalize I’m really big on normalizing and like sitting with someone for a moment just to, okay, this is what you’re feeling.

What are these symptoms? What are, how are you equating to these things? And then I kind of like to, cause I work primarily more with like young adults and, and couples. So I see a lot of times, That I will point it out a little bit more before they will particularly my couples, like if one of the, of the parties is having some executive functioning, the partners may be complaining about, she’s forgetting things all the time.

And I don’t understand why she can’t remember this. And it’s that it’s not that hard. Do this. Then I’m normally like, okay, well, maybe let’s look at some other options particularly that could be going on. Because I think that a lot of times people with ADHD, there’s a stigma of just being lazy. So I do look for that as well.

Like, have you been told so often you’re lazy? Do you have like negative self talk about yourself, about what you should be doing, what am I not accomplishing? And how is that showing up in your life? A lot of executive functioning is usually where I like to lean into. I like to start with normalizing, particularly pointing out things that I’m noticing and then potentially looking at how do we need to move forward?

What are you looking for to help you with? Some of the symptoms you’re experiencing, whether that’s getting with a psychiatrist, I mean, working with them or working on some routine and normalizing. This is how your brain works. There’s no need of trying to become the it girl that you see on TikTok, particularly this may not work for you, but we can find something that does work for you.

Miranda: That’s super helpful. Do you, do either of you like recommend your, clients go seek out a Psyche eval right away? Or like, what is, is that, is that something that is typically needed for an ADHD medic, ADHD diagnosis? Or do you feel like you are comfortable enough being like, this is what we’re diagnosing.

Like, what’s the role of a Psyche eval with this?

Christina: So I mostly see kids in adolescence. So a lot of the times I will get either kids that are just diagnosed or they school speculating an ADHD diagnosis. So I will always, Refer to for like a psych or a neuro eval just for The kind of posterity of like knowing that they’ve done everything and if it isn’t this like kind of figuring out Where we are and providing all the support that they can actually like get because once school is like Oh, there might be ADHD involved if there isn’t an md attached to like the diagnosis.

They’re like, oh no We can’t give support. So I will always refer like for that as a You Just as, like, an extra layer.

Miranda: Yeah, yeah. Well, and I was always told, too, that we really shouldn’t be doing, like, our own, like, we should be kind of referring for that additional diagnosis anyways. I don’t know, Joey, do you have other thoughts on that, too?

Joey: Yeah, I mean, I obviously, like, I, I trust, like, that y’all know what you’re doing and that, like, if you have suspicions about it, like, you’re not just gonna randomly be like, Oh, yeah, like, you have ADHD, that, you know, you’re gonna do a thorough evaluation. You know, and I also think, too, sometimes, like, I’ve had people who’ve come to me and they’ve been a little bit like, I don’t know and then their therapist, they’ll talk to their therapist about it, and their therapist will be like, oh, yeah, yeah, you’ve got ADHD and it’s really helpful to, like, you know, have that additional perspective because there is still a stigma attached to it where people sometimes are like, you know, I’m not sure if I want to, you know, Get that extra label.

I, I think it’s worth, you know, like bringing it up and, you know, even if you’re not comfortable, like being like, okay, this is definitely ADHD you know, getting someone else involved who does feel comfortable doing that is like a really good idea and I definitely think that, you know, like most therapists are going to be able to recognize that like, Hey, this is something that requires a little bit more evaluation.

I think that’s, that’s a good thing. Okay.

Miranda: I guess most of the time when I have had clients who have said, Hey, I mean, I mean, let’s be honest. It has usually been like I saw a tick tock the other day and it made me think that I probably have ADHD and I see a lot of college students. And so then I usually will say.

Exactly what you were just saying, Christina. Okay, what makes you think that? Let’s talk about symptoms. How long has this been going on? And then, you know, referring for a more thorough evaluation. Because even though I am someone who that, who can be like, Oh yeah, you totally, you know, you fit the criteria in these ways.

I usually want them to, you know, have a more thorough diagnosis or a more thorough evaluation. So that makes a lot of sense. What about like role of medication and like what sort of conversations, and anybody can take this, Joey, anyone. What sort of conversations do you all have about ADHD medications and, and I guess like Ooh, you’re really struggling.

Have you thought about medication? Or, I don’t know, what does that conversation usually look like?

Joey: One of the big things to keep in mind with like medications is that they do have a straight value to them. And it’s something that like you need to be very careful because they are sought out. I I used to work at a college and so I saw college students and around finals time, like, the number of ADHD evaluations suddenly spiked and so you always want to be very careful about, you know, like, promising medications to anyone or promising a specific medication because when they get to the prescriber, we might like, as we’re doing our evaluation, they might be like, by the way, you know, like, I’ve got, you know, bulimia or something, and I’m not about to give something, you know, Like Welbutrin, for example, which we sometimes use off label for ADHD to someone who has bulimia because They might have a seizure and die and that’s, you know, kind of a bummer.

If they that were to happen I again like, you know, I’m usually trying not to kill my patients. So it’s something that there’s a lot to think about, and we have to spend a lot of time, like, ruling out that there’s other things, or that there’s, like, contra contraindications to the medications, too, where, you know, if someone has an eating disorder, then I’m going to be pretty cautious about it.

If someone has a history of substance use problems, I might, you know, go for something that’s not going to carry as much potential for you know, being misused. If someone has really bad anxiety, I might pick a different medication than I would if they don’t have those issues. And there’s a lot of things to kind of think about it.

And it really depends on what the. specific cluster of symptoms they’re getting are. And one thing that I really try and emphasize too with my patients I’m working with that have ADHD is that they aren’t magic pills and they’re not going to solve everything. And I really try and encourage them like whether it’s talking with me about like some things that they can do to try and make sure that they’re not, The they’re setting themselves up for success with like their environment or their lifestyle, or they’re talking about it with their therapist, like that they’re also, that we’re coming at it from multiple angles.

So it really is an area that like, I pretty quickly try and get like therapist involved again, if they’re not already, if they haven’t already had that conversation, because it’s so critical that like they address it from both angles. Both sides.

Miranda: That’s super helpful just to even know. I mean, I don’t know.

I didn’t know you could use Wellbutrin off label like some stuff like that. I mean, I’m curious beyond so like what are the major, what are the major prescription drugs that are used for ADHD?

Joey: Yeah. So I, we’d like to kind of divide them into two separate categories, which would be the stimulants and the non stimulants.

So stimulants are the ones that people are going to be most familiar with, more likely than not, that’s Adderall or Ritalin or Vyvanse or Concerta or Mideas or There’s a lot, there’s a lot of them, like there’s a lot of different weird release Formulations that like you can go down a rabbit hole of like all of the different like stimulants out there but They’re typically either going to be a methylphenidate product, which would be like Ritalin or Concerta, or they’d be an amphetamine, which would be Adderall or Vyvanse or Mideas. And the big difference between them is gonna be some people get different side effects from like one group versus the other and then how they’re released, so how long they last. And then the other group, the non stimulants, those are going to be medications like clonidine or guanfacine or stratera.

And then there’s a bunch that we use off label, like we will sometimes use, like Welbutrin mentioned earlier. Another one that we’ll sometimes use off label would be modafinil, which is a wakefulness promoting medication which to me, I always was like, that sounds like a stimulant, but we don’t technically call it a stimulant.

So it’s a non stimulant. And then even sometimes we’ll like, depending on what they’re presenting with there’s a newer antidepressant called Trintellix that like originally they had been looking into it as being a stimulant. being like, is this an ADHD medication? And then they were like, Oh, it works really well for depression.

And so it got approved for depression. And it’s one that like, we’ll sometimes use it for people who have like, really bad cognitive symptoms of depression. But I’ve had a few people that like, we’re not like for whatever reason, the other meds didn’t work. And we’re like, okay, we’re desperate. Like and they also have like depressive symptoms or they’ve got really bad anxiety.

And I will. Try them on Trintellix as like a, you know, like a, an out there option if it really comes down to it. But there, there’s a lot of different choices out there. There are

Miranda: so many. What are some common like side effects that you’re seeing with some of these different drugs? Maybe this is like a two part question where it’s like, what do you want therapists to know, I guess, about some of these drugs?

And like, how can we be working together? So maybe that’s a three part question, but you know what I mean? Like, how do we come together to like watch out for our clients and also like be in communication?

Joey: Totally. So let’s start with side effects. So gonna vary between individual medications, but typically, like, most of the ADHD medications, even some of the non stimulant medications, are gonna be very, like, energizing.

So, like, if you think about things that you would associate with, like, caffeine, like, a lot of them are gonna be side effects that you see with, like, Adderall or Ritalin or Wellbutrin. Big things are going to be increase in anxiety, insomnia, appetite suppression I can, we’ll also see tremors sometimes if they have a history of psychosis, it can activate psychosis, so like you want to be really careful with that or if like, you know, a patient who previously like Didn’t like, have, you know, any, like, hallucinations and they come in and they’re like, there’s gnomes running around the room, like, I don’t know and you’re like, huh, I think that they were just started on an ADHD medication.

That would be a good, like, we want you to, like, communicate that to us and, like, also encourage them to communicate that to us as well. So, like that’s, that’s a big one. Yeah. There are a few medications that like Clonidine or Guanfacine, which are blood pressure medications but they also can help with ADHD.

Those ones tend to be a little bit more sedating and calming and they’re really good for people who get a bit too agitated or wild or anxious from like a stimulant medication or we’ll sometimes use them in conjunction with them. I, I’m a really big fan of clonidine. We actually kind of joke that like I’m a clonidine influencer.

Because like I, I love clonidine. Like I think it’s really underutilized. And it can really help people who have, like, trouble sleeping because they’re like, I want to keep doing everything because ADHD does not let you slow down sometimes. And so there’s a lot of, like, different, like, choices, or there’s a lot of different, like Things that you can run into with that particular set of medications.

Miranda: Okay, you just made me think of something where, like, in the DSM IV, we had different diagnoses, right? We had ADD, ADHD, but now in the DSM V, they’re combined into your ADHD. So, do you prescribe differently based I mean, I guess you just said you prescribe differently based on symptoms that But, kind of, so it would make me think that like someone that perhaps had like the hyperactivity, you would be more apt to prescribe them like a guanfazine, something that’s more calming or is that just not necessarily the case still?

Joey: Yeah, I would, I would be a little bit more likely to be like, okay, maybe we go with like something like Clonidine or Guanfacine where like, again, it’s going to calm them down a little bit. Stimulants can work in any of like the, the subtypes of ADHD where It’s not like they’re limited to the inattentive subtype, they do tend to be a little bit better than like clonidine or guanfacine would be, but both of those can also work for the inattentive subtypes or the combined subtype where it’s, it really is like you have to, like, individualize it to the person and also think of like their comorbidities as well too because that sometimes will Push me in one direction or the other, where if they’re coming in and they’re like, I’ve got really bad insomnia, I’ve gotten eating disorder.

Like I’m, I’m anxious. Like I’m, they’re just sitting there like vibrating. Cause they’re so like nervous. Like I’m, I’m probably going to hesitate to be like, you know, let’s throw something in that’s known to suppress appetite, cause you to have insomnia and also potentially make you really anxious. Like that just doesn’t seem like a great idea.

I would still lean, I would probably lean towards being like, okay, maybe we go with clonidine or we go with like stratera or we pick another medication that would not have those risks associated with them.

Miranda: Okay. Yeah. I mean, I think that makes a ton of sense. Switching gears a little bit, then you talked a lot about how, when you’re initially seeing clients In medication management and they’re not seeing a therapist, you encourage them to because you feel like it works really well hand in hand.

So, kind of like transitioning over to Christina and Davin, curious about what are some common interventions and things that you’re, that you’re doing with your clients with ADHD?

Davin: So. A lot of the things Joey was just talking about, they really resonated with me because I am someone who has ADHD. So a lot of the times I like to have my clients create a story of like their experience because I think each person’s experience with ADHD is different.

Like we said, there’s many subtypes. So there’s the inattentive and then there’s the hyperactive and there’s a combined. So I let them like create a story of their life, of what their experience is like, like through their lens. I often like to do that to understand what they’re actually experiencing, because I think if we just take, Oh, I’m having a hard time paying attention at school.

And then I think that this is what works for that. Oftentimes that doesn’t work because as we know as people with ADHD, routines do not work for a long time. So I’m really big on creating like I call it like a toolbox of routines. So like this routine may work for you this week and it’s going really well, but next week it may not work.

So we need another routine that’s there because we want to reduce the amount of thought you have to have and how much you have to pull at all these different things. So I like to Oftentimes when someone like even hints that they particularly may have ADHD or they’re having trouble with focusing or impulsivity, I’m like, okay, well, let’s, let’s create a story of your life.

Like give me a scenario in your life, write it out through your lens so I can understand what your experience is like. And then we work on normalizing that for them. Because I think because TikTok university has become so influential, a lot of people are trying to figure out how to not have these symptoms.

And I don’t like to really go in that direction particularly because I think it then also brings in this identity issue and self esteem and the way I view myself so I really like to curate what works for them in this place in their life and also focus on what else is going on around you because that can be influential like there could be some comorbid things going on there could be you’re just highly stressed and it’s really making it really difficult for you to focus at work, so.

Rationalizing, creating a story and then a toolbox of routines just to help reduce because one’s going to stop. So having one right behind it may be helpful.

Christina: Definitely do kind of similar things to in that aspect. I have ADHD as well. So like sometimes it’s like, Oh, everything’s perfect. Great. I’m focused and can work.

And then it’s like, Ooh, there’s a squirrel and I’m looking outside. But I think too, with like the kids, it’s also creating a toolbox for them of self regulation. And like when they do start to compare, cause. I see a lot of it where it’s like, Oh, well, Johnny can do it. Why can’t I do it? And it’s usually like within the sibling sets too.

If there’s one sibling that has ADHD and then all the other ones don’t, it’s like, Oh, they’re the problem quote unquote problem. But in reality, it’s just, Hey, we just need a little bit more to self regulate and kind of. Get back to a baseline. And it’s doing also a lot of like the parent education too, of like, what are we doing at home to promote that of like letting them get out and creating systems that work for them?

And some, there is that stigma on medication. So a lot of parents don’t want to put the kids on medication. So it’s like, okay, what are we going to do to release those outputs? And they’re just going to have more energy and you’re going to have to let them run a little longer. Okay. if that’s what they need.

Miranda: I love that. I haven’t been working with this population for a super long time, but I feel like all of a sudden in the last, like, I don’t know, six months, I think I have like eight different people with ADHD on my caseload. And so it’s been really cool to learn from them and learn about what works for them.

Because like what you said, Davin, I mean, every, it works, stuff works differently for other people. So I was going to say a couple of like key interventions or things that I will use and maybe I should back up a little bit and say like, oftentimes I say, okay, your ADHD isn’t necessarily the problem. It’s like, what are the symptoms that are, that you want to be attacking?

 You can be a very hyperactive person and maybe you’re in the right career field for that. And that doesn’t really matter. But like, you know, I mean, but maybe you’re someone who cannot, like you, you have, you know, these different goals or you have these different, like work things that you need to get done and you’re having a really hard time getting through it.

And so maybe in, in that area, I pull out my worksheet where it’s like, literally, I can put a link to it in the description of this podcast episode, because people From Therapist Aid, all it does is it talks about let’s break down that thing that you need to do. You have this task, let’s break it down into like seven subtasks because I think that that can be super helpful for a lot of like the college students that I work with that have ADHD.

I also often if I’m working with an adult with ADHD, I often recommend the book Scattered Minds. I don’t know if you all have read this. Such a good book. The author of it has ADHD and so I think that’s super key when you’re looking for books that are about Neurodivergence you have to be it has to be written by someone that has that But I can’t even begin to tell you how many times I’ve read like how much I’m underlining in this book how much I’m Reading and laughing to myself There was a portion in this book that talked about and I had to read this to my husband later because I was like, Oh my word, this is me.

And this is has been me for my entire life, but it talks about like the absence of mind and distractibility and this is this particular part of the book is something that I hear a lot of clients complain about themselves and they’ll say I decided to clean my room, looks like a tornado just passed through, I pick up a book off the floor to replace it on the shelf, and as I did so, I realized that there are these other books on there that I haven’t looked at in a while.

And then I picked up those books, and then you begin to read a poem. And then you realize that the poem has a classical reference in it, which prompts you to consult your guide on Greek mythology. And now you’re lost because one reference leads to another. An hour later, you’re interested in classical mythology, exhausted for one minute.

You return to your intended task. And then it’s realizing that, oh no, a pair of socks has gone on furlough. And then you’re trying to find it on the floor. And then you realize that you haven’t done laundry. And so it’s like you’re going back, you’re going from thing to thing. And then at the end of it, you realize that you never cleaned your room.

And I laughed out loud at this part because There are so many like little tiny interventions that you can kind of pick up from clients or just pick up from different podcasts or places over time and, and in particular, that issue of distractibility can be helpful of like having one thing I often recommend clients do is like have a laundry basket at the threshold of your room.

And so you’re not allowed to like leave your room because we all know that you can, you know, grab a book and then you. You know, go to different rooms and whatever. But to, if you have a laundry basket at the threshold of your room and you’re like, okay, I’m going to put everything in this laundry basket that needs to leave my room, then at least you’re not leaving your room.

You’re still like focused in on your task and you’re just kind of putting things in a pile of like, okay, I’ll deal with this in a little while. But all that to say, there are so many cool interventions. There’s so many little things that we can be doing. And Curious about other ideas that you all have had or, or things that you do with clients that have ADHD.

Christina: A big proponent of lists and like being able to like physically cross things off. Like I will recommend like whiteboards or like if they have like a glass door, like writing it with a dry erase marker and then like being able to erase it and be like, okay, I accomplished that. But it’s like also right in your face.

Of like, hey, it’s right here. Like you see it like if you have to walk to the bathroom It’s right there and you see the list you have to do. So it’s like that constant reminder

Davin: Yeah, I was gonna say kind of similarly to what you were saying Miranda I often tell my clients I get you one of those like little rolling things that rolls and Have a designated space for where everything that doesn’t supposed to be in this room or here just goes there And then at one point you can put all of those away also something That I wanted to kind of highlight is sometimes these things just don’t work because that’s just not how your brain works.

So I have a client who has really severe executive functioning issues and at times I kept trying to throw all these different interventions and I realized she wasn’t responding to them because They just weren’t working for her. There was also another layer to this. She was dealing with like severe depression.

So I think at times as clinicians, we have to be really flexible to understand it. It could be many different things just because I have ADHD And I’m having issues which focusing that may not be the only reason why I’m having difficulty in this area. That client particularly was In a graduate program and we talked about environment and she was like, when I go into work, I feel horrible.

The environment, the people there, no one wants to help. So we were so focused on like this ADHD and executive functioning that when I like widened the scope and talked about like the systems at which she was operating in, she was able to identify that there were things outside of herself. Again, I think it’s important to not solely always point at ourself when you have ADHD because it’s very easy.

The stigma is you’re lazy. If it’s a shoe on the floor, just pick the shoe up. I’m having a really difficult time picking the shoe up, so it must be me that’s the problem. So focusing on like some identity work as well as like what else is going on in your life. Sometimes switching from that, the main focus of this thing gives another area of opportunity to maybe Work on switching your focus potentially.

Joey: I love what Davin just said there where like people should like try and remind your clients that like ADHD isn’t like the entirety of their like world like there are other things that can really affect it where I get a lot of people who like around finals time they come in and they’re like, Joey, turn, turn up the dial on my ADHD medication.

And I’m like, have you considered you might be stressed out because finals are a terribly designed system. And it’s, it’s one of those things that like, I could, I mean, I could turn up the at their Adderall and then they’re going to be really anxious and it’s going to just create more problems. Or, you know, you could work on talking about like, how do you reduce their stress or like, how do you, like figuring out some of those other things that can play a big role in like their functionality from like a medication standpoint, one of the big ones I hear is like.

People who are on a stimulant and they don’t get like really hungry at all. Like during the middle of the day, like they’ll be like, yeah, it’s weird. My medication doesn’t seem like it’s working as well in the afternoon. And I’m always like, well, did you eat lunch? And they’re like, well, no, I don’t get hungry.

And I’m like, okay, like, so we need to like purposefully like add in eating because Weirdly enough, like, as soon as they start eating during the middle of the day, their medication’s working really well because they’re no longer hungry. And it’s something that, like, It’s a very, very simple, like, intervention.

We’re just reminding them that, like, anything you eat is going to help. I tell people, like, I’m not here to be, like, you know, the diet police. Like, if you want to eat, like, a slice of pizza and some ice cream, cool. Like if that’s what you can eat, go for it. Like It’s something that is going to help.

And like taking some of those things into account too, can really, really help people like end up being more successful.

Christina: I totally agree with that too. Cause like, I see a lot of like the nutrition piece and sleep with my clients where it’s like. They forget that basic ADL need of food and sleep are vital when it comes to kind of creating systems for an individual that has ADHD, like those are needed regardless.

So, like, just a reminder of having a snack on a list or having it in your pocket, it might be important. helpful strategy to

Miranda: What about for clients that are struggling? I mean, that’s something that’s super common. I see a lot of clients struggle with sleep as a result of their ADHD meds. What do you all recommend for those clients?

Like, do you recommend a med change or like what sort of changes do you typically see? That’s helpful.

Davin: My first question is usually, when are you taking your medication? Because even for myself, if you take it in. 12, it’s probably going to be a little harder to go to, especially if it’s an extended release to go to bed at night.

So like there’s some clients where I was like, you need to set your alarm at 6:30 to take it. Even if you’re not getting up at 6:30 to take it because you’re having trouble sleeping. Cause you’re not taking it till after you eat. You don’t eat until 12. That’s going to make it really difficult. This is going to releasing your body for a long time.

And now you’re trying to go to sleep and you’re looking at. The ceiling saying I have insomnia now. So now that’s a side effect, but also there is a way to be proactive potentially about that. Asking when are you taking your medication? Are you drinking water? That was a huge thing with my college clients.

They were on it and they would forget to take drink water. The most common thing, just drink some water. As soon as she would drink some water, she’s like, I feel so much better. You have dry mouth, all of these symptoms that are happening. There is a level of proactivity that needs to be there. to help with that if you actually want the medication to work for you and not to be up all night.

Christina: After the medication question, I usually go on a wider scope of it too, of is there other external factors? Is there, are there new stressors? Are there new things that are kind of going on? Because it’s sometimes if it’s not the medication, there’s New things going on, work, school, just family life, like so many different things could be impacting it too.

So not just being so isolated about it.

Miranda: Okay, I know that we are coming kind of to a close and so I’m watching the time but before we leave I want I know at least a couple of you have been diagnosed with ADHD and have like figured out how to thrive as a therapist with that diagnosis. And I’m curious, Davin, do you want to start?

Like how, how have you gotten into a rhythm? How do you, how do you like thrive as a clinician?

Davin: To be completely honest, it’s a forever evolving thing. So I want to normalize it. Like, there’s some weeks and some days where I’m not killing it. And there’s some weeks where I’ll go into that routine box and I’m like, this is what you really need to crack down on for this week.

For me, I think the same thing that I do to my clients I do to myself. I work really, Heavily on like my own identity because at times, because I got diagnosed later in life, which happens with a lot of adults, especially women. So I look back at my life and I’m like, dang, you were always killing it in school.

You always had good grades, but you always waited till the night before to do your assignment. So I also contributed that to, Oh, I just, I work well under pressure. So kind of going back and re narrating some of my experiences has been really important for me to be a thriving clinician because it’s not easy.

And that’s something I’m still working on being on go for one hour straight. And then particularly maybe having to do some notes after I’m not doing the notes. So I have to create a system that works for me and the way my brain operates. So I think for me is creating a system and then being okay. When that system’s not working, like being able to notice that’s not working for you right now.

Like you were doing good for a month with that system. It’s not working. And also just being kind to myself. There are some days. where my tank is zero and I have to be honest with myself and I have to rationalize that tell my my clinic director I didn’t get those notes done today. I apologize but I’m really having some executive functioning being aware of myself has helped me to be better as a clinician and to thrive just with the business aspect of it all.

Joey: I try and make sure that like I set up my environment so then I’m like most likely to be successful where like I as soon as like COVID hit and we were like all working from home I was like I do so much better from home. I am so much less likely to wander around the office and talk to everyone.

And I am just like way more productive. I can focus more on my patients. Like I’m better able to do things like working from home. I don’t do well in a clinic setting. Like and I recognize that about myself and thankfully Ellie is awesome. And like, they’re really flexible about that, where like they allow me to set up the environment for me to thrive.

I also know some of the things that I tend to get really like, like I will struggle with that it’s like, okay I can’t necessarily do this Well, I’m like, you know, like talking with a patient because I do need to put on my professional disguise like I try and find ways to get those out either before or after or in some cases during none of you would know this right now, but I’m actually exercising currently.

I have an under the desk elliptical that like you can’t tell that I’m doing it So when I’m feeling really like oh, I’ve got a lot of like, you know energy. I can’t sit still I can just you know well, I have to make sure that none of my cats are sleeping behind it because they have been known to go and be like this is the coziest place And that I want to go and sleep right now, obviously.

But like, as long as they’re not there, because they do get priority. I I can just, you know, put my feet on it and then I do a little bit of like movement and it really helps. And kind of recognizing some of those things or trying to incorporate some of like the things that you struggle with into your day.

And your routine and find a way. To. Work with them as opposed to against them can really, really be helpful.

Christina: I know for me, too. Like, I got fortunate, I was fortunate enough where my mom saw through my masking as a kid. So, she’s a teacher, so she was able to see kind of, oh, no, something’s off. Like, you’re overcompensating for something here.

So, I’ve had systems and routines in place since fourth grade. And a lot of those systems and routines are still things I do to this day. Writing things down on a physical piece of paper, if it’s on a virtual calendar, nine times out of 10, it’s not gonna be remembered, even though I get 12 notifications on my phone.

And I think just also like in my practice, being honest with like my younger clients of like, you know what, sometimes I’m gonna be like a squirrely brain and it connects with them and being able to kind of slow down with them of like, what do you see in me that you do? And kind of being able to connect on that level.

It allows that normalcy of not letting it be the whole story because there’s other parts of everything and everyone so kind of giving that connectiveness of Kind of just slowing down and being like who you are and authentic in yourself.

Miranda: Awesome. These are such good suggestions. Thank you all so much for joining.

I feel like we could talk and talk and talk about interventions and maybe what we need to do next is y’all need to get this book and we can have like a book club about it and have like a follow up podcast where we talk about how much we love or hate this book.

But thank you so much. I know we all have clients to get to. And so, so good to talk with you all. And yeah, thank you all for listening and we’ll see you next week.

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About the author

Miranda Barker headshot

Miranda Barker, MSW, LICSW

Director of Content and Production

Miranda specializes in working with people who have been touched by adoption or foster care (birth parents, adoptees, kids in foster care, etc). She enjoys working with people of all ages. Prior to joining Ellie, Miranda spent several years in the non-profit adoption field and then as a child protection investigator and case… Read more